Masui. The Japanese journal of anesthesiology
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Case Reports
[Anaphylactic reaction to aprotinin following topical use of biological tissue sealant].
Biological tissue sealant is used for facilitation of intra-operative hemostasis. It is composed of cryoprecipitated fibrinogen, bovine-thrombin and bovine-aprotinin. In this report, we describe a 38-yr-old woman in whom severe anaphylactic shock occurred immediately after the topical use of biological tissue sealant on the completion of modified radical mastectomy. ⋯ The level of CH50, C4, C1q and C5 decreased in the serum sample immediately after the shock, but C3 was unchanged. It was considered to be a direct degradation of the complement by the proteolytic enzymes. Biological tissue sealant should be used cautiously bearing in mind the possibility of anaphylactic complication.
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Hare lip and cleft palate surgery team activities in Cambodia were launched in 1989 by a non-governmental Japanese organization, Operations Unies. The objectives of the project are to provide appropriate surgical treatment and safe general anesthesia for local patients and also to conduct technology transfer of general anesthesia and surgery to the local medical staffs. From June 1991 to January 1993, a surgery/anesthesia team was dispatched 4 times and a total of 130 patients received surgical treatments under general anesthesia. ⋯ The reasons why we chose intravenous agents are difficulty in obtaining inhaled agents in Cambodia and lack of scavenging system in a operating room. Although halothane anesthesia with spontaneous breathing has been recommended in developing countries, total intravenous anesthesia could be one of the applicable techniques in these countries. In Cambodia, shortage of medical doctors and the absence of anesthesiologist constitute a major barrier to technology transfer in clinical anesthesia.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[A comparison between neuromuscular blocking effects of pipecuronium and vecuronium; a double blind controlled study in collaboration with 5 departments of anesthesiology].
Neuromuscular blocking effects of pipecuronium bromide 0.04 mg.kg-1 were compared those of vecuronium bromide 0.08 mg.kg-1 in a double blind study. Fifty surgical patients (ASA I or II) were allocated randomly to two groups of each 25 cases and they were anesthetized with nitrous oxide 4 l.min-1, oxygen 2 l.min-1 and isoflurane 1 MAC. Neuromuscular blockade was monitored by using mechanical twitch responses of the thumb to electrical stimulations of the ulnar nerve. ⋯ The blocks by both drugs responded to neostigmine. Cardiovascular side effects of the both agents were not found. From these results, it is concluded that pipecuronium is a useful nondepolarizing relaxant with a long duration of action and negligible side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effects of continuous interpleural vs. epidural infusion for postoperative pain relief following thoracotomy].
We studied whether continuous interpleural infusion of bupivacaine would be effective in alleviating pain after thoracotomy compared with effect of continuous epidural infusion of bupivacaine and buprenorphine. Twenty patients who had received thoracotomy and lobectomy were randomly divided into two groups to receive continuous interpleural infusion (IP group) of 0.5% bupivacaine at the rate of 5 ml.h-1 or continuous epidural infusion (E group) of 0.25% bupivacaine and 0.025 buprenorphine at the rate of 1 ml.h-1. The patients assessed their level of pain using a 100 mm visual analog scale (VAS) at rest and on coughing or changing the posture, verbal descriptor pain scale (VDPS), and times of supplemental analgesic. ⋯ VAS on coughing or changing the posture in IP group was significantly higher than in E group in the evening of the day of surgery, and VASs on coughing or changing the posture in IP group were higher than in E group for 3 postoperative days. Supplemental analgesics were administered significantly more often than in E group in the evening of the first postoperative day. We conclude that continuous interpleural infusion does not give better analgesia than continuous epidural infusion after thoracotomy.
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Randomized Controlled Trial Clinical Trial
[Effect of indomethacin as an adjunct to postoperative pain relief by continuous epidural infusion of bupivacaine and buprenorphine].
We examined the analgesic effects of indomethacin as an adjunct to postoperative epidural analgesia in 40 patients who underwent upper abdominal surgery. Twenty patients in control group were epidurally given 0.1 mg of buprenorphine in 8 ml of 0.25% bupivacaine immediately after surgery and subsequently infused 15 micrograms buprenorphine in 1 ml of 0.25% bupivacaine at a rate of 1 ml.h-1 for 48 h. ⋯ The patients who did not need additional narcotics in the control and indomethacin groups were 45% and 80%, respectively (P < 0.05). In upper abdominal surgery, postoperative pain relief by epidural buprenorphine and bupivacaine plus rectal indomethacin was more effective than that by epidural buprenorphine and bupivacaine.