Masui. The Japanese journal of anesthesiology
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Clinical Trial Controlled Clinical Trial
[Postoperative sore throat--a comparison of standard cuff, gas-barrier cuff and Brandt anesthesia tube cuff].
Excessive intracuff pressure due to nitrous oxide diffusion into the cuff can damage the tracheal mucosa. Several endotracheal tubes have been developed (Trachelon gas barrier type tube, Brandt Anaesthesia tube) to limit nitrous oxide-related intracuff pressure increase. We investigated whether the incidence of postoperative sore throat could be reduced by using these tubes. ⋯ The incidence of postoperative sore throat was not significantly different among the groups, 36% (5/14) in group S, 45% (5/11) in group G, and 33% (4/12) in Group B. This incidence did not correlate with intracuff pressure increase. In conclusion, specially manufactured endotracheal tubes to limit excessive intracuff pressure did not effectively attenuate the incidence of postoperative sore throat in this patient population.
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Forty-five patients scheduled for intra-abdominal gynecological surgeries, ranging in age from 30 to 60 years, were anesthetized with combined spinal-epidural (CSE) method using combined spinal-epidural needles inserted at the L2-3 interspace. Ten minutes after intrathecal administration of 0.4% isobaric tetracaine solution (2.5 ml) the upper level of analgesia was examined by pin prick method and the patients were divided into the group A (N = 7; anesthetic level > or = Th7), B (N = 7; Th8-10) and C (N = 31; Th11-L1) according to their anesthetic levels. Target anesthetic level (Th4-7) was obtained in group B by peridural administration of 2% mepivacaine in a dose of 5 ml and the surgery was performed. ⋯ In group A, no mepivacaine was used in the first hour of the surgery. In all patients, except one in group C, in whom general anesthesia was used after insufficient segmental analgesia, anesthesia was maintained by the CSE technique. We concluded that adequate anesthetic level for the intra-abdominal surgery can be obtained by intrathecal isobaric tetracaine administration combined with peridural mepivacaine of a dose calculated according to the anesthetic level ten minutes after the spinal block.
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Case Reports
[A case of severe hypertension caused by stellate ganglion block in a patient with facial palsy].
We report a case of severe hypertension following stellate ganglion block. A 61-year old woman received the left stellate ganglion block with 5 ml of 1% mepivacaine for her left facial palsy. ⋯ Systolic blood pressure remained above 190 mmHg for 60 minutes following the stellate ganglion block. We suggest that the extreme increase in blood pressure was due to the vagal nerve block associated with the left stellate ganglion block.
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We evaluated the relationship between the spread of contrast medium in epidural space and the analgesia area in epidural anesthesia in elderly patients. The spread of contrast medium was examined radiographically after the injection of iotrolan 5 ml through the epidural catheter and the analgesia area was examined by pin prick following the epidural injection of the same volume of 1% lidocaine. In lumbar group (group L) (n = 10), the radiographic spread was 10.4 (4-17) segments (mean, minimum-maximum) and the analgesic area was 8.5 (4-15) dermatomes. ⋯ The spread of contrast medium correlated well with the analgesic area in both groups (group L:Y = 0.79X + 0.31, r = 0.92, group C/ T:Y = 0.80X + 0.52, r = 0.79). The mean dose of local anesthetics required for analgesia was smaller than that of previous reports although individual variations were large. We conclude that the spread of contrast medium is useful for predicting the spread of epidural block.
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A case of severe accidental hypercapnia during anesthesia is presented. A 44-year-old woman underwent laparotomy under general anesthesia. Forty minutes after the start of the operation, BP rose slightly and HR increased from 110 to 140 x min-1. ⋯ Then, the pupils became promptly constricted and the response to painful stimuli appeared within 30 minutes. Her level of consciousness recovered completely after 4.5 hours of hyperventilation. She suffered from refractory hypotension (BP70-85 mmHg in systolic pressure) in spite of catecholamine administration, tachycardia (HR 140-160 x min-1) and ARDS in the ICU, but all the symptoms disappeared by the 16 hours after ICU admission.