Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Evaluation of efficiency of ACD-CPR and STD-CPR; a multi-institutional study].
We compared the efficacy of ACD-CPR and STD-CPR based on 64 multi-institutional reports. No significant differences were observed in the rate of restoration of spontaneous circulation (ROSC) and in cardiopulmonary parameters during CPR using the two methods. ⋯ ETCO2 never exceeded 20 mmHg in the non-ROSC cases, but it was higher in the ROSC cases. ACD-CPR is a good choice when trained persons are present or when extra hands are available to continue the CPR.
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Questionnaires on knowledge of resuscitation were distributed to 3,303 6th-year medical school students from 36 universities. The questionnaire included 13 questions based on the 1992 guidelines for cardiopulmonary resuscitation. From the 13 questions, each student was instructed to select 6 questions concerning assessment of consciousness level, method for confirming respiration, method for securing the airway, method for confirming circulation, pressure points for cardiac massage, and the ratio of respiration and cardiac massage. ⋯ Possible reasons for these results may be the lack of desire on the part of students to master resuscitation, confusion over new findings concerning resuscitation and guideline, insufficient understanding of the difference between the guidelines and new findings by educators, and restricted teaching time for resuscitation. Possible ways to improve the situation include efforts to make students more responsible to master resuscitation, efforts to enhance students' desire to learn, adoption of more practical education, inclusion of such questions in graduation examinations and the national examination for a medical license, adherence by educators to the guidelines, and efforts by educators to make a clear distinction between the guidelines and new findings. With new guidelines for cardiopulmonary resuscitation due out in the year 2000, methods for teaching resuscitation should be reconsidered in order to ensure that all medical students can competently perform resuscitation.
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A 9-year-old boy underwent biopsy of the tumor at the external auditory meatus under general anesthesia with a laryngeal mask airway(LMA). During emergence from anesthesia, laryngospasm with marked inspiratory effort and cyanosis occurred. The LMA was removed and the patient was orotracheally intubated following vecuronium administration. ⋯ We suspected negative pressure pulmonary edema and treated him with mechanical ventilation with positive end-expiratory pressure. Seventeen hours later the pink frothy sputum decreased and he was extubated. Laryngospasm during emergence from anesthesia with an LMA can induce negative pressure pulmonary edema, especially in pediatric patients.
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The authors studied 5,034 consecutive patients undergoing elective surgery. Preoperative, intraoperative, and postoperative variables were gathered and patient satisfaction was assessed using direct interviews at pre- and post-anesthesia clinic. ⋯ Other undesirable outcomes include discomfort of urine catheter, sore throat, memory of extubation, postoperative pain and so on. Anesthesiologist can improve the quality of anesthesia by preoperative explanation and preventative management for undesirable perioperative outcomes.
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Randomized Controlled Trial Clinical Trial
[Dose-response study of preincisional buprenorphine on emergence time and postoperative analgesic requirement in patients anesthetized with sevoflurane].
The effect of intravenous buprenorphine on emergence time from sevoflurane anesthesia and postoperative analgesic requirement was evaluated after otolaryngeal surgeries. Forty-five patients were randomly assigned to one of three treatment groups (n = 15 each): Control-group received saline as a control; 2 micrograms-group received buprenorphine 2 micrograms.kg-1; and 4 micrograms-group received buprenorphine 4 micrograms.kg-1, respectively. Study drug was administered intravenously at the induction of general anesthesia. ⋯ In the control-group, the 2 micrograms-group, and the 4 micrograms-group, 10, 1, and 3 patients, requested additional analgesics during the first 24 hours after surgery, respectively (control-group vs. 2 micrograms-group and 4 micrograms-group, P < 0.05). Nausea and vomiting occurred more frequently in the 2 micrograms-group and the 4 micrograms-group. We conclude that buprenorphine (2 or 4 micrograms.kg-1) reduced analgesic requirement during the first 24 hours after surgery without delaying emergence from sevoflurane anesthesia.