Masui. The Japanese journal of anesthesiology
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Twenty six gauge pencil point spinal needles and an adaptor for the fixation of the spinal needle were developed for combined epidural/spinal anesthesia on an experimental basis and applied on 110 patients. The length of the spinal needles was either 11.7 cm or 13 cm. Fifty out of 110 patients were punctured with the 11.7 cm needle and then were divided into 2 groups. ⋯ On the other hand, when a 13 cm spinal needle was employed, it often did not remain in place during drug injection. This problem could be solved, however, by using an adaptor with which the spinal needle was fixed firmly on the epidural needle at the point of dural puncture. The incidence of the post dural puncture headache was 1.7% (1 out of 60 patients).
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We studied the occurrence of brain dysfunction in regards to changes in cerebral oxygen saturation (rSo2) during open heart surgery. The subjects were 68 patients with the average age of 61 years. For the evaluation of brain function, Hasegawa Dementia Scale was used, and those patients whose scores were less than 23 points, or had decreased by more than 3 points from preoperative scores on the 7th postoperative day were categorized as the brain dysfunction group. ⋯ The patients in the dysfunction group were of older ages and postoperative lower cardiac index, which indicated that the occurrence of brain dysfunction is greatly influenced by low cerebral blood flow. Effect from the operative procedures and CPB alone seemed to be small. Cerebral oxygen saturation (rSo2) is believed to be a useful monitor of cerebral blood flow, and occurrence of brain dysfunction may be expected at values lower than 60%.
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Case Reports
[A case of emergency admission for CO2 narcosis in a patient with amyotrophic lateral sclerosis].
A 68-year-old man with severe dyspnea was admitted as an emergency case. He had no past history of any respiratory or neuromuscular diseases. Immediately after insufflation of oxygen, respiratory arrest occurred. ⋯ We conclude that if we meet with an emergency patient with CO2 narcosis without any pulmonary disorder, we have to suspect neuromuscular diseases, e.q. ALS. In some of such cases, mechanical ventilation supports social rehabilitation.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of airway complications on tracheal extubation in deeply sevoflurane anesthetized versus awake children].
We investigated the incidence of respiratory complications and oxygen saturation level during emergence from sevoflurane anesthesia in children whose tracheas were extubated while they were anesthetized or after they became awake. Thirty children, aged 1-10 years, were studied. Anesthesia was induced with sevoflurane or thiopental and maintained with nitrous oxide, oxygen and sevoflurane. ⋯ There was a significantly higher incidence of the airway obstruction but less incidence of cough and breath-holding in anesthetized group. Oxygen saturation level before and after tracheal extubation was not different between the two groups. In conclusion, with proper attention to airway obstruction, it may be possible to extubate while children are deeply anesthetized with sevoflurane.
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Randomized Controlled Trial Clinical Trial
[Effects of preoperatively administered flurbiprofen axetil on the action of inhaled anesthesia and postoperative pain].
Flurbiprofen axetil (FP) was evaluated in a randomized study relative to placebo in 26 patients undergoing endonasal ethmoidectomy. The FP group (n = 13) was administrated 1 mg.kg-1 FP 15 minutes before operation during a half hour. Likewise, the control group (n = 13) received intravenous NaCl 0.9%. ⋯ Body temperature of the FP group fell significantly before infusion. The FP group showed lower pain scores and required less dicrofenac sodium than the control group (P < 0.05). This study suggests that preoperative FP infusion relieves postoperative pain, but does not affect the action of the inhalation anesthetic.