Masui. The Japanese journal of anesthesiology
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The Bullard laryngoscope is an anatomically shaped rigid fiber optic instrument designed for indirect laryngoscopy and intubation. It requires no neck extension nor flexion to perform laryngeal intubation. This characteristic is especially useful in the case of difficult airway. ⋯ The Endotrol tube itself has such a suitable shape for nasal intubation that it can be introduced to the larynx with little directional change. Therefore, our method is mastered with a shorter training period than the intubation method with fiber-optic laryngoscopes. In conclusion, our intubation method with the Bullard laryngoscopes using the directional tip tubes (Endotrol) is useful for patients with difficult airways, and is also nontraumatic and easy to perform.
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Arterial as well as end-tidal PCO2 (PaCO2, PetCO2), and arterial to end-tidal PCO2 difference (P(a-ET)CO2) were studied in 16 ASA-I patients anesthetized for laparoscopy under controlled ventilation. Using constant ventilation throughout the procedure, PaCO2 and PetCO2 increased significantly (P less than 0.01) to the maximum level (about 10 mmHg above the control level) within 22 min after CO2 insufflation, along with significant increase in mean arterial pressure and heart rate. ⋯ Although mean P(a-ET)CO2 remained relatively constant during the procedure, a statistically significant correlation between PaCO2 and P(a-ET)CO2 was found at the time of maximum PetCO2 after CO2 insufflation (r = 0.71, P less than 0.01). These results suggest that when PvCO2 is increasing by CO2 insufflation, P(a-ET)CO2 depend on relative ventilation efficacy.
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Paralysis after long-term administration of neuromuscular blocking agents especially pancuronium and vecuronium has been reported since 1970's. In this article, these papers were reviewed, and the etiology and the clinical features were analyzed. Most of the cases of muscle paralysis after prolonged use of pancuronium bromide were associated with concomitant use of large doses of steroids. ⋯ In patients with impaired hepatic and/or renal functions, metabolites of neuromuscular blocking agents might accumulate. In some patients with paralysis after neuromuscular blocking agents, underlying neuromuscular complications such as critical illness polyneuropathy have been implicated with the cause of the muscle paralysis. In order to avoid paralysis after long-term administration of neuromuscular blocking agents, following recommendations are made. 1) Monitor neuromuscular blockade. 2) Examine patient's neuromuscular status before starting to give relaxants. 3) Be careful in giving relaxants in patients with poor renal and/or hepatic functions. 4) Use smallest possible amount of relaxant. 5) Be careful about the drugs administered simultaneously especially steroids and antibiotics. 6) During the use of a neuromuscular blocking agent, perform physical therapy of extremities to avoid disuse atrophy especially when its administration is temporally terminated.
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In spite of many investigations done for many years, the mechanism of general anesthesia remains still unclear. To elucidate the mechanism of general anesthesia, effects of sevoflurane anesthesia on norepinephrine metabolism in rat brain was studied. Sevoflurane 3% was administered for 20 minutes to Wistar male rats weighing 230-270g under spontaneous respiration. ⋯ Significant increases in NE levels were observed in the pons, thalamus and hippocampus by sevoflurane anesthesia for 20 minutes compared with the control group and also in the pons and midbrain at recovery from anesthesia. MHPG levels were significantly decreased in the pons and cortex by sevoflurane anesthesia, while an appreciable increase in MHPG levels was observed in the thalamus by sevoflurane anesthesia. It is concluded that NE metabolism is significantly suppressed in the pons, thalamus and hippocampus during sevoflurane anesthesia and this change in NE metabolism may be associated with a mechanism of sevoflurane anesthesia.
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Of 2,667 patients with herpes zoster who visited our hospital between January 1972 and March 1989, 136 patients whose treatments were started after more than 6 months following the onset were subjects of the present study. Thus we performed a retrospective study of the therapeutic effects of sympathetic ganglion block (using alcohol) on postherpetic neuralgia left untreated for more than 6 months after the onset. ⋯ Thus the patients who underwent sympathetic ganglion block with alcohol tended to show better results. The above findings suggest that, in patients with postherpetic neuralgia in whom the initiation of treatment was delayed, treatment mainly consisting of thoracic or lumbar sympathetic ganglion block using alcohol in combination with antidepressants and antianxiety drugs can greatly improve patients' activities of daily life and that, at present, this method is most effective in relieving postherpetic neuralgia.