Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Continuous epidural administration of droperidol to prevent postoperative nausea and vomiting].
This randomized double-blind trial was designed to evaluate the antiemetic effect of continuous epidural analgesia with droperidol mixed with bupivacaine and buprenorphine. We studied 78 patients for abdominal gynecological surgery under general-epidural anesthesia. ⋯ Droperidol 2.5 mg, however, showed not only significant antiemetic effect without any adverse action, but also the reduction of rescue analgesics. We conclude that the addition of a small dose of droperidol to epidural analgesics reduces the incidence of postoperative emesis and the requirement of rescue analgesics.
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Randomized Controlled Trial Clinical Trial
[Pre-treatment with ketamine reduces incidence and severity of pain on propofol injection].
The purpose of this study was to evaluate the effect of pre-treatment with ketamine on the reduction of pain during injection of propofol in adult patients. We conducted a prospective, randomized, double-blinded trial. Forty-three patients were randomly allocated to one of two groups according to the agents administered before hand; Group C, normal saline 2 ml and Group K, 1% ketamine 2 ml. ⋯ Thirty-six percent of patients in the C group complained moderate to severe pain but only 9% of patients in the K group. The mechanisms of prevention by ketamine of the pain on propofol-injection could not be clarified from our study, but it may be related to central effects of ketamine. In conclusion, ketamine pre-treatment before propofol administration significantly reduces incidence and severity of pain associated with propofol injection.
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Rhabdomyolysis is one of the perioperative complications in patients with Duchenne's muscular dystrophy (DMD). It has been suggested that sevoflurane can be used safely for anesthesia in patients with DMD. In this report, we describe a case with DMD who received anesthesia with sevoflurane, in which rhabdomyolysis developed postoperatively. ⋯ After the diuresis with mannitol and furosemide, the urine became clear. On the 4th postoperative day, he was discharged without any complication. This case suggested that rhabdomyolysis can develop after sevoflurane anesthesia in patients with DMD.
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Bilateral parotid gland swelling with hyperamylasemia occurred in two patients on the first postoperative day after cesarean section under combined epidural-spinal anesthesia. Total ephedrine doses used to treat hypotension due to anesthesia were 48 and 52 mg, respectively. These symptoms and findings seemed to have been caused by beta stimulating effect of high dose ephedrine.
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Randomized Controlled Trial Clinical Trial
[Concentrations of sevoflurane with and without nitrous oxide to block vasomotor reflexes to incision (MACBVR)].
The minimum alveolar concentration of an anesthetic that blocks the skin vasomotor reflex to surgical incision (MACBVR) for sevoflurane was determined in 37 patients aged 30-60 years scheduled for laparotomies with or without nitrous oxide. Thirty seven patients were randomly allocated to one of the two groups: a sevoflurane group and a sevoflurane/N2O (50 vol%) group. The skin blood flow of the finger tip was measured using a laser Doppler flowmeter. ⋯ There were no relations between the amplitude of the reduction in skin blood flow and the changes of hemodynamic variables in each group. However, the changes in SBP and HR at incision were significantly suppressed by addition of N2O (changes in SBP and HR: 41.6 +/- 20.4 mmHg and 35.4 +/- 12.5 bpm in the sevoflurane group vs. 24.6 +/- 10.2 mmHg and 18.1 +/- 9.5 bpm in the sevoflurane/N2O group, P < 0.01). The results suggest that N2O is useful to suppress adrenergic responses to a surgical stimulus during sevoflurane anesthesia.