Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Prevention of spinal hypotension associated with cesarean section by aortocaval compression--left 15 degree table tilt vs. uterine displacement by hand].
Women undergoing elective cesarean delivery were randomly assigned to receive a spinal anesthesia in either the semi-lateral (group SL) position or the supine position with uterine displacement (group UD). After spinal injection, group SL patients were turned to a 15 degrees left lateral supine position, and group UD patients had uterine displacement by hand. ⋯ Mean ephedrine requirement was significantly less in the SL group (P < 0.05). Apgar scores did not differ, but umbilical artery pH values were significantly higher in patients of the group SL (P < 0.01).
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In surgical graft replacement of the descending aorta graft, one-lung ventilation (OLV) is required to provide adequate surgical view and to allow removal of blood from the left lung. It is best to use a double-lumen tube (DLT) to assure OLV but it is sometimes difficult to place the left-sided DLT due to thoracic aneurysm or the dissection lumen. We retrospectively investigated tracheobronchial anatomy by chest X-ray and chest computed tomography (CT) in 29 cases of descending aorta replacement to determine how best to manage difficult placement of the left-sided DLT. ⋯ We experienced difficulty in placement of the left-sided DLT in 3 of 29 cases of descending aorta replacement. We can predict difficulty of left-sided DLT placement by the presence of compression of the tracheobronchial tree on chest CT.
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Randomized Controlled Trial
[Effect of landiolol on bispectral index scores in patients undergoing lower abdominal surgery].
The aim of this study was to examine the effects of landiolol on bispectral index scores (BIS) during surgery. ⋯ This study suggests that landiolol has no effects on BIS in patients undergoing lower abdominal surgery during sevoflurane-remifentanil anesthesia.
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Case Reports
[Case of difficult ventilation due to trachea stricture during general anesthesia in a morbidly obese patient].
Obesity has various coexisting illnesses, and the risk of the anesthesia management in an obese patient is high. We report a case of difficult ventilation by trachea stricture during general anesthesia in a morbidly obese patient.
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Stiff-person syndrome is an uncommon disease characterized by muscular rigidity and painful spasms in the axial and limb muscles. We report a 58-year-old woman with stiff-person syndrome undergoing thymectomy under general anesthesia. Before surgery, her medications were 25 mg of diazepam, 2 mg of clonazepam, and 15 mg of gabapentin per day. ⋯ After surgery, she was fully awake and TOFR recovered to 100%, but tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. On the next day, the tracheal tube was removed, and she was discharged from ICU. Because anesthetics may delay the recovery of respiratory function in a patient with stiff-person syndrome, careful assessment of respiratory function is needed at the emergence from general anesthesia.