Masui. The Japanese journal of anesthesiology
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Case Reports
[Postoperative disturbance of consciousness due to tumor emboli of the orifice of pulmonary artery].
We reported a case of an abrupt hypotension and hypoxemia which lasted more than 60 min due to emboli of tumor at the orifice of the pulmonary artery during operation. Although the emboli were removed under the cardiopulmonary bypass (CPB) and later the patient regained good respiratory and hemodynamic conditions, he had a disturbance of consciousness after the operation. ⋯ His consciousness improved quickly after the beginning of OHP. We conclude that OHP and CPB might be useful to treat the postoperative disturbance of consciousness due to hypotension and hypoxemia during operation.
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Randomized Controlled Trial Clinical Trial
[Patient-controlled analgesia with epidural pethidine or buprenorphine plus bupivacaine for postoperative analgesia].
We evaluated the efficacy of epidural patient-controlled analgesia (PCA) with pethidine or buprenorphine plus 0.25% bupivacaine for postoperative analgesia after laparotomy with a midline incision under general anesthesia. Twenty patients were randomly allocated to two groups. In one group (PCEA-P group; n = 10), epidural pethidine plus 0.25% bupivacaine by PCA with 5 mg of pethidine and 2.5 ml of 0.25% bupivacaine bolus with a lockout interval of 20 min was added to a continuous epidural infusion of 0.25% bupivacaine (2 ml.h-1) plus pethidine (100 mg.24h-1) for 72 h. ⋯ There were no significantly different analgesic effects between PCEA-P and PCEA-B for 48 h. The average doses of epidural PCA were 1.9 mg.kg-1.24 h-1 of pethidine, and 0.012 mg.kg-1.24 h-1 of buprenorphine, respectively. We conclude that PCEA-P and PCEA-B were effective for postoperative pain to the same degree for the first 48 h, but PCEA-P was superior to PCEA-B for the last 24 h.
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Comparative Study
[Effects of laryngeal mask airway on circulation and on incidence of postoperative sore throat and hoarseness].
We studied the effects of laryngeal mask airway (LM) insertion on circulation and on the incidence of postoperative sore throat or hoarseness as compared with tracheal intubation in 50 pediatric patients. LM insertion caused less change of heart rate and systolic blood pressure than tracheal intubation. The incidence of postoperative sore throat and hoarseness was less in the patient of LM group. We conclude that LM is useful in pediatric anesthesia when less circulatory changes are desirable or when the postoperative sore throat or hoarseness is to be avoided.
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We evaluated fatigue, stress and workload of anesthesiologists during anesthetic works using Holter ECG. Recorded heart rates of anesthesiologists enable us to draw the task graph and to calculate the workload scores according to their task behavior. We conclude that the application of Holter ECG is useful in measuring the fatigue, stress, and especially workload of anesthesiologists.
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We determined both the slope of the left ventricular end-systolic pressure-volume relation (Emax), which is a measure of contractility independent of loading conditions, and the slope of the arterial end-systolic pressure-stroke volume relation (Ea), which is a measure of arterial load independent of ventricular function, in 10 patients undergoing elective noncardiac surgery. Left ventricular end-systolic volume (Ves) was measured by transesophageal echocardiography and instantaneous left ventricular end-systolic pressure (Pes) was estimated from the dicrotic notch pressure in the radial artery. Emax was calculated during afterload reduction (nicardipine 30 micrograms.kg-1 iv), and the correlation of Emax to either Pes/Ves ratio or MAP (mean arterial blood pressure)/Ves ratio was accomplished in order to investigate whether these indices were clinically useful measurements of ventricular function or not. ⋯ Ea decreased significantly (P < 0.05) following intravenous nicardipine, demonstrating a decreased arterial load. The direction of changes in Ea was similar to that reported previously in systemic vascular resistance. From these results, we conclude that measurement of Emax (or Pes/Ves, MAP/Ves) and Ea using transesophageal echocardiography and radial artery pressure tracing is feasible and these are a useful tool to estimate left ventricular performance and arterial load during surgery.