Masui. The Japanese journal of anesthesiology
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Clinical Trial
[Pathway of the radial artery located with a small-caliber Doppler probe for arterial cannulation in pediatric patients].
The pathway of the radial artery of 23 patients, ranging in age from 17 days to 10 years, was located with a small-caliber Doppler probe, 1.5 mm in diameter, and the artery was punctured along the pathway traced on the skin surface. In all patients the arterial pathway, including its branch and diameter, was shown clearly. In 11 patients, ranging in weight from 5 to 24 kg, the artery was greater than 0.5 mm in diameter and was cannulated easily. ⋯ The thick tissue layer, including the skin and the subcutaneous layer over the small artery, was thought to interfere with the accurate location of the artery in the other six patients. Nevertheless, the arterial pathway traced on the skin surface facilitated successful percutaneous cannulation by another method in these six. Visualization of the arterial pathway by the small-caliber Doppler probe was thought to be helpful for percutaneous cannulation, with or without another cannulation method.
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For the efficient use of blood resources, we have adopted the Type and Screen system (T & S) and Maximum Surgical Blood Order Schedule (MSBOS) for elective operations. To evaluate the usefulness of these systems, we analyzed the crossmatched to transfused blood ratio (C/T ratio) for the period of one year before and after the adoption of the systems. ⋯ These results show the usefulness of these systems in perioperative blood transfusion system. It is possible to make use of blood more efficiently by further detailed re-evaluation of both T & S and MSBOS systems.
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We observed the histological changes in the spinal cord following percutaneous cervical cordotomy (PCC) and correlation of these changes with the efficacy of PCC in 7 cases. A fine monopolar electrode which we used, measured 0.25 mm or 0.27 mm in diameter with exposed length of 2 mm. An oval or elliptical-shaped lesion, 1 to 3 mm in width and 3 to 4 mm in length, was observed in 6 of these cases. ⋯ In these 5 cases, pain sensation on the opposite side of PCC was lost for a long time and pain was relieved until death (21-239 days after PCC). In the other 2 cases the lesion in the anterolateral column was tenuous or unrecognizable, and the loss of pain sensation was temporary with pain recurring by the next day. This study showed that an oval or elliptical-shaped lesion was made in PCC and that in cases in which main lesion was located in the anterolateral column, pain relief was long lasting.
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We report the anesthetic management of Cesarean section in a pregnant (31 weeks) woman with dilated cardiomyopathy. She had dyspnea and chest pain which were signs of congestive heart failure. The left ventricular ejection fraction was 38%. ⋯ There was no significant cardiovascular changes in the mother during the operation. The baby was apneic and showed no movement at birth, but he was immediately intubated and his condition became almost normal on the following day. In the anesthesiological management of Cesarean sections with cardiac disease, general anesthesia with fentanyl can be used to minimize cardiovascular changes in the mother as long as the baby is immediately resuscitated after delivery.
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Comparative Study Clinical Trial
[MAC-awake and wake-up time of isoflurane and sevoflurane with reference to the concentration of gas, duration of inhalation and patient's age and obesity].
We evaluated the influence of the concentration of volatile anesthetics, the duration of inhalation time, the patient's age and degree of obesity on MAC-awake (the end-tidal concentration of volatile anesthetics on awakening) and Wake-up time (the period from stopping inhalation to eye-opening in response to verbal command) following isoflurane (Iso) or sevoflurane (Sev) anesthesia in 240 patients (ASA I or II, age 17-84 yr). The patients were anesthetized with 50% oxygen, 50% nitrous oxide and various concentrations of Iso or Sev. ⋯ MAC-awake value of Iso was 0.14 +/- 0.05% (SD)% in all groups and that of Sev was 0.17 +/- 0.05% in Sev 0.9% group, 0.16 +/- 0.05% in Sev 1.3%, 0.17 +/- 0.06% in Sev 1.8%, respectively. All of them became smaller in aged groups than in younger groups but they were not influenced by the concentration of gas, the duration of inhalation nor the degree of obesity.(ABSTRACT TRUNCATED AT 250 WORDS)