Masui. The Japanese journal of anesthesiology
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Total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK) was given to over three thousand patients during four years from April 1989 through March 1993. The patients ranged in age from three months to eighty seven years. They underwent surgical, orthopedic, gynecological, thoracic, plastic and otolaryngeal surgeries, but patients who underwent craniotomy and obstetric operations were excluded. ⋯ Calcium channel blockers are very effective for antagonizing high blood pressure, and rapid recovery from anesthesia can be easily obtained by reducing ketamine dose given and also by application of epidural block. Intraoperative dreams may be avoided by concomitant use of benzodiazepines. Thus we are convinced that DFK can be a good as well as convenient anesthetic method for clinical anesthesia.
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Comparative Study
[Effects of sevoflurane on hemodynamics during the induction of anesthesia compared with those of isoflurane, enflurane and halothane].
The effects of sevoflurane (S), isoflurane (I), enflurane (E) and halothane (H) on hemodynamics were studied in 50 patients during the inhalation of 1.5 MAC of each anesthetic before the surgery. Mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and stroke volume index (SVI) were measured noninvasively using the automatic blood pressure manometer and the ultrasonic Doppler method (Accucom). ⋯ The values of CI, SVRI, SVI with S, as well as with I, were between those of E and H. These results indicate that sevoflurane causes the depression of blood pressure mostly by decreasing afterload during the induction of anesthesia, although the decrement with sevoflurane, as well as that with isoflurane, is less than that with enflurane.
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Intraoperative harvest and transfusion back of platelet-rich plasma (PRP) are an effective procedure to decrease the requirement of blood transfusion. We selected the right atrium as the site for collection and transfusion back of the blood for the harvest of PRP. We studied changes of the hemodynamics and mixed venous oxygen saturation (SvO2 during the intraoperative harvest of autologous PRP in two patients who were undergoing cardiopulmonary bypass (CPB) surgery. ⋯ The arterial blood pressure, cardiac output, and SvO2 decreased during the collecting phase and immediately returned to the baseline values during the returning phase. No change was observed in the heart rate and arterial oxygen saturation. We conclude that the usage of right atrium as the site for collection and transfusion back of the blood to harvest PRP is effective and useful, and the continuous monitoring of SvO2 is mandatory for detecting the decline of the cardiac output.
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Case Reports
[Anesthetic management for cesarean section in two parturients with quintuplet gestation].
Two parturients with quintuplet pregnancy underwent urgent or elective cesarean section under general anesthesia at 30 and 29 week gestational ages respectively. Since multiple gestation pregnancy requires enough medical staffs and instruments for preterm newborn resuscitation, emergency cesarean delivery was avoided. ⋯ The anesthesia and postoperative course of two patients and their babies were uneventful. Thus, anesthetic considerations may include; 1) high risk pregnancy related with huge pregnant uterus, 2) preterm labor, 3) preparation of sufficient man-power and instruments, 4) to avoid uterine contraction before delivery for fetal oxygenation, and 5) the puerperal promotion of uterine contraction to decrease blood loss.
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Induction of anesthesia with inhalation of sevoflurane was evaluated in 45 patients. Inhalation anesthesia was induced by a single vital capacity breath followed by spontaneous breathing. The compositions of anesthetic gases were as follows: 5% sevoflurane in oxygen, 5% sevoflurane in 67% nitrous oxide and oxygen, and 7% sevoflurane in 67% nitrous oxide and oxygen. ⋯ Changes in blood pressure and heart rate were relatively small. The technique was found to be acceptable to all of the patients studied. We conclude that the technique of single breath induction with sevoflurane is a safe and acceptable alternative to intravenous induction in cooperative adult patients.