Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[The effect of hypertonic saline infusion on lumbar epidural anesthesia].
The author compared hemodynamic effects of fluid loading during epidural anesthesia with 7.2% hypertonic saline (HS), lactate Ringer's (LR) or isotonic saline solutions in 24 ASA 1 patients undergoing elective lower abdominal or pelvic surgery, allocated randomly into three groups. The first two groups, patients received equal amounts of sodium (2.2 mmol.kg-1), and the latter group, isotonic saline solutions for 1-2 ml.kg-1.h-1 as control. After epidural injection (2%mepivacaine 0.1 ml.cm(Height)-1), fluid loading was performed for 20 minutes. ⋯ Increase of extracellular volume in group HS was observed by bioelectrical impedance analysis as in group LR. The author concludes that HS may be useful especially in the case not requiring a large volume of fluid loading. Finding ideal concentration, volume, and speed of infusion of intravenous fluids would be clinically useful.
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Randomized Controlled Trial Clinical Trial
[The volume and pH of gastric fluid in elective surgical patients after preoperative oral fluid intake].
The effect of preoperative oral fluid intake on the volume and pH of gastric fluid was examined in 45 elective surgical patients ranged in ages from 18 to 70 years. Two hours preoperatively they all received oral roxatidine 75 mg with 10 ml water, immediately followed by 150 ml oral water or 150 ml refreshing drink or no fluid as control. Just after the induction of anesthesia, a Salem-sump tube was put down to the stomach to collect gastric fluid in each patient. ⋯ As there were no significant differences in gastric pH values in the three groups, the highest value was found in the refreshing drink group. No significant difference in VAS of hungry and thirsty feeling was found among the three groups. We conclude that preoperative oral water or refreshing drink with roxatidine 75 mg 2 hours before the start of anesthesia may not increase the risk of aspiration during the induction of anesthesia.
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Randomized Controlled Trial Clinical Trial
[Does the difference in anesthetic methods influence postoperative nitrogen balance?].
To evaluate the influence of anesthesia on postoperative nitrogen balance after upper abdominal surgery, twenty-seven patients undergoing the surgery were investigated. They were allocated randomly to three groups receiving different anesthetic methods, i.e., epidural anesthesia, general anesthesia or balanced anesthesia. In the epidural anesthesia group, anesthesia was maintained with 0.5% isoflurane, nitrous oxide and oxygen supplemented with epidural analgesia extending from Th 1 to L 3. ⋯ Postoperative values of IL-6 and CRP also did not differ significantly among the three groups. Postoperative WBC was significantly higher in the balanced anesthesia group than in other two groups. The results suggest that the difference in anesthetic methods does not influence postoperative nitrogen balance.
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Randomized Controlled Trial Clinical Trial
[Evaluation of postoperative hypoxemia with a pulse oximeter].
We investigated postoperative hypoxemia by monitoring of SPO2 with a pulse oximeter for the first 5 hours in the ward. Forty-eight adults were divided into the general anesthesia along (G) group and the combination of epidural and general anesthesia (E) group. The patients were randomly administered either 3 l. min(-1) oxygen with face mask for the initial 3 hours or room air. ⋯ Significant correlations were found between Spo2 levels and both age (R = 0.75) and preanesthetic Spo2 (R = 0.66) in G group. Spo2 was significantly lower in the patients whose anesthesia was stopped after 5 p.m. than in those who were weaned before 5 p.m. In conclusion, there is a high incidence of postoperative hypoxemia for several hours in the ward, which can be relieved by 3 l. min(-1) oxygen inhalation with face mask.
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Case Reports
[Effective treatment of a man with head injury and multiple rib fractures with epidural analgesia].
A 46-year-old man involved in a traffic accident was admitted to our university hospital for treatment of acute subdural hematoma of the brain, multiple rib fractures and hemothorax. On admission, he manifested disturbance of consciousness, and his left upper and lower extremities were paralyzed. Blood gas analysis revealed hypoxia, and he was nasotracheally intubated. ⋯ Intracranial pressure did not increase, and epidural analgesia was without sequelae. The patient's level of consciousness gradually improved, rib fractures were treated and he was extubated on the 25th hospital day. These findings indicate that epidural analgesia is useful for controlling pain-related agitation caused by head and chest injuries if increased intracranial pressure is not present.