Masui. The Japanese journal of anesthesiology
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This report contains anesthesia-related mortality and morbidity in Japanese Society of Anesthesiologists Certified Training Hospitals (JSACTH) in the year 2000, as a part of the second series of annual studies started in 1999. JSA Committee on Operating Room Safety (CORS) sent confidential questionnaires to 794 JSACTH and received effective answers from 65.5% of hospitals. A total number of 941,217 anesthetics were documented. ⋯ Drug overdose or wrong choice (2.7%) as a human error occupied the 10th. In conclusion, the obtained incidences as to death, other critical incidents and their outcomes as well as the occurrence of principal causes in 2000 study were remarkably close to those in 1999 study. We expect that this second series of annual studies for five-years should reveal precise and definite direction for us to reduce anesthesia-related mortality and morbidity.
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In the period from April 1995 to March 2000, 11 parturient patients were diagnosed as having HELLP syndrome and underwent Caesarian section at our institution. All of the patients also had eclampsia or preeclampsia. Six of the operations were performed under general anesthesia and 5 were performed under regional anesthesia (one epidural and 4 spinal blocks). ⋯ No major complications occurred during the postoperative periods. Anesthetic management of a parturient patient with HELLP syndrome is modeled on the underlying preeclamptic condition. Determination of the appropriate anesthetic should be based on the patient's condition, condition of the fetus, and the urgency of the situation.
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Randomized Controlled Trial Clinical Trial
[Effect of nitrous oxide on the bispectral index during sevoflurane anesthesia].
We studied the effects of nitrous oxide on the relationship between end-tidal sevoflurane concentration and bispectral index (BIS) in patients undergoing abdominal surgery. Anesthesia was maintained with combination of epidural and sevoflurane anesthesia in air (control group; n = 15) or with 67% nitrous oxide (nitrous oxide group; n = 15). The end-tidal sevoflurane concentration was increased by 0.5% every 15 min to 3% and BIS values were recorded at each step. ⋯ Nitrous oxide with sevoflurane caused more reduction in BIS in comparison with sevoflurane alone. The sevoflurane concentration for BIS at 50 in the nitrous oxide group (0.9 +/- 0.4%) was significantly lower than that in the control group (1.2 +/- 0.4%). The results suggest that the hypnotic effect of sevoflurane was enhanced by the addition of nitrous oxide during abdominal surgery.
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Randomized Controlled Trial Clinical Trial
[Effects of concentration and dosage of lidocaine on preventing the pain on injection of propofol].
Although it is well-known that 2% lidocaine has an effective action for preventing propofol-induced pain, it has been unclear whether or not lidocaine of the concentration below 2% has the effective action similar to 2% lidocaine. One-hundred and thirty-two patients were randomly assigned to one of the six groups according to concentration and dosage of lidocaine administered at the time of the initiation of propofol infusion. Groups I and II received 1 ml and 2 ml of 1% lidocaine, respectively; Groups III and IV were given 1 ml and 2 ml of 0.5% lidocaine, respectively; Group V received 2 ml of 2% lidocaine; Group VI was administered 1 ml of normal saline as a control. ⋯ Number of patients complaining of a pain during induction was more in Group VI with significance (P < 0.0001) and number of patients complaining of uncomfortableness was also more with significance (P < 0.0001). Incidence of propofol-induced pain and degree of satisfaction with anesthetic induction were similar among the groups receiving lidocaine. Even 0.5% lidocaine may have the same effective action as 2% lidocaine for preventing the pain on injection of propofol.
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We report a case of myoglobinemia observed in the postoperative period due to forced positioning during nephrectomy. A 32-year-old male, weighing 93 kg, underwent the left nephrectomy due to renal cell carcinoma under general anesthesia with epidural block. The operation was performed uneventfully but he complained of severe pain in his right hip immediately after the recovery from anesthesia. ⋯ CT findings showed topical edema or necrosis of his right minor and medial gluteus muscle. Myoglobinemia continued only for 3 days after the operation without renal dysfunction. We may conclude that muscle injury during an operation followed by forced positioning for nephrectomy is caused not only by direct compression of the muscle, but also by obstruction of the profound intramuscular artery.