Masui. The Japanese journal of anesthesiology
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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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[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.
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We investigated the effects of arterial carbon dioxide tension on myocardial blood flow, tissue oxygen tension and metabolism in the anesthetized dogs. Eighteen adult mongrel dogs weighing 13.4 +/- 3.6 kg were anesthetized with 0.5% isoflurane, intubated and ventilated mechanically with 50% oxygen to maintain normocapnia. Endtidal CO2 fraction (FECO2) was monitored continuously by capnograph. ⋯ After normocapnic ventilation, hypocapnia was induced by increasing the respiratory rate, and hypercapnia was induced by adding 10% carbon dioxide to the inspired gas. The coronary blood flow and myocardial tissue oxygen tension increased during hypercapnia and the myocardial lactate extraction decreased, while excess lactate and cardiac venous L/P ratio increased during hypercapnia. These results indicate that hypercapnia increase coronary flow and myocardial tissue oxygen tension but myocardial aerobic metabolism is impaired during hypercapnia.
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Total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK) was given to over three thousand patients during four years from April 1989 through March 1993. The patients ranged in age from three months to eighty seven years. They underwent surgical, orthopedic, gynecological, thoracic, plastic and otolaryngeal surgeries, but patients who underwent craniotomy and obstetric operations were excluded. ⋯ Calcium channel blockers are very effective for antagonizing high blood pressure, and rapid recovery from anesthesia can be easily obtained by reducing ketamine dose given and also by application of epidural block. Intraoperative dreams may be avoided by concomitant use of benzodiazepines. Thus we are convinced that DFK can be a good as well as convenient anesthetic method for clinical anesthesia.
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Intraoperative harvest and transfusion back of platelet-rich plasma (PRP) are an effective procedure to decrease the requirement of blood transfusion. We selected the right atrium as the site for collection and transfusion back of the blood for the harvest of PRP. We studied changes of the hemodynamics and mixed venous oxygen saturation (SvO2 during the intraoperative harvest of autologous PRP in two patients who were undergoing cardiopulmonary bypass (CPB) surgery. ⋯ The arterial blood pressure, cardiac output, and SvO2 decreased during the collecting phase and immediately returned to the baseline values during the returning phase. No change was observed in the heart rate and arterial oxygen saturation. We conclude that the usage of right atrium as the site for collection and transfusion back of the blood to harvest PRP is effective and useful, and the continuous monitoring of SvO2 is mandatory for detecting the decline of the cardiac output.