Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Concentrations of sevoflurane with and without nitrous oxide to block vasomotor reflexes to incision (MACBVR)].
The minimum alveolar concentration of an anesthetic that blocks the skin vasomotor reflex to surgical incision (MACBVR) for sevoflurane was determined in 37 patients aged 30-60 years scheduled for laparotomies with or without nitrous oxide. Thirty seven patients were randomly allocated to one of the two groups: a sevoflurane group and a sevoflurane/N2O (50 vol%) group. The skin blood flow of the finger tip was measured using a laser Doppler flowmeter. ⋯ There were no relations between the amplitude of the reduction in skin blood flow and the changes of hemodynamic variables in each group. However, the changes in SBP and HR at incision were significantly suppressed by addition of N2O (changes in SBP and HR: 41.6 +/- 20.4 mmHg and 35.4 +/- 12.5 bpm in the sevoflurane group vs. 24.6 +/- 10.2 mmHg and 18.1 +/- 9.5 bpm in the sevoflurane/N2O group, P < 0.01). The results suggest that N2O is useful to suppress adrenergic responses to a surgical stimulus during sevoflurane anesthesia.
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Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 certified training hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to ASA physical status (ASA-PS). ⋯ We reconfirmed that ASA-PS is useful to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation in those with poor physical status. Reducing mortality and morbidity from surgical problems is also required for improving perioperative mortality.
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Correct positioning of central venous catheters (CVC) is important. We compared the positioning of CVCs by ECG-monitoring via the guidewire and that by method using patient height. "Certofix" triple-lumen CVCs were inserted in 60 cardiac surgical patients via right internal jugular puncture. Of these, 30 were placed with ECG guidance via the guidewire (Group ECG), and 30 with reference to patient height (modified Pere's method) (Group H). ⋯ In one case of group H, the catheter tip was placed in the right atrium. In group ECG, there was a significant correlation between height and the depth of insertion of CVC. In conclusion, ECG guidance via the guidewire is useful for avoiding CVC displacement.
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HIT type II is one of the severe complications of heparin therapy. The antibody for the heparin-PF 4 complex, which causes thrombocytopenia of less than 100 x 10(3).microliter-1, thrombosis and DIC-like symptoms, is produced. We managed the patient with HIT type II, who underwent off-pump CABG using argatroban, a direct thrombin inhibitor, as an anticoagulant. ⋯ We also investigated the platelet count in the 100 patients with heparin therapy in CCU. The incidence of the platelet depression after heparin administration was as high as 59%, and in 12% of the patients the platelet count dropped below 100 x 10(3).microliter-1. In conclusion, thrombocytopenia by heparin therapy is not rare, and argatroban as an anticoagulant during off-pump CABG is thought to be useful.
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It is well know that the amide-linked local anesthetics such as lidocaine accelerate Ca induced Ca release (CICR) rate. Since ropivacaine is a new amide-linked local anesthetic, effects of ropivacaine on Ca functions were studied using skinned skeletal muscle. The extensor digitorum longus muscle of male Hartley guinea pigs of about 500 g was prepared for this study. ⋯ Ropivacaine at a concentration of 10 mM inhibited initial rate of Ca uptake by sarcoplasmic reticulum. Ca sensitivity of the contractile system was not affected with 10 mM of ropivacaine. These results suggest that ropivacaine can be used safely in patients susceptible to malignant hyperthermia since ropivacaine 3 mM is not a concentration for clinical use.