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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Comparative Study
[Effects of sevoflurane on hemodynamics during the induction of anesthesia compared with those of isoflurane, enflurane and halothane].
The effects of sevoflurane (S), isoflurane (I), enflurane (E) and halothane (H) on hemodynamics were studied in 50 patients during the inhalation of 1.5 MAC of each anesthetic before the surgery. Mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and stroke volume index (SVI) were measured noninvasively using the automatic blood pressure manometer and the ultrasonic Doppler method (Accucom). ⋯ The values of CI, SVRI, SVI with S, as well as with I, were between those of E and H. These results indicate that sevoflurane causes the depression of blood pressure mostly by decreasing afterload during the induction of anesthesia, although the decrement with sevoflurane, as well as that with isoflurane, is less than that with enflurane.
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Case Reports
[Anesthetic management for cesarean section in two parturients with quintuplet gestation].
Two parturients with quintuplet pregnancy underwent urgent or elective cesarean section under general anesthesia at 30 and 29 week gestational ages respectively. Since multiple gestation pregnancy requires enough medical staffs and instruments for preterm newborn resuscitation, emergency cesarean delivery was avoided. ⋯ The anesthesia and postoperative course of two patients and their babies were uneventful. Thus, anesthetic considerations may include; 1) high risk pregnancy related with huge pregnant uterus, 2) preterm labor, 3) preparation of sufficient man-power and instruments, 4) to avoid uterine contraction before delivery for fetal oxygenation, and 5) the puerperal promotion of uterine contraction to decrease blood loss.