Masui. The Japanese journal of anesthesiology
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The purpose of this study was to examine the hemodynamics and bispectral index score during lower abdominal surgery under balanced anesthesia with the two different combination doses of desflurane and remifentanil. ⋯ The patients could be anesthetized adequately during lower abdominal surgery under balanced anesthesia with the two different combination doses of desflurane and remifentanil.
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Intraoperative monitoring of train-of-four (TOF) response is recommended to avoid inadequate dose of muscle relaxant and its antagonist. We have standardized monitoring of TOF response at the end of surgery in all the patients undergoing general anesthesia with rocuronium since October 2013. ⋯ We conclude that standardization of TOF response at the end of surgery reduces dose of sugammadex in patients with slight residual neuromuscular block though the dose in patients under deep muscle relaxation seems to be insufficient.
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Case Reports
[A Case of Repetitive Cardiac Arrest due to Coronary Vasospasm after Sugammadex Administration].
A 58-year-old man with no history of cardiac disease was scheduled for a cerebral aneurysm clipping surgery. Anesthesia was administered with propofol, rocuronium, fentanyl, and remifentanil. At the end of the surgery, extubation was performed 3 min after the administration of 200 mg sugammadex, along with a simultaneous blood-pressure decrease with ST elevation on lead II. ⋯ An acetylcholine provocation test performed later showed positive results. We suspect sugammadex to be the cause of coronary vasospasm, because the time courses of the two cardiac arrest episodes after sugammadex administration were very similar. Therefore, clinicians should consider sugammadex as one of the causative agents of cardiac arrest in the operating room.
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Complete tracheal ring causes congenital tracheal stenosis in neonates and infants. We have to prevent further tracheal stenosis in perioperative period. This is a case report of an infant with congenital tracheal stenosis due to complete tracheal ring who underwent primary cleft lip closure under general anesthesia. ⋯ He was discharged on 8 POD without complication. CT scan and its integrated 3 D image of the trachea were useful to understand the approximate structure. However endoscopic examination allowed more detailed structure-measurement below glottis.
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We developed a simulator using "slime" composed of polyvinyl alcohol (PVA) and borax to evaluate this new ultrasound-guided nerve block training model. Seventeen subjects used the training model in the present study. They had no previous experience in performing ultrasound-guided nerve block. ⋯ An in-plane approach was used to visualize the needle for the nerve block, and the amount of time required to stop the needle on the second gauze was measured 5 times for each subject. Significant differences were observed between the times for the first experiment and those for the third experiment to the fifth experiment In the fourth and fifth experiments, all subjects visualized the nerve block needle clearly above the target layer and were able to stop the needle at the target layer. The present simulation using our proposed ultrasound-guided nerve block training model was useful in terms of the amount of time required to perform the procedure and as well as in terms of its safety.