Masui. The Japanese journal of anesthesiology
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We experienced anesthetic management for six cases of the Batista operation and measured cardiac function before and after cardiopulmonary bypass (CPB) with transesophageal echocardiography. In the successful three patients, left ventricle ejection fraction and ejection time were maintained over 25% and 200 msec after CPB, respectively. In the other three resulting in implantation of left ventricular assist device, ejection fraction remained below 20% and ejection time under 200 msec after CPB. Intraoperative transesophageal echocardiography may be useful not only for monitoring of cardiac function but also for the prediction of prognosis.
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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.
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We experienced a case of stump pain relieved by continuous intravenous ketamine infusion therapy. A 59-year-old male had his left first through fourth toes amputated because a giant iron plate at work fell on his left foot fifteen years ago. Thereafter he had refractory spontaneous burning pain and night pain on his stump. ⋯ Thereafter stump pain was relieved to the level of VAS 20 mm. Therefore we diagnosed his stump pain as central pain of neuropathic origin. We suspect that continuous intravenous infusion of ketamine, a noncompetitive blocker of N-methyl-D-aspartic acid receptor, might be an effective and useful alternative treatment in a patient with refractory stump pain.
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Measuring arterial lactate concentration is a prompt, easy and relatively non-invasive way to estimate tissue oxygen metabolism. We evaluated whether perioperative levels of the arterial lactate concentrations can reflect the general severity of a pediatric patient's condition. A consecutive series of 112 patients, aged 5 days to 17 years (median age: 12 months), admitted to our pediatric intensive care unit (PICU) following cardiac surgery under cardiopulmonary bypass were studied. ⋯ Hyperlactemia greater than 2.2 mmol.l-1 at D1 predicted death with a sensitivity of 82% and a specificity of 72%. The measurement of early postoperative lactate levels, reflecting postoperative ability to eliminate intraoperative hyperlactemia, is a better way of assessing the severity of a pediatric patient's condition following cardiac surgery. The ideal time to measure early postoperative lactate levels should be determined by further research.
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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.