Masui. The Japanese journal of anesthesiology
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We describe three cases of extrapyramidal reactions apparently caused by epidural administration of droperidol. These patients suffered from chronic pain and was treated with epidural lidocaine and droperidol. Two patients received continuous administration of droperidol, and experienced acute dystonia and another after a single dose, developed akathisia. ⋯ Although we use higher doses with NLA or for management of fever than with epidural administration of droperidol, we seldom encounter cases of side effects with droperidol. Epidurally administrated droperidol spreads rostral within the neuraxis and causes delayed extrapyramidal reactions as epidural morphine develops delayed respiratory depression. We must be careful in caring patients suffering from chronic pain with continuous epidural administration of droperidol.
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Case Reports
[Hypoxic brain damage after prolonged cardiac arrest during anesthesia--changes in CT and serum NSE concentration].
A 48-year-old woman was scheduled for total hysterectomy under spinal anesthesia in a local hospital. Large doses of diazepam (20 mg) and pentazocine (30 mg) were administered for sedation five minutes after starting the operation. Four minutes later, cardiac arrest occurred. ⋯ The high concentration of serum NSE persisted for four days, and subsequently decreased to 112 ng.ml-1. This may have been a sign of completion of washout after brain death with no cerebral perfusion. It was concluded that if a case of cardiac arrest does not respond to closed chest massage, immediate open chest massage should be considered and that serum NSE may be an indicator of prognosis of hypoxic cerebral injury.
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The differential reactivities of three kinds of carbon dioxide absorbents, sodalime, Sodalime A and Baralyme with 5% sevoflurane were investigated in a closed system under administration of 5% carbon dioxide. The degradation products in the closed system were determined by gas chromatography and the temperature of the glass container which was filled with each carbon dioxide absorbent was monitored. The degradation products, P1, P3 and P5 were produced by every carbon dioxide absorbents even after one-hour circulation. ⋯ Baralyme contains higher proportion of KOH which has the highest reactivity with sevoflurane than the other constituents of carbon dioxide absorbents. The reactivity of sodalime, Sodalime A and Baralyme with 5% sevoflurane was thought to depend not on their temperature but on their chemical constitutions. These results suggested that the using high concentration sevoflurane with Baralyme should be reconsidered.
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Clinical Trial Controlled Clinical Trial
[Neuromuscular blockade with vecuronium and its reversal with edrophonium during total intravenous anesthesia, neuroleptanalgesia and sevoflurane anesthesia].
The neuromuscular blocking effect of vecuronium and its reversibility ith edrophonium were studied under total intravenous anesthesia (TIVA) and compared with those under NLA or sevoflurane anesthesia (SA) in 30 surgical patients. The degree of neuromuscular blockade was evaluated by acceleration of thumb adduction in response to supramaximal stimulation of the ulnar nerve using Accelograph (Biometer). TIVA was induced with droperidol 0.25 mg.kg-1, fentanyl 2-4 micrograms.kg-1 and ketamine 2 mg.kg-1, and maintained with continuous infusion of ketamine 2 mg.kg-1.h-1 with 30-35% O2 in air. ⋯ There was no significant difference among them. The times from completion of maximal block to 25% recovery of the twitch height in TIVA and NLA were 39.5 +/- 11.0 min and 37.4 +/- 5.8 min without significant difference. Those values, however, were significantly shorter than 64.5 +/- 35.2 min of SA.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[The effects of hypertonic lactated Ringer's solution during transurethral surgery].
We studied the plasma sodium level and osmolarity when hypertonic lactated Ringer's solution (HLS) with sodium of 213 mEq.l-1 was infused as intraoperative fluid in patients (n = 7) undergoing transurethral resection of the prostate (TUR-P). Regular lactated Ringer's solution was infused in other patients (n = 7) as the control drug. Plasma sodium level and plasma osmolarity decreased significantly in the patients with regular lactated Ringer's solution group. ⋯ However, three hours after the administration, serum ADH level increased significantly in HLS group while it remained unchanged in control group. It was suspected that the increase in serum sodium concentration might have stimulated secretion of ADH after TUR-P. Our study suggests that the administration of HLS prevents the hyponatremia and hypoosmolarity in patients undergoing TUR-P and that the HLS could be used routinely during this procedure as the essential fluid therapy.