Masui. The Japanese journal of anesthesiology
-
We evaluated the preoperative and intraoperative general condition of 33 pediatric kidney recipients. Eighteen patients were anaesthetized with lumbar epidural anaesthesia. Ten patients were with nitrous oxide-oxygen-halothane, 5 cases were with NLA. ⋯ During operation we could not maintain the cardiovascular stability following intratracheal intubation and manipulation of vena cava or abdominal aorta under NLA or nitrous oxide-oxygen-halothane anesthesia. Epidural analgesia inhibited the cardiovascular fluctuation following these surgical stresses. We concluded that epidural analgesia is the best anaesthesia for pediatric renal transplantation and phentolamine or PGE1 are useful to maintain cardiovascular stability and transplanted kidney function.
-
Comparative Study
[Haemodynamic effects of vasodilators in dogs--a comparison of prostaglandin E1, nicardipine and nitroglycerin].
Effects of vasodilation by prostaglandin E1 (PGE1), nicardipine (NIC) and nitroglycerin (TNG) were investigated separately in adult mongrel dogs. Mean arterial pressure was lowered and maintained at 90% and 70% of the control value. Cardiac output (CO), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) were measured by a thermodilution pulmonary artery catheter and blood flow of hepatic artery (HABF), portal vein (PVBF) and mesenteric artery was measured by electromagnetic flowmetry. 1) PGE1: Heart rate (HR) and CO were unchanged and left ventricular stroke work (LVSW) decreased. ⋯ Though LVSW was unchanged, right ventricular stroke work (RVSW) increased with elevation of PAP. In the hepatic circulation, HABF and PVBF decreased slightly. 3) TNG: LVSW and RVSW decreased significantly. HABF increased slightly and PVBF increased significantly.
-
Randomized Controlled Trial Comparative Study Clinical Trial
[A better method to attach an endotracheal tube to the stylet of the Bullard laryngoscope].
The Bullard laryngoscope with its introducing stylet is useful in a variety of patients with airway problems, but it poses difficulties in some cases where an endotracheal tube (ETT) catches on the ary-epiglottic fold and cannot be advanced into the trachea. This difficult may be avoided by slightly angulating the tip of the ETT so that it is directed in a better alignment toward the rima glottis. The efficacy of the two methods of angulation was studied. ⋯ Intubation on the first attempt was successful in 56% of group 1, 83% in group 2 and 100% in group 3. The patients in groups 1 & 2 in whom first attempt failed were all successfully intubated on the second trial with the method used in group 3. This method (180 degrees rotation of the ETT on the stylet), is applicable to any ETT with or without the Murphy eye.
-
Randomized Controlled Trial Clinical Trial
[Evaluation of a pressure and volume-relief instrument (modified Brandt's rediffusion system) to prevent increase in endotracheal tube cuff pressure].
Nitrous oxide diffuses into the endotracheal tube cuff and then overexpand the cuff. This causes upper airway obstruction and trauma in intubated patient during general anesthesia. We evaluated the efficacy and a safety of a pressure and volume-relief instrument (modified Brandt's rediffusion system), which can easily be made by ourselves, to prevent increases in endotracheal tube cuff pressure. ⋯ Pressure of endotracheal tube cuffs was monitored and recorded until the extubation. Time interval until the pressure of tube cuffs increased more than 23 mmHg, which inhibit the local circulation on the tracheal cartilage, in rediffusion group (274.7 +/- 95.9 min) was significantly longer than the duration in control group (64.7 +/- 23.5 min). We conclude that the rediffusion instrument is effective and safe to prevent the rise in the pressure of an endotracheal tube cuff.
-
Case Reports
[Right ventricular perforation and cardiac tamponade caused by a central venous catheter].
A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. ⋯ Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.