Masui. The Japanese journal of anesthesiology
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A one year-old girl with an arachnoid cyst received an arachnoid cystperitoneal shunt operation two tims, firstly under sevoflurane anesthesia, and secondarily under isoflurane anesthesia. After sevoflurane anesthesia, her serum CPK level increased markedly up to 7550 mU.ml-1, but such an increase was not observed following isoflurane anesthesia. The perioperative management was almost identical on these two occasions. A combination of sevoflurane anesthesia and succinylcholine might cause a significant increase in the serum CPK level.
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Effects of NaHCO3 on metabolic acidosis during hypoxia and after reoxygenation were studied in 18 anesthetized dogs. Metabolic acidosis was produced by inhalation of low fraction of oxygen (9%) for 2 hours. NaHCO3 1M was infused intravenously during hypoxia (n = 12) and 30 minutes after reoxygenation (n = 6) at the rate of 100 ml.min-1 (total 0.2 x body weight x base excess mEq). ⋯ In 8 of 12 dogs, myocardial glucose uptake increased but was not correlated with myocardial LA uptake and LV dP/dt max. Blood LA level correlated significantly with LV dP/dt max (r = 0.534, P < 0.01). It appears that during hypoxia, differing from reoxygenation, NaHCO3 may depress cardiac function due to intramyocardial acidosis.
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Case Reports
[Anesthesia for the intraoperative electrocorticography of patients with uncontrollable epilepsy].
For the surgical treatment of uncontrollable epilepsy, it is essential to delineate the epileptogenic focus by the use of intraoperative electrocorticography. Most general anesthetic agents, however, suppress the epileptogenic focus. Therefore, such a patient is usually kept awake during the procedure using local anesthesia. ⋯ In 2 patients, electrocorticographical focal seizure status was identified following the intraoperative electrocorticography. After the focus resection, seizure attacks were controlled only by the application of regular medical regimen in these patients. Low nitrous oxide and intermittent fentanyl administration can be recommended as a superior anesthesia technique for intraoperative electrocorticography.
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TOF Guard is one of the latest developments in the field of neuromuscular monitoring equipment. This system uses a miniature acceleration transducer (a piezo-electric ceramic wafer is used), simply fastened to the thumb with tape. The rationale behind the method is Newton's second law, stating that the acceleration is directly proportional to the force. ⋯ The result showed that there was a very close positive correlation between the values of T1, TOF ratio and posttetanic count simultaneously measured by both methods. The coefficient of correlation was 0.96, and its significance level was P < 0.001. From the clinical view point, it is concluded that TOF Guard is very useful because of its accuracy and because the equipment is easy to handle, compact and of low price as a neuromuscular monitoring system for routine anesthesia.
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[The effects of fresh gas flow rate on the work of breathing during semi-closed circuit anesthesia].
To evaluate the effects of fresh gas flow rate on the work of breathing during semi-closed circuit anesthesia, we measured respiratory frequency, tidal volume, inspiratory work of breathing, peak inspiratory and expiratory flow rate and fluctuations in airway pressure during breathing with fresh gas flow of 6 l.min-1, 3 l.min-1 and 1.5 l.min-1. There was no significant difference among three flow rates in terms of tidal volume, respiratory frequency, inspiratory work of breathing, peak inspiratory flow rate and fluctuation in airway pressure at inspiration. On the other hand, in the expiratory phase, peak expiratory flow rate was lower and fluctuation in airway pressure at expiration was higher at 6 l.min-1 than those at 3 l.min-1 and 1.5 l.min-1, which may be indicative of increased expiratory work of breathing. The present study shows that low fresh gas flow rate does not increase the inspiratory work of breathing and high fresh gas flow rate may increase the expiratory work of breathing, implying that lowering the fresh gas flow is profitable for the work of breathing during semi-closed circuit anesthesia.