Masui. The Japanese journal of anesthesiology
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A newly developed non-invasive monitor, NICO (Novametrix Medical Systems Inc.), measures cardiac output based on changes in respiratory CO2 concentration caused by a brief period of rebreathing. By applying modified form of the CO2 Fick principle, cardiac output is calculated. We determined the accuracy and precision of this technique (RBCO) by comparing it with continuous thermodilution technique (TDCCO) and pulse dye densitometry technique (PDD). ⋯ On the other hand, the overall difference between RBCO and PDD (n = 53) was -0.1 +/- 2.04 (bias +/- 2 SD)l.min-1. The degree of accuracy of RBCO was thought to be the same as those of TDCCO and PDD. We expect that NICO will be a useful cardiac output monitor in any method of general anesthesia in which PA catheterization is difficult or not indicated.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Patient-controlled epidural analgesia with bupivacaine and fentanyl suppresses postoperative delirium following hepatectomy].
Postoperative delirium occurs frequently following major surgery, especially after hepatectomy. We hypothesized that better methods of postoperative pain control would decrease postoperative delirium. To clarify the magnitude of postoperative pain and incidence of postoperative delirium in hepatectomy patients, subjects received patient-controlled epidural analgesia (PCEA) using bupivacaine and fentanyl (Group P), or continuous epidural mepivacaine (Group E) following intraoperative epidural administration of morphine. ⋯ Moreover, less amount of antipsychotic drugs was given in Group P than in Group E. These results suggest that the better pain relief and patient satisfaction provided by PCEA contributed to a decrease in the incidence of delirium, because of continuous opioid administration and patient-control analgesia. We concluded that PCEA with bupivacaine and fentanyl can limit postoperative delirium following hepatectomy.
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Randomized Controlled Trial Clinical Trial
[The effect of intravenous patient controlled analgesia on activities of daily life and medical expense after thoracotomy].
We investigated the efficacy of postoperative intravenous patient controlled analgesia (i.v.-PCA) combined with continuous epidural analgesia (CEA) after thoracotomy. One hundred and eight patients receiving postoperative CEA were randomly divided into two groups; the i.v.-PCA (+) group who received i.v.-PCA combined with CEA and the i.v.-PCA (-) group who did not receive i.v.-PCA. Pain score (100 mm visual analogue scale; VAS) at 24 h and 48 h, postoperative complications, activities of daily life (ADL), the length of hospital stay and medical expense were compared. ⋯ The i.v.-PCA (+) group could recover ADL more quickly and had better analgesic state compared with the i.v.-PCA (-) group. The incidence of postoperative complications was lower in the i.v.-PCA (+) group compared with the i.v.-PCA (-) group. It was concluded that the i.v.-PCA combined with CEA had the desirable effects on postoperative analgesia and recovery of postoperative ADL.
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Randomized Controlled Trial Clinical Trial
[The effect of sedation with propofol and fentanyl during epidural catheter insertion on intraoperative temperatures].
General anesthesia inhibits thermoregulation by suppressing tonic vasoconstriction and facilitates a core-to-peripheral redistribution of body heat, which is the major cause of core hypothermia during the first hour of anesthesia. We randomly assigned 16 patients to two groups; 1) patients who received fentanyl (1 microgram.kg-1, i.v.) and propofol (1.5 mg.kg-1.h-1) during insertion of epidural catheters (P group), and 2) no drug (control) group (C group). ⋯ One hour after induction of anesthesia, Ttym of P group was significantly higher than C group. We can conclude that a sedative dose of propofol and fentanyl before induction of general anesthesia inhibits redistribution hypothermia during general anesthesia.
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Comparative Study
[Blood concentration of propofol during cardiopulmonary bypass--comparison between arterial and internal jugular venous blood].
Twelve adult patients for cardiac surgery were divided into 2 groups, normothermia (6 patients) and mild hypothermia (6 patients), based on their body temperature during cardiopulmonary bypass (CPB). Propofol was continuously administered throughout each operation at a dose of 2 mg.kg-1.h-1. Arterial and internal jugular venous bulb blood samples were drawn simultaneously before CPB, at 5, 30, 60, and 90 minutes after the start of CPB, 30 minutes after the end of CPB, and at the conclusion of the operation, to measure propofol concentrations. ⋯ In the mild hypothermia group, however, no significant change in propofol concentration was observed. In both groups, there was no significant difference in propofol concentration between arterial and internal jugular venous bulb blood throughout the study period. Our results suggest that there are no significant differences between the effect of normothermic and that of mild hypothermic CPB on the pharmacokinetics of propofol in the brain.