Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[Anesthesia induction for laryngeal mask insertion--comparison of propofol with midazolam and propofol with thiopental].
We compared the patient's response to laryngeal mask (LM) insertion and hemodynamics among three anesthesia induction methods; P group using 2.5 mg.kg-1 propofol with 0.2 microgram.kg-1 fentanyl, M group using 0.2 mg.kg-1 midazolam with 0.2 microgram. kg-1 fentanyl, B group using 5 mg.kg-1 thiopental with 0.2 microgram.kg-1 fentanyl. Each 30 patients, 35 to 65 years, for elective mastectomy were entered in three groups. Preanesthetic medication was i.m. injection of 0.5 mg atropine and 5 mg midazolam 30 min before the induction. ⋯ The number of patients with difficult insertion or showing body movement or gagging were larger in the order of M group > B group > P group. Blood pressure and heart rate in the P group were significantly lower than those in the other two groups. It was concluded that P allowed the most smooth insertion of LM among the three groups, but it also induced hypotension and bradycardia.
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Comparative Study
[A simple, lightweight device for measurement of hemoglobin; the HemoCue Blood Hemoglobin Test].
In some situations such as a sudden bleeding during surgery, rapid testing of blood hemoglobin concentration is necessary. The HemoCue Blood Hemoglobin Test uses a lightweight photometer, which is easily movable anywhere. The HemoCue needs only 10 microliters of blood and it takes only about 45 seconds to produce the result. ⋯ To evaluate the accuracy of the HemoCue, we compared the blood hemoglobin concentrations measured by the HemoCue with those measured by the ABL 300. A positive correlation was found between the variables by the HemoCue (Y) and those by the ABL 300 (X); Y = 0.944X - 0.208, r = 0.97, P < 0.001. It is concluded that the HemoCue is a reliable device for measurement of blood hemoglobin concentration.
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Comparative Study
[Effects of halothane and sevoflurane on reversal of neuromuscular blockade induced by vecuronium in man].
To evaluate residual effects of inhalational anesthetics after reversal of neuromuscular blocking agent, neuromuscular function was monitored after halothane or sevoflurane anesthesia in thirty-seven patients (ASA physical status I or II) for elective surgery after obtaining informed consent. Electromyograph of the adductor pollicis muscle in response to train of four (TOF) stimulation was monitored throughout the study. The first twitch of TOF (T1; % of its control) and the ratio of the fourth twitch to the first twitch of TOF (T4/T1; TR) were recorded at 0, 2, 5, 10, and 15 min after reversal. ⋯ Both T1 (75.4 +/- 12.2%) and TR (68.0 +/- 12.6%) at 15 min after the reversal during 3% sevoflurane inhalation were below those of the stable group. We conclude that the residual sevofulrane after discontinuation of inhalation may impair the neuromuscular transmission after the reversal of neuromuscular blockade. Neuromuscular function should be monitored after the end of anesthesia even though the patient is fully awake.
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A 33 year-old parturient with triplet pregnancy underwent emergency cesarean section at 35 week of gestation under general anesthesia. The patient had received magnesium sulfate to prevent uterine contraction immediately before the cesarean section. Although serum magnesium value was not beyond therapeutic levels (3.3 mEq.l-1), the neuromuscular blocking effects with vecronium were strengthened. ⋯ In addition, it is possible that magnesium could interfere with postpartum uterine contractions because of its tocolytic properties. Magnesium sulfate therapy has several implications to anesthetic agents. We, anesthesiologists, should know about the biophysiological effects of magnesium and control the interaction between anesthetic agents and this electrolyte.
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To evaluate the effect of prostagrandin E1 (PGE1)-induced hypotension on cerebral blood flow (CBF) and carbon dioxide (CO2) reactivity of CBF, regional cerebral hemoglobin oxygen saturation (rSo2) was measured in non-neurosurgical patients (n = 10) under sevoflurane-anesthesia using near infrared spectroscopy. PGE1 was infused intravenously to maintain arterial pressure at a level of about 75% of the MAP (hypotensive group) under sevoflurane-anesthesia alone (normotensive group). Ventilation was controlled to adjust PaCO2 to hypocapnia (25-30 mmHg), normocapnia (35-40 mmHg) and hypercapnia (45-50 mmHg) in both normotensive and hypotensive groups. rSo2 during hypotension did not change by hypocapnia and normocapnia, but significantly increased by hypercapnia, compared with rSo2 during normotension. ⋯ When arterial oxygen content and cerebral metabolic rate of oxygen are constant, changes in rSo2 correlate with those of CBF. Therefore, CBF and CO2 reactivity of CBF that indicates autoregulation in response to changes in CO2 during hypotension were maintained as those during normotension. The results show that PGE2-induced hypotension maintains CBF and CO2 reactivity well in non-neurosurgical patients under sevoflurane anesthesia.