Masui. The Japanese journal of anesthesiology
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Comparative Study
[Effects of inverse ratio ventilation and positive end-expiratory pressure on gas exchanges in dogs with oleic acid induced pulmonary edema].
The purpose of this study was to determine the effect of inverse ratio ventilation (IRV) on gas exchanges and circulatory systems in 56 mongrel dogs with oleic acid induced pulmonary edema. The dogs were divided into 9 groups and were ventilated with 9 kinds of ventilatory modes such as I:E ratio of 1:2 (control), 2:1 (2:1 IRV), 3:1 (3:1 IRV), 1:2 with 5 cmH2O PEEP (1:2 PEEP 5), 2:1 with 5 cmH2O PEEP (2:1 PEEP 5), 3:1 with 5 cmH2O PEEP (3:1 PEEP 5), 1:2 with 10 cmH2O PEEP (1:2 PEEP 10), 2:1 with 10 cmH2O PEEP (2:1 PEEP 10) and 3:1 with 10 cmH2O PEEP (3:1 PEEP 10), using a Servo ventilator 900C. IRV could not improve arterial oxygenation in dogs with oleic acid induced pulmonary edema, but PEEP could significantly improve arterial oxygenation depending on PEEP level. ⋯ There was no significant alteration in hemodynamics after ventilatory modes were changed to IRV. Although oxygen delivery was the best in the 3:1 IRV group, there was no statistical significance between the 3:1 IRV group and others. It was concluded that IRV did not improve arterial oxygenation but showed a favorable effect for CO2 elimination, in dogs with oleic acid induced pulmonary edema.
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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.
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The differential reactivities of three kinds of carbon dioxide absorbents, Soda lime, Soda lime A, and Baralyme with sevoflurane were investigated. Sevoflurane was made to react with each carbon dioxide absorbents in a glass vial or in a closed system under administration of carbon dioxide. Glass vials were kept at 55 degrees C and 70 degrees C, and three kinds of carbon dioxide absorbents were compared regarding their reactivity under each temperature. ⋯ On the other hand, Soda lime A increased the temperature of glass container most. As increasing temperature tends to promote reaction, the possibility that the high temperature of the glass container contributes to the reactivity of sevoflurane with carbon dioxide absorbents exists. These results suggest that the highest reactivity of Soda lime A with sevoflurane was caused by the highest temperature of glass container although its chemical composition makes it most reactive with sevoflurane than the others.
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Case Reports
[Cardiac arrests probably induced by hypermagnesemia during anesthesia for caesarean section].
A 24-year-old pregnant woman was scheduled for Caesarean section during the 31st week of pregnancy. The patient had been treated with MgSO4 for premature labor and toxemia. During anesthesia, cardiac arrest occurred twice. ⋯ The second one occurred immediately after administration of methyl-ergometrine malate and seemed to be due to combined effects of hypermagnesemia and methyl-ergometrine malate. The patient and three babies did not develop any complication. In giving anesthesia for patients with hypermagnesemia, anesthetists should take account of interactions between magnesium, anesthetics and other drugs.
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A healthy 34 year old, male (70.2 kg, 168 cm) had lower leg fracture during rugby football and was scheduled for open reduction and fixation. Spinal anesthesia was planned by using Sprotte 24 gauge needle. In the operating theater, patient was positioned for spinal tap on his right side up. ⋯ To prevent these hazards, introducer for the Sprotte needle should be placed in epidural space before the Sprotte needle insertion. Also a Sprotte needle should be placed in subarachinoid space deep enough to prevent failed spinal anesthesia. The tip of the Sprotte needle is weak enough to bend and may present a new patient hazards.