Masui. The Japanese journal of anesthesiology
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The effects of end-expiratory negative extra-thoracic pressure (EENETP) and PEEP on the ventilatory response to CO2 were studied in seven healthy volunteers. The changes in functional residual capacity during EENETP -20 cmH2O and PEEP 5 cmH2O were 13.9 and 12.9 ml.kg-1, respectively. ⋯ The slopes during EENETP and PEEP were significantly decreased. These results indicate that EENETP and PEEP could worsen the CO2 response in patients with respiratory failure, especially, with chronic obstructive pulmonary disease in which functional residual capacity is increased.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Effects of epidural clonidine added to lidocaine solution upon the requirements of sedatives during epidural anesthesia].
The authors studied 34 patients undergoing abdominal total hysterectomy in order to evaluate whether epidural clonidine added to lidocaine solution could alter the requirements of sedatives during epidural anesthesia. Patients were randomly assigned to one of four groups; 18 ml of 2% lidocaine with 1:200,000 clonidine (n = 6), 1:100,000 clonidine (n = 7), 1:200,000 epinephrine (n = 13), or neither (plain, n = 8). ⋯ There was a significant difference (P less than 0.05) in the requirement of diazepam between the patients given lidocaine with 1:100,000 clonidine and those given plain lidocaine. The present results suggest that the addition of clonidine to lidocaine solution could reduce the requirements of sedatives in epidural anesthesia.
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Recent articles on total intravenous anesthesia (TIVA) were reviewed. The definition of TIVA is a combination of hypnotic agent, analgesic drugs and muscle relaxants, excluding simultaneous administration of any inhaled drugs. Anesthesia with single and massive doses of narcotic drugs such as fentanyl for cardiac anesthesia is not described in this paper. ⋯ This combination of the drugs is considered the best, because propofol, alfentanyl and sufentanyl are not available in Japan so far. TIVA has many advantages over inhaled anesthesia and it can be easily employed not only in the modern sophisticated situations but also in so-called field conditions. We anesthesiologists should be much more familiar with this method of anesthesia.
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Comparative Study
[Clinical study on total intravenous anesthesia with droperidol, fentanyl, and ketamine--6. Effects on postoperative liver function].
We have developed a new method of total intravenous anesthesia with droperidol, fentanyl, and ketamine, and have administered it to more than 700 surgical patients. We studied whether this method of anesthesia would influence postoperative liver function or not. A total of sixty elective surgical patients were the subjects of this study. ⋯ The patients for gastrectomy under enflurane-N2O anesthesia had significantly increased postoperative gamma-GPT levels compared with the patients of total intravenous anesthesia. Any other variables showed no significant difference among groups. We consider that this method of total intravenous anesthesia has no adverse effects on postoperative liver function as compared with other usual anesthetic methods.
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We studied effects of two methods of stellate ganglion block (SGB) by evaluating the extent and strength of sympathetic blockade using infrared thermography, and classifying thermographic hot areas in the ipsilateral hand after SGB. Twenty healthy volunteers (18 females, 2 males, age 29.7 +/- 7.7 years) were subjects for this study. C7 and C6-SGBs were performed on each subject using 5 ml of 1% plain mepivacaine at the anterior face of 7th cervical transverse process in C7-SGB or at the top of the anterior tubercle of 6th cervical transverse process in C6-SGB. ⋯ All subjects showed Horner's sign. No severe side-effect occurred in either group, but complaints of dysphagia appeared significantly more frequently in the C6-SGB group than in C7-SGB (P less than 0.05). In conclusion, C7-SGB was considered to be superior to C6-SGB in strength and certainty of the lower cervical and upper thoracic sympathetic blockade, with less of side-effects.