Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[A comparison of propofol and midazolam in sedation of mechanically-ventilated postoperative patients].
To compare the quality of sedation using propofol (n = 8) vs midazolam (n = 7) we evaluated their effectiveness, safety, and recovery time after their continuous infusion in patients who required mechanical ventilation after cervical spine surgery. We also calculated the cost of drugs used during the mechanical ventilation. In addition, processed electroencephalogram (pEEG) was monitored employing spectral edge frequency 90 (SEF 90) as an indicator of sedation. ⋯ There was no correlation between the value of SEF 90 and the depth of sedation during mechanical ventilation. In conclusion, propofol exhibited the shorter recovery time after cessation of the continuous infusion than midazolam, but it costed five times compared with midazolam. SEF 90 failed to indicate the depth of sedation during mechanical ventilation.
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Randomized Controlled Trial Clinical Trial
[Low dose intrathecal morphine and postoperative pain relief in elderly patients].
Patient (ASA PS I-III, mean age 68 +/- 14 yr) who had undergone lower extremity surgery under spinal anesthesia were studied to determine the effect of intrathecal administration of morphine 0.1 mg on intra- and postoperative pain relief and its side effects. They were randomly divided into control (C) and intrathecal morphine (M) groups (n = 25, respectively) and received 10 mg tetracaine in 4 ml of a quarter saline with 7.5 micrograms epinephrine. Incidence of intraoperative tourniquet pain was significantly lower in M group (36.8%) than in C group (64.3%). ⋯ Although incidences of postoperative nausea, vomiting, and itching were higher in M group than in C group, none required antiemetic or naloxone. Both groups showed no difference in postoperative respiratory depression measured by apnea monitor (Eden Trace II, Mallinkrodt Japan, Tokyo). The results suggest that a low dose of intrathecal morphine is effective on postoperative 24 hr pain relief in elderly patients and that its side effects are negligible.
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Randomized Controlled Trial Comparative Study Clinical Trial
[A comparison between midline and paramedian approaches for combined spinal-epidural anesthesia].
We compared midline approach with paramedian approach for combined spinal-epidural anesthesia (CSEA) by needle through needle technique. Seventy patients undergoing elective gynecological surgery received CSEA with a 27 G Whitacre spinal needle, which protrudes 12 mm beyond the tip of the Tuohy needle. The successful subarachnoid puncture with first attempt was noted in 33 patients (94%) of midline group (M group), in 31 patients (89%) of paramedian group (P group). ⋯ Abdominal radiography revealed the flexion of epidural catheter in 19 patients (54%) of M group and in 2 patients (6%) of P group. The choice of midline or paramedian approach for CSEA did not affect the success rate of the subarachnoid puncture, but paramedian approach required longer protrusion length of the spinal needle than midline approach. To raise the success rate of subarachnoid puncture by paramedian approach, a long protruded spinal needle is recommended.
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Randomized Controlled Trial Clinical Trial
[Tracheal intubation without muscle relaxants using propofol and varying doses of fentanyl].
This study was designed to evaluate airway and intubating conditions without muscle relaxants after administration of fentanyl and propofol in 55 patients aged 20-60 years for elective surgery. Patients were randomly assigned to one of four groups to receive fentanyl 0, 2, 3, or 4 micrograms.kg-1, respectively. Three minutes after the administration of fentanyl, propofol (2 mg.kg-1) was given for induction of anesthesia. ⋯ There were no significant differences among groups receiving fentanyl with respect to vocal cord position. The vocal cords were closed in 26% of patients receiving fentanyl and propofol for intubation. Tracheal intubation without muscle relaxants is not recommended because of the potential unacceptable intubating conditions.