Masui. The Japanese journal of anesthesiology
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A 67-year-old male patient with chronic tympanitis was scheduled for elective tympanoplasty. Propofol and fentanyl were used for induction and the patient was ventilated with sevoflurane, oxygen and nitrous oxide for general anesthesia. ⋯ The surgery was discontinued for the safety of the patient, in spite of the recovery of ventilation with a facemask. It is suspected that the ventilatory difficulty was caused by the following reasons; first, the laryngeal mask airway was shifted by change of the body position, second, the mask tip was inserted at the inlet of the larynx because the internal cuff pressure had risen with nitrous oxide.
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We experienced anesthetic management for a patient with platypnea-orthodeoxia syndrome. This syndrome is relatively uncommon and accompanies dyspnea and hypoxemia on changing to a sitting or standing from recumbent position. A 75-year-old man with the syndrome underwent atrial septal defect closure on cardiopulmonary bypass. ⋯ The perioperative and postoperative course was uneventful, except for hypoxemia during induction. Although the exact mechanisms of platypneaorthodeoxia remains to be solved, right-to-left shunt by an anatomical abnormality and by change of the atrial septum is considered one of the hypoxic mechanisms. We suggest that it is necessary to prevent right-to-left shunt and hypoxemia in anesthetic management of a patient with platypneaorthodeoxia syndrome.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Evaluation of a lockable combined spinal-epidural device for use with needle-through-needle technique].
Recently, a new combined spinal-epidural (CSE) device has been introduced which allows the spinal needle to be extended a maximum of 15 mm beyond the Tuohy needle and locked onto the epidural needle after dural puncture. The aim of this study was to compare this lockable CSE device with the conventional CSE device, which allows the spinal needle to be extended 9 mm beyond the Tuohy needle, and to measure the length of the protrusion of the spinal needle beyond the Tuohy needle (top-to-top distance: TTD). ⋯ The lockable CSE device improves the success rate of spinal anesthesia in needle-through-needle CSE anesthesia.
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Comparative Study
[Comparison of analgesics used during balanced anesthesia on the incidence of PONV].
When we make reference to the quality of anesthesia, we consider three points, early emergence, postoperative pain relief, and postoperative nausea and vomiting (PONV). Among these, PONV is comparatively neglected. Many analgesics used during anesthesia may cause PONV. ⋯ The type of analgesics used during balanced anesthesia is not important for development of PONV, but patient's factors, such as gender and BMI, are more closely associated with PONV.
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Postoperative nausea and vomiting are important complications after craniotomy. ⋯ These results indicate that the incidence of PONV after brain tumor resection is high and infratentorial surgery is a risk factor for PONV. Strategies for the prevention of PONV after craniotomy are required.