Masui. The Japanese journal of anesthesiology
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Comparative Study
[A comparison of pancuronium and vecuronium used during the induction of high-dose fentanyl anesthesia].
Effects on hemodynamics and blood catecholamine levels of pancuronium and vecuronium used during the induction of anesthesia, were studied in patients undergoing coronary artery bypass grafting. Anesthesia was induced out with fentanyl, 70 micrograms.kg-1, and diazepam, 0.2 mg.kg-1, and either pancuronium or vecuronium was administered in a dose of 0.2 mg.kg-1. Control measurements were made before the induction of anesthesia. ⋯ While NEP was unaffected in group P during the induction of anesthesia, it decreased significantly at S1 and S2, compared with control (S0), in group V. On the other hand, EP decreased significantly at S1 and S2 during the induction of anesthesia in both groups, but group V showed a greater change. The results of this study suggest that pancuronium is more advantageous than vecuronium as a muscle relaxant used during the induction of high-dose fentanyl anesthesia.
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Comparative Study
[Cervical epidural morphine and buprenorphine for postoperative pain relief after thoracic surgery--a comparative study in the same patients].
The effects of cervical epidural morphine and buprenorphine on postoperative pain were studied in 12 patients who received thoracic surgery twice. The patients who had received morphine 3 mg on the first operation were given buprenorphine 0.15 mg on the second operation, and the others received them vice versa. Morphine or buprenorphine was administered with 6 ml of 0.25% bupivacaine before skin incision. ⋯ The result of the questionnaires to the patients after operation shows that 10 patients (84%) were satisfied with morphine whereas only 6 patients (50%) were satisfied with buprenorphine. Seven patients preferred morphine to buprenorphine for postoperative analgesia, and the rest of the patients stated that analgesic effects were similar between the two. It seems that epidural morphine 3 mg may give more excellent postoperative pain relief after the thoracic surgery than epidural buprenorphine 0.15 mg.
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Case Reports
[Rupture of asymptomatic mycotic aneurysm after valve replacement in infective endocarditis].
Mycotic cerebral aneurysms (MCA) are one of the most serious complications of infective endocarditis. The rupture of MCA in patients under anticoagulant therapy following valve replacement carries high mortality. We encountered this serious complication in a patient who had no neurologic symptoms. ⋯ She was transferred to the intensive care unit and given continuous infusion of barbiturate to prevent increase of her intracranial pressure. CT scanning and arteriography 10 days after the MCA clipping, revealed a new subdural hematoma and MCA just proximal to the previous clip. It is important to bear in mind that patients with infective endocarditis can have mycotic cerebral aneurysms without any clinical neurologic symptoms.
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The most serious complication during long-term epidural catheterization is epidural infection. Bacterial culture of the irrigating fluid of epidural space was carried out periodically in 39 patients in whom epidural catheters were inserted for a long period of time. Eight (17%) of 47 samples of epidural irrigating fluid were contaminated by the normal skin flora. ⋯ When epidural irrigating fluid was contaminated, the epidural catheter was removed immediately and the patient was treated by antibiotics. None of the patients had epidural abscess or neurological deficit. In conclusion, bacterial culture of epidural irrigating fluid is valuable for the early diagnosis of epidural infection during long-term epidural catheterization.
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After normothermic ventricular fibrillation (Vf) cardiac arrest of 15 min, 15 female mongrel dogs received conventional cardiopulmonary resuscitation (CPR) for 3 min and then cardiopulmonary bypass through the femoral artery and veins (F-F bypass). Cardiac beat did not return in any dogs during the initial 3-min CPR. Spontaneous circulation was restored by defibrillation 5.2 +/- 3.8 (mean +/- SD) min after the initiation of the F-F bypass in all dogs except in one with bypass trouble. ⋯ The values of cardiac output measured just before weaning from the bypass and 30 to 60 min after weaning were significantly lower than those before inducing Vf (n = 5). On the electroencephalogram, intermittent burst waves reappeared 90.0 +/- 24.7 min after the initiation of resuscitation and EEG showed continuous waves 130.7 +/- 28.1 min (n = 7) after the initiation of resuscitation. The values of blood glucose, lactate and potassium 5 to 15 min after the initiation of F-F bypass were significantly higher than those before induction of Vf, while the values of hemoglobin, hematocrit, platelet and serum protein decreased significantly (n = 14).