Journal of anesthesia
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Journal of anesthesia · Mar 1994
Anesthesia mortality and morbidity in Japan: A study of lawsuit cases.
To date, there have been no systematic studies on anesthetic accidents in Japan. This study was conducted to clarify the present status of anesthetic accidents by sending a questionnaire to a group of plaintiff's lawyers specializing in medical malpractice. At present, because of manpower shortages, anesthesia is provided by either anesthesia specialists (anesthesiologists) or non-anesthesiologist physicians in Japan. ⋯ Of particular note was a large number of deaths from cardiac arrest and hypotension in spinal anesthesia administered by non-anesthesiologists. The results clearly showed that non-anesthesiologists had a substantial incidence of mortality cases among accidents compared with anesthesiologists. Human error was the most frequent cause, but a lack and/or a grave omission of intraoperative monitors was found in non-anesthesiologist-related cases.
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Journal of anesthesia · Mar 1994
Does intraoperative analgesia modify the immune response in surgical patients?
The effect of epidural analgesia combined with inhalational anesthesia on the perioperative immune response was measured by using two-color analysis for the classification of functional lymphocyte subpopulations. Twenty-eight patients undergoing upper abdominal surgery were divided into four groups: group 1, isoflurane and with N2O group 2, sevoflurane with N2O; group 3, epidural analgesia plus isoflurane with N2O; and group 4, epidural analgesia and sevoflurane with N2O. Peripheral lymphocyte subpopulations were measured before, during, and after the operation by using anti-CD4 and anti-CD8 monoclonal antibodies. ⋯ Additionally, stress hormones such as epinephrine (EP), norepinephrine (NE), and cortisol (CO) were measured. EP was increased during and after the operation in groups 1 and 2, and after the operation in group 4, but the level was maintained throughout the study in group 3. In conclusion, prevention of noxious stimuli originating from operative fields by epidural block could prevent the increase in EP and the reduction of helper-inducer T cells in patients undergoing upper abdominal surgery.
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Journal of anesthesia · Mar 1994
Effects and interaction of nicardipine and volatile anesthetics in the rat heart-lung preparation.
The effects of the calcium channel blocker nicardipine (N) and the volatile anesthetics halothane (H), enflurane (E), isoflurane (I), and sevoflurane (S) on myocardial metabolism after postischemic reperfusion were assessed in the isolated rat heart-lung preparation. Wistar-ST rats were randomly divided into six groups (each groupn=9) as follows: control (C) group, no drugs; N group, N (100 ng·ml-1); H group, 1% H and N; E group, 2.2% E and N; I group, 1.5% I and N; and the S group, 3.3% S and N. In the presence of the volatile anesthetics, the preparations were perfused for 10 min, made globally ischemic for 8 min, and then reperfused for 10 min. ⋯ Although there was no significant difference in myocardial lactate concentrations among the groups, ATP content in the N, H, E, I and S groups was significantly higher than in controls. Glycogen content in the N, E, I and S groups was also significantly higher than in controls. These results suggest that N improves myocardial recovery from ischemia; however, in the presence of H or E it may cause significant myocardial depression.