Masui. The Japanese journal of anesthesiology
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Transesophageal echocardiography (TEE) has been used as a monitor of cardiovascular function and as a diagnostic tool in anesthetic practice. TEE is the only available monitor to detect anatomical abnormalities such as of wall motion as well as valvular abnormalities. Doppler TEE has wider diagnostic functions. ⋯ There are, however, several shortcomings such as its cost, "too much sensitivity", requirement of some experience, interobserver variability, and so on. The computer-assisted on-line analysis would greatly augment usefulness of TEE. When these shortcomings are overcome, TEE would be one of the most important monitors in anesthetic practice.
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For spinal anesthesia of only one lower extremity, effect factors, assumed to influence the level of anesthesia including the degree of head-down position of the patients during injection, the volume of the drug and the rate of its injection, are studied using 0.2% hypobaric tetracaine solution in water. Seventy-two patients having the surgery of one lower extremity were divided into 7 groups according to the difference in the degree of head-down position (0, 2 and 5 degrees), in the volume (3, 5 and 7 ml) and the rate (0.2, 0.1 and 0.05 ml.s-1) of injection of tetracaine solution. ⋯ In these patients, the analgesic level in the non-operative side is restricted within S level, and HR and BP changes were very slight. The rate of injection had no effect on the analgesic level on both operative side and non-operative side.
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Comparative Study
[A comparison of hemodynamic changes with sufentanil-O2 and fentanyl-O2 anesthesia for coronary bypass grafting].
Hemodynamic changes were investigated in twenty patients undergoing coronary artery bypass grafting. Thirteen patients received sufentanil-O2 anesthesia and seven patients had fentanyl-O2 anesthesia. Systolic, diastolic, as well as mean arterial blood pressures, heart rate and rate pressure product (RPP) were measured before and after intubation, one minute after skin incision, and one minute after sternotomy. ⋯ Diastolic pressure was not significantly changed in each group. Stable hemodynamic parameters with no ST-T change were noticed during surgical procedure in each group. We conclude that sufentanil is a superior narcotic agent than fentanyl for the patients undergoing CABG, and it effectively blocks sympathetic reflex activity.
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Renal transplantation has come into use as a treatment for renal insufficiency, but infusion management before and after anesthesia for this operation is important. In order to prevent acute necrosis of the uriniferous tubules and to obtain urine outflow in early postoperative stage, a recent practice has been to give rapid infusions of large amounts of fluid, starting during the anastomosis of the renal vessels. ⋯ The cardiac output increased as a result, and no pulmonary edema was seen. We believe that our method of infusion management using a Swan-Ganz catheter is a useful technique in such cases.