Masui. The Japanese journal of anesthesiology
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Decreased mouth opening and limited neck mobility sometimes make direct laryngoscopy or tracheal intubation difficult and compromise the safety in establishing the airway during induction of general anesthesia. Recent report indicated that mouth opening was related to the craniocervical position in awake subjects. The query about whether the neck position modulate the mouth opening during anesthetic induction under paralyzed condition is not clarified. We hypothesized that the neck extension and the flexion induce changes in inter-incisor distance (IID) during anesthetic induction. ⋯ Craniocervical extension may play a desirable role in the airway management with mouth opening widely during anesthetic induction under neuromuscular blockade.
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It is important to control heart rate for coronary artery bypass grafting. The purpose of this study was to evaluate the effects of landiolol hydrochloride, ultra-short-acting beta-blocker, on cardiohemodynamics in 10 patients who underwent coronary artery bypass grafting. ⋯ These results suggest that landiolol hydrochloride possesses less negative inotropic action than negative chronotropic action. Landiolol hydrochloride did not affect both systemic and pulmonary vascular resistances because of high cardioselectivity.
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Combined administration of local anesthetics and an opioid is frequently used in order to minimize the dose of each drug and to reduce adverse effects. Although fentanyl is commonly administered with local anesthetic, side effects of fentanyl increase in a dose-dependent manner. In this study, we determined the optimal dose of epidural fentanyl after gynecological surgery. ⋯ Ropivacaine alone could not provide sufficient analgesia. Although the addition of 5 microg x ml(-1) fentanyl to 0.2% ropivacaine at a rate of 5 ml x hr(-1) improved postoperative pain, side effects caused by fentanyl increased. Supplementing 2 microg x ml(-1) fentanyl provided sufficient analgesia with the least incidence of side effects.
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We experienced an accidental case in which 5 mg of vecuronium was administered to a 5 kg infant boy, aged 2 months, incrementally for 55 minutes during general anesthesia. He received general anesthesia at the hospital where there is no anesthesiologist. After surgery the surgeon felt an unusual situation during emergence period from general anesthesia and then noticed overdose of vecuronium. ⋯ Extubation was performed safely 4 and half hours after the final administration of vecuronium. Finally, he could recover with no adverse effect. To predict the optimal dose of a non-depolarizing muscle relaxant to a pediatric patient, routine monitoring of neuromuscular block is effective and essential.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Which is more useful for central venous catheterization? A comparison between a 22 gauge metal needle (Argyle) and a 24 gauge plastic cannula with a metal needle (Insyte)].
Central venous catheterization is commonly performed by puncturing the internal jugular vein. However, placement of central venous catheters is not without risk. We compared the Argyle and the Insyte in terms of usefulness and incidence of complications during central venous catheterization. ⋯ Using the Argyle makes it a little more difficult to place the needle in the appropriate venous lumen. We conclude that central venous catheterization with the Insyte was quicker and safer than with the Argyle.