Masui. The Japanese journal of anesthesiology
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Spinal anesthesia combined with fentanyl sometimes induces sedation. We previously reported that the bispectral index (BIS) value during spinal anesthesia with isobaric bupivacaine is reduced with intrathecal fentanyl but not with intravenous or epidural fentanyl. The current study investigated whether the specific gravity of bupivacaine combined with intrathecal fentanyl in spinal anesthesia for cesarean section effected the BIS values. ⋯ The BIS values in patients who received intrathecal isobaric bupivacaine with fentanyl were lower than those with intrathecal hyperbaric bupivacaine and fentanyl.
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A 72-year-old woman, ASA physical status II, weighing 47 kg, with uterine cancer was scheduled for semiradical hysterectomy. She had uncontrolled diabetes mellitus with FBS 123 mg x dl(-1) and HbA1c 7.0%. After an epidural catheter had been placed at the L1-2 level, general anesthesia was induced with propofol 100 mg, fentanyl 50 microg and vecuronium 5 mg. ⋯ Magnetic resonance angiography (MRA) on the 10th postoperative day demonstrated the obstruction of the right superficial femoral artery and anterior tibial artery. Emergent fasciotomy is the recommended treatment for severe compartment syndrome. Early recognition, diagnosis, and surgical intervention averted potential neural and functional impairment in this patient.
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Ultrasound-guided arterial catheterization has been attempted, and its effectiveness demonstrated. We encountered 3 cases in which arterial catheterization (A-line) was difficult for the following reasons: the arterial lumen was narrow due to arteriosclerosis; the pulse of the radial artery was weak because of swelling in the arm and heart failure; and the deep artery was too hard for the needle to penetrate it. Using ultrasound guidance, arterial catheterization could be smoothly performed in all cases. Thus, ultrasound-guided arterial catheterization is effective for cases in which arterial catheterization using the usual palpation technique is difficult.
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A 76-year-old man underwent transurethral resection of bladder tumor under spinal anesthesia. Preoperative laboratory date showed normal platelet count (188,000 x microl(-1)) and normal coagulation profile (PT 11.4 sec, APTT 35.1 sec). Lumbar puncture was successfully performed at the L3-4 intervertebral space using a 27-gauge spinal needle with some technical difficulties. ⋯ On the 6th postoperative day, magnetic resonance image (MRI) showed a large epidural hematoma from L1 to L4. On the 13th postoperative day, the subjective symptoms disappeared and MRI on the 17th postoperative day revealed the absence of the hematoma. We should keep in mind that epidural hematoma as well as TNS can occur after spinal anesthesia even with a very fine needle.
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PulseCO for continuous cardiac output measurement is a relatively noninvasive and effective monitor. PulseCO is obtained from the arterial pulse waveform, but calibration by another method is necessary. We performed calibration of PulseCO by CO measurement using TEE and examined the utility of PulseCO. ⋯ The results suggest that PulseCO is very useful as an intraoperative cardiac output measurement monitor.