Masui. The Japanese journal of anesthesiology
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Comparative Study
[Comparison of two methods of local anesthetic administration using three phantom tissue models].
Local anesthetic is often administered around surgical wounds to reduce pain. It remains unknown, however, how the agent diffuses into tissue, or whether the method of administration has any impact on the drug diffusion. We evaluated drug-diffusion areas around wounds after administering a dummy agent by needle injection (NI) and direct infiltration (DI) using three phantom tissue models : agar, sponge, and pork rib. ⋯ The direct infiltration method is likely to diffuse local anesthetic into tissue more uniformly and more extensively than the needle injection method.
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Case Reports
[Case of large vein perforation caused by pumping using central venous catheter revealed by postoperative CT].
A 72-year-old woman, 157 cm in height and weighing 45 kg, was scheduled for emergency surgery for acute abdomen suggestive of gastrointestinal perforation. During the procedure, a triluminal central venous catheter (CVC) was inserted via the left internal jugular vein; venous blood could be aspirated separately through its lumens. On attempting blood transfusion, we noticed that the opening of one the CVC lumen tips was blocked and blood pumping was thus performed to achieve rapid transfusion. ⋯ After the intraoperative blood vessel perforation, the condition may have been aggravated by steroid use, amyloidosis, and blood vessel fragility, ultimately presenting the extravascular findings observed on CT. We thus believe that in cases where CVC is inserted via the left internal jugular vein, blood pumping in particular is believed to be dangerous. Although the risks of blood vessel perforation when using CVC are relatively low, the possibility of unexpected complications should be borne in mind.
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Comparative Study
[Glidescope: a comparison of percentage of glottic opening score between middle size and large size handles].
The aim of the present study was to compare the percent of glottic opening score between middle-size (#3) and large-size (#4) handles during laryngoscopy using the GlideScope videolaryngoscope (GVL) in Japanese women. ⋯ The use of GVL #3 handle is recommended for tracheal intubation for Japanese women.
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An 86-year-old woman was scheduled to receive fourth reconstructive surgery for femoral bone fracture under general anesthesia. She had been suspected with narrow angle glaucoma due to headache and bloodshot eyes during gastroscopy. During transfer to our hospital, she fell down and suffered from the right femoral neck fracture. ⋯ TOF ratio recovered to 80% 8 minutes after sugammadex 2 mg kg(-1) i.v., and increased to 100% 3 minutes after additional 1 mg x kg(-1). Intraocular pressure stayed below 20 mmHg during the intervention. We could achieve full reversal of neuromuscular blockade and suppress increase in intraocular pressure with use of sugammadex.
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Obstructive ileus is a life-threatening gastrointestinal condition that requires emergency operation. Patients with obstructive ileus sometimes develop coagulopathy. In such cases, central neuraxial blockade should be avoided. ⋯ In addition, ultrasonogrhaphy facilitates the prediction of depth of the posterior rectus sheath and improves the accuracy of local anesthetic placement. We conclude that RSB is effective for improving postoperative pain and intraoperative muscle relaxation of the abdominal wall. Ultrasound-guided RSB is an alternative method to central neuraxial blockade.