Journal of anesthesia
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Journal of anesthesia · Mar 1995
Attenuation of the vagolytic effect of atropine during high thoracic epidural anesthesia by heart rate fluctuation analysis.
Fifteen surgical patients received an epidural injection of 12 ml of 1.5% lidocaine through a catheter placed at C7-T1, followed by further injection as required. An intravenous bolus of 0.5 mg of atropine sulfate was administered simultaneously with the initial epidural injection. ⋯ At 90 min, the HFC showed gradual recovery to 69% whereas the LFC remained low (22%). These results indicate that 0.5 mg of intravenous atropine reduces the autonomic imbalance that occurs under high thoracic epidural anesthesia, but its duration is too short to be effective throughout the course of anesthesia.
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Journal of anesthesia · Mar 1995
Auditory brainstem responses after out-of-hospital cardiac arrest: Are they useful for outcome prediction?
We evaluated whether we could predict the neurologic outcome in 55 out-of-hospital cardiac arrest patients using auditory brainstem responses (ABR). ABR patterns were classified into one of 3 types by evaluation of 5 components: type 1, with all 5 components; type 2, lack of at least one response between the 2nd and 5th components; type 3, with only the first component or no response. The relation between the ABR patterns on the 3rd day following resuscitation and the neurologic outcome on hospital discharge was evaluated. ⋯ In the type-1 ABR patients, the negative predictive value that the patients were awake was 100%. In the type-3 ABR patients, the negative predictive value that the patients became brain dead was 90.9%. These results suggest that ABR on the 3rd post-resuscitation day may not be useful for predicting if patients are awake or become brain dead, although the loss of components may be a sign of morbidity, and the presence of the 2nd or later components indicates possible future prevention of brain death.
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Journal of anesthesia · Mar 1995
Transcutaneous electrical acupoint-stimulation potentiates the anesthetic effect of enflurane in humans.
The effect of transcutaneous electrical acupoint stimulation (TEAS) on enflurane anesthesia and hemodynamic changes during craniotomy was studied. Eighty neurosurgical patients were randomly divided into two groups. Anesthesia was induced with fentanyl, droperidol, thiopental, and suxamethonium by intubation. ⋯ The results showed that the ratio between expired concentration and minimum alveolar concentration of enflurane during operation in group B was 37.8%-47% lower than that in group A, and that the hemodynamics were more stable during operation. The results also demonstrated that the patients in Group B recovered faster after operation. It was concluded that TEAS with HANS significantly potentiated the anesthetic effect of enflurane.
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Journal of anesthesia · Mar 1995
Prophylactic hemostatic drugs do not reduce hemorrhage: Thromboelastographic study during upper abdominal surgery.
Although a number of hemostatic drugs are currently used during surgery to reduce hemorrhage, their effects on bleeding are still controversial. Furthermore, few studies have been made on their prophylactic effects. The purpose of this study was to clarify the effects of hemostatic drugs on bleeding. ⋯ No significant difference in blood loss was observed between the groups. Our findings, therefore, suggest that these two hemostatic drugs do not have prophylactic effects on intraoperative bleeding. Further studies are, however, necessary before applying these results to all surgical patients.
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Journal of anesthesia · Mar 1995
Fibrinolytic shutdown after cardiopulmonary bypass surgery is caused by circulating cytokines during operation, accompanied by endothelial injury.
It has been hypothesized that increased cytokines during cardiopulmonary bypass surgery cause postoperative fibrinolytic shutdown. To investigate the role of cytokines and to elucidate its mechanism, tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), plasminogen activator inhibitor-1 antigen (PAI-1 Ag), PAI-1 activity, and thrombomodulin in 16 patients undergoing elective cardiopulmonary bypass surgery were analyzed after induction of anesthesia, before and after cardiopulmonary bypass, and at the end of the operation. during surgery, TNF-α and LI-1β were detected in 44% and 63% of the cases, respectively. PAI-1 Ag (P<0.01), PAI-1 activity (P<0.001) and thrombomodulin (P<0.01) were significantly increased at the end of the operation. ⋯ In group 1, there was a significant positive correlation between thrombomodulin and PAI-1 Ag (r (2)=0.117,P<0.05) and PAI-1 activity (r (2)=0.124,P<0.05). In conclusion, TFN-α and IL-1β were released into the systemic circulation during cardiopulmonary bypass surgery, and this release may have been caused by vascular endothelial injury. These cytokines increased PAI-1 activity.