Masui. The Japanese journal of anesthesiology
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We studied the relationship between postoperative brain dysfunction and the state of atherosclerosis in the patients of open heart surgery, by analyzing the intraoperative cerebral oxygen saturation (rSO2) and the CO2 reaction. The subjects were 143 patients with average age of 64 years. ⋯ There were significantly high values of AI and beta as well as low rSO2, in elder age with low cardiac index and no correlation was observed between rSO2 and PaCO2 in the brain dysfunction group. The results suggested that a higher level of atherosclerosis is associated with the postoperative brain dysfunction with resultant decreased cerebral blood flow and disturbed reaction to CO2 of cerebral blood vessels.
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A study using 14C propofol showed that the liver is the main eliminating organ for the agent. The current study was designed to clarify pharmacokinetics of propofol during liver transplantation in pigs. Five small pigs weighing 25.4 +/- 2.5 kg were anesthetized with isoflurane (0.5-1.5%) and mechanically ventilated under muscle paralysis with pancuronium. ⋯ We studied pharmacokinetic parameters following an intravenous bolus injection of propofol at 2 mg.kg-1 in each phase, i.e. the pre-anhepatic, anhepatic and post-anhepatic phase during liver transplantation. Pharmacokinetic analysis showed that total plasma clearance of propofol in the anhepatic phase was significantly lower than that in the post-anhepatic phase. The results suggest that propofol may be metabolized extrahepatically and can be used at reduced doses in the anhepatic phase during liver transplantation.
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Randomized Controlled Trial Clinical Trial
[The effect of hypertonic saline infusion on lumbar epidural anesthesia].
The author compared hemodynamic effects of fluid loading during epidural anesthesia with 7.2% hypertonic saline (HS), lactate Ringer's (LR) or isotonic saline solutions in 24 ASA 1 patients undergoing elective lower abdominal or pelvic surgery, allocated randomly into three groups. The first two groups, patients received equal amounts of sodium (2.2 mmol.kg-1), and the latter group, isotonic saline solutions for 1-2 ml.kg-1.h-1 as control. After epidural injection (2%mepivacaine 0.1 ml.cm(Height)-1), fluid loading was performed for 20 minutes. ⋯ Increase of extracellular volume in group HS was observed by bioelectrical impedance analysis as in group LR. The author concludes that HS may be useful especially in the case not requiring a large volume of fluid loading. Finding ideal concentration, volume, and speed of infusion of intravenous fluids would be clinically useful.
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Randomized Controlled Trial Clinical Trial
[The volume and pH of gastric fluid in elective surgical patients after preoperative oral fluid intake].
The effect of preoperative oral fluid intake on the volume and pH of gastric fluid was examined in 45 elective surgical patients ranged in ages from 18 to 70 years. Two hours preoperatively they all received oral roxatidine 75 mg with 10 ml water, immediately followed by 150 ml oral water or 150 ml refreshing drink or no fluid as control. Just after the induction of anesthesia, a Salem-sump tube was put down to the stomach to collect gastric fluid in each patient. ⋯ As there were no significant differences in gastric pH values in the three groups, the highest value was found in the refreshing drink group. No significant difference in VAS of hungry and thirsty feeling was found among the three groups. We conclude that preoperative oral water or refreshing drink with roxatidine 75 mg 2 hours before the start of anesthesia may not increase the risk of aspiration during the induction of anesthesia.