All issues
Volume 16, Issue 7
Displaying 1-14 of 14 articles from this issue
- |<
- <
- 1
- >
- >|
-
[in Japanese]1996 Volume 16 Issue 7 Pages 561-564
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (453K) -
[in Japanese]1996 Volume 16 Issue 7 Pages 565-567
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (412K) -
[in Japanese], [in Japanese], [in Japanese]1996 Volume 16 Issue 7 Pages 568-571
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (1458K) -
[in Japanese]1996 Volume 16 Issue 7 Pages 572-576
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (469K) -
Hiroyuki YAMAMOTO, Hideyasu YOSHIKAWA1996 Volume 16 Issue 7 Pages 577-582
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe compared the effect of epidural analgesia provided by the continuous infusion of mepivacaine with or without a small dose of fentanyl in 20 patients undergoing laparotomy. Patients given general anesthesia combined with epidural anesthesia were assigned to one of two groups. Patients in the mepivacaine group (Group M) were given 1% mepivacaine alone. Patients in the fentanyl group (Group F) were given a mixture of 25 μg of fentanyl in 6ml of 1% mepivacaine. Continuous epidural infusion of each test solution was started at a rate of 6ml/hr immediately after 6ml bolus injection. There was no difference between the groups with regard to changes in heart rate and mean arterial pressure. The number of additional injections of mepivacaine for blood pressure control and postoperative pain scores were significantly lower in Group F than in Group M. Mean postoperative PaCO2 was greater in Group F than in Group M, but all values were within the normal range. There were no other side effects attributable to epidural fentanyl. Our results indicate that continuous epidural infusion of mepivacaine mixed with a small dose of fentanyl may enhance intraoperative epidural analgesia without complications.View full abstractDownload PDF (727K) -
Mitsuru KUNIHIRO, Kazuyoshi ISHIDA, Tsutomu SHIMABUKURO, Toshiaki HORI ...1996 Volume 16 Issue 7 Pages 583-587
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSFrom 1993 to 1994, 15 patients underwent combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). This group (CABG+CEA group) is compared with a group of 50 randomly selected patients without known carotid disease who underwent CABG alone during the same period (CABG group). The incidence of patients with medically treated hypertension was significantly higher in the CABG+CEA group. In the CABG+CEA group, median sternotomy was performed prior to CEA for emergency institution of cardiopulmonary bypass (CPB).
Demographic data revealed no significant difference between the groups inregard to age, coronary pathology and ventricular function. CPB time was longer (141 vs 110min.) in the CABG+CEA group. The patients in the CABG+CEA group had more incidence of blood transfusion (53% vs 24%) and need for noradrenaline infusion after CPB (53% vs 22%). Postoperative creatine kinase isozyme MB level was higher (131 vs 79 IU/l) in the CABG+CEA group. Neurological deficit occurred in only one patient in the CABG group.
We concluded that although patients who need combined CABG and CEA have a higher risk of myocardial ischemia than patients who undergo CABG alone, neurological evaluation after surgery showed that combined CABG and CEA was not significantly worse than CABG alone.View full abstractDownload PDF (701K) -
Koichi OTA, Mikito KAWAMATA, Keiichi OMOTE, Akiyoshi NAMIKI1996 Volume 16 Issue 7 Pages 588-593
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe evaluated the effects of low-dose continuous epidural infusion (1ml/hr.) of 1% lidocaine and morphine on postoperative pain in patients who underwent cholecystectomy (N=50), subtotalgastrectomy (N=28) and low anterior resection (N=24). All cases were administered 0.25% bupivacaine 6ml with morphine 2mg epidurally after the operation. These cases were divided into two groups: the patients of the epidural group received continuous epidural infusion of 1% lidocaine with morphine (2.7mg/day) at the rate of 1ml/hour for 72 hours; the patients of the control group received no epidural infusion. Continuous epidural infusion allowed a significant decrease in the supplementary use of analgesic for postoperative pain control. There were many patients who did not need supplementary analgesic drug, particularly in the cholecystectomy group receiving continuous epidural infusion. We conclude that low-dose continuous epidural infusion is a clinically useful method for postoperative pain control.View full abstractDownload PDF (710K) -
Yoshihisa KOGA, Osamu KUMODE, Tomoaki HIGASHIZAWA, Masashi ARIMITSU, T ...1996 Volume 16 Issue 7 Pages 594-599
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWhile it has become a well established index over the years, the 1963 ASA classification of patients physical status has several problems which could be ameliorated by introducing additional risk categories. According to a retrospective investigation (23, 285 cases) at our institute, over 40% of surgical patients under general anesthesia belonged to ASA class 2. We consider the ASA physical status class 2 to be too broad to accurately reflect physical status because of the small number of categories (5-rank classification). We developed a more precise and practical 7-rank classification including not only surgical risk itself but also anesthetic risk with new classes 1.5 (mild) and 2.5 (moderate to severe) added to the conventional 5-rank ASA classification. The 7-rank risk assessment of preanesthetic patients demonstrates a clear inverse relationship between risk classes and patient distribution and has been favorably accepted by anesthesia residents as well. We, therefore, propose the application of the 7-rank classification to estimate perioperative patient risk in daily anesthesia practice.View full abstractDownload PDF (1013K) -
Maki AOYAMA, Yasuo NAKAO, Masaharu KASAI, Koji ODANI, Osamu KEMMOTSU1996 Volume 16 Issue 7 Pages 600-603
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe examined the role of caudal epidural block as an adjunct to postoperative pain management in normal adult donors undergoing bone marrow harvest.
Thirty-nine bone marrow donors were enrolled in this study from April 1993 through January 1996.
Caudal epidural block using 1.0-1.5% lidocaine 20ml or 0.25% bupivacaine 20ml and narcotics (morphine 2mg or fentanyl 0.lmg) were combined with general anesthesia (sevoflurane/N2O) in 18 patients, while general anesthesia alone was administered in 21 patients.
Postoperative analgesics (diclofenac sodium) were requested by 3 donors (16.7%) who received caudal epidural block, while 14 donors (66.7%) who received general anesthesia alone required analgesics postoperatively.
There were no differences between the two groups in frequencies of nausea, vomiting or other complications.
Our results indicate that caudal epidural block is as effective as postoperative analgesia in normal adults who undergo bone marrow harvest.View full abstractDownload PDF (527K) -
Akiko KISARA, Yoshihiro YAGISHITA, Mai TAKAONO, Toshio YOGOSAWA, Yomih ...1996 Volume 16 Issue 7 Pages 604-608
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 68-year old male with recurrent gastric cancer was scheduled for total gastrectomy. Coronary spastic angina was diagnosed by ergonopine test preoperatively.
Before induction of anesthesia, we started continuous infusion of NTG (0.3μg/kg/min) and DTZ (0.8μg/kg/min), and general anesthesia was maintained with GOF.
When stomach was retracted, blood pressure declined from 150/85 mmHg to 100/50 mmHg and bradycardia of 50/min occurred. Atropine sulfate 0.5mg was injected and the concentration of halothane and infusion rate of DTZ were decreased. Blood pressure and heart rate gradually recovered. At this point, however, ST segment was elevated.
After bolus injection of 0.5mg NTG, the elevated ST segment returned to normal. Coronary arterial spasm was induced by vagovagal reflex due to gastric traction, and it was alleviated by NTG.
It seems that the continuous infusion rate of TNG and DTZ used was not sufficient to prevent coronary arterial spasm.
A higher continuous infusion rate of NTG and DTZ might have prevented coronary arterial spasm in this case.View full abstractDownload PDF (636K) -
Takuo HOSHI, Akihiko SUGA, Megumi KUMAGAI, Masayuki MIYABE, Shigehito ...1996 Volume 16 Issue 7 Pages 609-612
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 24-year-old female accidentally took bleaching agent into her eyes and was admitted to a hospital complaining of ocular pain due to corneal ulcer. Following admission, the pain and edema improved soon after rinsing her eyes and administering steriod. But corneal ulcer and orbital pain soon aggravated and corneal perforation occurred. After that, she had repeated episodes of corneal perforation, and keratoplasty was performed each time. She had undergone seven operations as of June 1995. Her major complaint, orbital pain, was only relieved by buprenorphine i.m. treatment. We tried to reduce her pain by applying stellate ganglion block and continuous subcutaneous infusion of buprenorphine but failed. During her hospitalization, we noticed that her behavior was strange and suspected that she might have hurt herself and/or not taken medicines properly. Finally we consulted psychiatrists and they started psychiatric treatment without giving any analgesics. Just after this therapy, her complaints of pain disappeared. Psychiatric examination strongly suggested that she had Munchausen's syndrome. And it became clear that she had been addicted to intramuscular buprenorphine injection.
This case suggests the importance of the team approach, especially with psychiatrists, in the case of chronic pain.View full abstractDownload PDF (547K) -
Michiyo NAKANO, Tetsuro UEFUJI, Osamu UMEGAKI, Kenji OGLI1996 Volume 16 Issue 7 Pages 613-615
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 73 year-old-man was scheduled to undergo cholecystectomy for cholelithiasis. Preoperative chest X-ray and other examinations showed no abnormality, nor did he complain of any respiratory symptoms. We tried to intubate an 8.0 mm I. D. endotracheal tube first, but were unsuccessful due to resistance below the vocal cords. In the end, we were able to pass a 6.0mm I. D. endotracheal tube into his trachea. Two weeks after the operation, the diagnosis of tracheobronchopathia osteochondroplastica (TO) was established by bronchof iberscopy and CT scan. TO is a relatively rare benign disease characterized by cartilaginous and/or osseous submucosal nodules projecting into the lumen of the larynx, trachea, and bronchi. Most of the cases are asymptomatic and frequently diagnosed incidentally during endotracheal intubation or bronchofiberscopy.View full abstractDownload PDF (909K) -
Keisuke YAMADA, Katsumi TASHIRO, Keiko NITTA, Kouzirou HIROTA, Ken YAM ...1996 Volume 16 Issue 7 Pages 616-619
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 7-year-old boy with tracheo-brachiocephalic artery fistula underwent ligation of the brachiocephalic artery. The left common carotid artery and subclavian artery were accidentally ligated together with the brachiocephalic artery during the procedure. Interruption of the left subclavian artery was found by disappearance of waves in the recordings of a pulse oximeter attached to the left middle finger and in the recordings of left radial artery pressure. Interruption of cerebral blood flow was found by loss of palpability of the left common carotid artery. Attention needs to be paid to the blood flow of the left common carotid artery in ligation of the brachiocephalic artery. It is necessary to palpate the left common carotid artery, set a pulse oximeter on the left ear and observe pupil size.View full abstractDownload PDF (911K) -
Shunichi NITTA, Hironori ITOH, Tsutomu KOBAYASHI1996 Volume 16 Issue 7 Pages 620-624
Published: September 15, 1996
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSFive patients with seronegative myasthenia gravis (SMG) undergoing thymectomy were studied. The first twitch response in the adductor pollicis muscle (T1) and train-of-four ratio (TOFR) were observed using Myograph 2000TM. During 60% nitrous oxide-2.5% sevoflurane anesthesia, vecuronium(0.01mg/kg) was incrementally injected intravenously until T1 decreased to less than 10% of the control. After the first dose of vecuronium, the T1 in three patients with generalized SMG greatly decreased to less than about 5% of the control. Furthermore, one of the patients with generalized SMG showed an extremely low TOFR (25%) at the beginning of neuromuscular monitoring. However, two patients with oculobulbar SMG needed additional doses of vecuronium. We thought that patients with generalized SMG had marked sensitivity to vecuronium compared with oculobulbar SMG.View full abstractDownload PDF (611K)
- |<
- <
- 1
- >
- >|