Masui. The Japanese journal of anesthesiology
-
Clinical Trial
[Cardiovascular responses during laryngeal mask airway insertion in normotensive, hypertensive and chronic renal failure patients].
The hemodynamic response to the insertion of the laryngeal mask airway (LM) following induction with propofol 2 mg.kg-1 was assessed and compared in normotensive (Normal), hypertensive (HT) and chronic renal failure (CRF) patients (n = 23 in each group). Before induction, in HT and CRF groups blood pressure and rate pressure products (RPP) were higher than in Normal group (P < 0.05). ⋯ There were no differences between groups in heart rate and rate of successful LM insertion. We concluded that LM insertion with propofol 2 mg.kg-1 was an effective induction method preventing the adverse circulatory responses in normotensive, hypertensive and chronic renal failure patients.
-
We report a case of emergency caesarean section due to bleeding from placenta praevia under general anesthesia in a patient with asthma. General anesthesia was induced by propofol 150 mg and suxamethonium 80 mg, and operation was started immediately after tracheal intubation under cricoid cartilage pressure. ⋯ Although anesthetic maintenance was carried out by oxygen-nitrous oxide-isoflurane after delivery, no asthmatic attack was seen throughout the operation. Anesthetic induction by propofol for emergency caesarean section might be safe and useful in a patient with asthma with little effects to neonates.
-
We developed a new type of bite block with a combined function as an endotracheal tube (ETT) holder for infants and small children to prevent airway troubles caused by tube kinking, dislodging, extubation and oral membrane trauma. One mm thick plastic plate sized 3.5 x 2 cm was curved to make an open roll. The outer surface of the roll was covered and glued with soft plastic tube (5.0 mm ID endotracheal tube), cut in 3.5 cm length to give an elastic outer surface for the patient's comfort. ⋯ Our bite block has following advantages over other types of bite blocks and tube holders especially for children; 1) the volume of foreign bodies (ETT and bite block) occupying the oral cavity can be reduced and this attenuates the patient's discomfort, 2) good holding of the ETT can prevent its dislodging and decrease the incidence of accidental extubation and 3) suctioning is easier because of wide oral space. The four sizes of the bite block suitable for 4.0, 4.5, 5.0, 5.5 and 6.0 mm ID ETTs are manufactured. We applied this device to several ICU patients and found its use practical and safe.
-
We examined the influence of the bolus injection rate of propofol on the cardiovascular depression and injection pain. Fifty-one patients of ASA grade 1 or 2 were randomly allocated to two groups. After premedication with midazolam 0.06 mg.kg-1 and atropine 0.006 mg.kg-1 i.m., propofol 2 mg.kg-1 was injected to a forearm vein at a rate of 800 ml.hr-1 in Group A or 1 ml.s-1 in Group B. ⋯ The induction time was significantly shorter in Group B than in Group A (40 vs. 73 sec: P < 0.01). There were no significant differences between the two injection rates in peak reductions in systolic and diastolic blood pressure and heart rate. In conclusion, rapid injection of propofol was effective to shorten the induction time without any adverse effects.
-
The efficacy and safety of postoperative analgesia with continuous epidural infusion of either morphine or fentanyl in combination with a low dose of bupivacaine were evaluated in 205 patients after upper abdominal surgery. Each patient was given bupivacaine alone (0.125% or 0.25%) or one of six combinations; 0.25%, 0.125%, or 0.0625% bupivacaine with morphine (M: 10 micrograms.ml-1) or fentanyl (F: 1 microgram.ml-1). After injection of 6 ml of each solution at the end of surgery, continuous epidural infusion was started at a rate of 4.2 ml.hr-1 for 48 hr. ⋯ Regarding the plasma catecholamines measured 24 hr after the surgery, there was no significant change in fentanyl groups as well as in the group given 0.125% bupivacaine alone. Although the incidence of hypotension and pruritus was slightly higher in morphine groups, no patient developed respiratory depression. It is suggested, therefore, that a small dose of opioid should be added when continuous epidural infusion is required.