Masui. The Japanese journal of anesthesiology
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In spite of many investigations done for many years, the mechanism of general anesthesia remains still unclear. To elucidate the mechanism of general anesthesia, effects of sevoflurane anesthesia on norepinephrine metabolism in rat brain was studied. Sevoflurane 3% was administered for 20 minutes to Wistar male rats weighing 230-270g under spontaneous respiration. ⋯ Significant increases in NE levels were observed in the pons, thalamus and hippocampus by sevoflurane anesthesia for 20 minutes compared with the control group and also in the pons and midbrain at recovery from anesthesia. MHPG levels were significantly decreased in the pons and cortex by sevoflurane anesthesia, while an appreciable increase in MHPG levels was observed in the thalamus by sevoflurane anesthesia. It is concluded that NE metabolism is significantly suppressed in the pons, thalamus and hippocampus during sevoflurane anesthesia and this change in NE metabolism may be associated with a mechanism of sevoflurane anesthesia.
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Of 2,667 patients with herpes zoster who visited our hospital between January 1972 and March 1989, 136 patients whose treatments were started after more than 6 months following the onset were subjects of the present study. Thus we performed a retrospective study of the therapeutic effects of sympathetic ganglion block (using alcohol) on postherpetic neuralgia left untreated for more than 6 months after the onset. ⋯ Thus the patients who underwent sympathetic ganglion block with alcohol tended to show better results. The above findings suggest that, in patients with postherpetic neuralgia in whom the initiation of treatment was delayed, treatment mainly consisting of thoracic or lumbar sympathetic ganglion block using alcohol in combination with antidepressants and antianxiety drugs can greatly improve patients' activities of daily life and that, at present, this method is most effective in relieving postherpetic neuralgia.
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The changes in EMG evoked by train-of-four (TOF) stimulation of ulnar nerve were recorded to determine proper single bolus dose of vecuronium for endotracheal intubation in surgical patients. Onset and duration of neuromuscular block were judged by percent depression of EMG. Mean time intervals for 90% depression in TOF seen in 0.10 mg.kg-1 vecuronium group (n = 10), 0.15 mg.kg-1 vecuronium group (n = 10) and 0.20 mg.kg-1 vecuronium group (n = 10), were 181.1 sec, 135.0 sec and 120.0 sec, respectively. ⋯ No statistically significant difference was observed in recovery time between 0.10 mg.kg-1 and 0.15 mg.kg-1 group. These results indicate that the appropriate dose of vecuronium for rapid intubation is considered to be 0.15 mg.kg-1. This dose is allowable for surgical procedures of short duration.
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Four patients with severe and intractable cancer pain were treated with continuous subarachnoid analgesia (CSA). All patients underwent placement of a 32-gauge subarachnoid catheter attached to an infusion pump allowing continuous administration of local anesthetic agent and morphine. ⋯ At present, CSA is not a routine treatment, because it may lead to severe complications. CSA produces excellent pain relief without disturbing consciousness and is recommended for the treatment of severe and intractable cancer pain.
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Optimal dose of epidural midazolam with saline for postoperative pain relief was investigated. Forty three patients for upper abdominal surgery were divided into 5 groups. Each group had either 10 ml saline only (saline group), 10 ml saline + midazolam 0.025 mg.kg-1 (0.025 group), 10 ml saline + midazolam 0.05 mg.kg-1 (0.05 group), 10 ml saline + midazolam 0.075 mg.kg-1 (0.075 group), or 10 ml saline + midazolam 0.1 mg.kg-1 (0.1 group) administered epidurally for complaint of postoperative pain. ⋯ TNA was about 2 hours in 0.025 and 0.05 groups, over 6 hours in 0.075 and 0.1 groups. Complete sleep was the cause of long TNA in 0.075 and 0.1 groups. It was concluded that optimal dose of epidural midazolam with saline 10 ml was 0.05 mg.kg-1 for postoperative pain relief after upper abdominal surgery.