Masui. The Japanese journal of anesthesiology
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This study was done to clarify whether end-tidal carbon dioxide (ETCO2) concentration is an effective monitor as an indicator of survival and prognosis of patients who arrived with cardiac arrest. We measured ETCO2 concentration in 30 patients with pre-hospital cardiac arrest during cardiopulmonary resuscitation (CPR). ⋯ In 13 patients who were not resuscitated, the initial values of ETCO2 during CPR were below 1.0%, whereas the other 11 patients showed high ETCO2 values (above 1.5%), which were dependent on the degree of chest compression. This suggests that ETCO2 monitoring during cardiopulmonary resuscitation is a good non-invasive indicator to evaluate the efficacy of chest compression itself, but its initial values during CPR are not correlated with success of resuscitation in patients with pre-hospital cardiac arrest.
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Comparative Study
[Solubility of desflurane (I-653), sevoflurane, isoflurane, and halothane in human blood].
The blood/gas partition coefficients for the new volatile anesthetic agent desflurane (I-653), sevoflurane, isoflurane, and halothane were determined, simultaneously, in 8 human volunteers to compare the solubilities of these agents in blood. The blood/gas partition coefficient for desflurane [0.49 +/- 0.03 (mean +/- SD)] was smallest, followed by sevoflurane (0.62 +/- 0.04), isoflurane (1.27 +/- 0.06), and halothane (2.46 +/- 0.09). ⋯ The results of this study confirm that among these agents the solubility of desflurane in human blood is the smallest. The results suggest that the washin and washout of desflurane will be more rapid than that of sevoflurane, isoflurane, and halothane, and the washin and washout of sevoflurane will be more rapid than that of isoflurane and halothane.
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Randomized Controlled Trial Clinical Trial
[The effect of continuous epidural infusion of a combination of 1% mepivacaine and buprenorphine for post-operative pain relief].
Using a portable 2 ml.hr-1 type infusor (Baxter Infusor), the effect of continuous epidural infusion for post-operative pain relief for 72 hours was studied in 32 patients after upper abdominal surgery. The patients were randomly allocated into four groups: Group 1 (n = 8) received continuous epidural infusion of 1% mepivacaine and buprenorphine 0.2 mg (48 ml.hr-1); group 2 (n = 8) 1% mepivacaine and buprenorphine 0.4 mg (48 ml.hr-1); Group 3 (n = 8) saline and buprenorphine 0.2 mg (48 ml.hr-1); Group 4 (n = 8) saline and buprenorphine 0.4 mg (48 ml.hr-1). The effect was evaluated at intervals of 12-hour until 72 hours postoperatively. ⋯ In each period during the 12 to 72-hour after operation, the percentage of the patients who needed no supplemental buprenorphine was 62.5-100%, which is higher than during the 0 to 12-hour (25.0%). The percentage of the patients who showed no pain on coughing and changing in position in Group 1 and 2 was higher than in Group 3 and 4 in each period (P less than 0.05 12-24 and 36-72 hr). Continuous epidural infusion using Baxter Infusor with the combination of 1% mepivacaine and buprenorphine is effective for alleviating postoperative pain during the 12 to 72 hours after the operation, and for prevention of pulmonary complications.
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We observed the incidence of pump errors by the interference from the electrosurgical unit (Vallylab, Force 4B) set at coagulation or cut mode, with three infusion pumps: Terumo STC-523, STC-525 and STC-525-01. The STC-525-01 painted with electrically conductive paint inside was used during electrosurgery on experimental basis. Malfunctioning of the STC-523 pump occurred frequently by using electrosurgical unit set at coagulation mode and placed close to the pump. ⋯ Therefore, the STC-252-01 pump can be used safely during electrosurgery. Additionally, we discovered, through an estimation of radiated electrical field around the electrosurgical unit, the cable of an active electrode was important as an interference source. To minimize electrosurgical interferences, we propose the following recommendations; 1) keeping the infusion pump and its AC line as far as possible from the active electrode cable, 2) keeping the output of electrosurgical unit as low as possible, 3) operating the pump with its internal battery power supply, and 4) monitoring the operation of the pump while using electrosurgery.
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Effects of incremental positive end-expiratory pressure (PEEP) on right ventricular (RV) hemodynamics were studied in 10 patients undergoing coronary artery bypass grafting, abdominal aneurysmectomy and partial hepatectomy, using Swan-Ganz catheter mounted with the rapid response thermistor. PEEP was increased from 0 (baseline) to 15 cmH2O with increment of 5 cmH2O, and right ventricular ejection fraction (RVEF), RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), and cardiac output (CO) were computed with a thermodilution technique at each PEEP. ⋯ Decreased cardiac and stroke volume indices were attributed to the decrease of preload caused by the increase of intrathoracic pressure. We conclude that PEEP at 5 to 15 cmH2O does not influence right ventricular hemodynamics, and RVEDV is a reliable index to monitor RV hemodynamics instead of right arterial pressure to determine optimal PEEP.