Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery].
Subcutaneous opioid is one way of managing postoperative pain in patients undergoing anticoagulant therapy. We have evaluated the safety and the efficacy of postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery. ⋯ We recommend administration of 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine subcutaneously, which maintains high Pao2 and requires less analgesic.
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Comparative Study
[Comparison of total intravenous anesthesia and inhalation anesthesia regarding hormonal responses during lung lobectomy].
Anesthetic techniques can modulate surgical stress responses. We studied the response of plasma epinephrine, norepinephrine, dopamine, adrenocorticotrophic hormone (ACTH), and serum cortisol during lung lobectomy under sevoflurane, propofol and fentanyl anesthesia. ⋯ Propofol-fentanyl anaesthesia prevents the increase in catecholamines and reduces the ACTH response during lung lobectomy.
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Spinal anesthesia has been often used for inguinal herniorrhaphy. With the advancement of surgical technique, tension free inguinal herniorrhaphy is now performed under local anesthesia. Local anesthesia, however, does not always offer sufficient anesthesia. ⋯ Advantages of psoas compartment block for inguinal herniorrhaphy are its easiness to perform, little burden of anesthesia and high efficacy. Demerits are slow onset of block and necessity for prolonged patient monitoring. Further investigations on dose and patient position are required for psoas compartment block to become useful for inguinal herniorrhaphy.
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Case Reports Comparative Study
[Comparison of cardiac output measured by pulseCO and that by vigilance during inferior vena cava clamping].
PulseCO is a low invasive apparatus to measure cardiac output continuously from arterial pulse waveform (PulseCCO). It is thought that the accuracy of PulseCCO measurement is clinically acceptable with stable hemodynamics. We measured and evaluated PulseCCO during inferior vena cava clamp (IVC clamp). ⋯ With IVC clamp maneuver which is thought to cause rapid change of cardiac output, PulseCCO showed more rapid change in comparison with VigilanceCCO. In the state where hemodynamics change rapidly, PulseCO can be a more useful monitor.
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We report two patients in whom the presence of a tracheal tube induced asthmatic attack or hemodynamic instability and the laryngeal mask was useful during emergence from anesthesia. Case 1:A 24-year-old man with asthma was scheduled for reconstruction of an amputated finger. After induction of anesthesia and neuromuscular blockade, the trachea was intubated without complications. ⋯ After uneventful operation, sevoflurane and nitrous oxide were turned off. Multiple premature ventricular contractions (PVCs) with hypertension and tachycardia occurred, and necessitated the restart of sevoflurane. Under deep anesthesia, the laryngeal mask was inserted and the trachea extubated, and the patient regained consciousness without complications.