Journal of anesthesia
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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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The neurophysiologic mechanism of the suppressive action of enflurane on spinal nociceptive transmission was examined in rabbits with intact and with transected spinal cords. Enflurane suppressed nociceptive responses in both intact and transected spinal cord groups. ⋯ These results suggest that enflurane suppresses nociceptive responses by activating descending inhibitory systems and directly suppressing activity at the spinal level. This suppressive action of enflurane does not interact with the opioid receptor.
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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 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.
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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.