Masui. The Japanese journal of anesthesiology
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Twenty patients who underwent thoracotomy were given 2mg of epidural morphine postoperatively. Serum morphine concentrations were determined, analyzed pharmacokinetically, and compared with the degree of analgesia obtained. Excellent analgesia was attained in 11 patients and fair analgesia in the remaining 9 patients. ⋯ Maximal concentration (Cmax) was calculated to be 38.5 +/- 4.2 ng.ml-1 in the excellent analgesia group and 25.7 +/- 4.3 ng.ml-1 in the fair group. The area under the concentration-time curve (AUC) in the fair group was approximately 20% of that in the excellent group. It is concluded that serum morphine levels correlated with analgesic effect in patients receiving epidural morphine after thoracotomy.
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Changes in central venous pressure (CVP) during intermittent positive pressure ventilation with a Bennett 7200 respirator were measured in 30 postoperative patients without hemodynamic abnormalities. The tidal volume was changed from 300 ml to 900 ml and the PEEP was changed from 0 cmH2O to 8 cmH2O, step by step, respectively. Mean airway pressure (Pmean), maximal airway pressure (Pmax), arterial blood pressure, and heart rate were measured simultaneously with the measurement of CVP. ⋯ The value of CVP was considered to be 7.5 +/- 6.2 cmH2O when Pmean was zero. There was no change in the arterial blood pressure and heart rate throughout the measurement. This suggests that increases in CVP might not reflect any accompanying hemodynamic change.
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The changes of serum colloid osmotic pressure (COPm), serum protein and water balance were examined in 9 patients during and for 2 weeks after operation which required prolonged anesthesia. The values of serum total protein (TP), serum albumin (Alb) and COPm decreased by about 17% three hours after the start of anesthesia and by 15%, 20% and 24%, respectively, after 18 hours. These values returned to each preoperative value about one week after the operation. ⋯ There was no correlation between COPm and water balance. When COPm was 17.5mmHg or lower, calculated colloid osmotic pressure value was higher than COPm as the Alb/TP ratio decreased. Decreases in the values of COPm and serum protein during operation were considered to have been caused mainly by increased capillary permeability.
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The effects of intrathecal clonidine on spinal fentanyl analgesia were studied by the hot-plate test (52.0 degrees C) in rats. Clonidine (5 micrograms) and/or fentanyl (5 micrograms) were administered alone or combined in volume of 10 microliters through a chronically-implanted polyethylene catheter (PE-10) whose tip was near the lumbar enlargement of the spinal cord. Injections were done repeatedly every two or three days to determine the time course of thermal analgesia. ⋯ In this group, the tolerance developed in only three animals by the 9th injection. In conclusion, combined intrathecal administration of clonidine with fentanyl potentiated the analgesic effect of fentanyl and then definitely suppressed the tolerance formation even if a small dose of clonidine which produces no analgesic effect was used. These results suggest that intrathecal or epidural administration of clonidine with narcotics might be useful in managing intractable pain.
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The optimum doses according to age of butorphanol tartrate as a supplemental drug during epidural and spinal anesthesia were investigated in 60 patients without complications. We classified patients into 4 groups by age as A, B, C and D-group. A-group consisting of patients between 20 to 40 years received 1.5mg of butorphanol. ⋯ Butorphanol injections decreased HRs, mean BPs and RRs significantly. But there was no one whose PaCO2 increased more than 50 mmHg and no difference was found in degree of side effects between the groups. In conclusion, this study suggests that the decision to administer doses depending on the age is useful to decrease frequency of the grave side effects, especially respiratory depression which the elderly people frequently fall into.