Masui. The Japanese journal of anesthesiology
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Comparative Study
[Sevoflurane comparably decreases the threshold for thermoregulatory vasoconstriction as isoflurane].
The core temperature triggering thermoregulatory arteriovenous shunt constriction is defined as the threshold for vasoconstriction. Vasoconstriction helps prevent further core hypothermia by decreasing cutaneous heat loss and constraining metabolic heat to the core thermal compartment. A previous study showed isoflurane inhibited thermoregulatory threshold. ⋯ Morphometric characteristics were comparable in each group. The threshold for vasoconstriction was 35.1 +/- 0.4 degrees C in the patients given 1.0 MAC sevoflurane, which was comparable that in those given 1.0 MAC isoflurane: 35.3 +/- 0.7 degrees C. We thus conclude that sevoflurane impairs thermoregulation comparably with isoflurane.
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We investigated the usefulness of nasal/oral discriminate sampling system (NODSS) that had been developed recently in order to obtain the accurate end-tidal carbon dioxide (PET(CO2)) from a spontaneously breathing patient through a nomal airway. Fifty patients were monitored using a capnograph with NODSS following extubation in the postanesthesia unit. PET(CO2) data were collected by means of nasal, oral or nasal/oral sampling. ⋯ Furthermore, the mean (PaCO2 - PET(CO2)) gradient was 4.98 mmHg in patients aged over 60, while it was 2.02 mmHg in patients aged under 60, suggesting that PET(CO2) could not be a good index in elderly people. There was no significant difference in the mean (PaCO2 - PET(CO2)) gradient among different methods of anesthesia. In conclusion, NODSS was useful in determining PET(CO2) more accurately and estimating PaCO2 precisely when used in relatively young people by selective nasal or oral sampling.
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Most general anesthetics, opioids, sedatives and local anesthetics perturb thermoregulatory responses. Accordingly the core temperatures triggering sweating, thermoregulatory vasoconstriction and shivering are varied in perioperative periods. Redistribution hypothermia is a quite common phenomenon during not only general anesthesia but epidural/spinal anesthesia. ⋯ However, obtaining effective decrease of core temperature is sometimes difficult because of thermoregulatory vasoconstriction. Subsequently, vasodilation therapy with appropriate drugs is now under investigation. Hypothermia per se causes critical complications in patients, and the maintenance and warming method to maintain normothermia is important in perioperative period.
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Recent reports of cauda equina syndrome following continuous spinal anesthesia have generated concern regarding the safety of not only this particular technique but also of the local anesthetic agent itself. This concern has been reinforced by data suggesting that similar injuries have occurred with repeated injection after a "failed spinal", and by reports of transient radicular irritation following single subarachnoid injection. ⋯ These experiments suggest that the recent injuries resulted from a direct effect of the local anesthetic and that anesthetic-induced impairment does not result from blockade of the sodium channel, per se. These experiments also suggest that development of a safer anesthetic is a realistic goal.
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Comparative Study
[Comparison of a new double-lumen endobronchial tube by Portex with Broncho-Cath].
We compared the clinical usefulness of two double-lumen endobronchial tubes, one furnished by Concord Portex and the other Broncho-Cath by Mallinckrodt. Only left-sided 37 french size tubes were used. ⋯ All parameters were slightly better in the Portex tube than in the Broncho-Cath, but the differences were not significant. It is concluded that the Portex tube is as useful as the Broncho-Cath or it may be superior to the Broncho-Cath.