Journal of anesthesia
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Ischemic neuronal injury is characterized by early death mediated by excitotoxicity and by delayed death caused by apoptosis. Current evidence indicates that volatile agents, barbiturates, and propofol can protect neurons against ischemic injury caused by excitotoxicity. In the case of volatile agents and propofol, neuroprotection may be sustained if the ischemic insult is relatively mild; however, with moderate to severe insults, this neuronal protection is not sustained after a prolonged recovery period. ⋯ Cerebral ischemia is characterized by continued neuronal loss for a long time after the initial ischemic insult. Therefore, in investigations of cerebral ischemia, the duration of the recovery period should be taken into consideration in the analysis of the neuroprotective effects of anesthetic agents. A combination of different approaches that target specific stages of the evolution of ischemic injury may be required for sustained neuroprotection.
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Journal of anesthesia · Jan 2005
Clinical TrialThe incidence and risk factors of difficult mask ventilation.
The ability to ventilate and oxygenate a patient using a bag-mask breathing system may be lifesaving in the case of failure of the initial intubation attempt. In this study, we aimed to determine the incidence of difficult mask ventilation (DMV) and to find preoperative risk factors for this procedure. ⋯ Mallampati class 4, male patients, history of snoring, increasing age, and increasing weight were found to be risk factors for DMV in our study.
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Journal of anesthesia · Jan 2005
Case ReportsAnesthetic management for repair of adult Bochdalek hernia by laparoscopic surgery.
This report describes anesthetic management of a case (a 64-year-old man) who was originally diagnosed as paraesophageal hernia before surgery and later diagnosed as Bochdalek hernia during laparoscopic surgery. Anesthesia was started with oxygen, nitrous oxide, and sevoflurane, and respiration was managed using controlled mechanical ventilation. Although left pneumothorax was noticed during laparoscopic surgery (aeroperitonia pressure: 10 cmH2O), the surgery was performed using the same anesthesia procedure, because hardly any changes were observed on the monitor and vital signs were stable. ⋯ A chest drain tube was inserted immediately, after which the pneumothorax was improved. Pneumothorax is considered to be inevitable in cases of laparoscopic repair of Bochdalek hernia. To prevent exacerbation of pneumothorax, anesthetic management should consist of discontinuing the use of nitrous oxide and lowering the aeroperitonia pressure concomitently with the use of positive airway pressure.
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Journal of anesthesia · Jan 2005
Informed consent for anesthesia: survey of current practices in Japan.
Anesthesia requires informed consent because it is an invasive procedure with certain risks. However, the state of informed consent for anesthesia in Japan remains unclear. The purpose of this survey was to examine the state of informed consent for anesthesia in Japan. ⋯ Although consent for anesthesia was obtained at more than 90% of departments, only 59.9% of departments would keep records of having obtained consent. This survey found that the explanation of anesthesia varied among hospitals and was not standardized in Japan. Further attention is needed on how to improve the documentation of informed consent.
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Journal of anesthesia · Jan 2005
Comparative StudyComparison of the intracuff pressures of three different tracheostomy tubes.
The purpose of this study was to compare the cuff pressures of three tracheostomy tubes, MERA sofit CLEAR, Blue Line Tracheostomy Tube, and Tracheosoft. Each tracheostomy tube with an internal diameter of 7.0 mm was put into a plastic column. The cuff was then inflated with air to seal the column, and the column was filled with water. ⋯ The cuff air was increased by 1 ml from 4 ml to 10 ml, and the intracuff pressure was then measured. The intracaff pressure of the Blue Line Tracheostomy Tube was the highest at the same cuff volume, and that of the Tracheosoft was next. Based on these results, the MERA sofit CLEAR was found to maintain most safely the lowest intracuff pressure to seal the trachea among the three tracheostomy tubes tested.