Masui. The Japanese journal of anesthesiology
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In order to find out the effectiveness of continuous epidural infusion with a portable disposable pump (Baxter Infusor) in management of post-operative pain, a comparative study was made on a continuous epidural infusion method with a syringe pump versus a twice-a-day intermittent epidural infusion method. Study 1: With 41 patients who underwent thoracic/abdominal surgery between June, 1991 and September, 1991, researches were conducted on the effects of pain relief, methods for postoperative pain relief and weaning course from confinement to bed. The degree of pain examined at five points--at 4 hours, 12 hours, 16 hours, 24 hours and 28 hours postoperatively--indicated a significantly lower level in the Infusor group, compared with the intermittent infusion group (P less than 0.05). ⋯ When the syringe pump method and the intermittent method were compared, the evaluation of the syringe pump method was significantly higher (P less than 0.05). The evaluation by nurses, on the other hand, was remarkably higher on the infusion method than on the other two methods (P = 0.0001). Based on the results of the two studies summarized above, the Infusor method is considered to be most effective for pain control among the three methods.
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We developed a manually operated portable cardiopulmonary bypass circuit for resuscitation. The circuit is composed of, in turn, a venous drainage catheter, one-way valve, self-inflating reservoir, one-way valve, artificial lung, and an arterial catheter. These components are interlocked with conducting tubes with quick connectors. ⋯ If the balloon is inflated with some amount of liquid, the same volume of functional capacity of the reservoir is lost. Thus the reservoir volume is adjusted, the hemodilution with a priming solution is minimized, and an excessive stroke volume with an inadvertent compression of the reservoir-pump is prevented as well. This innovation will make our standard size bypass circuit applicable to almost all patients, except for a newborn or infant who requires a special size of bypass circuit, and improve the survival rate of cardiopulmonary resuscitation.
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The anatomy of the epidural space was examined in 82 patients 3 to 90 years old who had indications of epidural anesthesia. The superfine fiberscope with an outer diameter of 0.8 mm was utilized for this study. It was advanced through 18 gauge Tuohy needle inserted into the epidural space. ⋯ Vessels were encountered on the dura and the flaval ligaments, as well as in the connective tissue. Large amounts of connective tissue were present in all cases. No complications, such as accidental dural puncture, epidural hematoma, infection, nerve injury attributed to this technique were observed.
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Effect of diltiazem on cardiovascular response to laryngoscopy and tracheal intubation was studied in 20 patients without hypertension and 10 patients with hypertension to be operated on under general anesthesia. The patients were divided into three groups: the first group without hypertension (group C, n = 10) received saline as control, the second group without hypertension (group N, n = 10) received bolus injection of diltiazem, and the third group with hypertension (group H, n = 10) received bolus injection of diltiazem. Diltiazem was administered 2 min before intubation at a dose of 0.2 mg.kg-1 as a bolus injection. ⋯ Changes of heart rate were comparable among the three groups. Complications were not remarkable except one case in which systolic pressure decreased to 80 mmHg. The results suggest that bolus injection of diltiazem at a dose of 0.2 mg.kg-1 attenuates cardiovascular response to laryngoscopy and tracheal intubation without serious complications.
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The therapeutic effect of ulinastatin, an inhibitor of the protease activity, on endotoxin shock was evaluated using 17 Beagle dogs. Single intravenous injection of ulinastatin at a dose of 5,000 or 25,000 U.kg-1 failed to suppress the endotoxin-induced circulatory disturbance but significantly inhibited increases in pulmonary arterial pressure and pulmonary vascular resistance that occur early following administration of endotoxin. ⋯ Elevation of the granulocytic elastase activity was inhibited dose-dependently by administration of ulinastatin. The above results indicate that ulinastatin may be a promising drug for the treatment of endotoxin shock.