Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[Appropriate duration of postoperative pain relief by continuous epidural infusion in patients receiving hysterectomy or ovarian tumor resection: comparison of three methods].
We evaluated effects of continuous epidural infusion on postoperative pain, and frequency of its side effects. Patients who had undergone elective gynecological operations were randomly allocated into three groups by difference in duration of indwelling of epidural catheters: patients receiving epidural block only during operations (group M); patients receiving continuous epidural infusion for 2 postoperative days (group B 2); patients receiving continuous epidural infusion for 4 postoperative days (group B 4). In group M, morphine 3 mg and 1 or 2% lidocaine 5-7 ml were given before the start of operation, and epidural catheter was removed after the end of operations. ⋯ Frequencies of supplementary analgesics were 3.7, 0.6 and 0.4 times in group M, B 2, B 4, respectively. Times to initiation of bowel movement after operation were 39.8, 46.5 and 61.7 hrs in group M, B 2, and B 4, respectively, and most patients in group B 4 felt uncomfortable. These results suggest that continuous epidural analgesia for 2 postoperative days is appropriate, but the duration should be determined according to patient's conditions and complications.
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We managed a morbidly obese patient [body weight 150 kg, body height 157 cm (body mass index, 61 kg.m-2)] with intestinal obstruction due to incarcerated postoperative ventral hernia. The trachea was intubated while applying cricoid pressure. The SpO2 decreased rapidly down to 30% during intubation, but increased to 100% after ventilation with oxygen. Potential problems in the anesthetic management of morbidly obese patients for emergency surgery are discussed.
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Comparative Study Clinical Trial
[Success rate of anesthesia induction using target-controlled infusion of propofol with fentanyl].
Twenty-one patients were studied to compare the success rate of anesthesia induction using target-controlled infusion of propofol with and without fentanyl. All patients were premedicated with atropine 0.5 mg and hydroxyzine 25-50 mg. Five minutes after intravenous administration of fentanyl 2 micrograms.kg-1, patients were given infusions of propofol designed to achieve target blood concentrations of 3 micrograms.kg-1. ⋯ The success rate of anesthesia induction within three minutes of achieving the target concentration was 90%. Pain on injection and reduction in blood pressure were infrequent. Selecting a target concentration of 3 micrograms.kg-1 with fentanyl 2 micrograms.kg-1 can be expected to successfully induce anesthesia in the majority of patients without major hemodynamic side effects and pain on injection.
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Combined spinal-epidural anesthesia (CSEA) offers theoretic advantages especially for lower abdominal and limb surgery, because it produces the rapid onset of anesthesia and the proper muscle relaxation, with the option to extend the blockade with an epidural catheter. Whereas it is not known whether this anesthetic method is commonly used in clinical practice in Japan. We analyzed questionnaires on CSEA obtained form 148 hospitals. ⋯ In general, CSEA was not a widely performed anesthetic technic in Japan. CSEA should contribute to reduction of the incidence of postoperative nausea and vomiting caused by general anesthetics, and produce pre-emptive analgesia. We hope CSEA to be a common anesthetic procedure, although some disadvantages exist in training system for junior staff, national health insurance scheme and available local anesthetics in Japan.
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Clinical Trial
[Anesthetic and perioperative management of 1000 cases of congenital heart surgery--massive vasodilator therapy and early extubation].
We report our anesthetic and perioperative management of 1000 cases of congenital heart surgery in Okayama University Medical School over the last six and a half years. Most of these patients were anesthetized by fentanyl and all patients were managed in our ICU postoperatively. ⋯ Neonatal mortality rate has been still high, 18.9%, which has been our main problem. We tried to extubate patients with complex congenital heart diseases earlier postoperatively for the last three years, using massive dose of vasodilators without nitric oxide.