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Volume 10 (1990)
- Issue 5 Pages 403-
- Issue 4 Pages 305-
- Issue 3 Pages 207-
- Issue 2 Pages 125-
- Issue 1 Pages 1-
Volume 10, Issue 1
Displaying 1-16 of 16 articles from this issue
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[in Japanese]1990 Volume 10 Issue 1 Pages 1-11
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (1919K) -
Toshihiko MORINAGA, Takesuke MUTEKI, Tatsuo KATAYAMA, Tatsuhiro HIRAKI ...1990 Volume 10 Issue 1 Pages 12-20
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSChubby Puffer syndrome is characterized by obesity, daytime somnolence, and chronic upper airway obstruction due to adenotonsillar hypertrophy. Anesthetic problems include difficult airway security leading to hypoxia and hypercapnia, delayed emergence from anesthesia, and postoperative apnea. A 13-year-old girl (weight 89 kg, height 159 cm) with the syndrome was scheduled for adenoidectomy and tonsillectomy. Preoperative apnea monitor (CHEST Apnomonitor, MAY-715) showed 296 apneas for 10 hours. Following 0.5 mg of atropine intramusculary as premedication, anesthesia was success-fully induced by face mask with nitrous oxide and halothane in oxygen, measuring arterial blood O2 saturation and endtidal CO2 concentration continuously by CAP-NOMAC and SATLITE (DATEX). Endotracheal intubation was performed uneventfully. The sleep apnea disappeared after the surgery.View full abstractDownload PDF (788K) -
Tamie YORIMITSU, Shigeru KUNIYOSHI, Kiyoshi CHINEN1990 Volume 10 Issue 1 Pages 21-25
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe chance to operate on a patient over 80 years old has increased about 1.2 times in the past five years here at OKINAWA CHUBU Hospital. Okinawa Prefecture has the longest life expectancy rate in all Japan.
A retrospective study was done on 726 operations involving patients over 80 years of age from March 1983 to February 1988.
Preoperative complications included hypertension (37%), arrhythmia (27%), ischemic heart disease (22%) and chronic obstructive pulmonary disease (22%). About 60% of the patients had unstable blood pressure intraoperatively which required treatment with antihypertensives or varopressor agents. The foremost postoperative complications were asthma attacks and pneumonia (12%). Six patients who had painles myocardial infarc-tion either during the intraoperative or postoperative period, all had preoperative cardiovascular complications.
The mortality rate within one month of Surgery was 4.9% and was significantly higher in emergency operations, Physical Status 4, general surgery and neurosurgery. There was no significant difference in the mortality rates of octagenarians and nonagenarians, so we concluded that operations on the latter are not contraindicated if the operation will improve activity of daily living.View full abstractDownload PDF (533K) -
Evaluation of Hemodynamic StabilityJun HARADA, Kou TAKAKURA, Yukio GOTO, Kyouko TSUBOTA, Mariko NIWA, Kat ...1990 Volume 10 Issue 1 Pages 26-33
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe application of anewnarcotic-antagonist analgesic, eptazocine in modified neurole-ptanesthesia was investigated in 60 patients whose ASA classifications were 1-2. The anesthesia was maintained with intravenous eptazocine and diazepam combined with inhalation of nitrous oxide and oxygen. To evaluate the utility of eptazocine in neurole-ptanesthesia, the hemodynamic stabilities during the anesthesia using eptazocine were compared with those using buprenorphine, pentazocine and butorphanol. The hemodynamic stability was estimated by relative, and absolute instability those were obtained from the measurement of systolic blood pressure, heart rate and rate-pressure-product for every 5 minutes.
The stability during the anesthesia with eptazocine was slightly inferior to that with butorphanol. But, there was no difference in the stability between with eptazocine and with pentazocine, buprenorphine. The delayed recovery and respiratory depression were not found after the anesthesia, and no other clinical adverse reactions were observed during and after the anesthesia. The results suggest that eptazocine may become one of the useful analgesics for neuroleptanesthesia.View full abstractDownload PDF (621K) -
Takao SHIMADA, Susumu FUJIOKA, Kitaroh OHMORI, Hiroshi MIZOTA1990 Volume 10 Issue 1 Pages 34-39
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSIn the last two years, we engaged in anesthetic management of 56 cases of serious craniofacial anomalies or deformities including Crouzon's disease and Apert's syndrome.
The reconstructive procedures were composed of broad facial bone osteotomy and bone grafting. The marked problems in the anesthetic management included: induction of anesthesia and method of intubation for special facial anomalies and upper respiratory stenosis; slipping of the endotrachial tube associated with the forward transfer of the maxilla; regulation of fluid and blood transfusions for massive hemorrhage (blood loss/blood volume: 92.1% on avarage); and postoperative respiratory control.View full abstractDownload PDF (2200K) -
Tetsushi FUKUSHIGE, Rie OGATA, Tatsuhiro HIRAKI, Takesuke MUTEKI1990 Volume 10 Issue 1 Pages 40-46
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe have conducted the questionaire of how double-lumen endobronchial tubes (DLT) were used in the adult thoracic surgeries in 1987. The purpose is to establish the safer application of DLT through the apprehension of current usage of DLT and complications elicited by DLT. The questionaires were sent to 434 authorized hospitals with qualified anesthesiologists. Two hundreds and fifty four (58.1%) institutions of them responded to the inquiry. DLT were found to be used in 3, 392 cases out of 11, 280 thoracic surgeries. But the way of confirmation regarding the location of tubes and the treatment of collapsed lung varied with the institutions. In addition, there were many complications induced by DLT, hypoxia 149 cases, difficult intubation 129 cases, atelectasis 78 cases, and injury 12 cases.
Therefore, at present, we should not use DLT without consideration in each case. However, bronchofiberscope would be simultaneously required in case of the usage of DLT.View full abstractDownload PDF (524K) -
Yoshimitsu SANJO, Kazuyuki IKEDA1990 Volume 10 Issue 1 Pages 47-55
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe designed a software simulating brain concentration of inhaled anesthe during clinical anesthesia with use of our former reported pharmacokinetic model and then installed it to the respiratory monitoring system, named Respiratory Anesthetic and Metabolic SCANned monitoring system, RAMSCAN2 (Central Uni Co., Tokyo). Both of the simulated and the measured values of anesthetics can be displayed on the terminal screen of RAMSCAN2 in real time. 20 minutes long of future trend of anesthetics concentrations which are shown as MAC value can be displayed.
The clinical usefullness of these real time joint of simulation and monitoring at the operating table side are considered as follows; (1) during induction time, simulative trials for a reasonable setting of the vaporizer is convenient; (2) during recovery time, simulat-ed MAC is still available after the sampling probe for gas monitoring was removed coincide with extubation; (3) for the use of the teaching the uptake and elimination of anesthetics, both of measured and predicted data are shown in real time at the same operating table side.View full abstractDownload PDF (850K) -
Kenji TAKI, Jun SASAKI, Hiroyuki MATSUYA, Kazuyoshi SAITO, Koji MIKAMI ...1990 Volume 10 Issue 1 Pages 56-61
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSAfter an arm was given an electrical charge for 9 minutes at 1.5 mA using a handmade iontophoresis apparatus, the effective duration of iontophoretic anesthesia with 1.0% procaine, 1.0% lidocaine, 0.3% dibucaine and 1.0% mepivacaine was measured with a temperature sensory tester at 50°, using a1 grm needle for pain and a brush for touch. Also the painless depth in skin was measured by puncturing with a 21G needle. Procaine, lidocaine and mepivacaine were found to be better for iontophoretic anesthesia. In the case of lidocaine, the effective duration and the painless depth were found to be depen-dent on both the concentration and volume of the lidocaine. But 4% solution of lidocaine may be the limit for getting the deepest effective distance at a 1.5 mA electrical charge for 9 min, when a positive electrode is a circular area of φ20mm.View full abstractDownload PDF (641K) -
Tohru IDE, Takayuki MATSUMAE, Noriyuki ITOH, Teruyoshi NOGUCHI1990 Volume 10 Issue 1 Pages 62-65
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe anesthetic management in eight cases with traumatic rupture of the diaphragm admitted to the Chiba Emergency Medical Center was reviewed. Five cases had tears of the left diaphragm with herniation of stomach, spleen and small bowel, while the other three had the right with herniation of liver. All were produced by indirect trauma followed traffic accidents and were associated with other fatal injuries such as cerebral contusion, liver rupture, pelvic fracture and so on. Pre-operatively, a nasogastric tube was inserted to decompress stomach in all cases and crossing-match blood for massive transfusion was prepared. In seven cases, tracheal intubation was performed with the patient awake. Analgesia was maintained with nitrous oxide, oxygen and titrated incre-ments of non-depolarizing muscle relaxant. Diazepam, pentazocine and ketamine were administered as necessary, but halothane was given in only one case. Until the abdominal contents were removed from the pleural cavity and the suture of diaphragm was finished, manual ventilation was gently and gradually controlled to avoid cardiovascular collapse. Post-operatively, the patients were taken to an Intensive Care Unit with the tracheal tube in place.View full abstractDownload PDF (426K) -
Makoto TOHYAMA, Hideyoshi FUJIHARA, Ryo KIMURA, Kazunori SATO1990 Volume 10 Issue 1 Pages 66-72
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe patients with prolonged QT interval syndrome (LQTS) are at potential risk of sudden death from ventricular arrhythmia, Torsade de Pointes (TdP) or ventricular fibrillation. Therefore, it must be crucial to prevent the arrhythmia during the perioper-ative period.
A 69-year-old woman was hospitalized for the operation of the colon cancer. At addomission the ECG showed a prolonged QTc of 0.50 sec, but no one pointed out this abnormal finding. The patient had an attack of TdP on the first postoperative day.Intravenous lidocaine (50mg) was unsuccessful even by two attempts. Defibrillation treatment resulted in the sinus rhythm. The patient was diagnosed as sporadic type LQTS, because a prolongation of the QT interval was seen in all ECG recordings during the perioperative period and she had no hereditary or secondary causes of the prolonged QT interval. The attacks were considered to be due to the stress of the operation.
The anesthetic management must be concentrated upon the prevention of the life threatening arrhythmia. The patients must be well sedated, and the factors that may further prolong QT interval must be avoided. In case of emergency, the antiarrhythmic agents, cardiac pacemaker and defibrillator must be prepared for the treatment of the arrhythmia. Such patients should be put under the intensive care during the perioperative period.View full abstractDownload PDF (792K) -
Sukejuro OHTA, Shigeru MATSUMOTO, Megumi KAYABA, Masahiro SUZUKI1990 Volume 10 Issue 1 Pages 73-80
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSAuthors investigated the clinical significance of both the auditory brainstem response (ABR) and the short-latency somatosensory evoked potential (SSEP) during total spinal block (TSB) in six patients, measuring the EEG power spectrum at the same time.
TSB was performed with the subarachnoid injection of 15∼20ml of 1.5% lidocaine at the C7-Th1 level. It was observed as followed: 1) The complete disappearance of each component in SSEP or ABR (except Erb's potential or wave I) took place within 10 min of TSB. 2) The initial reappearance of evoked potential waveforms was observed after 58±15 (mean±SD) min of TSB. This phenomenon significantly preceded the transitional change of the EEG power spectrum simultaneously occurring with the arousal by 10min.
These results suggested that the continuous monitoring SSEP or ABR might define the inhibitory effects of TSB on the area from the brainstem to the cerebral cortex and could predict the period of arounsal out of TSB.View full abstractDownload PDF (821K) -
Eiichi CHIHARA, Yumi SAKAI, Yoshiyuki HORI, Satoru HASHIMOTO, Yoshifum ...1990 Volume 10 Issue 1 Pages 81-86
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSFew reports have documented the right ventricular obstructive HCM (hypertrophic cardiomyopathy) and have explained its hemodynamics. The systolic murmur was noticed at the preoperative round, and through the following cardiologic examination the patient without symptom was diagnosed as HCM with right ventricular obstruction. To avoid myocardial ischemia he was well sedated with diazepam and narcotics preoper-atively. Halothane with nitrous oxide prevented an excessive cardiac contraction during anesthesia. The arterial wave form changed into a spike & dome like figure in a hyperdynamic stage, and the systolic murmur disappeared with halothane induced mild cardiac depression. The result and the literature implied the left ventricular dysfunction was probable to occur through the right ventricular abnormality. The anesthetic management is considered similar to that of a typical HOCM: maintaining both preload and afterload, reducing cardiac contractility, keeping sinus rhythm etc.View full abstractDownload PDF (583K) -
Yoshio MATSUDA, Tsuyomu IKENOUE, Takahiro HIRANO, Toshihiko MATSUMOTO, ...1990 Volume 10 Issue 1 Pages 87-94
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSSeven patients complicated by post partum respiratory failure were reviewed. Its occurence rate was 0.15% throughout this study period. All the patients had pregnant induced hypertension as obstetric complications de novo. By using Swan-Ganz catheter and the determination of colloid osmotic pressure (COP), these patients were differentiated as follows: Three patients had hemodynamics findings consistent with pulmonary capillary leak. Two patients had alterations in the COP-PCWP (pulmonary capillary wedge pressure) gradient. Two patients had evidence of left ventricular failure.
It was recognized that central monitoring using Swan-Ganz catheter was one of the useful methods in the management of critically ill obstetric patients.View full abstractDownload PDF (823K) -
Kenji ONO, Keiko NAKAYAMA, Itidai KUDO, Yoshito OKUTU1990 Volume 10 Issue 1 Pages 95-98
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSTwo cases of acute hypertensive response and arrhythmia probably due to Prostaglan-din F2α during cesarean section are reported.
Case 1 was a healthy 24-year-old woman who prepared for emergency cesarean section because of fatal distress. Lumbar spinal anesthesia was induced with 0.3% dibucaine 1.8 ml. After delivery for the purpose of uterine constriction prostaglandin F2α 1000 μg was injected directly into the myometrium. Immediately the patient complained of severe headache, blood pressure rose to 198/100mmHg from 128/60mmHg, and ECG showed multifocal ventricular premature beats. Total 80mg lidocaine was administrated. 10 minutes later blood pressure decreased to 128/70mmHg and ventricular premature beats disappeared.
Case 2 was a healthy 29-year old woman who was prepared elective cesarean section because of breech position. Lumbar spinal anesthesia was induced with 0.3% dibucaine. After delivery prostaglandin F2α was injected directly into myometrium. After injection blood pressure rose to 150/80mmHg from 110/56mmHg, ECG showed multiple su-praventricular premature beats and the patient complained of nausea. 5 minutes later premature beats disappeared with no therapy.
The possibility that an inadvertent intravenous injection produced these reactions must be considered. It is cautious that these systemic reaction is occurred with regional injection of prostaglandin F2α.View full abstractDownload PDF (503K) -
Akihiko WATANABE, Yuzo HARADA, Akira MIZUGUCHI, Akiyoshi NAMIKI1990 Volume 10 Issue 1 Pages 99-102
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe experienced epidural anesthesia for a morbidly obese patient.
A 14-year-old male (167cm, 154kg) was scheduled for surgical procedure of a tibial bone fracture. A commercial Tuohy needle was successfully punctured into the epidural space at the level of the L2-L3 interspace, whereas the distance between the epidural space and skin was about 11cm. A catheter was inserted into the space rostrally through the needle. Administration of 2% lidocaine (10ml) via the epidural catheter resulted in well-effective analgesia and the surgery was performed unevently.
Epidural and spinal anesthesia may be technically difficult in obese patients, as bony landmarks are obscured. However it has been known that regional anesthesia is useful for morbidly obese patients since they have many perioperative problems. The chief reason for selection of epidural anesthesia rather than spinal anesthesia was to avoid the possibility of respiratory, cardiovascular and neurological complications in this obesity.View full abstractDownload PDF (967K) -
Keiji NAKATANI, Hidekazu YUKIOKA, Mitsugu FUJIMORI1990 Volume 10 Issue 1 Pages 103-106
Published: January 15, 1990
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSChubby Puffer syndrome is characterized by obesity, daytime somnolence, and chronic upper airway obstruction due to adenotonsillar hypertrophy. Anesthetic problems include difficult airway security leading to hypoxia and hypercapnia, delayed emergence from anesthesia, and postoperative apnea. A 13-year-old girl (weight 89 kg, height 159 cm) with the syndrome was scheduled for adenoidectomy and tonsillectomy. Preoperative apnea monitor (CHEST Apnomonitor, MAY-715) showed 296 apneas for 10 hours. Following 0.5 mg of atropine intramusculary as premedication, anesthesia was success-fully induced by face mask with nitrous oxide and halothane in oxygen, measuring arterial blood O2 saturation and endtidal CO2 concentration continuously by CAP-NOMAC and SATLITE (DATEX). Endotracheal intubation was performed uneventfully. The sleep apnea disappeared after the surgery.View full abstractDownload PDF (420K)
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