Masui. The Japanese journal of anesthesiology
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Case Reports
[Pain management using patient controlled epidural analgesia for transient osteoporosis of the hip in pregnancy].
We report the case of a 37-year-old woman who developed severe pain in bilateral legs and hip in the eighth month of pregnancy. She was diagnosed as transient osteoporosis of the hip in pregnancy by the MRI findings. ⋯ After delivery, diclofenac sodium was administered for three weeks. Complete clinical improvement was observed in the seventh month after delivery.
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A 68-year-old man was scheduled for pancreaticoduodenectomy under general anesthesia. He was suffering from Charcot-Marie-Tooth disease (CMTD) for 34 years, and complicated with liver cirrhosis. Anesthesia was induced with propofol and fentanyl, and maintained with oxygen-air-sevoflurane and remifentanil. ⋯ Rocuronium was injected intravenously for tracheal intubation, supplemented as required using an electrical nerve stimulator. The longer duration of action of rocuronium was observed in this case because the patient was complicated with CMTD and liver cirrhosis. We suggest that monitoring neuromuscular function may be necessary to detect subtle residual neuromuscular blockade when rocuronium is used in a patient with CMTD and liver dysfunction.
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Propofol target-controlled infusion (TCI) is now commonly used for induction and maintenance of anesthesia. In this study, we measured the propofol plasma concentrations in obese patients in order to test our hypothesis that propofol TCI is reliable for use in obese patients. ⋯ We conclude that propofol TCI is a reliable method for maintaining anesthesia even in obese patients. At emergence, however, the data suggested that the plasma concentrations might be lower than the estimated values in obese patients.
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Case Reports
[Case of inguinal hernia repair with transversus abdominis plane block and rectus sheath block].
Transversus abdominis plane block is effective for lower abdominal and inguinal operations, and rectus sheath block is effective for abdominal operations. Recently, ultrasound guided nerve block has been employed, and these techniques can be performed with ultrasound scanning. ⋯ We did not want to select general anesthesia for him, and performed rectus sheath block and transversus abdominis plane block. We achieved good anesthetic management using two peripheral blocks under ultrasound scanning.
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In adult patients, there is a strong correlation between the appropriate depth of insertion of a left double-lumen endobronchial tube (DLT) and height. However, for patients with the same height, we noted the tendency of the depth of insertion being about 1 cm shorter for patients under 19 years of age compared to that for those over 20 years. ⋯ During intubation of the bronchi with DLT in patients under 19 years, the optimal depth of DLT insertion is less than that for patients over 20 years.