Masui. The Japanese journal of anesthesiology
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Patient-controlled sedation (PCS) using propofol under spinal anesthesia in transurethral lithotripsy was carried out in a 44 year old patient with von Gierke disease accompanied with liver dysfunction, chronic renal failure, hypoglycemia and metabolic acidosis. After administering spinal anesthesia PCS was started (0.2 mg.kg-1 intravenous bolus dose of propofol; infusion at 2 mg.kg-1.h-1; a three-minute lockout time interval following an initial doses of 0.4 mg.kg-1). ⋯ This patient was much satisfied with this sedation in an interview during the postoperative period. PCS using propofol is a useful method without respiratory depression for a patient with von Gierke disease.
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Comparative Study
[A comparative study of transcranial Doppler sonography and near-infrared spectroscopy for the assessment of cerebrovascular CO2 reactivity].
Simultaneous measurements of time averaged mean blood flow velocity in the right middle cerebral artery (Vmca) by transcranial Doppler sonography (TCD) and regional cerebral oxygen saturation (rSo2) by near-infrared spectroscopy (NIRS) were performed in 30 subjects under propofol /fentanyl/ oxygen anesthesia. End-tidal CO2 pressure (PetCO2) was controlled by adjusting minute ventilation. A paired measurements of Vmca and rSo2 was repeated at PetCO2 of 50, 45, 40, 35, 30, and 25 mmHg in each subject. ⋯ There were significant linear correlations between PetCO2 and Vmca (R > 0.94, P < 0.01), between PetCO2 and rVmca (R > 0.94, P < 0.01), between PetCO2 and rSo2 (R > 0.92, P < 0.01), and between rSo2 and Vmca (R > 0.88, P < 0.05) in each subject. Furthermore, there was a significant linear correlation between rVmca based CO2 reactivity and rSo2 based CO2 reactivity (R = 0.60, P < 0.001). These results indicate that measurements of rSo2 may be an alternative method for evaluating cerebrovascular CO2 reactivity when poor ultrasound window.
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A 28-year old female schizophrenic patient underwent electroconvulsive therapy (ECT) under propofol anesthesia. She received ECT five times, and Bispectral Index (BIS) was recorded four times out of the five ECT. BIS values (mean +/- SD) were 95.3 +/- 1.3 before anesthesia, 38.0 +/- 13.1 after loss of consciousness, 45.3 +/- 12.7 immediately after ECT and 27.3 +/- 11.6 about two minutes after ECT. In conclusion, ECT may decrease BIS during continuous propofol infusion.
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We investigated the effects of combined inhalational and lumbar epidural anesthesia on body temperature in 8 women for long-lasting lower abdominal surgery. Probes for forehead deep temperature and skin-surface temperatures were placed on the forehead, forearm, fingertip and toe tip on patients' arrival at the operating room. Tympanic membrane temperature was also measured. ⋯ In conclusion, anesthetics-induced redistribution of body heat significantly affects the core temperature throughout anesthesia. Peripheral hypothermia results in core temperature drop when the redistribution is induced by anesthetics. Thermoregulatory vasoconstriction may not only suppress heat loss but also increase core temperature through centralization of body heat.
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Randomized Controlled Trial Clinical Trial
[Reduction of pain on injection of propofol: a comparison of fentanyl with lidocaine].
We compared the effect of fentanyl and lidocaine on pain during injection of propofol. One hundred and sixty patients premedicated with midazolam were randomly allocated to one of four groups (n = 40, respectively); Group C, propofol 2 mg.kg-1; Group F, fentanyl 0.1 mg 3 min prior to propofol; Group L, lidocaine 40 mg added to 200 mg propofol; Group FL, fentanyl 0.1 mg 3 min prior to propofol mixed with lidocaine 40 mg. Propofol was injected via a vein on the dorsum of the hand in a half of the patients in each Group or the forearm vain in the other half. ⋯ Injection via the forearm vain tended to reduce the severity of pain compared with the vain on the dorsum of the hand. The time until loss of consciousness was significantly less in the groups receiving fentanyl than the groups without fentanyl (P < 0.01). In conclusion, prior administration of fentanyl is as effective as premixing of lidocaine in preventing the pain on injection of propofol, and the simultaneous application of them may abolish the pain.