Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[The effect of olprinone administered after cardio-pulmonary bypass during open heart surgery, evaluated by its plasma concentrations and hemodynamic changes].
Plasma concentrations and hemodynamic effects of olprinone were evaluated in seventeen patients undergoing open heart surgery. The patients were randomized into the bolus group (15 micrograms.kg-1 bolus dose +0.1 microgram.kg-1.min-1 infusion, n = 9) and the non-bolus group (0.1 microgram.kg-1.min-1 infusion, n = 8). ⋯ In the bolus group, increases in the cardiac index and stroke volume index were significantly higher compared with the non-bolus group. From these results we conclude that olprinone given in bolus (15 micrograms.kg-1) followed by continuous infusion (0.1 microgram.kg-1.min-1) is efficacious and safe during weaning from CPB.
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Comparative Study
[Utility of an infrared ear thermometer as an intraoperative core temperature monitor].
We investigated the utility of an infrared ear thermometer (M 10, Terumo) as an intraoperative core temperature monitor. Temperatures of the axilla and inner ear were measured before and after anesthesia. Bladder, rectal, and forehead deep temperatures were continuously measured using a core temperature monitor (CTM-205, Terumo) during anesthesia. ⋯ The inner ear temperature showed a close correlation with rectal, bladder, forehead deep, and axillary temperatures (r = 0.72-0.79, P < 0.01). The smallest temperature difference in this study was found to be that between the inner ear and forehead deep temperatures (-0.10), and the limit of agreement between these temperatures was also the smallest (0.81). In conclusion, we recommended the use of an infrared ear thermometer as an intraoperative core temperature monitor, especially in lower abdominal surgery, in which neither rectal nor bladder temperature monitoring is reliable.
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Case Reports
[Differential lung ventilation using Fogarty catheter after accidental damage of bronchial blocker cuff].
We performed differential lung ventilation using a Fogarty catheter after accidental damage of a bronchial blocker. A 57-year-old-man underwent thoracoscopic surgery for right pneumothorax. Anesthesia was induced with fentanyl and midazolam, and maintained with propofol and continuous epidural block with 2% mepivacaine. ⋯ Its balloon was inflated for differential lung ventilation. The procedure was performed successfully and uneventfully. We conclude that Fogarty catheter is an effective replacement for a damaged bronchial blocker cuff during differential lung ventilation.
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Total intravenous anesthesia (TIVA) is recommended to avoid air pollution. However, intermittent administration of anesthetic agents has a large disadvantage of delayed emergence time. ⋯ In this study, we maintained anesthesia with continuous intravenous administration of propofol using twice step down method every one hour. We conclude that the reduction of propofol maintenance dose for every 1/6 in one hour produces fewer dropout cases.
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A 56-year-old male who had received total thymectomy for treatment of myasthenia gravis was scheduled for sigmoidectomy under general anesthesia. Since his symptoms had become worse after the thymectomy along with increased anti-acetylcholine receptor antibody titer, preoperatively we could not estimate his sensitivity to non-depolarizing muscle relaxants. We initially tried tracheal intubation without using a non-depolarizing muscle relaxant immediately after intravenous injection of propofol 2 mg.kg-1 and fentanyl 4 micrograms.kg-1. ⋯ Successful intubation was performed with 3.5 mg of vecuronium. We conclude that the initial trial of tracheal intubation should be performed without a non-depolarizing muscle relaxant in patients with myasthenia gravis whose symptoms have become worse after thymectomy. If first attempt is unsuccessful, the tracheal intubation should be performed with a smaller dose of vecuronium using an electrical nerve stimulator.