Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Effect of injection speed on sensory blockade in spinal anesthesia with 0.5% hyperbaric tetracaine].
We investigation the effect of injection speed on sensory blockade in spinal anesthesia. Forty two female patients, scheduled for total abdominal hysterectomy, were allocated randomly to 3 groups of 14 each according to the injection speed of 0.5% hyperbaric tetracaine: Group F (fast; injection speed > or = 0.2 ml.s-1), Group M (moderate; 0.1 < injection speed < 0.2 ml.s-1) and Group S (slow; injection speed < or = 0.1 ml.s-1). Spinal puncture was performed via the median approach at the L3-4 interspace with the patient in a lateral position. ⋯ In our opinion, anesthetics injected slowly were diluted less by CSF, and the actual baricity of them was higher, and this made the difference within 30 min. In Group M, anesthetic effects and patient's condition were stable. We suppose that this injection speed (0.1-0.2 ml.s-1) is suitable for spinal anesthesia.
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Acute angle-closure glaucoma is a rare complication of surgery. We experienced a case of postoperative acute glaucoma after total hip replacement under general anesthesia. A 49-year-old female without signs or symptoms of glaucoma was premedicated with the intramuscular administration of secobarbital, atropine and ranitidine. ⋯ The laser iridotomy performed on her at 5th and 7th post-operative days improved her vision completely. The post-operative glaucoma may cause serious permanent loss of vision. An early diagnosis of this post-operative complication and its treatment with drugs and surgery should be emphasized.
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We investigated the effects of low-dose prostaglandin E1 (PGE1) on serum and urinary concentrations of inorganic fluoride in 39 adult patients undergoing upper abdominal surgery. Anesthesia was maintained with a combination of N2O-O2-sevoflurane and thoracic epidural anesthesia. Twenty-two patients received infusion of PGE1 at a rate of 0.02 micrograms.kg-1.min-1 throughout surgery. ⋯ Urinary fluoride excretion during surgery was significantly greater in PGE1 group than in control group. These results suggested that PGE1 might prevent elevation of serum and urinary fluoride concentrations in patients receiving high-dose sevoflurane. This effect might result from enhanced urinary excretion of fluoride with PGE1.
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To determine the optimum dose of lidocaine administered in the trachea prior to endotracheal intubation, we divided 102 surgical patients 3-5 years of age into 3 groups, i.e., group 1; 1 mg.kg-1 was sprayed in the trachea, group 2; 2 mg.kg-1 was sprayed in the trachea, group 3; 1 mg.kg-1 was sprayed in the trachea, and 1 mg.kg-1 in the pharynx and the oral cavity simultaneously. The venous serum concentration of lidocaine was measured two times either 1.5, 3, 5, 10, 15, 20, 30 or 45 min after the spray in each case. In group 1, the mean concentration of lidocaine reached the maximum of 1.05 micrograms.ml-1 at 5 min and decreased gradually after that with a small inter-individual variation. ⋯ There were a few cases where serum level was over 7 micrograms.ml-1. In group 2, after reaching the mean maximum concentration of 1.38 micrograms.ml-1 at 5 min, the serum level decreased more slowly, suggesting a slow absorption from the pharynx and/or the oral cavity. We conclude that the recommended dose of lidocaine for endotracheal administration is less than 2 mg.kg-1.
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Clinical Trial
[The effect of vasodilator on the occurrence of postoperative shivering and the fall of core temperature].
We evaluated the effect of intraoperative vasodilator therapy on the occurrence of postoperative shivering and the fall of core temperature during 37 abdominal operations by the stepwise multiple regression analysis. As the vasodilator, we used PGE1 at the dose of 0.02-0.05 microgram.kg-1.min-1. ⋯ And intraoperative and postoperative core temperatures were not affected by that therapy. From these results, we conclude that intraoperative vasodilator therapy suppressed the occurrence of postoperative shivering without a fall of core temperature.