Masui. The Japanese journal of anesthesiology
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We have evaluated the effectiveness of central venous catheter placement using right atrial electrocardiography (RAECG). Consecutive patients under general anesthesia (n = 42) who required a central venous catheter underwent RAECG-guided catheter insertion procedure via right internal jugular vein. Catheter tip position was verified by post procedure portable chest radiography. ⋯ The average insertion depth of catheters was 16.4 cm. We also attempted to predict the optimal catheter insertion depth for each patient from the previous measurements of external landmarks, but it was found to be difficult to predict reliably. In this point of view, we should use RAECG technique to make sure the proper positioning of the catheter tip.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effects of sevoflurane and isoflurane on hepatic blood flow in man].
The influences of sevoflurane and isoflurane on hepatic blood flow (HBF) in man were investigated employing the method of continuous infusion of indocyanine green. HBF and cardiac output (CO) were measured in patients before and after induction of anesthesia with thiamylal, fentanyl, and N2O, and again during isoflurane (n = 9) or sevoflurane (n = 8) anesthesia before the start of surgery. ⋯ Although CO decreased similarly in both groups during anesthesia, the HBF/CO ratio in isoflurane group increased significantly, and the ratio in sevoflurane group did not change significantly. We conclude that whereas isoflurane increases HBF, sevoflurane does not change it in anesthetized patients.
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Case Reports Comparative Study
[Comparison of the effects of halothane, isoflurane and sevoflurane in the treatment of severe asthmatic attack: a case report].
A 19-year-old woman suffered from a severe asthmatic attack. She did not respond to any of the conventional therapies and eventually lapsed into a state of unconsciousness. ⋯ The inhalation of isoflurane, halothane and sevoflurane decreased the airway resistance and systemic vascular resistance in direct relationship to the dosage administered. Because the patient's metabolic rate is low and the occurrence of arrhythmias is rare with isoflurane, we concluded that isoflurane is the best alternative for the patient with asthma.
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A 65 yr-old male with severe scar pain on his right lower abdomen underwent selective nerve block through epidural space using a superfine fiberscope. A12-gauge Tuohy needle (internal diameter 2.2 mm) was inserted at the intervertebral space of Th12-L1. The fiberscope (external diameter 1.1 mm) was introduced through the needle and the epidural space was observed. ⋯ Then 2% lidocaine 1.5 ml and 60% megumine sodium amidotrizoate 1.5 ml were slowly injected. Soon after injection of anesthetic, analgesia area (Th11-L1) was obtained, and Th12 nerve root was identified by X ray. Epidural blockade using a superfine fiberscope seems to be one of the useful and reliable methods for the selective nerve blockade.
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We studied the relationship between postoperative brain dysfunction and the state of atherosclerosis in the patients of open heart surgery, by analyzing the intraoperative cerebral oxygen saturation (rSO2) and the CO2 reaction. The subjects were 143 patients with average age of 64 years. ⋯ There were significantly high values of AI and beta as well as low rSO2, in elder age with low cardiac index and no correlation was observed between rSO2 and PaCO2 in the brain dysfunction group. The results suggested that a higher level of atherosclerosis is associated with the postoperative brain dysfunction with resultant decreased cerebral blood flow and disturbed reaction to CO2 of cerebral blood vessels.