Masui. The Japanese journal of anesthesiology
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Case Reports
[Case report : Severe anaphylactic shock followed by positive skin-prick-test to multiple vasoconstrictors].
A 71-year-old woman was scheduled for revision of total hip replacement under general anesthesia. Twenty minutes before entering the operating room, slight urticaria was caused by drop infusion of cefotiam. It was stopped immediately and the patient entered the operating room without any symptoms. ⋯ We decided to stop the operation, and the patient was moved to the intensive care unit (ICU). A few hours after entering the ICU, she was extubated and moved to the general ward next day. Skin-prick-tests performed 14 days later indicated that she was allergic to ephedrine, methoxamine, epinephrine, dopamine and a few more drugs.
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We evaluated Disposable Crystal Laryngoscope Blades in terms of preventing infection. Most anesthesiologists were satisfied with the view offered by the Disposable Crystal Laryngoscope Blade; however more force is necessary to lift the epiglottis during intubation. It may be more difficult to use by residents, inexperienced anesthesiologist, or emergency medical technicians, although the Disposable Crystal Laryngoscope blade is useful for preventing infection.
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A 31-year-old woman with aplastic anemia was admitted for the management of delivery at 33 weeks of gestation. Platelet count was 2.3 x 10(4) x microl(-1) on admission. Corticosteroid therapy after admission was not effective, and we decided to manage the delivery with elective cesarean section after platelet transfusion. ⋯ Blood loss during operation was 858 g, and complications were not seen during operation. In the case of delivery with uncontrolled aplastic anemia, elective cesarean section is thought to be safe. If platelet count is over 5.0 x 10(4) x microl(-1) after platelet transfusion, spinal anesthesia should be used.
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A 59-year-old woman with a body mass index of 30 and an edematous, tender goiter was scheduled for subtotal thyroidectomy. She had a history of dyspnea, cough, hoarseness, sleep disturbance in the supine position, difficulty in expelling sputum, and inability to rotate her neck to the left. Chest CT showed an adenomatous goiter, measuring 42 x 57 x 105 mm, with invasion into the mediastinal space, 17 mm right glottic shift, and 21 mm right tracheal shift. ⋯ Awake fiberoptic intubation was selected for anesthesia induction, and was easily performed using a Parker Flex-Tip tracheal tube (Parker Medical, Highland Ranch, Colorado, USA), after intravenous injection of 200 microg of fentanyl, 8% lidocaine pump spray on the larynx with a direct laryngoscope, and 5 ml of 4% lidocaine spray on the vocal cords and trachea through a bronchoscope. The operation was completed successfully without any adverse events. Awake fiberoptic intubation with a Parker Flex-Tip tracheal tube is easily performed in a patient with a difficult airway due to obesity, goiter, and laryngo-tracheal shift.
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Randomized Controlled Trial Comparative Study
[Technical advantages of ultrasound-guided obturator nerve block compared with the nerve stimulating technique].
We investigated the onset time of obturator nerve block and time required for the nerve block comparing two groups in a prospective randomized study. ⋯ Ultrasound imaging facilitated the identification of obturator nerves between adductor muscles. Ultrasound-guided obturator nerve block is a safe, quick and useful technique.