Masui. The Japanese journal of anesthesiology
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Ochronosis is a rare disease. Usually symptoms appear in the third, fourth, or later decade of life. The most common symptom is arthropathy, but cardiovascular system can be involved in this disease. ⋯ We started rapid infusion of a plasma substitute, and gradually decreased the infusion rate of dopamine to 4 microg x kg(-1) x min(-1). Then electrocardiogram returned to first-degree atrioventricular block. We estimated that second-degree atrioventricular block in this patient might have been exaggerated by dopamine at least in part.
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Comparative Study
[Comparison of three kinds of less invasive cardiac output measuring systems in aged patients].
Recently, the number of operations for aged patients have been increasing. They usually have various preoperative complications especially cardiovascular systems, and cardiac output measuring under general anesthesia is useful for their operative managements. The aim of this study was to compare the accuracy of three kinds of less invasive equipments for cardiac output measurements, i.e. the impedance cardiography (ICG), the partial CO2 rebreathing (NICO), and the arterial pressure-based cardiac output (APCO). ⋯ Three kinds of less invasive cardiac output measurement systems have enough functions to use during surgery for aged patients.
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Case Reports
[Severe hypotension as a complication of intramyometrial injection of vasopressin: a case report].
A thirty-year-old woman was scheduled for laparoscopic myomectomy. After insertion of an epidural catheter at the L4-5 interspace, general anesthesia was induced with thiopental 250 mg followed by vecuronium 8mg intravenously to facilitate tracheal intubation. General anesthesia was maintained with sevoflurane and nitrous oxide. ⋯ To decrease blood pressure and heart rate, we increased inspiratory concentrations of sevoflurane and nitrous oxide and administered local anesthetics via epidural catheter, and hemodynamic parameters became gradually stable. We estimate that severe hypotension observed in this case is associated with intramyometrial injection of vasopressin. Increased blood concentration of vasopressin might cause vasoconstriction of coronary artery, increases in afterload, and/or direct myocardial depression resulting in decreased cardiac output.
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Predictability of the extent of spinal anesthesia by plain bupivacaine has been controversial. ⋯ Results of this retrospective study imply the unpredictability of the extent of spinal anesthesia produced by plain bupivacaine.
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We report two cases of awake craniotomy successfully managed using remifentanil. During the intraoperative awake period lasting 2 to 2.5 hours, the infusion of low doses of remifentanil (0.02-0.05 microg x kg(-1) min(-1)) with or without propofol kept the patients comfortable and sufficiently awake to conduct various tasks but did not produce excessive respiratory depression. Because remifentanil can be titrated rapidly due to its extremely short duration of action, it may be useful for awake craniotomy for which both analgesia and sedation have to be tuned carefully according to the patient's need.