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Volume 22, Issue 6
Displaying 1-7 of 7 articles from this issue
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Takafumi KATO, Hitoshi MERA, Takeshi MAEDA, Akiyoshi HOSOYAMADA2002 Volume 22 Issue 6 Pages 217-222
Published: July 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPropofol and thiopental sodium were used as inductive anesthetic agents for electroconvulsive therapy (ECT). The seizure duration, regarded as the index of the therapeutic effect of ECT, and hemodynamic valuables after ECT were comparatively measured. The seizure duration was shorted by the dosage of propofol injection, however the seizure duration was not remarkably changed by the dosage of thiopental injection. The hemodynamic valuables were relatively stable under the dosages of both Propofol and thiopental. As the result of these facts, thiopental sodium is more a suitable anesthetic agent for ECT than propofol, given macroscopic observation of post-ECT convulsion.View full abstractDownload PDF (647K) -
Seiya NAKAMURA, Manabu KAKINOHANA, Tohru FUJIHARA, Hiroshi IHA, Kazuhi ...2002 Volume 22 Issue 6 Pages 223-227
Published: July 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 73-year-old man with bilateral carotid artery stenosis had coronary artery stenosis and abdominal aortic aneurysm (AAA) . We experienced anesthetic management for the patient with bilateral carotid artery stenosis undergoing off-pump CABG combined with AAA repair. These kinds of surgical operations and the resultant complications might cause the perioperative cerebral ischemia, so we used both TCD monitoring to measure intraoperative cerebral blood flow and also continous epidural anesthesia for early evaluation to neurological deficit as well as pain control after the surgery. Off-pump CABG was performed first and subsequently AAA repair was carried out. Intra-and post-operative courses were satisfaction and no neurologic defects were observed. We confirmed that TCD was particularly useful for assessing cerebral blood flow in an easy and non-invasive fashion, and that a continuous epidural block was effective in providing quick awakening and in early evaluation of neurological deficits in those patients.View full abstractDownload PDF (642K) -
Yoko WATANABE, Saori HASHIGUCHI, Koichi TSUZAKI, Junzo TAKEDA2002 Volume 22 Issue 6 Pages 228-232
Published: July 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 7-year-old patient with neuroblastoma complaining of intractable back and abdominal pain was successfully managed with intravenous morphine using a patient-controlled analgesia (PCA) device. Initially, his pain was controlled with 80mg •d-1 of oral morphine. However, the breakthrough nature of the pain required the introduction of intravenous PCA, where a bolus button was controlled by his parents according to his request. The maximum dose of morphine reached up to 960mg •d-1 (2.2mg• kg-1 •h-1), but no significant side effects were observed. On the other hand, administration of an intravenous infusion of ketamine was effective for shooting pain which was not controlled with a morphine infusion. Among the key factors to achieve this well-controlled status were an accuracy of pain assessment, early recognition of side effects, and good communication between family members and medical caregivers, so we should emphasize the critical role of family education in pediatric home palliative care.View full abstractDownload PDF (1228K) -
Hiromi MIYAHARA, Eiko WATANABE, Aya IGARASHI, Mihoko KAWAKITA, Homare ...2002 Volume 22 Issue 6 Pages 233-236
Published: July 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSAdvances in the treatment of congenital heart disease have led to a new group of patients with complex heart anomalies.
We report two cases scheduled for orchiopexy with double outlet right ventricles. Case 1 is a 3-year-old boy who underwent a Fontan operation, and case 2 is a 1-year-old boy who underwent a bidirectional Glenn procedure. In these patients, with the creation of non-pulsatile passive pulmonary circulation, the maintenance of an adequate transpulmonary pressure gradient and avoidance of an increase in pulmonary vascular resistance (PVR) are of major importance for anesthetic management. Impairment of venous return caused by high airway pressure may reduce cardiac output more critically than in patients with normal circulation. For these reason, anesthesia was maintained with volatile anesthetics under spontaneous breathing and assist ventilation at low pressure. To suppress an increase in PVR due to surgical stress, adequate premedication and analgesics was used.
We obtained satisfactory results for circulatory and respiratory perioperative stability in anesthetic management of patients who underwent right ventricular exclusion procedures.View full abstractDownload PDF (500K) -
Yasunari URAKAMI, Motohiro NAKAMURA, Hiroshi FUKUYAMA, Ichiro TAKENAKA ...2002 Volume 22 Issue 6 Pages 237-241
Published: July 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe report a case of ventilation difficulty which was caused by tracheomalacia from chronic compression by the right aortic arch which was undiagnosed preoperatively. A previously healthy 77-year-old obese woman underwent laparoscopic cholecystectomy. She had an uneventful course of anesthesia induction. Ten minutes after peritoneal insufflation of carbonic dioxide, it suddenly become difficulty to ventilate her with an anesthetic ventilator. Fiberscopy revealed obstruction of the trachea because of extrinsic compression by a pulsated mass. While performing manual ventilation with high inflation pressure, airway obstruction improved gradually without any specific treatment. Postoperatively, a computer tomography scan showed that the right aortic arch and descending aorta compressed the trachea, which caused tracheomalacia.
We determined that the trachea, weakened by chronic external compression, was occluded as a result of the cumulative of several factors associated with anesthesia and surgery, including anesthesia induction, muscle relaxation, positive pressure ventilation, peritoneal insufflation, supine position and intravenous fluid. This case illustrates the potential for life-threatening airway obstruction during anesthesia caused by asymptomatic anomalies of great vessels even in adult patients.View full abstractDownload PDF (2099K) -
Kazuhiko WATANABE, Tomohiro OKUDA, Tetsuya TAKAHASHI, Shigeyuki YAMADA ...2002 Volume 22 Issue 6 Pages 242-246
Published: July 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSFlexible fiber optic epiduroscopy (FEE) from the sacral hiatus into a saline-expanded lumbar epidural space is a new technique to permit diagnostic and theraptic interventions in the lumbar spine.We treated thirty-eight patients with FEE. Unfortunately, in two cases (5.2%), FEE was impossible due to the overt narrowness of the sacral canal. Because caudal block was successful by performed before FEE, we were not able to envisage the narrowness of the sacral canal. The anteroposterior diameter of the sacral canal at the level of the apex of the hiatus must be sufficiently large to admit a FEE guidecatheter (diameter=2.7mm). Trotter found that there were approximately 5.0% with a diameter of 2.0mm or less. We recommend that the diameter of the hiatus be assessed by x-ray or MRI examination before FEE.View full abstractDownload PDF (1926K) -
Kyoko ABE, Takashi HORIGUCHI, Toshiaki NISHIKAWA2002 Volume 22 Issue 6 Pages 247-250
Published: July 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe examined dreams occurry during propofol-fentanyl-nitrous oxide anesthesia combined with epidural anesthesia in twenty-seven patients who were ASA physical status I or II undergoing gynecological or lower limb surgery, when propofol was infused at a dose of 2-3 mg•kg-1•h-1. The patients were asked whether they had experienced dreams and their contents and impression, immediately after awakening from the anesthesia and on the first postoperative day. Eighteen patients (64%) reported dreaming after awakening from the anesthesia, while thirteen patients (48%) reported dreaming on the first postoperative day. All of their dreams were positive in nature. Three patients remembered their dreams in detail. A small dose of propofol infusion, and fentanyl-nitrous oxide anesthesia combined with epidural anesthesia provides pleasant dreams in surgical patients without inducing intraoperative awareness.View full abstractDownload PDF (466K)
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