Journal of anesthesia
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Journal of anesthesia · Sep 1989
Anesthesia for a patient with recessive dystrophic epidermolysis bullosa.
Two different anesthetic methods were employed for a patient with recessive dystrophic epidermolysis bullosa (R-DEB). One was plexus brachial block in combination with ketamine infusion. ⋯ In the later, however, some blisters were newly formed on the region where the anesthesist's fingers were attached to hold a face mask. Although mask anesthesia was considered to be not always suitable for patients with DEB, we chose it because tracheal intubation may cause more serious damage to the upper airway leading to airway obstruction.
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Journal of anesthesia · Mar 1989
Effects of anesthetic and related agents on calcium-induced calcium release from sarcoplasmic reticulum isolated from rabbit skeletal muscle.
We have investigated the effects of anesthetic and related agents on Ca(2+)-induced Ca2+ release (CICR) in heavy sarcoplasmic reticulum isolated from rabbit skeletal muscle. The purpose of this study is to elucidate their possible role as triggering agents in malignant hyperthermia (MH). ⋯ It is unlikely that lidocaine is a potent facilitator of CICR at any concentrations. We conclude that procaine, lidocaine, non-depolarizing muscle relaxants and opiate can be used safely for MH susceptible patients and that ketamine and succinylcholine are not recommended.
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Journal of anesthesia · Mar 1989
Effects of tracheal insufflation of oxygen (TRIO) on blood gases during external cardiac compressions in dogs under ventricular fibrillation.
Tracheal insufflation of oxygen (TRIO) is a form of constant-flow ventilation. We studied the effect of TRIO at a flow rate of 2 L/kg/min on arterial blood gases during external cardiac compressions in dogs with ventricular fibrillation. ⋯ No pulmonary barotrauma was observed. The findings suggest that TRIO might be used as a temporary measure for emergency ventilation when CPR is performed in certain situations such as upper airway abnormalities or cardiac arrest outside the hospital setting, where intermittent positive pressure ventilation is not feasible.
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Journal of anesthesia · Mar 1989
A new closed-system using partially frozen injectate for thermodilution cardiac output determinations.
The FI (partially frozen injectate) system, a new closed-system devised by the authors for thermodilution cardiac output determinations, has two major features: 1) it needs no ice-filled receptacle to keep injectate cold because it uses partially frozen injectate, and 2) it can go without monitoring the injectate temperatures during the whole process of cardiac output determinations. The author evaluated the accuracy and reproducibility of cardiac output determinations with the FI system in 10 critically ill patients, as compared with another closed-system (which is commercially available) and the standard open method. ⋯ Even when no monitoring of injectate temperatures was made, the predicated error in the calculated cardiac output resulted as low as 2% with the FI system. The mean cardiac output values were not statistically different between the FI system and the other two systems.
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Journal of anesthesia · Mar 1989
A new technique of identifying the epidural space "dripping infusion method".
We developed a new visual technique o identifying the epidural space, using the hydrostatic pressure produced by a suspended micro-drip intravenous apparatus. When the needle pierces the ligamentum flavum, the resistance to positive pressure disappears and the saline in the apparatus flows freely into the epidural space. Thus, the entry of the needle point into the epidural space is visually confirmed by the appearance of dripping flow in the drip bulb (dripping infusion sign). ⋯ In the remaining 11 patients (2.2%), a false dripping infusion sign appeared at the more superficial site than expected. If the pressure waveform in the epidural space is analyzed, the correct positioning of the needle can be easily confirmed. We believe that this method is one of the most accurate visual methods of identifying the epidural space and useful for teaching the epidural blockade to students and residents.