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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We studied the level of analgesia obtained with epidural injection of 2% mepivacaine using combined spinal and epidural analgesia (CSE) and compared with the level obtained by epidural analgesia (EA). We inserted a catheter into the epidural space through the L2/3 interspace, and hyperbaric tetracaine was injected through the L3/4 interspace with 26G spinal needle in thirty patients for CSE. We checked the the level of analgesia 90 min after spinal anesthesia. ⋯ We also showed the regression line Y = 16.1-0.7X (P < 0.05) for EA 15 min after epidural injection of mepivacaine in other 23 patients. To achieve the same level of analgesia of Th8 or Th6 with CSE and EA, the doses for epidural injection were calculated as 5.5 ml, 10.5 ml with CSE and 11.5 ml, 14.4 ml with EA, respectively. These results show that the epidural dose of local anesthetic for CSE is 1/2 to 2/3 of that necessary for EA.
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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.