Masui. The Japanese journal of anesthesiology
-
It has been proposed that sensory block from the 10 th thoracic nerve (T 10) to the 1 st lumbar nerve (L1) is necessary for pain relief after cesarean section. However, we have experienced complaints of unsatisfactory pain relief from some patients in whom T 10-L 1 sensory block was achieved. We evaluated the relation between range of sensory block and satisfaction regarding pain relief in patients after cesarean section. ⋯ We propose that sensory block ranging from T 5 to T 9 in addition to T 10-L 1 is necessary to obtain satisfactory pain relief after cesarean section.
-
Case Reports
[A case of severe coronary artery spasm associated with anaphylactic reaction caused by protamine administration].
A 65-year-old man with mitral regurgitation and atrial fibrillation underwent mitral valve plasty and Maze's operation. Cardiopulmonary bypass (CPB) was finished uneventfully. But after protamine administration, severe systemic hypotension occurred suddenly with electrocardiographic ST-segment elevation and wide QRS intervals. ⋯ This case suggests that coronary artery spasm associated with anaphylactic reaction was induced by administration of protamine. It is known that intravenous protamine administration sometimes causes adverse events. As in this case, we should consider the possibility of severe coronary spasm associated with anaphylactoid reaction even if other symptoms of anaphylactic reactions such as cutaneous manifestation and bronchospasm are not present.
-
Evoked potentials are used to monitor the central nervous system during neurosurgery and it is well known that they are affected by the depth of anesthesia. Many studies on the evoked potential like somatosensory evoked potential (SEP) and auditory brain stem response (ABR) are reported, but studies on visual evoked potential (VEP) are few. We investigated the influence of the propofol concentration on VEP in neurosurgical patients. ⋯ Amplitude of VEP is strongly affected by the concentration of propofol. Caution should be taken in evaluating VEP in patients undergoing propofol anesthesia.
-
We report the use of dexmedetomidine for sedation in a 4-year-old boy with a history of bronchial asthma for day-care MRI. Diazepam and atropine sulfate were administrated orally as premedication. In the recovery room, 0.7 microg x kg(-1) x h(-1) of dexmedetomidine was administered intravenously after a bolus infusion 6.0 microg x kg(-1) x h(-1) for 10 min. ⋯ Subsequently, he went home. It is felt that dexmedetomidine is suitable for sedation during MRI examination because it has little effect on respiration. However, the vital sings must be carefully observed during and after the administration of dexmedetomidine because information on its usefulness for pediatric patients or/and day-care are inadequate and infusion rate of disposable pump varies depending on environmental temperature or consistency of drugs.
-
A patient with old myocardial infarction was sedated using dexmedetomidine after carotid endarterectomy with the intention of protecting the wound. The patient was kept intubated and sedated overnight. The next morning, he was weaned off from the respirator easily and extubated under sedation using 0.7 microg x kg(-1) x h(-1) of dexmedetomidine. ⋯ Therefore, postoperative care was easy and without any complications such as wound dehiscence and angina pectoris syndrome. It is felt that dexmedetomidine is safe and suited for extubation under sedation because it has little effect on respiration. However, an increased dose of dexmedetomidine or addition/substitution with a different drug may necessary if the deeper sedation or muscle relaxant is necessary in patients with unstable hemodynamics or severe body movement at the period except peri-extubation.