Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Multicenter Study
[Effects of sevoflurane and propofol on neuromuscular blocking action of Org 9426 (rocuronium bromide) infused continuously in Japanese patients].
The purpose of this study was to investigate the interaction of anesthetic agents with Org 9426 (rocuronium bromide) infused continuously. The effect of intubation dose of Org 9426 on its infusion rate was also investigated. ⋯ Patients receiving sevoflurane anesthesia required a markedly lower Org9426 infusion rate compared with patients receiving propofol anesthesia.
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Comparative Study
[Comparison of pentazocine and fentanyl in total intravenous anesthesia using propofol].
Pentazocine may be an alternative for fentanyl during total intravenous anesthesia (TIVA) using propofol. The authors compared the efficacy and safety of pentazocine for analgesics in TIVA using propofol. ⋯ The results suggest that pentazocine would provide a stable hemodynamic state, rapid recovery and an effective postoperative pain relief to the same degree as with fentanyl in TIVA with propofol.
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We report a patient who developed pulmonary edema due to airway obstruction after extubation. A 22-year-old man underwent removal of the nails for thoracoplasty under general anesthesia combined with epidural anesthesia. Upper airway obstruction occurred after extubation. ⋯ However, inspiratory wheezing was heard over both lung fields. Chest X-ray taken 90 minutes after the event revealed pulmonary edema. Pulmonary edema gradually resolved after intravenous furosemide and oxygen inhalation by mask.
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Determination of end-tidal carbon dioxide pressure (PET(CO2)) is effective to confirm adequate ventilation, because arterial to end-tidal carbon dioxide tension difference (deltaa-ET(CO2)) does not change normally during operation. But deltaa-ET(CO2) may change during laparoscopic surgery, because peritoneal insufflation of CO2 will increase CO2 production and reduce functional residual volume. Changes in deltaa-ET(CO2) were reported in laparoscopic cholecystectomy with cardiovascular complication, but there is controversy about how deltaaET(CO2) will change in more complicated and long laparoscopic surgery. In this prospective study, we examined changes in deltaa- ET(CO2) during laparoscopic colorectal surgery. ⋯ In laparoscopic colorectal surgery, Pa(CO2) should be checked for at least the first 60 minutes to confirm adequate ventilation.
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Case Reports
[Prolonged paralysis after long-term administration of vecuronium in the intensive care unit].
A 51-year-old woman with renal failure requring hemodialysis received a total of 446 mg of vecuronium over a period of 4 days to help mechanical ventilation and developed generalized muscle weakness after its discontinuation. It took 2 wks to wean her from mechanical ventilation and 3 wks for her to be able to walk. ⋯ We believe that the cause is the accumulation of vecuronium and active metabolites due to renal failure. The case suggests that we should minimize the duration of neuromuscular block in patients with renal failure by aggressive use of sedatives and analgesics and the optimization of ventilator settings.