Journal of anesthesia
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Journal of anesthesia · Jan 2007
Randomized Controlled TrialEpidural ropivacaine infusion for the treatment of pain following axillary muscle-sparing thoracotomy: a dose-evaluation study.
We aimed to investigate the optimal dose of continuous epidural ropivacaine for effective analgesia with minimal side effects after axillary muscle-sparing thoracotomy. ⋯ Our results showed that epidural analgesia using ropivacaine, at 12 mg x h(-1), provided the best analgesia with few side effects.
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Journal of anesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyPreoperative epidural fentanyl reduces postoperative pain after upper abdominal surgery.
Forty patients, American Society of Anesthesiology (ASA) physical status 1-2, undergoing subtotal gastrectomy were enrolled in this study. The patients were allocated to two groups with or (group P) and without (group C) preoperative epidural fentanyl 100 microg. Postoperatively, all patients received continuous infusion of the study solution, containing fentanyl 30 microg x ml(-1) and 2 mg/ml bupivacaine, at a rate of 0.7 ml x h(-1) for 72 h. ⋯ We compared the total rescue doses of analgesics during each period of 24 h until 72 h postoperatively. Although the total rescue doses of analgesics were not different between the groups, the median PHPS score was lower in group P than in group C, except at 0 h after the surgery. Preoperative epidural fentanyl 100 microg may increase the analgesic potency of postoperative epidural low-dose infusion of bupivacaine with fentanyl.
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Journal of anesthesia · Jan 2007
Case ReportsAnesthetic management of simultaneous coronary artery bypass grafting and cardiac pheochromocytoma resection under cardiopulmonary bypass.
We experienced simultaneous coronary artery bypass grafting and cardiac pheochromocytoma resection under cardiopulmonary bypass in a 79-year-old woman with atherosclerotic angina. During manipulation of the tumor under cardiopulmonary bypass, the serum norepinephrine concentration increased to over seventy times the normal limit, and there was a 25-mmHg rise in mean arterial pressure. ⋯ However, the serum catecholamine concentration surged in our patient during tumor manipulation under cardiopulmonary bypass, probably because of the reperfused blood from the operating field. We suggest that cardiopulmonary bypass be performed for the anesthetic management of cardiac pheochromocytoma resection, because excessive hypertension can be avoided during cardiopulmonary bypass, even if the catecholamine concentration increases excessively when handling the tumor.
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Journal of anesthesia · Jan 2007
Fulminant-type malignant hyperthermia in Japan: cumulative analysis of 383 cases.
We investigated the transition of clinical signs of fulminant-type malignant hyperthermia (f-MH) by analyzing a database consisting of 383 cumulative cases of f-MH from 1961 to 2004. The cases were divided by time period into group 1 (1961-1984), group 2 (1985-1994), and group 3 (1995-2004). The variables considered were age, sex, type of agents used (succinylcholine and volatile anesthetics), dantrolene administration, clinical signs, laboratory data, and mortality. ⋯ In groups 1, 2, and 3, the rates of dantrolene administration were 18.4%, 93.6%, and 86.7%; the rates of occurrence of ventricular arrhythmia were: 75.2%, 55.6%, and 35.0%; and the rates of generalized muscle rigidity were 64.7%, 60.9%, and 23.9%, respectively. The mortality rate decreased over time, from 42.3% in group 1, to 15.0% in group 2 and group 3. We considered that this decrease occurred because of the increased use of dantrolene and the early diagnosis of malignant hyperthermia in the latter two groups.
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Journal of anesthesia · Jan 2007
Comparative StudyEarly neuropsychological dysfunction in elderly high-risk patients after on-pump and off-pump coronary bypass surgery.
Advanced age is associated with systemic atherosclerosis and is a risk factor for neurological dysfunction after coronary artery bypass grafting (CABG). However, few studies have investigated early neurological dysfunction after off-pump CABG in elderly patients. ⋯ Off-pump CABG reduced postoperative NP dysfunction in elderly patients with severe systemic atherosclerosis compared to on-pump CABG.