Masui. The Japanese journal of anesthesiology
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Peripheral nerve block has many advantages in surgical anesthesia with or without general anesthesia; postoperative analgesia, faster postoperative rehabilitation, and chronic pain management. However, serious adverse complications after peripheral nerve block can happen. Therefore, anesthetists should obtain full informed consent for possible complications, and require scrupulous attention to this procedure. This review focuses on complications of brachial plexus block because it is the most popular peripheral nerve block.
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Epidural anesthesia has many advantages, including block of surgical stress, postoperative pain management and prevention of postoperative complications. Therefore, we should use epidural anesthesia when indicated. However, patients with preexisting spinal stenosis or lumbar radiculopathy have higher incidence of neurologic complications after epidural anesthesia. ⋯ It is important to have measures for safety in performing epidural anesthesia at every hospital. Recently, we have many anesthetic techniques, including epidural anesthesia, remifentanil infusion, ultrasound-guided peripheral nerve blocks and intravenous PCA. Therefore, we should choose an anesthesia method based on the careful evaluation of the benefit and risk balance for the patient's safety to reduce the incidence of complications.
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To evaluate the suitability of GlideScope Ranger, endotracheal intubation was performed in 100 surgical patients undergoing general anesthesia. The time to complete intubation, percentage of glottic opening score and optimizing procedures were recorded. ⋯ It was easily handled not only by experienced anesthetists but also by novice personnel. GlideScope Ranger could be an effective aid to airway management in surgical patients.
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Kasabach-Merritt syndrome (KMS) is a rare and severe coagulation disorder caused by vascular malformations within or outside the liver. It is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, and consumption coagulopathy. We successfully managed the anesthesia for a giant hemangioma resection complicated with KMS using FloTrac/Vigileo system. ⋯ The increase of SVV and sudden decrease of APCO and SBP were recognized during surgical procedure. The SVV demonstrated marked changes in response to hemorrhage, and it was more sensitive than CVP change during operation. We conclude that SVV is an accurate predictor of intravascular hypovolemia, and it is a useful indicator for assessing the appropriateness and timing of applying fluid for improving circulatory stability during a giant hemoangioma resection.
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Comparative Study
[Influence of remifentanil on postoperative pain with intravenous patient-controlled analgesia following total knee arthroplasty].
There is a controversy about the development of acute opioid tolerance during remifentanil infusion for postoperative pain. We investigated whether intraoperative remifentanil infusion leads to rapid development of tolerance. We also investigated whether adjuvant analgesic is effective or not. ⋯ Intraoperative remifentanil increased postoperative pain during movement. Remifentanil seems to cause acute torelance. NSAIDs given before operation may be useful for postoperative analgesia.