Masui. The Japanese journal of anesthesiology
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We examined the hemodynamic responses to tracheal intubation during anesthetic induction by inhalational sevoflurane with continuous administration of remifentanil. ⋯ During sevoflurane anesthesia, remifentanil infusion at 0.5 microg x kg(-1) x min(-1) for more than 210 sec could provide the effective blocking of the sympathetic response to tracheal intubation with more than 50% probability.
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It is difficult to evaluate the tolerance to anesthesia of patients undergoing operations, who have risk factors of congestive heart failure, such as hypertension, old age or various cardiac diseases. BNP (B type natriuretic peptide) is a useful biomarker as a screening tool for LV dysfunction. Therefore we hypothesized that the measurement of BNP may be useful for perioperative management of these patients. ⋯ We cannot predict any circulatory characteristics and cardiac events from preoperative BNP measurement; however BNP measurement is useful for screening asymptomatic chronic heart failure due to LV diastolic dysfunction.
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For management of postoperative bladder spasm by the ureteral reimplantation, general anesthesia and epidural anesthesia are selected in many hospitals, but epidural anesthesia is not a common technique for various complications and risks. We examined whether postoperative bladder spasms can be prevented by general anesthesia combined with single shot caudal anesthesia. ⋯ General anesthesia combined with single shot caudal anesthesia suppressed postoperative bladder spasm. All patients were discharged within 3 postoperative days.
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Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia was reviewed. Common crisis which is encountered during regional anesthesia includes toxic reaction to local anesthetic drugs, allergic reaction induced by local anesthetic drugs, reaction induced by epinephrine, nerve injury, hematoma etc. Concerning peripheral nerve block, crisis encountered during brachial plexus block, interscalene block and supraclavicular block used for surgical operation of upper extremity was discussed. ⋯ Especially, epidural hematoma and epidural abcess have possibility to cause nerve defect symptoms such as motor paralysis and sensory disturbance if appropriate treatment was not started in early stage. Moreover crisis such as cauda equina syndrome and anterior spinal cord syndrome have possibility to remain permanent and hard to cure. We anesthesiologists should make efforts to prevent crisis, to detect crisis in early stage, and to treat it in early stage.