Masui. The Japanese journal of anesthesiology
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We used a Swan-Ganz catheter with a fast-response thermistor to measure the right ventricular ejection fraction (RVEF) during the anesthetic management of two patients with epinephrine-dominant pheochromocytomas. Pre-operatively, one patient received alpha adrenergic blocking agents (prazocine, doxazocine) to control the blood pressure but the other patient did not receive any agents. ⋯ The importance of preoperative preparation with alpha adrenergic blocking agents was confirmed by the reductions in RVEF and RVEDVI (right ventricular end-diastolic volume index) after resection of the tumor. Not only left heart monitoring but also right heart monitoring with RVEF and RVEDVI are recommended for the proper management of a patient with pheochromocytoma.
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Continuous postoperative pain relief produced by epidural block with bupivacaine and buprenorphine was evaluated in 12 patients after thoracotomy, 19 patients after upper abdominal surgery, and 14 patients after lower abdominal surgery. Patients initially received 8 ml of 0.25% bupivacaine and 0.1 mg of buprenorphine at recovery room in operating theater and continuously received the mixture of 0.25% bupivacaine and 5 micrograms.ml-1 buprenorphine at a rate of 1 ml.h-1 using a portable pump. ⋯ About ninety percent of the patients needed one additional narcotics during 48 postoperative hours. The authors conclude that epidural analgesia with the mixture of bupivacaine and buprenorphine produces satisfactory postoperative pain relief.
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Recently, it was demonstrated that intra-bladder pressure (IBP) measured through a transurethral catheter accurately reflects intra-abdominal pressure (IAP). We monitored IBP during closure of abdominal wall defects in three newborn infants with gastroschisis. ⋯ IBP correlated well with inferior vena cava pressure (r = 0.93) which reflects IAP. We advocate the use of IBP monitoring as a simple and reliable means of indirectly determining IAP during operations for closure of abdominal wall defects in newborn infants with omphalocele or gastroschisis.