Masui. The Japanese journal of anesthesiology
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In eight anesthetized mongrel dogs with thiopental, diazepam and pancuronium bromide, ECMO with arterio-venous shunt was performed under hypoventilation for 24 hours. The blood flow through the ECMO which was connected between the femoral artery and vein was approximately 40% of the cardiac output. ⋯ The ECMO improved the abnormal parameters, which were induced by the hypoventilation, to almost normal range (PaO2 80mmHg, PaCO2 30mmHg) for 24 hours. Furthermore, there were no abnormalities in cardiovascular and other systems during ECMO.
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Postoperative pain relief with epidural morphine and buprenorphine was studied in 33 patients following hepatectomy. Morphine 2mg or buprenorphine 0.06mg in 10ml of normal saline was administered through an epidural catheter inserted at the Th10-11 or L3-4 interspace. ⋯ Buprenorphine injected at the thoracic level produced good and long-lasting (22.6 +/- 9.9 hours) pain relief, although buprenorphine injected at the lumbar level produced incomplete analgesia. The epidural administration of morphine 2mg at L3-4 or buprenorphine 0.06mg at Th10-11 may be recommended for postoperative analgesia following hepatectomy.
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Case Reports
[A complete relief of intractable postherpetic neuralgia with intrathecal methylprednisolone acetate].
A 72-year-old man, 154 cm tall, weighing 53 kg was suffering from severe herpetic neuralgia on his left 10th intercostal nerve area. His pain continued even he was treated with frequent epidural nerve block (4 to 5 times per week) by an anesthesiologist. He was referred to our hospital on his 105th pain day. ⋯ The pain was relieved completely after the block. And he complained nothing about the skin area which had been disturbing his life for a long time. Auditory brainstem response which was recorded during the block showed prolongation of the latency of phase III and phase V at 40 minutes after the intrathecal injection of lidocaine.
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From Sheiner's equation on pharmacokinetics and pharmacodynamics, we derived a new equation which described the pharmacodynamics of nondepolarizing muscle relaxants during the onset phase. This equation showed that log (l0/l-1) had a linear relation to log (t) where "t" is the time after the administration of nondepolarizing muscle relaxant and "l" and "l0" are the twitch height at t = t and t = 0 respectively. It also implies that the administration dose (D) is inversely proportional to the onset time (OT), i.e., D. ⋯ We proved that these two relations held well for the actual 7 cases of vecuronium use in man. In conclusion, when vecuronium dose level was within 0.15-0.30 mg.kg-1 i.v., the dose was inversely proportional to the onset time which was defined as the time interval from the end of the administration of vecuronium until the single twitch was depressed under 5% of control value, i.e., Dose (mg.kg-1) x onset-time (sec) not equal to 24. During anesthesia with enflurane as well as during neuroleptanesthesia, a dose of vecuronium 0.3 mg.kg-1 (n = 7) was found to produce a duration of neuromuscular blocking action equal to the mean duration produced by pancuronium 0.1 mg.kg-1.