Masui. The Japanese journal of anesthesiology
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Multicenter Study Comparative Study Clinical Trial Controlled Clinical Trial
[Evaluation of the action of pipecuronium bromide in patients under halothane anesthesia--a comparison with pancuronium bromide regarding their neuromuscular blocking and cardiovascular effects].
Neuromuscular blocking and circulatory actions of pipecuronium bromide (PPB) were evaluated in patients under halothane-nitrous oxide-oxygen anesthesia in comparison with those of pancuronium bromide (PCB) in a multi-center cooperative study. Twitch tension of the adductor pollicis muscle was elicited by supramaximal stimulation of the ulnar nerve every 10 seconds. The study was performed according to the following 4 steps and the results were obtained. 1) Cumulative administration of 0.01 mg.kg-1 of PPB or PCB resulted in the potency ratio of 1.3:1.0 and the dose response curves of the two agents paralleled with each other. 2) With PPB 0.05 mg.kg-1 or 0.1 mg.kg-1, almost 100% block of the twitch was obtained. ⋯ Intervals between the doses showed large individual differences and no significant change was observed with repeated doses. 4) Safety of the drug. No significant change in heart rate or blood pressure was observed with PPB but with PCB a significant increase in heart rate was observed. The study revealed that PPB is slightly more potent than PCB and the duration of action is longer, but it has no untoward cardiovascular action in man under halothane anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
[A comparison of 7 types of epidural catheters].
The stiffness on bending of 7 types of epidural catheters was measured with the help of a cantilever beam. 1415 patients scheduled for lithotripsy, requiring epidural anesthesia, were selected and randomly assigned to receive one of the catheters. The patients were divided into 2 groups according to the resistance to insertion. The incidence of intravenous insertion, subarachnoid location and paresthesia during catheter insertion were assessed. ⋯ When the catheter was hard or pushed against the resistance to insertion, the incidence of paresthesia increased. When the catheter was hard and pushed against the resistance to insertion, transforaminal escape increased. A soft catheter should be chosen to minimize the incidence of paresthesia or transforaminal escape.
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We reported the requirement of supplemental analgesics following epidural opioids including Opial 5mg and 10mg, and morphine HCl 2.5mg, for 24 hours in postoperative period after surgery of body surface, and lower and upper abdominal surgeries. Incidence of their side effects was also observed. Opial contains 50% morphine HCl and other opioids such as codeine, thebaine, papaverine, and noscapine etc. ⋯ Kinds and doses of opioids used, suggest that epidural administration of other opioids contained in Opial has some analgesic effect. After the surgery of body surface the opioid requirement may be influenced by the intraoperative anesthetic technics and the state of mind of the patient. Urinary retention was the most interesting side effect observed and our data suggest that papaverine contained in Opial may have favorable effect and morphine HCl may have adverse effects regarding its incidence.
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We experienced anesthetic management of three cases of osteogenesis imperfecta. Case 1: A 2-year-old boy weighing 8.6 kg was premedicated with chloral hydrate 250 mg intrarectally, but he was very excited on arrival at the operating room. Induction of anesthesia was performed by intramuscular injection of ketamine 40 mg. ⋯ However, on the first surgery, hyperthermia did not occur under combined light halothane (0.3-0.5%) anesthesia with caudal epidural block. Case 3: A 14-year-old female underwent osteotomy of the radius under brachial plexus block without any anesthetic complications. In conclusion, anesthetic considerations for children with this disease are as follows; 1) It is necessary to premedicate to provide good preoperative sedation. 2) Care should be taken to use inhaled anesthetic agents (halothane and enflurane) because of tendency to develop abnormal hyperthermia. 3) It is desirable to use regional anesthesia.
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Eight patients, of ASA physical status I or II soon after total knee replacement under general anesthesia, were studied to compare negative extra-thoracic pressure ventilation (NETPV) with positive airway pressure ventilation (PAPV). The measured parameters during the two ventilatory modes were tidal volume, arterial blood gas and functional residual capacity change (delta FRC). ⋯ When the patients were ventilated with the same values of minute ventilation on NETPV and PAPV, there was no significant difference in blood gas values. These findings suggest that efficiency of NETPV is less than that of PAPV at the same absolute working pressure but pulmonary gas exchange of NETPV is almost equal to that of PAPV at the same minute ventilation in the normal lung.