Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Effects of oral clonidine premedication on the heart rate response to intravenous atropine during propofol anesthesia].
Propofol induces suppression of the sympathetic nervous activity, and attenuates the heart rate responses to intravenous atropine. Similarly, clonidine suppresses the heart rate response to intravenous atropine under awake and enflurane-anesthetized patients. The purpose of this study is to evaluate effects of clonidine on the heart rate response to atropine under propofol anesthesia. ⋯ Oral clonidine premedication attenuates the heart rate responses to IV atropine under propofol anesthesia.
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Case Reports
[Sinus arrest during laryngoscopy for induction of general anesthesia with intravenous fentanyl and propofol].
A 43-year-old woman with Plummer's disease underwent left thyroid lobectomy without premedication using ambulatory electrocardiogram monitoring under general anesthesia. Anesthesia was induced with an intravenous bolus of fentanyl 100 microg, lidocaine 40 mg, propofol 80 mg and vecuronium 7 mg. As she moved 5 min after induction of anesthesia, fentanyl 100 microg and propofol 30 mg were administered additionally. ⋯ We consider this phenomenon as a result of vagovagal reflex. Fentanyl and propofol, by reducing sympathetic tone to a greater extent than parasympathetic tone, decrease blood pressure and heart rate, and predispose to a parasympathetic response for noxious stimulation. This case indicates that intravenous injection of atropine must be immediately used for bradycardia during laryngoscopy for induction of general anesthesia with fentanyl and propofol.
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Fiberoptic intubation can cause laryngeal injury during blind insertion of a tracheal tube. A patient with hypopharyngeal cancer was scheduled for laser surgery and we selected nasal fiberoptic intubation due to laryngeal deformity. ⋯ A piece of mucosa and blood clot was found in the lumen of the tracheal tube and hematoma was observed on the surface of arytenoid cartilage. Careful selection and optimal manipulation of the tracheal tube is important and surgical airway access should be immediately available before fiberoptic procedure in a patient with friable and vascular-rich laryngeal lesion.
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Insertion of a nasogastric tube in anesthetized and intubated patients is sometimes difficult. We studied the movement of a gastric tube in order to find a way for successful insertion of a nasogastric tube. ⋯ Our study showed that using a 5 cm height pillow was a best way to insert a nasogastric tube, but ipsilateral head rotation did not contribute to the procedure.
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Syringe swap is an important problem in anesthetic care, causing harm to patients. We examined the effect of colored syringe and a colored sheet on the incidence of syringe swaps during anesthetic management. ⋯ The use of the sheet together with colored syringes can prevent syringe swaps during anesthesia.