Masui. The Japanese journal of anesthesiology
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We investigated the relationship between maintenance bolus dose of vecuronium bromide (Vb) and the recovery time measured by TOF Guard in patients anesthetized with isoflurane (1.2-2.0%)-N2O-O2 (GOI group, n = 19) and epidural anesthesia (2% mepivacaine) plus isoflurane (0.5%)-N2O-O2 (EPI group, n = 14). In both groups, anesthesia was induced with propofol 2 mg.kg-1 and Vb 0.1 mg.kg-1 and ventilation was controlled to keep end tidal CO2 between 35-40 mmHg. When the muscle relaxation recovered to 25% of train-of four ratio (TOFR), doses of Vb 0.06, 0.04 or 0.02 mg.kg-1 were administered. ⋯ There were no significant differences in the recovery time between these two groups. In both groups, although the recovery time to TOFR 25% was prolonged significantly in proportion to the increasing doses of Vb, the increase did not correlate with the dose of Vb. We suggest that frequent administration of Vb 0.02 mg.kg-1 decreases the total amount of Vb to keep TOFR within 25%.
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We report a "walking" catheter resulted in failed epidural anesthesia. An 85-year-old woman was scheduled for insertion of a nail in the left humerus. At 10 a.m. on the day of surgery, a Tuohy needle was inserted into the epidural space between the C6 and C7 vertebrae, and then we inserted an epidural catheter for 5 cm. ⋯ We infused 10 milliliters of 1% mepivacaine through the epidural catheter. Hypesthesia was obtained on the right side of her neck, from the C2 to the C5 level, after 10 minutes. Epidurography after surgery showed that the coiled catheter was placed straight into the right side of the epidural space; contrast medium infused through the catheter was found spread only to the right side from the C2 to the C4 level.
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We investigated the post-operative delirium in elderly patients of over 65 years of age. This investigation consisted of two studies, a prospective study and a retrospective study. In the prospective study, we evaluated the incidence of post-operative delirium and the incidence of post-operative delirium was estimated pre-operatively using State-Trait Anxiety Inventory (STAI) and Mini Mental State Examination (MMSE) in 24 patients scheduled for elective surgery under general anesthesia in the period from Nov. 1995 to Oct. 1996. ⋯ In these patients, several factors such as blood transfusion, emergency operation, dehydration, thrombosis of the superior mesenteric artery, history of ischemic heart disease, brain infarction and atrial fibrillation were thought to be major risk factors triggering post-operative delirium. In this study we could not conclude that STAI or MMSE are useful to estimate the incidence of post-operative delirium preoperatively. However, our result suggests that we should be careful about the incidence of post-operative delirium in elderly patients with pre-operative risk factors as mentioned above.
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Comparative Study Clinical Trial
[A comparison of the incidence of postoperative nausea and vomiting after propofol-fentanyl anesthesia and that after nitrous oxide-isoflurane anesthesia].
We compared the incidence of postoperative nausea and vomiting after total intravenous propofol-fentanyl anesthesia (TIVA group) and that after thiamylal-nitrous oxide-isoflurane anesthesia (GOI group) in 60 ASA physical I and II patients for elective abdominal simple total hysterectomy. When the patients returned to the ward, the incidence of nausea was lower in TIVA group than in GOI group (P < 0.05), but no difference was found in the incidence of vomiting between the two groups. ⋯ Postoperative pain scores were similar between the two groups, while total postoperative evaluation scores (nausea, vomiting, pain, fever, and sleep disturbance) were lower in TIVA group (P < 0.05). We conclude that TIVA with propofol-fentanyl reduced the incidence of nausea and improved total evaluation scores in the immediate postoperative period.
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Pharmacokinetics of propofol and ketamine during propofol-fentanyl-ketamine (PFK) anesthesia for pediatric surgery was studied. Plasma levels of propofol (Pp) were maintained approximately at 2.5 micrograms.ml-1 during surgery. Fifteen minutes after the cessation of propofol infusion, Pp decreased to 1.5 micrograms.ml-1. ⋯ On the other hand, plasma norketamine (Pn) levels increased gradually during surgery and stayed at 100-150 ng.ml-1 after the end of ketamine infusion to play an important role in post-operative sedation and pain relief. In conclusion, pharmacokinetics of propofol and ketamine in pediatric patients was similar to that in adult patients. PFK anesthesia can be used safely for pediatric as well as for adult patients.