Masui. The Japanese journal of anesthesiology
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We experienced a case of intractable lower limb pain successfuly treated by spinal cord stimulation with an electrode inserted retrogradely. The patient is a 32 year-old-man suffering from intractable lower limb pain on the area innervated by the sciatic nerve from unidentified cause for about 4 years. We tried various treatments such as epidural block, S 1 nerve-root block including thermocoagulation technique, opiate. ⋯ Therefore, 6 years after the onset of the symptom, we tried to stimulate electrically the nerve with an electrode inserted retrogradely. This method of spinal cord stimulation produced enough pain reduction. The method of retrograde insertion of an electrode for spinal cord stimulation seems to be a good way to treat intractable pain of the area innervated by a single spinal nerve.
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Applying cricoid pressure is a simple and effective means of preventing aspiration of gastric juice and content. This procedure prevents a possible reflux by compressing the esophagus between the cricoid cartilage and the cervical vertebral bodies. Recent studies recommend a pressure of 30-40 N. The present study was undertaken to determine whether with education and practice, anesthesia assisitants could be taught a recommended cricoid pressure and retain this skill. ⋯ This model represents an easy and practical means of training the application of the optimal level cricoid pressure but the training should be continued.
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Case Reports
[Powder-induced anaphylactic shock following use of powdered latex gloves during gynecological open laparotomy].
A 42-year-old woman with hysteromyoma underwent total abdominal hysterectomy under general and epidural anesthesia. Three years before, she had undergone resection of lipoma on her left shoulder under local anesthesia uneventfully. She had no previous history of hypersensitivity. ⋯ Latex allergy should be suspected if an anaphylactic reaction or shock accompanied by circulatory collapse, respiratory failure, and skin symptoms of unknown origin occurs during surgery. As women more often come into contact with household articles containing latex, we suspect that women are prone to developing sensitivity towards latex. We recommend that powder-free or latex-free surgical gloves should be available not only for patients with a high risk of developing latex allergy, but also for patients indicated for gynecological open laparotomy.
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We prepared questionnaires for the rotating residents during their assignment for anesthesiology in the novel Japanese residency programs for the year 2004. ⋯ Stepwise regression analysis was shown to be helpful in improving the questionnaires regarding the training in anesthesiology.
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The effect of anesthetics on somatosensory evoked potential (SEP) and auditory brain stem response (ABR) has been a subject of intense reseach over the last two decades. In fact, volatile anesthetics have been repeatedly shown to decrease cortical amplitude in a dose-dependent fashion but the information regarding the effect of propofol is incomplete. The purpose of this study was to compare the effects of sevoflurane and propofol on evoked potentials during comparable depth of anesthesia guided by bispectral index (BIS). ⋯ VEP was most strongly affected with anesthetics, and ABR showed less marked influence of sevoflurane and propofol. Propofol based TIVA technique would induce less change in evoked potentials than sevoflurane.