Masui. The Japanese journal of anesthesiology
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Effects of autologous blood transfusion and isovolemic colloids transfusion on hemorrhagic shock model in rats were investigated. The hemorrhagic shock model in rats was prepared by rapid exsanguination and the blood pressure was kept at 40 mmHg for 30 min. As a marker of hemodynamic change, the blood gas analysis was performed, and the tissue oxygen pressure of the liver and the spleen was also measured. ⋯ However, the liver PtO2 did not show any changes during hemorrhagic shock, although the spleen PtO2 tended to decrease. These changes seen at the hemorrhagic shock were equally restored after the treatment with either autologous blood transfusion or isovolemic colloids transfusion. These results indicate that either autologous blood transfusion or isovolemic colloids transfusion can be useful for the therapy of severe hemorrhagic shock, and the NO production in the liver can participate in the maintenance of homeostasis under hemorrhagic shock.
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Case Reports
[Two cases of epidural neulolysis using ethyl alcohol and histopathologic changes in the spinal cord].
We report two cases of cancer pain treated with transcatheter thoracic epidural neurolysis using ethyl alcohol, and epidural histopathologic changes in the spinal cord observed in one of the patients. Case 1: A 59-year-old woman complained of intractable right thoracic back pain due to mediastinal osteo-sarcoma. After obtaining pain relief by epidural block using local anesthetics, we did transcatheter thoracic epidural alcohol block using 2-4 ml of 75-100% ethyl alcohol for three times. ⋯ We performed twice transcatheter thoracic epidural neurolysis using 2-3 ml of 75% ethyl alcohol. Her VAS score decreased from 7/10 to 3/10 and the pain relief was maintained until her death 2.5 months after the neurolysis. Motor palalysis was not observed in both cases.
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The effects of vasodilators and anesthetics on the circulatory and metabolic conditions were compared during hypotensive anesthesia. Forty two subjects undergoing tympanoplasty were divided into 6 groups: PG + S: N2O/sevoflurane with prostaglandinE1 (PG), TM + S: N2O/sevoflurane with trimetaphan (TM), NG + S: N2O/sevoflurane with trinitoglycerin (NG), PG + P: N2O/propofol with PGE1, TM + P: N2O/propofol with TM, NG + P: N2O/propofol with NG. ⋯ Although pHi decreased slightly during hypotensive anesthesia in all groups, pHi was not decreased below the critical level of 7.30. The circulatory and metabolic conditions under induced hypotensive anesthesia were influenced by both vasodilators and anesthetics, and the dosage of vasodilator to decrease arterial blood pressure was dependent on the anesthetic used simultaneously.
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Randomized Controlled Trial Clinical Trial
[Efficacy of patient-controlled epidural analgesia using a disposable PCA device].
We evaluated efficacy of patient-controlled epidural analgesia (PCEA) using a disposable PCA device (3.0 ml type). Twenty-two patients for elective gynecological surgery were randomized into two groups. Patients of the continuous epidural group received epidural fentanyl (15 micrograms.ml-1) with bupivacaine (1.25 mg.ml-1) from a disposable infusion pump (infusion rate: 2.1 ml.hr-1). ⋯ The incidences of side effects were similar in both groups. Respiratory depression and sedative effects were not observed in both groups. We conclude that PCEA using a disposable PCA device (3.0 ml type) seems to be effective for postoperative pain relief.
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Preoperative patients have various kinds of anxiety. However we do not know much about their psychological burden. Therefore, we investigated types of their anxiety with questionnaires prior to operation and analyzed them according to their anesthetic method, type of surgery and age. ⋯ Patients whose age was 10 to 19 had anxiety about their anesthetic method. Anesthesiologists should recognize that preoperative patients have various kinds of anxiety. It is important for us to examine the patients appropriately according to their psychological and physical condition.