Masui. The Japanese journal of anesthesiology
-
Neurological outcome and pathological changes of the brain were studied in 5 female mongrel dogs, which were subjected to normothermic ventricular fibrillation (Vf) cardiac arrest of 15 min and resuscitated by using cardiopulmonary bypass through the femoral artery and veins (F-F bypass). Spontaneous circulation was restored by one or two defibrillating countershocks in all 5 dogs 5.2 +/- 1.1 (mean +/- SD) min after initiation of the F-F bypass. The F-F partial bypass was continued for 164 +/- 30 min under mild hypothermia. ⋯ Soon after extubation, the animals barked, moved the forelegs and could drink water. Neurological deficit scores (normal: 0, brain death: 500) improved to become below 100 except in 1 dog. However, macroscopic examination of the brain in 2 dogs with prominent recovery disclosed atrophy of the central gyrus and microscopic examination revealed typical ischemic injuries of the vulnerable neurons at the cerebellum, hippocampus and cerebral cortex in the frontal lobe.
-
The effect of three solutions on postoperative pain relief by continuous epidural infusion was studied. Seventy-five patients after upper or lower abdominal surgeries were assigned to one of three groups and the postoperative pain relief was evaluated for 48 hours. ⋯ However, even in Group III, the percentage of patients complaining of pain at bed rest was still high during early postoperative period (56% at 6 hours postoperatively). The results suggest that further consideration is necessary on agents selection and dosage adjustment for the postoperative epidural analgesia.
-
After normothermic ventricular fibrillation (Vf) cardiac arrest of 15 min, 15 female mongrel dogs received conventional cardiopulmonary resuscitation (CPR) for 3 min and then cardiopulmonary bypass through the femoral artery and veins (F-F bypass). Cardiac beat did not return in any dogs during the initial 3-min CPR. Spontaneous circulation was restored by defibrillation 5.2 +/- 3.8 (mean +/- SD) min after the initiation of the F-F bypass in all dogs except in one with bypass trouble. ⋯ The values of cardiac output measured just before weaning from the bypass and 30 to 60 min after weaning were significantly lower than those before inducing Vf (n = 5). On the electroencephalogram, intermittent burst waves reappeared 90.0 +/- 24.7 min after the initiation of resuscitation and EEG showed continuous waves 130.7 +/- 28.1 min (n = 7) after the initiation of resuscitation. The values of blood glucose, lactate and potassium 5 to 15 min after the initiation of F-F bypass were significantly higher than those before induction of Vf, while the values of hemoglobin, hematocrit, platelet and serum protein decreased significantly (n = 14).
-
Comparative Study
[A comparison of pancuronium and vecuronium used during the induction of high-dose fentanyl anesthesia].
Effects on hemodynamics and blood catecholamine levels of pancuronium and vecuronium used during the induction of anesthesia, were studied in patients undergoing coronary artery bypass grafting. Anesthesia was induced out with fentanyl, 70 micrograms.kg-1, and diazepam, 0.2 mg.kg-1, and either pancuronium or vecuronium was administered in a dose of 0.2 mg.kg-1. Control measurements were made before the induction of anesthesia. ⋯ While NEP was unaffected in group P during the induction of anesthesia, it decreased significantly at S1 and S2, compared with control (S0), in group V. On the other hand, EP decreased significantly at S1 and S2 during the induction of anesthesia in both groups, but group V showed a greater change. The results of this study suggest that pancuronium is more advantageous than vecuronium as a muscle relaxant used during the induction of high-dose fentanyl anesthesia.
-
Case Reports
[Rupture of asymptomatic mycotic aneurysm after valve replacement in infective endocarditis].
Mycotic cerebral aneurysms (MCA) are one of the most serious complications of infective endocarditis. The rupture of MCA in patients under anticoagulant therapy following valve replacement carries high mortality. We encountered this serious complication in a patient who had no neurologic symptoms. ⋯ She was transferred to the intensive care unit and given continuous infusion of barbiturate to prevent increase of her intracranial pressure. CT scanning and arteriography 10 days after the MCA clipping, revealed a new subdural hematoma and MCA just proximal to the previous clip. It is important to bear in mind that patients with infective endocarditis can have mycotic cerebral aneurysms without any clinical neurologic symptoms.