Journal of anesthesia
-
Journal of anesthesia · Sep 1996
Clinical evaluation of a new continuous intraarterial blood gas monitoring system in the intensive care setting.
The present study was designed to evaluate a new continuous intraarterial blood gas monitoring system under routine clinical intensive care conditions. Nine mechanically ventilated adult patients were enrolled in this study. A multiparameter intravascular sensor was inserted into the radial or dorsalis pedis artery through a 20-gauge cannula in each patient. ⋯ In clinically important ranges of Po2, less than 200 mmHg in particular, the bias and precision values were -2.25±6.48 mmHg in the range of less than 100mmHg, and 0.98±14.38 mmHg in the range of 100-200 mmHg. Variations of sensor accuracy as a function of elapsed time were within the clinically acceptable range throughout the study period. These findings suggest that this new device is sufficiently useful for routine clinical settings.
-
We report a case of femoral neuropathy caused by retractors used during operation. The patient (a 74-year-old woman) was scheduled for right hemicolectomy for cecum cancer, and anesthesia was maintained with nitrous oxide and sevoflurane in oxygen plus extradural anesthesia. After operation, the patient complained of hypesthesia in the anterolateral and medial area governed by the femoral nerve. ⋯ After 2 months, the patient had completely recovered from the neurological symptoms. These manifestations were indicative of femoral neuropathy resulting from the pressure of large-bladed self-retraining retractors. It is important to include femoral neuropathy in the differential diagnosis of postoperative paralysis of the lower limb.
-
Journal of anesthesia · Sep 1996
Neuromuscular effects of sevoflurane in patients with myasthenia gravis.
The current study evaluated the neuromuscular responses following administration of sevoflurane in 14 patients with myasthenia gravis (MG) (I-IIb in Osserman's classification) scheduled for thymectomy and in 11 control patients (ASA I-II) who underwent elective surgery. The electromyographic (EMG) response of the abductor digiti minimi was measured following train-of-four (TOF) stimulation of the ulnar nerve every 20 s. After induction of anesthesia with a combination of 3-4 mg·kg(-1) thiopental and 1-2 μg·kg(-1) fentanyl with 66% N2O and oxygen, an inspired concentration of 4% sevoflurane was administered via a face mask for 7 min. ⋯ On the other hand, no notable changes were observed in patients with normal neuromuscular functions. The most significant factor that correlated with the depression of the TOFR values induced by 1 MAC sevoflurane was the anti-AchR antibody titers (P=0.029). Our results indicate that MG patients have an increased neuromuscular sensitivity to sevoflurane.
-
Journal of anesthesia · Sep 1996
Comparative hemodynamic effects of hypotension induced by CGRP and PGE1 in dogs.
Calcitonin gene-related peptide (CGRP) produces vasodilation, hypotension, and tachycardia. We compared the hemodynamic effects of CGRP-induced hypotension with the effects of prostaglandin E1 (PGE1), which is currently used as a hypotensive agent during anesthesia. Eighteen mongrel dogs were anesthetized with pentobarbital (25 mg·kg(-1)), and 0.87% halothane in oxygen (1MAC). ⋯ The different results for changes in CI and cardiac contractility during the CGRP- and PGE1-induced hypotension were probably due to differences in ventricular filling pressure. Hypotension induced by PGE1 was associated with a significant decrease in heart rate (HR), whereas CGRP did not affect HR. This study shows that both CGRP and PGE1 are effective in decreasing afterload and in inducing hypotension; the results suggest that CGRP is a useful vasodilator for inducing hypotension during halothane anesthesia.
-
Journal of anesthesia · Sep 1996
Effect of nicardipine on vascular capacitance: Comparison with sodium nitroprusside during induced hypotension.
The purpose of this study was to examine the effects of nicardipine and sodium nitroprusside (SNP) on vascular capacitance in the rat. In ten rats anesthetized with pentobarbital, mean arterial pressure was lowered to about 70 mmHg and subsequently 50 mmHg by intravenous infusion of nicardipine or SNP. Vascular capacitance was assessed before and during nicardipine- or SNP-induced hypotension by measuring the mean circulatory filling pressure (MCFP). ⋯ MCFP was significantly decreased by SNP from 7.1 ±0.3 mmHg at control to 5.6 ± 0.4 mmHg and 4.4 ± 0.3 mmHg at mean arterial pressures of 70 mmHg and 50 mmHg, respectively. However, MCFP stayed at a similar level to that of the control during nicardipine-induced hypotension. These results suggest that nicardipine has a negligible influence on vascular capacitance during induced hypotension, whereas SNP has a potent vasodilating effect on the venous system as well as the arterial system.