Masui. The Japanese journal of anesthesiology
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This study was designed to investigate the influence of bilateral stellate ganglion block (SGB) on hemodynamics in 15 mongrel dogs. Following general anesthesia, each dog received SGB with 1.5% mepivacaine. Cardiovascular effect of bilateral SGB was assessed by measuring mean artery pressure (MAP), heart rate (HR), cardiac output (CO), right atrial pressure (RAP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP) and common carotid arterial blood flow (CCAF). ⋯ CO decreased for 13% compared with the control value. However, this change was not statistically significant. There was a significant increase in the bilateral CCAF, but the degree of the increase of CCAF was greater after unilateral SGB than after the bilateral SGB.
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Improvement of perinatal mortality rate in Japan is remarkable for the last two decades, but maternal mortality rate is still relatively high in comparison with the improvement of the perinatal mortality rate. Maternal mortality rate 1991 in Japan was 8.5. Maternal deaths occurred mostly in perinatal period. ⋯ Antacid medications were rare in our study group. After induction of general anesthesia, airway was maintained by masks (36.0%) or endotracheal tube (64.0%). Obstetric analgesia by local anesthetics was not used widely.
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The relative accuracy and precision of the two non-invasive thermometry systems, FirstTemp (Intelligent Medical Systems, USA), an infrared tympanic thermometer, and CTM-205 (Terumo, Japan), a newly developed deep body thermometry system, were evaluated in 32 patients undergoing various surgeries under general anesthesia using esophageal temperature as the reference value. The "limits of agreement (mean difference +/- 2SD)" of the "core" temperature measured by FirstTemp and esophageal temperature was 0.4 +/- 0.5 degrees C, and was larger (P < 0.01) than those between rectal temperature and esophageal temperature (0.2 +/- 0.7 degrees C), between tympanic membrane temperature and esophageal temperature (-0.1 +/- 0.4 degrees C), and between "forehead deep body temperature" measured by CTM-205 and esophageal temperature (-0.2 +/- 0.7 degrees C). ⋯ The repeatability of the measurement by FirstTemp was good; the difference between paired measurement values was 0 +/- 0.2 degrees C (mean +/- 2SD). We conclude that the relative accuracy and precision of the two systems are still not sufficient for monitoring body temperature during general anesthesia.
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Case Reports
[Six cases of epidural abscess probably caused by epidural block and examination by gadolinium-MRI imaging].
We treated six cases of epidural abscess caused probably by epidural block. Three patients were given only chemotherapy and the other three underwent surgical treatment. ⋯ Accelerated blood sedimentation rate, positive CRP results and abnormal findings at the site of the catheter insertion appeared to be important initial signs for the early discovery of epidural abscesses. The route of infection, selection of treatment methods, methods of prevention and examination by Gadolinium-MRI imaging were also discussed.
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We report an anesthetic management for Cesarean section and clipping of aneurysm in a pregnant woman with a subarachnoidal hemorrhage secondary to a ruptured cerebral aneurysm. Anesthesia was induced with thiopental, vecuronium and sevoflurane, and maintained with sevoflurane (0.5-1%) before the delivery. ⋯ We also infused prostaglandin E1 continuously at a rate of 50-70 ng.kg-1.min-1 to control arterial blood pressure and to maintain good contraction of the uterus during clipping surgery. We conclude that prostaglandin E1 is useful as a vasodilator after delivery because prostaglandin E1 contracts the uterus.