Journal of anesthesia
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Journal of anesthesia · Mar 1996
Does increasing end-tidal carbon dioxide during laparoscopic cholecystectomy matter?
To examine the adverse effects of peritoneal carbon dioxide (CO2) insufflation during laparoscopic cholecystectomy, both hemodynamic and respiratory alterations were continously monitored in 17 adult patients using noninvasive Doppler ultrasonography and a continuous spirometric monitoring device. During the surgery, which was performed under inhalational general anesthesia, intraabdominal pressure was maintained automatically at 10mmHg by a CO2 insufflator, and a constant minute ventilation, initially set to 30-33 mmHg of end-tidal CO2 (ETCO2), was maintained. ⋯ The stress of 10mmHg pneumoperitoneum was a major cause of hemodynamic changes during laparoscopic cholecystectomy. Some clinical strategies such as deliberate intraabdominal insufflation at the initial phase might be required to minimize these hemodynamic changes.
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Journal of anesthesia · Mar 1996
Effects of osmotic pressure on intrathecal and epidural lidocaine anesthesia.
Lidocaine (1%), either in plain distilled water or in 10% dextrose, was intrathecally or epidurally administered to urethane-chloralose anesthetized cats. Electrical stimulation was applied to the gracile tract at a cervical level, and the resultant antidromic compound action potentials were recorded from the sural nerve. ⋯ Lidocaine-free plain distilled water or dextrose solution caused partial suppression of the compound action potentils. The suppression was more marked following plain distilled water application than following application of 5% or 10% dextrose.
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Journal of anesthesia · Mar 1996
Effects of age on neuromuscular blockade by vecuronium as measured by accelography under sevoflurane anesthesia.
We evaluated possible differential effects of age on a single bolus intravenous injection of vecuronium using accelography under sevoflurane anesthesia. Thirty anesthetized patients were divided into three groups of 10 patients as follows: group 1=age 1-5 years; group 2=age 20-40 years, and group 3=age >70 years. Vecuronium 0.1 mg·kg(-1) was given to facilitate tracheal intubation. ⋯ Clinical duration, i.e., the time from completion of maximal block to 25% recovery of train-of-four (TOF) ratio in group 1 was significantly shorter than that in group 3 (43.6±12.0 min and 67.3±15.6 min;P<0.01). The reversal time from 25% to 75% of the TOF ratio after the administration of neostigmine in group 1 was not significantly different from those in groups 2 and 3 (172.5±73.9s, 219.0±59.7s, and 222.0±155.7s). The authors conclude that the time to maximal twitch depression after the administration of vecuronium is significantly shorter in children than that in adults, and that the fastest recovery from vecuronium is also observed in children.
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Journal of anesthesia · Mar 1996
Epidural anesthesia during upper abdominal surgery provides better postoperative analgesia.
Since repeated noxious stimuli may sensitize neuropathic pain receptors of the spinal cord, we tested the hypothesis that the appropriate blockade of surgical stimuli with epidural anesthesia during upper abdominal surgery would be beneficial for postoperative analgesia. Thirty-six adult patients undergoing either elective gastrectomy or open cholecystectomy were randomly allocated to receive either inhalational general anesthesia alone (group G) or epidural anesthesia along with light general anesthesia (group E) throughout the surgery. ⋯ While there was no significant difference in the bupivacaine dose, more patients undergoing gastrectomy in group G required supplemental analgesics than those in group E, and the VAS scores in group E demonstrated significantly better postoperative analgesia compared to group G after both types of surgery. Thus, an appropriate epidural blockade during upper abdominal surgery likely provides better postoperative pain relief.
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Journal of anesthesia · Mar 1996
Ketamine and its isomers have equipotent relaxant effects on tracheal smooth muscle contracted by tachykinins.
Recent studies indicate that not only inflammatory cells but also neural mechanisms by which tachykinins such as substance P (SP) and neurokinin A (NKA) are released from vagal afferent C-fiber contribute to asthma. Although ketamine (K) has been used in the anesthetic management of asthmatic patients, the mechanism by which K relaxes the airway smooth muscle is still uncertain, and no information exists on any differential effect of K and its isomers. We determined the spasmolytic effect of racemic [R(±)]K and its isomers S(+) K and R(-) K on SP and NKA-induced contraction of tracheal smooth muscle in guinea pigs. ⋯ R(±), R(-), or S(+) K (4.5-18.0×10(-4)M) was cumulatively administered into the bath. The calculated ED50 values (the concentration that relaxed the contraction by 50%) of R(±), R(-) and S(+) K were 7.6±0.5, 7.8±0.6, and 7.6±0.5 (10(-4)M), respectively, when the contraction was elicited with SP, and 8.0±1.0, 8.2±1.2, and 7.9±1.3 (10(-4)M), respectively, when NKA was used. We concluded that K and its isomers have equipotent spasmolytic effects on airway smooth muscle precontracted with tachykinins.