Masui. The Japanese journal of anesthesiology
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We report the anesthetic management of a patient with cardiac sarcoidosis. Cardiac sarcoidosis is characterized by a high incidence of complete atrioventricular block, right bundle branch block, and ventricular arrhythmias. Cases of sudden death during stable cardiac function have been reported. ⋯ Anesthesia was induced with midazolam and vecuronium, and the trachea was intubated. Anesthesia was maintained with nitrous oxide, sevoflurane in oxygen. Anesthetic method adapted to prevent severe complications including sudden death resulted in good condition of the patient during the perioperative period.
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We evaluated the alterations of the brain stem and mid-latency evoked potentials (BAEP and MLAEP) in 10-patients who were scheduled for elective abdominal surgery under oxygen-nitrous oxide-sevoflurane anesthesia. With oxygen 2 l.min-1 and nitrous oxide 4 l.min-1, we measured the latency of BAEP and MLAEP at the end-expired sevoflurane concentrations of 0%, 0.3%, 0.6%, 1.0%, 1.5% and 2.0%, respectively. The latency of BAEP was slightly prolonged with oxygen-nitrous oxide-sevoflurane anesthesia. The latency of MLAEP was markedly prolonged with the increase of sevoflurane concentration, and all waves but Na wave disappeared at the 2.0% sevoflurane concentration.
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To evaluate the potentiating effect of nitrous oxide on the succinylcholine (SCh)-induced neuromuscular blockade, 0.16, 0.20, 0.25 or 0.31 mg.kg-1 of Sch was given during thiamylal-fentanyl anesthesia with or without nitrous oxide, and the evoked electromyograph of hypothenar muscles was measured. ED50 and ED95 in the group receiving nitrous oxide were 0.187 and 0.301 mg.kg-1, and 0.218 and 0.389 mg.kg-1 in the group not receiving nitrous oxide respectively. ⋯ It was demonstrated that nitrous oxide decreased electromyographically measured SCh requirements by 16.1%. In addition, the dose-effect relationship for SCh-induced neuromuscular blockade varied widely, and gender did not affect the degree of block.
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A 58 year old man in status asthmatics refractory to drug therapy, was relieved by long-term isoflurane inhalation. In status asthmatics, it takes long time to recover from airway-damage, and inhalation-time will be prolonged in many cases. ⋯ Especially, isoflurane did not cause an increase in the serum fluoride revel, and will not lead to renal insufficiency in spite of its inhalation for 120 hours. It seems that isoflurane is suitable for long-term inhalation.
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We measured the density and specific gravity at room (20 degrees C) and body (37 degrees C) temperatures of spinal anesthetic solutions, which have been commercially prepared in Japan. Solutions investigated were; (1) 0.4 % and 0.5 % tetracaine (T) in water, 0.5 % T in normal saline, 5 % glucose and 10 % glucose, (2) 0.3 % dibucaine in 5 % sodium chloride: (P), (3) 0.24 % dibucaine with 0.12 % tetracaine in 9.5 % glucose: (N); (4) 3 % lidocaine in 8.5 % glucose: (X); and (5) 0.5 % bupivacaine in water containing preservatives: (M). We also determined the density and specific gravity of normal human cerebrospinal fluid (CSF) in Japanese (n = 10) at 37 degrees C. ⋯ Thirty seven centigrade 0.5 % T in normal saline and 37 degrees C 0.5 % M in water had the density comparable to 37 degrees C human CSF and were considered to be relatively isobaric solutions. Our data demonstrated that human CSF had various densities. Therefore, it is possible that these isobaric solutions would vary their pharmacodynamic profiles in intrathecal use according to individual CSF characteristics and temperature of the solution.