Masui. The Japanese journal of anesthesiology
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Comparative Study
[Recovery from sevoflurane anesthesia delayed in hepatectomy patients due to influence of operation].
We reported that recovery from total intravenous anesthesia with propofol was delayed in hepatectomy patients, and the hazard ratio was half against controls. This study was designed to evaluate recovery from sevoflurane anesthesia in patients for hepatectomy. ⋯ Recovery from anesthesia with sevoflurane was delayed in hepatectomy, and the hazard ratios were half against controls. We speculate that the influence of hepatectomy caused delay of recovery from anesthesia in hepatectomy patients.
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We report two cases of epidural anesthesia in an 11-year-old obese girl (BMI 34.5) using ultrasound imaging by an inexperienced resident. It was useful for performing epidural anesthesia in these difficult cases to observe anatomical structure around epidural space and to measure the angle and distance from the skin to the epidural space. ⋯ In both cases, epidural puncture was performed smoothly at the first attempt and there was no adverse effect. We conclude that using ultrasound imaging before epidural puncture in obese children is safer and more educational for residents.
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Case Reports
[Peripheral nerve blocks for amputation of lower limb in three critically ill patients].
In 3 critically ill patients, amputation of the lower limb above knee was performed uneventfully under femoral, sciatic, and obturator nerve blocks together with topical anesthesia of the lower limb.
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Dexmedetomidine has the advantage of producing sedation accompanying patient's cooperation without respiratory depression. We managed the airways of 10 cases with suspected difficult tracheal intubation under sedation with dexmedetomidine. ⋯ Dexmedetomidine is a safe and effective sedative for awake difficult airway management, for example, fiberscopic intubation, tracheostomy and direct laryngoscopy, though some attention must be paid to circulatory changes.
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In carotid endarterectomy (CEA), it is essential to maintain the systemic blood pressure (BP) and cerebral perfusion pressure, especially during cross clamping, and vasopressors are often required. To elucidate the effect of norepinephrine (NE) on the cerebral circulation in patients undergoing CEA, regional oxygen saturation (rSO2) in bilateral frontal poles was monitored by near infrared spectroscopy during NE infusion. ⋯ NE used to maintain the MAP decreased the brain rSO2. NE would aggravate the balance between cerebral oxygen supply and consumption in patients undergoing CEA. Further investigations are necessary to clarify the effect of systemically administered norepinephrine on the cerebral circulation.