Masui. The Japanese journal of anesthesiology
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We measured the intracuff pressure of two different tracheal tubes, Portex Profile Soft-Seal Cuff with high N2O gas-barrier property and "high-volume, low-pressure" cuff (Mallincrodt Lo-Contour). Twenty adult patients undergoing elective abdominal surgery, were maintained with total intravenous anesthesia combined with epidural block, and ventilated with oxygen in air (FIO2 = 0.4). Initially, intracuff pressure was adjusted to 25 mmHg with air, and monitored over 180 min. ⋯ The decrease in intracuff pressure of Portex Profile Soft-Seal Cuff was significantly smaller than that of "high-volume, low-pressure" cuff 150-180 min later. We conclude that to prevent tracheobronchial aspiration during prolonged general anesthesia without N2O, tracheal tube cuff with gas-barrier property may be safer than usual "high-volume, low-pressure" cuff. We recommend to check the intracuff pressure especially during the first 30 min and at intervals of several hours.
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Case Reports
[Orotracheal intubation using a Styletscope in a patient with restricted opening of the mouth].
We used a Styletscope (FSS) for endotracheal intubation in a 61-year-old man with restricted mouth opening. The degree of mouth opening was only 1.5 cm. ⋯ After induction of anesthesia using propofol and vecuronium, orotracheal intubation was accomplished promptly and smoothly using this scope. The Styletscope is a useful device for orotracheal intubation in patients with restricted mouth opening.
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Oscillometric noninvasive arterial pressure monitoring devices frequently fail to measure pressure precisely in patients with arrhythmia, such as atrial fibrillation, because beat-by-beat changes in pulse pressure and mean pressure level distort the relation between cuff pressure and oscillometric wave amplitude. To overcome this problem, we developed a new algorithm for oscillometric measurement in which oscillometric wave amplitude is corrected according to changes in pulse pressure and mean arterial pressure level. In 7 patients with atrial fibrillation, we compared systolic pressure thus estimated with that simultaneously measured invasively in the radial artery and averaged during oscillometric measurement. ⋯ Correction based on plethysmographically estimated pulse pressure decreased unmeasurable cases to 6% (P < 0.01). Standard error of systolic pressure estimates was 6.44 +/- 1.83, 4.10 +/- 0.85, and 4.75 +/- 1.26 mmHg with no, invasive, and plethysmographical correction in this order (P < 0.01). We conclude that oscillometric wave amplitude correction based on beat-by-beat pulse pressure and mean arterial pressure level lessened the number of unmeasurable cases and improved measurement precision in patients with atrial fibrillation.
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[The changes of bispectral index induced by administration of midazolam during propofol anesthesia].
The effect of the additional administration of midazolam or flumazenil on bispectral index (BIS) during propofol anesthesia was investigated in 22 scheduled surgical patients. Midazolam 10 or 30 micrograms.kg-1, or flumazenil 6 or 12 micrograms.kg-1 was injected to the patients to evaluate their effect on BIS after achieving steady state of hypnosis more than 1 hr of propofol anesthesia with 5 mg.kg-1.hr-1. The only midazolam 30 micrograms.kg-1 significantly reduced BIS value from 47.8 +/- 8.6 to 36.8 +/- 6.5. The synergistic interaction between midazolam and propofol assessed by BIS might be less clear than that assessed by hypnotic dose of propofol using psychopharmacological investigation.
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We investigated the incidence of the postoperative nausea and vomiting (PONV) following cardiac surgery with cardiopulmonary bypass. We conducted a prospective study of 65 cases with direct interviews by anesthesiologists who are blind to this protocol every 6 hours during ICU stay. ⋯ Incidence of PONV was 43%, but 70% of female patients complained of PONV. Prophylactic antiemetic strategy might be clinically relevant to female patients who are to undergo open heart surgery with cardiopulmonary bypass.