Masui. The Japanese journal of anesthesiology
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A program for on-line simulation of blood propofol concentration was developed. Various pharmacokinetic model programs are available for the estimation of intravenous anesthetic concentration. But manual entry of data such as body weight, rate of infusion and the timing of changing the flow rate is mandatory in these programs. ⋯ Based on the obtained data, pharmacokinetic model was solved with personal computer. Calculated blood concentrations of propofol were displayed in a numeric form and a trend graph was obtained. This program provides useful information for maintainance of anesthesia with propofol.
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In the second part of this review, we summarized the effects of alpha 2-adrenoceptor agonists (clonidine and dexamedetomidine) in regional anesthesia and pain control, and evaluated their usefulness as anesthetic adjuvants and analgesics in the clinical settings. In addition, we referred to practical problems associated with their use.
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Case Reports
[Postoperative pain relief for a patient with elective mutism by patient controlled analgesia].
We previously reported that intrathecal (i.t.) administration of morphine reduced postoperative pain in pediatric patients after spinal instrumentation for scoliosis (Cotrel-Dubousset method), and the i.t. administration of morphine before incision produced better pain relief than that given after the surgical procedure. In this study, we evaluated postoperative pain relief in a patient with elective mutism who had been given i.t. morphine 0.15 mg before surgery. The patient was scheduled to undergo patient controlled analgesia (PCA) intravenously with morphine after surgery. ⋯ The used morphine volume shown on a PCA device was evaluated at scheduled times. No patient developed hemodynamic instability or respiratory depression during the monitoring period. We conclude that PCA can be useful for the patient with elective mutism.
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Randomized Controlled Trial Clinical Trial
[Intraoperative continuous epidural lidocaine combined with preoperative administration of epidural morphine for post-hepatectomy pain relief].
In a randomized double-blind study, the use of continuous epidural lidocaine during surgery combined with preoperative epidural morphine was compared with that of preoperative epidural morphine alone for postoperative analgesia in 20 patients undergoing hepatectomy. Morphine 2 mg was administered through a catheter inserted epidurally at T10-11 before surgery, followed by continuous epidural administration of 1% lidocaine 5ml.h-1 in group Lid (n = 10) or normal saline 5ml.h-1 in group NS (n = 10) during surgery. Anesthesia was maintained with N2O-O2-isoflurane in both groups. ⋯ All patients in both groups had adequate analgesia for the remainder of their stay in the ICU. No patient had any serious adverse effect. We conclude that continuous epidural administration of lidocaine during hepatectomy combined with administration of epidural morphine just before surgery results in better pain relief during the early postoperative period than that obtained with epidural morphine alone, and is without serious side effects.
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Comparative Study
[Cervical spine movement during orotracheal intubation using the McCoy laryngoscope compared with the Macintosh and the Miller laryngoscopes].
The movement of cervical spine during orotracheal intubation was compared using the McCoy, Macintosh or Miller laryngoscope blade. Twenty ASA 1-2 patients requiring tracheal intubation were studied. ⋯ The results indicated that delta C1-occiput was larger and delta C1 + C5 smaller with the McCoy laryngoscope compared with the others. The use of the McCoy laryngoscope results in less cervical spine movement during laryngoscopy and therefore should be of particular benefit in the presence of cervical spine instability as well as in the normal patients.