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Volume 15, Issue 3
Displaying 1-13 of 13 articles from this issue
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Natsuo HONDA1995 Volume 15 Issue 3 Pages 187-196
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSIt is well-known fact that progressive hyperthermia exerts fatal damage on living body. But the lethal mechanism is not fully understood. So physiological studies were performed in animals with whole body hyperthermia by surface warming.
During hyperthermia, various parameters were serially measured including body temperature, aortic pressure, heart rate, blood gases, tissue blood flow, brain wave, hormonal responses and others. And, a number of pathophysiological changes were observed, including hyperthermia, hypermetabolic state, tachycardia, hypoxia, hyperkalemia, lacticidemia, acidosis, coagulopathy, endotoxins and others. From these results, it is considered that various factors are involved in the aetiology of whole body hyperthermia. but the elevated body temperature, metabolic acidosis, hypotension and hypoxia are the important factors which determine the fatal outcome.View full abstractDownload PDF (1055K) -
[in Japanese]1995 Volume 15 Issue 3 Pages 197-201
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (646K) -
[in Japanese]1995 Volume 15 Issue 3 Pages 202-209
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (1020K) -
Masakazu YOKOI, Hiroyuki YAMADA, Jun-ichi MASUDA, Makoto MATSUSHIMA, J ...1995 Volume 15 Issue 3 Pages 210-214
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe studied the effect of epidural blood patch (EBP) on prevention of lumbar puncture headache (LPH) in patients who had inadvertent dural puncture (DP) with a 17-gauge Hanaoka needle (H needle) or Touhy needle.
A total of 122 patients were randomly divided into two groups: a prophylactic EBP group (n=58) and non-EBP group (n=64). In the patients of the EBP group, an average volume of 8.5ml of autologous blood was injected into the epidural space through an epidural catheter soon after accidental DP occured.
There was no difference between the EBP group (25.9%) and non-EBP group (34.4%) in the frequency of post-operative LPH. The incidence of post-operative EBP was higher in the non-EBP group (25%) than in the EBP group (5.2%) (p<0.05). The duration of LPH was shorter in the EBP group (2.5 days) than in the non-EBP group (4.9 days).
In conclusion, EBP soon after DP does not reduce the incidence of LPH, but does relieve the extent of symptoms and shortens the period of LPH. It therefore seems useful for treatment of accidental DP.View full abstractDownload PDF (631K) -
Yukiko MINAMOTO, Hideaki MIKI, Rie KITAMURA, Satoshi YAMADA, Kazuo YAM ...1995 Volume 15 Issue 3 Pages 215-220
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPerioperative management and outcome of cardiac surgery in patients with renal dysfunction were retrospectively examined in 27 patients with preoperative creatinine clearance (Ccr) of less than 50ml/min. These patients were divided into two groups based on the preoperative level of Ccr: group A (Ccr_??_20ml/min, n=12) and group B (20<Ccr_??_50ml/min, n=15). Comparisons were made between the groups in regards to the following parameters: duration of cardiopulmonary bypass (CPB), aortic crossclamp, perioperative renal therapy, morbidity, and mortality. Use of the extracorporeal ultrafiltration method (ECUM) during CPB was significantly higher in group A than in group B (P<0.05). Renal-protective agents including furosemide, dopamine and dibutyryl cAMP were used in all but the dialysis group patients. The postoperative use of continuous veno-venous hemodiafiltration (CVVHD) and other renal replacement therapy was significantly higher in group A than in group B (P<0.05). Five patients (42%) in group A eventually died of multiple organ failure resulting from low output syndrome, while two patients (13%) in group B died of postoperative complications unrelated to preoperative renal dysfunction. These results indicate that group A patients are associated with higher mortality than group B patients, even with the aid of CVVHD.View full abstractDownload PDF (707K) -
Preventive Effect of Prostaglandin E1 on Hemolysis in Intraoperative Blood-salvaging AutotransfusionEiichiroh KATAOKA, Hideaki HAYASHI, Tatsuya NISHIUCHI, Hisatoshi OHSUM ...1995 Volume 15 Issue 3 Pages 221-226
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSBecause of complications such as viral infection and graft-versus-host disease, we have made every effort to avoid homologous transfusion at Osaka National Hospital. We utilize autologous transfusion and induce hypotensive anesthesia to reduce homologous transfusion in elective surgery.
We investigated the effect of prostaglandin E1 (PGE1) on hemolysis in intraoperative blood-salvaging autotransfusion. Twenty-two patients (ASA 1-2) who were anesthetized with modified NLA and in whom primary total hip replacement was performed were randomly allocated to one of two groups. Ten patients were given induced hypotensive anesthesia with PGE1 (PG group) and twelve patients isoflurane (ISO group).
Free-hemoglobin concentrations in salvaged blood and waste rinse fluid were measured, and the hemolysis rate during the blood-salvaging process was calculated.
The concentration of free hemoglobin in reinfused blood and waste rinse fluid was lower in the PG group than in the ISO group. These findings suggest that less hemolysis occurred in the PG group, resulting in a higher salvage rate.
These results suggest that induced hypotensive anesthesia with PGE1 reduces hemolysis in intraoperative blood-salvaging autotransfusion.View full abstractDownload PDF (683K) -
Yoshihiko OHNISHI, Takahiko HIRATA, Osamu UCHIDA, Masakazu KURO1995 Volume 15 Issue 3 Pages 227-232
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe measured cardiac output continuously in eight patients undergoing surgery for abdominal aortic aneurysm using a continuous cardiac output measurement catheter (CCOM). This catheter measures the blood flow velocity of the intra-pulmonary artery by heat-dissipation, enabling continuous calculation of cardiac output. Before abdominal aortic cross-clamping, CCOM catheter readings correlated significantly with conventional thermodilution values (r=0.941). Although both values also correlated significantly during and after abdominal aortic cross-clamping (r=0.880, and r=0.887 respectively), CCOM values tended to be larger during cross-clamping and smaller after unclamping than thermodilution values. This was probably due to some dislocation of the tip of the catheter.
We conclude that continuous cardiac output measurement by CCOM catheter satisfies clinical requirements with other cardiac measurements, calibrating appropriately even in some situations in which rapid changes in cardiac output are anticipated.View full abstractDownload PDF (713K) -
Shigeru SAITO, Hitoshi SHIMADA, Haruhiko FUKURA, Koichi NISHIKAWA, Tos ...1995 Volume 15 Issue 3 Pages 233-237
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA transportable hyperbaric chamber called the Gamow bag has been reported to be effective in the treatment of high-altitude disorders. The problem with this device is that the operator has to endure a considerable amount of physical exertion to prevent carbon dioxide accumulation in the bag and to supplement the consumed oxygen. To solve this problem, we applied soda lime with a respiratory circuit, which is widely utilized as a carbon dioxide absorber in operation units and in intensive care units of hospitals. Using this system, the amount of exercise required from the operator could be reduced by approximately 90%. In a clinical trial at high altitude, three patients with acute mountain sickness were successfully treated by the Gamow bag equipped with this respiratory system. We concluded that this hyperbaric chamber with soda lime is effective for emergency care of high altitude disorders. Further application of this device to victims of carbon monoxide intoxication or air embolization appears promising.View full abstractDownload PDF (1023K) -
Association with Surgical ManipulationKazuaki KOHRIYAMA, Kazunori KOGA, Masayuki KAMOCHI, Takeyoshi SATA, Ak ...1995 Volume 15 Issue 3 Pages 238-242
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA case of coronary artery spasm during left upper-lung lobectomy is reported. A 59-year-old male patient with left lung cancer was scheduled for left upper lobectomy. He had no history of ischemic heart disease. His preoperative ECG was within the normal range.
Nitrous oxide-oxygen-isoflurane anesthesia combined with thoracic epidural analgesia was employed for the surgery. During surgical manipulation, arterial blood pressure suddenly decreased to 50/30mmHg, and elevation of ST-segment was observed simultaneously. He was successfully treated with trinitroglycerin, diltiazem and dopamine. During lung lobectomy, surgical manipulation may be a risk factor in coronary artery spasm through hypotension.View full abstractDownload PDF (509K) -
Kumiko ARAKURA, Chieko NISHIMURA, Tetsutaro OTAGIRI, Hiroyuki MITONO, ...1995 Volume 15 Issue 3 Pages 243-246
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe present two cases in which surgical therapies were performed immediately after cesarean section deliveries. In the first case, the fetus was diagnosed as having a cardiac tumor in utero. Shortly after birth, the infant underwent an operation for removal of the tumor. It was unsuccessful. In the second case, the fetus was diagnosed with severe aortic valve stenosis and transferred to a children's hospital in order to receive surgical treatment. After birth, this infant underwent balloon valvulotomy and had a good octcome. Our experience indicates that fetal surgery should consistently be done at medical institutes for maternal and child health.View full abstractDownload PDF (494K) -
Iwao KOBAYASHI, Hiromi TAKAHASHI, Yasuhide HATAKEYAMA, Shin KAWANA, Ak ...1995 Volume 15 Issue 3 Pages 247-250
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSParathyroidectomies were performed under general anesthesia with nitrous oxide, oxygen and sevoflurane in three patients with primary hyperparathyroidism (PHPT). In two cases with high serum calcium (>15.0mg/dl), dehydration and hypercalcemia were corrected preoperatively with normal saline and elcatonin. Anesthesia was induced with thiamylal and vecuronium and maintained with 70% nitrous oxide, 30% oxygen and 2-3% sevoflurane. Anesthesia and surgery were completed uneventfully, except for an episode of increase in serum calcium from 12.3 to 15.0mg/dl in one patient. All patients emerged from anesthesia rapidly without any signs of hypo or hypercalcemia. The results of these three cases suggest that the characteristics of sevoflurane, which include early high controllability of anesthetic depth, muscle relaxation, stable hemodynamics and rapid awakening after surgery, are suitable for PHPT.View full abstractDownload PDF (530K) -
Hirofumi HINO, Osamu OKAWA, Akiko MIYAZAWA, Takeshi TATEDA, Tadashi AO ...1995 Volume 15 Issue 3 Pages 251-254
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA case of hyperglycemia in a diabetic patient during cardiopulmonary bypass is reported. The hyperglycemia apparently occurred because of administration of solution including glucose for replacement therapy of hyperkalemia and decreasing pancreatic blood flow caused by decreased mean perfusion pressure during cardiopulmonary bypass. The maximum serum glucose level was 914mg/dl. The mean blood flow velocity of the right middle cerebral artery, which was evaluated by using transcranial Doppler ultrasonography (TCD), increased to 44cm/sec (from 28cm/sec at the serum glucose level of 320mg/dl). After decreasing the glucose level (482mg/dl), the mean flow velocity also decreased. There was no difference between hyperglycemia and normoglycemia states in PaCO2, mean perfusion pressure and rectal temperature. This suggests that an elevation of glucose level may be associated with a reduction in cerebral blood flow.View full abstractDownload PDF (516K) -
Naoyuki FUJIMURA, Mikito KAWAMATA, Yuri NAKAE, Hajime SONODA, Masayuki ...1995 Volume 15 Issue 3 Pages 255-258
Published: April 15, 1995
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 51-year-old male with constrictive pericarditis and hydratid cysts of the liver due to echinococcosis was scheduled for pericardiectomy and hepatic segmentectomy.
Anesthesia was induced with thiamylal (4mg/kg) i. v., and maintained by nitrous oxide (66%) and isoflurane (1.0-2.0%) in oxygen (33%). To increase cardiac index (CI), pericardiectomy was performed first, preparing cardiopulmonary bypass for accidental extensive bleeding and severe arrythmia during surgery. However, the surgery was performed uneventfully. Following this surgical procedure, CI increased from 2.35l/min/m2 to 3.82l/min/m2. Systemic blood pressure was maintained at 100/60mmHg even when bleeding occurred during hepatic segmentectomy.
Isoflurane anesthesia, which is known to maintain heart rate and hepatic blood flow better than other inhalative anesthetics, appeared to be safe and useful during simultaneous surgery of cardiac and liver echinococcosis in the present patient.View full abstractDownload PDF (461K)
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