THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

[title in Japanese]

[in Japanese]

1992 Volume 12 Issue 3 Pages 291-298
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.291

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Logics and Ethics in Medicine

Kenichi IWATSUKI

1992 Volume 12 Issue 3 Pages 299-307
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.299

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Medicine is originally biology of human being in a wide sense. Being a field of natural science, it is founded on logics and it has nothing to do with ethics in itself. Therefore, there is a possibility that techniques derived from medical science develop antiethical results, when they are applied to medical practice without giving due ethical consideration. This is also the case in science and technology. Science is irrelevant to ethics, but technology, if uncontrolled, can cause a catastrophe such as nuclear disasters.
Previously medical ethics was rather the morals for doctors in their profession, as was shown in the oath of Hippocrates. However, it is not medical ethics but bioethics that should be taken into consideration in order to control the application of recent scientific advances to medical practice.
Bioethics is primarily based on the respect of human life. It should be a matter of deep concern for doctors in medical practice, when they are going to apply newly-developed medical knowledge and technique to patients.
An urgent subject concernig bioehtics seems to be an organ transplantation from a brain-dead patient. It should be emphasized that such a procedure is done only after a social consensus is reached.
It is not a great doctor but a good doctor who is now expected by patients.
In conclusion the words of Dr. Kussmaul are presented.
"Nur guter Mensch kann ein guter Arzt sein."

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[title in Japanese]

[in Japanese]

1992 Volume 12 Issue 3 Pages 308-319
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.308

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[title in Japanese]

[in Japanese]

1992 Volume 12 Issue 3 Pages 320-328
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.320

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1992 Volume 12 Issue 3 Pages 329-337
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.329

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese]

1992 Volume 12 Issue 3 Pages 338-348
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.338

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[title in Japanese]

[in Japanese]

1992 Volume 12 Issue 3 Pages 349-355
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.349

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Bedside Assessment of Cardiac Function Using Heart-Lung Interactions

Michael R. Pinsky

1992 Volume 12 Issue 3 Pages 356-357
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.356

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Constant-Flow Ventilation

[in Japanese]

1992 Volume 12 Issue 3 Pages 358-365
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.358

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[title in Japanese]

[in Japanese]

1992 Volume 12 Issue 3 Pages 366-368
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.366

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[title in Japanese]

[in Japanese], [in Japanese]

1992 Volume 12 Issue 3 Pages 369-371
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.369

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[title in Japanese]

[in Japanese]

1992 Volume 12 Issue 3 Pages 372-375
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.372

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[title in Japanese]

[in Japanese]

1992 Volume 12 Issue 3 Pages 376-378
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.376

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Effects of Surgical Stress on Post-operative Urinary Concentrations of Catecholamines

Tetsuji MAKITA, Osamu SHIBATA, Toshiya TSUJITA, Ken TSUZAKI, Makoto FU ...

1992 Volume 12 Issue 3 Pages 379-383
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.379

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Post-operative urinary concentrations of catecholamines were measured for seven days in 23 patients undergoing elective surgery under neuroleptanesthesia. They were divided into three groups ; gastrectomy group (n=8), hysterectomy group (n=8) and hip joint surgery group (n=7).
The urinary concentrations of catecholamines in the recovery room were highest in all groups.
The urinary concentrations of norepinephrine in gastrectomy group were significantly higher than preinduction values for seven post-operative days as compared to those in other groups.
However, post-operative urinary concentrations of epinephrine in all groups were significantly lower than preinduction values in all three groups.
These results suggest that the sympathetic system has been activated at least for seven days after gastrectomy.

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A Change of the Respiration and Circulation in Transurethral Prostatectomy under Spinal Anesthesia

The Comparison with Epidural Anesthesia

Akira SHIGIHARA, Hiroshi IWAMA, Kaneyuki KAWAMAE, Akira OKUAKI

1992 Volume 12 Issue 3 Pages 384-392
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.384

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A change of the respiration and circulation in transurethral prostatectomy under spinal anesthesia was examined by comparison with epidural anesthesia.
At the first half of operation, blood pressure, pulmonary arterial pressure, central venous pressure, and systemic vascular resistance index decreased significantly. At the latter half of operation, tidal volume decreased, but systemic and pulmonary vascular resistane index increased significantly under spinal anesthesia by comparison with epidural anesthesia. Post-operation, PaO₂ fell significantly only under spinal anesthesia.
Spinal anesthesia will be apt to paralize assisted respiratory muscle and to be illbalanced Va/Qt by the decreased blood and pulmonary arterial pressure. Still more, at the latter half of operation, it is possible that left cardiac load will be caused by the fallen cardiac output, and right cardiac load will be caused by the increased vascular resistance and irrigating fluid absorbed from surgical field.
We must take care that spinal anesthesia may suppress the respiration and circulation in poor risk's patients more than epidural anesthesia.

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Effect of Zopiclone as a Preoperative Night Hypnotic

Yutaka YAMAZAKI, Keiji ENZAN, Hiromi AKIYAMA, Yoichi IWASAKI, Tadataka ...

1992 Volume 12 Issue 3 Pages 393-397
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.393

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To evalute the usefulness and safety for a preoperative night hypnotic, we conducted a randomized parallel group study of Zopiclone using Triazolam as a reference drug in 100 patients schedulled operation.
Each patient received one tablet of Zopiclone (7.5mg, Z group, n=50), or Triazolam (0.25mg, T group, n=50) at 9 o'clock pm on the preoperative night. We performed a 7-item sleep-questionnaire before and on the morning of operation for evaluation as a preoperative night hypnotic.
Sleep induction time in Z group was significantly shorter than in T group. Also, quality of sleep in Z group was superior to in T group. CNS side-effects (dizziness, hangover) in Z group was few, compared with in T group.
We conclude that Zopiclone appears to be an useful and safe preoperative night hypnotic.

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Multi-Center Double-Blind Study on TN-873R (Nifedipine Suppository) as a Preanesthetic Medication for Hypertensive Patients

Masayuki KASAMATSU, Yutaka INADA, Masao NAGANO, Masao FUJITA, Katsuo N ...

1992 Volume 12 Issue 3 Pages 398-408
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.398

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A double-blind clinical trial was conducted in 192 hypertensive patients in 17 institutes to assess the safety and efficacy of TN-873R (nifedipine suppository) in treating hypertension during perioperative period. Ninety five patients received TN-873R as a preanesthetic medication and 97 control patients received inactive placebo.
The blood pressure level of TN-873R group was significantly lower than placebo group. The other antihypertensive drugs were less frequently needed in patients of TN-873R group (8.3%) than placebo group (32.6%). Prescribed frequency of vasopressor due to unexpected severe hypotension was not significantly different in both groups. The incidence of side effects was statistically the same in both groups and severe side effects were not observed. Anesthesiologists participating in the trial indicated that TN-873R was useful.
The results suggest that preoperative administration of TN-873R is useful for the management of hypertensive patients during operation and anesthesia.

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Anesthesia for Tracheal Reconstruction in Infants with Generalized Hypoplasia by Using Extracorporeal Membrane Oxygenator

Keiko TSUDA, Mami ASAISHI, Suzuko CHIGUSA, Yumiko TAKAO, Hiroshi MURAT ...

1992 Volume 12 Issue 3 Pages 409-414
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.409

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Tracheal stenosis is a life-threatening disease. Especially generalized hypoplasia of trachea is uncommon and often needed total tracheal reconstruction. According to the location and the length of stenosis, various techniques have been described for adequate ventilation and oxygenation during surgery.
We reported two successful cases of ventilatory management using extracorporeal membrane oxygenator (ECMO) for total tracheal reconstruction. Under ECMO the flow should be kept about 55ml/kg/min. PaO₂ and PaCO₂ during ECMO should be maintained between 100∼400mmHg and 30∼45mmHg respectively.

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A Drug-Induced Psychiatric Disturbance in 4 ICU Patients

Takao SUZUKI, Toshihide TSUJIMOTO, Takeshi YOSHIYAMA, Yoshiaki KAWAGUC ...

1992 Volume 12 Issue 3 Pages 415-419
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.415

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Many kinds of drugs are used for patients in the ICU. There is a drug-induced psychiatric disturbance as the side effect (adverse reaction) of these drugs. This may be regarded as an ICU syndrome.
We have reported four cases of psychiatric disturbance induced by lidocaine, famotidine, atropine sulfate, digoxine, or propranolol.
It is important to rule out a drug-induced psychiatric disturbance, when an ICU syndrome is suggested.

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A Case of Hypoxemia Following Tourniquet Release

The Usefulness of Pulse-Oximetry during Spinal Anesthesia

Nobuaki SHIME, Mitsuyoshi LEE

1992 Volume 12 Issue 3 Pages 420-423
Published: 1992
Released on J-STAGE: December 11, 2008

DOIhttps://doi.org/10.2199/jjsca.12.420

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A 50-year-old male without systemic complications received fixation of patella under the spinal anesthesia. A few minutes after the tourniquet release, arterial oxygen saturation suddenly decreased to 63%. Arterial blood gas analysis revealed pH ; 7.42, PaO₂ ; 32mmHg and PaCO₂ ; 39mmHg. This hypoxemia disappeared immediately after supplemental oxygen therapy via a face mask (4l/min). Arterial blood gases were normalized on the next day. The patient recovered without complications. The "Posthyperventilation hypoxia", respiratory depression by sedatives, the decrease in mixed venous oxygen contents following tourniquet deflation, pulmonary micro-atelectasis and microembolism were suggested as the causes of hypoxemia. Pulse-oximetry was useful in detecting hypoxemia in this case.

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