Masui. The Japanese journal of anesthesiology
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We examined the blood propofol concentrations when patients responded to vocal command in patients with panperitonitis (Group P:N = 11) and patients for elective laparotomy (Group E:N = 19). In both groups, general anesthesia was induced and maintained by intravenous administration of propofol, fentanyl and ketamine following insertion of an epidural catheter. ⋯ Although the demographic factors and the anesthetic conditions were similar in both groups, the blood propofol concentration at emergence from anesthesia in Group P was significantly higher than that in Group E (1.04 + 0.11 vs 0.84 + 0.14 microgram.ml-1, P = 0.03). Our data suggest that blood propofol levels should be kept higher during propofol anesthesia in patients with panperitonitis.
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A 28-year-old parturient with acute cortical blindness and eclampsia was scheduled for an emergency cesarean section. Computed tomography (CT) of the head revealed low-density areas suggesting cerebral edema in posterior regions. The operation was performed under general anesthesia with sevoflurane. ⋯ The operation was performed uneventfully. Her consciousness returned to normal by the following day and visual recovery was complete within 72 hr postpartum. The patient and the infant showed no complication on their discharge.
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ProSeal laryngeal mask airway (PLMA, LMA-ProSeal) is a newly developed laryngeal mask airway intended to overcome two major disadvantages of the conventional laryngeal mask airway, i.e., poor protection of the airway from gastric regurgitation and low sealing effect around the laryngeal inlet. The new PLMA can provide air-tight sealing by a second cuff positioned at the back of the mask and a bypass channel for the alimentary tract by a second tube (drain tube) opening at the tip of the mask. However, clinical feature of this new device has been assessed by few authors. ⋯ There were no significant complications related to the PLMA. We concluded that the PLMA can provide high sealing pressure and isolate the airway from the alimentary tract. Further study including adverse effect of the high sealing effect should be required.
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We studied the effects of increases in isoflurane concentration on the bispectral index (BIS) in 16 patients undergoing lower abdominal surgery during isoflurane/epidural anesthesia. In 8 patients, the lungs were ventilated with an air/oxygen mixture (inspired oxygen fraction 0.33) [N(-) group], and in another 8 patients, the lungs were ventilated with 66% nitrous oxide in oxygen [N(+) group]. During surgery, patients received 1.0 MAC (1.15%) end-tidal isoflurane and the BIS was recorded after 10 min of unchanged end-tidal concentration. ⋯ In N (+) group, the BIS decreased in four patients at isoflurane concentration > 1.6 MAC, and the BIS did not decrease at 1.8 MAC in another four patients. The mean BIS values were 27 (17) at 1.6 MAC and 21(21) at 1.8 MAC. The present data suggest that BIS may not correlate with anesthetic effect of isoflurane at isoflurane concentration > 1.0 MAC.
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Pronounced decrease in arterial blood pressure during propofol or midazolam infusion for sedation of critically ill patients, has raised the possibility that they have a direct negative inotropic action. Accordingly, in the current study, changes in the left ventricular (LV) contractility were examined during i.v. infusion of these two sedatives in anesthetized dogs. Myocardial contractility was assessed with the slope (Ees) of the LV end-systolic pressure-volume relationship and the slope (Msw) of the LV end-diastolic volume-stroke work relationship. ⋯ Midazolam, also, decreased in Ees and Msw significantly. No significant differences were observed between three different doses of midazolam. It is concluded that propofol shows the dose-dependent inhibition of myocardial contractility, but midazolam induces dose-independent inhibition.