Masui. The Japanese journal of anesthesiology
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Case-1: A 72-year-old woman with no past neurological history was scheduled for a rectum resection under general combined with epidural anesthesia. An epidural catheter was introduced at T11-12 interspace without any difficulties. During the operation, she had hypotensive episode needing dopamine, but waked up from anesthesia without any event. ⋯ The MRI examination two weeks after the operation showed degeneration below middle thoracic spinal cord. His neurologic symptoms have not improved for two years. The etiology of neurologic deficits of these two case is not obvious although the relation between epidural anesthesia and neurologic symptoms was most likely.
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We studied the relationship between postoperative brain dysfunction and the state of atherosclerosis in the patients of open heart surgery, by analyzing the intraoperative cerebral oxygen saturation (rSO2) and the CO2 reaction. The subjects were 143 patients with average age of 64 years. ⋯ There were significantly high values of AI and beta as well as low rSO2, in elder age with low cardiac index and no correlation was observed between rSO2 and PaCO2 in the brain dysfunction group. The results suggested that a higher level of atherosclerosis is associated with the postoperative brain dysfunction with resultant decreased cerebral blood flow and disturbed reaction to CO2 of cerebral blood vessels.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effects of sevoflurane and isoflurane on hepatic blood flow in man].
The influences of sevoflurane and isoflurane on hepatic blood flow (HBF) in man were investigated employing the method of continuous infusion of indocyanine green. HBF and cardiac output (CO) were measured in patients before and after induction of anesthesia with thiamylal, fentanyl, and N2O, and again during isoflurane (n = 9) or sevoflurane (n = 8) anesthesia before the start of surgery. ⋯ Although CO decreased similarly in both groups during anesthesia, the HBF/CO ratio in isoflurane group increased significantly, and the ratio in sevoflurane group did not change significantly. We conclude that whereas isoflurane increases HBF, sevoflurane does not change it in anesthetized patients.
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A study using 14C propofol showed that the liver is the main eliminating organ for the agent. The current study was designed to clarify pharmacokinetics of propofol during liver transplantation in pigs. Five small pigs weighing 25.4 +/- 2.5 kg were anesthetized with isoflurane (0.5-1.5%) and mechanically ventilated under muscle paralysis with pancuronium. ⋯ We studied pharmacokinetic parameters following an intravenous bolus injection of propofol at 2 mg.kg-1 in each phase, i.e. the pre-anhepatic, anhepatic and post-anhepatic phase during liver transplantation. Pharmacokinetic analysis showed that total plasma clearance of propofol in the anhepatic phase was significantly lower than that in the post-anhepatic phase. The results suggest that propofol may be metabolized extrahepatically and can be used at reduced doses in the anhepatic phase during liver transplantation.
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Case Reports Comparative Study
[Comparison of the effects of halothane, isoflurane and sevoflurane in the treatment of severe asthmatic attack: a case report].
A 19-year-old woman suffered from a severe asthmatic attack. She did not respond to any of the conventional therapies and eventually lapsed into a state of unconsciousness. ⋯ The inhalation of isoflurane, halothane and sevoflurane decreased the airway resistance and systemic vascular resistance in direct relationship to the dosage administered. Because the patient's metabolic rate is low and the occurrence of arrhythmias is rare with isoflurane, we concluded that isoflurane is the best alternative for the patient with asthma.