Masui. The Japanese journal of anesthesiology
-
Isoflurane often produces tachycardia during clinical anesthesia. We examined the effect of a stepwise increase of isoflurane concentration on hemodynamic parameters in the absence or presence of nitrous oxide (N2O). After induction with thiamylal (3 mg.kg-1), isoflurane in oxygen or in 66% N2O-oxygen was administered with mask ventilation. ⋯ Isoflurane tended to increase HR in a dose-related manner and induced a hyperdynamic response during rapid increasing of isoflurane concentration. This response may have beed caused by the irritating effect of isoflurane on the airways. Addition of N2O attenuated this response because it increases the speed of induction and the depth of anesthesia.
-
Comparative Study Clinical Trial Controlled Clinical Trial
[Comparison of the clinical usefulness of the two types of combined spinal epidural needles].
The clinical usefulness of Combined Spinal-Epidural (CSE) needles, Portex Spinal/Epidural set (P needles) and Hakko Disposable Needles set type H (H needles) was compared on 30 patients undergoing elective orthopedic lower limb surgeries. Although the calibers of the epidural needles were a little different, both needles were introduced quite easily in the epidural space. The spinal needles were inserted successfully to the subarachnoid space in 27 out of 30 cases by the P needles and 23 out of 30 cases by the H needles. ⋯ Adequate spinal anesthesia was established in 26 patients (87%) and 19 patients (63%) by the P needles and the H needles, respectively. One case of the accidental location of the epidural catheter in the subarachnoid space was observed in each group. As the CSE device, the P needles were more sophisticatedly designed for easier insertion to the subarachnoid space than the H needles.
-
A sixty-year-old male patient with caries of the cervical spine suffered from cardio-respiratory arrest outside the hospital. Laryngeal mask was inserted into his pharynx and he was brought to the emergency department of our hospital under CPR by emergency paramedical staffs. Endotracheal intubation was tried three times with a Macintosh laryngoscope but was unsuccessful. ⋯ At last Bullard intubating laryngoscope with videocamera system was operated. An endotracheal tube was easily inserted into his trachea with it and effective cardiopulmonary resuscitation was managed under reliable airway maintenance. These facts indicate that Bullard intubating laryngoscope is valuable at the emergency department and it should be always available there.
-
We evaluated the significance of patient's position in the measurement of gastric contents at the induction of anesthesia (n = 18). After the induction of general anesthesia with tracheal intubation, a nasogastric tube (16F) was inserted into the stomach. ⋯ The existence of the gastric content which can not be aspirated with supine position was confirmed. We conclude that it is necessary to place the patient on bilateral decubitus positions besides supine to evaluate the volume of the gastric content correctly.
-
Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of subcutaneous administration of buprenorphine with patient controlled analgesia system for post-operative pain relief].
We conducted a study comparing patients receiving continuous subcutaneous administration of analgesia with self controlled analgesia system (CSAA group) with those receiving continuous epidural infusion (Epi group) for postoperative analgesia after abdominal surgery. Fourteen patients were randomized into two groups: CSAA group (n = 7) received 20 micrograms.h-1 of buprenorphine (Bu) subcutaneously with additional 20 micrograms of Bu using Baxter infusor BB+PCA; Epg group (n = 7) received continuous epidural infusion of 0.4 mg of Bu and 46 ml of 0.25% bupivacaine daily (16.7 micrograms.h-1 of Bu) using Baxter infusor 2 ml.h-1 type. In both groups, patients received supplemental 0.1 mg of Bu subcutaneously as needed. ⋯ There was no severe side effect in both groups. We conclude that continuous subcutaneous administration of analgesic was effective for postoperative analgesia, and almost the same analgesic effect was obtained as compared with continuous epidural analgesia. We calculated that the adequate dose of Bu subcutaneously during early postoperative period to be about 30 micrograms.h-1 of Bu.