Masui. The Japanese journal of anesthesiology
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We report two cases of elderly patients who underwent ultrasound-guided combined femoral nerve and lateral femoral cutaneous nerve blocks for osteosynthesis of femur neck fracture. In both cases, neuraxial anesthesia was contraindicated due to coagulopathy, and severe restrictive ventilatory disorder was observed. The femoral nerve and lateral femoral cutaneous nerve blocks were performed with 20ml of 0.375% ropivacaine under ultrasonographic visualization using a high frequency linear probe. ⋯ Supplemental local infiltration of anesthetics and intravenous low-dose sedative drugs were administered during surgery. The perioperative course was uneventful in both cases. This combined block technique could be a choice for osteosynthesis of femur neck fracture especially in high-risk patients.
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Comparative Study
[Functional analysis of the smart vent compensation system and the fresh gas decoupling system].
In MIPPV mode, an anesthetic machine supplies a fixed amount of tidal volume (TV) corresponding to changes of fresh gas flow (FGF) in a certain period of time. In this research, we examined discrepancy of delivered TV and preset TV, after a change of FGF in both fresh gas decoupling system (FGDS) and smart vent compensation system(SVCS). ⋯ FDGS has a valve for closing FGF in the inspiratory phase and it makes the gas circuit over volume, but SVCS changes the volume of gas delivery to the ventilator by CPU according to FGF changes. Therefore it is assumed that the safety system of SVCS is superior to FDGS in high and low FGF.
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Case Reports
[Perioperative management for cardiovascular operations in two patients with cold agglutinin disease].
Cold agglutinin (CA) reacts reversibly with red blood cells at a low temperature and may cause thromboembolism of various organs. Therefore, special consideration is required in patients with cold agglutinin disease (CAD) undergoing cardiovascular surgery requiring hypothermia. Case 1: A 71-year-old man with elevated CA was scheduled to undergo total aortic arch replacement. ⋯ However, no safety standards for perioperative management of patients with CA are clearly established. Generally, it is more important to figure out the TA and to prevent the low-temperature exposure below the TA. In cases of normothermic procedures, further consideration for cerebral and myocardial protection is important.
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Two patients with cancer medicated by transdermal fentanyl patch (FP) for more than one month underwent operation under general anesthesia. FP had not been removed. Anesthesia was maintained with inhalation of sevoflurane 2-3%, nitrous oxide, and intermittent administration of intravenous fentanyl. ⋯ They recovered from anesthesia quickly, and there were no complications due to fentanyl during the perioperative course. One patient needed additional intravenous fentanyl for postoperative analgesia. When FP is applied during the operation, it is useful because it can be of use for postoperative pain control.
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Randomized Controlled Trial
[Cardiac anesthesia induction by low target plasma concentration setting of propofol using target-controlled infusion].
Propofol-anesthesia administerd using target-controlled infusion (TCI) has been proposed for cardiac surgery. But, moderate target concentration of propofol during induction using TCI has not been studied in detail. ⋯ We have demonstrated that propofol TCI at a target concentration of 1.5 microg x ml(-1) is effective for hemodynamic stability during induction of anesthesia in patients for cardiac surgery under CPB.