Masui. The Japanese journal of anesthesiology
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The effect of ketamine on the arrhythmogenic dose of epinephrine (ADE) was studied in dogs anesthetized with halothane-nitrous oxide. Groups K (ketamine 2, 4, 6, 10, 20 mg.kg-1.hr-1) were compared with group C (only halothane-nitrous oxide), and the ADE in group K2, 10 was significantly lower than that in group C. The arrhythmogenicity of ketamine was not found in group K20. ⋯ The ketamine inhibited adrenal catecholamine secretion, but plasma epinephrine level in group K4 was higher than that in group C when the same dose of epinephrine was infused. Therefore the inhibition of neuronal and extraneuronal catecholamine uptake by ketamine would offer an explanation for the augmentation of response to epinephrine. Then, this augmentation would cause the arrhythmogenic action of ketamine.
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Plasma concentrations of alpha-atrial natriuretic peptide (alpha-ANP), antidiuretic hormone (ADH) and aldosterone (ALDS) were determined by radioimmunoassay in 9 patients undergoing aortocoronary bypass grafting under high dose fentanyl (94.4 micrograms.kg-1) anesthesia. These three levels in pre-anesthetic period (control values) were within normal ranges suggesting the absence of congestion and dehydration. ⋯ Present results indicate that high dose fentanyl anesthesia cannot suppress ADH and ALDS level during CPB as was previously demonstrated and the observed rise in alpha-ANP level is considered to be inadequate not only for diuresis but also for vascular dilatation. Administration of alpha-ANP to ameliorate circulatory insufficiency after CPB should probably be considered.
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The present system of French emergency medicine and its philosophy were described from my experience at SAMU (service d'aide medicale urgente). Three factors of emergency medicine; pre-hospital care, emergency transport and emergency information service are managed by anesthesiologists. Anesthesiologists on duty at the tele-medicine center give medical team instructions to start at once. ⋯ They start to give intensive care medicine to critically ill patients on the spot. The philosophy of SAMU is that doctors should go out of the hospital. Anesthesiologists in the area organize the emergency medical system in France.
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A case of priapism following epidural anesthesia was reported. A 67 year old man received epidural anesthesia for the transurethral resection of a malignant bladder tumor. Epidural anesthesia which he had wanted to receive was given through the L3 to L4 intervertebral space with 18 ml of 2% lidocaine. ⋯ For the penile erection, intracavernous injection of etilefrine hydrochloride was effective and surgical procedure could be done smoothly. The mechanism of priapism remained unclear but imbalance of the autonomic nervous system may be a involved. This case suggests that intracavernous injection of etilefrine hydrochloride is effective for treatment of penile erection during transurethral surgery.
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The effect of ketamine infusion to control the intractable pain which had not responded to ordinary procedures in 12 patients with advanced cancer were evaluated. Ketamine 250 mg or 500 mg in 500 ml of transfusion fluid with or without 10 to 20 mg of droperidol was administered intravenously at the rate of 3 to 20mg of ketamine per hour. The pain scores by VAS in most of the patients decreased significantly with an averaged value of 8.3 before the treatment to 1 during the procedure. ⋯ Slight disorientation in one patient and drowsiness in 5 were seen during the infusion. No cardiovascular or respiratory complications were noted. These results indicate that ketamine infusion is a useful therapeutic procedure to treat cancer pain which resist ordinary pain therapies.