Masui. The Japanese journal of anesthesiology
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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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Huge laryngeal cyst is rare, but may cause difficulty or inability in tracheal intubation during induction of general anesthesia. A 69-year-old patient was scheduled for laryngomicroscopic cystectomy. In this patient, we examined two methods of oro-tracheal intubation either with rigid laryngoscopy or flexible fiberscopy using transnasal fiberoptic monitoring. ⋯ Postoperative respiratory management under intubating state was necessary because of bleeding, airway edema, and deviation of the larynx after tumor resection. We reported anesthetic management of a patient with epiglottis gigantic cyst occupying the laryngopharyngeal airway. It is a rare tumor leading to difficulty of induction of anesthesia and necessitating postoperative intubated respiratory care.
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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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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.