Masui. The Japanese journal of anesthesiology
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Comparative Study
[Effects of halothane and sevoflurane on reversal of neuromuscular blockade induced by vecuronium in man].
To evaluate residual effects of inhalational anesthetics after reversal of neuromuscular blocking agent, neuromuscular function was monitored after halothane or sevoflurane anesthesia in thirty-seven patients (ASA physical status I or II) for elective surgery after obtaining informed consent. Electromyograph of the adductor pollicis muscle in response to train of four (TOF) stimulation was monitored throughout the study. The first twitch of TOF (T1; % of its control) and the ratio of the fourth twitch to the first twitch of TOF (T4/T1; TR) were recorded at 0, 2, 5, 10, and 15 min after reversal. ⋯ Both T1 (75.4 +/- 12.2%) and TR (68.0 +/- 12.6%) at 15 min after the reversal during 3% sevoflurane inhalation were below those of the stable group. We conclude that the residual sevofulrane after discontinuation of inhalation may impair the neuromuscular transmission after the reversal of neuromuscular blockade. Neuromuscular function should be monitored after the end of anesthesia even though the patient is fully awake.
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Mesenteric traction syndrome (MTS) consists of decreased systemic vascular resistance, increased cardiac output, facial flushing and palmar erythema. Local production of PGI2 is thought to be the cause. We experienced a rare case of MTS that occurred during coronary artery bypass graft surgery (CABG). ⋯ After this episode, the operation was performed uneventfully. The time sequence between the onset of the surgical procedure and the hemodynamic and cutaneous findings strongly suggest the release of PGI2 and MTS. In patients undergoing CABG with the gastroepiploic artery graft, pretreatment with NSAID might avoid sudden circulatory changes of MTS.
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Comparative Study
[A simple, lightweight device for measurement of hemoglobin; the HemoCue Blood Hemoglobin Test].
In some situations such as a sudden bleeding during surgery, rapid testing of blood hemoglobin concentration is necessary. The HemoCue Blood Hemoglobin Test uses a lightweight photometer, which is easily movable anywhere. The HemoCue needs only 10 microliters of blood and it takes only about 45 seconds to produce the result. ⋯ To evaluate the accuracy of the HemoCue, we compared the blood hemoglobin concentrations measured by the HemoCue with those measured by the ABL 300. A positive correlation was found between the variables by the HemoCue (Y) and those by the ABL 300 (X); Y = 0.944X - 0.208, r = 0.97, P < 0.001. It is concluded that the HemoCue is a reliable device for measurement of blood hemoglobin concentration.
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Effects of melatonin on muscle contractility and on the blocking properties of succinylcholine and vecuronium were investigated in vitro using phrenic nerve-hemidiaphragm preparations of rats. Melatonin (26-520 microM) alone had almost no effect on the contractility. ⋯ Because the property of the block produced by succinylcholine is nicotinic receptor desensitization, we consider that melatonin potentiates succinylcholine-induced block with facilitation of the desensitization. These results suggest that melatonin has calcium channel blocking effect.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Anesthesia induction for laryngeal mask insertion--comparison of propofol with midazolam and propofol with thiopental].
We compared the patient's response to laryngeal mask (LM) insertion and hemodynamics among three anesthesia induction methods; P group using 2.5 mg.kg-1 propofol with 0.2 microgram.kg-1 fentanyl, M group using 0.2 mg.kg-1 midazolam with 0.2 microgram. kg-1 fentanyl, B group using 5 mg.kg-1 thiopental with 0.2 microgram.kg-1 fentanyl. Each 30 patients, 35 to 65 years, for elective mastectomy were entered in three groups. Preanesthetic medication was i.m. injection of 0.5 mg atropine and 5 mg midazolam 30 min before the induction. ⋯ The number of patients with difficult insertion or showing body movement or gagging were larger in the order of M group > B group > P group. Blood pressure and heart rate in the P group were significantly lower than those in the other two groups. It was concluded that P allowed the most smooth insertion of LM among the three groups, but it also induced hypotension and bradycardia.