Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of radiculitis induced by spinal cord electrical stimulation by a percutaneously inserted needle].
Spinal cord electrical stimulation was performed by a percutaneously inserted needle for causalgia of the right upper limb. The end of electrode was positioned along a line extending down the 5th vertebral body in the vicinity of the right 6th cervical nerve root, after which it was permanently implanted following confirmation of desensitizing effects. Although the patient later returned to normal life without requiring any ancillary medication, beginning after a period of roughly six months, the pain suddenly began to increase when stimulated. ⋯ After selective radicular block, the patient's complaint diminished. Based on the above findings, we consider that the physical stimulation caused by the electrode in contact with the nerve root brought about inflammation of the 6th cervical nerve root. This patient was then treated by removing the causative stimulation and selective radicular block of affected nerve, the details of which are reported.
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Case Reports
[A critical patient relieved from status asthmaticus with isoflurane inhalation therapy].
In cases of life-threatening status asthmaticus which are refractory to drug therapy, the administration of inhalation anesthetics can be life-saving as they help alleviate bronchial spasm. We had an 11-year-old female patient suffering from status asthmaticus who was moribund from severe CO2 narcosis and was not responding to any of the conventional therapies. She finally fell into ventricular fibrillation. ⋯ The endotracheal tube was removed 4 hours later. She had an uneventful recovery and was discharged from the hospital 11 days later. With its low metabolic rate and therefore low organ toxicity, as well as its low arrhythmogenicity with remarkable bronchodilating activity, we feel isoflurane may well be superior to other inhalation anesthetics in the treatment of status asthmaticus.
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We investigated appropriate puncture site, angle of needle entry, and the distance of the insertion for CT monitored celiac plexus block using CT photograms on prone position in sixteen patients with gastrointestinal diseases. In retrocrural approach during CT monitored celiac plexus block, the average distances of puncture sites to midline were 3.84 cm on the right and 4.06 cm on the left, and the average needle angles were 74.1 degrees on the right and 76.9 degrees on the left. ⋯ From these results, we found high possibilities of organ injuries using the conventional technique for celiac plexus block. We conclude that we could perform celiac plexus block more safely and surely using the retrocrural approach by CT monitoring, as serious complications are avoidable by viewing ideal puncture course on CT photographs.
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The effects of atropine or pirenzepine on bronchoconstriction and reduction in heart rate during vagus nerve stimulation were studied in 10 anesthetized dogs. The bronchoconstriction produced by electrical stimulation of the vagus nerves, 5 min after intravenous injection of atropine or pirenzepine, was recorded as an increase in pulmonary inflation pressure. ⋯ Pirenzepine inhibited the increase in pulmonary inflation pressure more than atropine. Our results suggest that pirenzepine which inhibits bronchoconstriction is useful in patients with bronchial asthma and/or COPD as an anticholinergic agent.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Continuous epidural infusion of bupivacaine and buprenorphine for postoperative pain relief].
The efficacy for postoperative analgesia and side-effect of combined epidural infusion of bupivacaine and buprenorphine in comparison with each of these drugs alone were evaluated in 150 patients. All patients received initially bupivacaine 8 ml and buprenorphine 0.1 mg. ⋯ No significant difference in the incidence of side-effect was found among the three groups. We conclude that epidural analgesia with the combination of buprenorphine and bupivacaine is safe, and easy to manage, giving pain relief superior to that provided by each of these drugs alone.