We compared the effects of the lightwand technique on hemodynamic responses, time-to-intubation, number of attempts, and complications during tracheal intubation with those of direct-vision laryngoscopy in normotensive (LN and TN group; n = 20, respectively) and hypertensive (LH and TH group; n = 20, respectively) patients. Lightwand or laryngoscopic oral endotracheal intubation was performed after the induction of anesthesia with fentanyl and propofol and muscle relaxation with vecuronium. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded, and the change from "before intubation" to "immediately after intubation" (DeltaP) in each variable was calculated. In normotensive patients, significantly larger DeltaP in systolic blood pressure was observed in the LN group than in the TN group (P < 0. 05). In hypertensive patients, there were no significant differences between the LH group and the TH group in DeltaP after intubation. The time-to-intubation and number of attempts in the lightwand groups were significantly longer and more frequent than those in the laryngoscope groups (P < 0.05). The number of patients who complained of hoarseness was larger in the lightwand groups than in the laryngoscope groups (P < 0.05). We conclude that the lightwand technique significantly attenuates hemodynamic changes after intubation in comparison with the laryngoscopic technique in normotensive patients. However, in hypertensive patients, there is no difference in hemodynamic changes between the two techniques.

Comparison of haemodynamic changes induced by sevoflurane and halothane in paediatric patientsSevoflurane is used in paediatric anaesthesia 1,2 because of its small blood-gas partition coefficient (0.63), 3 which enables rapid induction of, and rapid emergence from anaesthesia. Paediatric patients have a relatively high minimum alveolar concentration (MAC) of volatile anaesthetics that may cause marked haemodynamic depression, especially in neonates and infants. 4-7 In mongrel dogs, sevoflurane decreases cardiac output (CO) and mean blood pressure (mBP) without change in the heart rate (HR). 8 The MAC of sevoflurane in children is much higher (2.49%) 2,9 than that in adults (1.71-2.05%). t~191 However, there are no reports of haemodynamic effects of sevoflurane in paediatric patients receiving high concentrations of sevoflurane. The purpose of this study was to compare the haemodynamic effects of sevoflurane and halothane in paediatric patients by using impedance cardiometry, a noninvasive method to measure CO and stroke volume (SV). MethodsAfter approval by the Ethics Committee of Sapporo Medical University, agreement was obtained from the parents of patients, to whom this study was fully explained. The investigation was carried out in 38 patients (from one to six years old) of ASA class I, who were to undergo CAN J ANAESTH 1995 / 42:7 / pp 603-7

These results suggest that the negative chronotropy induced by propofol is mediated in part by M2-acetylcholine receptor activation, which involves the enhancement of NO production in cultured rat ventricular myocytes.

We experienced a case of unanticipated difficult intubation with direct laryngoscopy because of narrowing of the retropharyngeal air space and laryngeal vestibulum. It is suggested that three-dimensional computed tomography is useful for evaluating both the abnormality of an airway and its relationship to surrounding tissue.

Tracheal temperature--the temperature of the tracheal wall--is believed to reflect the core temperature. The trachea reacts quickly to temperature changes because it is surrounded by various large arteries and veins. Using the blood temperature from the cardiopulmonary bypass (CPB) and the jugular vein temperature as standards for core temperature, we evaluated the utility of monitoring the tracheal temperature during cardiac surgery. The tracheal temperature was measured by a thermistor which was attached to the anterior inner surface of the cuff of a tracheal tube. The tracheal temperature had correlation coefficients more than 0.99 with both blood temperature from the CPB (r = 0.993, P < 0.001) and jugular vein temperature (r = 0.993, P < 0.001) during CPB. Because the blood from the CPB draining into the ascending aorta and the jugular vein temperature might reflect the hypothalamic temperature directly, the tracheal temperature, which correlates with both of these quite closely, may reflect the core value directly. The monitoring of the tracheal temperature is not only valuable in monitoring the core value, but is also convenient during general anesthesia.

The purpose of this study was to determine the onset times of vecuronium neuromuscular block administered into either the central circulation or a peripheral vein. One hundred and twenty adult patients with a pulmonary artery (PA) catheter were randomly divided into one of three groups with respect to the routes of vecuronium administration (n = 40 in each group). Anaesthesia was induced with midazolam 2.5 mg iv and fentanyl 10-50 micrograms.kg-1 iv and maintained with intermittent doses of fentanyl 50 micrograms iv and nitrous oxide 60-70% in oxygen. After immobilization of the forearm in a splint, the ulnar nerve was stimulated supramaximally every 12 sec. The resulting force of the evoked thumb twitch was recorded (Myograph 2000, Biometer, Denmark). The times from the injection to the first depression of twitch response (latent onset) in patients given vecuronium 0.08 mg.kg-1 into the pulmonary artery, the right atrium, and a peripheral vein on the hand were 58.0 +/- 19.5, 71.5 +/- 17.1, and 82.4 +/- 18.0 sec (mean +/- SD), respectively. The latent onset of neuromuscular block occurred sooner in patients given vecuronium into the central vein than when administered into a vein on the hand (P < 0.01). In comparing the patients given vecuronium into the central vein, the onset times to 95% twitch depression (onset) were 152.3 +/- 40.7 and 168.2 +/- 35.5 sec. The onset of block was found to be faster when vecuronium was administered into the pulmonary artery than into the right atrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract

No abstract