Masui. The Japanese journal of anesthesiology
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We developed a manually operated portable cardiopulmonary bypass circuit for resuscitation. The circuit is composed of, in turn, a venous drainage catheter, one-way valve, self-inflating reservoir, one-way valve, artificial lung, and an arterial catheter. These components are interlocked with conducting tubes with quick connectors. ⋯ If the balloon is inflated with some amount of liquid, the same volume of functional capacity of the reservoir is lost. Thus the reservoir volume is adjusted, the hemodilution with a priming solution is minimized, and an excessive stroke volume with an inadvertent compression of the reservoir-pump is prevented as well. This innovation will make our standard size bypass circuit applicable to almost all patients, except for a newborn or infant who requires a special size of bypass circuit, and improve the survival rate of cardiopulmonary resuscitation.
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Effect of diltiazem on cardiovascular response to laryngoscopy and tracheal intubation was studied in 20 patients without hypertension and 10 patients with hypertension to be operated on under general anesthesia. The patients were divided into three groups: the first group without hypertension (group C, n = 10) received saline as control, the second group without hypertension (group N, n = 10) received bolus injection of diltiazem, and the third group with hypertension (group H, n = 10) received bolus injection of diltiazem. Diltiazem was administered 2 min before intubation at a dose of 0.2 mg.kg-1 as a bolus injection. ⋯ Changes of heart rate were comparable among the three groups. Complications were not remarkable except one case in which systolic pressure decreased to 80 mmHg. The results suggest that bolus injection of diltiazem at a dose of 0.2 mg.kg-1 attenuates cardiovascular response to laryngoscopy and tracheal intubation without serious complications.
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The anatomy of the epidural space was examined in 82 patients 3 to 90 years old who had indications of epidural anesthesia. The superfine fiberscope with an outer diameter of 0.8 mm was utilized for this study. It was advanced through 18 gauge Tuohy needle inserted into the epidural space. ⋯ Vessels were encountered on the dura and the flaval ligaments, as well as in the connective tissue. Large amounts of connective tissue were present in all cases. No complications, such as accidental dural puncture, epidural hematoma, infection, nerve injury attributed to this technique were observed.
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A pathological study was performed on the effects of prolonged extracorporeal lung assist (ECLA) with a heparin-bonded artificial lung and circuit in goats. A veno-venous ECLA was carried out in 15 goats for 5 to 10 days. Ten of them (Group I) were subjected to heparin-bonded devices and the other 5 (Group II) were subjected to the usual devices as control. ⋯ Except for congestion, histological examination in these groups failed to reveal any remarkable changes. Electron microscopic study showed that heparin-bonded ECLA could maintain the normal alveolar structure. Compared with a usual system, ECLA with a heparin-bonded bypass exerted no significantly different effects on the thrombi formation and tissue histology, in spite of less systemic heparin administration for a prolonged period.
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The therapeutic effect of ulinastatin, an inhibitor of the protease activity, on endotoxin shock was evaluated using 17 Beagle dogs. Single intravenous injection of ulinastatin at a dose of 5,000 or 25,000 U.kg-1 failed to suppress the endotoxin-induced circulatory disturbance but significantly inhibited increases in pulmonary arterial pressure and pulmonary vascular resistance that occur early following administration of endotoxin. ⋯ Elevation of the granulocytic elastase activity was inhibited dose-dependently by administration of ulinastatin. The above results indicate that ulinastatin may be a promising drug for the treatment of endotoxin shock.