Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial
[Intravenous patient controlled analgesia combined with continuous thoracic epidural analgesia for post-thoracotomy pain].
We compared the efficacy of intravenous patient controlled analgesia of buprenorphine plus continuous thoracic epidural infusion of bupivacaine (IV-PCA group) with the efficacy of continuous thoracic epidural infusion of bupivacaine and buprenorphine (the TEA group). No patient in IV-PCA group required supplemental analgesics, while 90% of TEA group required supplemental intramuscular buprenorphine to relieve post-thoracotomy pain. In TEA group, 94% of the supplemental drugs were administered during night shifts. These results indicate that IV-PCA of buprenorphine combined with continuous thoracic epidural infusion of bupivacaine is more effective analgesic management than continuous TEA with buprenorphine and bupivacaine.
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A 76-year-old woman with thoracic aortic aneurysm involving distal aortic arch was scheduled for graft replacement from ascending to proximal aortic arch with endovascular stent graft to descending aorta. Surgical procedures were performed under median sternotomy with hypothermic systemic circulation arrest and selective cerebral perfusion. The stent graft composed of 30 mm Gianturco Z stent and 27.5 mm woven Dacron graft was introduced into the descending aorta under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. ⋯ TEE was also useful to find the dislodgement of the stent graft after deployment. This surgical technique, being less invasive than conventional thoracotomy, would be indicated for elderly patients with distal aortic arch aneurysm. TEE is the vital imaging technique for placement of the stent graft, as well as for intraoperative cardiac monitoring.
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Case Reports
[Anesthetic management for MIDCAB using the target controlled infusion and the bispectral index].
We report our experience in using the target controlled infusion (TCI) of propofol combined with the bispectral index (BIS) monitoring for anesthetic management of minimally invasive direct coronary artery bypass (MIDCAB) in a 43-year-old-male patient with angina pectoris. After premedication, the patient was connected to the monitor with electrodes for BIS monitor. Then, anesthesia was induced with fentanyl and propofol using TCI technique. ⋯ Furthermore, diltiazem was infused continuously for cardiac rate control, as well as infusion of nicorandil, nitroglycerine for prevention of coronary artery spasms, and prostaglandin. After the operation, the patient was alert in 8 minutes and we could extubate in 12 minutes. The use of TCI combined with BIS monitoring for maintenance of anesthesia for MIDCAB is useful and safe.
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We conducted an anesthetic management to perform tracheostomy and tracheolysis in a 33 year-old female with severe stenosis extending to the lower trachea and right main bronchus. The minimal diameter of the stenotic lesion of the trachea was 3 mm according to the preoperative examinations including tomography, CT scan and magnetic resonance imaging. ⋯ Total intravenous anesthesia with propofol and fentanyl could provide adequate depth of anesthesia during surgery and rapid recovery with good spontaneous respiration after the termination of the infusion. VV-ECMO was a useful method to support gas-exchange in a case not requiring circulatory assistance without uneven oxygenation sometimes observed in VA-ECMO.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Effects of infusion methods of propofol on quality of sedation and ease of sedation control during gynecological laparotomy under spinal anesthesia].
Twenty patients were prospectively and randomly studied to investigate effects of infusion methods of propofol on quality of sedation and ease of sedation control during gynecological laparotomy under spinal anesthesia. After establishment of spinal anesthesia, patients were randomly assigned to one of the following two groups, i.e. conventional continuous infusion group (Cont group) and target-controlled infusion group (TCI group). In the Cont group, propofol was started at a rate of 6 mg.kg-1.hr-1 until response to command disappeared. ⋯ Satisfaction VAS, anxiety VAS, discomfort VAS, sedation score and times of changing infusion condition were similar in both groups. Total dose of propofol was significantly less in the TCI group. In conclusion, quality of sedation and ease of control of sedation were comparable in both groups and continuous infusion method is simple.