The aim of this study was to assess the anesthetic management and postoperative analgesic effect of continuous epidural infusion for the minimally invasive Nuss procedure. A total of 21 operated cases were analyzed retrospectively. Thoracoscopy was used in all cases. General anesthesia with endotracheal intubation was induced and maintained with oxygen, air, sevoflurane, and fentanyl in all cases. Thoracic epidural anesthesia was performed after induction at the level between Th4 and 12. When the bar was placed via insertion under the sternum, six patients exhibited sinus tachycardia and one showed premature atrial contraction for 2-4 beats before recovering spontaneously within 1 min. Operations were uneventful. The mean operating time was 115 min and anesthetic time was 193 min. In X-ray findings, residual pneumothorax and pleural effusion were found in seven (33.3%) and eight (38.0%) patients, respectively. In all cases, these symptoms were resolved spontaneously within 5 days. Epidural fentanyl (0.3 microg.kg(-1).h(-1)) in 0.125% bupivacaine (0.15 ml.kg(-1).h(-1)) or 0.2% ropivacaine (0.15 ml.kg(-1).h(-1)) were used for 3 days to relieve postoperative pain. Postoperatively, 12 (57.1%) patients required no additional analgesics, and 4 (19.0%) patients required a single dose of dicrofenac sodium or pentazocine. Although the Nuss procedure is minimally invasive, we should pay attention to the possibility of many intra- and postoperative complications. Continuous epidural infusion of fentanyl with local anesthetics provides effective postoperative pain relief and prevents complications such as bar displacement after the Nuss procedure.
Changes in skeletal muscle of a patient with malignant hyperthermia (MH) were examined in skinned fibers. In the patient's muscle, the Ca-induced Ca release mechanism showed a significantly higher sensitivity to Ca than that in normal muscles and the maximum rate of Ca release at a sufficiently high concentration of Ca was also significantly higher. Halothane accelerated Ca-induced Ca release to a similar extent both in the patient's and normal muscles. No difference was observed in the properties of Ca uptake by the sarcoplasmic reticulum (SR) and of the contractile protein system between the patient's and normal muscles. The changes observed in the Ca-induced Ca release mechanism were considered to be sufficient to explain the disease.
General anesthesia combined with infraorbital nerve block is effective in reducing the consumption of isoflurane and postoperative pain intensity in ESS.
These results indicate that the inhibition of voltage-gated sodium channels, at least tetrodotoxin-sensitive channels, may contribute to the antinociceptive effect of carbamazepine on CFA-induced inflammatory pain, since lower doses of intrathecal carbamazepine and tetrodotoxin attenuated thermal responses to a greater extent in inflamed rats than in intact rats.
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