Masui. The Japanese journal of anesthesiology
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We examined 171 patients who had undergone anterior cervical fusion to determine the frequency and the causes of postoperative respiratory disturbance (PRD). Postoperative tracheal intubation was necessary in 11 patients (6.4%), but only 4 of them (2.3%) required reintubation due to PRD caused by surgical procedures. ⋯ As C 3 was fused in the 4 patients with PRD, requiring reintubation, upper airway obstruction due to serious swelling of the soft tissue surrounding C 3 might be the factor leading to postoperative reintubation. One of the PRD patients who suffered from postoperative unilateral phrenic nerve palsy required controlled ventilation.
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We investigated the relationship between maintenance bolus dose of vecuronium bromide (Vb) and the recovery time measured by TOF Guard in patients anesthetized with isoflurane (1.2-2.0%)-N2O-O2 (GOI group, n = 19) and epidural anesthesia (2% mepivacaine) plus isoflurane (0.5%)-N2O-O2 (EPI group, n = 14). In both groups, anesthesia was induced with propofol 2 mg.kg-1 and Vb 0.1 mg.kg-1 and ventilation was controlled to keep end tidal CO2 between 35-40 mmHg. When the muscle relaxation recovered to 25% of train-of four ratio (TOFR), doses of Vb 0.06, 0.04 or 0.02 mg.kg-1 were administered. ⋯ There were no significant differences in the recovery time between these two groups. In both groups, although the recovery time to TOFR 25% was prolonged significantly in proportion to the increasing doses of Vb, the increase did not correlate with the dose of Vb. We suggest that frequent administration of Vb 0.02 mg.kg-1 decreases the total amount of Vb to keep TOFR within 25%.
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Comparative Study Clinical Trial
[A comparison of the incidence of postoperative nausea and vomiting after propofol-fentanyl anesthesia and that after nitrous oxide-isoflurane anesthesia].
We compared the incidence of postoperative nausea and vomiting after total intravenous propofol-fentanyl anesthesia (TIVA group) and that after thiamylal-nitrous oxide-isoflurane anesthesia (GOI group) in 60 ASA physical I and II patients for elective abdominal simple total hysterectomy. When the patients returned to the ward, the incidence of nausea was lower in TIVA group than in GOI group (P < 0.05), but no difference was found in the incidence of vomiting between the two groups. ⋯ Postoperative pain scores were similar between the two groups, while total postoperative evaluation scores (nausea, vomiting, pain, fever, and sleep disturbance) were lower in TIVA group (P < 0.05). We conclude that TIVA with propofol-fentanyl reduced the incidence of nausea and improved total evaluation scores in the immediate postoperative period.
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Pharmacokinetics of propofol and ketamine during propofol-fentanyl-ketamine (PFK) anesthesia for pediatric surgery was studied. Plasma levels of propofol (Pp) were maintained approximately at 2.5 micrograms.ml-1 during surgery. Fifteen minutes after the cessation of propofol infusion, Pp decreased to 1.5 micrograms.ml-1. ⋯ On the other hand, plasma norketamine (Pn) levels increased gradually during surgery and stayed at 100-150 ng.ml-1 after the end of ketamine infusion to play an important role in post-operative sedation and pain relief. In conclusion, pharmacokinetics of propofol and ketamine in pediatric patients was similar to that in adult patients. PFK anesthesia can be used safely for pediatric as well as for adult patients.
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We gave anesthesia twice to a 4-year-old boy with congenital sensory neuropathy with anhydrosis. At the first surgery, anesthesia was induced with midazolam and maintained with nitrous oxide, oxygen and sevoflurane 0.5-0.8% under mask breathing. Surgery was performed without any trouble but the patient vomited postoperatively for three days. ⋯ The patient often moved during surgery, and therefore, we changed from propofol to oxygen and sevoflurane 1.0-1.5% anesthesia. Nitrous oxide was not used. After the surgery, no vomiting occurred.