Masui. The Japanese journal of anesthesiology
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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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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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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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Review Case Reports
[Bronchospasm during anesthesia in a patient with Prader-Willi syndrome].
A patient with Prader-Willi syndrome developed bronchospasm during anesthesia. The patient was a 9-year-old boy and was scheduled for orchiopexy. His psychomotor development was delayed, and at 12 months of age he was diagnosed as Prader-Willi syndrome by chromosomal examination. ⋯ The bronchospasm was improved gradually and surgery was finished. Prader-Willi syndrome is an uncommon disease first reported by Prader in 1956 and characterized by hypotonia, hypomentia, hypogonadism and obesity. In the perioperative management for a patient with Prader-Willi syndrome, special attention must be paid to the abnormalities in the upper and lower respiratory systems.
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Comparative Study Clinical Trial
[Incidence of nausea and vomiting after cholecystectomy performed via laparotomy or laparoscopy].
Postoperative nausea and vomiting (PONV) are commonly observed adverse effects of general anesthesia. In a retrospective study of laparoscopy group (101 patient) and laparotomy group (101 patient), we evaluated the incidence of PONV after laparoscopic cholecystectomy. ⋯ The risk of PONV was greater in laparoscopy group in female patients (23.4% versus 9.3% in laparotomy group, P < 0.05) and in obese patients (25.0% versus 0% in laparotomy group, P < 0.01) during the first postoperative hour. We conclude that laparoscopic cholecystectomy increases the incidence of PONV in early postoperative period probably by the effect of residual stretching and irritation of the peritoneum, and the risk is increased in female and obese patients.