Masui. The Japanese journal of anesthesiology
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We report two cases of tracheal stenosis for endoscopic treatment under general anesthesia with laryngeal mask airway. The tracheal stenosis of the two patients was so close to the glottis that endotracheal tube could not be inserted, and laryngeal mask airway was beneficial for maintaining airway and obtaining operating field. During the procedure, patients breathed spontaneously and we could support their ventilation easily and sufficiently. Endoscopic treatment of the airway obstruction by Nd-YAG laser associated with balloon dilatation and stent is an effective method of relieving the distressing symptom of asphylaxia, and laryngeal mask airway is considered to be useful for performing successful endoscopic procedure.
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The extent of sensory block is determined by the cephalad distribution of the local anesthetic in the cerebrospinal fluid and uptake by neuronal tissue in sufficient amounts to produce the block. Out of many factors that have been considered to affect the distribution, this paper discusses factors involved in patient characteristics and technique of injection; the age of the patient, the volume of cerebrospinal fluid, the rate of injection, the site of injection, and the position of the patient. ⋯ Recent studies have shown that the management of posture to control the level of spinal anesthesia is not so easy as previously thought. It is my conclusion that knowledge of these factors is essential in the performance of reliable and safe spinal anesthesia.
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We encountered a rare case of complications at the time of central venous catheterization due to extrapleural hematoma. A 71-year-old woman was scheduled to undergo subtotal gastrectomy. After introduction of general anesthesia, a CVP catheter was inserted from the right jugular vein, but it was removed intraoperatively, because of poor dropping of the infusion fluid. ⋯ However thoracic drainage resulted in an extremely small amount of blood-like fluid. The abnormal defect in the right pulmonary field was found to be an extrapleural hematoma by thoracic CT on the first postoperative day. The hematoma was reduced by subsequent management in 7 days, and the patient was discharged from the ICU without any further complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol potentiates the neuromuscular blocking effects of vecuronium in man].
The possible interaction between vecuronium and propofol has been investigated in 40 healthy (ASA I-II) patients. They were randomly allocated to two groups according to the method of anesthesia; continuous propofol infusion group (propofol) and droperidol and fentanyl group (control). ⋯ The ED50 and ED95 (dose required to produce a 50% and 95% depression of twitch tension, respectively,) of vecuronium in the propofol group (n = 20) were 29.4 +/- 0.5 and 56.6 +/- 2.1 micrograms.kg-1 (mean +/- SEM), and in the control group (n = 20), 36.7 +/- 1.8 and 73.6 +/- 5.2 micrograms.kg-1, respectively. Under propofol anesthesia, the cumulative dose-response curves of vecuronium were shifted to the left when compared with control ED50 and the slope showed that propofol had potentiated the action of vecuronium.
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Case Reports
[Malfunctioning of cerebral function monitors in three cases of carotid endarterectomy].
In three patients, EEG, jugular venous oxygen saturation (Sjvo2) and near infrared spectroscopy (NIRS) were monitored to detect cerebral ischemia during carotid endarterectomy. In all cases, no changes in Sjvo2 and NIRS were observed during carotid artery occlusion, but in two patients EEG showed changes when carotid artery was clamped. It is important to know the precise mechanism of cerebral monitors to assess the cerebral ischemia in patients with preexisting neurological disorder during carotid endarterectomy.