Masui. The Japanese journal of anesthesiology
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We investigated the relationship between the intra- and postoperative incidence of bronchospasm and the predisposing preoperative factors in 105 patients with reactive airway disease. (1) The incidence of bronchospasm in intra- and postoperative period was not associated with age, sex, duration of bronchial asthma, severity of disease, duration of the anesthesia and operation, or with FEV1.0%. (2) The incidence of intraoperative bronchospasm was high with general anesthesia using endotracheal intubation (8.9%), but low with general anesthesia using mask and regional anesthesia (0% and 2.2%, respectively). (3) The incidence of postoperative bronchospasm was about 20% with both general and regional anesthesia. However, the incidence of postoperative bronchospasm was higher in thoracic and abdominal surgeries than in other surgeries (39.5%:10.4%). (4) The incidences of intra- and postoperative bronchospasm increased in proportion to the proximity of the latest asthmatic attack to the operative date. (5) Prophylactic preoperative inhalation of bronchodilators was effective in the prevention of intraoperative bronchospasm, but some patients developed postoperative wheezing within a few days after the cessation of postoperative inhalation.
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Randomized Controlled Trial Clinical Trial
[Influence of epidural anesthesia on the halothane MAC-intubation in emergence in infants and children].
The alveolar anesthetic concentration level at which the patient first shows movement when emerging from anesthesia is defined as MAC-intubation in emergence in infants and children. Twenty one patients of ASA physical status 1, were studied to determine the halothane MAC-intubation in emergence. The patients were divided into two groups; a general anesthesia alone group and a general anesthesia plus epidural anesthesia group. ⋯ The time from the discontinuation of halothane to the first body movement tended to be longer without epidural anesthesia. RR and ETCO2 did not differ between the two groups of patients. The halothane MAC-intubation in emergence in the general anesthesia alone group was 0.26%, and adding epidural anesthesia decreased this concentration to 0.18%.
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Clinical Trial
[Pathway of the radial artery located with a small-caliber Doppler probe for arterial cannulation in pediatric patients].
The pathway of the radial artery of 23 patients, ranging in age from 17 days to 10 years, was located with a small-caliber Doppler probe, 1.5 mm in diameter, and the artery was punctured along the pathway traced on the skin surface. In all patients the arterial pathway, including its branch and diameter, was shown clearly. In 11 patients, ranging in weight from 5 to 24 kg, the artery was greater than 0.5 mm in diameter and was cannulated easily. ⋯ The thick tissue layer, including the skin and the subcutaneous layer over the small artery, was thought to interfere with the accurate location of the artery in the other six patients. Nevertheless, the arterial pathway traced on the skin surface facilitated successful percutaneous cannulation by another method in these six. Visualization of the arterial pathway by the small-caliber Doppler probe was thought to be helpful for percutaneous cannulation, with or without another cannulation method.
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For the efficient use of blood resources, we have adopted the Type and Screen system (T & S) and Maximum Surgical Blood Order Schedule (MSBOS) for elective operations. To evaluate the usefulness of these systems, we analyzed the crossmatched to transfused blood ratio (C/T ratio) for the period of one year before and after the adoption of the systems. ⋯ These results show the usefulness of these systems in perioperative blood transfusion system. It is possible to make use of blood more efficiently by further detailed re-evaluation of both T & S and MSBOS systems.
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We observed the histological changes in the spinal cord following percutaneous cervical cordotomy (PCC) and correlation of these changes with the efficacy of PCC in 7 cases. A fine monopolar electrode which we used, measured 0.25 mm or 0.27 mm in diameter with exposed length of 2 mm. An oval or elliptical-shaped lesion, 1 to 3 mm in width and 3 to 4 mm in length, was observed in 6 of these cases. ⋯ In these 5 cases, pain sensation on the opposite side of PCC was lost for a long time and pain was relieved until death (21-239 days after PCC). In the other 2 cases the lesion in the anterolateral column was tenuous or unrecognizable, and the loss of pain sensation was temporary with pain recurring by the next day. This study showed that an oval or elliptical-shaped lesion was made in PCC and that in cases in which main lesion was located in the anterolateral column, pain relief was long lasting.