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Volume 14, Issue 10
Displaying 1-20 of 20 articles from this issue
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Masuhiko TAKAORI, Ken'ichi KIMURA, Akira FUKUI, Masao FUKUNAGA1994 Volume 14 Issue 10 Pages 745-749
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSChanges in serum magnesium (Mg) concentration were studied in patients who underwent surgery under general anesthesia (diazepam + pentazocin + nitrous oxide) and in whom no digestive, endocrinological or renal function abnormalities existed. Within the first one hour after initiation of anesthesia, 7.5ml/kg each of lactated Ringer's solution and half lactated Ringer's solution (KN3A ®) were infused. In the subsequent one hour, 2.5ml/kg of the same solutions were infused. During these periods, no marked changes were observed in arterial blood pressure, heart rate, arterial pH, PO2 and PCO2 or serum concentrations of sodium, potassium, and albumin. However, total calcium concentration in serum tended to decrease and calcium ion concentration decreased significantly. Serum Mg concentration remained essentially unchanged. Nevertheless, a slight positive correlation was noted between changes in serum Mg concentration and Ca++ concentration.
It was concluded therefore that serum Mg concentration would remain unchanged during surgery under general anesthesia. In the future, however, additional studies should be done during major surgery accompanied with extensive tissue damage or circulatory derangement.View full abstractDownload PDF (564K) -
Yasuyuki HONMA, Noriaki KANAYA, Hiroshi IWASAKI, Hideya OHMORI, Sumihi ...1994 Volume 14 Issue 10 Pages 750-754
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe effects of midazolam sedation on the level of spinal anesthesia were investigated by using both cold-sensation and pin-prick tests in 40 patients. After spinal anesthesia, 0.05mg•kg-1 of midazolam was administered intravenously for intraoperative sedation. After surgery, block levels were evaluated twice: under midazolam sedation and 4 min after intravenous injection of either flumazenil, 0.2mg (n=20) or saline 1ml (n= 20). Blood concentrations of midazolam were measured after surgery in the flumazenil group. In the flumazenil group, 10 of 20 patients (50%) showed a change in anesthetic level at more than one segment 4 min after flumazenil injection. In contrast, only 1 of 20 patients (5%) showed a change in anesthetic level in the control group 4 min after saline injection. There was no significant relationship between the changes in anesthetic level and blood concentrations of midazolam. It is concluded that midazolam may affect the level of spinal anesthesia. This must be borne in mind when treating patients with high spinal anesthesia.View full abstractDownload PDF (492K) -
Hitoshi IMAIZUMI, Shoji SAKANO, Naoyuki FUJIMURA, Yoshito NAKAYAMA, Yo ...1994 Volume 14 Issue 10 Pages 755-761
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSLung injury by smoke inhalation alone or in combination with large cutaneous burn is thought to be the leading cause of death in fire victims. In this study, lung ventilation and perfusion scintigraphies were performed in six patients with hypoxemia (<70mmHg) following smoke inhalation.
Lung ventilation scintigrams using 133Xenon demonstrated retention of Xenon on washout image showing air trapped in all lung fields. Lung perfusion scintigrams using 99mTc-MAA (microaggregated human serum albumin) demonstrated non-segmental and multiple hypoperfusion areas. The hypoperfusion areas were suspected to show hypoxic pulmonary vasoconstriction secondary to decreased intraalveolar oxygen pressure. These data indicate an increase in mismatched ventilation and perfusion. Hypoxemia persisted for about one week after the injury, and the hypoperfusion areas disappeared one to three weeks after the injury.
We concluded from these data that hypoxemia caused by smoke inhalation was due to an increase in mismatched ventilation and perfusion. Attention should therefore be paid to hypoxia not followed by clinical signs and symptoms for a few hours after the smoke inhalation injury.View full abstractDownload PDF (1281K) -
Masakazu YOKOI, Yoshiro KOBAYASHI, Kimiyasu SATOH, Jun DOI, Junzo TAKE ...1994 Volume 14 Issue 10 Pages 762-770
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPreoperative activity of enzymes derived from skeletal muscle (creatine kinase: CK; lactate dehydrogenase: LDH; glutamate oxaloacetic transaminase: GOT) in patients with trauma including fracture (traumatic group) and in non-trumatic patients (control group) were compared.
CK activity was lower than 200IU/l in 97.8% of patients in the control group, and only 0.4% higher than 1, 000IU/l. However, the serum CK level in 28.9% and 3.4% of patients was higher than 200IU/l and 1, 000IU/l in the traumatic group. The maximam CK activity was 8, 404IU/l in the traumatic group. CK, LDH, and GOT activity in the traumatic group was higher than in the control group. Activity of these three kinds of enzymes in patients suffering from multiple trauma was higher than in those with single trauma. Patients with trauma in the spine, pelvis, thorax, and abdomen tended to show higher serum muscle-derived enzyme activity than patients with fracture in clavicula or extremities.
Of several orthopedic diseases, only patients suffering from spinal cord injury showed higher CK activity than those who underwent general surgery. The mean serum CK level in spinal cord injury patients was 185IU/l, and its maximum was 706IU/l. We concluded that traumatic patients showed high CK activity of up to several thousand IU/l, while patients with spinal cord injury also had high CK activity, but less than 1, 000IU/l.View full abstractDownload PDF (820K) -
Nagahide YOSHIDA, Tatsushi FUJITA, Kohsuke BABA, Yasushi IGARASHI, Yuj ...1994 Volume 14 Issue 10 Pages 771-776
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe effects of clonidine given as a premedicant on intrinsic monoamine concentration in CSF and on duration of anesthetic effect were studied following spinal anesthesia with dibucaine.
Monoamine in CSF was analysed by liquid chromatographic system with multiple electrochemical detectors.
Duration of sensory blockade of spinal anesthesia was significantly prolonged by clonidine premedication, whereas duration of motor blockade was not prolonged. Clonidine premedication significantly decreased the concentration of intrinsic monoamines such as NE, MHPG, DA and DOPAC, but did not significantly change 5-HT and 5-HIAA.
These results suggest that clonidine inhibits the activity of the descending noradrener-gic medullospinal pathway, but that it has little effect on the serotonergic pathway. a2-adrenergic receptors in the spinal dorsal horn may play an important role in the analgesic effect of clonidine.View full abstractDownload PDF (495K) -
Kazuko KOSAI, Naoto NAGATA, Mayumi TAKASAKI, Osamu KONDOU1994 Volume 14 Issue 10 Pages 777-782
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSCardiovascular effects of cervical epidural analgesia produced with 7ml of 2% mepivacaine solution were studied in two groups: group 1 (n=8) had an average analgesic level of C5 to T5 and group 2 (n=7) of T1 to T10. In group 1, the heart rate decreased by 14%, but mean arterial pressure, cardiac index, and right ventricular ejection fraction remained unchanged. Central venous and pulmonary capillary wedge pressures increased by 71% and 35%, respectively. In group 2, heart rate, mean arterial pressure and cardiac index decreased by 19%, 20% and 39%, respectively. Central venous pressure increased by 96% but pulmonary capillary wedge pressure and right venticular ejection fraction remained unchanged. These results suggest that cervical epidural analgesia, especially with a caudal spread of the block, depresses cardiac performance.View full abstractDownload PDF (596K) -
Toru GOYAGI, Toru GOYAGI, Masao YAMASHITA1994 Volume 14 Issue 10 Pages 783-786
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSOnset time of lumbar epidural anesthesia in infants and chidren was compared.
Bupivacaine (0.25% with 200, 000 epinephrine, 0.75ml•g-1) was injected into the lumbar epidural space in 359 infants and children. Reactions to the skin incision under light sevof lurane and N2O anesthesia were recorded.
The time from the epidural injection to the skin incision was similar (18 min vs 20 min) in children (body weight_??_10kg) and infants (body weight<10kg). Children showed more frequent reactions than infants (24/164 vs. 5/195, p<0.01).
This finding suggests that the time from epidural injection to skin incision should be longer in children than in infants.View full abstractDownload PDF (453K) -
Ken YAMAMOTO, Wen-Zhi Li, Yutaka MATSUMOTO, Katsumi TASHIRO, Tsutomu K ...1994 Volume 14 Issue 10 Pages 787-792
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSBacterial contamination of anesthesiologists' hands was studied using the fingerprintcontact sampling method. Methicillin-sensitive Staphylococcus aureus (4 cases) and Enterobacter (2 cases) were isolated together with resident skin flora in a total of forty trials. Efficacy of disinfectants (0.2% benzalkonium chloride in 70% ethanol, 7.5% povidone iodine, 4% chlorhexidine gluconate and non-antiseptic soap) was evaluated by the reduction ratio of Staphylococcus epidermidis. Benzalkonium in ethanol (WelpasTM) was the most effective disinfectant tested.View full abstractDownload PDF (566K) -
Izumi HARUKUNI, Kazuyuki MIZUYAMA, Shigehito SATO, Soichiro YAMASHITA, ...1994 Volume 14 Issue 10 Pages 793-797
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe report on a 38-year-old man with severe cardiac failure due to infective endocarditis who underwent surgery for ruptured mycotic intracranial aneurysm.
After induction of general anesthesia, cardiac output decreased from 3.9l/min to 2.7 L/min. Cardiac output increased to 5.2l/m, and pulmonary arterial pressure decreased from 84/36 mmHg to 48/20 mmHg with amrinone at a rate of 5 ug•kg-1•min-1. The postoperative course was uneventful and no further neurological deficit was found. Mitral valve replacement was performed 4 days after the neurosurgery without any intracranial bleeding.
Amrinone improved cardiac function remarkably during trapping of mycotic intracranial aneurysm in a patient with severe cardiac failure.View full abstractDownload PDF (528K) -
Kyoko SHIOHAMA, Hitoshi YOSHIOKA, Hiroko HIROTA, Kokichi HASE1994 Volume 14 Issue 10 Pages 798-801
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 57-year-old woman complicated with severe dilated cardiomyopathy (DCM) successfully underwent gastrectomy utilizing intra-aortic balloon pumping (IABP).Because her left ventricular function had been excessively impaired (LVEF= 17% on echocardiography), we planned to insert an IABP device prior to induction of anesthesia as a perioperative circulatory assist. We had difficulty in obtaining her and her family's informed consent for anesthesia because of high-risk anesthetic complication. Anesthesia was induced with intravenous midazolam and fentanyl, and maintained with nitrous oxide and continuous epidural morphine. During induction of anesthesia we started IABP and administration of dopamine and dobutamine as soon as hypotension occurred.After that, her hemodynamic status greatly improved and her perioperative course was uneventful. This experience suggests that IABP is useful in perioperative management of patients with severe cardiac dysfunction such as DCM.View full abstractDownload PDF (431K) -
Seiji TAKAOKA, Kyoko ANDO, Sumio AMAGASA, Yoshihide MIURA1994 Volume 14 Issue 10 Pages 802-806
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 26-year-old patient in the 37th week of pregnancy was admitted for delivery. At age 18 the patient had a STA-MCA bypass operation for Moyamoya disease, and subsequently experienced mild neurological symptoms (speech disturbance, vertigo and paralysis of the right hand) when excited. Since the stress of trans-vaginal delivery was likely to exacerbate the neurological symptoms, and control of blood pressure and management of Paco2 were deemed necessary, Cesarean section under general anesthesia was scheduled. Before induction, epidural catheterization and radial artery puncture were performed. Anesthesia was induced by midazolam, fentanyl and nitrous oxide, oxygen and sevoflurane, and maintained with nitrous oxide, oxygen and sevoflurane. Blood pressure was controlled with ephedrine and nicardipine at the level at rest, Paco2 was monitored with a capnometer and ventilation was adjusted to maintain around 35mmHg. Delivery was uncomplicated and successful. Epidural analgesia was useful for post-operative pain control. No adverse symptoms occurred. Mother and child were discharged without event.View full abstractDownload PDF (525K) -
Yoshihiko OHNISHI, Yukio HAYASHI, Tohru MIZOGUCHI, Masakazu KURO1994 Volume 14 Issue 10 Pages 807-811
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe report a case whose serious postoperative complication was monitored by near-infrared spectroscopy (NIR), showing poor peripheral tissue oxygenation during surgery. The patient underwent vascular grafting for abdominal aortic aneurysm and aorticsclerotic obstruction. The peripheral tissue oxygenation of her right leg was monitored with NIR continuously during the surgery. The monitor showed that oxyhemoglobin gradually decreased following abdominal aortic clamping and that it did not fully recover in spite of cross-clamp release. Circulatory insufficiency of the leg occurred, and the patient unfortunately had to undergo amputation of the leg 11 days after the operation. The prompt as well as accurate detection of the poor state of oxygenation could be monitored by NIR in this case. Application of the instrument is easy and noninvasive, suggesting that NIR is useful for monitoring peripheral circulation.View full abstractDownload PDF (543K) -
Yoshi TSUKIYAMA, Hiroshi IRANAMI, Junko NISHIDA, Yoshio HATANO1994 Volume 14 Issue 10 Pages 812-816
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSNeonates and infants with hypoplastic left heart syndrome (HLHS) are rarely encountered by anesthesiologists, because despite numerous attempts at surgical palliation and correction, they show the highest operative mortality among pediatric patients with congenital heart disease. In this report, we describe problems associated with anesthetic management during successful palliative surgery for HLHS in five neonates. The major problem was control of systemic and pulmonary blood flow, since both circulations are supplied by a single ventricle in a parallel manner. Hyperventilation and inotropic support improved the degree of arterial oxygenation, but this led to progressive metabolic acidosis and oliguria due to a decrease in systemic blood flow. On the other hand, although hypoventilation and discontinuation of inotropic support improved the acid-base balance and urine outflow, this led to exacerbation of arterial oxygenation. Our experience suggests that the adequacy of systemic blood flow in patients with HLHS should be evaluated by accurate titration of urine volume and acidbase balance. PaO2 should be maintained within a range of 30 to 40mmHg to maintain adequate pulmonary blood flow.View full abstractDownload PDF (493K) -
Kumiko TANABE, Tomoki HASHIMOTO, Masaki NIWA, Tomoo TAKEDA, Tomokazu H ...1994 Volume 14 Issue 10 Pages 817-821
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 55-year-old woman with a history of uneventful laparoscopic chorecystectomy was scheduled to undergo right hemithyroidectomy for thyroid tumor under general anesthesia. Her thyroid function was normal. About 20 minutes after skin incision, intratracheal pressure suddenly increased from 15 to 40 cmH2O, blood pressure and heart rate decreased, and cardiac arrest occurred. Cardio-pulmonary resuscitation was immediately and successfully performed and hemodynamics returned to normal, but the operation was postponed. Pulmonary embolism was suspected and heparine and urokinase were administered, although the patient did not have suspected risk factor for thromboembolism. The patient's condition improved gradually. The diagnosis was established by pulmonary scintigram on the 16th day after the cardiac arrest.
When sudden changes in respiratory and circulatory states are observed during anesthesia, pulmonary embolism should be considered as a possible cause, even if the patient does not have risk factor for embolism.View full abstractDownload PDF (816K) -
Masayuki SHINOHARA, Tsutomu MATSUMOTO, Yasuhisa OKUDA, Toshimitsu KITA ...1994 Volume 14 Issue 10 Pages 822-824
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 67-year-old male was diagnosed as having a large epiglottic cyst. Computed tomography of the neck demonstrated that the cyst, on the lingual surface of the epiglottis, was about 30 mm in diameter. He was therefore scheduled to undergo surgery for removal of the cyst. Before anesthesia, we anticipated that adequate visualization of the larynx and tracheal intubation would be impossible, so nasal intubation was performed with a fiberoptic bronchoscope under local anesthesia. A size 7.5 cuffed tracheal tube was inserted into the trachea on the first attempt without difficulty. Intubation using fiberoptic bronchoscopy proved to be a very useful method for a patient with a large epiglottic cyst.View full abstractDownload PDF (840K) -
Sawako TAKEBE, Katsumi YUFU, Hiroshi AONO, Kouzou YAMAMOTO, Yoshiaki M ...1994 Volume 14 Issue 10 Pages 825-828
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 40-year-old woman with severe toxemia of pregnancy was diagnosed as having HELLP syndrome after emergency cesarean section. Despite the administration of diuretics and sufficient infusion, anuria was observed during and after the operation. Six hours after the operation, when diastolic blood pressure decreased to the normal range, the anuria improved. We speculate that hypovolemia and vasospasms may be the causes of this anuria. Because of its rapid onset and severe consequences, HELLP syndrome should be kept in mind when women with severe toxemia of pregnancy complain of abdominal symptoms.View full abstractDownload PDF (421K) -
Mayumi SAHARA, Shunichi NITTA, Katsumi TASHIRO, Takumi TANIGUCHI, Tsut ...1994 Volume 14 Issue 10 Pages 829-833
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 58-year-old male with dilated hypertrophic cardiomyopathy underwent laminectomy for ossification of posterior longitudinal ligament under general anesthe-sia. Preoperative Holter ECG showed multifocal ventricular premature contractions and ventricular tachycardia. Left ventricular ejection fraction assessed by angiography was 37%. In order to treat accidental ventricular fibrillation which may arise in prone position during the operation, a pair of disposable electrodes for a defibrillator (FG-1400) were attached to the chest before inducing anesthesia. Anesthesia was maintained with a high dose of fentanyl, and hemodynamic variables were monitored by Swan-Ganz catheter. After anesthesia was induced, low level (1.6l/min/m2) cardiac index (Cl) and high wedge pressure (19mmHg) of pulmonary capillary (PCWP) were noted. Administration of dopamine and dobutamine was started with low dosage (2μg/ kg/min) when Cl decreased to 1.3l/min/m2; Cl then increased gradually. Moreover, Cl and PCWP improved to the normal range at the end of the operation. Throughout anesthesia, heart rate and blood pressure remained stable without any life-threatening arrhythmia.View full abstractDownload PDF (532K) -
Akimasa MIYATA, Shuichi SHIRASAKI, Asahei MAEDA, Noriyuki ANZAWA, Yuic ...1994 Volume 14 Issue 10 Pages 834-837
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe potential of a local anesthetic ointment formulation (lidocaine and tetracaine) to provide topical anesthesia of the intact skin for venepuncture was investigated. The ointment (1g) was applied one hour before intravenous cannulation to 20 adults and 15 children. The topical anesthetic effect of this ointment was evaluated by pain score and existence of complications. No patient reported unusual sensation and analgesia was satisfactory for 80% of these patients. We measured plasma levels of lidocaine in 16 patients. No remarkable increase in plasma lidocaine levels was observed in any patient, and the range was between 0-0.1μg/ml. These findings suggest that lidocaine and tetracaine ointment are useful in decreasing pain of venepuncture.View full abstractDownload PDF (388K) -
Junro TANIGUCHI, Kazuo HAMATANI1994 Volume 14 Issue 10 Pages 838-841
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 48-year-old man who had migraine attack with severe occipital headache preceded by nausea, vomiting, vertigo and left hemiataxia, resulting in an infarction of the lateral medulla (lateral medullary syndrome, Wallenberg's syndrome) is described. In this case, vertebral artery angiography revealed an occlusion in the left posterior inferior cereberal artery, and brain MRI revealed an infarction in the lateral medulla. The diagnosis was considered to be migrainous infarction.View full abstractDownload PDF (1007K) -
Kenji TAKI, Masayasu NAKAYAMA, Noriaki KANAYA, Masako SATOH, Yuzuru YA ...1994 Volume 14 Issue 10 Pages 842-847
Published: 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe introduced a preoperative consultation system in 1989 in Sapporo Medical University and Hospital in which an anesthesiologist examines patients who have troublesome complications before surgery and are expected to have some problems during anesthesia or the postoperative period. More and more patients have been processed through this system every year, reaching 13% of total anesthetic cases in 1992. The incidence of complications in patients detected through this system was as follows: 57% in cardiovascular diseases, 28% in respiratory diseases, and 15% in neuromuscular diseases. Nine percent of those patients were directed to additional preoperative examinations or treatments. An about 1% reduction in cancellations of operations was achieved by introduction of this system. We believe this preoperative consultation system has enabled not only smoother performance of scheduled operations but also a reduction in the incidence of perioperative complications.View full abstractDownload PDF (560K)
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