Masui. The Japanese journal of anesthesiology
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To study the effect of patient's age, height, body mass index (BMI), site of injection, and volume injected on determining the spread of hyperbaric spinal anesthesia in the term parturient, we performed a retrospective analysis on 86 parturients who had received 0.3% hyperbaric dibucaine for cesarean section. All patients received subarachnoid injection of the drug in the left lateral decubitus position on a horizontal operating table. ⋯ However, neither of them was a significant determinant of the level of analgesia. In conclusion, patient's age, height, BMI, site of injection and volume injected were not significant determinants of hyperbaric dibucaine spinal anesthesia in the term parturient.
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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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To evaluate the effect of prostagrandin E1 (PGE1)-induced hypotension on cerebral blood flow (CBF) and carbon dioxide (CO2) reactivity of CBF, regional cerebral hemoglobin oxygen saturation (rSo2) was measured in non-neurosurgical patients (n = 10) under sevoflurane-anesthesia using near infrared spectroscopy. PGE1 was infused intravenously to maintain arterial pressure at a level of about 75% of the MAP (hypotensive group) under sevoflurane-anesthesia alone (normotensive group). Ventilation was controlled to adjust PaCO2 to hypocapnia (25-30 mmHg), normocapnia (35-40 mmHg) and hypercapnia (45-50 mmHg) in both normotensive and hypotensive groups. rSo2 during hypotension did not change by hypocapnia and normocapnia, but significantly increased by hypercapnia, compared with rSo2 during normotension. ⋯ When arterial oxygen content and cerebral metabolic rate of oxygen are constant, changes in rSo2 correlate with those of CBF. Therefore, CBF and CO2 reactivity of CBF that indicates autoregulation in response to changes in CO2 during hypotension were maintained as those during normotension. The results show that PGE2-induced hypotension maintains CBF and CO2 reactivity well in non-neurosurgical patients under sevoflurane anesthesia.
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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.