Masui. The Japanese journal of anesthesiology
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Recent experimental studies reported by several independent groups demonstrated that in the initial interventions of cardiopulmonary resuscitation (CPR), airway protection (A) and artificial breathing (B) are not essential for successful recovery from cardiac arrest. In this study, we reviewed and compared those reports to investigate individual effects of A and B on initial CPR. Airway protection: Spontaneous gasping during cardiac arrest is accompanied by upper airway protective reflexes such as head tilt and open mouth. ⋯ Arterial blood gas analyses demonstrated that CPR without B developed hypercarbia, but maintained oxygen tensions in physiological levels. The frequency of chest compression is in the range of high frequency ventilation, which might allow for successful oxygenation regardless of limited tidal volumes. A series of experimental studies for CPR without A or B call for establishment of a simple CPR method for bystanders, namely "Just compress the chest".
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Comparative Study Clinical Trial Controlled Clinical Trial
[Comparison of epidural versus intravenous administration of fentanyl during epidural block].
Effects of epidural anesthesia induced with bupivacaine alone (group C), bupivacaine and fentanyl (group E), or bupivacaine and intravenous fentanyl (group I) on the onset and spread of cold sensory block, the onset of analgesia and the degree of motor block were compared. Seventy-five patients undergoing lower limb or abdominal surgery were allocated to three groups of 25; patients of group C received 15 ml of 0.5% bupivacaine and 2 ml of 0.9% saline epidurally, patients of group E received 15 ml of 0.5% bupivacaine and 2 ml of fentanyl epidurally, and patients of group I received 2 ml of fentanyl intravenously and 15 ml of 0.5% bupivacaine and 2ml of 0.9% saline epidurally. The onset time of cold sensory block at T11 was significantly shorter in groups E (6.8 +/- 1.9 (SD) min) and I (7.3 +/- 1.7 min) than in group C (9.3 +/- 1.9 min). ⋯ There was no significant difference in motor block at 20 min among the three groups. Respiratory depression appeared more frequently in group I than in groups C and E. These results suggest that epidural administration of fentanyl offers a clinical advantage over intravenous administration for analgesia during epidural block.
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Case Reports
[Combined spinal and epidural anesthesia for laparotomy in a geriatric patient with severe obstructive lung disease].
Asthma and heavy smoking are the risk factors for postoperative respiratory distress, especially after general anesthesia. We experienced a case of sigmoidectomy in a geriatric patient with severe obstructive lung disease accompanied by asthma and a long history of smoking. The patient was a 70 year old man with 1 second volume of less than 0.6 l, because of asthma and long smoking history of 40 pieces of cigarettes a day for 50 years. ⋯ Without any special treatment his dyspnea disappeared spontaneously. During and after the surgery, no exacerbation occurred in his respiratory state. It is suggested that spinal anesthesia combined with epidural anesthesia is useful for a patient with severe obstructive lung disease.
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Case Reports
[Breakage of a Seldinger spring guide wire during percutaneous catheterization of a subclavian vein].
Spring guide wires have been widely used for the central venous catheterization with the popularity of the Seldinger technique. We report here an accidental breakage of a spring guide wire during percutaneous catheterization of a subclavian vein. The venipuncture by a plastic catheter over an introducer needle and the insertion of a spring guide wire through the catheter were easily achieved. ⋯ A plastic catheter over an introducer needle for a subclavian venipuncture is so flexible that it is occasionally bent between the clavicle and the first rib after pulling out of the inside needle. Probably, that is the reason of the difficulties of the insertion of an indwelling catheter and the pulling out of a guide wire. The use of a rigid metal needle for the venipuncture is an alternative way to avoid these troubles.
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Case Reports
[High epidural anesthesia for asthmatic patients--case reports and philological Investigation].
The author experienced anesthetic management of three chronic asthmatic patients for emergency or scheduled lower intraperitoneal operations. The patients were operated under high epidural anesthesia with upper level of T2, in the same way as non-asthmatic patients scheduled for the same lower abdominal operations. ⋯ Conversely, there were many asthmatic patients reported who had been relieved of attacks or whose symptoms and signs had not been changed by thoracic sympathetic blockade including epidural anesthesia. At the present time, neurohumoral innervation of the lungs remains to be elucidated, and it would be overhasty to conclude that epidural anesthesia is contraindicated in asthmatic patients.