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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Eleven healthy pregnant women were studied to determine temperature changes after induction of epidural anesthesia during cesarean delivery. Epidural anesthesia was induced by 2% lidocaine 15-20 ml (T 5 level) at 25 degrees C ambient temperature. Tympanic membrane and skin surface temperature, skin-temperature gradients (forearm-fingerchip, calf-toe), thermal perception (1-10 scale VAS) and the presence or absence of shivering were measured. ⋯ Temperature gradients of upper limb increased to 2.0 +/- 3.7 degrees C (50 minutes after induction) and the lower limbs decreased to -1.4 +/- 0.55 degrees C (30 minutes after induction). Shivering occurred in 3 patients. We conclude that epidural anesthesia impaired thermoregulatory control and induced redistribution hypothermia as in nonpregnant individuals.
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Review Case Reports
[Bronchospasm during anesthesia in a patient with Prader-Willi syndrome].
A patient with Prader-Willi syndrome developed bronchospasm during anesthesia. The patient was a 9-year-old boy and was scheduled for orchiopexy. His psychomotor development was delayed, and at 12 months of age he was diagnosed as Prader-Willi syndrome by chromosomal examination. ⋯ The bronchospasm was improved gradually and surgery was finished. Prader-Willi syndrome is an uncommon disease first reported by Prader in 1956 and characterized by hypotonia, hypomentia, hypogonadism and obesity. In the perioperative management for a patient with Prader-Willi syndrome, special attention must be paid to the abnormalities in the upper and lower respiratory systems.