Masui. The Japanese journal of anesthesiology
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We measured fluctuation of injection pressure by several types of commercially available syringe pumps in order to investigate the effect of syringe volumes (Terumo syringe) and speed settings on the irregularity of injection speeds. We recorded the injection pressure continuously with various speed settings, except that one of the pumps injected irregularly at the settings of 2 and 1 ml.h-1. With 50 ml syringes, only two of the six pumps injected precisely at all the speed settings. ⋯ With 30 ml syringes, injection pressures fluctuated in most of the six syringe pumps at a speed lower than 5 ml.h-1. In conclusion, changes in injection pressures depend on types of syringes, syringe volumes and speed settings. We urge not to use a 30 ml syringe to infuse vasoactive drugs with syringe pumps.
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In 31 cases of trans-urethral resection of the prostate (TUR-P), the lumbar epidural block was carried out with the catheter placed caudad. In 23 of 31 cases, it was found that the catheters were inserted caudad with coiling, but not so distant from the puncture site. In 3 cases, the catheters were placed caudad beyond a vertebral segment, in 2 cases cephalad, in another 2 cases passed through the intervertebral foramen, and in the other case the position undetectable. ⋯ In 3 cases, the catheters were successfully placed caudad beyond a vertebral segment and the levels of analgesia 10 minutes after the injection were T11-T10 to S3-S5. In the anesthetic management of TUR-P, it is necessary to obtain complete analgesia in sacral segments and to avoid high thoracic epidural block. We concluded that this method was useful for the anesthetic management of TUR-P.
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A retrospective study was conducted on the cause of hypotension during spinal anesthesia and also on the relation between the level of anesthesia and the hypotension. Two hundred twenty three patients who had received spinal anesthesia for gynecological surgery were divided into two groups. Group I consisted of 87 patients with a significant decrease in blood pressure, while group II consisted of 136 patients with no significant decrease in blood pressure. ⋯ The degree of hypotension was greater at higher levels of spinal anesthesia. More than 50% of the patients with T5 or higher levels of anesthesia had a significant decrease in blood pressure. We conclude that the cause of the significant decrease in blood pressure during high spinal anesthesia is in most part due to the blockade of the cardiac sympathetic nerve.
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Case Reports
[Clinical experience of extracorporeal life support with the use of centrifugal pump ECMO].
Many reports have documented the good results with the use of extracorporeal life support in severe respiratory and circulatory failure. In our institution, we have used the centrifugal pump (Bioconsol 540: Biomedicus Co. Ltd.) ECMO for extracorporeal life support, and obtained good results in three cases. ⋯ Duration of total bypass in three cases were 34, 51 and 140 hours, respectively. Recent reports on the use of centrifugal pump have indicated that it can bring excellent results of circulatory assist for cardiogenic shock. Compared to the roller pump method, the use of centrifugal pump ECMO was very simple, and could serve as an effective method for providing improvement in a relatively short period.
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Several recent studies evaluated alkali therapy for lactic acidosis (LA). We studied the effects of sodium bicarbonate (NaHCO3) on LA due to hemorrhagic shock in dogs. After inducing hemorrhagic shock in twelve mongrel dogs, we divided them into two groups: the first group was treated with 7% NaHCO3 and the second with 4.9% sodium chloride (NaCl). ⋯ Arterial pH and base excess increased significantly in the NaHCO3 group. The increases of pyruvate and lactate were significantly greater in the NaHCO3 group than in the NaCl group, but the other metabolic data were not significantly different. We did not find that NaHCO3 had greater beneficial effect than NaCl in hemorrhagic shock model, and the use of NaHCO3 for LA due to hemorrhagic shock may not be recommended.