Masui. The Japanese journal of anesthesiology
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Comparative Study
[Comparison of the vascular effects of propofol and those of thiopental in patients under cardiopulmonary bypass].
The effects of propofol (1 mg.kg-1) and thiopental (2.5 mg.kg-1) on the vascular smooth muscle were investigated in 10 cardiac patients on cardiopulmonary total bypass using a constant perfusion flow. Radial mean arterial blood pressure (mAP) decreased to 85 +/- 5% (P < 0.01, vs preinjection) in the post-injection late phase (2-3 min) after propofol, and to 90 +/- 6% (P < 0.01) after thiopental. MAP after thiopental showed a transient initial increase to 115 +/- 8% (P < 0.01) in the post-injection early phase (-1 min). ⋯ The increase in SBF after propofol was greater than that after thiopental (P < 0.05). The decrease in mAP and the increase in SBF under the constant perfusion flow are considered mainly due to a direct drug action of dilating peripheral vessels. In conclusion, this in vivo human study suggests that propofol (1 mg.kg-1) causes more potent vasodilatation in the peripheral vessels than thiopental (2.5 mg.kg-1).
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The study was performed to evaluate differential neural blockade during lumbar epidural anesthesia with a cutaneous current perception threshold (CPT) sensory testing device. Fourteen patients undergoing elective gynecological surgery received 10 ml of 2% lidocaine through an epidural catheter inserted at the L 1/2 interspace. CPTs at 2000, 250, and 5 Hz stimulation and sensation to light touch, temperature, and pinprick at ipsilateral dermatomes V, Th 9, and L 2 were measured before and every 5 min, until 60 min after the epidural lidocaine. ⋯ There was no effect on any measurements made at V. In conclusion, epidural lidocaine results in a differential neural blockade as measured with CPT testing. Since the 2000-Hz stimulus detect abnormalities that correlate with large fiber functioning, it is suggested that loss of touch sensation is associated with effects of epidural lidocaine on large fibers.
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Case Reports
[Management of difficult airway during induction of anesthesia in a patient with Hallermann-Streiff syndrome].
An 18-year-old female with Hallermann-Streiff syndrome underwent the fixation of prolapsus recti. She had significant microgenia, mental retardation and pharyngeal airway stenosis. During induction of anesthesia with halothane and nitrous oxide, severe upper airway obstruction and respiratory depression occurred. ⋯ Lowering anesthetic level restored her spontaneous breathing and airway patency. Although the direct laryngoscopic view under light anesthesia with halothane was limited to the epiglottic tip, blind orotracheal intubation using stylet was accomplish after several attempts. At the end of anesthesia, the tracheal tube was extubated after the patient had become fully awake and had recovered completely from neuromuscular blockade monitored by electromyography.
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Case Reports
[Tracheal intubation for emergent tracheostomy in a patient complicated with tracheal stenosis].
We report the management of anesthesia for emergent tracheostomy in a patient with severe tracheal stenosis. A 63-year-old male was scheduled for an emergency tracheostomy for severe tracheal stenosis due to the invasion of a thyroid cancer. A preoperative neck CT revealed the tracheal stenosis, extending from 1-2 cm below the vocal cord to the upper end of the sternum. ⋯ General anesthesia with endotracheal intubation was considered necessary to provide an open airway during tracheostomy. Anesthesia was induced with thiopental, and a 6.0 mm endotracheal tube with cuff was successfully introduced with a balloon introducer (AIRGUID E) using suxamethonium. We were able to perform tracheostomy uneventfully.
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Clinical Trial
[Lidocaine tape (Penles--a dressing tape based on 60% lidocaine--) reduces the pain of postherpetic neuralgia].
The treatment of postherpetic neuralgia (PHN) by topical administration of local anesthetics has a number of drawbacks. Lidocaine tape (Penles) is a 15 cm2 dressing tape based on 60% lidocaine used to anesthetize skin when an intravenous catheter is inserted. This study aims to evaluate the analgesic efficacy of lidocaine tape in patients with PHN by comparing the results with those of surgical drape (Tegaderm). ⋯ Pain score was reduced at measurements taken starting from 1 hour after lidocaine tape application (P < 0.05). Lidocaine tape induced minor side-effects, erythema in a patient and increase in pain in another patient. In conclusion, lidocaine tape is effective for relief of PHN.