Masui. The Japanese journal of anesthesiology
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We report two cases of elderly patients who underwent ultrasound-guided combined femoral nerve and lateral femoral cutaneous nerve blocks for osteosynthesis of femur neck fracture. In both cases, neuraxial anesthesia was contraindicated due to coagulopathy, and severe restrictive ventilatory disorder was observed. The femoral nerve and lateral femoral cutaneous nerve blocks were performed with 20ml of 0.375% ropivacaine under ultrasonographic visualization using a high frequency linear probe. ⋯ Supplemental local infiltration of anesthetics and intravenous low-dose sedative drugs were administered during surgery. The perioperative course was uneventful in both cases. This combined block technique could be a choice for osteosynthesis of femur neck fracture especially in high-risk patients.
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After the approval of the drug-eluting coronary stent in Japan in 2004, Japanese cardiologists took the benefit of this new technology to improve the post percutaneus coronary intervention complication of restenosis. Post market studies of drug-eluting coronary stent are becoming available. Unfortunately, many of the results indicate the risk of late stent thrombosis. ⋯ However, many reports suggest the increasing risk of stent thrombosis in patients with the drug-eluting coronary stents presenting for non-cardiac surgery. They also suggest that, in contrast to bare metal stent, there may be no association between the risk of stent thrombosis and time intervals from stent placement to surgery. We should pay more attention to management of patients with drug-eluting coronary stents presenting for non-cardiac surgery.
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Two patients with cancer medicated by transdermal fentanyl patch (FP) for more than one month underwent operation under general anesthesia. FP had not been removed. Anesthesia was maintained with inhalation of sevoflurane 2-3%, nitrous oxide, and intermittent administration of intravenous fentanyl. ⋯ They recovered from anesthesia quickly, and there were no complications due to fentanyl during the perioperative course. One patient needed additional intravenous fentanyl for postoperative analgesia. When FP is applied during the operation, it is useful because it can be of use for postoperative pain control.