Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Total intravenous anesthesia with Diprivan (1% propofol emulsion) using a manual drip-infusion technique].
Continuous intravenous administration of Diprivan (1% propofol emulsion, P) is usually carried out using a syringe-pump or an infusion-pump to adjust the infusion rate. We assessed the accuracy of the infusion dose of P and the serum concentration of propofol by manual controls during anesthesia. Twenty eight patients, anesthetized with oxygen, P and vecuronium in combination with fentanyl and epidural block were randomly assigned to either of the following groups; P was administered using the drip-infusion (the group D, n = 14) or a syringe-pump (the group S; n = 14). ⋯ The Vc was well correlated with the Vm in the group D (r = 0.976) and in the group S (r = 0.974). Mean serum propofol concentrations of the group D and S were 2.50 +/- 0.57 and 2.35 +/- 0.62 micrograms.ml-1, respectively. The results suggest that the drip-infusion technique of P may be substituted safely by the syringe-pump for continuous total intravenous anesthesia.
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Randomized Controlled Trial Clinical Trial
[The effects of intravenous anesthetics, propofol, fentanyl and ketamine on the excitability of spinal motoneuron in human: an F-wave study].
We have investigated the effects of various intravenous anesthetics, propofol, fentanyl and ketamine on the excitability of spinal motoneuron using an F-wave analysis in a total of 28 patients. All patients were divided randomly into three groups as follows; 2 mg.kg-1 intravenous bolus injection followed by 6 mg.kg-1.h-1 infusion of propofol (P group), 1 mg.kg-1 intravenous bolus injection followed by 1 mg.kg-1.h-1 infusion of ketamine (K group), and 5 micrograms.kg-1 injection of fentanyl (F group). The F-wave was determined after supramaximal electrostimulation of the median nerve in distal point. ⋯ We found a significant (P = 0.018) reduction of the persistence from 77.5 +/- 15.2 to 40.9 +/- 16.8% in the propofol group. On the other hand, no significant changes in F-wave parameters were found in ketamine, or fentanyl group. These results suggested that motoneuron excitability in spinal cord could be inhibited by anesthetic dose of propofol, but not by ketamine or fentanyl.
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Multicenter Study
[Multicenter study of cardiac events and anesthetic management of patients with ischemic heart diseases undergoing noncardiac surgery].
We designed a joint research project to investigate the incidence of ischemic heart diseases in patients undergoing noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. Of the 8358 surgical patients in the 8 departments of anesthesiology between March 1997 and June 1997, 328 (3.9%) had ischemic heart diseases. Among the 328 patients, 54 (16.4%) developed perioperative cardiac events, including myocardial infarction (3 patients) and either lethal or potentially dangerous dysrhythmias (51 patients). ⋯ Therapeutically, isosorbide, nitroglycerin, beta-blockers, calcium channel blockers, and/or nicorandil were administered to prevent perioperative ischemia. So far, no generally accepted management strategies have been established in patients with cardiovascular disorders based on large-scale outcome trials in Japan. Therefore, nationwide large multicenter trials are awaited with interest in order to establish helpful guidelines to improve the perioperative management and to reduce ischemia in cardiac patients undergoing noncardiac surgery.
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Positioning of patients with cervical spinal lesions under general anesthesia may lead to serious neurological complications. The authors attempted awake pronation in eighteen patients to minimize the risks. In all patients, cervical instability or cervical spinal cord compression was diagnosed, and posterior fusion or laminoplasty under general anesthesia was planned. ⋯ Operations were accomplished without major troubles in all patients. During post anesthetic interviews, eight patients had memory of the positioning, but none of them had any complaints about the procedure. Awake pronation may be useful to minimize the risk of neurological complications related to positioning of surgical patients, and also need less assistance by medical staff.
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A 46-year-old female with mitochondrial encephalomyopathy underwent the replacement of right femur head under continuous epidural anesthesia. Considering that this disease is a neuromuscular disorder, general anesthesia should be avoided. ⋯ We managed this patient uneventfully with continuous epidural anesthesia and the use of acetated Ringer's solution during the perioperative period. We consider that continuous epidural anesthesia is useful for a patient with mitochondrial encephalomyopathy.