Masui. The Japanese journal of anesthesiology
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"Guidelines on Blood Products Use" published in 1999 recommends restricting the use of fresh frozen plasma (FFP) solely to correct multiple coagulation factor deficiencies. We retrospectively studied the use of FFP in patients with massive intraoperative bleeding before and after publication of the new guidelines. There were 22 patients whose blood loss was more than their circulating blood volume (7% of body weight) in the past two years. ⋯ FFP was given to all 22 patients. The mean dose of FFP decreased from 26.8 ml.kg-1 to 17.8 ml.kg-1 after publication of the new guidelines but the difference was not statistically significant. The volume infused was more than that recommended to improve blood coagulation in massive bleeding, i.e., 8-10 ml.kg-1.
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Oscillometric noninvasive arterial pressure monitoring devices frequently fail to measure pressure precisely in patients with arrhythmia, such as atrial fibrillation, because beat-by-beat changes in pulse pressure and mean pressure level distort the relation between cuff pressure and oscillometric wave amplitude. To overcome this problem, we developed a new algorithm for oscillometric measurement in which oscillometric wave amplitude is corrected according to changes in pulse pressure and mean arterial pressure level. In 7 patients with atrial fibrillation, we compared systolic pressure thus estimated with that simultaneously measured invasively in the radial artery and averaged during oscillometric measurement. ⋯ Correction based on plethysmographically estimated pulse pressure decreased unmeasurable cases to 6% (P < 0.01). Standard error of systolic pressure estimates was 6.44 +/- 1.83, 4.10 +/- 0.85, and 4.75 +/- 1.26 mmHg with no, invasive, and plethysmographical correction in this order (P < 0.01). We conclude that oscillometric wave amplitude correction based on beat-by-beat pulse pressure and mean arterial pressure level lessened the number of unmeasurable cases and improved measurement precision in patients with atrial fibrillation.
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[The changes of bispectral index induced by administration of midazolam during propofol anesthesia].
The effect of the additional administration of midazolam or flumazenil on bispectral index (BIS) during propofol anesthesia was investigated in 22 scheduled surgical patients. Midazolam 10 or 30 micrograms.kg-1, or flumazenil 6 or 12 micrograms.kg-1 was injected to the patients to evaluate their effect on BIS after achieving steady state of hypnosis more than 1 hr of propofol anesthesia with 5 mg.kg-1.hr-1. The only midazolam 30 micrograms.kg-1 significantly reduced BIS value from 47.8 +/- 8.6 to 36.8 +/- 6.5. The synergistic interaction between midazolam and propofol assessed by BIS might be less clear than that assessed by hypnotic dose of propofol using psychopharmacological investigation.
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The incidence and duration of hoarseness following tracheal intubation with general anesthesia were studied retrospectively from November 1998 to October 2000 in postanesthetic clinic of Nara Medical University. Total number of patients was 3977 and 37.1% of them complained of hoarseness. ⋯ The hoarseness decreased the satisfactory level for anesthesia in 1.0% of total patients and 12.8% of patients with persistent hoarseness. We consider that preoperative explanation and postoperative communication by anesthesiologists are important.
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A 36-year-old man with intractable epileptic seizures underwent insertion of subdural electrodes on bilateral temporal lobes under air-oxygen-sevoflurane anesthesia. After the completion of the operation, we measured electrocorticogram at end-tidal sevoflurane concentration of 2.5%, 1.5%, and 1.5% with 0.1 mg intravenous fentanyl. ⋯ When 0.1 mg fentanyl was intravenously administrated during 1.5% sevoflurane anesthesia, the frequency of the spike waves was further reduced. Caution should be taken when using sevoflurane-fentanyl anesthesia because this combination may interrupt identification of epileptic focus on intraoperative electrocorticogram.