Journal of anesthesia
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Journal of anesthesia · Mar 1994
Sevoflurane reduced but isoflurane maintained hepatic blood flow during anesthesia in man.
The indocyanine green (ICG) clearance rate (K) and estimated total hepatic blood flow (THBF) were studied by the single injection technique. The THBF was estimated from the calculated circulating blood volume and the fixed extraction rate. The blood concentration of ICG was determined by the finger piece technique. ⋯ ICG (0.5 mg·kg-1) was administered intravenously and K was determined three times following the injection. The K value in the halothane and sevoflurane groups decreased significantly 1 h after induction of anesthesia: from 0.188±0.048 to 0.142±0.029 in the halothane group and from 0.178±0.027 to 0.155±0.021 in the sevoflurane group. There was no significant change in the K value in the isoflurane group throughout the study.
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Journal of anesthesia · Mar 1994
Anesthesia mortality and morbidity in Japan: A study of lawsuit cases.
To date, there have been no systematic studies on anesthetic accidents in Japan. This study was conducted to clarify the present status of anesthetic accidents by sending a questionnaire to a group of plaintiff's lawyers specializing in medical malpractice. At present, because of manpower shortages, anesthesia is provided by either anesthesia specialists (anesthesiologists) or non-anesthesiologist physicians in Japan. ⋯ Of particular note was a large number of deaths from cardiac arrest and hypotension in spinal anesthesia administered by non-anesthesiologists. The results clearly showed that non-anesthesiologists had a substantial incidence of mortality cases among accidents compared with anesthesiologists. Human error was the most frequent cause, but a lack and/or a grave omission of intraoperative monitors was found in non-anesthesiologist-related cases.
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Journal of anesthesia · Mar 1994
Effects of continuous epidural block on motor nerve conduction velocity in patients with lower spine disorders.
Thirty-one patients with severe low back pain were treated by continuous epidural block for 18±3 (mean±SEM) days. Motor nerve conduction velocity (MCV) of the common peroneal nerve was measured before and after the treatment. After the treatment, the visual analogue scale score (VAS) and straight leg-raising (SLR) test were markedly reduced (P<0.01), and MCV was increased significantly (P<0.001). ⋯ A significant correlation (P<0.001) between VAS and MCV was demonstrated after treatment. However, in three patients who showed no reduction in VAS even after the treatment, MCV became significantly (P<0.05) slower in spite of nearly normal SLR test results. These results suggest that epidural block treatment improves not only pain but also MCV, and that two parameters, SLR test and pain intensity, are related closely to the MCV.
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Journal of anesthesia · Mar 1994
Effects and interaction of nicardipine and volatile anesthetics in the rat heart-lung preparation.
The effects of the calcium channel blocker nicardipine (N) and the volatile anesthetics halothane (H), enflurane (E), isoflurane (I), and sevoflurane (S) on myocardial metabolism after postischemic reperfusion were assessed in the isolated rat heart-lung preparation. Wistar-ST rats were randomly divided into six groups (each groupn=9) as follows: control (C) group, no drugs; N group, N (100 ng·ml-1); H group, 1% H and N; E group, 2.2% E and N; I group, 1.5% I and N; and the S group, 3.3% S and N. In the presence of the volatile anesthetics, the preparations were perfused for 10 min, made globally ischemic for 8 min, and then reperfused for 10 min. ⋯ Although there was no significant difference in myocardial lactate concentrations among the groups, ATP content in the N, H, E, I and S groups was significantly higher than in controls. Glycogen content in the N, E, I and S groups was also significantly higher than in controls. These results suggest that N improves myocardial recovery from ischemia; however, in the presence of H or E it may cause significant myocardial depression.
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Journal of anesthesia · Mar 1994
Effects of saikosaponins on hepatic damage induced by halothane and hypoxia in phenobarbital-pretreated rats.
The effects of saikosaponins-a.-b1,-b2,-c, and-d on hepatic damage induced by halothane and hypoxia were investigated in the rat. Inhalation of halothane under a hypoxic condition significantly increased serum glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) levels in rats pretreated with phenobarbital compared with rats pretreated without phenobarbital. ⋯ Saikosaponins-a and-d, the most effective saikosaponins against hepatic damage, inhibited the increases in cytochrome P450 and NADPH-cytochromec reductase activity which are induced by phenobarbital treatment. Therefore, it is suggested that the cytoprotective effect of saikosaponin against halothane-induced hepatitis under hypoxia is caused by inhibition of phenobarbital stimulation of the enzyme system for hepatic drug metabolism.