Masui. The Japanese journal of anesthesiology
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The effects of hydroxyethyl starch on the coagulation system have received attention, and safe dosage of high molecular weight hydroxyethyl starch is generally found to be 20 ml.kg-1. Low molecular weight hydroxyethyl starch, HESPANDAR (HES), seems to induce weaker specific effects on blood coagulation than high molecular weight hydroxyethyl starch. The aims of this study are to estimate the maximum safe dosage of HES, and to investigate the etiology for coagulopathy induced by HES. ⋯ The evidences of clinical microbleeding were observed when patients had received HES more than 30 ml.kg-1. The decrease of Factor 8 and the observed tendency of clinical microbleeding showed a significant positive relationship (P = 0.0002). We conclude from our results that the maximum safe dosage of HES is about 30 ml.kg-1, and HES may affect blood coagulation by lowering the plasma concentration of Factor 8.
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We could perform endotracheal intubation in three patients whose ventilation had been anticipated possible preoperatively but endotracheal intubation impossible, using a fiberoptic bronchoscope while ventilating via Patil-Syracuse mask. This method is an alternative in a "can ventilate/cannot intubate" situation.
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Randomized Controlled Trial Clinical Trial
[Continuous total intravenous anesthesia is useful for postoperative pain management].
We compared postoperative pain in two groups. All anesthetic agents were continuously administered intravenously in a continuous PKF (propofol 2-10 mg.kg-1.h-1, ketamine 240 micrograms.kg-1.h-1 and fentanyl 0.4 microgram.kg-1.h-1) group. In a control group, anesthesia was maintained by GOI (N2O-oxygen-isoflurane). ⋯ To evaluate pain, VAS and Prince Henry Score on rest, cough and movement were taken 2 hrs and 5 hrs postoperatively, and in the morning and afternoon of the 1st as well as 2nd postoperative days. The continuous PKF group showed lower scores than the GOI group. It is a great advantage to use continuous PKF for postoperative pain management, and our data indicate that low dose ketamine may induce pre-emptive analgesia.
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Comparative Study Clinical Trial Controlled Clinical Trial
[General anesthesia with propofol and fentanyl for adult cardiac surgery].
We employed propofol anesthesia with a restricted dose of fentanyl in adult cardiac surgery with the aim of early tracheal extubation and evaluated its effects on the intraoperative factors and postoperative recovery compared with those of a previous benzodiazepine-fentanyl regimen. During surgery, control group patients (n = 17) received intermittent bolus of benzodiazepines and fentanyl without restriction, whereas propofol group patients (n = 17) received continuous administration of propofol and the restricted dose of fentanyl (20 micrograms.kg-1). ⋯ The propofol group patients required smaller doses of vasodilators during cardiopulmonary bypass (average PGE1: 0.096 microgram.kg-1.min-1 vs 0.047 microgram.kg-1.min-1, P = 0.046, NTG: 0.69 microgram.kg-1.min-1 vs 0.31 microgram.kg-1.min-1, P = 0.009). It is suggested that propofol-based anesthesia could replace the previous regimen with no adverse hemodynamic effects and might have a potential to provide faster recovery and improve peripheral circulatory status in adult cardiac surgery.