Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[Circulatory changes at the time of anesthetic induction and endotracheal intubation--comparison of thiamylal induction group and propofol induction group].
We examined the circulatory changes after intravenous thiamylal with additional injection of thiamylal 1 minute before intubation and after propofol at the time of anesthetic induction and endotracheal intubation. Sixty ASA I or II patients were studied after the institutional and informed consents. We compared the following three groups. ⋯ But the systolic and diastolic pressures were significantly more stable in Group II and Group III. The change of the RPP was slight and most stable in Group II compared with the other two groups. We conclude that additional injection of thiamylal 4 mg.kg-1 following induction of anesthesia with thyamylal 3 mg.kg-1 1 minute before endotracheal intubation is an effective method for minimizing the increase in blood pressure and circulatory changes at the time of rapid induction of anesthesia and endotracheal intubation.
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Randomized Controlled Trial Clinical Trial
[Anesthetic management by continuous total intravenous anesthesia].
Total intravenous anesthesia (TIVA) is one of the most recommended methods of anesthesia for the prevention of air pollution. But the intermittent administration of anesthetic agents has a disadvantage of elongating emergence time. When inexperienced residents undertake TIVA with larger doses of drugs to stabilize vital signs, it takes long emergence time. ⋯ The patients with general anesthesia combined with epidural anesthesia showed longer B time than the patients with only general anesthesia. But there were no differences in Op time and Pr time. We conclude that the continuous TIVA is useful to reduce emergence time and prevent air pollution.
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We compared the distance between the upper central incisors and the laryngoscope blade with the four different types of laryngoscope blade (McCoy, Macintosh, Miller, Belscope). Twenty-three patients scheduled for general anesthesia were studied. The tooth-blade distance was measured when optimum visibility of the glottis was obtained. ⋯ The visibility grade was significantly worse with the Macintosh than with the other types of laryngoscope. The results indicate that the McCoy and the Belscope provide less incidence of upper dental injuries and greater visibility than either with the Macintosh or the Miller. Furthermore, the force applied to the handle is thought to be smaller with the McCoy than with the Belscope.
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We used a new method for central venous (CV) access via the distal femoral vein using ultrasound guidance in two cases. In the first case, because of multiple catheter punctures for hemodialysis previously, femoral catheter placement was impossible using a standard landmark technique. In the second case of laryngoplasty, it was also impossible to place a CV catheter at usual groin sites because of extensive mycosis. ⋯ However, the femoral CV catheters at inguinal site has been associated with higher incidence of catheter infection than the subclavian or internal jugular vein. These methods have a potential for decrease in catheter infection rate. These two case reports suggest that the CV catheterization at distal femoral site by ultrasound-guidance is useful as a new method of CV access.
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Case Reports
[Epidural anesthesia for cesarean section in a twin pregnant patient with severe aortic stenosis].
A 35-year-old twin primigravida with aortic stenosis underwent cesarean section under epidural anesthesia. She had her ventricular septal defect repaired at 3 years of age. Preoperative ultrasonic study revealed severe aortic stenosis in which valve area was 0.77 cm2 and pressure gradient between the left ventricle and the aorta was 80 mmHg. ⋯ Otherwise, peripartal hemodynamics was stable, and she was transferred to the intensive care unit (ICU). Postoperative pain was controlled with epidural infusion of fentanyl. She did not complain of chest pain perioperatively and was discharged from the ICU next day.