Masui. The Japanese journal of anesthesiology
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A survey of unexpected cardiac arrests, excluding those associated with cardiac surgery, that had occurred during anesthesia and surgery in the period 1980-1999 was conducted. There was no significant difference between the number of such cardiac arrests that occurred in the 1980 s (29/36,159, 0.080%) and the number in the 1990 s (33/37,643, 0.088%). According to the classification by Keenan et al., there were 3 cases (0.0083%) in the 80 s and 4 cases (0.0106%) in the 90 s that occurred due to anesthetic management. ⋯ This increase seems to be due to an increase in the number of severe and multiple injuries and an increase in complicated major surgery. The increase in number of cases due to preoperative conditions also depends on coronary spasm and cardiac conduction insufficiency. Taking into consideration the improvement in intraoperative monitoring and the development of novel anesthetics in the 90 s, greater efforts should be made by anesthesiologists to reduce the incidence of cardiac arrest due to anesthetic management, and preoperative evaluation of surgical patients needs to be reconsidered.
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Historical Article
[Notes about two paintings in the Francis A. Countway Library of Medicine].
Two interesting mural-sized oil paintings hang in the Francis A. Countway Library of Medicine in Boston. One is "The First Operation Under Ether" painted by Robert C. ⋯ On the other hand, "The First Successful Kidney Transplantation" was planned by the three doctors who were themselves involved in the memorable operation. The painter, Joel Babb, began to recreate the scene after he had been handed some sketches and photos of the event and several photos of the participants. In this case, it seems that authenticity was the main consideration.
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The efficacy of gas exchange during partial liquid ventilation (PLV) may be affected by positive end-expiratory pressure (PEEP), tidal volume (TV) and perflubron (PFOB) dose. The purpose of the present study was to clarify which factors were important for improving gas exchange during PLV. Fourteen rabbits were anesthetized and tracheostomized. ⋯ Pulmonary compliance was significantly decreased with PEEP in hTV ventilation in addition to 15 ml.kg-1 PFOB. The results suggested that adequate gas tidal volume was the most important factor for improving gas exchange during PLV. However, PEEP or larger dose of PFOB should be avoided because they may decrease pulmonary compliance.
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Randomized Controlled Trial Clinical Trial
[Low concentration/high volume is more effective than high concentration/low volume for postoperative continuous epidural analgesia with the combination of bupivacaine and fentanyl].
In 40 females undergoing gynecologic laparotomy, lumbar epidural analgesia using a disposable infusion pump was continued for postoperative 48 hours. Then the analgesic effect of epidural bupivacaine (4.8 mg.kg-1) plus fentanyl (12 micrograms.kg-1) diluted with normal saline was prospectively compared between the two groups; high concentration/low volume group (HC/LV, 96 ml of total volume and 2 ml.h-1 of infusion rate, n = 20) versus low concentration/high volume group (LC/HV, 240 ml of total volume and 5 ml.h-1 of infusion rate, n = 20). ⋯ No significant differences in the incidence of side effects were observed between the groups. These results suggest that when the equivalent dose is given, the volume rather than the concentration of the solution is important for postoperative continuous epidural analgesia with the combination of bupivacaine and fentanyl.
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Comparative Study
[Comparison by simulation of the efficiency of surgical blood order equation (SBOE) with that of maximum surgical blood order schedule (MSBOS)].
The maximum surgical blood order schedule (MSBOS) is used to promote efficient blood ordering practice for surgical patients. A surgical order equation (SBOE) was developed to calculate the number of units of red blood cells that should be ordered considering specific patient variables. We compared the efficiency of SBOE with that of the MSBOS by simulations. ⋯ The SBOE reduced the ordered units more effectively than the MSBOS. The SBOE reduces crossmatch-to-transfusion ratio (C/T ratio) from 1.2 to 1.6 but it would reduce the ordered units in statistical significance in only two of six types of operations. In conclusion, the SBOE could improve C/T ratio.