Masui. The Japanese journal of anesthesiology
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We evaluated the effects of anesthetic drugs and temperature on brain stem and mid-latency evoked potentials (BAEP and MLAEP) in 20-patients who were scheduled for elective cardiac operation using cardiopulmonary bypass with moderate hypothermia. At esophageal temperature of 36 degrees C, the latency of MLAEP was slightly prolonged by the increase of fentanyl dose, which suggested that the latency prolongation of MLAEP could not block the oscillation of auditory stimulation. ⋯ The latency of BAEP was markedly prolonged at 27 degrees C and returned to the normal latency at 36 degrees C. The latency of MLAEP retained by high dose fentanyl suggests that patients may be aware during cardiopulmonary bypass at normothermia, and BAEP may be one of the useful brain function monitors during cardiopulmonary bypass.
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Randomized Controlled Trial Clinical Trial
[Effects of preoperatively administered flurbiprofen axetil on the action of inhaled anesthesia and postoperative pain].
Flurbiprofen axetil (FP) was evaluated in a randomized study relative to placebo in 26 patients undergoing endonasal ethmoidectomy. The FP group (n = 13) was administrated 1 mg.kg-1 FP 15 minutes before operation during a half hour. Likewise, the control group (n = 13) received intravenous NaCl 0.9%. ⋯ Body temperature of the FP group fell significantly before infusion. The FP group showed lower pain scores and required less dicrofenac sodium than the control group (P < 0.05). This study suggests that preoperative FP infusion relieves postoperative pain, but does not affect the action of the inhalation anesthetic.
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In 1984, Cormack and Lehane defined laryngoscopic view in four grades. As the view worsens, the difficulty of intubation may increase but it is not clear. In this study, we examined the endotracheal intubation techniques to the grade III or IV airways. ⋯ In conclusion, the grade III or IV airways were not always difficult to intubate. But when the conventional technique failed, the gum-elastic bougie or laryngeal mask airway was a fairly useful aid to endotracheal intubation. Moreover our handmade flexible guide tube made the intubation through the laryngeal mask airway safe and reliable.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of airway complications on tracheal extubation in deeply sevoflurane anesthetized versus awake children].
We investigated the incidence of respiratory complications and oxygen saturation level during emergence from sevoflurane anesthesia in children whose tracheas were extubated while they were anesthetized or after they became awake. Thirty children, aged 1-10 years, were studied. Anesthesia was induced with sevoflurane or thiopental and maintained with nitrous oxide, oxygen and sevoflurane. ⋯ There was a significantly higher incidence of the airway obstruction but less incidence of cough and breath-holding in anesthetized group. Oxygen saturation level before and after tracheal extubation was not different between the two groups. In conclusion, with proper attention to airway obstruction, it may be possible to extubate while children are deeply anesthetized with sevoflurane.
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We described a case of anaphylaxis diagnosed by the evaluation of plasma mast cell tryptase and a case of anaphylactoid reaction. In a patient undergoing pulmonary lobectomy, anaphylaxis, showing the elevation of plasma tryptase, was provoked by physiological glue for hemostasis during the operation. During the operation, cardiovascular collapse occurred suddenly, at which time the cause was not diagnosed. ⋯ Increase in plasma histamine concentration to 4.94 ng.ml-1 that could induce systemic reaction was noticed; however, concentrations of plasma tryptase 25 min, 3h and 7h after the episode were not elevated. This finding indicated that the adverse reaction was not based on degranulation of mast cell, and was anaphylactoid reaction provoked by nonspecific histamine-release. In conclusion, measurement of plasma tryptase is a useful method for differential diagnosis of anaphylaxis and anaphylactoid reaction.