Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[The dosage of sedative was reduced by patient-controlled sedation during epidural anesthesia].
The dosage of sedatives required for sedation was studied in patients who underwent total abdominal histerectomy under epidural anesthesia using patient-controlled sedation (PCS) and in those with anesthesiologist-controlled sedation (ACS). Patients in experimental groups received 1.0 or 1.5 mg bolus dose of midazolam by their request until desirable sedation was obtained using a computer-controlled device. ⋯ The level of sedation showed wider variation in PCS groups than in ACS groups. The results suggest that PCS is a technique which allows reduction of sedatives in patients who undergo operation under local anesthesia.
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Comparative Study Clinical Trial Controlled Clinical Trial
[A radiological analysis of the position of lumbar epidural catheters: a comparison between median and paramedian approach].
The position of lumbar epidural catheters was confirmed by radiography in 71 patients. Catheters were advanced by 5 cm cephalad in the lumbar epidural space by paramedian approach (Group P: n = 28) or median one (Group M: n = 43) and contrast media was injected through the catheters. ⋯ The incidence of the abnormal position of the catheters was higher in group M than in group P significantly. To advance an epidural catheter longer into the lumbar epidural space, paramedian approach may be superior to median one.
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Case Reports
[Pulmonary edema after cesarean section in a parturient with long term use of ritodrine].
A 31-year-old multigravida with a gestation of 31 weeks was admitted in premature labor with placenta previa. The premature labor had been inhibited for two and half months with a tocolytic agent (ritodrine). However, at 32-week gestation an infection was found, the labor broke through the therapy and cesarean section was carried out under spinal anesthesia. ⋯ However, with overdosage, maternal cardiac and pulmonary complications may occur. In this case, it is possible to have been caused by the long term use of ritodrine. Additionally, the excessive fluid administration, hypoprotenemia, decreased colloid osmotic pressure and infection also might have been the contributing factors for the disorder.
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Case Reports
[Prolonged muscle paralysis after long-term infusion of muscle relaxants and large doses of steroids].
We have recently encountered three patients who developed prolonged muscle paralysis after long-term infusion of muscle relaxants and administration of large doses of steroids. Among many factors implicated in the cause of this paralysis, steroids and muscle relaxants were suggested to be most likely causative agents. In order to avoid such muscle paralysis, we must be careful to limit the dose of relaxants as small as possible. For this purpose, monitoring of neuromuscular blockade is indispensable.
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We use an angiofiberscope (AFS), an echocardiography (ECG) and a transesophageal echocardiography (TEE) as useful and productive tools for medical education perioperatively. We employed these monitors in the training of 5th-year medical students on general anesthesia in the operating room. ⋯ ECG was used routinely to evaluate preoperative cardiac function, while TEE was used during operation. These monitors play very useful role in medical education for students.