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Volume 12 (1992)
- Issue 7 Pages 679-
- Issue 5 Pages 581-
- Issue 4 Pages 429-
- Issue 3 Pages 291-
- Issue 2 Pages 147-
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Volume 12, Issue 7
Displaying 1-21 of 21 articles from this issue
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[in Japanese]1992 Volume 12 Issue 7 Pages 679-694
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (1940K) -
Tomoyuki UDAGAWA, Hidenori TOYOOKA, Yoshitaka FUJII, Keisuke AMAHA, Yo ...1992 Volume 12 Issue 7 Pages 695-702
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSNineteen patients with myasthenia gravis were anesthetized with isoflurane (N2O-O2 -Isoflurane, GUI) or ènflurane (N2O-O2-Ènflurane, GOÈ), prior to undergo transsternal thymectomy.
The larynx was very easily visualized following slow induction with either inhaled anesthetic for ten minutes.
The patients anesthetized with GOI demonstrated stable hemodynamics during the operation, and adequate muscle relaxation was obtained for operation as shown by the depression in T1 and TR.
Using a scoring system which predicts the postoperative need for mechanical ventilation, we found that Isoflurane had no adverse effects on postoperative respiratory function.
As the blood/gas coefficient of isoflurane is smaller than that of ènflurane, induction and recovery from GOI may be accomplished more quickly than that with GOÈ.
In conclusion, isoflurane may be a useful anesthetic agent for myasthenic patients.View full abstractDownload PDF (833K) -
Blood Transfusion Alone during Their OperationAkira FUKUI, Kenichi KIMURA, Masuhiko TAKAORI, Mitsuyasu KAGIYAMA, Aya ...1992 Volume 12 Issue 7 Pages 703-709
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSIn this study, we attempted to analyse factors which added postoperative homologous blood transfusion in patients who were performed their operation using autologous blood transfusion alone.
The factors related to the additional homologous blood transfusions by surgeons were as follows: Hematoctit (Hct) on the 1st postoperative day, preoperative Hct. Hct immediately after transfused hemodilutional and salvaging autologous blood, erythrocyte wash availability, preoperative serum iron value, intraoperative bleeding per body weight, operating time, body weight, and bleeding per body weight 6 hours postoperatively in this order.
Necessities of preoperative medication with iron preparations, efficacy of intraoperative red cell salvaging and effort for shorting operation period were advocated for avoidance of homologous blood transfusion.View full abstractDownload PDF (639K) -
Masayoshi TERASHIMA, Michiya OKAZAKI, Cyoichiro TASE, Akira OKUAKI, Ak ...1992 Volume 12 Issue 7 Pages 710-715
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSHemodilutional autologous blood transfusion (HAT) is useful for avoidance of homologous blood transfusion during surgery. The HAT can be carried out more easily rather than other autotransfusions. We evaluated the clinical usefulness and efficacy of the HAT in 196 patients, in whom posterolateral fusion (PLF) of the lumbar spine was performed, in this study. The patients were divided into two groups. Group 1 is composed of 99 cases with HAT and Group 2 is composed of 97 cases without HAT. In the Group 1, 1, 086±24ml (500-1, 600ml) of autologous blood was collected immediately before the operation. No significant difference was noted in the operative duration between the two groups, but the surgical blood loss exceeded in the Group 1. Both the loss of red blood cells and amount of homologous blood used, however, were significantly less in the Group 1 than those in the Group 2, respectively. Homologous blood transfusion was avoided actually in 60 cases of the Group 1 and contrary in 27 cases of the Group 2. The HAT, which can prevent transfusion-transmitted diseases and immunoreaction after homologous blood infusion, is promised to be used more often in the future.View full abstractDownload PDF (621K) -
Naoyuki FUJIMURA, Akihiko WATANABE, Itaru OHYAMA, Takahiro ITIMIYA, Si ...1992 Volume 12 Issue 7 Pages 716-720
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThis study was performed to evaluation the effect of preoperatively preserved autologous blood transfusion added to intraoperative blood salvaging autotransfusion in adult patients undergoing CABG surgery.
Patients were divided into two groups: intraoperative blood salvasing autotransfusion alone (Group I n=28) and in combination with preoperatively preserved autologous blood transfusion (Group II n=16). The average volume of homologous blood used was 1386±964ml in Group I and 750±618 ml in Group II. The average volume of fresh whole blood trasfusion was 914±1039ml in Group I and 38±150ml in Group II. These volumes in Group II were significantlyless than those in Group I. No significant differences between the two groups were noted in the other parameters.
It is concluded that preoperatively preserved autologous blood transfusion added to intraoperative blood salvaging autotransfusion could be effective for reducing the volume of homologous blood transfusion, especially in fresh whole blood.View full abstractDownload PDF (414K) -
A Comparison between Two Different Doses of 0.5% Hyperbaric TetracaineYasumitsu SATO, Hiromichi ICHINOSE, Toshihiro TSUKAKUBO, Keiko TANAKA, ...1992 Volume 12 Issue 7 Pages 721-725
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe incidence of visceral pain during cesarean section under spinal anesthesi a was evaluated in 29 women who, randomly divided into two groups, received differnt doses, 8mg of 0.5% hyperbaric tetracaine in group A, 12.5mg of the drug in group B. The occurrence and severity of visceral pain (10-cm visual analogue scale score) as well as the level of sensory anesthesia to pinprick were recorded by an observer who was unaware of the amount of drug given. The mean maximum level of sensory anesthesia was Th3.5±0.1 in group A and Th3.4±0.2 in group B and the difference was not significant. No patient complained of visceral pain before delivery of the infant. After delivery, visceral pain occurred 12 patients in group A (80%), but only 5 in group B (36%). The defference of visual analogue scale score between the two groups was statistically significant: 4.1±0.7 in group A, 1.5±0.7 in group B. The use of higher dose of tetracaine resulted in a lower incidence of visceral pain. This result shows that an increase in tetracaine dose administered intrathecally is necessary for complete block of C -fibers transmitting visceral pain as well as A-delta fibers transmitting incisional pain.View full abstractDownload PDF (538K) -
The Influence of Sampling Site of Airway Gas on a-ETDCO2Hiroyuki KINOSHITA, Hiroshi MIYAWAKI, Naoko OKAFUJI, Tatuo KUNII, Take ...1992 Volume 12 Issue 7 Pages 726-730
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe influences of the sampling site and shunt ratio of airway gas on arterial to end -tidal PCO2 difference (PaCO2-PETCO2 difference: a-ETDCO2) were examined during one-lung ventilation in six patients scheduled for elective surgical procedures of esophageal cancer. During one-lung ventilation, anesthesia was maintained with enflurane(0.75-1.5%)in 100% oxygen supplemented with epidural lidocaine (1%) and small amount of fentanyl. Using a capnograph(Ohmeda 5200 CO2 monitor, Oxicap), measurements of PETCO2were performed, the airway gas being sampled from two different sites: one from the catheter placed into the endobronchial tube of the double lumen tube (the catheter tip near the carina) (A) and the other from Y-piece portion of the anesthesia circle(B). During one-hour period of one-lung ventilation, PETCO2 was significantly smaller(29.4±2.3 vs 32.8±1.8mmHg) and a-ETDCO2 was greater (10.2±1.5 vs 6.8±0.9mmHg)in sampling site B when compared to those in sampling site A. The increase in a-ETDCO2 appeared to be greater during one-lung ventilation than that during bilateral-lung ventilation. There were significant correlations between PETCO2 and PaCO2 in both sampling sites. Whereas, no significant correlation was found between a-ETDCO2 and shunt ratio. In summary, during one-lung ventilation, especially when the sampling site for capnography is distant from carina, a-ETDCO2 becomes greater than as expected during bilateral-lung ventilation.View full abstractDownload PDF (522K) -
Shiro TOMIYASU, Keisuke FURUTA, Shigeki SHIBATA, Rumiko IDE, Sadayo NI ...1992 Volume 12 Issue 7 Pages 731-737
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe effects of small doses of midazolam (0.08mg/kg) used as a rapid sequence induction agent combined with thiamylal (4mg/kg: Group M) were compared with 4μg/kg of fentanyl combined with thiamylal 4mg/kg(Group F) or 6mg/kg of thiamylal alone(Group C). Under monitoring of the electrocardiogram and direct arterial pressure from radial artery, measurement of plasma catecholamine (epinephrine and norepinephrine) concentration as sympatho-adrenal response and blood gas analysis were done during induction of anesthesia, laryngoscopy and tracheal intubation.
In group M, increases in systolic blood pressure and heart rate following intubation were inhibited when compared with group C, Whereas significant increase in heart rate probably due to baro-reflex was observed comparing with group F. The significant elevation of plasma norepinephrine level after intubation was only observed in group C. The changes in PaO2 and PaCO2showed no differences among the groups during study period.
In this study, we demonstrated that supplementary doses of midazolam are able to reduce the dose requirement of thiamylal and to blunt circulatory responses to induction of anesthesia and tracheal intubation. Although these data confirmed the safety and efficacy of midazolam as a rapid sequence anesthetic induction agent, a careful observation should be done when used in patients with heart diseases, because of the small dose of midazolam resulting tachycardia.View full abstractDownload PDF (719K) -
Masahiro YANAGIMOTO, Maki MIZOGAMI, Tetsuo FUJIBAYASHI, Yoshihiro SUGI ...1992 Volume 12 Issue 7 Pages 738-742
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPressure-volume curves (P-V curves) before and after insertion of the laryngeal mask airway (LMA) were measured in 60 elective patients. After insertion of the LMA, clinical and fiberscopic assessment of the positioning of the LMA was performed. Fiberscopic findings were classified in three types. The larynx was alone seen in 33.3% ("Perfect type"). The epiglottis and the larynx were seen with direct fiberscopic finding of the vocal cord in 46.7% ("Intermediate type"). And, the vocal cord could not be seen directly 13.3% ("Incomplete type"). Insertion of the LMA was impossible in 6.7%. The initial inspiratory airway pressure of the "incompletetype" was always rising characteristically on the P-V curve.
The epiglottis was within mask in 60%, as judged by fioberscopic finding. Clinically, evidence of airway obstruction was not detected. On the P-V curve, however, the rise of the initial airway pressure was found out in 13.3%.View full abstractDownload PDF (413K) -
Kazuhisa SHIROYAMA, Taro OKAMOTO, Takashi MIKAMI, Yasuhiro FUJIOKA, Ki ...1992 Volume 12 Issue 7 Pages 743-748
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPulmonary complications occur frequently in postoperative stage of esophageal cancer. We made a retrospective study of the causes of pulmonary complications in the patients who underwent esophagectomy and reconstruction for esophageal cancer.
Twenty-nine patients who were admitted to our ICU after the operation were divided into two groups. Group I consists of 11 patients who needed mechanical ventilatory support more than one week because of hypoxemia, and group II of 18 patients who were able to be weaned from mechanical ventilation within one week.
Age, duration of operation, preoperative pulmonary function, blood loss during operation, method of reconstruction fluid administration and urine output during and after operation, dose of irradiation before operation, and extensiveness of lymph node dissection were analyzed and compared between the group I and the grup II. There was a statistically significant difference only in the extensiveness of lymph node dissection.
The above results suggest that the extensive lymph node dissection during the surgery for esophageal cancer plays an important role in causing pulmonary edema and atelectasis possibly through mechanical compression of the lung and disturbance of the pulmonary lymph flow.View full abstractDownload PDF (668K) -
Akemi MIYAGAWA, Kazuo TANIGUCHI, Akio MIZUTANI, Kazumitsu SENDAYA, Shi ...1992 Volume 12 Issue 7 Pages 749-753
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe studied the effects of iontophoresis using several Ca channel blockers on pain relief in 18 healthy adult volunteers.
We administered 4% lidocaine with/without several Ca channel blocers (2mg of nicardipine, verapamil, or diltiazem). We used a NAKAHAMA pain meter to evaluate pain relief.
In the 4% lidocaine group and the Ca channel blockers without 4% lidocaine groups, the pain threshold doubled significantly in comparison with that of a control group. No significant differences in pain threshold were observed between the Ca channel blocker groups.
Compared with the lidocaine group, the nicardipine+lidocaine and diltiazem+lidocaine groups showed a tend toward a longer pain relierf effect. However, neither combination affected blood pressure or heart rate. Our results suggest that an analgesic effect can be achieved from the infiltration of Ca channel blockers through the skin.View full abstractDownload PDF (483K) -
Koko TOBA, Ken TSUZAKI, Toru FUJIGAKI, Harumasa NAKAMURA, Osamu SHIBAT ...1992 Volume 12 Issue 7 Pages 754-758
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe experienced the anesthetic management of 60 cases of asthmatic patients from 1986 to 1991. These patients were adult and had been treated with some bronchodilators. We divided these cases into two groups, i. e., neuroleptanesthesia (NLA) and inhalation anesthesia groups, and compared the incidences of asthma attack and circulatory complication during anesthesia.
Asthma attack occured in 17.6% of patients under NLA and 18.6% under inhalational anesthesia (statistically not significant). The group of inhalational anesthesia showed a higher incidence (16.2%) of circulatory complications as compared with the NLA group (5.9%).
The results suggest that NLA is useful for asthmatic patients especially if those patients have cardiovascular disturbances.View full abstractDownload PDF (534K) -
Minoru SUGAI, Hiroshi NAGASAKA, Isao MATUMOTO, Takao HORI, Kazuto ARAK ...1992 Volume 12 Issue 7 Pages 759-764
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThree patients with spinal cord injury were treated for incontinence by saddle block with phenolglycerin after drug therapy failed. Cystometry had demonstrated detrusor hyperreflexia. Two patients were improved. There have been no severe complications. These results confirmed that the saddle block with phenolglycerin should be considered as an additional method of treatment of detrusor hyperreflexia in patient with a spinal cord injury.View full abstractDownload PDF (991K) -
Masaki KITAHARA, Jun KATAGIRI, Michiko YAMADA, Muneyasu SHA, Akito OHM ...1992 Volume 12 Issue 7 Pages 765-769
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA case of bidirectional tachycardia (BT) occuring during induction of anesthesia is reported, The patient was a 61 year old female with rectal carcinoma who was scheduled for elective surgical resection. She had no history of myocardial ischemia nor had she ever recieved digitalis. preoperative ECG and chest x-ray were normal. Lab data also revealed no abnormality except slight anemia. After the administration of thiopental 75mg and pancuronium 6mg IV, she was ventilated with oxygen 31, nitrous oxide 31, and halothane 3% by a mask. During this period, ECG suddenly changed from normal sinus rythm (NSR) to supraventricular tachycardia, then to the BT and BP was unmeasurable. Ventilation was continued with 100% oxygen, and soon ECG returned to NSR and BP became stable without any other treatment. The operation was completed uneventfully. Postoperative ECG showed NSR and no evidence of myocardial dysfunc-tion was noted. It is presumed that the BT resulted from myocardial ischemia induced by hypotention during induction.View full abstractDownload PDF (585K) -
Yoshihiro HIRABAYASHI, Hiromasa MITSUHATA, Kohjiro FURUYA, Shigeo IKEN ...1992 Volume 12 Issue 7 Pages 770-773
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSEffects of postoperative pain relief produced by continuous epidural infusion with bupivacaine (1ml /hr) were evaluated in patients underwent thoracotomy (group A, n=14), those underwent upper abdominal surgery (group B, n=21), and those underwent lower abdominal surgery (group C, n=15). The patients were initially received 8ml of 0.25% bupivacaine and 0.1mg of buprenorphine at recovery room in operating theater and were continuously received the 0.25% bupivacaine at the rate of 1 ml /hr by a disposable nonelectrical portable pump. The patients who did not need additional narcotics for the first postoperatvie 24-hours in group A, group B and group C were 21%, 29% and 67%, respectively. Those for the second postoperatvie 24-hours in each group was 43%, 62% and 67%, respectively. The authors concluded that epidural injection with buprenorphine 0.1 mg and continuous epidural infusion with 0.25 bupivacaine at the rate of 1 ml/hr have a slight effectiveness for postoperative pain management in the patients underwent lower abdominal surgery. However, this procedure was disappointing in the patients underwent thoracotomy or upper abdominal surgery.View full abstractDownload PDF (434K) -
Keiichi OMOTE, Akiko HATTORI, Maki MATSUMOTO, Akiyoshi NAMIKI1992 Volume 12 Issue 7 Pages 774-776
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSSpinal myoclonus, which is induced by some organic changes at the involved level of the spinal cord, consists of involuntary, rhythmic contractions of muscle groups innervated by the spinal cord region. Spinal myoclonic involuntary movement of the lower extremities occurred following spinal anesthesia in a 63-year-old female patient who had received an oophorectomy for the ovarian tumor. With lowering the height of the spinal analgesia, the myoclonus subsided and disappeared. The possible underlying mechanisms are discussed.View full abstractDownload PDF (337K) -
Yoshiki MASUDA, Yasuo SHICHINOHE, Tetsuo OMOTE, Hiromi TAKAHASHI, Masa ...1992 Volume 12 Issue 7 Pages 777-780
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA case of life-threatened anaphylactic reaction by Xylocaine jelly ® was reported. A 51 year-old man who had been operated upon the neck resection due to oropharynx tumor underwent to repair a fracture of a mandibullar bone. He had a past history of having been in an anaphylactic shock with anesthetics. By the skin test, positive reactions to thiamylal, fentanyl and lidocaine for local anesthesia had been observed. Awake nasal intubation was selected because of difficulty of intubation. In the operating room, a shock followed after filling Xylocaine jelly ® into nasal cavity for inserting a nasal airway. Although endotracheal intubation was tried immediately, it brought ventricullar fibrillation and then immediate cricothyroid ligament incision allowed to be intubated. Cardioversion was successfully performed to the patient. After continuous infusion of adrenalin, the patient recovered without any sequelae.
In the skin test of this case, the cause to an allergic reaction was supposed to methylparaben or sodium carboxymethyl cellulose which were additives. Some additives should be considered as a cause for severe anaphylactic reaction.View full abstractDownload PDF (409K) -
A Case ReportTomoyuki MATSUDA, Kengo YODA, Akiko SAITO, Etsuko CHIFU, Yoshifumi TAN ...1992 Volume 12 Issue 7 Pages 781-786
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 41-year-old male, undergoing hemodialysis (HD) for chronic renal failure over twenty years, was diagnosed pheochromocytoma in the left adrenal gland. The patient had often occured hypertensive crisis showed over 200mHg of systolic blood pressure and after HD. Plasma adrenaline concentration was 1.15ng/me (normal range, <0.12), and noradrenaline was 2.85ng/me (0.06-0.45). In the course of forty days before the surgery, Prazocin had been given. HD was continued three times per week, and the patient's body weight gradually increased by 1 kg. Anesthesia was induced by fentanyl, thiamylal, and vecuronium, and was maintained with nitrous oxide, oxygen and isoflur-ane. Potassium-free crystalloid and colloid solutions were infused intravenously, under monitoring pulmonary capillary wedge pressure and cardiac output so as not to be overtransfusion. Hypertensive episodes occurred with insertion of the pulmonary artery catheter into internal jugular vein and upon manipulation of the tumor. Blood pressure was controlled with intravenous administration of phentramine and propranolol, or drip infusion of norepinephrine.
In this case, intraoperative monitoring by Swan-Ganz ® catheter Was essentially for proper water balance management, and hypoglycemia (50-70mg/de) continued from 2 hours following to the removal of the tumor until next day.View full abstractDownload PDF (487K) -
Shinji KOHRO, Michiaki YAMAKAGE, Hideaki TUCHIDA, Osamu SATOH, Akiyosh ...1992 Volume 12 Issue 7 Pages 787-791
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe reported on 12 cases that underwent the operations for the resection of cardiac tumor from 1981 to 1991. There were 8 cases with left atrial tumor, 2 cases with right atrial one, 1 case with right ventricular one, and 1 case with left ventricular one.
Perioperative complications were severe hypotension due to disturbance of blood flow (3 cases) and heart blook (7 cases). We coped with disturbance of blood flow by changing the patient's position (2 cases) and administration of catecholamine (1 case), and heart blook by using transient (5 cases) and permanent (2 cases) pacemaker for sick sinus syndrome.View full abstractDownload PDF (558K) -
Catheter Displacement into the Intercostal SpaceMikito KAWAMATA, Masayuki MIYABE, Tetsuo TSUKAMOTO, Yuri NAKAE, Osamu ...1992 Volume 12 Issue 7 Pages 792-795
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe experienced catheter displacement into intercostal space, which has not been reported as a complication related to interpleural analgesia.
A 56-year-old female, weight 47 kg, height 156 cm had left nephrectomy. After the surgery, a Tuohy needle was directed at angle of 30 degrees to the skin and aimed medially at the arch of the 9th rib the lateral decubitus. A 5-ml glass syringe with a smoothly moving plunger, containing 2 ml of air was attached to the needle, then the syringe and needle were advanced. When the plunger of the syringe was drawn inward, the syringe removed, and an epidural catheter was advanced 5 cm into the space through the needle.
An injectton of bupivacaine through the catheter was not effective for postoperative pain relief. Fifteen minutes the injection, the patient fell into a delirious state, and then respiratory depression and unconsciousness. Using an injection of radiopaque agent through the catheter, an X-ray showed that the catheter had been displaced into the 8 th intercostal space.
This suggested that the catheter had been inserted into the intercostal space when we tried to insert the catheter into the interpleural space for Interpleural anal-gesia, in spite of having used a standard method to confirm interpleural negative pressure.View full abstractDownload PDF (952K) -
Tetsuji NAKAI, Tetsuo SATO1992 Volume 12 Issue 7 Pages 796-801
Published: 1992
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPersistant hiccups and hiccups during operation should be well treated The etiology of hiccups is complex, but we have treated two cases. The first case of hiccups was persisted for two years and treated with accumulation of carbon dioxide. And the 2nd case of hiccups were evoked during operation and treated with droperidol.View full abstractDownload PDF (1002K)
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