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Volume 22, Issue 7
Displaying 1-9 of 9 articles from this issue
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Makiko KOMORI, Keiko NISHIYAMA, Makoto OZAKI, Takamichi SHINJO2002 Volume 22 Issue 7 Pages 257-262
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThirty-six cases of leg amputation due to diabetic gangrene were discussed retrospectively reganding preoperative data, anesthetic methods and perioperative complications. All the patients had chronic renal failure and ischemic heart disease (IHD) and were on hemodialysis (HD). There were 26 men and 10 women, aged 37-85 y.o. (mean : 67 y.o.). The anesthetic technique used for surgery was general anesthesia in twenty-nine patients and spinal in seven. Preoperatively, echocardiography was carried out in order to detect silent ischemia and to evaluate cardiac function for all the patients together with autonomic function tests (heart rate variations during deep breathing and postural hypotension). We found that major preoperative problems were autonomic neuropathy, cerebrovascular disorders, hepatic dysfunction, heart failure, sepsis, respiratory disease and anemia. Their hemodynamic changes and plasma glucose levels were relatively stable during surgery. After surgery with general anesthesia, no aspiration pneumonitis occurred even with gastroparesis, and neither neurological injury nor meningitis occurred with spinal anesthesia. No patients died in the early postoperative period. Preoperative evaluation of autonomic neuropathy and cardiac function, and perioperative intensive management of hemodynamics are essential in diabetic patients with HD and IHD.View full abstractDownload PDF (844K) -
Effects of Nitrous Oxide Administration on Para-aortic Line Obliteration in Postoperative Chest FilmHiromi KATOH, Junichi IKEGAKI, Reiko UOKAWA, Hiroshi KAETSU2002 Volume 22 Issue 7 Pages 263-269
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSTo examine the effects of nitrous oxide administration on atelectasis produced during general anesthesia evaluated by para-aortic line obliteration on postoperative plain chest X-ray films, 175 ASA 1-2 patients undergoing elective major surgery (82 upper abdominal, 54 lower abdominal and 39 head/neck operations) were evaluated. Subjects were allocated to Group G (with nitrous oxide) or Group A (no nitrous oxide) and postoperative chest X-ray film was studied within 1hr of emerging from anesthesia and para-aortic line obliteration ratio (PALO) was measured as division of obliterated by the total para-aortic line length. Upper abdominal surgery patients resulted in a significant increase of PALO than lower or head/neck surgery patients in both Group G and A. PALO of Group G was significantly higher than of Group A in upper abdominal surgery patients. However, there was no difference of PALO between two groups in lower abdominal and head/neck surgery patients. In conclusion, nitrous oxide results in minimal effects on PALO during lower abdominal and head/neck surgery, while it increases PALO during upper abdominal surgery.View full abstractDownload PDF (2470K) -
Naoyuki HIRATA, Noriaki KANAYA, Saori KUROSAWA, Akiyoshi NAMIKI2002 Volume 22 Issue 7 Pages 270-274
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe investigated the effects of propofol on the sedation level and heart-rate variability (HRV) during the induction of anesthesia. Fifteen scheduled surgical patients (ASA1, 2) received propofol 20mg•kg-1•hr-1 intravenously. The sedation level was monitored using a bispectral index (BIS) monitor (Aspect, Newton, USA) and the HRV was monitored using a real-time power spectral analysis monitor (Memcalc/Tarawa, SuwaTrust Japan) . Entropy, low frequency (0.05-0.15Hz) power (LF), high frequency (0.15-0.4Hz) power (HF) and the LF/HF were continuously monitored. Changes in HRV were observed when the BIS values reached 80, 60, 40 and the minimum. After the induction of anesthesia, entropy, LF and HF decreased in a BIS-dependent manner. In conclusion, propofol may cause cardiovascular depression via a reduction in the activity of the cardiac autonomic system.View full abstractDownload PDF (479K) -
Detected by Ventriculo-arterial CouplingTatsuhiro OKA, Yoshiko OZAWA, Yoshinori OHKUBO2002 Volume 22 Issue 7 Pages 275-280
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe assessed hemodynamic changes in elderly and younger patients after the induction of anesthesia with thiopental at 4.0mg•kg-1. After obtainning institutional approval and informed consent, 17 younger adults (<70yrs) and 10 elderly (>70yrs) patients were studied. All were free of significant cardiovascular disease. Before and after administration of thiopental, electrocardiograms, arterial pressure and phonocardiograms were continuously recorded for how long. Ventricuroarterial coupling (Ees/Ea) was calculated using the method described by Hayashi and Shigemi. In both groups, the mean arterial pressure (MAP) and Ees/Ea significantly decreased after administration of thiopental. However, the averages of the Ees/Ea after thiopental induction were within normal limits (1<Ees/Ea<2) in both groups. Our results suggest that mechanical efficiency is well-maintained in elderly patients after thiopental induction, whereas thiopental can decrease Ees/Ea and MAP.View full abstractDownload PDF (607K) -
Takeshi ANZAI, Hirotsugu OKAMOTO, Eri NAKAHARA, Mihoko INAMURA, Sumio ...2002 Volume 22 Issue 7 Pages 281-286
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe compared the hemodynamic changes, anesthetic effects, and side effects of accompanying two different spinal anesthesia techniques, small-dose bupivacaine with fentanyl and bupivacaine alone, in a retrospective fashion. In patients who had received 20μg of intrathecal fentanyl combined with 6mg of bupivacaine, the decrease in the systolic blood pressure was less than that of the patients who had received intrathecal bupivacaine alone (12.5-15mg). The incidence of the use of vasoconstrictive drugs was less in patients with small-dose bupivacaine and fentanyl than in patients with bupivacaine alone. Also, less fluid replacement was needed in patients with low-dose bupivacaine and fentanyl. Furthermore, the levels of sensory and motor blockade, and the onset of anesthesia revealed no difference between the two groups. The opioid-related side effects were not observed in patients with intrathecal fentanyl. These results suggest that spinal anesthesia with low-dose bupivacaine combined with fentanyl provides more stable hemodynamics with less fluid and vasoconstrictive drug therapy than spinal anesthesia with bupivacaine alone. Therefore, spinal anesthesia with small-dose bupivacaine and fentanyl may be appropriate for the elderly as well as for patients with renal or congestive heart failure.View full abstractDownload PDF (634K) -
Yasuhiro MAEHARA, Yasuko ICHIHARA, Junji SASAKI, Kazumasa YOSHIDA, Hir ...2002 Volume 22 Issue 7 Pages 287-292
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSAn abnormally accelerated Ca-induced Ca release (CICR) rate is known to be correlated with malignant hyperthermia susceptibility (MHS) . Kawamoto et al. developed a computer program (CICRpred) for predicting the results of the CICR test. We evaluated the CICRpred with cases who received a biopsied CICR test (b-CICR) in our institute.
Fourteen patients (male/female : 9/5) who were suspected of MHS and who had received b-CICR were enrolled in this study. Eight variables were inputted for calculation with CICRpred. The results of CICRpred were compared with the results of b-CICR.
Eight patients, 4 abnormal and 4 normal in b-CICR, were diagnosed as abnormal by CICRpred and 6 patients, 1 abnormal and 5 normal in b-CICR, had normal results. In this computer program, we determined that the CICRpred had a sensitivity of 80%, a specificity of 56%, a positive predictive value of 50%, and a negative predictive value of 83%.
We concluded that the CICRpred is a useful program as a screening test in clinical settings because of harmlessness, its easy input, and good sensitivity.View full abstractDownload PDF (1582K) -
Kazuyoshi HARANO, Masumi KANSHA, Michiko SATO, Jun TAKAMATSU, Shousuke ...2002 Volume 22 Issue 7 Pages 293-299
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe prospectively investigated how satisfied patients were with anesthesiologists' preanesthesia rounds with a questionnaire. Three approaches were set up as follows: 1) anesthesiologists' preanesthesia rounds; 2) anesthesia contract; and 3) anesthesia illustrating pamphlet. There were no significant differences among 1), 2) and 3) concerning the patients' understanding of the anesthesia. In terms of patients' understanding the risk of anesthesia, the group 2) understood the risk (96.7%) more than the group without 2) (92.7%). The ratio of the group 2) (13.7%) who was anxious about anesthesia was more than that of the group without 2) (3.3%). Concerning the signing of the anesthesia contract, about 40% of patients were reluctant to sign. On the other hand, patients regarded 3) useful for understanding anesthesia and relieving stress. In conclusion, the combined use of 1), 2) and 3) was recommended for informed consent of preanesthesia rounds.View full abstractDownload PDF (1734K) -
Shinichiro TAKAHASHI, Masaki NAKANE, Manabu HARADA, Masao SUZUKI, Mana ...2002 Volume 22 Issue 7 Pages 300-302
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe report a case of Prader-Willi syndrome in a 31-year-old man with marked restrictive ventilatory impairment who underwent ophthalmologic surgery. Although upper airway obstruction occurred following intravenous administration of fentanyl, it was easily improved by mask ventilation. Anesthesia was maintained with sevoflurane and the operation was performed successfully. A study suggests that adult patients with Prader-Willi syndrome also have abnormalities in pulmonary function due to respiratory muscle weakness. Therefore special attention must be paid during anesthetic management even in adult patients with Prader-Willi syndrome.View full abstractDownload PDF (400K) -
Motohiro SEKINO, Hideo HASHIGUCHI, Atsushi KAWAKUBO, Kazuhiro HIRANO, ...2002 Volume 22 Issue 7 Pages 303-306
Published: September 15, 2002
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 61-year-old female with hypertrophic obstructive cardiomyopathy (HOCM) with a single-lead VDD pacemaker, underwent removal of a spinal tumor in the prone position. Transesophageal echocardiography was possible in the prone position, and was useful in assessing the left ventricular volume and left ventricular out flow tract. When mono-polar electrocautery was used, tachycardia and hypotension occurred, probably caused by electro-magnetic interference. In patients with HOCM with a single-lead VDD pacemaker, mono-polar electrocautery should be avoided.View full abstractDownload PDF (458K)
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