Masui. The Japanese journal of anesthesiology
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Case Reports
[Two cases of epidural neulolysis using ethyl alcohol and histopathologic changes in the spinal cord].
We report two cases of cancer pain treated with transcatheter thoracic epidural neurolysis using ethyl alcohol, and epidural histopathologic changes in the spinal cord observed in one of the patients. Case 1: A 59-year-old woman complained of intractable right thoracic back pain due to mediastinal osteo-sarcoma. After obtaining pain relief by epidural block using local anesthetics, we did transcatheter thoracic epidural alcohol block using 2-4 ml of 75-100% ethyl alcohol for three times. ⋯ We performed twice transcatheter thoracic epidural neurolysis using 2-3 ml of 75% ethyl alcohol. Her VAS score decreased from 7/10 to 3/10 and the pain relief was maintained until her death 2.5 months after the neurolysis. Motor palalysis was not observed in both cases.
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The effects of vasodilators and anesthetics on the circulatory and metabolic conditions were compared during hypotensive anesthesia. Forty two subjects undergoing tympanoplasty were divided into 6 groups: PG + S: N2O/sevoflurane with prostaglandinE1 (PG), TM + S: N2O/sevoflurane with trimetaphan (TM), NG + S: N2O/sevoflurane with trinitoglycerin (NG), PG + P: N2O/propofol with PGE1, TM + P: N2O/propofol with TM, NG + P: N2O/propofol with NG. ⋯ Although pHi decreased slightly during hypotensive anesthesia in all groups, pHi was not decreased below the critical level of 7.30. The circulatory and metabolic conditions under induced hypotensive anesthesia were influenced by both vasodilators and anesthetics, and the dosage of vasodilator to decrease arterial blood pressure was dependent on the anesthetic used simultaneously.
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Randomized Controlled Trial Clinical Trial
[Efficacy of patient-controlled epidural analgesia using a disposable PCA device].
We evaluated efficacy of patient-controlled epidural analgesia (PCEA) using a disposable PCA device (3.0 ml type). Twenty-two patients for elective gynecological surgery were randomized into two groups. Patients of the continuous epidural group received epidural fentanyl (15 micrograms.ml-1) with bupivacaine (1.25 mg.ml-1) from a disposable infusion pump (infusion rate: 2.1 ml.hr-1). ⋯ The incidences of side effects were similar in both groups. Respiratory depression and sedative effects were not observed in both groups. We conclude that PCEA using a disposable PCA device (3.0 ml type) seems to be effective for postoperative pain relief.
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Preoperative patients have various kinds of anxiety. However we do not know much about their psychological burden. Therefore, we investigated types of their anxiety with questionnaires prior to operation and analyzed them according to their anesthetic method, type of surgery and age. ⋯ Patients whose age was 10 to 19 had anxiety about their anesthetic method. Anesthesiologists should recognize that preoperative patients have various kinds of anxiety. It is important for us to examine the patients appropriately according to their psychological and physical condition.
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The May-Hegglin anomaly is a rare hereditary disorder characterized by the presence of giant platelets and platelet deficiency. This report presents a successful management of a patient with May-Hegglin anomaly. A 5-year-old girl with May-Hegglin anomaly was scheduled for closure of fistulae of her ears. ⋯ Five units of platelet were transfused during the operation. No bleeding tendency was observed perioperatively. It is important to plan the management of anesthesia for a patient with bleeding tendency.