Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Effect of landiolol and combined use of landiolol and olprinone on hemodynamics in patients undergoing off-pump coronary artery bypass grafting].
Beta blockers are frequently used to reduce cardiac oxygen demand in off-pump coronary artery bypass grafting (OPCAB). However, significant bradycardia or negative inotropic effects are seen on occasion. We hypothesized that combined use of landiolol (L), an ultra short-acting beta blocker, and olprinone (O), a phosphodiesterase 3 inhibitor, is useful because it can increase cardiac index and prevent tachyarrhythmia even during dislocation of the heart in OPCAB. ⋯ Combined use of landiolol and olprinone increases cardiac index and decreases systemic vascular resistance index during OPCAB.
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Randomized Controlled Trial
[Evaluation of motor block of the lower legs in continuous lumbar epidural infusion of ropivacaine].
Continuous epidural infusion of ropivacaine is commonly used for postoperative analgesia because of its motor-sparing properties. But there are a few patients whose motor block of the lower legs is prolonged. The aim of this study is to investigate the effect of low density ropivacaine regarding motor block of the lower legs when administered continuously into the lumbar epidural space. ⋯ For avoiding prolongation of motor block of the lower legs in continuous lumbar epidural infusion for postoperative analgesia, 0.1% ropivacaine would be better than 0.2%. We should pay attention to the fact that the use of ropivacaine after spinal anesthesia prolongs and increases motor block of the lower legs.
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The American Society of Anesthesiologists (ASA) published a clinical practice guideline of preoperative fasting in 1999. A nationwide survey conducted in Japan in 2003 reveals that many hospitals have a much longer fasting period. We conducted a similar survey in three limited areas in Japan to assess the changes in fasting practice. ⋯ Longer preoperative fasting periods are still common practice in Japanese hospitals.
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We report 2 patients for whom anesthetic management using aortic occlusion balloon catheter (AOBC) was performed thrice. A 14-year-old boy and a 43-year-old man with sacral giant cell tumor underwent tumor resection. In both patients, transcatheter arterial embolization (TAE) was performed several times before the operation. ⋯ Because the AOBC could not decrease the severity of venous hemorrhage, we expected increased hemorrhage with an increase in the extent of surgery. In addition, preoperative multiple TAE might lead to the development of collateral circulation around the sacrum and augment the amount of blood loss in that region. Although the AOBC could reduce intraoperative hemorrhage, uncontrollable bleeding may occur if the sacral giant cell tumor shows extensive dissemination.
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Although the cases of upper airway obstruction with ProSeal laryngeal mask airway (PLMA) during spontaneous respiration were reported, the structural comparison with other types of laryngeal mask are not known. We thus examined the relationship between upper airway obstruction and the structure of laryngeal mask. ⋯ The upper airway obstruction is caused by PLMA due to the deep bowl cup form which is distinctive design of PLMA. Bulky side cuff limits the movement of arytenoids. The bowl cup pushes up the oral cavity forward, and the supraglottic soft tissues are displaced inward because those tissues are not fixed by the thyroid cartilage. Other types of LMA listed above do not have these features. This suggests that Supreme or Classic LMA is suitable for spontaneous respiration than PLMA, and it is risky to choose PLMA for emergency airway management without knowing these features.