Masui. The Japanese journal of anesthesiology
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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.
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A 26-year old woman presented with acute hepato-renal dysfunction, coagulation abnormalities and diabetes insipidus associated with hypernatremia in the latter term of pregnancy (39 weeks). Such transient diabetes insipidus during pregnancy as in this case has been reported to be resistant to AVP, but to respond to DDAVP. Because of fetal compromise, an urgent cesarean section was performed. ⋯ After delivery of twin babies, her symptoms recovered gradually. In conclusion, diabetes insipidus during pregnancy as in this case is transient and disappear after delivery. However, multiple organ dysfunction may become worse and cause fetal death, unless surgical procedure with appropriate anesthetic management is performed.
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Comparative Study
[Effects of nicardipine on hemodynamics and skin blood flow--comparison between N2O-sevoflurane and N2O-isoflurane anesthesia].
Dividing the surgical patients into GOS (N2O-oxygen-sevoflurane anesthesia) group and GOI (N2O-oxygen-isoflurane anesthesia) group, we studied the effects of nicardipine on hemodynamics and skin blood flow under each anesthetic method. Control measurements were taken when the hemodynamic parameters were stable during surgery and the incremental doses of nicardipine (0.5 mg) were administered up to a total of 2.0 mg. The changes in hemodynamic parameters and skin blood flow were measured at the nicardipine dosage of 0.5 mg (S1), 1.0 mg (S2), 1.5 mg (S3), and 2.0 mg (S4). ⋯ Blood pressure, on the other hand, decreased at S1 and S2, but showed little change at S3 and S4 in both groups. Skin blood flow tended to increase in the GOS group, but in the GOI group little change in skin blood flow was noted at S1-S3. Skin blood flow tended to decrease at S4 in the GOI group.
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Anesthesia was administered to an 11 year old boy with %FVC 11%. The patient had dyspnea and severe constrictive pulmonary disorder with an almost normal chest radiograph. ⋯ Pulmonary fibrosis was caused by anti-cancer drugs given in his infancy. He died of cardiorespiratory failure 14 months postoperatively.
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Case Reports
[Neuromuscular effects of vecuronium in patients receiving long-term administration of dantrolene].
We report two patients who received anesthesia using vecuronium (VCB) subsequent to long-term treatment with orally administered dantrolene. The present data suggest that these doses used of dantrolene do not prolong the duration of neuromuscular blockade induced by VCB. An 8 year old boy was given general anesthesia after medication with 20 mg.day-1 of dantrolene orally for two years. ⋯ The neuromuscular blocking effect of VCB was monitored by the same method as described above. Again, there was no apparent prolongation of neuromuscular blocking action of VCB. Evidently, VCB may be used in the clinic under standard conditions of neuromuscular monitoring in patients under previous long-term treatment with dantrolene.