Masui. The Japanese journal of anesthesiology
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Isoflurane often produces tachycardia during clinical anesthesia. We examined the effect of a stepwise increase of isoflurane concentration on hemodynamic parameters in the absence or presence of nitrous oxide (N2O). After induction with thiamylal (3 mg.kg-1), isoflurane in oxygen or in 66% N2O-oxygen was administered with mask ventilation. ⋯ Isoflurane tended to increase HR in a dose-related manner and induced a hyperdynamic response during rapid increasing of isoflurane concentration. This response may have beed caused by the irritating effect of isoflurane on the airways. Addition of N2O attenuated this response because it increases the speed of induction and the depth of anesthesia.
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Randomized Controlled Trial Clinical Trial
[Effects of pressure support ventilation (PSV) or PSV+PEEP on the respiratory function during general anesthesia under spontaneous ventilation].
This study was performed to examine the hypothesis that PSV with PEEP compared to spontaneous breathing with a circle anesthesia system may have beneficial effects on gas exchange and work of breathing during inhalational anesthesia. Nine patients (age; 58 +/- 20 yr) scheduled to receive general anesthesia for orthopedic (n = 3) or ENT (n = 6) surgery were randomly assigned in a triple cross-over manner to breathe with a standard anesthesia circle system, 5 cmH2O PSV, and 5 cm H2O PSV above 5 cmH2O PEEP. General anesthesia was induced with thiamylal (5 mg.kg-1) and succinylcholine (1 mg.kg-1), followed by tracheal intubation. ⋯ PaCO2 was lower during PSV+PEEP, but the difference was not significant. This level of PSV or PSV with PEEP may have little beneficial effects on gas exchange in our study condition. The mean WOBp was smaller in the PSV with PEEP group but the difference was not statistically significant.
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Clinical Trial Controlled Clinical Trial
[Effect of celiac plexus block and thoracic epidural block on arterial ketone body ratio].
We evaluated the effect of intraoperative celiac plexus block (CPB) and thoracic epidural block (TEB) on arterial ketone body ratio (AKBR) in the patients undergoing total or partial gastrectomy. Mean arterial pressure (MAP), heart rate, AKBR, and arterial blood gas were measured at the end of esophago-jejunostomy, gastro-duodenostomy, or gastro-jejunostomy (pre-block) and at the end of operation (post-block), respectively. After pre-block measurement, CPB with 99.5% ethanol 15-20 ml was carried out in 8 patients with advanced gastric cancer (CPB group); TEB with 2% lidocaine was performed on 8 patients (TEB group); and neither CPB nor TEB was done on 8 patients (control group). ⋯ However, there were no difference in AKBR, pH, and BE between pre-block values and post-block values in TEB group as in the control group. These findings suggest that ethanol used in CPB reduces the redox state of hepatic mitochondria and increases lactate. Therefore we should pay attention to the changes in AKBR, pH, and BE after celiac plexus block with ethanol.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of subcutaneous administration of buprenorphine with patient controlled analgesia system for post-operative pain relief].
We conducted a study comparing patients receiving continuous subcutaneous administration of analgesia with self controlled analgesia system (CSAA group) with those receiving continuous epidural infusion (Epi group) for postoperative analgesia after abdominal surgery. Fourteen patients were randomized into two groups: CSAA group (n = 7) received 20 micrograms.h-1 of buprenorphine (Bu) subcutaneously with additional 20 micrograms of Bu using Baxter infusor BB+PCA; Epg group (n = 7) received continuous epidural infusion of 0.4 mg of Bu and 46 ml of 0.25% bupivacaine daily (16.7 micrograms.h-1 of Bu) using Baxter infusor 2 ml.h-1 type. In both groups, patients received supplemental 0.1 mg of Bu subcutaneously as needed. ⋯ There was no severe side effect in both groups. We conclude that continuous subcutaneous administration of analgesic was effective for postoperative analgesia, and almost the same analgesic effect was obtained as compared with continuous epidural analgesia. We calculated that the adequate dose of Bu subcutaneously during early postoperative period to be about 30 micrograms.h-1 of Bu.
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Randomized Controlled Trial Clinical Trial
[Effect of continuous infusion of flumazenil on unexpected postoperative resedation by midazolam].
Resedation after general anesthesia induced by midazolam is thought to be not an unusual problem for the anesthetists. We investigated the effect of continuous infusion of flumazenil on the patients who had general anesthesia using midazolam as an induction agent and had flumazenil for prolonged recovery after procedure. Fourteen of 54 patients were judged as prolonged recovery and were given 0.25 mg of flumazenil. ⋯ In the second group, 0.25 mg of flumazenil in 250 ml of lactated Ringer's solution was given continuously for 2 hours after the first flumazenil. All the patients were fully awake after the first flumazenil but one case of resedation occurred in the first group and in none of the patients in the second group. We conclude that continuous infusion of 0.25 mg of flumazenil for 2 hours is effective and makes anesthetist free from anxiety of postoperative resedation by midazolam.