Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Anesthesia induction for laryngeal mask insertion--comparison among sevoflurane, isoflurane and propofol].
We compared the patient's response to laryngeal mask (LM) insertion and hemodynamics among three anesthesia induction methods; S group used sevoflurane and slowly increased to 5% in 50% nitrous oxide; I group used isoflurane and slowly increased to 3% in 50% nitrous oxide; and P group used 2.5 mg.kg-1 propofol with 0.2 microgram.kg-1 fentanyl. Thirty patients, 35 to 65 years, for elective mastectomy were the subjects of study in each of the three groups. Preanesthetic medication was composed of i.m. injection of 0.5 mg atropine and 5 mg midazolam 30 min. prior to the induction. ⋯ Blood pressure (BP), heart rate (HR) and rate pressure product (RPP) in the P group were significantly lower than those in the other two groups. I group showed significant increase in BP, HR and RPP. It was concluded that sevoflurane enabled the most smooth insertion of LM among the three methods of anesthesia with the least hemodynamic change.
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Randomized Controlled Trial Clinical Trial
[Comparison of propofol and pentazocine combined with thiamylal for laryngeal mask insertion].
We evaluated the combination of pentazocine and thiamylal as induction agents for laryngeal mask airway (LMA) insertion and compared this with propofol. Ninety-four patients, ASA grade 1 or 2, were randomly assigned to one of four induction groups as follows; group P: propofol 2.5 mg.kg-1, group p 0.3: pentazocine 0.3 mg.kg-1 followed by thiamylal 5 mg.kg-1, group p 0.6: pentazocine 0.6 mg.kg-1 followed by thiamylal 5 mg.kg-1, and group T: thiamylal 5 mg.kg-1. In group T (n = 5), insertion of LMA was impossible due to inadequate anesthesia. ⋯ Heart rate did not show any significant change. We conclude that the induction with the combination of pentazocine and thiamylal provides suitable conditions for LMA insertion with more stable hemodynamics compared with propofol. Doses of 0.3 mg.kg-1 seem to be desirable for LMA insertion.
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Comparative Study
[Effect of propofol as an agent for anesthetic induction on pituitary-adrenocortical function during anesthesia and surgery].
Effect of propofol as an agent for anesthetic induction on plasma levels of cortisol, beta-endorphin-like immunoreactivity (beta-ELI), growth hormone (GH) and prolactin were evaluated in 20 non-abdominal surgical patients ranged in ages from 19 to 64 years. Anesthesia was induced with either intravenous propofol 2-2.5 mg in ten patients or intravenous thiopental 4-5 mg in the remaining 10 patients as the control group, and succinylcholine was administered intravenously to facilitate tracheal intubation. Enflurane-nitrous oxide-oxygen was then given to maintain anesthesia in all the patients of both groups. ⋯ Plasma GH levels were not affected with anesthesia, but they increased slightly during surgery in both groups. Plasma prolactin levels increased significantly during anesthesia and surgery in both groups, and they decreased after the emergence from anesthesia but were still significantly higher than the preanesthetic values in both groups. The authors' findings suggest that effects of propofol as an agent for anesthetic induction on pituitary-adrenocortical function during anesthesia and surgery are comparable to those of thiopental, and that propofol does not exert inhibitory effect on pituitary-adrenocortical function during anesthesia and surgery.
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Case Reports
[Pulmonary edema due to acute airway obstruction immediately after tracheal extubation].
A 33-year-old male was scheduled for tonsillectomy and pharyngoplasty due to sleep apnea syndrome. The intubation was uneventful following induction with thiamylal and vecuronium. Anesthesia was maintained with O2-N2O-sevoflurane. ⋯ The patient was ventilated mechanically by applying a positive end-expiratory pressure of 5cm H2O, and furosemide and dopamine were administered intravenously. The patient was extubated the next day, and discharged from hospital ten days later. We considered that the lung edema was induced by the severe negative pressure generated by inspirating against a closed upper airway, as well as by the hyperadrenergic state and severe hypoxemia observed during and after extubation.
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To determine whether ketamine has a possibility to predispose a patient to malignant hyperthermia (MH), the author investigated the effects of ketamine on the intracellular calcium kinetics with the skinned fiber technique in skeletal muscle cells of guinea pigs. Intracellular calcium kinetics including calcium induced calcium release (CICR) from sarcoplasmic reticulum (SR), calcium uptake into SR, and sensitivity of contractile proteins for calcium were assessed by using calcium concentration-response relationships. ⋯ Thus, ketamine is not associated directly with occurrence of MH because ketamine has no significant effects on CICR. However, an increase in intracellular calcium concentration due to depressed calcium uptake into SR and an increased sensitivity of contractile proteins for calcium may lead to symptoms and signs like MH.