Masui. The Japanese journal of anesthesiology
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Macroglossia is the commonest symptom of Beckwith-Wiedemann syndrome (BWS) and sometimes requires surgical tongue reduction for cosmetic, feeding, drooling and speech problems. ⋯ Airway disorder was not alleviated by tongue reduction surgery or glossopexy.
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It has been demonstrated that preparatory ultrasound scanning can facilitate lumbar epidural anesthesia. We compared longitudinal with transverse approach of ultrasound imaging to test the precision and the quality of acquired images in cesar ean delivery patients. ⋯ Both planes provided accurate information about the epidural space and depth, and the longitudinal plane was superior in the imaging quality. It was suggested that both approaches may help identify epidural spaces.
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A 64-year-old woman was scheduled for the removal of hepatic cystadenoarcinoma. The preoperative examination did not reveal any neurological disorders. Anesthesia was induced with midazolam (5 mg) and remifentanil (0.1.ag x kg-1 x min-1) and the trachea was intubated following administration of rocuronium. ⋯ Two min later, she became fully awake and alert with increase in BIS (above 90). Laboratory examination showed that the plasma concentrations of propofol, midazolam, and its active metabolite alpha-hydroxymidazolam before administration of flumazenil were within the range considered to have no sedative effects. From experience of this case, administration of flumazenil may be beneficial for improvement in consciousness in cases with unexpectedly delayed emergence from anesthesia.
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Transportable capnometers(EMMA) can be useful in the emergency department or Rapid Response System. Before EMMA can be implemented, it must be compared with currently employed capnography methods. Methods : The concentration of CO2 in a reference gas was measured by two EMMA machines and a side-stream capnometer (CAPNOX ), respectively. Next, Etco2 in twelve patients under general anesthesia was measured by both EMMA machines and the side-stream capnometer, respectively. Results were analyzed using Pearson's correlation coefficient and the Bland-Altman plot. Results : With regard to the reference gas ([CO2] of 38 mmHg), the EMMA machines reported CO, concentrations of 37.2 mmHg and 35 mmHg, and the capnometer reported 38 mmHg. For the 12 anesthetized patients, 47 Etco2 readings were taken. Pearson's correlation coefficient between the first EMMA machine and the capnometer was 0.98 (P<0.0001, bias 3.6 mmHg, 95% limits of agreement 1.3-5.9mmHg) and between the second EMMA machine and the capnometer was 0.99 (P<0.0001, bias 0.85 mmHg, 95% limits of agreement-0.7-2.4 mmHg). ⋯ In patients under general anesthesia, EMMA measured Etco2 within 4 mmHg of side-stream capnography, indicating sufficient accuracy for clinical use. At the same time, discrepancies in readings between individual machines must be taken into consideration.
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We reviewed the indications for and features of preoperative epidural catheterization under radiographic monitoring. This technique allows easy epidural catheterization and achieves reliable effects for postoperative analgesia, reducing the burden on patients, particularly those with morbid obesity, strong transformation of spine or unilateral operations such as total knee arthroplasty or pneumectomy. Standard methods are as follows: (1) the patient is placed in a prone position on the fluoroscopic table; and (2) the operator usually stands to the left of the patient. ⋯ It is important that the operator advances the catheter to the epidural space on the operative side (right, left or middle). Finally, confirmation is made under radiographic imaging that the catheter remains at the back of the epidural space. Preoperative epidural catheterization under radiographic monitoring is a safe, reliable, and educational method.