Masui. The Japanese journal of anesthesiology
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Comparative Study
[Influences of anesthetic method on post-cholecystectomy pain--a comparison between epidural and general anesthesia].
This study was designed to compare the influence of epidural anesthesia with that of general anesthesia on postoperative pain state and management. We studied 16 patients who underwent elective laparotomy-cholecystectomy with epidural anesthesia without general anesthesia or with general anesthesia (nitrous oxide-isoflurane). ⋯ Postoperative rest pain of the epidural group remained at a lower state of pain than that of the general anesthesia group not only for 48 hours (P < 0.005) but also until 72 hours (P < 0.005) after surgery. We concluded that the epidural anesthesia produces a greater postoperative pain relief than general anesthesia.
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We experienced a case of abortive malignant hyperthermia during funnel chest surgery. Although a 5-year-old boy had muscle rigidity after the intravenous injection of succinylcholine chloride, the tracheal intubation was easy. ⋯ Postoperative course was uneventful. It is necessary to pay a particular attention to possible malignant hyperthermia in patients with funnel chest surgery.
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Anesthetic management of cesarean section for twenty multiple pregnant patients, who were pregnant with triplet or quadruplet, was compared with that for 325 single pregnant patients and 21 twin pregnant patients. For anesthetic methods, spinal anesthesia was chosen most frequently in the multiple pregnant patients, as in single and twin (more than 75 percent). ⋯ In multiple pregnant patients who received spinal anesthesia, gestational age was lower; birth weight was lighter; length of fundus uteri was longer; and blood loss including amniotic fluid was larger. In triplets, the third infants' UID-time was prolonged and their Apgar score was lower.
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We compared the combined spinal and thoracic epidural analgesia with 2% lidocaine for caesarean section, with spinal analgesia using 2% lidocaine, tetracaine or dibucaine, and also with lumbar epidural analgesia. The analgesia at high thoracic level could be achieved with combined spinal and epidural analgesia more easily than with others. The frequency of side effects with the combined spinal and epidural analgesia, such as hypotension, decrease of fetal heart rate and so on, was less than that with others. In conclusion, the combined spinal and thoracic epidural analgesia with 2% lidocaine is more useful for caesarean section, than the spinal analgesia or the lumbar epidural analgesia alone.
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Interaction of midazolam and thiopental in amnestic effect was studied in 30 adult patients who underwent elective surgery of lower extremities under epidural or spinal anesthesia in combination with oxygen, nitrous oxide and low concentration of sevoflurane. Combination of midazolam 2.0-3.0 mg (0.041 +/- 0.006 mg.kg-1) and thiopental 3-5 mg.kg-1 produced amnestic effect in 87% of patients. No side effects, such as decrease in O2 saturation, upper airway obstruction, cardiovascular depression and delayed emergence were observed with this small dose of midazolam. Administration of midazolam 2.0-3.0 mg before epidural, or spinal anesthesia in the operating room under observation of anesthesiologists, followed by thiopental 3-5 mg.kg-1, was safe and comfortable to the patients.