Masui. The Japanese journal of anesthesiology
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Bupivacaine has been used for spinal anesthesia since 1982 in our department. We performed a retrograde investigation of 121 cases who had lower limb surgery and anesthetized with plain 0.5% bupivacaine solution during the year of 1987. Doses of bupivacaine, maximum spread of analgesia and spinal tap level were analyzed. ⋯ However patient's physical status and surgical procedure are more important to obtain the good analgesic level. There was no significant respiratory depression nor hypotension during and after the surgery. It is concluded that 3-4 ml of 0.5% bupivacaine provided satisfactory spinal anesthesia for the lower limb surgery.
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We had a patient who had repeated inadvertent subdural catheterization. Eighty-two year old woman with post herpetic neuralgia had a continuous epidural anesthesia for the relief of pain. An epidural catheter was inserted at the Th 5-6 interspace using a paramedian approach. ⋯ The diagnosis of subdural block can be made by a subsequent injection of contrast medium, since an unusual clinical course might be seen. Subdural space has a poor blood supply, and injected medium may stay in this space for considerable period of time. Subdural catheterization in epidural anesthesia probably occurs more frequently than previously recognized.
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We reported an anesthetic experience of a 6-year-old male patient with arthrogryposis multiplex congenita who underwent tonsillectomy and adenoidectomy. The induction and maintenance of anesthesia were smoothly performed with inhalation of 1-5% sevoflurane in nitrous oxide and oxygen. ⋯ Halothane and succinylcholine chloride were not used to avoid possible hyperthermia. Anesthetic management of patients with arthrogryposis multiplex congenita was discussed citing literature references.
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[Effect of nafamostat mesilate on serum activities of pancreatic enzymes and plasma hormone levels].
To evaluate the effect of nafamostat mesilate, a potent protease inhibitor, on the pancreatic enzymes and the endocrine system in patients undergoing open-heart surgery with extracorporeal circulation, serum activities of amylase, trypsin, alpha 1-antitrypsin (alpha 1AT) and pancreatic secretory trypsin inhibitor (PSTI), and plasma levels of cortisol and catecholamines were measured. Seven patients (nafamostat group) received intravenous nafamostat mesilate 0.5 mg.kg-1.hr-1 during cardiopulmonary bypass (CPB). The remaining seven patients (non-nafamostat group) did not receive any protease inhibitor. ⋯ Nafamostat group showed lower plasma dopamine levels and higher epinephrine levels compared with non-nafamostat group. The result suggests that nafamostat mesilate administered during CPB could not influence the changes in the activities of pancreatic enzymes. Further studies are needed to clarify the effect of this protease inhibitor on the endocrine system.
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The effects of corticosteroids (hydrocortisone, methylprednisolone) on the recovery time from the vecuronium induced neuromuscular block were studied using evoked potential measurements by stimulating ulnar nerve. Plasma concentrations of vecuronium were examined after the administration of hydrocortisone and methylprednisolone using high performance liquid chromatography in 78 surgical patients. Recovery time from the block induced by vecuronium was prolonged by corticosteroids. ⋯ In the study of plasma concentration, blood samples were taken 40 minutes after administration of vecuronium, plasma concentration of vecuronium is significantly higher in patients given hydrocortisone (124 +/- 8.32 ng.ml-1) (mean +/- SE) than control patients (68.2 +/- 4.71 ng.ml-1) (P less than 0.001). It is speculated that corticosteroids lower the clearance of vecuronium. Prolongation of recovery time from vecuronium induced block after the administration of corticosteroids may be explained not only by the direct effect of hydrocortisone on the neuromuscular junction but also by the effect of hydrocortisone to prolong the elimination of vecuronium from plasma.