Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[The effect of epidural saline injection on analgesic level during combined spinal and epidural anesthesia].
The purpose of this study is to clarify the volume effect of epidural saline injection 20 min after spinal anesthesia. Thirty patients undergoing combined spinal and epidural anesthesia for orthopedic surgery were randomly divided into two groups: a control group (n = 15) and a saline group (n = 15). In the control group, 2% lidocaine 3 ml with 0.4% tetracaine was injected into the subarachnoid space from L 4-5 interspace using Durasafe (Becton Dickinson, USA) and saline was not injected into the epidural space. ⋯ However, the levels of analgesia 3, 5, 10, 40 and 100 min after epidural saline injection in the saline group were significantly higher than those in the control group (P < 0.05). The highest analgesic level was obtained 10 min after epidural saline injection and reached to T 4.3 +/- 1.1. In conclusion, epidural saline injection increases the analgesic level 20 min after spinal anesthesia because of the volume effect.
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Patient-controlled sedation (PCS) using propofol under spinal anesthesia in transurethral lithotripsy was carried out in a 44 year old patient with von Gierke disease accompanied with liver dysfunction, chronic renal failure, hypoglycemia and metabolic acidosis. After administering spinal anesthesia PCS was started (0.2 mg.kg-1 intravenous bolus dose of propofol; infusion at 2 mg.kg-1.h-1; a three-minute lockout time interval following an initial doses of 0.4 mg.kg-1). ⋯ This patient was much satisfied with this sedation in an interview during the postoperative period. PCS using propofol is a useful method without respiratory depression for a patient with von Gierke disease.
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Comparative Study
[A comparative study of transcranial Doppler sonography and near-infrared spectroscopy for the assessment of cerebrovascular CO2 reactivity].
Simultaneous measurements of time averaged mean blood flow velocity in the right middle cerebral artery (Vmca) by transcranial Doppler sonography (TCD) and regional cerebral oxygen saturation (rSo2) by near-infrared spectroscopy (NIRS) were performed in 30 subjects under propofol /fentanyl/ oxygen anesthesia. End-tidal CO2 pressure (PetCO2) was controlled by adjusting minute ventilation. A paired measurements of Vmca and rSo2 was repeated at PetCO2 of 50, 45, 40, 35, 30, and 25 mmHg in each subject. ⋯ There were significant linear correlations between PetCO2 and Vmca (R > 0.94, P < 0.01), between PetCO2 and rVmca (R > 0.94, P < 0.01), between PetCO2 and rSo2 (R > 0.92, P < 0.01), and between rSo2 and Vmca (R > 0.88, P < 0.05) in each subject. Furthermore, there was a significant linear correlation between rVmca based CO2 reactivity and rSo2 based CO2 reactivity (R = 0.60, P < 0.001). These results indicate that measurements of rSo2 may be an alternative method for evaluating cerebrovascular CO2 reactivity when poor ultrasound window.
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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.
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Comparative Study Clinical Trial
[A comparison of the grade of laryngeal visualisation;--the McCoy compared with the Macintosh and the Miller blade in adults].
Effectiveness in visualization of the vocal cord during orotracheal intubation with McCoy (McC) compared with Macintosh (Min) and Miller (Mil) blades were investigated. After an institutional review board approval, 117 patients for elective surgery under general anesthesia requiring tracheal intubation were investigated. Five board certified anesthesiologists tried to visualize the vocal cord of a patient three times with the three different types of laryngoscope. ⋯ Two Grade 3 views with McC, 34 with Min and 14 with Mil were obtained. Seven Grade 4 views were obtained with Mil. The grades of laryngeal visualization with McC were significantly lower than those with Min and Mil.