Masui. The Japanese journal of anesthesiology
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Pharmacokinetics of propofol and ketamine during propofol-fentanyl-ketamine (PFK) anesthesia for pediatric surgery was studied. Plasma levels of propofol (Pp) were maintained approximately at 2.5 micrograms.ml-1 during surgery. Fifteen minutes after the cessation of propofol infusion, Pp decreased to 1.5 micrograms.ml-1. ⋯ On the other hand, plasma norketamine (Pn) levels increased gradually during surgery and stayed at 100-150 ng.ml-1 after the end of ketamine infusion to play an important role in post-operative sedation and pain relief. In conclusion, pharmacokinetics of propofol and ketamine in pediatric patients was similar to that in adult patients. PFK anesthesia can be used safely for pediatric as well as for adult patients.
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We monitored bilateral cerebral oxygen saturation and hemoglobin index while the brain received separate perfusion for major vascular surgery. Before surgery, left cerebral oxygen saturation and hemoglobin index were within normal limits but right cerebral oxygen saturation and right hemoglobin index were low. ⋯ No paralysis or any other neurological complications occurred postoperatively. We conclude that such monitoring is useful during and after anesthesia under separate brain perfusion.
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During perioperative period, plasminogen abnormality can result in unusual or unexplained clotting that occurs spontaneously or after minor trauma. However, there has been no report on perioperative anticoagulation therapy and monitoring in patients with hereditary plasminogen abnormality undergoing cardiac surgery. We performed a successful perioperative anticoagulation therapy and monitoring of a patient with hereditary plasminogen abnormality undergoing cardiac surgery. ⋯ When the patient was admitted to ICU, anticoagulation therapy was started immediately. During perioperative period, no episode suggesting thrombosis was observed. In conclusion, we consider that this successful anticoagulation therapy and monitoring during CPB has been achieved by use of Hepcon/HMS.
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In order to evaluate cerebral oxygenation and perfusion during deep hypothermic circulatory arrest (DHCA) and selective cerebral perfusion (SCP), continuous measurement of regional cerebral oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) was performed. Two patients undergoing aortic arch surgery performed under DHCA and SCP were studied. 1) Circulatory arrest produced a continuous decrease in rSO2. Introduction of SCP increased rSO2 to even above the pre-circulatory arrest level (reperfusion hyperoxia). 2) During SCP, changes in rSO2 correlated well with the naso-pharyngeal temperature, SCP flow rate, and level of carbon-dioxide insufflation to SCP. 3) These changes in rSO2 paralleled with those of jugular venous hemoglobin saturation (SjO2) measured simultaneously, although SjO2 frequently exhibited artifacts. We conclude that rSO2 measurement may be a non-invasive and continuous measure in the evaluation of cerebral oxygenation and perfusion during DHCA and SCP.
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We gave anesthesia twice to a 4-year-old boy with congenital sensory neuropathy with anhydrosis. At the first surgery, anesthesia was induced with midazolam and maintained with nitrous oxide, oxygen and sevoflurane 0.5-0.8% under mask breathing. Surgery was performed without any trouble but the patient vomited postoperatively for three days. ⋯ The patient often moved during surgery, and therefore, we changed from propofol to oxygen and sevoflurane 1.0-1.5% anesthesia. Nitrous oxide was not used. After the surgery, no vomiting occurred.