Masui. The Japanese journal of anesthesiology
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Comparative Study
[Efficacy of ring-shape cover in active skin surface warming in neonates--a retrospective comparative study with conventional methods].
Prevention of perioperative hypothermia is one of the most essential factor for neonatal anesthesia. Recently the forced-air warming system has been considered the most effective method in preventing perioperative hypothermia in adults, in children, and in infants during maxillofacial operations. However, its use for abdominal or thoracic surgery in neonates has not been examined. In the present study, we studied the effects of the forced-air warmer with a ring-shape cover, and compared this method with the conventional method retrospectively. ⋯ In F-group, temperatures were well maintained, while C-group failed to maintain. In F-group, the mean value of base excess at the beginning of the operation was -1.8 mM, but it was restored to normal level without administration of sodium bicarbonate. No complications were found. Thus, compared to conventional methods, the forced-air warming system with a ring-shaped cover is an efficient method for body temperature management in neonatal anesthesia.
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Clinical Trial Controlled Clinical Trial
[The effects of premedication on induction doses of propofol and hemodynamic responses during induction].
We chose five sedatives for premedication and investigated the effect of these drugs on the induction doses of propofol. One hundred patients were allocated into one of five groups of 20. These groups consisted of control group (C) given only atropine 0.5 mg i.m.; CL group (plus clonidine 0.15 mg orally); H group (plus hydroxyzine 25 mg i.m.); M group (plus midazolam 3 mg i.m.) and D group (plus diazepam 10 mg orally). ⋯ We consider that this was one of the reasons why induction doses of both H and CL group could not decrease significantly. We concluded that midazolam 3 mg decreased propofol induction dose significantly. Both midazolam 3 mg and clonidine 0.15 mg decreased RPP before induction and hemodynamic responses to induction and intubation were stable.
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A case of severe bronchospasm under epidural anesthesia with fentanyl was described. The etiology of the bronchospasm may not have been related to sympathetic nervous blockade, histamine release, or anaphylaxis. In an asthmatic patient, it should be noted that epidural anesthesia with fentanyl could develop bronchospasm.
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We report, a case of aortic dissection after the termination of cardiopulmonary bypass (CPB), which was diagnosed by transesophageal echocardiography (TEE). A 70-year old male with aortic regurgitation received aortic valve replacement. ⋯ Furthermore wall motion abnormality was found by TEE, and aorto-coronary bypass was performed after observation by TEE. This case report suggests that TEE is useful not only for diagnosis but also for therapeutic orientation of aortic dissection.
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To test the hypothesis that local anesthetic solution diffuses across the parietal pleura into the intercostal nerves in interpleural analgesia, tissue bupivacaine concentrations were assayed after interpleural injection of bupivacaine in rabbits. Thirty animals were killed at 10, 20, or 30 min after administration of 0.5% bupivacaine (1 ml.kg-1) into the left pleural cavity. The left intercostal muscle (lt-ICM), right intercostal muscle (rt-ICM) and femoral muscle (FM) were sampled immediately after killing the animals. ⋯ On the other hand, the bupivacaine concentrations in rt-ICM and FM were less than 2.0 micrograms.g-1 at any sampling time. (P < 0.01 vs. lt-ICM). These results indicate that bupivacaine administered interpleurally diffuses from the pleural space into the ipsilateral intercostal muscle. Direct diffusion of bupivacaine could cause intercostal nerve block following interpleural analgesia.