Masui. The Japanese journal of anesthesiology
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Case Reports
[Subdural catheterization uncovered by severe hypotension during epidural plus general anesthesia].
We experienced three cases of accidental subdural catheterization during epidural combined with general anesthesia. In each case, epidural catheterization was performed before induction of general anesthesia. Aspiration through the catheter and a response to a test dose were negative. ⋯ It is often difficult to identify subdural placement of an epidural catheter under general anesthesia since signs of massive sensory blockade are masked by general anesthesia. In each case, we suspected malpositioning of the catheter by severe hypotension due to sympatholysis which was difficult to treat. Subdural catheterization is a complication of epidural anesthesia that probably occurs more frequently than previously recognized and is usually unpredictable during general anesthesia.
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We studied the occurrence of brain dysfunction in regards to changes in cerebral oxygen saturation (rSo2) during open heart surgery. The subjects were 68 patients with the average age of 61 years. For the evaluation of brain function, Hasegawa Dementia Scale was used, and those patients whose scores were less than 23 points, or had decreased by more than 3 points from preoperative scores on the 7th postoperative day were categorized as the brain dysfunction group. ⋯ The patients in the dysfunction group were of older ages and postoperative lower cardiac index, which indicated that the occurrence of brain dysfunction is greatly influenced by low cerebral blood flow. Effect from the operative procedures and CPB alone seemed to be small. Cerebral oxygen saturation (rSo2) is believed to be a useful monitor of cerebral blood flow, and occurrence of brain dysfunction may be expected at values lower than 60%.
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We evaluated the effects of anesthetic drugs and temperature on brain stem and mid-latency evoked potentials (BAEP and MLAEP) in 20-patients who were scheduled for elective cardiac operation using cardiopulmonary bypass with moderate hypothermia. At esophageal temperature of 36 degrees C, the latency of MLAEP was slightly prolonged by the increase of fentanyl dose, which suggested that the latency prolongation of MLAEP could not block the oscillation of auditory stimulation. ⋯ The latency of BAEP was markedly prolonged at 27 degrees C and returned to the normal latency at 36 degrees C. The latency of MLAEP retained by high dose fentanyl suggests that patients may be aware during cardiopulmonary bypass at normothermia, and BAEP may be one of the useful brain function monitors during cardiopulmonary bypass.
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In 1984, Cormack and Lehane defined laryngoscopic view in four grades. As the view worsens, the difficulty of intubation may increase but it is not clear. In this study, we examined the endotracheal intubation techniques to the grade III or IV airways. ⋯ In conclusion, the grade III or IV airways were not always difficult to intubate. But when the conventional technique failed, the gum-elastic bougie or laryngeal mask airway was a fairly useful aid to endotracheal intubation. Moreover our handmade flexible guide tube made the intubation through the laryngeal mask airway safe and reliable.
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Randomized Controlled Trial Clinical Trial
[Effects of preoperatively administered flurbiprofen axetil on the action of inhaled anesthesia and postoperative pain].
Flurbiprofen axetil (FP) was evaluated in a randomized study relative to placebo in 26 patients undergoing endonasal ethmoidectomy. The FP group (n = 13) was administrated 1 mg.kg-1 FP 15 minutes before operation during a half hour. Likewise, the control group (n = 13) received intravenous NaCl 0.9%. ⋯ Body temperature of the FP group fell significantly before infusion. The FP group showed lower pain scores and required less dicrofenac sodium than the control group (P < 0.05). This study suggests that preoperative FP infusion relieves postoperative pain, but does not affect the action of the inhalation anesthetic.