Masui. The Japanese journal of anesthesiology
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We studied neuromuscular blocking effects of isoflurane using a neuromuscular transmission monitor in three myasthenia gravis patients. Severity of myasthenia gravis was different among three patients. ⋯ Also, TOF ratio decreased by 12% in a mild case, by 22% in a moderate case, and 48% in a severe case during isoflurane anesthesia. We conclude that in patients with more severe myasthenia gravis, neuromuscular blocking effect of isoflurane is more potentiated.
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In our hospital, a patient must be transported to one of several types of wards according to the degree of severity of illness (PPC-system). Severely ill patients are surveyed in ICU and HCU with various kinds of monitors. On the contrary, for the patients outside the ICU and HCU wards, the number of monitors is not enough even during postoperative periods. ⋯ The number of hypoxemic patients was greater not only after longer operations and anesthesia, but also in obese patients (P < 0.05) as reported previously. Interestingly, we also found more hypoxemic patients in common wards than in ICU and HCU wards. In conclusion, a portable pulse oximeter is a useful equipment in ordinary wards during postanesthesia round.
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We have studied the effects of prostaglandin E1 (PGE1) on the release of lysosomal enzymes such as beta-glucuronidase in leukocyte (beta-GL) and granulocyte elastase (GEL) in 52 patients for major abdominal surgery. All patients were divided into two groups; the PG group (24 patients) and the control group (28 patients). The patients of the PG group received PGE1 continuously at the rate of 0.03 to 0.1 micrograms.kg-1.min-1 during surgery. ⋯ The GEL/granulocyte ratio in the PG group was significantly smaller than that of the control group during surgery. The rate of change of beta-GL was significantly depressed in the PG group compared to that of the control group. These findings suggest that the administration of PGE1 during major abdominal surgery inhibits the release of lysosomal enzymes, and this prevents tissue injury during and after surgery.
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The safety and efficacy of epidural opioids as postoperative analgesics for children with cerebral palsy were studied in 85 pediatric patients with cerebral palsy. The patients were 5 to 15 years of age and were undergoing elective orthopedic operations on the lower extremities. These patients were divided into four groups. ⋯ Although groups 2-4 compared with group 1 were still sedated at 24 hours after the operation, there was no difference in degree of sedation among the groups 2-4. The epidural opioids did not increase the frequency of side effects such as nausea, vomiting etc. The authors conclude that epidural opioids achieve safe and useful postoperative pain control in children with cerebral palsy.
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Case Reports
[Anesthetic experience of emergency cesarean section for a patient with myotonic dystrophy].
We report an anesthetic experience of a 28-year-old female patient complicated with myotonic dystrophy who underwent emergency Cesarean section due to threatened abortion. Anesthesia was induced with intravenous thiopental followed by topical spray of 4% lidocaine 5 ml to intubate trachea and maintained with neuroleptanesthesia with droperidol, fentanyl and nitrous oxide in oxygen. ⋯ However, the female infant, with Apgar score of 1 point at five minutes after delivery, died due to multiple organ failure three weeks after the delivery. Anesthetic management of a patient with myotonic dystrophy was also discussed with a literature review.