Masui. The Japanese journal of anesthesiology
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Case Reports
[Prolonged respiratory depression following general anesthesia in a patient with dystrophia myotonica].
A case of general anesthesia for a 52 year old female with previously undiagnosed dystrophia myotonica was reported. The patient was diagnosed as flaccid paralysis of the bilateral lower extremities but myotonic symptoms were not found preoperatively. The patient underwent duodenal resection to have a benign tumor removed. ⋯ The patient was examined again by a neurologist and a final diagnosis of dystrophia myotonica was made. Prolonged recovery from anesthesia and postoperative respiratory depression observed in this patient was due to preoperatively undiagnosed dystrophia myotonica. A careful preoperative examination should be made to minimize possible complication related to anesthesia in the disease.
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The effects of intrathecal clonidine on spinal fentanyl analgesia were studied by the hot-plate test (52.0 degrees C) in rats. Clonidine (5 micrograms) and/or fentanyl (5 micrograms) were administered alone or combined in volume of 10 microliters through a chronically-implanted polyethylene catheter (PE-10) whose tip was near the lumbar enlargement of the spinal cord. Injections were done repeatedly every two or three days to determine the time course of thermal analgesia. ⋯ In this group, the tolerance developed in only three animals by the 9th injection. In conclusion, combined intrathecal administration of clonidine with fentanyl potentiated the analgesic effect of fentanyl and then definitely suppressed the tolerance formation even if a small dose of clonidine which produces no analgesic effect was used. These results suggest that intrathecal or epidural administration of clonidine with narcotics might be useful in managing intractable pain.
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A series of 305 infants and children between 1 day to 14 years of age were operated upon using caudal anesthesia. We used 1% mepivacaine 1.2 ml.kg-1 to obtain a level of anesthesia above T10, 1.0 ml.kg-1 above L1, and 0.8 ml.kg-1 above S. Complete failure occurred in 4.3% of patients. ⋯ The coefficients of correlation between D and height is 0.97, and high correlation existed also between D and body weight (r = 0.93). This confirms that body weight can be used as a parameter to determine the dose of local anesthetic agent. We conclude that this technique is a safe, reliable and simple way to produce surgical analgesia in infants and children.
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One hundred healthy parturients scheduled for elective cesarean section were studied prospectively. Fifty patients received spinal anesthesia with 12mg of hyperbaric tetracaine and were defined as the spinal group. Other fifty patients received epidural anesthesia with 300mg of lidocaine and were defined as the epidural group. ⋯ Prehydration did not improve significantly neither acid-base balances of umbilical arterial and venous blood nor Apgar scores of the neonates in either group. We conclude that massive fluid load is not indispensable immediately before the regional anesthesia for the parturient. Furthermore, because this method is not reliable, its advantages and disadvantages including the possibility of enhancing pulmonary edema should be evaluated.