Masui. The Japanese journal of anesthesiology
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The interaction of sevoflurane and nitrous oxide (N2O) on the MAC was studied in the four groups of patients between 30-60 years of age scheduled for laparotomies. Patients received one of four different concentrations of N2O [0% (n = 14), 25% (n = 16), 50% (n = 15), or 70% (n = 18)]. Anesthesia was induced with sevoflurane and N2O using a semiclosed circuit with a carbon dioxide absorber. ⋯ The extrapolated MAC value for N2O was 102%. The MAC values of sevoflurane in O2 and N2O were similar to the previously reported values. We conclude that in adults, N2O concentrations in the dose range 0-70% reduce sevoflurane MAC in a linearly additive manner.
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Randomized Controlled Trial Clinical Trial
[Premixing lidocaine reduces the incidence and severity of pain on injection of propofol].
The purpose of this study was to confirm the effect of premixed lidocaine for the reduction of pain during injection of propofol in adult patients. We conducted a prospective, randomized, double-blind trial on 106 patients. In the study group (n = 54), lidocaine 40 mg (2 ml of lidocaine 2%) was added to 180 mg of propofol (18 ml). ⋯ Eleven patients (20.4%) in the study group experienced pain compared with 25 (48.1%) in the control group. Thirteen in the control group complained moderate or severe pain compared with only one in the study group. In conclusion, lidocaine 40 mg premixed with 180 mg propofol significantly reduces the incidence and severity of pain associated with propofol injection.
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Case Reports
[Perioperative management of a patient with severe anemia caused by rare Jr (a-) blood].
We experienced the anesthetic management of a patient with severe anemia as low as 1.8 g.dl-1 of hemoglobin and 6.5 per cent of hematocrit before surgery. His blood had been determined as type B, anti-Jra antibody positive and the proper blood was unavailable. ⋯ The operation finished relatively uneventfully and the patient was transferred to the common ward from the intensive care unit on the fifth postoperative day. We conclude that maintaining the patient's circulating volume to avoid shock should be given priority in a case of severe anemia.
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We report five patients who developed intraoperative myocardial ischemia but were treated successfully with nicorandil. Case 1; An 84 year-old male underwent emergent laparotomy and ileolysis under inhalational plus thoracic epidural anesthesia. During his emergence from anesthesia, arterial pressure and heart rate increased abruptly due to excitement, leading to ST-T depression on V5 lead. ⋯ In each case, intraoperative myocardial ischemia was treated successfully with nicorandil. Neither hypotension nor arrhythmia resulted from its bolus injection. Nicorandil might be a useful therapeutic tool for myocardial ischemia during anesthesia.
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Recent experimental studies reported by several independent groups demonstrated that in the initial interventions of cardiopulmonary resuscitation (CPR), airway protection (A) and artificial breathing (B) are not essential for successful recovery from cardiac arrest. In this study, we reviewed and compared those reports to investigate individual effects of A and B on initial CPR. Airway protection: Spontaneous gasping during cardiac arrest is accompanied by upper airway protective reflexes such as head tilt and open mouth. ⋯ Arterial blood gas analyses demonstrated that CPR without B developed hypercarbia, but maintained oxygen tensions in physiological levels. The frequency of chest compression is in the range of high frequency ventilation, which might allow for successful oxygenation regardless of limited tidal volumes. A series of experimental studies for CPR without A or B call for establishment of a simple CPR method for bystanders, namely "Just compress the chest".