Masui. The Japanese journal of anesthesiology
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Case Reports
[Two cases of intraoperative awareness during intravenous anesthesia with propofol in morbidly obese patients].
We experienced two cases of intraoperative awareness during intravenous anesthesia with propofol and fentanyl in morbidly obese patients. The rates of propofol infusion were calculated according to the adjusted body weights, or reduced intentionally as obese patients are generally believed to require lower doses of propofol compared with non-obese patients. Our postoperative analysis by simulations using the anesthesia records showed that, when the simulation was based on real body weight, the blood/effect-site concentrations of propofol in both patients would have been below the necessary levels to keep the patients unconscious during the operation, but when the simulation was based on adjusted body weight, those concentrations might have been within the necessary range to maintain an adequate hypnotic level. We propose that the rate of propofol infusion should be the same in obese and non-obese patients and should be calculated according to the real body weight not to the adjusted body weight.
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A 71-year-old man with a history of allergic rhinitis for 6 years received spinal anesthesia using 2 ml of 0.3% dibucaine for transurethral prostatectomy. Two months previously he had undergone prostate biopsy and cystoscopy under spinal anesthesia with isobaric bupivacaine uneventfully. Forty five minutes after injection of dibucaine he complained of itching in the periorbital area, and developed tremor and muscle rigidity followed by loss of consciousness. ⋯ Continuous infusion of epinephrine was needed for complete relief of symptoms. An intradermal test with 0.3% dibucaine carried out 6 days after surgery demonstrated a 12 x 8 mm wheal with flare. Although anaphylactic reaction to an amide local anesthetic has been reported to be quite rare, this is the 7th case report of anaphylactic reaction to dibucaine used for spinal anesthesia in Japan.
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We evaluated the effect of olprinone hydrochloride on intraocular pressure (IOP) and ocular blood flow in patients after cardiac surgery under cardiopulmonary bypass (CPB). ⋯ We demonstrated that olprinone hydrochloride led to a decrease in IOP and an increase in ocular blood flow in patients after cardiac surgery under CPB.
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The aim of this study is to examine the duration and magnitude of vasodilating effect induced by sympathetic block with the addition of different concentrations of clonidine to mepivacaine. ⋯ Sympathetic block with the addition of clonidine to local anesthetics increases both duration and magnitude of its vasodilating effect. However, sympathetic block with the addition of higher doses of clonidine to local anesthetics may induce shorter duration and lower magnitude of vasodilating effect compared with local anesthetics alone.
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The purpose of this investigation was to determine whether elimination of premedication before general anesthesia affects preoperative anxiety. ⋯ We conclude that elimination of premedication does not increase anxiety in comparison with patients receiving sedatives, but makes patients feel comfortable by way of preoperative conversation. Elimination of premedication also makes ambulatory entrance possible, both improving safety with respect to patient identification and reducing the demand on nursing.