Masui. The Japanese journal of anesthesiology
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Axillary veins (AxV) are increasingly selected instead of the subclavian veins (SCV) for safe and successful catheterization in adults using ultrasound echo although quite rarely in children. The diameters and depths of the pediatric internal jugular veins (IJV) are well known but those of pediatric AxV are unfamiliar even to anesthesiologists. We evaluated the diameters and the depths of the AxV and IJV in children undergoing cardiac surgery. ⋯ The diameters of the AxV are about 0.6 times and the depths are about 1.5 times those of the IJV and it seems difficult to use AxV for pediatric CVC from the standpoint of venous diameters and depths.
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A 32-year-old pregnant woman diagnosed with aplastic anemia was admitted for emergent caesarean delivery of 26th week of the gestation due to PIH (pregnancy-induced hypertension) and NRFS (non-reassuring fetal status). After compensating platelets counts to 5.3x10(4) microl-1, general anesthesia was induced with propofol and rocuronium. Anesthesia was maintained with O2 and sevoflurane until delivery and with modified-NLA after delivery. ⋯ She survived perioperative period and was to be treated for aplastic anemia. Her baby was discharged neurologically free. We should be ready to respond to anesthetic requirement for urgent cases of aplastic anemia.
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Randomized Controlled Trial
[Effect of continuous intravenous infusion of flurbiprofen axetil and tramadol hydrochloride for postoperative pain management of laparoscopic colectomy].
In this study, we evaluated the efficacy of continuous intravenous infusion of flurbiprofen axetil (FA) combined with tramadol hydrochloride (TH) for postoperative pain control after laparoscopic colectomy. ⋯ Continuous intravenous injection of FA plus TH is more effective than FA alone for postoperative pain management after laparoscopic colectomy.
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A 62-year-old woman was treated for schizophrenia for 40 years. When the symptoms had deteriorated and new medications had to be added, CPK rose and she malignant syndrome was suspected. The electroconvulsive therapy (ECT) was proposed because of no improvement of the symptoms. ⋯ Anesthesia was induced and maintained using target controlled infusion (TCI) of propofol. After ECT was performed, sugammadex sodium 4 mg . kg-1 was administered at 2 post-tetanic counts (PTC) and the patient could come out the operating room safely and speedy. ECT using rocuronium bromide and sugammadex sodium can be performed safely and speedily, when suxamethonium chloride cannot be used.
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Amyotrophic lateral sclerosis (ALS) is a degenerative disease involving motor neurons. The anesthetic problem is increased susceptibility to non-depolarizing muscle relaxants and the feasibility of spinal and epidural anesthesia. An 86-year-old man with ALS underwent colostomy to the ileus. ⋯ Post-operative course was uneventful. Our anesthetic management of ALS patient using sugammadex was successful. Further evidence is required to establish appropriate use of sugammadex for ALS patients.