ABSTRACT
BACKGROUND: Epidrum (ED) is a device to facilitate the epidural anesthesia procedure. Using ED, we can visually confirm the needle's penetration into the epidural space by collapse of the diaphragm. We investigated the usefulness of ED for teaching identification of the epidural space. METHODS: Forty parturients scheduled for cesarean section were randomly allocated to an ED group or loss of resistance (LOR) group. Epidural anesthesia was performed by residents (operators) under the instruction of advising doctors (observers). In the LOR group, the epidural space was identified by the conventional LOR technique using a glass syringe filled with normal saline. In the ED group, ED was attached to a Tuohy needle and was charged with 1.5 ml of air to expand its diaphragm. Ease of identification of the epidural space was scored by the operator and the observer. The time to identify the epidural space (TI) was recorded. RESULTS: TI in the ED group was significantly shorter than that in the LOR group. ED was superior to LOR for identification of the epidural space not only by operators but also by observers. CONCLUSIONS: The results suggest that ED is a useful device for teaching identification of the epidural space.
Subject(s)
Anesthesia, Epidural/instrumentation , Anesthesiology/education , Epidural Space/anatomy & histology , Anesthesia, Obstetrical/instrumentation , Anesthesiology/instrumentation , Cesarean Section , Female , Humans , PregnancyABSTRACT
BACKGROUND: This study was conducted to evaluate the effects of continuous epidural analgesia on the postoperative pain and the early recovery after laparoscopy-assisted colectomy (LAC). METHODS: A total of 50 patients undergoing elective LAC were investigated for postoperative pain score and other variables retrospectively. RESULTS: Thirty patients who had received epidural analgesia (E group) showed significantly lower pain scores for 2 and 24 hours after surgery, compared with twenty patients who had received analgesics intramuscularly or transrectally (C group). The patients in the E group needed significantly less supplemental analgesics than those in C group for 12 to 24 hours after the operation. The incidence of postoperative complications and the early recovery were not significantly different between the two groups. CONCLUSIONS: These results show that postoperative continuous epidural analgesia is effective for postoperative pain relief in patients after laparoscopy-assisted colectomy.
Subject(s)
Analgesia, Epidural , Analgesics/administration & dosage , Colectomy , Laparoscopy , Pain, Postoperative/drug therapy , Aged , Elective Surgical Procedures , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: This study was conducted to evaluate the effects of continuous epidural analgesia on the postoperative pain and the early recovery after laparoscopy-assisted gastrectomy (LAG). METHODS: A total of 66 patients undergoing elective LAG were investigated for postoperative pain score and other variables retrospectively. RESULTS: Forty-four patients who had received epidural analgesia (E group) showed significantly lower pain scores for 2, 12 and 48 hours after surgery, compared with 22 patients who had received analgesics intramuscularly or transrectally (C group). The patients in the E group needed significantly less supplemental analgesics than those in C group for 2 and 12 hours after the operation. The early recovery and the incidence of postoperative complications were not significantly different between the two groups. CONCLUSIONS: These results show that postoperative continuous epidural analgesia is effective for postoperative pain relief in patients after laparoscopy-assisted gastrectomy.
Subject(s)
Analgesia, Epidural/methods , Gastrectomy , Laparoscopy , Pain, Postoperative/drug therapy , Analgesics/administration & dosage , Female , Humans , Male , Middle AgedABSTRACT
An 80-year-old man with chronic bronchitis and hypertension was admitted with rectal cancer and cholecystolithiasis. Under general and epidural anesthesia, laparoscopic cholecysytectomy was performed with slightly elevated EtCO2. He underwent head-down tilt for laparoscopic rectectal amputation. Twenty five minutes after positioning, he developed ventricular tachycardia and died. Autopsy showed acute myocardial infarction super-imposed on the scar of lateral wall from old infarction. The laparoscopic operating techniques have become popular, but we do not know the safety limits of the pneumoperitoneal pressure and the angle of head-down tilt position. In our case, the cardiac event occurred 25 minutes after head-down tilt, and the head-down tilt position when combined with pneumoperitoneum may have a fatal influence on high-risk cardiac patients.
Subject(s)
Intraoperative Complications/etiology , Laparoscopy , Myocardial Infarction/etiology , Rectum/surgery , Aged , Aged, 80 and over , Anesthesia, Epidural , Anesthesia, General , Cholecystectomy, Laparoscopic , Cholelithiasis/complications , Cholelithiasis/surgery , Fatal Outcome , Head-Down Tilt/adverse effects , Humans , Male , Pneumoperitoneum, Artificial/adverse effects , Rectal Neoplasms/complications , Rectal Neoplasms/surgeryABSTRACT
The effects of intracerebroventricular injection of excitatory amino acids which act on the N-Methyl-D-aspartate (NMDA) receptor complex on the duration of loss of righting reflex (DLRR) induced by intravenous injection to ketamine (20 mg/kg) were investigated in rats. Ketamine-induced DLRR was 10.3 min, but NMDA receptor agonistsD-alanine (200 µg) or NMDA (0.15 µg) did not change DLRR. However,D-alanine combined with NMDA significantly shortened DLRR (7.7 min). The NMDA receptor antagonist 7-chlorokynurenic acid (10 µg) alone prolonged DLRR significantly (16.2 min), but not when combined withD-alanine. These data suggest that NMDA receptor blockade contributes at least partially to the mechanism of ketamine anesthesia.
