Masui. The Japanese journal of anesthesiology
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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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Case Reports
[Total intravenous anesthesia with propofol, ketamine, and fentanyl (PFK) for a patient with mitochondrial myopathy].
Anesthetic management for a patient with mitochondrial myopathy is described. A 57 year-old-female underwent laparoscopic cholecystectomy for cholelithiasis. The patient had been diagnosed as having mitochondrial myopathy from muscle biopsy. ⋯ Her reaction to vecuronium bromide was within normal limits evaluated with a neuromuscular activity parameter, train-of-four ratio. No serious acidosis, hyperlactemia, hypothermia, nor prolonged recovery from the anesthesia was observed. As inhaled anesthetics may be contraindicated for mitochondrial myopathy, and nitrous oxide for laparoscopic surgery is relative contraindication, total intravenous anesthesia with muscle relaxant titration is appropriate for laparoscopic surgery for patients with mitochondrial myopathy.
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Case Reports
[A successful weaning from mechanical ventilation by diaphragmatic plication for unilateral diaphragmatic paralysis].
A patient with unilateral diaphragmatic paralysis (UDP) after cardiac surgery, commonly extubated without any troubles, encounters a serious fetal respiratory complication in a rare case. We had a case of a 68-year-old man under long term mechanical ventilation (MV) because of UDP and phrenic nerve injuries after the replacement of the ascending aorta. After this operation he suffered from mediastinal infection and needed MV for a few days. ⋯ The patient was successfully weaned from MV on the 4th postoperative day of the right DP. Pulmonary function test was improved dramatically. In a case of long term MV due to UDP, DP can be one of effective treatments.
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This is a report of a retained epidural catheter segment after placement of 20-G polyethylene catheter (Hakko Medical) through 17-G Tuohy needle and 25-G spinal needle (Top Company) for a patient receiving combined spinal-epidural anesthesia. Retained catheter fragment (approximately 10.6 cm) was removed easily with small incision under local anesthesia. Electron microscopic findings of the catheter showed that the catheter might have been traumatized by the Tuohy needle through which the catheter was placed or by the spinal needle for intrathecal anesthesia, resulting in having been sheared off.
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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.