Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol and sevoflurane--a comparison of anesthesia for laryngomicrosurgery].
Laryngomicrosurgery has some special characteristics. It is under much stress such as intubation and direct laryngoscopy during a short operation time. Therefore both adequate anesthesia and quick recovery are needed. ⋯ The emergence time was significantly shorter in Group P than in Group S. The state of recovery was much better in Group P compared with Group S in both 5 minutes after extubation and 5 minutes after entering the recovery room. Therefore, anesthesia with propofol and small dose of fentanyl at induction is more adequate compared with anesthesia with sevoflurane in laryngomicrosurgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of transarterial technique and paresthesia technique of axillary brachial plexus block].
Axillary brachial plexus blocks were established in 40 patients using transarterial technique (n = 20) or paresthesia technique (n = 20). Sensory and motor blockades of nerves supplying the upper extremity were compared at 10, 20 and 30 minutes after the injection of local anesthetics (1.5% plain mepivacaine 40 ml). Sensory blockades of the radial nerve and axillary nerve were significantly higher with transarterial technique than paresthesia technique. ⋯ Proximal and distal spreads of the local anesthetic-contrast medium mixture within the axillary neurovascular sheath were studied in 20 patients. No statistically significant difference was observed in the spread of contrast agent between the two techniques. Transarterial technique is a recommendable method for hand surgery and especially indicated for the surgery of the area supplied by the radial nerve.
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Case Reports
[Preanesthetic assessment of a patient with giant negative T waves on ECG following subarachnoid hemorrhage].
Giant negative T waves on ECG are associated with intracranial hemorrhage such as subarachnoid hemorrhage, ischemic heart disease such as subendocardial infarction, myocardial disease and others. They embarrass us in anesthetic management of urgent neurosurgical patients because of the requirement of making differential diagnosis among these diseases accompanying the ECG abnormality. An 80 year old woman undergoing radical clipping for cerebral artery aneurysm showed giant negative T waves on ECG. ⋯ We thought that giant negative T waves were caused by subarachnoid hemorrhage and decided to perform anesthesia and surgery. Circulation during anesthesia and surgery was stable except a transient decrease in blood pressure due to massive hemorrhage during rupture of the aneurysm. We conclude that preanesthetic assessment of cardiac function by echocardiography is useful for anesthetic management of patients with giant negative T waves on ECG undergoing urgent radical operation for cerebral aneurysm.
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We investigated the relationship between cardiac output and PETCO2 as well as blood PCO2 in 10 patients undergoing cardiac surgery of long duration under high-dose fentanyl anesthesia. After anesthetic induction, the minute ventilation was kept constant at 10 ml.kg-1 x 10 cycles.min-1 and a pulmonary artery catheter was inserted. PETCO2, PaCO2 and cardiac index (CI) were measured simultaneously. ⋯ PETCO2 decreased when cardiac output decreased. A decrease in PACO2 explained the decrease in PETCO2 better than an increase in VD/VT did. Decreased cardiac output might cause hypocapnia through decreased CO2 delivery to the lung, decreased CO2 production and/or increased ventilation-to-perfusion ratio.
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Clinical Trial
[Cervival spine movement during light-guided orotracheal intubation with lightwand stylet (Trachlight)].
We assessed the degree of movement of the cervical spine (C-spine) during light-guided orotracheal intubation using a lightwand stylet (Trachlight). Twenty ASA 1-2 patients were studied. Following induction of anesthesia and obtaining muscle relaxation, the cross-table lateral radiograph of C-spine was taken before and during the intubation with Trachlight. ⋯ The results showed that delta C1-occiput was larger and delta C1 + C5 was smaller with Trachlight than with conventional or McCoy laryngoscopy we had previously reported. We concluded that light-guided intubation technique using Trachlight needed less movement of the C-spine in contrast to direct laryngoscopy. We believe that Trachlight is an easy, alternative and beneficial device for patients in whom cervical spine movement is limited or undesirable.