Masui. The Japanese journal of anesthesiology
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Total intravenous anesthesia with propofol, fentanyl and ketamine (PFK) was given to two patients complicated with myotonic dystrophy. Case-1: A 42-year-old female underwent a hemithyroidectomy. Anesthesia was induced slowly with intravenous ketamine 20 mg and propofol 60 mg. ⋯ When a nasogastric tube was pulled out, her respiration stopped suddenly and she was intubated again only for two hours without any troubles. In both cases their serum CPK levels and rectal temperatures were very stable. PFK method would be a choice for patients with myotonic dystrophy.
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A 75 year-old female with osteoarthritis of bilateral knee joints was scheduled for right total knee replacement. Her medical history included coronary artery disease, bronchial asthma, and previous surgery of lumbar laminectomy, but she had no neurological deficit before the operation. A 22-gauge spinal needle was inserted at the L 4-5 level and 4 ml of 0.5% bupivacaine with preservatives (Marcain 0.5%) was administered. ⋯ Myelogram showed inflammation of cauda equina on the fourth day after the operation. She suffered from hydrocephalus two months later and MRI utilizing gadolinium as a contrast medium was consistent with a diagnosis of adhesive arachnoiditis of thoracolumbar region. Her neurological deficit showed no improvement for two years.
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To test the hypothesis that arterial oxygenation during one lung ventilation (OLV) is impaired more in obese patients than in non-obese control patients, we performed consecutive measurements of arterial oxygen tension (PaO2) during OLV in 48 patients scheduled for pulmonary lobectomy. Minimum value of PaO2 during OLV was significantly less in 16 obese patients [body mass index (BMI) > 25] compared to 32 control patients (BMI < 25). Moreover, PaO2 value of left lung ventilation was significantly less than the value of right lung ventilation in obese patients while the difference was not statistically significant in the control group.
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Using transesophageal echocardiography (TEE) we assessed left ventricular end-systolic elastance (Ees) during the pre- and post-cardiopulmonary bypass (CPB) periods in 10 patients undergoing an elective coronary artery bypass graft surgery. The end systolic volume of the left ventricle was obtained by TEE, and the end systolic pressure was obtained by the femoral artery pressure wave form. ⋯ There were no significant differences in cardiac output, ejection fraction and Ees between pre-CPB and post-CPB period. Intraoperative end-systolic pressure-volume relationship may be clinically useful to assess left ventricular function and also useful to confirm anesthetic management in patients who has undergone an coronary artery bypass graft surgery.
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We studied the blood sugar levels after hypothermic cardiopulmonary bypass (CPB) in diabetics and non-diabetics. Twenty eight patients were divided to the following four groups by the preoperative value of hemoglobin-A1c (HbA1c) and medication; (1) HbA1c < 6.0 and given oral anti-diabetic medication, (2) HbA1c > 6.0 and given oral anti-diabetic medication, (3) HbA1c > 6.0 and given insulin injection, and (4) non-diabetics. Both in diabetics and non-diabetics, the blood sugar levels were higher than 300 mg.dl-1 during cardiopulmonary bypass. ⋯ In group (2) and (3), the blood sugar levels after 60 minutes of CPB were higher than 250 mg.dl-1, and insulin 8 units were given. After 30 minutes of insulin injection, the blood sugar levels of group (2) were lower than 250 mg.dl-1, but those in group (3), the blood sugar levels were still higher than 250 mg.dl-1, and another 8 units of insulin were given. The diabetic patients whose HbA1c levels were higher than 6.0 and given anti-diabetic medication before operation, need insulin after CPB.