Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
[Perioperative stress response in elderly patients for elective gastrectomy--the comparison between isoflurane anesthesia and sevoflurane anesthesia both combined with epidural anesthesia].
The difference in stress responses between isoflurane anesthesia (I group) and sevoflurane anesthesia (S group) was studied. Twelve patients for elective gastrectomy were divided into two groups: S group, 7 patients, 78 +/- 4.3 years of age, and I group, 5 patients, 77.4 +/- 6.9 years of age. Anesthesia was induced by fentanyl, midazolam and sevoflurane or isoflurane with 100% oxygen. ⋯ During operation, it was confirmed that the responses of sympathetic nervous system (epinephrine, norepinephrine) and pituitary-adrenocortical system (ACTH, cortisol) were maintained in both groups. After operation plasma norepinephrine levels increased in both groups. Although the responses of I group tended to be stronger than that of S group, there was no significant difference between the two groups.
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A 49-year-old male with amyotrophic lateral sclerosis (ALS) was scheduled for gastrectomy. Anesthetic management was performed under general anesthesia with sevoflurane and epidural anesthesia with lidocaine. ⋯ He had little pain and showed no progress in neurological symptoms in the postoperative period. Neuromuscular monitoring is essential in administrating non-depolarizing neuromuscular blocking agents to patients with ALS, and epidural anesthesia may be useful for perioperative management of patients with ALS.
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We investigated the brain protection effects of propofol anesthesia and nitrous oxide-oxygen-isoflurane anesthesia (GOI) using forebrain ischemic model of male Sprague-Dawley rats. Propofol group (P, n = 15) was anesthetized with propofol, oxygen and nitrogen (FIO2 = 0.33), and isoflurane group (GOI, n = 15) with 66% nitrous oxide, 33% oxygen and 1.2% isoflurane under mechanical ventilation. The anesthesia was deepened until electroencephalographic burst suppression appeared in each group. ⋯ Propofol reduced the apoptosis, i.e., reduced the TUNEL positive cell count (GOI = 121.2 +/- 25.2.mm-1; P = 53.8 +/- 11.4.mm-1; P < 0.01; mean +/- SD) on the day 2 after ischemia, and also reduced the delayed neuronal death (alive CA-1 cell count; GOI = 18.1 +/- 8.9.mm-1; P = 33.1 +/- 12.8.mm-1; P < 0.01) on the day 7 after ischemia. It is important to determine the recovery interval after brain ischemia in detection of DND and apoptosis. We conclude that propofol inhibits neuronal apoptosis after brain ischemia and consequently reduces the delayed neuronal death in the CA-1 pyramidal cell layer of the hippocampus.
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The extent of sensory block is determined by the cephalad distribution of the local anesthetic in the cerebrospinal fluid and uptake by neuronal tissue in sufficient amounts to produce the block. Out of many factors that have been considered to affect the distribution, this paper discusses factors involved in patient characteristics and technique of injection; the age of the patient, the volume of cerebrospinal fluid, the rate of injection, the site of injection, and the position of the patient. ⋯ Recent studies have shown that the management of posture to control the level of spinal anesthesia is not so easy as previously thought. It is my conclusion that knowledge of these factors is essential in the performance of reliable and safe spinal anesthesia.
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An incorrect Japanese terminology of "Masuigaku [symbol: see text]" has been used widely to express "anesthesiology" or "anaesthetics" [symbol: see text] since the first Department of Anesthesiology was established in Tokyo University in 1952. The reason why the nomenclature "Masui-gaku" is wrong is as follows: Japanese nomenclatures for clinical medical sciences should include a Chinese character "Ka [symbol: see text]" such as "nai-ka-gaku" for internal medicine, "ge-ka-gaku" for surgery and "gan-ka-gaku" for ophthalmology. Accordingly the name "Masui-gaku" is erroneous to mean "Anesthesiology" and it should be "Masui-ka-gaku" [symbol: see text]. ⋯ Most people consider that "Ma [symbol: see text]" is originated from "[symbol: see text] (Hemp, Asa)" or "[symbol: see text] (Marihuana, Taima)", however, this is definitely incorrect and "Ma [symbol: see text]" of "Ma-sui" has no direct relation with the pharmacological effect of hemp. Thus the misuse of "Masui-ga-ku" might have caused serious academic and social confusions, such as misunderstanding of anesthesiologists as comedical technicians, leading to a poor social acceptance of anesthesiology and anesthesiologists for these fifty years in Japan. To correct this confused situation I would like to ask our colleagues to use correctly these nomenclatures.