Masui. The Japanese journal of anesthesiology
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During surgery, the anesthesiologists adjust the concentration of inhaled anesthetics according to the change in blood pressure in order to achieve good control of anesthesia. Usually the thinking patterns of individual anesthesiologists differ from one to another. ⋯ The results showed that anesthesiologists' regulation rules were formed independently of the 3 drugs and were specific to individuals. Some trends depending on institution were observed, but no statistically significant difference was found.
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Clinical Trial Controlled Clinical Trial
[Augmentation by succinylcholine of the neuromuscular blocking effect of vecuronium in children].
To evaluate the influence of succinylcholine (Scc) on the neuromuscular blocking effect of subsequently administered vecuronium in children, 30 patients aged 2-14 years scheduled for elective surgery were studied after obtaining the informed consent from the parents. Anesthesia was induced with inhalation of sevoflurane, nitrous oxide and oxygen. T1 of the adductor pollicis muscle to ulnar nerve stimulation elicited by train of four stimulation at 2 Hz was monitored continuously by an acceleration transducer. ⋯ Short onset of action and potentiation of maximal block were demonstrated in group SV. After vecuronium administration, a complete suppression of T1 was observed in 8 patients of group SV and only 1 patient of group V. The present study demonstrates that the neuromuscular blockade of vecuronium can be potentiated with the prior administration of Scc in pediatric patients.
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The change of analgesic levels, plasma concentrations and the radiographical changes of epidural space due to continuous epidural block were studied in 54 patients receiving pain relief. All the patients received 2 ml per hour of 2% lidocaine or 0.5% bupivacaine via the catheter over two weeks. The effect of epidural block was determined on 1, 2, 4, 7, 10 and 14 days, the epidurogram was performed on 1, 7, 14 days, and plasma concentration of lidocaine or bupivacaine was measured on 1, 3, 7, 14 days. ⋯ The effects and plasma concentrations of epidural block decreased significantly after a week, and the mean segmental number of radiographic spread decreased significantly after two weeks. The decreasing effect or duration of epidural block was due to decrease in spread of anesthetics because of adhesion around the catheter in the epidural space. We conclude that the safety period of continuous epidural block is within 2 weeks.
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The cytokines such as tumor necrosis factor and interleukin-1 secreted from macrophages/monocytes proved to play important roles in the pathogenesis of endotoxemia, severe pancreatitis and other surgical injuries. However, it is still unclear how inhalational anesthetic agents influence the secretion of these cytokines from macrophages/monocytes. ⋯ The inhibitory action of isoflurane disappeared between 1 and 3 hours after stopping isoflurane inhalation. We concluded that isoflurane could inhibit TNF-alpha and IL-1 beta secretions from peripheral blood monocytes stimulated by LPS in a dose-dependent fashion and that the inhibitory action of isoflurane was reversible.
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To evaluate effects of stellate ganglion block (SGB) on coronary circulation under coronary occlusion, the changes in cardiac function and tissue blood flow in the myocardial ischemic area after right and left SGB were observed in the dogs. Tissue blood flow in the myocardial ischemic area measured with laser doppler flowmeter showed no significant change after right or left SGB. ⋯ On the other hand, in the left SGB group, heart rate, circumflex branch blood flow and rate pressure product showed no significant changes, while end-diastolic pressure and myocardial oxygen extraction rate increased significantly (P < 0.05). These data suggest that although right SGB might be useful to improve the oxygen demand-supply relation, left SGB does not improve the oxygen demand-supply relation and might increase the risk of myocardial ischemia.