Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Effects of oral alpha 2 adrenergic agonists, clonidine and tizanidine, on tetracaine spinal anesthesia].
This study was conducted to evaluate the effects of oral clonidine and tizanidine, alpha 2 adrenergic agonists, as premedication for tetracaine spinal anesthesia in 63 gynecological patients. The patients were randomly allocated to one of six groups. Group 1 (n = 7), group 2 (n = 8) and group 3 (n = 7) received 13 mg of tetracaine intrathecally in 10 % glucose solution 2.6 ml. ⋯ Heart rate and systolic blood pressure in group 6 (clonidine-tetracaine-phenylephrine group) showed significant decreases (P < 0.05) after the spinal anesthesia. We concluded that oral premedication of clonidine and tizanidine prolonged tetracaine spinal anesthesia. From the view point of the prolongation of spinal anesthesia and the hemodynamic stability, oral premedication with tizanidine seems to be useful.
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Clinical Trial
[Effect of sevoflurane and nitrous oxide anesthesia on auditory brainstem responses in children].
The effect of sevoflurane and nitrous oxide anesthesia on the auditory brainstem response (ABR) was studied in 70 infants and children ranging in age between 1 month and 15 years. The latencies in ABR under a non-anesthetic state are no longer in the waves originating from the central portion in younger subjects. This tendency was recognized under ketamine anesthesia as control and sevoflurane and nitrous oxide anesthesia as well. ⋯ The changes in infants were relatively large compared with elder subjects. These concentrations did not decrease the amplitude of waves I, III and V significantly in any age group. Sevoflurane exerted little influence on ABR, and it would be useful for ABR testing in children.
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Randomized Controlled Trial Clinical Trial
[Bupivacaine-fentanyl continuous infusion is superior to morphine bolus injection in postoperative epidural analgesia].
We compared bolus injection of morphine 51 +/- 9 micrograms.kg-1 (M-S group) with 48 h-continuous infusion of bupivacaine and fentanyl mixture (BF-C group) for postoperative epidural analgesia in 100 patients who had undergone upper abdominal laparotomy. The epidural analgesia was started about 60 min before completion of surgery. The mixed solution, consisting of bupivacaine 48 ml (240 mg), fentanyl 24 ml (1.2 mg) and 0.9% saline (24 ml), was administered at a rate of 2 ml.h-1 by using a 100 ml balloon infuser. ⋯ There was no significant difference in side effects between the two groups. The plasma fentanyl concentration in the BF-C group (n = 5) was maintained almost constant for the period from 24 to 49 hours after the start of infusion and was approximately 1.6 ng.ml-1. We conclude that continuous infusion of bupivacaine (2.5 mg.ml-1) and fentanyl (12.5 micrograms.ml-1) at a rate of 2 ml.h-1 is superior to bolus injection of morphine for postoperative analgesia.
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Clinical Trial
[Pain management in advanced pediatric cancer patients--a proposal of the two-step analgesic ladder].
Pain treatment for 17 pediatric cancer patients in our institution was evaluated and disirable cancer pain management for children was discussed. Most of the patients (aged 1-17 years) suffering severe pain for about one month were in the advanced stage of the malignant diseases (e.g. leukemia). The pain etiology was mostly tumor-associated while therapy-related pain accounted for 23.5%. ⋯ Moreover sufficient doses for the pain relief are not necessarily given to the pediatric patients because of a limit to the dosage of NSAIDs. The period of pediatric cancer pain in which the patient require a methodical treatment and receive benefit from pain relief is relatively short in the advanced stage, not to mention the early stage in which chemotherapy is efficacious against cancer disease itself. Therefore, to obtain effective pain control within a short time, the authors propose the pain management for advanced pediatric cancer patients by the two-step analgesic ladder prescribing weak or strong opioid analgesics first, adapted from the three-step ladder of the WHO Cancer Pain Relief, 1986.
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The author introduces a new laryngoscope 'MacCoy Laryngoscope' and report its characteristics. The design of this laryngoscope is based on the standard Macintosh blade and it is attached to a standard handle. The characteristics of this laryngoscope are the hinged blade tip, which is controlled by a lever attached to the blade. ⋯ Therefore this laryngoscope reduces the force employed during laryngoscopy and eliminates contact with the upper teeth. It does not require any special training in its use. The MacCoy Laryngoscope is useful for both routine and difficult intubation.