Masui. The Japanese journal of anesthesiology
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Multicenter Study Clinical Trial
[A clinical study of total intravenous anesthesia by using mainly propofol, fentanyl and ketamine--with special reference to its safety based on 26,079 cases].
During a period of five years from January 1996 through December 2000 total intravenous anesthesia with mainly propofol, fentanyl and ketamine was administered to 26,079 patients including cardiac and neurosurgical patients at the University of Hirosaki Hospital and five other affiliated hospitals. The patients studied ranged from 1 year 8 months to 93 years in age, 9.2 kg to 135.0 kg in body weight and from 18 min to 22 hours 50 min in anesthetic time. With adequate monitoring, fentanyl 1-2 micrograms.kg-1 was given at first, then total-dose of ketamine 1 mg.kg-1 and propofol 1-2 mg.kg-1 were administered for the induction of anesthesia in adult patients. ⋯ Their postoperative hepatic and renal functions evaluated by various biochemical indices and urine output were adequately maintained during anesthesia and for a week postoperatively. They were followed up to 3 months postoperatively only to fail to detect any adverse events related directly to this method of anesthesia. These data suggest that total intravenous anesthesia with propofol, fentanyl and ketamine has a very wide margin of safety.
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Randomized Controlled Trial Clinical Trial
[The effect of ketamine on reducing postoperative agitation after sevoflurane anesthesia in pediatric strabismus surgery].
We investigated the effect of ketamine on reducing postoperative agitation after sevoflurane anesthesia in children undergoing elective strabismus surgery. Fifty-five children, 3-9 years of age, were randomly assigned to the following three groups; ketamine (group K, n = 18), pentazocine (group P, n = 19), and flurbiprofen axetil(group F, n = 18). Group K received ketamine 1 mg.kg-1 intravenously, followed by infusion of ketamine 1 mg.kg-1.hr-1 during surgery, group P received pentazocine 0.2 mg.kg-1 intravenously after induction of anesthesia, and Group F received intravenous flurbiprofen axetil, 1 mg.kg-1 5 minutes before the end of surgery. ⋯ At T 1 and T 2, the incidence of agitation(AFPS > or = 3) in group K was less than that of group F and group P. However, in group K, more patients needed oxygen supplement after extubation. We concluded that coadministration of ketamine could be beneficial for reducing postoperative agitation after sevoflurane anesthesia in pediatric strabismus surgery.
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Although peripartum cardiac arrest is rare, the prognosis of the event may be worse than in nonpregnant patients because the events is often associated with pulmonary or amniotic embolisms. The following report is a case of cardiac arrest which occurred at the induction of anesthesia for the postpartum hysterectomy. A 31-year-old woman was treated with infusion of ritodrine chloride for preterm labor and placenta previa. ⋯ Since she was not resuscitated with cardiac massage, we started intravenous epinephrine, electronic cardioversion, the percutaneous cardiopulmonary support and intra-aortic balloon pumping with epinephrine and dopamine infusions leading to a successfully outcome. In this case, we believe that the combination of propofol and suxamethonium had the most impact on producing the cardiac arrest. Therefore, the case emphasizes the potential danger of using these combination for patients who have been treated with ritodrine.
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Hydrogen peroxide is widely used for irrigation of surgical wounds. However, its administration has been associated with gas embolism. We report a case of gas embolism after wound irrigation with hydrogen peroxide in a 11-year-old boy undergoing extraction of the extra-traumatic splint under general anesthesia. ⋯ When the patient awoke from anesthesia, he showed tonic convulsion. But he recovered without any complications. The administration of hydrogen peroxide into a closed tissue is contraindicated during surgery.