Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of preoperative epidural morphine on postoperative pain].
Postoperative analgesia was assessed by examining nurses' records of 421 gynecological operative cases between January, 1989 and November, 1990. The criterion used in the analysis was the need for analgesics for pain within 24 hours postoperatively. After receiving morphine (2 mg, 4 mg, 5 mg, 6 mg) with local anesthetics or physiological saline solution into the epidural space (lower thoracic, lower lumbar, or both regions), the patient was intubated with thiopental, diazepam, and a muscle relaxant (vecuronium or pancuronium). ⋯ The percentage of patients without pain was significantly larger in the group receiving 6 mg of morphine even in comparison with the groups receiving lesser doses. No serious complications occurred postoperatively in any group. In conclusion, preoperative morphine administered into the epidural space is effective for postoperative analgesia in gynecological operation, especially when morphine 6 mg was administered in the lower epidural (4 mg) and lower lumbar epidural (2 mg) space.
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We report a case of 31-year-old woman with pregnant toxicosis, who developed transient blindness after caesarean section under lumbar anesthesia. The patient was hypoxic due to atelectasis when she developed blindness, but she had no ophthalmologic abnormalities. MRI depicted abnormal high intensity areas (HIA) with T 2-weighted images (T 2 WI) in the occipital lobes and the basal ganglia. ⋯ The patient was diagnosed as cortical blindness due to RIND. Although most of the transient cortical blindness are accompanied with pregnant toxicosis with hypertension, there are some cases without pregnant toxicosis. We stress the importance of maintaining the blood pressure within the normal range in patients with hypertension who undergo surgery under spinal anesthesia.
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Acceleration of heart rate simultaneously with excitatory movements was observed during anesthesia with propofol in four patients. Anesthesia was induced with propofol 2.5 mg.kg-1 i.v. and maintained with propofol 10 mg.kg-1.hr-1 i.v. About ten minutes after the induction, the patients showed jerking movements such as pronation or flexion of their arms, and/or plantar flexion. ⋯ Another patient with no involuntary movements showed no heart rate changes. These results suggest that heart rate acceleration in four patients was closely related to excitatory movements caused by propofol. As it was not influenced by muscular relaxation, heart rate monitoring would be useful to detect latent excitatory movements under muscular relaxation.
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We have retrospectively analyzed twelve pregnancies in nine patients with intracranial arteriovenous malformation (AVM) managed at our hospital from 1984 to 1995. Following radical excision of AVM before or during pregnancy in 6 cases, transvaginal deliveries were performed without untoward sequelae. ⋯ Anesthesia courses in two patients for the resection of ruptured AVM during pregnancy were uneventful under enflurane and nitrous oxide anesthesia, or balanced anesthesia using fentanyl and nitrous oxide in oxygen. Simultaneous cesarean section craniotomy was not performed at our hospital.
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Review
[Adrenergic receptor and alpha 2 agonist--4: Applied and clinical pharmacology of alpha 2 agonist].
Alpha 2 adrenergic agonists currently are used in the anesthetic management of the surgical patient for their sedative/hypnotic, anesthetic-sparing, analgesic, and sympatholytic properties. Experimental and clinical studies have progressed to the point where anesthesiologists are now focusing on the use of these agents for their analgesic and anesthetic effects. This interest has coincided with the development and clinical introduction of dexmedetomidine. Clinical studies using existing alpha 2 agonists have revealed a tremendous potential for these agents that will be fully realized when more selective and specific compounds become available.