Journal of anesthesia
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Journal of anesthesia · Mar 1994
Subanesthetic sevoflurane does not affect sympathetic or parasympathetic function.
To evaluate the effects of subanesthetic enflurane and sevoflurane on the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS), the blood level of norepinephrine (NE) and fluctuations in the R-R intervals were measured on electrocardiogram in humans given either 0.5 MAC enflurane or sevoflurane. Enflurane suppressed circulating plasma NE and elevated coefficients of variation (CV) of R-R intervals after 20 and 30 min of inhalation. ⋯ Sevoflurane lowered the CV to 84% of control after 30 min of inhalation. These results indicate that subanesthetic concentrations of sevoflurane are unlikely to perturb sympathetic and parasympathetic activities in humans without surgical stimulation when compared with enflurane.
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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
Intravenous magnesium sulfate as a preanesthetic medication: A double-blind study on its effects on hemodynamic stabilization at the time of tracheal intubation.
The effects of magnesium sulfate (MgSO4) as a preanesthetic medication were studied with regard to whether it can sedate or relieve a patient who is scheduled to undergo surgery, and whether it can control the hemodynamic response to tracheal intubation. Twenty adult patients in ASA status 1-2 undergoing elective surgery were studied. ⋯ The changes in mean arterial pressure (MAP) and rate pressure product (RPP) after the intubation were significantly suppressed in magnesium-treated patients, but a sedative effect was not observed. Therefore, MgSO4 was useful as a preanesthetic medication in suppressing the hemodynamic response associated with tracheal intubation.
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Journal of anesthesia · Mar 1994
Evaluation of twitch responses obtained from abductor hallucis muscle as a monitor of neuromuscular blockade: Comparison with the results from adductor pollicis muscle.
The twitch responses evoked from the abductor hallucis muscle (AHM) and the adductor pollicis muscle (APM) were examined simultaneously in 20 anesthetized patients following a single bolus intravenous administration of 0.04 mg·kg-1 of vecuronium bromide. The mean onset time of vecuronium-induced depression of AHM twitch responses was significantly slower than that of APM twitch responses (4.9±1.5 minvs 3.7±1.2 min, mean±SD,P<0.001), and when the clinical duration times of vecuronium were compared, AHM twitch responses recovered more quickly than APM twitch responses (15.3±4.1 minvs 19.6±6.7 min,P<0.01), although there was no statistically significant difference in the spontaneous recovery time between AHM and APM (9.8±2.9 minvs 10.0±3.6 min). It is concluded that the twitch responses of AHM may be a useful monitor of neuromuscular blockade in anesthetized patients in whom setting the blockade monitor on the patient's arms is difficult, although monitoring of twitch response of AHM is less sensitive than that of APM in case of vecuronium administration.
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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.