Masui. The Japanese journal of anesthesiology
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Femoral to radial artery pressure gradient was evaluated in 14 patients undergoing coronary artery bypass graft under normothermic cardiopulmonary bypass (CPB). CPB was instituted at a flow rate of 2.6 l.min-1.m-2, using non-pulsatile pump and blood temperature of pump arterial line was controlled to maintain bladder temperature between 36 and 37 degrees C. Pressure gradients occurred 30 min after commencement of CPB and the mean gradients of systolic, diastolic and mean artery pressure were maximum all at the end of CPB (38 +/- 7 mmHg, 4 +/- 1 mmHg and 10 +/- 2 mmHg). ⋯ Throughout the operation, nasopharyngeal and blood temperature remained unchanged, while mean palm temperature increased from 31.8 degrees C (after induction) to 34.6 degrees C (30 min after commencement of CPB) and thereafter remained between 33.3 and 33.9 degrees C. This increase in peripheral temperature might indicate that normothermic CPB was accompanied by peripheral vasodilatation. These results indicate that the magnitude of femoral to radial pressure gradient during normothermic CPB is similar to that during mild hypothermic CPB.
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We experienced the anesthetic management for two patients with congenital tracheomalacia. Inhaled anesthetics are considered to worsen the respiratory condition of tracheomalacia because of its bronchodilating effect. ⋯ Inhaled anesthetics have possibility of worsening the degree of tracheomalacia and have been used very carefully. However, we considered that slow induction with inhaled anesthetics in children with congenital tracheomalacia is a safe and necessary technique, under careful observation of respiratory conditions.
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We experienced three cases of successful balloon catheter dilatation for bronchial stenosis under general anesthesia. There was no problem for two patients, but the third patient planned for stent insertion had bronchiomediastinal fistula. This procedure is generally performed under local anesthesia but more safely done under general anesthesia with muscle relaxants considering operative failure by bucking, pain of patients and prolonged procedure.
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We have reported that the Japanese herbal medicine "Saiko-Keishi-To" (SK) which is often used for treating epileptic patients activates the GABAA receptor-mediated chloride current (Icl). In the present study, we examined whether the SK-induced Icl could be potentiated by several intravenous anesthetics known to interact with the GABAA receptor, and also examined whether SK could potentiate the GABA-induced Icl. Whole-cell patch-clamp recordings were made from cultured rat dorsal root ganglion cells. ⋯ The peak amplitude of the Icl evoked by GABA (10 microM) increased after propofol (5 microM) to 617 +/- 189% of the control (n = 4), but decreased to 84 +/- 7% of the control by SK (0.2 mg.ml-1, n = 4). These results indicate that the SK-induced Icl can be potentiated by the intravenous anesthetics, positive allosteric modulators of the GABAA receptor-Cl- channel complex and that SK is not a positive allosteric modulator, but a partial agonist for the GABAA receptor. Our study thus suggests that the combined use of SK and anticonvulsants such as barbiturates and benzodiazepines may be more effective in treating epileptic patients than SK alone.