Masui. The Japanese journal of anesthesiology
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Multicenter Study
[A multicenter study of cardiac events and anesthetic management of patients with ischemic heart diseases for noncardiac surgery--a follow-up report].
We have conducted a joint research project to investigate the incidence of ischemic heart disease in patients for noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. From September to November 1997 we had 7288 patients scheduled to undergo noncardiac surgery in the 8 departments of anesthesiology. ⋯ In our region of Japan, 3-4% of surgical patients tend to develop ischemic heart disease and 3.1% of them demonstrated severe cardiac complications perioperatively. Compared with United States we encounter fewer surgical patients with ischemic heart disease, but the risk of developing perioperative cardiac complications in such patients is almost the same for both countries.
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We report three cases in which the target-controlled propofol infusion technique was used in obese patients for general anesthesia. General anesthesia was induced by intravenous administration of fentanyl 150-300 micrograms and ketamine 50-80 mg and propofol 2 micrograms.ml-1 to achieve a target blood concentration by target-controlled infusion system. ⋯ The estimated blood concentrations of propofol at emergence from anesthesia calculated by ConGrace ranged from 1.49-1.69 micrograms.ml-1, and it took 230-300 seconds to emerge from anesthesia. The target-controlled propofol infusion technique appears useful to control the depth of anesthesia in obese patients.
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Comparative Study Clinical Trial
[A comparison of bullard laryngoscope and intubating laryngeal mask using fiberoptic guidance for tracheal intubation].
The purpose of this study is to compare the success rate of tracheal intubation, intubation time and laryngoscopic view of the larynx by Bullard laryngoscope or by intubating laryngeal mask using fiberoptic guidance in 50 patients. Following a standardized induction protocol, conventional laryngoscopic view by Macintosh's laryngoscope was obtained and classified by Cormack's grades. We measured the times from incertion of laryngoscopy or laryngeal mask until obtaining the best view of the larynx and until tracheal intubation. ⋯ The success rate of tracheal intubation was higher by Bullard laryngoscopy than by intubating laryngeal mask. The durations of laryngoscopy and tracheal intubation were significantly shorter and Cormack's grades were significantly lower by Bullard laryngoscopy than by laryngeal mask and fiberscopy. These results demonstrate that tracheal intubation by Bullard laryngoscope is faster and more successful compared with intubating laryngeal mask using fiberoptic guidance.
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Comparative Study
[A comparison of fentanyl and buprenorphine in total intravenous anesthesia using propofol during spinal surgery].
A retrospective study was performed to compare the hemodynamic effect and postoperative pain relief of fentanyl (Group F, n = 11) and buprenorphine (Group B, n = 11) in total intravenous anesthesia (TIVA) using propofol during spinal surgery. All patients were premedicated with midazolam (3-5 mg) i.m. Anesthesia was maintained with propofol infusion, and increments of fentanyl or single dose of buprenorphine with 40% oxygen in air. ⋯ All patients in Group F, and only two in Group B (P < 0.02) received analgesics within 20 hours. Neither nausea nor respiratory depression was found in both groups. This study suggests that buprenorphine would provide a more stable hemodynamic state and better postoperative pain relief than fentanyl in TIVA using propofol.
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Cornelia de Lange syndrome involves anomalies in cardio-vascular and musculo-skeletal systems, and mental retardation. In addition, a patient with this syndrome shows a peculiar look. A 22-year-old woman with Cornelia de Lange syndrome underwent general anesthesia twice. ⋯ After the administration of 4% lidocaine 3.5 ml into the pharynx, orotracheal intubation was attempted, but was not successful. Then blind naso-tracheal intubation was performed successfully under spontaneous respiration under sevoflurane-oxygen inhalation. The induction of anesthesia with sevoflurane under spontaneous respiration was useful for blind naso-tracheal intubation in a case with difficult intubation such as in Cornelia de Lange syndrome.