Masui. The Japanese journal of anesthesiology
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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 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.
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Lamina V-type neurons on the spinal dorsal horn which responded to the bradykinin injection into the femoral artery were studied neurophysiologically in the spinal transected cats by the tungsten microelectrode method. It has been demonstrated that the separate and combined antinociceptive effects of fentanyl, clonidine and midazolam administered intrathecally can produce reduction in response to noxious stimuli. Fentanyl (25 micrograms), clonidine (30 micrograms) and midazolam (1.0 mg) separately suppressed noxious evoked activity at the spinal level. ⋯ These suppressive effects were reversed by each antagonist (naloxone, yohimbine and flumazenil). These findings suggest that when two of these drugs are combined at subanalgesic doses, a significant synergistic interaction is exerted. Therefore, the use of these drugs in combination can reduce the total amount of any one drug required for analgesia in the spinal cord and also reduce the side effects of these agents.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Effects of sevoflurane and isoflurane on intraocular pressure in adult patients].
We investigated effects of two anesthetic agents, sevoflurane and isoflurane, on intraocular pressure (IOP). Forty adult patients were allocated randomly to two groups; Group S (sevoflurane) or Group I (isoflurane). All patients were given a bolus of thiamylal (4-5 mg.kg-1) and vecuronium (0.1-0.2 mg.kg-1) and maintained with 1-3% sevoflurane or isoflurane supplemented with nitrous oxide. ⋯ It seems that the remarkable reductions of IOP after inductions are mainly caused by induction agents. In both groups, hemodynamic parameters showed no remarkable changes during maintenance. These results suggest that both sevoflurane and isoflurane are useful anesthetics for elderly patients receiving ophthalmic surgeries.
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Isoflurane is generally considered to prevent increase in bronchomotor tone. We report a case of bronchospasm associated with exposure to isoflurane. A 11-year-old girl was scheduled for tonsillectomy because of repeated fever. ⋯ Intramuscular epinephrine was given and sevoflurane was discontinued. After this, the wheezing improved. Four days later she underwent tonsillectomy under sevoflurane anesthesia uneventfully.