Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[The effect of preoperative oral fluid intake on the volume and pH of gastric contents in elective surgical patients--a comparison of tea with apple juice].
This study aimed to investigate the effect of 150 ml of either tea or apple juice on the volume and pH of gastric contents in 40 elective surgical patients, ranging in age from 18 to 70 years. They were given diazepam 5 approximately 10 mg and roxatidine 75 mg orally 2 hours before the start of isoflurane anesthesia or modified neuroleptic anesthesia. ⋯ There was a significant difference in the gastric volume between the two groups (P < 0.05), while no significant difference in gastric pH was observed. This result suggests that apple juice is not appropriate as preoperative drink because apple juice increases gastric contents, and may cause aspiration pneumonia.
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We experienced a difficult orotracheal intubation in a patient with Cornelia de Lange syndrome. The patient was an eight-year-old girl with Cornelia de Lange syndrome, cleft palate and tetralogy of Fallot who underwent emergency hemicolectomy for strangulation ileus. ⋯ The patient's condition was stable during both intubation and operation. In conclusion, we must be careful on endotracheal intubation of patients with congenital anomalies.
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Most general anesthetics, opioids, sedatives and local anesthetics perturb thermoregulatory responses. Accordingly the core temperatures triggering sweating, thermoregulatory vasoconstriction and shivering are varied in perioperative periods. Redistribution hypothermia is a quite common phenomenon during not only general anesthesia but epidural/spinal anesthesia. ⋯ However, obtaining effective decrease of core temperature is sometimes difficult because of thermoregulatory vasoconstriction. Subsequently, vasodilation therapy with appropriate drugs is now under investigation. Hypothermia per se causes critical complications in patients, and the maintenance and warming method to maintain normothermia is important in perioperative period.
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Recent reports of cauda equina syndrome following continuous spinal anesthesia have generated concern regarding the safety of not only this particular technique but also of the local anesthetic agent itself. This concern has been reinforced by data suggesting that similar injuries have occurred with repeated injection after a "failed spinal", and by reports of transient radicular irritation following single subarachnoid injection. ⋯ These experiments suggest that the recent injuries resulted from a direct effect of the local anesthetic and that anesthetic-induced impairment does not result from blockade of the sodium channel, per se. These experiments also suggest that development of a safer anesthetic is a realistic goal.
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Comparative Study
[Sevoflurane comparably decreases the threshold for thermoregulatory vasoconstriction as isoflurane].
The core temperature triggering thermoregulatory arteriovenous shunt constriction is defined as the threshold for vasoconstriction. Vasoconstriction helps prevent further core hypothermia by decreasing cutaneous heat loss and constraining metabolic heat to the core thermal compartment. A previous study showed isoflurane inhibited thermoregulatory threshold. ⋯ Morphometric characteristics were comparable in each group. The threshold for vasoconstriction was 35.1 +/- 0.4 degrees C in the patients given 1.0 MAC sevoflurane, which was comparable that in those given 1.0 MAC isoflurane: 35.3 +/- 0.7 degrees C. We thus conclude that sevoflurane impairs thermoregulation comparably with isoflurane.