Masui. The Japanese journal of anesthesiology
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In 57 adult patients undergoing valve replacement surgery or valve plastic surgery, pressure gradient between the femoral and radial artery was evaluated after cardiopulmonary bypass (CPB). During CPB, the rectal temperature was kept at mild or moderate hypothermia. Nitrates and prostaglandin E1 were administered in all patients during operation. ⋯ Systemic vascular resistance (SVR) decreased significantly from the pre-CPB level to the post-CPB level. There was no significant difference between Group A and Group B in SVR, but a higher femoral-to-radial artery pressure gradient was observed in Group A until the end of operation. Hypertension and the use of vasodilator change the tone of peripheral blood vessels and intensify femoral-to-radial artery pressure gradient after CPB.
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In order to evaluate the effect of intra-operative blood transfusion on post-operative decrease of ionized Mg (Mg2+), we performed following studies. 1) We measured ionized Mg (Mg2+), total Mg, ionized Ca (Ca2+), total Ca and citrate before and after operation in 70 patients. 2) We evaluated the effect of citrate on Mg2+ and Ca2+ in vitro. 3) We also measured these values during blood transfusion in 8 patients. There was no significant difference between post-operative Mg2+ of 45 patients without blood transfusion (0.49 +/- 0.07 mmol.l-1, % decrease from pre-operative value was 13.4 +/- 9.2%; mean +/- SD), and that of 25 patients with blood transfusion (0.48 +/- 0.09 mmol.l-1, 17.9 +/- 10.2%). ⋯ During blood transfusion, Mg2+ (0.41 +/- 0.05 mmol.l-1) and ionized % (54.5 +/- 8.3%) decreased significantly just like Ca2+ with elevated citrate concentration (0.95 +/- 0.59 mmol.l-1). In conclusion, intra-operative blood transfusion had minor effect on the post-operative decrease of Mg2+, and the major cause was thought to be the dilution of extracellular fluid by Mg-free fluid administered during operation.
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Total intravenous anesthesia (TIVA) is recommended in view of avoiding air pollution. However, intermittent administration of anesthetic agents has a disadvantage of delayed emergence time. We have suggested continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp), and reported that the elder or the patients anesthetized for a long time show delayed emergence from continuous TIVA. ⋯ Emergence was evaluated from the 2nd step down of propofol to awareness. There was a linear relationship between the emergence (2nd step down time of propofol to awareness) (Y) and the anesthetic time (X); Y = 0.175X + 3.00. We conclude that the last 1/6 (= 0.175) of anesthetic time is the point to reduce maintenance doses of propofol to achieve more rapid emergence.
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We reviewed 75 judicial precedents on anesthetic malpractice during surgical procedure which had appeared in legal journals in the period between 1963 and 1997. Anesthetic techniques employed were: general anesthesia (35 cases), spinal anesthesia (19 cases), local anesthesia (12 cases), and others (9 cases). Anesthesiologists were involved in 16 lawsuits, of which anesthesiologists lost 6 suits between 1986 and 1995. ⋯ Recent judgments suggested the importance of anesthetic managements, correct recording and appropriate monitoring by anesthesiologist during and immediately after surgery. Spinal anesthesia should be performed by anesthesiologist, and the frequency of anesthetic accident should be decreased. Japan is still in short of anesthesiologists and efforts should be paid to increase the number of anesthesia specialists.
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To assess the current state of leak in anesthetic machines, we selected 66 units of anesthetic machines for inspection and repair from various medical institutions. Based on a newly designed inspection flow chart a low flow leak test for internal circuits of the anesthetic machines was performed. The conventional low flow leak test was also performed for smooth detection of leak for rational evaluation. ⋯ After the inspection and repair, leak in 77.5% of the anesthetic machines either disappeared or decreased and the average residual leak dropped to 0.34 l.min-1. However, 47% of the anesthetic machines still failed to meet the standard of the low flow leak tests. To further improve the situation, more detailed inspection and repair are necessary especially for precise detection of the cause of leak in the internal circuit of anesthetic machines which often remains undetected.