Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[The influences of nitrous oxide and ketamine on electroencephalogram during propofol-anesthesia].
The influence of nitrous oxide and ketamine on electroencephalogram (EEG) during the induction of general anesthesia with propofol was quantitatively analyzed. ⋯ When anesthesia is induced with nitrous oxide and/or ketamine together with propofol, and BIS is taken as an index of depth of anesthesia, the intracerebral concentration of propofol becomes excess.
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Comparative Study
[A comparison of two methods for continuous cardiac output measurement: PulseCO VS CCO].
PulseCO (PulseCO) (PulseCO Hemodynamic Monitor, LiDCO Co., London, England) is a low invasive apparatus to measure cardiac output continuously from arterial pulse waveform. CCO (774 HF 75, Edwards Lifescience Co., California, USA) is a continuous cardiac monitor commonly used clinically. The purpose of this study is to compare the accuracy of these two methods for cardiac output measurement with the thermodilution technique (TDCO) as control. ⋯ PulseCO was low invasive, and showed a significantly better correlation with TDCO, compared with CCO.
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We report here a case of upper airway obstruction occurring after extubation in a 55-yr-old 60 kg man after elective nephrectomy. Anesthesia was maintained with O2 (33%), N2O, sevoflurane (1.5-2%), and propofol infusion (2 mg x kg(-1) x hr(-1)). Blood loss was 1,965 ml, part of which was substituted by blood transfusion and albumin infusion. ⋯ Subsequent investigations using a fiberscope confirmed extensive soft tissue swelling, maximal at the level of the vocal cord and extending up- and down-wards to the trachea, indicating that the obstruction is caused by severe laryngeal edema. We believe that edema may have been caused by hypoalbuminemia (1.3 g x dl(-1)) at the end of operation. Therefore, it should be noted that hypoalbuminemia may cause laryngeal edema leading to acute airway obstruction.
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An eight-year-old boy with Cornelia de Lange syndrome underwent left inguinal hernioplasty and orchiopexy under general anesthesia. The patient with Cornelia de Lange syndrome had severe primordial growth failure with muscle-skeletal system such as cleft palate, micrognathia, and micromelia of the extremities and mental retardation as well as characteristic faces such as deep supercilia, etc. We suspected difficulty of endotracheal intubation due to this syndrome. ⋯ Anesthesia was maintained uneventfully by bolus intravenous injection of ketamine 5 mg and inhalation of oxygen and sevoflurane 2-3% with mechanical ventilation. The anesthetic management in a patient with Cornelia de Lange syndrome should be carried out with careful preoperative evaluation of physical status, and especially the difficult endotracheal intubation should be kept in mind. Induction of general anesthesia with injection of ketamine followed by inhalation of sevoflurane without muscle relaxant is a safe method in Cornelia de Lange syndrome.
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We investigated retrospectively the relationship between the intrathecal dose of 0.5% hyperbaric bupivacaine and the use of 2% mepivacaine through an epidural catheter. ⋯ Spinal anesthesia induced by 1.2 ml of 0.5% hyperbaric bupivacaine with sequential epidural block induced by 5-10 ml of 2% mepivacaine caused no hypotension during cesarean section.