Masui. The Japanese journal of anesthesiology
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Low flow anesthesia (LFA) using a fresh gas flow (FGF) of 600 ml.min-1 with oxygen and nitrous oxide flow each set at 300 ml.min-1, and dial setting of sevoflurane 3% was administered to 30 patients for a duration of 5 hours. There were no problems such as unsuitable concentrations of nitrous oxide and sevoflurane in inspired and expired gases or low FIO2 below 0.3 during anesthesia in 15 patients of group A. Their body weight was 53 +/- 5 kg. ⋯ It was suggested that in group A the FGF per body weight was suitable; in group B though oxygen flow was larger than oxygen consumption, hypoxia occurred due to saturation of nitrous oxide in the body; and in group C the FGF was insufficient. The compound A was detected in the breathing circuit, and the concentration was around 20 ppm and it did not depend on the duration of LFA. It was concluded in this study that LFA using the FGF of 600 ml.min-1 with setting of 3% sevoflurane, 50% oxygen and nitrous oxide, could be performed safely without risks such as hypoxia and severe delay of induction for patients weighing 53 +/- 5 kg for a duration of 5 hours.
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We investigated the effects of cardiac output on PETCO2 in anesthetized patients. We studied 8 adult patients undergoing long-lasting lower abdominal surgery. Anesthesia was maintained with epidural combined with inhalational anesthesia. ⋯ Thus, PETCO2 decreased with decreasing cardiac output. A decrease in PACO2 explained the decrease in PETCO2 better than an increase in VD/VT did. Decreased cardiac output caused hypocapnia through decreased CO2 production and/or increased ventilation to perfusion ratio i.e. relative hyperventilation.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Intravenous neostigmine enhances the analgesic effect of epidural anesthesia].
A single-blind trial of the intravenous neostigmine on epidural anesthesia was carried out on 75 patients undergoing lower limb or lower abdominal surgery. They were allocated to three groups of 25: patients of group C received 2 ml of 0.9% saline, patients of group AN 1 ml (0.5 mg) of atropine and 2 ml (1 mg) of neostigmine, and patients of group N 2 ml (1 mg) of neostigmine, intravenously 5 min before epidural injection of 15 ml of 2% mepivacaine solution without epinephrine. We assessed the onset and spread of cold sensory block and analgesia, and the degree of motor block and sedation. ⋯ The incidence of bradycardia and fecal incontinence was significantly higher in group N than in groups C and AN. These results demonstrate that intravenous neostigmine potentiates the analgesic effect of epidural anesthesia mediated by a cholinergic muscarinic mechanism. However, in clinical practice, it does not seem to be useful, because of the side effects.
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We experienced three cases of successful balloon catheter dilatation for bronchial stenosis under general anesthesia. There was no problem for two patients, but the third patient planned for stent insertion had bronchiomediastinal fistula. This procedure is generally performed under local anesthesia but more safely done under general anesthesia with muscle relaxants considering operative failure by bucking, pain of patients and prolonged procedure.
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Randomized Controlled Trial Clinical Trial
[Influence of preanesthetic medication on the effect of a local anesthetic tape].
We investigated the influence of preanesthetic medication on the pain relieving effect of the lidocaine tape during needle insertion for venous cannulation. Ninety patients scheduled for elective surgery were randomly divided into three groups of 30 each; patients without preanesthetic medication (group N), patients who received 0.1 mg.kg-1 of diazepam (group D) and 5 micrograms.kg-1 of clonidine (group C) as a preanesthetic medication. ⋯ No significant difference of the pain score was seen between the groups. We concluded that the effect of lidocaine tape was not influenced by the preanesthetic medication.