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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Comparative Study
[Differential effects of muscle relaxants on the evoked electromyogram of the thenar and hypothenar muscles].
This study compares the neuromuscular blocking effect of nondepolarizing relaxants on the thenar and hypothenar muscles in 14 anesthetized patients with nitrous oxide-halothane. Vecuronium (60 micrograms.kg-1 iv) or pancuronium (60 micrograms.kg-1 iv) was given and supramaximal stimulation was applied to ulnar nerve at the wrist. The evoked compound action potentials were measured over the thenar and hypothenar muscles of the right hand simultaneously. ⋯ There was significant higher T1/Tc and T1/T4 ratio for the hypothenar muscle than for the thenar muscle within 60 minutes from pancuronium administration. These data suggest that relative potency of muscle relaxant on these two muscles seems to be drug specific. This phenomenon brings certain practical difficulties on monitoring of neuromuscular function with evoked electromyogram during anesthesia.
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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.