Masui. The Japanese journal of anesthesiology
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We evaluated, as an index of thermoregulation and hemodynamics, the validity of deep body thermometry that measures deep tissue temperature transcutaneously by creating an area under an insulated thermistor probe of zero thermal flow between skin and subcutaneous tissue in 27 patients undergoing cardiac surgery. Deep body temperatures (DBT) were measured at the forehead (FH) and palm (P), and the DBT gradients (DBTFH-P) were compared with simultaneously measured mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance (SVR), the gradients (TESODBTP, TRECDBTP) of the esophageal and rectal temperatures and palm DBT during a three hour period after discontinuing cardiopulmonary bypass. ⋯ There were no correlations between DBTFH-P and MAP, CI and SVR. We conclude that the measurement of DBTFH-P is useful as a reliable non-invasive method of monitoring core and shell temperature to evaluate thermoregulation.
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Effects of succinylcholine (SCC), 1 mg.kg-1, given following incomplete recovery from muscle paralysis induced by vecuronium were investigated in 27 female patients undergoing elective surgery, which was performed under epidural anesthesia. Anesthesia was induced with thiamylal 5 mg.kg-1 followed by SCC to facilitate orotracheal intubation. Vecuronium bromide 0.08 mg.kg-1 was given and the lungs were ventilated with 67% N2O in O2 and 0.6% sevoflurane. ⋯ Administered at 75% recovery from vecuronium, SCC produced total neuromuscular blockade without initial recovery. The overall duration of the SCC effect (time from the administration to 90% recovery) was 7-18 min. No prolonged paralysis from SCC occurred.
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Comparative Study
[Study of neuromuscular transmission with evoked electromyography--11. Comparison between blocks by magnesium and by pancuronium].
Effects of magnesium (Mg) on muscle compound action potentials (CAPs) which were elicited from gastrocunemius muscle by sciatic nerve stimulation in cats were studied, and the results were compared with those of alpha-bungarotoxin (alpha BuTX) and of non-depolarizing relaxants which had been reported previously. Recovery curves (RCs) of CAPs and train-of-four ratios (TOFR) as parameters of neuromuscular blockade were estimated during blocks by Mg as well as the methods described in the previous reports. The following results were obtained. 1) Neuromuscular blocks which were dependent on serum [Mg2+] were observed in accordance with cumulative dosages of MgSO4 solutions. 2) Recovery curves of CAPs showed a pattern which was characterized by extreme potentiations of test responses at shorter intervals of paired stimuli, followed by a slight depression at longer intervals than 500 msec. This pattern of RC was remarkably different from those after alpha BuTX and relaxants. 3) The mechanisms to produce these differences of RCs were discussed, and it is concluded that the notable depression of RCs derived from muscle relaxants may be caused by inhibitory effect on nerve terminals of relaxants which have different mechanism from that by Mg.
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Leonhardt and coworkers have suggested that PuO2 may indicate degree of renal medullary perfusion and function. The changes in PuO2 during N2O-O2-isoflurane anesthesia (GOI) and N2O-O2-sevoflurane anesthesia (GOS) were studied in 20 patients (GOI group: 10 cases, GOS group: 10 cases) who underwent elective surgeries. ⋯ These results suggest that isoflurane and sevoflurane administration caused a reduction in renal medullary perfusion, and that the low perfusion during sevoflurane anesthesia lasted longer than during isoflurane anesthesia. Measurement of PuO2 has a number of problems, but we believe that PuO2 is useful as an indicator of renal medullary blood flow.
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Case Reports
[Cardiopulmonary resuscitation with cardiopulmonary bypass for intraoperative cardiac arrest].
A 67-year-old man was scheduled for left upper lobectomy under epidural and general anesthesia. About 1 hour after the beginning of operation, he developed cardiac arrest due to sudden massive bleeding from the pulmonary artery. In spite of open chest cardiac massage and intravenous administration of epinephrine, we could not resuscitate him successfully. ⋯ However, he developed low cardiac output syndrome due to long time ischemia resulting in hemorrhagic infarction. Therefore, the intra-aortic balloon pumping was started and his hemodynamics was immediately restored. We presume that CPB is useful for intraoperative resuscitation and this gives us new application of advanced life support for the patient in whom the conventional technique is ineffective.