Masui. The Japanese journal of anesthesiology
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We report successful management of anesthesia in two cases of knee arthroscopic surgery of meniscal lesions using ultrasound-guided combined femoral-obturator nerve block with inhalation anesthesia. The blocks were performed with 30 ml of 0.5% ropivacaine under ultrasonographic visualization. The perioperative courses were uneventful and there was no complaint about postoperative pain. ⋯ Our technique relieved postoperative pain effectively because knee joint is innervated by the femoral and obturator nerves in great measure. Ultrasound-guided femoral and obturator nerve block is easier and more successful than sciatic nerve block. General anesthesia with combined femoral-obturator nerve block could be a useful technique with less complication for knee arthroscopic surgery.
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Case Reports
[Anesthetic management of an adult patient with Fontan circulation for laparoscopic surgery].
Advances in the surgical and medical management of children with congenital heart disease have decreased the mortality of these patients. As a result, more patients are surviving into adulthood and are presenting for noncardiac surgery. We experienced a case of anesthetic management of an adult patient with Fontan circulation for laparoscopic surgery. ⋯ Throughout the operation, including the period of pneumoperitoneum, the hemodynamic status remained stable, and adequate oxygenation and ventilation were maintained. The surgery ended uneventfully, and the trachea was extubated in the operating room. In anesthetic management of patients with Fontan circulation for laparoscopic surgery, it is important to understand the physiology of the circulation, and consider the influence of the pneumoperitoneum on the hemodynamics.
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Case Reports
[Combined spinal-epidural anesthesia for cesarean section in a parturient with myotonic dystrophy].
Myotonic dystrophy (MD) is a muscle disorder characterized by progressive muscle wasting and weakness, and is the most common form of muscular dystrophy that begins in adulthood, often after pregnancy. MD might be related to occurrence of malignant hyperthermia. Therefore, the cesarean section is often performed for the parturient with MD. ⋯ She had no adverse events and was discharged on the 8th postoperative day. Later her baby was diagnosed as congenital MD by gene analysis. Combined spinal-epidural anesthesia with the amide-typed local anesthetic agents could be useful and safe for cesarean section in the parturient with MD.
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The backward, upward and rightward pressure (BURP) maneuver and cricoid pressure (CP) are easily confused because of their similarities. We surveyed nurses to determine their knowledge and skills regarding these maneuvers. ⋯ We found that the nurses are confused with the BURP and CP maneuvers. Unless applied correctly, these maneuvers may interfere with tracheal intubation. Constant education and training are essential for effective and safe implementation of these maneuvers.
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Rapid sequence intubation is a common procedure in emergency patients at risk for pulmonary gastric aspiration. However, in some of these cases may accompany a difficult airway. ⋯ All patients were successfully intubated without any complication. We believe that AWS is a useful device for rapid sequence intubation.