Masui. The Japanese journal of anesthesiology
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In order to know how the catheters are placed abnormally in the epidural space, we inserted the epidural catheters under fluoroscopy. The catheter was placed straightly upward when the epidural puncture was done in the center of epidural space. ⋯ When the catheter wedged at the side wall, it made loop and curled or kinked. We thought that the cause of abnormal location of the catheters in epidural space is the right angle between the wall of the epidural space and the direction of catheter.
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We did anesthetic management on a pediatric patient with Cornelia de Lange syndrome presenting a peculiar look, variable physical deformities, and some growth and mental retardations. An 8-year-old male patient was scheduled for inguinal hernioplasty under general anesthesia. ⋯ The area of skin incision was infiltrated with 0.25 % bupivacaine for the purpose of post-operative analgesia, and as a result, psychologically and physically stable condition was obtained during post-operative periods. It is necessary to understand not only the patient's physical conditions but also mental ones in order to make the anesthetic management safer and more satisfactory.
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A retrospective study of the lumbar and thoracic epidural anesthesia (catheterization) in infants and children younger than 12 years was undertaken in children's hospitals in Japan. Seventeen institutions replied to our questionnaire and 10 institutions experienced these procedures in the year preceding September 1994. The total number of the lumbar and thoracic epidural anesthesia performed was 324, with average of 32.4 +/- 31.1, and maximum of 113 and the minimum of 2. ⋯ The patient had herpes zoster. On the other hand, several institutions cast doubt on the necessity of epidural anesthesia in infants and children. The long-term influence on the developing nervous system should be investigated.
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A 74 year-old woman with a 6-month history of RSD following herpes zoster on her right arm was treated with stellate ganglion blocks (SGB), continuous epidural block (CEB) and continuous intravenous infusion of ketamine known as one of the NMDA receptor blockers. Of the symptoms of RSD, burning pain and hyperperspiration but allodynia disappeared after the treatment with SGB 8 times and CEB for 4 days. Allodynia disappeared completely after ketamine treatment, where ketamine was infused once using a subanesthetic dose for 2 hours. It is considered that ketamine is one of the useful drugs for the treatment of neuropathic pain with allodynia.
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We used a laryngeal mask for Nd-YAG laser operations of airway stenosis due to tracheal granulation, broncheal granulation and subglottic tumor. Anesthesia was induced with inhalation of N2O-O2-sevoflurane in two cases and intravenous thiopental in one case. The laryngeal mask was inserted with intravenous injection of vecuronium. ⋯ Laryngeal mask airway was stable with respect to circulation and respiration during Nd-YAG laser irradiation. Ignition of a laryngeal mask caused by Nd-YAG laser is much less common compared to that of a tracheal tube with cuff. Therefore, we recommend to use laryngeal mask airway for Nd-YAG laser operation of airway stenosis because of much less danger of ignition and because it keeps good cardiovascular and respiratory conditions.