Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial
[The techniques to identify the epidural space do not influence the success rate in combined spinal-epidural anesthesia: a comparison between loss-of-resistance and hanging-drop].
The hanging-drop (HD) technique has been attributed to a negative epidural pressure induced by making a tent of the dura by the Tuohy needle. We, therefore, hypothesized that the HD technique would result in more successful intrathecal placement of the spinal needle in combined spinal-epidural anesthesia (CSEA) compared with the loss-of-resistance (LR). Seventy patients received CSEA using the needle-through-needle method with a spinal needle extending 9 mm beyond the Tuohy needle. ⋯ Failure to obtain CSF after 3 attempts was not significantly different between the two techniques; 26% and 31% in HD and LR, respectively. In conclusion, there was no advantage of the HD technique for obtaining CSF in CESA compared with the LR. It seems that spinal needle length beyond the Tuohy needle should be more than 9 mm.
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Case Reports
[Anesthetic management of a hyper-obese patient by target-controlled infusion (TCI) of propofol and fentanyl].
We gave total intravenous anesthesia to an over-100% hyper-obese patient using target-controlled infusion (TCI) of propofol and fentanyl. To keep him asleep, we maintained his BIS in a range of 40 to 60 by adjusting the target concentration of propofol. ⋯ The relationship between BIS value and effect-site concentration of propofol was almost the same as that assessed in ordinary adults of a normal weight. We conclude that the estimated concentration of propofol is a good indicator of the effect of propofol and that TCI is a useful technique in obese patients as well as in ordinary adults.
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We present a case of a 46-year-old female patient with systemic lupus erythematosus who developed herpes zoster of the right eighth cervical nerve. Her whole right forearm, hand and the first through fifth fingers were coated with some gel and protected against pain. ⋯ Reduction of pain and edema as well as improvement in mobility of each joint of her right upper extremity was observed. We suspect that SGB, continuous cervical epidural block and ulnar nerve block are effective and useful alternative treatments in a patient with PHN associated with CRPS of the eighth cervical nerve.
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Historical Article
[New study on the history of anesthesiology (8)--Etymological consideration on a Japanese word "Masui"].
The author briefly describes etymology of a Japanese word "Masui" ([symbol: see text]) and discusses why this word has not been correctly understood by lay people as well as Japanese anesthesiologists. The word "Masui" was coined by Seikei Sugita in 1850 when he translated Dutch edition of Schelesinger's monograph on ether anesthesia into Japanese. ⋯ The author thinks that one of the causes for this inadequate acceptance is that the correct Japanese words of "Masuika-gaku" and "Masuika-i" for Anesthesiology and Anesthesiologists were not coined and the incorrect words as "Masuigaku" and "Masui-i" have been used. Not a small number of Japanese anesthesiologists still employ the words "Masuigaku" and "Masui-i" without any special reasons.
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Randomized Controlled Trial Clinical Trial
[Relationship between minimum alveolar concentration and electroencephalographic bispectral index as well as spectral edge frequency 95 during isoflurane/epidural or sevoflurane/epidural anesthesia].
To investigate the relationship between minimum alveolar concentration (MAC) and electroencephalographic variables, we measured the bispectral index (BIS) and the spectral edge frequency 95 (SEF 95) in 17 patients undergoing elective surgery during isoflurane/epidural (n = 8) or sevoflurane/epidural (n = 9) anesthesia. Patients received 2.0 MAC end-tidal concentrations of isoflurane or sevoflurane, and the BIS and the SEF 95 were recorded after 15 min of an unchanged end-tidal concentration. The concentration of the inhalational agent was decreased to 1.2 MAC, and measurements were repeated again. ⋯ There were significant differences in the BIS and the SEF 95 at 2.0 MAC between isoflurane and sevoflurane groups. In contrast, the BIS and the SEF 95 showed no difference at 1.2 MAC between the groups. These findings suggest that different inhalational anesthetics may have different effects on the BIS and the SEF 95.