Masui. The Japanese journal of anesthesiology
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We investigated the roentgenogram of the epidural catheter in 82 patients in whom the injection of local anesthetics had no effect. Contrast medium 0.5 ml was injected through the epidural catheter and antero-posterior roentgenogram was taken. The roentgenograms were categorized into three patterns, according to the relationship of the catheter to the pedicle of lamina, or to the spread of contrast medium. ⋯ The catheter was thought to be misinserted intravascularly. In other 35 cases, catheter ran laterally on the pedicle of lamina, or the spread of medium 2 mins after the injection was indicated by a dumpling-shape even when the tip was in the vertebral column. In these cases, the catheter was thought not to be outside the epidural space.
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Twenty one patients who underwent prolonged surgical procedures over 10 hours under total intravenous anesthesia with droperidol, fentanyl and ketamine were studied to evaluate post-operative hepatic and renal functions as judged by serum levels of GOT, GPT, BUN and creatinine. They were divided into two groups. Ten patients of the PGE1 group were given PGE1 at a rate of 0.035 micrograms.kg-1.min-1 during anesthesia, and the remaining eleven of the control group were not given PGE1. ⋯ In both groups, post-operative s-GOT and s-GPT levels were increased significantly compared with pre-operative values, but there was no significant difference between the two groups. Serum BUN levels of the 7-10 the post-operative days were increased significantly in the PGE1 group, but those of the control group were not. These data suggest that our method of total intravenous anesthesia with droperidol, fentanyl and ketamine, when applied even for prolonged surgical procedure over 10 hours, would have beneficial effects on the post-operative hepatic and renal functions.
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Effects of 3 local anesthetics, bupivacaine, mepivacaine and lidocaine, upon natural killer cytotoxicity were studied in vitro. Mononuclear cell layer was recovered by Ficoll-Paque sedimentation from heparinized venous blood obtained prior to the induction of anesthesia. The mononuclear cells were divided into three groups: control group was incubated in medium only: low concentration group incubated in medium with 2.0 micrograms.ml-1 of mepivacaine (n = 20) or lidocaine (n = 20), or 0.5 micrograms.ml-1 of bupivacaine (n = 21); high concentration group in medium with 20 micrograms.ml-1 of mepivacaine or lidocaine, or 5 micrograms.ml-1 of bupivacaine. ⋯ Neither bupivacaine nor mepivacaine inhibited % NK cytotoxicity at both low and high concentrations compared with control. Lidocaine significantly inhibited % NK cytotoxicity at low concentration, but did not inhibit at high concentration compared with control. We concluded that neither bupivacaine nor mepivacaine inhibited % NK cytotoxicity at concentration of clinical dose compared with control in vitro, but lidocaine inhibited % NK cytotoxicity at a concentration of 2.0 micrograms.ml-1 compared with control.
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Ninety-nine elective abdominal surgeries were performed under high dose epidural fentanyl anesthesia. PGE1 (0.02 microgram.kg-1.min-1 = 0.02 gamma) was administered to 34 patients (0.02 gamma group), and PGE1 (0.05 gamma) was administered to 16 patients (0.05 gamma group). PGE1 was not administered to 49 patients (control group). ⋯ The forearm-fingertip temperature gradient was lower in the 0.02 gamma and 0.05 gamma groups than in the control group. The incidence of postanesthetic shivering was significantly lower in the 0.05 gamma group than in the other groups. These results suggest that; 1) PGE1 (0.02 gamma and 0.05 gamma groups) affects the peripheral blood flow and peripheral temperature, and 2) PGE1 (0.05 gamma group) significantly affects the incidence of postanesthetic shivering.
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Lactated Ringer's solution was prepared, in which concentration of potassium was either 10 or 20 mEq.l-1, and that of glucose was 1.4%. Each preparation was infused into 10 patients who underwent surgical operations under general anesthesia. Effects of this fluid therapy on changes in serum potassium and blood sugar were studied comparing with infusion of lactated Ringer's solution in which concentration of potassium was 10 mEq.l-1, and glucose was 0.7%. ⋯ On the other hand, the former tended to decrease and the latter tended to increase with the lactated Ringer's solution containing potassium 10 mEq.l-1 and glucose 1.4%. We consider that the homeostatic effect with the lactated Ringer's solution containing 20 mEq.l-1 of potassium and 1.4% of glucose would be to lower blood glucose level by concomitant intracellular influx of potassium and glucose. Therefore these high potassium lactated Ringer's solutions balanced adequately with glucose are useful for fluid therapy during surgical procedure under general anesthesia.