Journal of anesthesia
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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
Case ReportsConsiderations for general anesthesia combined with epidural anesthesia in a patient with stiff-person syndrome.
We report the successful management of anesthesia in a patient with stiff-person syndrome (SPS) undergoing a thymectomy using a volatile anesthetic combined with epidural anesthesia. The anesthetic concern in patients with SPS is the possibility of postoperative hypotonia due to the presence of excessive gamma-aminobutyric acid (GABA) resulting from an interaction between the anesthetic agents and preoperatively taken therapeutic drugs. Epidural anesthesia has the advantages of decreasing the required amount of anesthetics with GABAergic action, and relieving the postoperative pain that causes the symptoms of SPS. Epidural anesthesia could be a useful technique in SPS patients.
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Journal of anesthesia · Jan 2007
Randomized Controlled TrialUse of a wire-guided cannula for radial arterial cannulation.
We compared the success rates of arterial cannulation with a wire-guided cannula (WGC) and the direct technique with a conventional non-wire-guided cannula (non-WGC). A total of 100 adult patients requiring an arterial line in the operating room were assigned randomly to undergo radial arterial cannulation either with the WGC or with the non-WGC. ⋯ Patient characteristics did not affect either the success rates or the insertion times for the two types of cannula. In conclusion, we have confirmed that the success rates of radial arterial cannulation for patients whose physical status is relatively good were similar with the use of the WGC and the non-WGC.
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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.