Masui. The Japanese journal of anesthesiology
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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.
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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.
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Induction of anesthesia with inhalation of sevoflurane was evaluated in 45 patients. Inhalation anesthesia was induced by a single vital capacity breath followed by spontaneous breathing. The compositions of anesthetic gases were as follows: 5% sevoflurane in oxygen, 5% sevoflurane in 67% nitrous oxide and oxygen, and 7% sevoflurane in 67% nitrous oxide and oxygen. ⋯ Changes in blood pressure and heart rate were relatively small. The technique was found to be acceptable to all of the patients studied. We conclude that the technique of single breath induction with sevoflurane is a safe and acceptable alternative to intravenous induction in cooperative adult patients.
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We compared the effect of hypertonic salt solution (7.2%, HS) with that of normal saline (NS) and lactated Ringer's solution (LR) for the treatment of hemorrhagic shock. We monitored hemodynamic parameters, thoracic duct lymph flow, and tissue oxygen tension over 3 hours after hemorrhage. Twenty-seven anesthetized mongrel dogs (0.5% halothane) were bled to an aortic pressure of 60 mmHg for 90 min following 40 mmHg for 30 min and then they were resuscitated with each solution. ⋯ We found that hemodynamics were restored in HS group as well as in other two groups. On the other hand, thoracic duct lymph flow and tissue oxygen tension of renal cortex and liver increased significantly over other two groups. We conclude that small volume resuscitation with 7.2% NaCl may be effective in the initial treatment of hemorrhagic shock from the view of tissue circulation in vital organs.
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Comparative Study
[Comparison of the severity of postoperative pain in patients after thoracic, upper abdominal or lower abdominal surgery].
Different factors influence the severity of postoperative pain. Personality and cultural factors as well as anxiety and fear modify the degree of postoperative pain. The site of surgery is also a major determinant. ⋯ Demands of analgesics were not different among three groups at any evaluated point. Pain after thoracic surgery was consistent during 72 postoperative hs, but in the upper and lower abdominal surgery groups pain at 72 hs was significantly weaker than that at 24 hs. We conclude that postoperative pain was not different among the three surgery groups, but pain after upper and lower abdominal surgery decreased more rapidly compared with that after thoracic surgery.