Masui. The Japanese journal of anesthesiology
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Patients with severe neurological impairment may develop recurrent pneumonia due to aspiration. Laryngotracheal separation and tracheoesophageal diversion are one of the surgical treatments to prevent salivaly aspiration. We report anesthetic management for laryngotracheal separation and tracheoesophageal diversion of five pediatric patients with severe cerebral palsy. ⋯ Recurrent fever and aspiration pneumonia subsided in all of them. Our impression is that laryngotracheal separation and tracheoesophageal diversion are not so invasive surgical treatment for intractable pneumonia. But perioperative management should be concerned about both respiratory and neurological problems.
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A 49-year-old female with mitochondrial encephalomyopathy underwent surgery for implantation of an artificial cochlear device. She had some characteristic clinical features, including muscle weakness, deafness and dementia. Anesthesia was induced with 5 mg.kg-1 of propofol, and the trachea was intubated without a muscle relaxant. ⋯ Bispectral index (BIS) was monitored and maintained at approximately 40. No cardiovascular instabilities or increase in plasma lactate concentration were observed during surgery. The patient had a smooth recovery from the propofol anesthesia, and the BIS value returned to the pre-anesthetic level 10 min after completion of the anesthesia, suggesting that the use of propofol is a safe means for inducing and maintaining anesthesia in patients with mitochondrial encephalomyopathy.
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To determine low hemoglobin concentrations in the washed fluid is useful for calculation of blood loss and that in the supernatant is also useful for evaluation of hemolysis during extracorporeal circulation or in the blood preparations. The HemoCue Low Hemoglobin Photometer is a new lightweight device, which is easily movable anywhere and is able to determine hemoglobin concentration in low ranges (0.03-3.00 g.dl-1). We investigated the accuracy and reliability of the HemoCue Low Hemoglobin Photometer. ⋯ A high positive correlation was found between the values measured by the HemoCue Low Hemoglobin Photometer (Y) and the calculated values (X); Y = 1.047 X, r = 0.999, P < 0.0001. It took only 11-54 seconds (mean value: 31.4 seconds) for the measurement. It is concluded that the HemoCue Low Hemoglobin Photometer is a reliable and useful device for measurement of low hemoglobin concentration.
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Randomized Controlled Trial Clinical Trial
[Efficacy of bispectral index monitoring in improving anesthetic management, economics, and use of the operating theater].
This study was designed to assess the efficacy of bispectral index (BIS) monitoring in reducing the amount of volatile anesthetics used and improving recovery profiles. Sixty patients (ASA physical status 1 or 2) undergoing various surgical procedures under sevoflurane/nitrous oxide anesthesia were studied. The patients were randomly assigned to two groups of which anesthesia was carried out with (BIS group) or without (control group) monitoring BIS, and in the latter, anesthesiologist was blinded to the BIS values. ⋯ Compared with control group, the patients in BIS group were extubated earlier and became eligible for discharge earlier from recovery room than control group. There was no significant difference in the incidence of intraoperative complications between the groups. Titrating sevoflurane concentration with BIS monitoring during anesthesia decreased anesthetic consumption and improved recovery compared with standard clinical practice.
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Randomized Controlled Trial Clinical Trial
[Pretreatment with lidocaine accelerates onset of vecuronium-induced neuromuscular blockade].
The purpose of this study was to investigate the effect of pre-treatment with lidocaine on the onset of vecuronium-induced neuromuscular block in a randomized, double-blinded trial. Thirty-one patients were randomly allocated to one of two groups according to the agents administrated 3 min prior to vecuronium injection; Group C, normal saline 0.75 ml.kg-1 and Group L, 2% lidocaine 1.5 mg.kg-1. Anesthesia was induced with propofol 1.5 mg.kg-1 followed by continuous infusion at 8 mg.kg-1.hr-1. ⋯ Changes in SBP, DBP and HR did not differ between Group L and Group C. The mechanisms by which lidocaine reduced the time to onset of neuromuscular block caused by vecuronium could not be clarified from our study, but this may be related to pre- and post-junctional effects of lidocaine at neuromuscular junction. In conclusion, administration of lidocaine prior to tracheal intubation reduces the time to onset of neuromuscular block caused by vecuronium, but does not attenuate changes in blood pressure and heart rate caused by tracheal intubation.