Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[Sedative and hypnotic properties of propofol during epidural or spinal anesthesia].
The sedative and hypnotic properties of propofol were studied in 40 patients undergoing elective gynecologic or orthopedic surgery using epidural (epidural group, n = 20) or spinal (spinal group, n = 20) anesthesia. Patients were given a bolus dose of 1 mg.kg-1 immediately followed by a continuous infusion of 4 mg.kg-1.h-1 of propofol after epidural or spinal anesthesia. The patients were asked to open their eyes on command at 10-sec interval from the end of the bolus infusion of propofol. ⋯ Oxygen inhalation was needed in 75% of the patients in the epidural group and 100% in the spinal group. These results indicate that bolus and continuous infusion of propofol produces rapid induction, deep level of sedation, and rapid recovery during epidural or spinal anesthesia. However, respiratory depression appeared at this infusion rate during regional anesthesia.
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We experienced a case of difficult tracheal intubation in a 15-year-old boy with von Recklinghausen disease scheduled for resection of a right neck tumor. His scoliosis made it difficult to intubate and to manage airway because he easily developed dyspnea. We tried nasotracheal intubation with the patient awake under sedation using a bronchofiberscope, but we found an unexpected tumor jeopardizing his airway patency near his vocal cord. Preoperative examination of a tumor in the airway is essential in the anesthetic management of the patients with von Recklinghausen disease.
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We investigated the effect of intravenous magnesium, a N-methyl-D-asparate (NMDA) receptor antagonist, in 8 patients suffering from neuropathic pain (post herpetic neuralgia or causalgia etc.). After the nerve block, magnesium sulphate (0.5 mol.l-1) 5 ml was administered intravenously by bolus infusion taking 5 min, followed by continuous infusion of the same dose for one hour. All patients were treated with this therapy once a week. ⋯ Some patients felt heat sensation immediately after the bolus infusion of Mg, and had a good sleep after this therapy. However, there were not any severe side effects and significant change in HR or BP. We conclude that this therapy with magnesium once a week is safe and effective for relieving neuropathic pain.
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Thirteen patients were intubated with cuffed reinforced spiral tracheal tubes. Intracuff pressure and volume were measured as the position of the head and neck was altered. No significant changes in intracuff pressure and volume were observed with lateral rotation of the head. ⋯ Reinflated intracuff volume decreased and reinflated intracuff pressure increased significantly, and residual excessive pressure was observed in 4 patients with flexion. Both reinflated intracuff volume and pressure increased significantly, and excessive pressure was observed in 8 patients and residual air-leak developed in a patient in spite of excessive pressure with extension. The authors speculate that endotracheal tube movement by changes in head and neck position has effects on intracuff pressure and volume.
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We evaluated the usefulness of the intubating laryngeal mask airway (ILMA) in patients who were predicted to have possible difficult airway. Patients with possible difficult airway were defined as those with limited head extension, Mallampati's classification of grade IV, thyro-mental distance < 4 cm, or Cormack grade III-IV on the laryngoscopy. ⋯ In the group of possible difficult airway, 83% of patients were intubated through the ILMA successfully, and in the control group, 86%. We conclude that the ILMA may become an additional tool in patients with difficult intubation.