Masui. The Japanese journal of anesthesiology
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Biography Historical Article
[New studies on the history of anesthesiology--a new study on Seishu Hanaoka's "Nyugan Ckiken Roku" (a surgical experience with breast cancer)].
Among Japanese physicians before the Edo era, Seishu Hanaoka is the most well known even in foreign countries as well as in Japan. His detailed biography is described in a monograph by Shuzo Kure published in 1923 which has been the most important book for the study of Seishu Hanaoka. Hanaoka had worked very hard in various fields as surgeons, educator, poet and community developer. ⋯ For these errors Shuzo Kure falsified them to be printed in his book. He even altered Chinese characters in one of the photographs of the manuscript in his book. 3) Shuzo Kure did not exhibit this manuscript at the exhibition on the occasion of 150 anniversary of Seishu Hanaoka's death in Tokyo, supposedly to avoid careful study by other investigators. All above mentioned findings strongly suggest us that the manuscript "Nyugan Chiken Roku" could be transcribed by one of Hanaoka's disciples and not by Hanaoka himself.
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We analyzed retrospectively the technical and clinical consequences of combined spinal-epidural anesthesia by needle-through-needle approach over the last two years. A Tuohy-type 18-gauge epidural needle (Perican; B. Braun Co.) and long pencil-pointed 27-gauge spinal needle (Whitacre; Becton-Dikinson Co.) were selected. ⋯ Inadequate spinal anesthesia was supplemented with epidural anesthesia in 13% of abdominal, 21% of gynecological and 7% of orthopedic cases. No serious complication occurred. We conclude that this needle-through-needle approach facilitates subarachnoid puncture with an ultra-fine spinal needle and subsequent epidural catheterization serves for supplemental and post-operative analgesia unless inappropriate subarachnoid indwelling occurs.
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Changes in serum concentrations of propofol after administration of three different fluids were investigated in 42 scheduled surgical patients. Anesthesia was induced with propofol 2 mg.kg-1 and maintained with constant rate infusion of propofol 6 mg.kg-1.hr-1. After achieving a stable depth of anesthesia, 5 ml.kg-1 of acetate Ringer's solution, 6% hydroxyethyl starch saline solution or 20% mannitol solution was infused in 15 minutes. ⋯ The dilution rate of the plasma from the fractional change in blood hemoglobin increased to 0.08 +/- 0.02, 0.24 +/- 0.03, and 0.36 +/- 0.03, respectively. Administration of mannitol might markedly increase distribution volume of propofol, and this can be attributed to osmotic action of mannitol and resultant expansion of extracellular fluid volume. The results of the present investigation suggest that this pharmacokinetic change decreased the concentration of propofol more significantly in mannitol treatment patients than in Ringer's solution or 6% hydroxyethyl starch saline treatment patients.
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We compared preoperative complications and intraoperative hemodynamic changes in very old patients, 85 years or older, and those with elderly patients aged 70-84 for hip fracture repair. Spinal anesthesia with 0.25 or 0.5% of bupivacaine was performed except for the patients with dementia and/or deformity of the spinal column. ⋯ Two patients of very old groups had severe intraoperative complications, heart failure and grave arrhythmia, but other patients underwent the operation without severe complication. In conclusion, even in very old patients with hip fracture, spinal anesthesia was performed safely unless patients had serious diseases preoperatively.
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Randomized Controlled Trial Clinical Trial
[Efficacy of patient-controlled epidural analgesia using a disposable PCA device].
We evaluated efficacy of patient-controlled epidural analgesia (PCEA) using a disposable PCA device (3.0 ml type). Twenty-two patients for elective gynecological surgery were randomized into two groups. Patients of the continuous epidural group received epidural fentanyl (15 micrograms.ml-1) with bupivacaine (1.25 mg.ml-1) from a disposable infusion pump (infusion rate: 2.1 ml.hr-1). ⋯ The incidences of side effects were similar in both groups. Respiratory depression and sedative effects were not observed in both groups. We conclude that PCEA using a disposable PCA device (3.0 ml type) seems to be effective for postoperative pain relief.