Masui. The Japanese journal of anesthesiology
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Recent reports of cauda equina syndrome following continuous spinal anesthesia have generated concern regarding the safety of not only this particular technique but also of the local anesthetic agent itself. This concern has been reinforced by data suggesting that similar injuries have occurred with repeated injection after a "failed spinal", and by reports of transient radicular irritation following single subarachnoid injection. ⋯ These experiments suggest that the recent injuries resulted from a direct effect of the local anesthetic and that anesthetic-induced impairment does not result from blockade of the sodium channel, per se. These experiments also suggest that development of a safer anesthetic is a realistic goal.
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Comparative Study
[Comparison of a new double-lumen endobronchial tube by Portex with Broncho-Cath].
We compared the clinical usefulness of two double-lumen endobronchial tubes, one furnished by Concord Portex and the other Broncho-Cath by Mallinckrodt. Only left-sided 37 french size tubes were used. ⋯ All parameters were slightly better in the Portex tube than in the Broncho-Cath, but the differences were not significant. It is concluded that the Portex tube is as useful as the Broncho-Cath or it may be superior to the Broncho-Cath.
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A 63-year old man was scheduled for nephrectomy and cholecystectomy. Anesthesia was maintained by oxygen-nitrous oxide-isoflurane (0.5 approximately 1%) and epidural anesthesia. Operation was performed with the patient on left decubitus position. ⋯ The intraoperative course was uneventful. At the end of the operation, the patient showed no shivering and general condition was good. In this case, Warm Touch is useful to restore body temperature against intraoperative hypothermia during abdominal surgery.
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Monosynaptic reflex responses (MSRs) in the isolated spinal cord of newborn rats were elicited in the ventral root by stimulation of the ipsilateral dorsal root. MSRs were considered to be mediated by non-NMDA class glutamate receptors. We studied the depressant effects of halothane, isoflurane, enflurane, and sevoflurane on MSR amplitudes as a function of anesthetic concentration comparing with MAC value of each anesthetics. ⋯ Concentration-response curves for MSR amplitudes were constructed and the concentrations which produced a half-maximum inhibition (IC50) were 0.56, 0.65, 0.97 and 1.18 mM for halothane, isoflurane, enflurane, and sevoflurane, respectively. These IC50 values correlated well with those of MAC values (r = 0.999, P < 0.001) obtained from adult rats in an in vivo condition. The MSR response in the isolated spinal cord of newborn rats is considered as a useful model for analysis of potency of volatile anesthetics.
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We reported 3 cases of sudden syncope during saddle block under sitting position. Patients were healthy and had no history of fainting. Syncope occurred following hypotension and bradycardia during difficult lumbar dural punctures under sitting position. ⋯ The first sign of syncope was hypotension and bradycardia due to cardiac C-fiber reflex. How to prevent this NCS under saddle block are as follows; 1. vigorous search for history of syncope, 2. pay attention to the patients during spinal tap, 3. skillful technique in spinal tap, and 4. proper premedication including anticholinergic agents. Treatments include 1. changing position to supine, 2. elevation of both legs to increase ventricular end-diastolic pressure, and 3. use of vasopressors including phenylephrine.