Masui. The Japanese journal of anesthesiology
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A retrospective study was conducted on the cause of hypotension during spinal anesthesia and also on the relation between the level of anesthesia and the hypotension. Two hundred twenty three patients who had received spinal anesthesia for gynecological surgery were divided into two groups. Group I consisted of 87 patients with a significant decrease in blood pressure, while group II consisted of 136 patients with no significant decrease in blood pressure. ⋯ The degree of hypotension was greater at higher levels of spinal anesthesia. More than 50% of the patients with T5 or higher levels of anesthesia had a significant decrease in blood pressure. We conclude that the cause of the significant decrease in blood pressure during high spinal anesthesia is in most part due to the blockade of the cardiac sympathetic nerve.
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Case Reports
[Clinical experience of extracorporeal life support with the use of centrifugal pump ECMO].
Many reports have documented the good results with the use of extracorporeal life support in severe respiratory and circulatory failure. In our institution, we have used the centrifugal pump (Bioconsol 540: Biomedicus Co. Ltd.) ECMO for extracorporeal life support, and obtained good results in three cases. ⋯ Duration of total bypass in three cases were 34, 51 and 140 hours, respectively. Recent reports on the use of centrifugal pump have indicated that it can bring excellent results of circulatory assist for cardiogenic shock. Compared to the roller pump method, the use of centrifugal pump ECMO was very simple, and could serve as an effective method for providing improvement in a relatively short period.
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Several recent studies evaluated alkali therapy for lactic acidosis (LA). We studied the effects of sodium bicarbonate (NaHCO3) on LA due to hemorrhagic shock in dogs. After inducing hemorrhagic shock in twelve mongrel dogs, we divided them into two groups: the first group was treated with 7% NaHCO3 and the second with 4.9% sodium chloride (NaCl). ⋯ Arterial pH and base excess increased significantly in the NaHCO3 group. The increases of pyruvate and lactate were significantly greater in the NaHCO3 group than in the NaCl group, but the other metabolic data were not significantly different. We did not find that NaHCO3 had greater beneficial effect than NaCl in hemorrhagic shock model, and the use of NaHCO3 for LA due to hemorrhagic shock may not be recommended.