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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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
Clonidine premedication for sevoflurane anesthesia in upper abdominal surgery.
The effects of clonidine as a preanesthetic medication were compared with diazepam on clinical courses of sevoflurane anesthesia in 22 patients undergoing upper abdominal surgery. The patients were divided into two groups of 11 patients each according to preanesthetic medication: atropine 0.5 mg i.m. plus clonidine 0.3 mg p.o., or atropine 0.5 mg i.m. plus diazepam 10 mg p.o. 60-90 min prior to induction of anesthesia. Anesthesia was induced with fentanyl and thiopental, and was maintained with sevoflurane, 0.5%-1.5%, nitrous oxide and oxygen, supplemented with fentanyl, 0.5 μg·kg-1·hr-1. ⋯ Pain score after extubation was higher in the diazepam group than in the clonidine group. The time when patients responded to verbal command after discontinuation of anesthetics was similar in both groups. Therefore, clonidine pretreatment was useful for sevoflurane anesthesia in upper abdominal surgery.
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Journal of anesthesia · Mar 1994
Preoperative estimation of pulmonary extravascular thermal volume in patients undergoing pneumonectomy.
Pulmonary extravascular thermal volume (PETV) was measured during pulmonary artery occlusion in 18 patients preoperatively and 7 patients postoperatively who were undergoing pneumonectomy. We found that the PETV decreased from 6.6±2.3 ml·kg-1 before occlusion to 4.1±1.6 ml·kg-1 during occlusion. ⋯ There was a significant correlation between the PETV during occlusion and that at 3 weeks after pneumonectomy (r=0.66,P<0.05). In conclusion, PETV during pulmonary artery occlusion is a reliable baseline value in the assessment of postoperative pneumonectomy values.