Masui. The Japanese journal of anesthesiology
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We report two cases of epidural anesthesia in an 11-year-old obese girl (BMI 34.5) using ultrasound imaging by an inexperienced resident. It was useful for performing epidural anesthesia in these difficult cases to observe anatomical structure around epidural space and to measure the angle and distance from the skin to the epidural space. ⋯ In both cases, epidural puncture was performed smoothly at the first attempt and there was no adverse effect. We conclude that using ultrasound imaging before epidural puncture in obese children is safer and more educational for residents.
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Case Reports
[Peripheral nerve blocks for amputation of lower limb in three critically ill patients].
In 3 critically ill patients, amputation of the lower limb above knee was performed uneventfully under femoral, sciatic, and obturator nerve blocks together with topical anesthesia of the lower limb.
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Dexmedetomidine has the advantage of producing sedation accompanying patient's cooperation without respiratory depression. We managed the airways of 10 cases with suspected difficult tracheal intubation under sedation with dexmedetomidine. ⋯ Dexmedetomidine is a safe and effective sedative for awake difficult airway management, for example, fiberscopic intubation, tracheostomy and direct laryngoscopy, though some attention must be paid to circulatory changes.
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In carotid endarterectomy (CEA), it is essential to maintain the systemic blood pressure (BP) and cerebral perfusion pressure, especially during cross clamping, and vasopressors are often required. To elucidate the effect of norepinephrine (NE) on the cerebral circulation in patients undergoing CEA, regional oxygen saturation (rSO2) in bilateral frontal poles was monitored by near infrared spectroscopy during NE infusion. ⋯ NE used to maintain the MAP decreased the brain rSO2. NE would aggravate the balance between cerebral oxygen supply and consumption in patients undergoing CEA. Further investigations are necessary to clarify the effect of systemically administered norepinephrine on the cerebral circulation.
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VATS (video-associated thoracic surgery) is mainly undertaken under general anesthesia only. Considering with patient's respiratory stability and postoperative pain relief, epidural anesthesia has advantages over general anesthesia. According to our clinical experience, side effects of epidural morphine, especially nausea and vomiting, often torture patients, especially woman. ⋯ Statistically significant gender differences of effectiveness and side effects of epidural morphine in VATS were observed only in nausea and vomiting.