Masui. The Japanese journal of anesthesiology
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We investigated the effect of intraoperative bleeding on the changes in estimated and measured blood concentrations of propofol, and the relationship between anesthetic effect of propofol and serum albumin concentration in a patient undergoing prostatectomy during propofol/epidural anesthesia. The rate of propofol infusion was titrated to keep the BIS value about 50. The estimated blood concentration of propofol calculated by ConGrase, a program for on-line simulation of blood propofol concentration, was monitored during anesthesia. ⋯ When the amount of bleeding reached about 2000 mg, the difference between estimated and measured blood concentrations of propofol did not increase. As the serum albumin concentration decreased, the concentration of propofol to keep bispectral index about 50 decreased. This study suggests that the change in serum albumin concentration following intraoperative bleeding is an important factor in the anesthetic effect of propofol.
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We have developed an automated electronic anesthesia record system using a hospital LAN. As the number of monitors we can use in the operating room is increasing, it is impossible to record all physiologic parameters in a handwritten anesthesia record. Physiologic parameters are recorded every 10 seconds from the anesthesia monitor. ⋯ At the end of the operation, intraoperative data are sent to a host computer and the anesthesia record is printed. We can use this database for clinical research and retrospective case reviews. The implementation of the automated electronic anesthesia record in anesthesia practice will improve quality of patient care.
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We experienced intraoperative anesthetic management of two cases of heart transplantation in Japan. Both patients were in the end stage of cardiac failure due to dilated cardiomyopathy. ⋯ Anti-arrythmic therapy including heart pacing and protection of right heart failure are important for the circulatory management of heart transplantation. The anesthesiologist is needed not only for the management of respiration and circulation but also for the prevention of infection and control of the time schedule.
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CO2 absorbents convert sevoflurane to fluoromethyl-2,2-difluoro-1-(trifluoromethyl) vinyl ether (compound A), whose toxicity in rats raises concern regarding the safety of sevoflurane in a low-flow system. SPHERASORB is a new CO2 absorbent which does not contain KOH. However, the reaction between SPHERASORB and sevoflurane has not been examined. ⋯ The maximum concentration of compound A in the circuit was 12.2 +/- 1.4 ppm for SPHERASORB and 18.6 +/- 0.4 ppm for Sodasorb II (P < 0.05). The maximum temperature of SPHERASORB was lower than that of Sodasorb II (P < 0.05). SPHERASORB can reduce compound A formation, compared to Sodasorb II.
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Case Reports
[Use of intubating laryngeal mask airway for three patients with difficult intubation].
We used intubating laryngeal mask airway (ILM) for three patients with difficult intubation, and tracheal intubation was successfully performed through the ILM in all three cases. Difficult intubation in the first case was caused by direct invasion of malignant lymphoma into the right maxillary sinus leading to restricted mouth opening. ⋯ Subsequently, all patients were intubated through the ILM successfully. We realized that the ILM is useful and should be prepared on the induction of anesthesia in patients suspected of difficult intubation.