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Volume 14, Issue 1
Displaying 1-15 of 15 articles from this issue
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A Comparison of Halothane, Enflurane, Isoflurane, Sevoflurane and KetamineJun HAYAKAWA, Toshinari SHIBATA, Yutaka USUDA1994 Volume 14 Issue 1 Pages 1-6
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe evaluated the effect of trimetaphan induced hypotension on arterial blood-gases in patients undergoing mastectomy. Fifty patients studied were divided into five groups of 10 patients each according to the anesthetic agents used: halothane, enflurane, isoflurane, sevoflurane and ketamine. Nitrous oxide and oxygen were used in all groups. Mean arterial pressure during induced hypotension was maintained at 70% of that before hypotension. Significant reduction in PaO2 was observed during induced hypoten-sion in all groups. There was no difference between the five groups in the degree of PaO2 decrease.These findings suggest that induced hypotension may impair pulmonary gas exchange, regardless of the anesthetic agent used, by changing the ventilation-perfusion ratio. Therefore, pulseoxymetry or continuous arterial blood-gas monitoring should be used under these conditions.View full abstractDownload PDF (660K) -
Yoshiyuki SHUDO, Jirou KONO, Shigeyoshi TOYOTA, Tomoko OTAKE, Yoshikiy ...1994 Volume 14 Issue 1 Pages 7-11
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe generation of oxygen radicals in PMNLs and the consumption of serum comple-ment were examined in 11 patients undergoing cardiopulmonary bypass and in 9 non -cardiac surgery patients cotinuously exposed to 100% oxygen. The measurements were made before induction and end of cardiopulmonary bypass in open heart surgery and in non-cardiac surgery before induction after 3-hour exposure to 100% oxygen. Arterial blood PMNLs were purified in two steps with dextran sedimentation and netriqoate sodium Ficoll centrifugation.
The oxidative burst response of these cells was measured to determine their ability to generate superoxide anion. Determination was made by cytochrome C reduction assay.
Studies on the generation of superxide in PMNLs showed that is has a tendency to decline in non-cardiac patients and increase in cardiopulmonary bypass patients.Serum complement was not consumed significantly during and after cardiopulmonary bypass. PAO2/PaO2 ratio did not show any remarkable change in either group. Mean duration of extracorporeal circulation was 153min, and exposure to 100% oxygen 180min.
It was concluded from the results of this study that extracorporeal circulation and exposure to high-concentration oxygen for a short duration do not affect pulmonary parenchyma and oxygenation.View full abstractDownload PDF (493K) -
Utilization of Notebook Type Personal Computer, RS-232C Multiplexer and Spreadsheet SoftwareTeiji SAWA, Masami OGAWA, Maho IMOTO1994 Volume 14 Issue 1 Pages 12-20
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSOn-line data logging from four clinical monitors was tried using a notebook type personal computer and RS-232C multiplexer. As communication softwares, Lotus 1-2-3 and its on-line data logging add-in software 1-2-3 DataLogger were used. Heart rate, 4-ch blood pressure, 4-ch body temperature, percutaneous arterial oxygen saturation, and mixed venous saturation were recorded from these monitors automatically into the spread sheet of Lotus 1-2-3. Rate pressure product, systemic vascular resistance, and pulmonary vascular resistance could be easily calculated and displayed as real time graphs from data taken up into the work sheets using the graphic function or calculation function of Lotus 1-2-3. We are now using this system especially in the training of cardiac anesthesia.View full abstractDownload PDF (859K) -
Yoshitaka FUJII, Hiroyoshi TANAKA1994 Volume 14 Issue 1 Pages 21-24
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSAnalgesia, postoperative headache and movement during epidural and spinal anesthesia were compared in a double-blind manner. Forty patients undergoing arthroscopic knee surgery were divided into two groups at random: a spinal group (S group, n=20) and an epidural group (E group, n=20). Patients in the S group were administered a subarachnoid injection of 2.5∼3.0ml of plain 0.5% bupivacaine. Patients in the E group were injected with plain 2% lidocaine 15ml into the epidural space and with both 1% lidocaine 10ml and 0.5% bupivacaine 10ml into the caudal space. Analgesia was similar in both groups. The incidence of postoperative headache was lower among the E group patients. It was possible to move patients of the E group earlier after surgery. We conclude that epidural and caudal anesthesia is useful in arthroscopic knee surgery patients.View full abstractDownload PDF (387K) -
Makoto FUKUSAKI, Osamu IWANAGA, Masanori MATSUMOTO, Keiko OGATA, Rumik ...1994 Volume 14 Issue 1 Pages 25-32
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSControlled hypotension by prostaglandin E1 (PGE1) under hemodilution of hematocrit (Hct) 23% was performed during hip surgery, and liver function and renal tubular function were compared with those in the case of hemodilution of Hct 31% by measuring arterial blood ketone body ratio (AKBR) and urine N-acetyl-β-D-glucosaminidase (NAG-index), respectively. No marked change was observed in the AKBR values after hemodilution, during hypotension and post-operation compared to the control values (before hemodilution) and also those of the group with Hct 31%. NAG-index values significantly increased in the hemodilution Hct 23% group after hypotension and post-operation compared with either the control or Hct 31% group. No marked change was noted in liver or kidney functions by blood examinations for one month after the operation. These results indicate that liver function is maintained normally under the controlled hypotension induced by PGE1 with hemodilution of Hct 23%. However, renal tubular function is temporarily affected, while clinical manifestation and other abnormal clinical findings in renal function are not observed throughout.View full abstractDownload PDF (889K) -
Makoto FUKUSAKI, Masanori MATSUMOTO, Osamu IWANAGA, Keiko OGATA, Rumik ...1994 Volume 14 Issue 1 Pages 33-39
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSFor hip surgery, controlled hypotension by prostaglandin E1 with hemodilution of Hct 24% (hemodilutional group, 12 females) was carried out, and its clinical safety in recovery from postoperative anemia and complications were comparatively studied without hemodilution (non-hemodilutional group, 13 females). As soon as 1, 000ml of blood in the hemodilutional group was collected before operation, 3% dextran solution of the same amount was transfused. The autologous blood was transfused after operation. In the non-hemodilutional group, stored and salvaged blood autotransfusions were used. Anemia recovered in the 4th week in the hemodilutional group, and in the 3rd week in the non-hemodilutional group after operation. There were no patients transfused homologous blood in either group. Liver and renal function in the blood chemistry examinations were within normal limits after operation in the hemodilutional group. The rate of occurance of thrombophlebitis was the same in both groups. There were no patients behind the rehabilitation schedule in either group. The results suggest that controlled hypotension by PGE1 with hemodilution of Hct 24% would pose no substantial clinical problems, and would be a useful means of avoiding homologous blood transfusion.View full abstractDownload PDF (816K) -
Masashi KAWAMOTO, Nobuhiko TANAKA, Ayumi SHIMOKAWA, Hiroki YOKOO, Mayu ...1994 Volume 14 Issue 1 Pages 40-46
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPower spectral analysis of heart rate variability was applied to assess the effect of thoracic level spinal anesthesia on cardiac autonomic nerve activity (CAA) in 12 patients, consisting of 6 juveniles (15-19 yrs) and 6 adults (20-24 yrs), whose analgesia levels were above T4 after subarachnoid hyperbaric tetracaine. By using the fast Fourier transform method, power spectral analysis on 256 s'R-R data was performed and repeated at 1-minute intervals for 30min. In the spectra, the high-frequency band was integrated to estimate parasympathetic activity and the low-frequency band was used to determine sympathetic and parasympathetic activities. The ratio of these variables was used as an index of CAA balance. Heart rate, blood pressure and respiration were monitored. Dermal level of analgesia was assessed by pin-prick response. Four juveniles received ephedrine and/or atropine, whereas no adult needed such agents. In juveniles, both high and low-frequency band-power decreased, although the ratio increased. In adults, high-frequency band-power and the ratio increased. It was shown that spinal anesthesia increased parasympathetic nerve activity. We concluded that power spectral analysis of heart rate variability would be useful to reveal changes in CAA during spinal anesthesia, and that CAA in young patients is apt to be vagotonic when thoracic level of anesthesia is achieved.View full abstractDownload PDF (726K) -
Prediction by Multiple FactorsKen YAMAMOTO, Keizo SHIBATA, Hiromitsu KOBAYASHI, Koujiro HIROTA, Shun ...1994 Volume 14 Issue 1 Pages 47-53
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe incidence of difficult laryngoscopy at tracheal intubation was assessed in 3, 698 patients undergoing elective operation. Various factors were preoperatively measured to predict the difficulty of laryngoscopy. The incidence of difficult laryngoscopy was 72 out of 3, 698 cases (1.9%). A simple predictive method with three factors (incisor gap, neck movement, receding mandible) resulted in sensitivity, specificity and positive predictive values of 61.1%, 74.8% and 4.6%, respectively. The predictive method using these three factors is quite simple, and could stand comparison with more complicated predictive methods.View full abstractDownload PDF (758K) -
Seiji TAKAOKA, Sumio AMAGASA, Hideo HORIKAWA, Yoshihide MIURA, Katsuya ...1994 Volume 14 Issue 1 Pages 54-58
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 64-year old woman with retroperitoneal tumor (diagnosis: cystadenocarcinoma of the pancreatic head) was scheduled for surgery.
Durning anesthesia using a combination of continuous epidural block and N2O-O2-isoflurane method, we experienced unexpected severe attack of hypertension when the tumor was manipulated. This series of circulatory episodes were managed, using various vasoactive drugs, with considerable difficulty. This tumor was suspected to be a catecholamine-secreting tumor and was histologically diagnosed as a paraganglioma after the operation.
The possibility of catecholamine-producing tumor should be kept in mind in case of retroperitoneal tumor with uncertain diagnosis.View full abstractDownload PDF (872K) -
Chiaki TACHIBANA, Nagisa KOBAYASHI, Keiko SATOH, Yoko OHE, Toshiki DOI ...1994 Volume 14 Issue 1 Pages 59-62
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 66-year-old woman undergoing ASD repair was intravenously administered bovine lung heparin 400IU/kg before extracorporeal circulation. However ACT did not increase up to the effective level (300s) and thus the operation was postponed.
She was given a diagnosis of heparin-induced thorombocytopenia by the platelet aggregation test with heparin. After oral ticlopidine treatment for one month, she was scheduled for a second operation. The ACT was prolonged at 432 seconds after 400IU/kg heparin i. v., but the patient remained asymptomatic. Our experience with this case strongly reminded us that the measurement of ACT after intravenous administration of heparin is essential for open-heart surgery.View full abstractDownload PDF (373K) -
Seiji TAKAOKA, Sumio AMAGASA, Tatsuro TAKAHASI, Hideo HORIKAWA1994 Volume 14 Issue 1 Pages 63-67
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSCongenital fusion of the jaws is a rare malformation that presents some problems in anesthetic management, such as choice of anesthesic method and maintenance of a patient airway. Endotracheal intubation is mandatory, but great difficulties are usually anticipated.
In a 33-month-old baby with this malformation, we inserted a nasotracheal tube of 3.5mm o. d. guided by a 2.2mm o. d. fiberoptic bronchoscope passed through the tube without sedation. The patient was then anesthetized with a combination of nitrous oxide-oxygen-sevoflurane.
Fbberoptic bronchoscopy facilitates endotracheal intubation in babies with difficult airways, and anesthesiologists should be well-versed in this method.View full abstractDownload PDF (909K) -
Hideya OHMORI, Sumihiko SEKI, Noriaki KANAYA, Hiroshi IWASAKI, Akiyosh ...1994 Volume 14 Issue 1 Pages 68-71
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 46-year-old man with mandibular cancer was operated on two times under isof lurane anesthesia within about one month. The third operation was performed about three months later under sevoflurane anesthesia. The patient showed symptoms of hepatic dysfunction on the next day. Hematological tests showed remarkable increase of serum transaminase as follows; GOT 2, 427IU•l GPT 1, 141IU•l-1 LDH 1, 146IU•l-1. Alkaline phosphatase and eosinophil count were within the normal ranges. GOT and LDH returned to normal levels within 3 days, and GPT recovered within 20 days. Drug-induced lymphocyte stimulating test (DLST) on the 30th postoperative day indicated that isof lurane was positive and halothane and sevof lurane were false positive. In conclusion, hepatic dysfunction in this patient may have been caused by cross-sensitization between isoflurane and sevoflurane.View full abstractDownload PDF (432K) -
Reiko TAKAHASHI, Masaya GANZUKA, Yoshiki SAEKI, Kazuo HAMATANI1994 Volume 14 Issue 1 Pages 72-76
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSBackground: The purpose of this study was to measure the pressure in the anal canal during caudal epidural anesthesia.
Methods: The pressure in the anal canal was measured via side-opening perfused catheter in 10 adult patients. The pressure under resting condition was recorded before and following the injection of 10 ml of 1.5% mepivacaine into the caudal epidural space. The pressure when anus was contracted at will was also meassured before and at 5min and 10min after injection.
Results: After completion of the injection of mepivacaine, the pressure was gradually decreased. At 4min, the mean resting pressure was significantly decreased to 70% (p<0.05). The voluntary contractive pressures at 5min and 10min were also significantly decreased to 65% and 51%, respectively (p<0.05).
Conclusions: Decrease of pressure in the anal canal appeared surely and early. Pressure in the anal canal can be an effective indicator of the effect of caudal epidural anesthesia.View full abstractDownload PDF (515K) -
Tetsu KIMURA, Seiji WATANABE, Shinichi INOMATA, Yukiko NISHIJIMA, Yuic ...1994 Volume 14 Issue 1 Pages 77-81
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe successfully recorded oxygen uptake and carbon dioxide washout curves before and after return of spontaneous circulation. We introduce the case and discuss the implication of the unprecedented recording. A 67-year-old male patient underwent resection of the rectum under epidural and light sevoflurane anesthesia. During the emergence phase of anesthesia, coincidentally wide QRS waves were observed in the EKG monitor, and then ventricular fibrillation (Vf) took place. External cardiac massage was immediately started. The first countershock successfully defibrillated the heart, but a few minutes later Vf occured again. About 30 minutes after the first fibrillation onset, intra-aortic balloon pumping (IABP) was started via the right femoral artery. The fourth defibrillation attempt 10 minutes later on IABP successfully defibrillated the heart. Immediately after the return of spontaneous circulation, the patient responded well enough to all verbal commands. He was tentatively diagnosed as having had a coronary spasm. At the 45-minute point after the first fibrillation, monitoring of ETCO2 and ETO2 was started using a Raman scattering gas monitor (RASCALTM). When spontaneous circulation returned, ETCO2 value increased from 10mmHg to 60mmHg, and ETO2 value abruptly decreased from almost 100% to 90%.View full abstractDownload PDF (515K) -
Katsuhito NAKAMARU, Tamotsu NAGAKAWA, Hideyuki KUBO, Toshihiko SATONE, ...1994 Volume 14 Issue 1 Pages 82-88
Published: January 15, 1994
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe efficacy of Nova Stat Profile 6 Electrolyte Analysis System (SP-6) in measuring sodium (Na+), potassium (K+), chloride (Cl-), ionized calcium (Ca++), glucose and hematocrit (Ht) in heparinized whole blood was evaluated. Moreover, the effects of blood viscosity, heparin and muscle relaxation drug on these data were analyzed. Linearity, reproducibility, carry-over ratio and correlation with other machines were examined. Simultaneously, the durability of each electrode and membrane were examined.
All data showed good linearity except for Ht, Which was out of automatic correction. The durability of electrodes and membranes were more than 3 months in Na+ and K+, about 3 months in Ca+, and about 8 days in Cl- and glucose. Blood viscosity and muscle relaxation drug had no effects on those parameters, but in case adding more than 25μl of heparin to the samples, the measured values were effected significantly. Cleaning solution for its exclusive use damaged the electrode membranes, and sodium hypochlo-rite which was used for cleaning the sampling route damaged the K+ electrode.
We concluded that Nova SP-6 is useful, rapid and accurate machine for blood examination, although some improvements on maintenance should be necessary.View full abstractDownload PDF (599K)
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