Journal of anesthesia
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The stability of enflurane in soda lime was examined. A product of enflurane decomposition was detected after the reaction of enflurane with soda lime, but not in the absence of soda lime. ⋯ The same decomposition product was produced by the reaction of enflurane with potassium, sodium, or calcium hydroxides, and it was also detected in the gas phase at a maximum concentration of 1.29 ppm at 420 min after 5% enflurane circulated with 200 ml/min carbon dioxide gas in a closed anesthesia circle system with a soda lime canister and a model lung. We concluded that enflurane was decomposed to 1-chloro-1,2-difluorovinyl difluoromethyl ether by soda lime.
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Journal of anesthesia · Mar 1994
Intravenous magnesium sulfate as a preanesthetic medication: A double-blind study on its effects on hemodynamic stabilization at the time of tracheal intubation.
The effects of magnesium sulfate (MgSO4) as a preanesthetic medication were studied with regard to whether it can sedate or relieve a patient who is scheduled to undergo surgery, and whether it can control the hemodynamic response to tracheal intubation. Twenty adult patients in ASA status 1-2 undergoing elective surgery were studied. ⋯ The changes in mean arterial pressure (MAP) and rate pressure product (RPP) after the intubation were significantly suppressed in magnesium-treated patients, but a sedative effect was not observed. Therefore, MgSO4 was useful as a preanesthetic medication in suppressing the hemodynamic response associated with tracheal intubation.
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We evaluated the incidence and severity of serum magnesium (Mg) abnormality along with other electrolyte and acid-base disturbances before and during the course of orthotopic liver transplantation (OLT) in pediatric patients. Serum Mg, Na, K, ionized Ca, pH, and blood gas measurements were performed before and hourly during the course of OLT. Hypomagnesemia was frequently observed in children undergoing OLT. ⋯ However, hypernatremia, hypokalemia, a decrease in ionized Ca, and metabolic acidosis were commonly observed during the course of OLT. We conclude that electrolyte abnormalities, including hypomagnesemia and metabolic acidosis, commonly develop in children during the course of OLT. The frequent assessment of electrolytes, pH and blood gases is essential for the correction of these abnormalities during the course of OLT.
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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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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.