Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Co-administration of nitrous oxide reduces the pressor response against oro-tracheal intubation during induction of anesthesia with propofol infusion at a low rate].
This study investigated the effect of co-administration of nitrous oxide on the cardiovascular changes during induction of anesthesia with propofol infusion at a low rate. Sixty patients undergoing general anesthesia were randomly allocated into two groups, and received the inhalation of 100% oxygen (group 1) or 60% nitrous oxide and oxygen (group 2) via face mask for 3 minutes before administration of propofol at 15 mg.kg-1.hr-1. After beginning of propofol infusion, patients inhaled each gas continuously and the loss of response to simple commands by the anesthesiologist was considered as hypnosis. ⋯ The dose of propofol and the time for achieving hypnosis showed no significant difference (73 +/- 20 vs. 68 +/- 19 mg and 4.8 +/- 1.0 vs. 4.4 +/- 1.0 min, respectively). Almost all patients were sedated with inhalation of nitrous oxide before infusion of propofol, but no additive effect was observed with nitrous oxide and propofol. Co-administration of nitrous oxide during propofol infusion at a low rate was an effective method to avoid undesirable pressor responses against oro-tracheal intubation without causing adverse cardiovascular depression.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effects of milrinone on hemodynamics in patients undergoing cardiac surgery].
The phosphodiesterase inhibitor, milrinone is used to treat low cardiac output syndrome, especially after cardiac surgery. But there were few reports about the precise hemodynamic effects at separation from cardiopulmonary bypass (CPB). We examined the hemodynamic effects of milrinone in 24 patients undergoing elective coronary artery bypass graft (CABG). ⋯ Systemic vascular resistance index and mean arterial pressure decreased significantly (P < 0.0001, P < 0.05, respectively) in the milrinone group as compared with the control group. There were no significant differences in heart rate, mean pulmonary arterial pressure, pulmonary artery occlusion pressure, mean right atrial pressure, stroke volume index, and pulmonary vascular resistance index between the two groups. These hemodynamic effects showed that milrinone supported cardiac performance after CPB for CABG.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia].
We compared recovery characteristics of propofol anesthesia with those of sevoflurane anesthesia in pediatric outpatients. One hundred and four children, 3 months to 6 years of age, ASA physical status 1 or 2, were randomly assigned to following four groups; sevoflurane (group S), propofol (group P), sevoflurane with premedication (group MS), or propofol with premedication (group MP). Midazolam 0.5 mg.kg-1 and famotidine 1 mg.kg-1 were administered orally 30 min before the induction in the MS and MP group. ⋯ Postoperative pain was similar among the four groups. There were no differences in the incidence of vomiting. Propofol anesthesia provided slower emergence and less agitation compared with sevoflurane anesthesia.
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Randomized Controlled Trial Clinical Trial
[Changes in sedative level during induction of anesthesia using a single volatile anesthetic].
We investigated the changes in sedative level during induction of anesthesia using a single volatile anesthetic, sevoflurane, compared with the changes when propofol and sevoflurane were used. We used a bispectral index (BIS) monitor (Aspect, Newton, USA) to monitor the sedative level. Thirty patients were randomly divided into one group receiving sevoflurane alone (S group, n = 15) and another group receiving propofol and sevoflurane (PS group, n = 15). ⋯ The decrease in the BIS value was smooth in the S group, whereas it increased transiently and varied greatly in the PS group. Two patients in the PS group showed body movement during induction of anesthesia, and the BIS values in both cases transiently exceeded 60. BIS monitor is useful for monitoring the sedative level during induction of anesthesia, and induction using a single volatile anesthetic such as sevoflurane is smooth.
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Ten pregnancies and 7 deliveries in 5 patients of Marfan syndrome were managed at our institution. Three patients were delivered with a cesarean section under general anesthesia, and one was delivered under epidural anesthesia. Three underwent vaginal delivery with epidural anesthesia. ⋯ Emergency cesarean sections are performed in the cases of progressive dissection and urgent obstetric indication. General anesthesia was induced with fentanyl and midazolam to minimize cardiovascular response to tracheal intubation. We emphasize that evaluation of cardiovascular status and multidisciplinary approach are the key in the anesthetic management of parturients with Marfan syndrome.