Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are t...Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.展开更多
The purpose of this study was to evaluate cardiopulmonary effects of MLBP-TIVA with or without controlled ventilation in horses and to determine effects of positioning on cardiovascular function in mechanically ventil...The purpose of this study was to evaluate cardiopulmonary effects of MLBP-TIVA with or without controlled ventilation in horses and to determine effects of positioning on cardiovascular function in mechanically ventilated horses.Five healthy adult horses were anesthetized with MLBP-TIVA for 2-hours on 3-occasions at 4-week interval with (CMV-group) or without controlled mechanical ventilation (SB-group) and in lateral (LR-group) or dorsal (DRgroup) recumbency.Anesthesia was induced with lidocaine (1 mg/kg: IV) and propofol (3 mg/kg: IV) following premedications with medetomidine (0.005 mg/kg: IV) and butorphanol (0.02 mg/kg: IV),and then maintained by propofol infusion combined with constant rate infusions of medetomidine (0.0035 mg/kg/h),lidocaine (3 mg/kg/h)and butorphanol (0.024 mg/kg/h).Data were compared between groups using repeated-measures ANOVA.The level of significance was set at P 【 0.05.Cardiovascular parameters were maintained within acceptable ranges in SB-group.However,severe hypercapnia with insufficient oxygenation was observed (PaCO2: 83 ~103 mmHg,arterial O2pressure [PaO2]: 155 ~171 mmHg).In CMV-group,significant decreases in heart rate (29 ~ 31 beats/min,P = 0.020),cardiac output (17 ~ 21 L/min,P= 0.005) and PaCO2 (42 ~ 50 mmHg,P = 0.001) and a significant increase in PaO2 (395 ~ 419 mmHg,P =0.005) were observed compared to SB-group.Mean pulmonary arterial pressure and mean atrial blood pressure were significantly decreased in DR-group compared to LR-group (18 ~ 20 mmHg vs 27 ~ 31 mmHg,P = 0.001 and 8 ~ 9 mmHg vs 15 ~ 17 mmHg,P = 0.003,respectively).Arterial O2pressure was significantly lower in DR-group than in LR-group (171 ~301 mmHg vs 385 ~416 mmHg,P =0.043).Cardiovascular functions were maintained within acceptable range during MLBP-TIVA in horses.Controlled ventilation is useful for improving hypercapnia and oxygenation.Also,MLBP-TIVA provides a preservation of cardiovascular function leading to compensation for decreased preload in horses positioned in dorsal recumbency.展开更多
The purpose of this study was to evaluate effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine...The purpose of this study was to evaluate effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine,lidocaine,butorphanol and propofol (MLBP-TIVA).Five healthy adult horses were anesthetized with MLBP-TIVA for 2-hours on 3-occasions at 4-week interval. In each occasion,horses were anesthetized in lateral recumbency with (CV-LR-group) or without controlled ventilation (SB-LRgroup) or in dorsal recumbency with controlled ventilation (CV-DR-group). Anesthesia was induced with lidocaine (1mg/kg: IV) and propofol (3 mg/kg: IV) following premedications with medetomidine (0. 005 mg/kg: IV) and butorphanol (0. 02 mg/kg: IV),and then maintained by constant rate infusions of propofol (6 mg/kg/hr),medetomidine (0. 0035 mg/kg/h),lidocaine (3 mg/kg/h) and butorphanol (0. 024 mg/kg/h). All horses breathed 100% oxygen during anesthesia. In the CV-groups,horses were mechanically ventilated to maintain arterial CO2pressure (PaCO2)within 40 ~ 50 mmHg. Cardiopulmonary parameters were compared between groups using repeated-measures ANOVA.The level of significance was set at P 【 0. 05.In the SB-LR group,cardiovascular parameters were maintained within acceptable ranges (heart rate: 37 ~ 39beats/min,mean arterial blood pressure: 109 ~ 115 mmHg,mean pulmonary arterial pressure [MPAP]: 28 ~ 29 mmHg,mean right atrial pressure [MRAP]: 19 ~ 21 mmHg,cardiac output: 27 ~ 30 L/min) but severe hypercapnia with insufficient oxygenation (PaCO283 ~ 103 mmHg,arterial O2pressure [PaO2]155 ~171 mmHg) was observed. Cardiopulmonary parameters were maintained with acceptable ranges in the both CV groups. In the CV-LR group,significant decreases in heart rate (29 ~ 31 beats/min,P = 0. 020),cardiac output (17 ~ 21 L/min,P = 0. 005) and PaCO2 (42 ~50 mmHg,P =0. 001) and a significant increase in PaO2 (395 ~419 mmHg,P =0. 005) were observed compared to the SB-group. In the CV-DR group,MPAP (18 ~ 20 mmHg,P = 0. 001),MRAP (15 ~ 17 mmHg,P =0. 003) and PaO2 (171 ~301 mmHg,P =0. 043) were significantly decreased compared to the CV-LR-group.Cardiovascular functions were well maintained in horses during MLBP-TIVA. Controlled ventilation was useful for improving hypercapnia and oxygenation. It is thought that MLBP-TIVA preserves cardiovascular function and provides compensation for decreased preload in horses positioned in dorsal recumbency.展开更多
文摘Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.
文摘The purpose of this study was to evaluate cardiopulmonary effects of MLBP-TIVA with or without controlled ventilation in horses and to determine effects of positioning on cardiovascular function in mechanically ventilated horses.Five healthy adult horses were anesthetized with MLBP-TIVA for 2-hours on 3-occasions at 4-week interval with (CMV-group) or without controlled mechanical ventilation (SB-group) and in lateral (LR-group) or dorsal (DRgroup) recumbency.Anesthesia was induced with lidocaine (1 mg/kg: IV) and propofol (3 mg/kg: IV) following premedications with medetomidine (0.005 mg/kg: IV) and butorphanol (0.02 mg/kg: IV),and then maintained by propofol infusion combined with constant rate infusions of medetomidine (0.0035 mg/kg/h),lidocaine (3 mg/kg/h)and butorphanol (0.024 mg/kg/h).Data were compared between groups using repeated-measures ANOVA.The level of significance was set at P 【 0.05.Cardiovascular parameters were maintained within acceptable ranges in SB-group.However,severe hypercapnia with insufficient oxygenation was observed (PaCO2: 83 ~103 mmHg,arterial O2pressure [PaO2]: 155 ~171 mmHg).In CMV-group,significant decreases in heart rate (29 ~ 31 beats/min,P = 0.020),cardiac output (17 ~ 21 L/min,P= 0.005) and PaCO2 (42 ~ 50 mmHg,P = 0.001) and a significant increase in PaO2 (395 ~ 419 mmHg,P =0.005) were observed compared to SB-group.Mean pulmonary arterial pressure and mean atrial blood pressure were significantly decreased in DR-group compared to LR-group (18 ~ 20 mmHg vs 27 ~ 31 mmHg,P = 0.001 and 8 ~ 9 mmHg vs 15 ~ 17 mmHg,P = 0.003,respectively).Arterial O2pressure was significantly lower in DR-group than in LR-group (171 ~301 mmHg vs 385 ~416 mmHg,P =0.043).Cardiovascular functions were maintained within acceptable range during MLBP-TIVA in horses.Controlled ventilation is useful for improving hypercapnia and oxygenation.Also,MLBP-TIVA provides a preservation of cardiovascular function leading to compensation for decreased preload in horses positioned in dorsal recumbency.
文摘The purpose of this study was to evaluate effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine,lidocaine,butorphanol and propofol (MLBP-TIVA).Five healthy adult horses were anesthetized with MLBP-TIVA for 2-hours on 3-occasions at 4-week interval. In each occasion,horses were anesthetized in lateral recumbency with (CV-LR-group) or without controlled ventilation (SB-LRgroup) or in dorsal recumbency with controlled ventilation (CV-DR-group). Anesthesia was induced with lidocaine (1mg/kg: IV) and propofol (3 mg/kg: IV) following premedications with medetomidine (0. 005 mg/kg: IV) and butorphanol (0. 02 mg/kg: IV),and then maintained by constant rate infusions of propofol (6 mg/kg/hr),medetomidine (0. 0035 mg/kg/h),lidocaine (3 mg/kg/h) and butorphanol (0. 024 mg/kg/h). All horses breathed 100% oxygen during anesthesia. In the CV-groups,horses were mechanically ventilated to maintain arterial CO2pressure (PaCO2)within 40 ~ 50 mmHg. Cardiopulmonary parameters were compared between groups using repeated-measures ANOVA.The level of significance was set at P 【 0. 05.In the SB-LR group,cardiovascular parameters were maintained within acceptable ranges (heart rate: 37 ~ 39beats/min,mean arterial blood pressure: 109 ~ 115 mmHg,mean pulmonary arterial pressure [MPAP]: 28 ~ 29 mmHg,mean right atrial pressure [MRAP]: 19 ~ 21 mmHg,cardiac output: 27 ~ 30 L/min) but severe hypercapnia with insufficient oxygenation (PaCO283 ~ 103 mmHg,arterial O2pressure [PaO2]155 ~171 mmHg) was observed. Cardiopulmonary parameters were maintained with acceptable ranges in the both CV groups. In the CV-LR group,significant decreases in heart rate (29 ~ 31 beats/min,P = 0. 020),cardiac output (17 ~ 21 L/min,P = 0. 005) and PaCO2 (42 ~50 mmHg,P =0. 001) and a significant increase in PaO2 (395 ~419 mmHg,P =0. 005) were observed compared to the SB-group. In the CV-DR group,MPAP (18 ~ 20 mmHg,P = 0. 001),MRAP (15 ~ 17 mmHg,P =0. 003) and PaO2 (171 ~301 mmHg,P =0. 043) were significantly decreased compared to the CV-LR-group.Cardiovascular functions were well maintained in horses during MLBP-TIVA. Controlled ventilation was useful for improving hypercapnia and oxygenation. It is thought that MLBP-TIVA preserves cardiovascular function and provides compensation for decreased preload in horses positioned in dorsal recumbency.
