Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Effects of intravenous vasopressor on spread of spinal anesthesia with 0.5% hyperbaric bupivacaine for caesarean delivery].
It is known that when isobaric bupivacaine is applied for Caesarean delivery, phenylephrine is superior to ephedrine in preventing rostral spread of spinal anesthesia. In this study, we prospectively investigated whether phenylephrine can prevent rostral spread of spinal hyperbaric bupivacaine. ⋯ 1. Phenylephrine prevented rostral spread of spinal hyperbaric bupivacaine. 2. Haemodynamic changes were significantly different between the two groups. 3. Umbilical artery pH was significantly higher with phenylephrine than with ephedrine.
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Case Reports
[Prolonged apnea from rocuronium in a patient with hypermagnesemia after cesarean section: a case report].
A patient developed prolonged apnea after emergency cesarean section. The patient was a 38-year-old primiparous woman with myoma uteri and her body weight was 44.8 kg. She received intravenous magnesium sulfate 1 g x hr(-1) as tocolytic agent for threatened premature delivery. ⋯ After the operation which was finished in 65 minutes, the effect of rocuronium remained for more than 100 minutes after its administration probably due to hypermagnesemia. Rocuronium shows rapid onset, and several studies indicate that it can be used for rapid sequence induction instead of suxamethonium. But rocuronium should be used carefully and its effect should be monitored in a patient with hypermagnesemia.
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We report a pregnant woman who developed non-traumatic spinal subdural and epidural hematoma. A 31-year-old woman at 28 weeks of gestation developed progressive ascending paralysis. ⋯ An emergency cesarean section followed by spinal decompression was performed 60 hours after the onset. The patient's neulogical function recovered completely after the surgey.
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Case Reports
[Arytenoid cartilage dislocation caused by endotracheal intubation which resolved spontaneously].
Arytenoid cartilage dislocation following tracheal intubation is a rare complication. A 48-year-old man underwent an operation for laparoscopic cholecystectomy under general anesthesia. Although no anaesthetic or operative problem had occurred, hoarseness was noticed after the operation, continuing beyond 25 days thereafter. ⋯ About four weeks later, the arytenoid cartilage dislocation resolved spontaneously. Other findings suggest that spontaneous reduction can be expected in many patients with anterior arytenoid dislocation. Patients suffering from arytenoid cartilage dislocation should be observed for several weeks if possible because there exist some reports in the literature describing spontaneous resolution after its dislocation.
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Primary tracheal cancer is extremely rare, but critical tracheal stenosis is seen in many cases. Although laser resection or stent placement is performed under general anesthesia, anesthetic management for tracheal tumor is extremely difficult in terms of airway management. We report a 65-year-old woman scheduled to undergo bronchoscopic laser surgery and insertion of Dumon stent for tracheal tumor which severely obstructed the upper airway. ⋯ Although desaturation due to unsuccessful venous drainage and difficult ventilation by laryngeal edema during the operation and tracheal obstruction by a clot after the operation was observed, the patient's clinical condition improved. In cases of severe tracheal stenosis, airway obstruction by hemorrhage, secretion and laryngeal edema, etc. occur easily. Therefore, some kind of measures should be taken for the operation and a number of precautions must be taken during the perioperative period.