Masui. The Japanese journal of anesthesiology
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The effects of corticosteroids (hydrocortisone, methylprednisolone) on the recovery time from the vecuronium induced neuromuscular block were studied using evoked potential measurements by stimulating ulnar nerve. Plasma concentrations of vecuronium were examined after the administration of hydrocortisone and methylprednisolone using high performance liquid chromatography in 78 surgical patients. Recovery time from the block induced by vecuronium was prolonged by corticosteroids. ⋯ In the study of plasma concentration, blood samples were taken 40 minutes after administration of vecuronium, plasma concentration of vecuronium is significantly higher in patients given hydrocortisone (124 +/- 8.32 ng.ml-1) (mean +/- SE) than control patients (68.2 +/- 4.71 ng.ml-1) (P less than 0.001). It is speculated that corticosteroids lower the clearance of vecuronium. Prolongation of recovery time from vecuronium induced block after the administration of corticosteroids may be explained not only by the direct effect of hydrocortisone on the neuromuscular junction but also by the effect of hydrocortisone to prolong the elimination of vecuronium from plasma.
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Sevoflurane is reported to react with sodalime, a common carbon dioxide absorber which resolves into several products. We measured the reaction products of sevoflurane when this anesthetic reacted with sodalime-A, a new carbon dioxide absorber under various conditions. Analysis of reaction products was done by gas chromatography using a 2 m column packed with DOP. ⋯ Reaction products of sevoflurane with two types of carbon dioxide absorber were checked with gas chromatography. Degradation products except P1 with sodalime-A was less than with conventional sodalime at any conditions. P1 production was about twice to three times more than that with sodalime.
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Anesthetic management of patients with cardiomyopathy was studied. In the past 8 years, we experienced 24 surgical procedures for 16 patients complicated with cardiomyopathy of whom 6 cases with hypertrophic type (HCM) and 10 cases with dilated type (DCM). In HCM there was no correlation between the incidence of intraoperative complication and preoperative evaluation by New York Heart Association. ⋯ In DCM, preoperative episode of heart failure, arrhythmias and conduction disturbance on ECG were considered as anesthetic risk factors. Both in HCM and DCM, there were no statistical significance in complication between general anesthesia and epidural anesthesia. The authors recommend epidural technique as a method of choice for HCM patient.
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Cardiac pheochromocytoma is a rare disease, and there have been few reports concerning anesthetic management for the resection. This is a report of a 46-year-old man with cardiac pheochromocytoma with the perioperative changes in plasma catecholamine concentrations. Anesthesia was maintained with enflurane (0.5-2.0%) and 50% nitrous oxide in oxygen. ⋯ A serious increase in plasma norepinephrine concentration occurred during both bicaval cannulation and manipulation of the tumor. Although the anesthetic management for resection of adrenal pheochromocytoma has been well-documented, that of cardiac pheochromocytoma requires following specific considerations. 1) Serious hypertension and arrhythmias may occur during manipulation of the heart. 2) It is possible to dissect the tumor safely after isolation of the heart from systemic circulation. It is of great interest that the blood pressure remained almost unchanged during cardiopulmonary bypass despite a marked increase in catecholamine concentrations. 3) Operative mortality rate is high.
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Comparative Study
[Effects of dopamine and dobutamine on hepatic circulation and metabolism in hemorrhagic hypotensive pigs].
Effects of dopamine and dobutamine in a dose of 5, 10 or 20 micrograms.kg-1.min-1 on hepatic blood flow and hepatic metabolism were studied in normotensive and hemorrhagic hypotensive (MAP 50mmHg) pigs during 1 MAC enflurane anesthesia. PaCO2 was maintained within a physiological range (30-35mmHg) by controlled ventilation. Portal venous blood flow and hepatic arterial blood flow were measured by ultrasonic blood flowmetry. ⋯ Also in the hemorrhagic hypotensive state, dopamine increased significantly total hepatic blood flow and hepatic oxygen supply by increasing both portal venous blood flow and hepatic arterial blood flow, but dobutamine did not produce similar increase. On the other hand, there was no significant change in hepatic oxygen consumption in both normotensive and hypotensive pigs by dopamine and dobutamine administration. These results suggest that dopamine is superior to dobutamine for hepatic circulation and hepatic metabolism especially in the hemorrhagic hypotensive state.