Masui. The Japanese journal of anesthesiology
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We have been offering active postoperative analgesia service (PAS). In order to further enhance the quality of PAS, we reviewed 1500 cases of postoperative continuous epidural analgesia (PCEA). ⋯ These results indicate that to improve our method of PCEA with PDIP, we must re-assess our regimen used for continuous epidural infusion for postoperative pain relief, and develop measures to prevent side effects and complications.
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Comparative Study
[Dynamic cerebral blood flow autoregulation during sevoflurane anesthesia and TIVA].
Dynamic cerebral blood flow autoregulation during sevoflurane anesthesia and total intravenous anesthesia (TIVA) is unclear. We examined the cerebral circulation autoregulation during anesthesia by sevoflurane or TIVA. ⋯ These results suggest that TIVA by propofol and fentanyl maintains the dynamic autoregulation of cerebral blood flow, but sevoflurane impairs the autoregulation.
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In this study we have surveyed the rate of use of pulmonary artery catheter (PAC) in 319 cardiovascular operations from 1997 to 2001. The rate was decreasing year by year from 100%(6/6) in 1997, 77%(39/51) in '98, 32%(24/75) in '99, 20%(19/93) in 2000, to 8.5%(8/94) in 2001. Especially in elective coronary artery bypass grafting (CABG), an extreme reduction was found: 100%(3/3), 95% (19/20), 17%(6/35), 2.2%(1/45), 0%(0/53), respectively. ⋯ Cardiac functions monitored with PAC can be largely substituted with TEE except mixed venous oxygen saturation, but it is not continuous monitoring. Current indications of PAC is for patients with pulmonary hypertension and low cardiac output, as well as those who are predicted to be difficult for postoperative management, and those who have off pump CABG with inverted heart position, at our institution. Routine use of PAC for cardiac surgery should be reconsidered.
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The risk of occupational exposure to waste anesthetic gases still remains during inhaled induction. In this study we investigated how much we were occupationally exposed to anesthetic gases during induction period. ⋯ The induction with intravenous anesthetics is a better method in order to reduce occupational exposure of anesthesiologists to anesthetic gases.
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During light sedation under local anesthesia, usually only percutaneous arterial oxygen saturation (SpO2) has been monitored for respiration. Measuring end-tidal carbon dioxide tension (EtCO2) has been difficult in such cases because of many air leaks from mask or cannula. We investigated the usefulness of a new nasal cannula with which EtCO2 can be monitored simultaneously with oxygen delivery. ⋯ A new cannula with EtCO2 port is useful to oxygenate and measure EtCO2 simultaneously except when patients snore or move.