Masui. The Japanese journal of anesthesiology
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Case Reports
[A critical patient relieved from status asthmaticus with isoflurane inhalation therapy].
In cases of life-threatening status asthmaticus which are refractory to drug therapy, the administration of inhalation anesthetics can be life-saving as they help alleviate bronchial spasm. We had an 11-year-old female patient suffering from status asthmaticus who was moribund from severe CO2 narcosis and was not responding to any of the conventional therapies. She finally fell into ventricular fibrillation. ⋯ The endotracheal tube was removed 4 hours later. She had an uneventful recovery and was discharged from the hospital 11 days later. With its low metabolic rate and therefore low organ toxicity, as well as its low arrhythmogenicity with remarkable bronchodilating activity, we feel isoflurane may well be superior to other inhalation anesthetics in the treatment of status asthmaticus.
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Hemodynamic changes and left ventricular performance were investigated by simplified mechanocardiography using finger plethysmography instead of carotid artery pulse tracing in patients who received 4 volatile anesthetics with or without nitrous oxide. Systolic blood pressure (Ps), diastolic blood pressure (Pd), heart rate (HR), pre-ejection period (PEP), left ventricular ejection time (LVET), isovolemic contraction time (ICP), PEP/LVET, Pd/ICT, and 1/PEP2 were selected as indices which represent hemodynamics and systolic time intervals. Enflurane 0.6 and 1.2MAC prolonged PEP, and shortened 1/PEP2 and Pd/ICT significantly. ⋯ Addition of nitrous oxide prolonged PEP and PEP/LVET, and shortened Pd/ICT. Isoflurane 1.2MAC lowered Ps and increased HR. The results indicate that cardiac performance was depressed by volatile anesthetics in the order of enflurane, halothane, sevoflurane and isoflurane.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Continuous epidural infusion of bupivacaine and buprenorphine for postoperative pain relief].
The efficacy for postoperative analgesia and side-effect of combined epidural infusion of bupivacaine and buprenorphine in comparison with each of these drugs alone were evaluated in 150 patients. All patients received initially bupivacaine 8 ml and buprenorphine 0.1 mg. ⋯ No significant difference in the incidence of side-effect was found among the three groups. We conclude that epidural analgesia with the combination of buprenorphine and bupivacaine is safe, and easy to manage, giving pain relief superior to that provided by each of these drugs alone.
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We investigated appropriate puncture site, angle of needle entry, and the distance of the insertion for CT monitored celiac plexus block using CT photograms on prone position in sixteen patients with gastrointestinal diseases. In retrocrural approach during CT monitored celiac plexus block, the average distances of puncture sites to midline were 3.84 cm on the right and 4.06 cm on the left, and the average needle angles were 74.1 degrees on the right and 76.9 degrees on the left. ⋯ From these results, we found high possibilities of organ injuries using the conventional technique for celiac plexus block. We conclude that we could perform celiac plexus block more safely and surely using the retrocrural approach by CT monitoring, as serious complications are avoidable by viewing ideal puncture course on CT photographs.
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We report a case of malfunction of an anesthetic ventilator by an unusual cause. A 48-year-old male with gastric cancer was scheduled for gastrectomy. Anesthesia was maintained with enflurane, N2O, O2 and epidural blockade using a semiclosed circuit system. ⋯ After the surgery, we recognized that the controller unit of expiratory valve of the ventilator was obstructed by a Tamper Proof Film, which seals the outlet of a commercial bag of lactated Ringer's solution (Solulact, Terumo Co.). It seems that the film dropped accidentally between the main part and the ventilator system of anesthetic machine when the bellows was exchanged before the surgery, and moved on to the controller unit of the expiratory valve of the ventilatory system during surgery. In conclusion, it is necessary for anesthetists to understand the inner structure and system of the anesthetic machine and to check the anesthetic machine to avoid the troubles and accidents related to anesthetic machine.