Journal of anesthesia
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Journal of anesthesia · Mar 1994
Statistical analysis of visual prognosis following stellate ganglion block treatment on patients with retinal vessel obstruction.
The visual outcome in 308 patients treated for retinal vessel obstruction was examined retrospectively and the effectiveness of each treatment was evaluated using stepwise multiple linear regression analysis and the chi-square test. Visual acuity was used as the parameter for assessing treatment effectiveness and the variables investigated included treatment factors [stellate ganglion block (SGB), urokinase administration, and prostaglandin administration] and patient factors (age, duration of visual impairment before treatment, hypertension, and diabetes mellitus). SGB treatment, the duration of visual impairment, and the presence of diabetes mellitus were significantly correlated with the visual prognosis following treatment. These results support the current hypothesis that SGB is a viable treatment for patients with obstructive disease of the retinal vessels.
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The neurophysiologic mechanism of the suppressive action of enflurane on spinal nociceptive transmission was examined in rabbits with intact and with transected spinal cords. Enflurane suppressed nociceptive responses in both intact and transected spinal cord groups. ⋯ These results suggest that enflurane suppresses nociceptive responses by activating descending inhibitory systems and directly suppressing activity at the spinal level. This suppressive action of enflurane does not interact with the opioid receptor.
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Journal of anesthesia · Mar 1994
Evaluation of twitch responses obtained from abductor hallucis muscle as a monitor of neuromuscular blockade: Comparison with the results from adductor pollicis muscle.
The twitch responses evoked from the abductor hallucis muscle (AHM) and the adductor pollicis muscle (APM) were examined simultaneously in 20 anesthetized patients following a single bolus intravenous administration of 0.04 mg·kg-1 of vecuronium bromide. The mean onset time of vecuronium-induced depression of AHM twitch responses was significantly slower than that of APM twitch responses (4.9±1.5 minvs 3.7±1.2 min, mean±SD,P<0.001), and when the clinical duration times of vecuronium were compared, AHM twitch responses recovered more quickly than APM twitch responses (15.3±4.1 minvs 19.6±6.7 min,P<0.01), although there was no statistically significant difference in the spontaneous recovery time between AHM and APM (9.8±2.9 minvs 10.0±3.6 min). It is concluded that the twitch responses of AHM may be a useful monitor of neuromuscular blockade in anesthetized patients in whom setting the blockade monitor on the patient's arms is difficult, although monitoring of twitch response of AHM is less sensitive than that of APM in case of vecuronium administration.
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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 of continuous epidural block on motor nerve conduction velocity in patients with lower spine disorders.
Thirty-one patients with severe low back pain were treated by continuous epidural block for 18±3 (mean±SEM) days. Motor nerve conduction velocity (MCV) of the common peroneal nerve was measured before and after the treatment. After the treatment, the visual analogue scale score (VAS) and straight leg-raising (SLR) test were markedly reduced (P<0.01), and MCV was increased significantly (P<0.001). ⋯ A significant correlation (P<0.001) between VAS and MCV was demonstrated after treatment. However, in three patients who showed no reduction in VAS even after the treatment, MCV became significantly (P<0.05) slower in spite of nearly normal SLR test results. These results suggest that epidural block treatment improves not only pain but also MCV, and that two parameters, SLR test and pain intensity, are related closely to the MCV.