Decreased intraoral secretions during sedation-analgesia with propofol-ketamine and midazolam-ketamine combinations.

PURPOSE: To investigate salivary flow over time with a balanced sedation-analgesia technique using a propofol-ketamine (PK) or a midazolam-ketamine (MK) combination in human volunteers. METHODS: In the PK group, boluses of 1 mg.kg(-1) of propofol and 0.7 mg.kg(-1) of ketamine were initially administered. This was followed by an infusion, given over a 1-h period, of propofol (5 mg.kg(-1)) admixed with ketamine (0.7 mg.kg(-1)). In the MK group, 0.07 mg.kg(-1) of midazolam and 0.7 mg.kg(-1) of ketamine was followed by the infusion of a midazolam (0.07 mg.kg(-1)) and ketamine (0.7 mg.kg(-1)) admixture, also given over a period of 1 h. Salivary flow was measured prior to and at 10-min intervals during the sedation-analgesia, as well as for 30 minutes after its termination. RESULTS: Mixed intraoral secretions were significantly reduced, by 43% and 47%, on average, in the PK and MK groups, respectively, when compared with presedation levels, and had not returned to baseline levels 30 min after discontinuation of the infusion. CONCLUSION: Sedation-analgesia with PK and MK combinations controls intraoral secretions by reducing salivary flow.

[Experiences in general anesthesia of patients with scoliosis presupposed to have difficulties in airway maintenance].

We experienced general anesthesia of two patients with cerebral palsy presupposed to have difficulties in tracheal intubation by reason of scoliosis. Case 1 is a 26-year-old woman. Chest X-ray photography and respiratory sounds in both pulmonary areas indicated neither airway stricture nor respiratory distress, but severe scoliosis presupposed difficult tracheal intubation. However, under the impression of possible intubation obtained by preoperative laryngoscopy, orotracheal intubation was tried with rapid induction. Epiglottis deviation to the left noted upon developing larynx made the glottis direct invisible, but some compression of cricoid from outside barely succeeded in intubation. The fixation of the endotracheal tube found much difficulties in its proper positioning so as to make stethoscopy uniform in both pulmonary areas, but trial rotations of the tube both in various directions and at various depths barely managed to find a position of uniform stethoscopy in both pulmonary areas, in which position the tube was fixed as proper positioning. Anesthesia was performed by nitrous oxide.oxygen.halothane; peroperative hemodynamics remained stable and arterial blood gas analysis presented no problems. Case II is a 16-year-old man. Resting respiration presented stridor and chest X-ray photography indicated scoliosis and laryngeal stricture. Patient's lack in the degree of cooperation made laryngoscopy impossible. Thus, in view of a high possibility of difficult tracheal intubation, orotracheal intubation was tried under the control of spontaneous respiration. While the intubation was being carried out by means of a stylet without developing larynx, severe bronchostriction was palpable at the point when the tube barely passed through the glottis, making the intubation impossible. However, the tube barely managed to be inserted while rotating with the stylet being extracted. Anesthesia was carried out by nitrous oxide.oxygen.halothane; peroperative hemodynamics underwent no remarkable change and arterial blood gas analysis presented no problems.

[Studies on the method of sterilization with ethylene oxide gas. 1. Sterilization procedure and sterilizing effect].

Undertaken to ensure perfection of sterilization with ethylene oxide gas (EO gas) in routine clinical laboratory practice, an investigation was made of the relationship between sterilization procedure and sterilizing effect using the film bag delivery system and chamber system. Using a biological indicator as a monitor of sterilizing effect, the efficiency of sterilization was studied under various likely conditions and compared. The results led to the following conclusions: 1. Sterilization with EO gas by the film bag delivery system, because of this procedure being unable to be performed at a constant temperature, was shown to prove inadequate due to insufficient exposure to gas especially in winter season (when room temperature fell below 10 degrees C). 2. With the EO gas sterilization method using the film bag delivery system, which is believed to be effective within the ordinary range of humidity of the atmosphere, sterilizing effect was recognized to be affected by excess wetting of an object of sterilization that was caused by inadvertent manipulation or due to a predisposing attribute of the object, such as shape or outline. 3. All materials are sterilized upon being packaged. It is necessary therefore to make best choice of package material with respect of texture and size. Reuse influence to sterilizing effect. 4. The method of sterilization with EO gas using the chamber system has the advantage in that operating conditions are all automatically controlled. For this reason, there was not a single instance of failure to sterilize due to inappropriateness of temperature and humidity. From these results it is concluded that sterilising effect was affected by sterilization procedure and condition.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies on the method of sterilization with ethylene oxide gas. 2. Residual EO gas on sterilized objects].

Ethylene oxide gas (EO gas) adsorbed onto sterilized objects was quantitated in an effort to take a safety measure against residual EO gas following its use in sterilization. We measured residual amounts of EO gas adsorbed onto laboratory wares, small medical tools and appliances just after post-sterilization airation to examine whether they were rendered entirely free from EO gas by the process. The results led us to arrive at the following conclusions: 1. EO gas was recognized to remain on sterilized objects even after allowing them to stand for about 16 hours following airation. 2. The amount of residual EO gas was smaller on metallic products and larger on rubber products (notably rubber gloves). An exceedingly high concentration of EO gas was noted to remain on a tooth-brush, among other plastic materials. These facts seem to indicate that the amount of residual EO gas is closely related to the texture and shape of materials to be sterilized. 3. As regards the potential toxicity of residual EO gas. However, their sensitivity was proved to be questionable, judgment on a result being subject to considerable individual variations. 4. Nevertheless, it is incontestable that these devices can at least provide a rough estimate of unavailing since monitoring by direct measurement of residual EO gas is virtually infeasible from a practical point of view.