Masui. The Japanese journal of anesthesiology
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We present a case of oro-pharyngeal burn which occurred during electrodissection of the adenoid and tonsil in a 5-year-old boy. We intubated the patient with an uncuffed spiral tube of appropriate size and noticed a slight gas leak during positive-pressure ventilation. Anesthesia was maintained with a mixture of 60% nitrous oxide, 40% oxygen and 2.5% sevoflurane. ⋯ Although it is well known that sevoflurane is nonflammable in the concentration of clinical use, several reports show that sevoflurane is flammable in concentration of 10% under pure oxygen or nitrous oxide. We concluded that this accident was caused by electrocautery-induced ignition of the gauze packed into the larynx under a high concentration of oxygen which leaked through an uncuffed endotracheal tube. We have to bear in mind that any flammable substance may ignite when using electrocautery in a small space such as the mouth under oxygen-rich environment.
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We report a case of delayed recovery after the termination of propofol and nitrous oxide anesthesia. On the preoperative examination hepatic dysfunction (Indocyanine green (ICG) plasma retention rate at 15 minutes of 22%) was pointed out. ⋯ Although at the end of the operation, the propofol infusion and nitrous oxide were stopped simultaneously, 59 minutes were necessary before the emergence from anesthesia. We consider that an average infusion rate of propofol should be decelerated in a case of ICG clearance time elongation.
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The margin of safety for controlled hypotension is still unclear especially in the central nervous system (CNS) which is one of the most sensitive organs to hypoxia and ischemia. Recently, cerebral optical spectroscopy in the infrared light range was developed as a useful tool which makes it possible to monitor cerebral oxygenation (rSO2) non-invasively and continuously during anesthesia. Resulting rSO2 mainly reflects oxygen extracts by cerebral tissue and then indicates cerebral oxygen delivery. ⋯ However rSO2 decreased significantly by 9.0 +/- 1.1% in same controlled hypotension condition under FIO2 0.4. This decrease in rSO2 could be potentially harmful for CNS although any post-operative neurological disorder was not observed in our cases. We conclude that cerebral oxygen delivery may be insufficient even in the moderate controlled hypotension, and thus higher FIO2 is recommended in such procedures.
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Investigating the labor by anesthetists in general hospitals with more than 600 beds during the month of September 1995. ⋯ There must be overwork of 5-day working anesthetists, who are working for too many hours for anesthesia. It is necessary to have better quality service in the OR.
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Comparative Study
[The comparison of IRV and PEEP on gas exchanges in dogs with aspiration pneumonia].
The purpose of this study was to determine the effects of pressure control inverse ratio ventilation (PC-IRV) and PEEP (in which both mean airway pressure and tidal volume were the same), on the gas exchange and the hemodynamics in 40 dogs in which the bronchi were injected with 2 ml.kg-1 0.1 N-hydrochloric acid. The dogs were classified into 5 groups and were ventilated with 5 kinds of ventilatory modes for 8 hours. The control group was ventilated by volume control ventilation (VCV) without PEEP, using a Servo Ventilator 900 C. ⋯ In group C, PaO2 showed the highest increase. PC-IRV decreased PaCO2. It was concluded that PC-IRV did not improve arterial oxygenation but showed a favorable effect for CO2 elimination in dogs with aspiration pneumonia induced by hydrochloric acid.