Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial
[Economical benefit of continuous total intravenous anesthesia].
Total intravenous anesthesia (TIVA) has been recommended in view of avoiding air pollution. However, intermittent administration of anesthetic agents has a large disadvantage of delayed emergence. We reported that continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp) could bring rapid emergence. ⋯ Continuous PKBp is more economical than the high flow GOS, and continuous PKBp in Japan is more economical than in U. S. A.
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We successfully anesthetized an 80-year-old female for Pringle maneuver which was applied at the time of liver transection and consisted of cross-clamping the hepatoduodenal ligament for 25 minutes and releasing the clamp for 2 minutes until the completion of the liver transection. Anesthesia chosen was total intravenous anesthesia with propofol, fentanyl and ketamine (PFK) in combination with epidural anesthesia. ⋯ Transient increases in liver enzymes were seen during early postoperative period, but no signs of hepatic failure were observed. In this patient, PFK anesthesia was useful and safe for the liver transection with Pringle maneuver.
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Low flow anesthesia (LFA) at a fresh gas flow (FGF) level of 10 ml.kg-1.min-1 with oxygen flow set at 0.5 ml.kg-1.min-1: 0.5 ml.kg-1.min-1 nitrous oxide and 3% isoflurane was performed using time-cycled ventilator on 10 patients of ASA class I or II, with age of 55 +/- 13 (mean +/- SD) years and body weight of 55 +/- 10 kg for 5 h. Excessive anesthetic gases from the anesthesia gas monitor were led to an expiratory breathing tube. After rapid induction and tracheal intubation, denitrogenation was performed for about 5 min using a 100% oxygen flow of 6 l.min-1 before LFA. ⋯ There was no need to change the flow of oxygen and nitrous oxide for 5 hrs. No SpO2 lower than 95% was observed during this study. This method is a clinically safe, easily applicable anesthesia method and used the smallest FGF reported in LFA without occurrence of low FIO2.
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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.