Journal of anesthesia
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Journal of anesthesia · Dec 1994
Does sex difference influence the neuromuscular blocking potencies of vecuronium?
One hundred and fifty patients of ASA class I-II undergoing elective surgery were given vecuronium 0.1 mg·kg-1 under fentanyl- (NLA), halothane, enflurane, isoflurane, or sevoflurane anesthesia, and the spontaneous recovery was monitored to study the sex differences as to onset time, duration [(T1, train of four (TOF)], and recovery index (T1, TOF). The onset time was significantly shorter in women than in men under isoflurane and sevoflurane anesthesia. No significant differences were seen between the sexes in terms of duration and recovery index of both T1 and TOF. ⋯ It remains unclear, however, whether or not the effects of volatile gases to the sensitivity of receptors may contribute to the observed sex difference. Similar durations and recovery indexes in any anesthetic method indicate that the drug's rate of elimination is similar between the sexes. In conclusion, female patients favor the rapid onset of vecuronium when used under isoflurane or sevoflurane, but the recovery from the paralysis seems to be the same between the sexes regardless of the type of general anesthesia used.
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Journal of anesthesia · Dec 1994
Lumbar epidural buprenorphine for postoperative pain relief following hepatectomy.
The induction of postoperative pain relief with lumbar epidural or intramuscular buprenorphine was studied in 30 patients undergoing hepatectomy. When patients first complained of pain after surgery, 0.06 mg or 0.12 mg of buprenorphine in 10 ml or 20 ml of saline was administered through an epidural catheter inserted at the L3-4 interspace, or 0.12 mg was administered intramuscularly. Two of seven patients receiving epidural buprenorphine 0.12 mg in 10 ml saline were completely pain-free, and the other five patients in this group had only slight pain. ⋯ There were no significant changes over time in circulatory or respiratory variables induced by buprenorphine. No patient had serious adverse effects. Lumbar epidural administration of buprenorphine 0.12 mg diluted to 10 or 20 ml (20 ml might be preferable) with saline is recommended for induction of postoperative analgesia following hepatectomy.
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Journal of anesthesia · Sep 1994
Flecainide is effective against premature supraventricular and ventricular contractions during general anesthesia.
The effect of intravenously administered flecainide on premature supraventricular (PSCs) and ventricular contractions (PVCs) which developed under general anesthesia was evaluated. Flecainide was infused intravenously at a rate of 0.2 mg/kg/min until the efficacy of this drug appeared or for 10 min; thus, the maximum dose was determined to be 2 mg/kg. Flecainide was administered to 10 patients who experienced more than 5 supraventricular and/or ventricular contractions/min for a period of more than 5 min (PVCs, 4 patients; PSCs, 6 patients). ⋯ This dose of flecainide did not affect the heart rate and QRS interval, but caused a transient decrease in systolic blood pressure from 127±6 mmHg (SE) to 114±6 mmHg, a 14% increase in the PQ interval, and a 6.3% increase in the QT interval. These results suggest that flecainide is a promising drug for the treatment of PSCs and PVCs which develop during general anesthesia. Transient hypotension and cardiac conduction disturbances immediately after injection may occur when flecainide is used intravenously.
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Journal of anesthesia · Sep 1994
The effect of prostaglandin E1 on the increase of serum lactate and plasma granulocyte elastase activity during radical surgery for esophageal cancer.
Serum lactate concentrations and the lactate/pyruvate (L/P) ratio were measured in two groups of patients undergoing radical esophagectomy, as an indicator of tissue hypoxia, and β-glucuronidase and granulocyte elastase as indicators of tissue damage. One group received prostaglandin E1 (PGE1) and the other group received nothing. Serum lactate concentrations and the L/P ratio increased significantly 30 min after starting thoracotomy in the patients who were not treated with PGE1. ⋯ There was no change in serum β-glucuronidase activity in both groups. This study suggests that low doses of PGE1 maintain organ blood flow without affecting blood pressure. However, these low doses of PGE1 could not suppress granulocyte elastase release.