Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Usefulness of tracheal tube with N2O gas-barrier cuff].
We evaluated three different tracheal tubes, Portex Profile Soft-Seal Cuff (PSSC), Portex Profile Cuff (PC) and Mallincrodt Lo-Contour (LC), when they are used in the artificial trachea and in anesthetized patients. When a cuff was inflated in the artificial trachea, PSSC with a cuff of high N2O gas-barrier property, and PC could achieve air-tight sealing with a smaller amount of injected air, compared with LC. This finding suggests that the inflated cuff-shape and cuff-fold formation are important to block the airway leakage with small volume of air. ⋯ Intracuff pressures were increased significantly with the passage of time. In PSSC group, however, intracuff pressure was 25 +/- 6 mmHg (mean +/- SD) at two hours, and in other two groups it was between 32 and 48 mmHg. The use of a tracheal tube with gas-barrier cuff is recommended to prevent a high tracheal wall pressure.
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A 37-year-old man with exophthalmos underwent resection of the left apical peridontal cyst under general anesthesia. Eye patches (Opticlude) without adherence to epibulbar area were used during anesthesia and surgery. ⋯ Staining with fluorescein dye demonstrated corneal abrasion in the lower third of the left eye. The corneal abrasion healed in two days after topical treatment.
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Apneic anesthesia with intermittent ventilation (AAIV) under inhalational anesthesia has been reported to improve visualization of the larynx with lack of vocal cord motion in laryngeal microsurgery. In this study, we evaluated AAIV using total intravenous anesthesia with propofol and fentanyl instead of inhalational anesthesia in 11 patients undergoing microsurgery of the larynx, and examined the effects of AAIV on respiration and circulation. Anesthesia was maintained with infusion of propofol 4-10 mg.kg-1.h-1 and intermittent administration of fentanyl and vecuronium intravenously. ⋯ End-tidal carbon dioxide level increased for 14.9 mmHg immediately after apneic periods. Propofol vielded stable and adequate levels of anesthesia during apneic periods. We conclude that AAIV using constant monitoring of Spo2 is a useful and safe technique, and that propofol is a suitable anesthetic agent for AAIV.
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Randomized Controlled Trial Clinical Trial
[The effects of propofol anesthesia with or without the use of nitrous oxide on the intraoperative involuntary movement, the postoperative awareness and vomiting].
The authors investigated the effect of anesthesia with nitrous oxide and propofol on intraoperative involuntary movement, muscle relaxant usage, postoperative nausea and vomiting, the total amount of propofol used, and recovery time from anesthesia. Eighty-eight patients for gynecological surgery were randomly divided into group PE: propofol/epidural (n = 44), and group PEG: propofol/epidural/nitrous oxide (n = 44). ⋯ The authors found no correlation between the use of nitrous oxide and intraoperative involuntary movement, subsequent development of postoperative quality of awareness, recovery time, nausea and vomiting. We recommend PEG method for gynecological surgery rather than PE from an economical viewpoint because it is associated with the reduction of mean propofol and muscle relaxant used.
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Case Reports
[Epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy (DCM)].
A 23-year-old patient with dilated cardio myopathy (DCM) was scheduled for a cesarean section. We inserted an epidural catheter at the L 2/3 interspace and injected 1.5% lidocaine 6 ml with epinephrine 30 micro g and fentanyl 50 micro g. The analgesic level 15 minutes after injection was achieved up to the eighth thoracic dermatome. ⋯ Analgesia was sufficient for the surgery, and heart rate and blood pressure were stable throughout the operation. The infant's apgar scores were 9 and 10. Epidural anesthesia is one of the options for cesarean section in pregnant women with DCM.