Masui. The Japanese journal of anesthesiology
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A 65 yr-old male with severe scar pain on his right lower abdomen underwent selective nerve block through epidural space using a superfine fiberscope. A12-gauge Tuohy needle (internal diameter 2.2 mm) was inserted at the intervertebral space of Th12-L1. The fiberscope (external diameter 1.1 mm) was introduced through the needle and the epidural space was observed. ⋯ Then 2% lidocaine 1.5 ml and 60% megumine sodium amidotrizoate 1.5 ml were slowly injected. Soon after injection of anesthetic, analgesia area (Th11-L1) was obtained, and Th12 nerve root was identified by X ray. Epidural blockade using a superfine fiberscope seems to be one of the useful and reliable methods for the selective nerve blockade.
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We have evaluated the effectiveness of central venous catheter placement using right atrial electrocardiography (RAECG). Consecutive patients under general anesthesia (n = 42) who required a central venous catheter underwent RAECG-guided catheter insertion procedure via right internal jugular vein. Catheter tip position was verified by post procedure portable chest radiography. ⋯ The average insertion depth of catheters was 16.4 cm. We also attempted to predict the optimal catheter insertion depth for each patient from the previous measurements of external landmarks, but it was found to be difficult to predict reliably. In this point of view, we should use RAECG technique to make sure the proper positioning of the catheter tip.
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Randomized Controlled Trial Clinical Trial
[Does the difference in anesthetic methods influence postoperative nitrogen balance?].
To evaluate the influence of anesthesia on postoperative nitrogen balance after upper abdominal surgery, twenty-seven patients undergoing the surgery were investigated. They were allocated randomly to three groups receiving different anesthetic methods, i.e., epidural anesthesia, general anesthesia or balanced anesthesia. In the epidural anesthesia group, anesthesia was maintained with 0.5% isoflurane, nitrous oxide and oxygen supplemented with epidural analgesia extending from Th 1 to L 3. ⋯ Postoperative values of IL-6 and CRP also did not differ significantly among the three groups. Postoperative WBC was significantly higher in the balanced anesthesia group than in other two groups. The results suggest that the difference in anesthetic methods does not influence postoperative nitrogen balance.
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To investigate if sevoflurane saturates the metabolic capacity of the enzymes responsible for sevoflurane at clinically-used concentration ranges, we compared plasma fluoride levels and urinary excretion of inorganic fluoride in piglets after (1) low concentration sevoflurane anesthesia versus (2) high concentration sevoflurane anesthesia. Eleven male piglets, weighing 18-23.5 kg, were randomly divided into two groups: 1) L group: five animals were anesthetized for two hours with sevoflurane at 0.8% end-tidal concentration (0.4 MAC); 2) H group: six animals were anesthetized for two hours with sevoflurane at 3.0% end-tidal concentration (1.4 MAC). Plasma inorganic fluoride levels, blood sevoflurane concentration, urinary inorganic fluoride concentration and urine volume were measured. ⋯ The H group also showed significantly higher urinary excretion of inorganic fluoride than the L group. Therefore, metabolite production levels in the H group were significantly higher than the L group. These results suggest that low concentration sevoflurane anesthesia did not saturate the metabolic capacity of the enzymes responsible for defluorination of sevoflurane in piglets.