THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA
Online ISSN : 1349-9149
Print ISSN : 0285-4945
ISSN-L : 0285-4945
Volume 7, Issue 1
Displaying 1-19 of 19 articles from this issue
  • Hideaki UEYAMA
    1987 Volume 7 Issue 1 Pages 1-18
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    In this paper, the recent progresses in the neurosurgical anesthesia have been reviewed. It has been clarified now that following increase in intracranial pressure in the cases of head trauma, brain tumor and intracranial hemorrhage, catecholamine in blood will elevate and thus cardiac output, systemic and pulmonary arterial pressures, PCWP increase then myocardiac damage, increase in the intrapulmonary shunt, increase in pulmonary capillary permeability, hypercoagulability, increase in arterial FFA level, negative balance in nitrogen will be induced. It will be reasonably considered that isoflurane is superior than halothane or enflurane for neurosurgical anesthesia, because it will remarkedly less increase cerebral blood flow, decrease cerebral O2 consumption, dose not change autoregulation of cerebral blood flow, does not increase CSF production and dose not change autoregulation of cerebral blood flow, does not increase CSF production and does not inhibit CSF absorption. It will be concluded that isoflurane anesthesia with supplemental use of barbiturate will be more excellent anesthesia method for neurosurgery comparing with NLA with nitrous oxide inhalation which usually accelerate the release of catecholamine by less inhibition of surgical stress.
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  • [in Japanese]
    1987 Volume 7 Issue 1 Pages 19
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
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  • [in Japanese]
    1987 Volume 7 Issue 1 Pages 20-23
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
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  • [in Japanese]
    1987 Volume 7 Issue 1 Pages 24-27
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
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  • [in Japanese]
    1987 Volume 7 Issue 1 Pages 28-30
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
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  • [in Japanese]
    1987 Volume 7 Issue 1 Pages 31
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
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  • [in Japanese]
    1987 Volume 7 Issue 1 Pages 32-35
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
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  • [in Japanese]
    1987 Volume 7 Issue 1 Pages 36
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
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  • Hirotada KATSUYA
    1987 Volume 7 Issue 1 Pages 37-44
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    There is little arguments about indications of mechanical ventilation (MV) for acute respiratory acidosis which does not respond to conservative therapy. MV for severe hypoxemea without hypercapnia, on the contrary, is a matter of controversy. The author believes that beneficial effects of MV are expected in critically ill patients even without hypercapnia, since MV not only increases alveolar ventilation but also reduces burden of respiratory work and energy expenditure.
    We now have several modes of MV available such as differential lung ventilation (DLV), high frequency ventilation (HFV) and so on. Marked hypoxemia due to severe unilateral or uneven pulmonary lesion which is resistant to conventional MV can be treated successfully by DLV. The author speculates that HFV is effective to mobilize sputa in the peripheral bronchi resulting in improved oxygenation.
    Precise evaluation of pathophysiology of the patient's lungs and delicate application of selected modes of MV can improve survival of critically ill patients with acute respiratory failure.
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  • Seishiro MIYAGI, Mikio IREI, Satoru JINNO, Masahiko TOME
    1987 Volume 7 Issue 1 Pages 45-54
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    Two hundred and thirty consecutive episodes of acute exacerbations in 126 COPD patients (male 76, female 50, : average age 71.4 yrs and 74.8 yrs respectively) were treated according to the therapeutic protocals made by our own.
    110 episodes in 51 patients required mechanical ventilatory support, mainly because they developed disturbance in consciousness, abnormality in respiratory rate (over 40 or below 6), inability of bringing up in addition to severe hypercapnia or refractory severe hypoxemia.
    Ventilatory modes were selected according to the type of respiratory failure. Thus, assisted or controlled ventilatory modes for acute Type II and IMV (Intermittent Mandatory Ventilation) for mixed one (acute respiratory failure on chronic one).
    Weaning was made by on-off method for acute Type II and gradual reduction in frequency of IMV along with muscle powering exercise for mixed one.
    The survived cases among those apllied IMV mode were successfully weaned in average days of 10.5 and overall mortality rate for those mechainivally ventilated was 27.7%.
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  • What mode is the best for weaning
    Tatsuya KUBOTA, Fumio ONODERA
    1987 Volume 7 Issue 1 Pages 55-66
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    SIMV (synchronized intermittent mandatory ventilation) have been widely used during weaning process from mechanical ventilatory support. SIMV however, is not an optimal mode for weaning, because a patient sometimes complains of respiratory discomfort such as feeling of airway obstruction and dyspnea.
    Aims of this study were performed to evaluate SIMV, CPAP and PSV (pressure support ventilation) which was provided with newly developed ventilators. From the results of comparison of work of breathing and oxygen consumption between demand valve type and continuous flow type, the first study indicated that patient's respiratory discomfort on IMV mode was attributable to airway resistance of respiratory circuit including valve system, when demand valve type's ventilator was used. On the second study, by using graphical analysis of presssure volume curve we observed the mechanical improvement about IMV/CPAP mode of recent advanced ventilators. As one of features of PSV which is recently designed, this mode can provide patient's demand inspiratory time, even though inspiratory airway pressure is reached to a clinician-selected level of assisted ventilation. On the clinical application of PSV to a patient during weaning process, patient comfort, reduced respiratory rate and decreased CO2 production (VCO2) were observed.
    We may conclude that the PSV is thus the preferable pressure assist mode for intubated patients. The clinical significance of these properties during the weaning process remains to be determined and needs further investigation.
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  • Michio YOSHINARI
    1987 Volume 7 Issue 1 Pages 67-74
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    Since 1982, we have used HFJV as one of the routine ventilatory modes. The purposes of it's application are (1) improvement of oxygenation, (2) lowering of the maximum inspiratory pressure and (3) physiotherapy.
    We examined HFJV for these 3 criteria and the results are as follows.
    1. HFJV improves oxygenation, PaO2 elavats, A-a DO2 decreases and respiratory index also decreases. Using mongreal dogs, we made pulmonary edema model by administration of 0.07-0.1ml/kg oleic acid via S-G catheter. Then we compared HFJV and CMV under the condition of same mean airway pressure. Almost all parameters, such as PaO2, A-a DO2, respiratory index and cardiac index were nearly same under this condition. We concluded only PEEP effect of HFJV results in improvement of oxygenation.
    2. Lowering of the maximum inspiratory pressure is effective for prevention and treatment of barotrauma.
    3. HFJV for physiotherapy is most effective. It's useful treatment method to not only usual atelectasis but also intractible status asthmatics. Soon after application of HFJV to these patients, we could suction large amounts of secretions and then they improved clinically.
    Especially HFJV was effective to the intractible status asthmaticus patients, who don't respond existing vigorous treatments such as administration of large amounts of fluid, xantines, steroids, epinephrine and isoproterenol, conventional mechanical ventilation and inhalation anesthesia. We think HFJV solves mucous plug by internal vibration and for that reason it is effective to the intractible status asthmatics.
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  • Yutaka USUDA, Osamu YAMAGUCHI
    1987 Volume 7 Issue 1 Pages 75-80
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    Thirty patients with acute respiratory failure who admitted to our ICU for mechanical ventilatory support, fifteen weaning from ventilator and fifteen died, were studied on the airway pressure relation to the prognosis.
    Soon after beginning of mechanical ventilation with/without positive end-expiratory pressure (PEEP), the mean values of peak inspiratory pressure were 34±3cmH2O in the survivors and 32±1cmH2O in the non-survivors, respectively. In the survivors, the effective compliance increased and the peak inspiratory pressure decreased from the first day of the treatment. But, in the non-survivors, the effective compliance and the peak inspiratory pressure did not change significantly. In this group, the mean value of the peak inspiratory pressure was 40±2cmH2O at the day of death.
    In conclusion, the prognosis of the patient whose compliance increases by the treatment is thought to be good. But, the patient without responce to the treatment in a few days is more serious, so another respiratory support such as extra-corporeal membrane exygenator will be indicated in the future.
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  • Hiromasa SEKIGUCHI
    1987 Volume 7 Issue 1 Pages 81-88
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    Conventional bilateral positive pressure ventilation (IPPV or CPPV) may not be applied to the unilateral lung disease and/or the case of remarkable difference in the compliance of both lungs. Since ventilation with equal airway pressure to both lungs will expand mainly the more compliant (better) lung, so the pulmonary blood flow will shift to the less compliant (worse) lung from the over-expanded lung. Accordingly, the V/Q mismatching will increase. And also the conventional ventilation is often not applicable to the patients with unilateral bulla or bronchopleural fistula.
    Differential lung ventilation (DLV) using, as a rule, double lumen endbronchial tube and two ventilators may be effective in such conditions above mentioned. The main purpose of DLV is to correct the V/Q mismatching between left and right lungs.
    The best way for DLV may be as follows.
    1. Lateral positioning, better side down.
    2. Equal VT to each lungs.
    3. Two electronically controlled ventilators are connected each other using a computer system, and one lung should be ventilated following the real-time informations about VT, CST, or RAW, etc. obtained (and computed) from the other lung.
    As it is troublesome to use two ventilators of same type, it may be beneficial to apply high frequency ventilation (HFV) or continuous flow ventilation (CFV) to one lung and CPPV to the other. Our dog study of one lung pneumonitis by HCL infusion revealed that this method improved PaO2 compared to the conventional bilateral ventilation.
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  • Hideo IWASAKA, Masahiko MIYAKO, Yoshio HAYANO, Takayuki NOGUCHI, Shuns ...
    1987 Volume 7 Issue 1 Pages 89-92
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    The authors reported the anesthetic mangement of a 51-year-old male with Mounier-Kuhn syndrome. This was a rare syndrome consisting of marked dilatation of the trachea and major bronchi usually due to a congenital defect of the connective tissues of the tracheo-bronchial tree. Most of the clinical features include chronic cough productive of copious and pulurent sputum, low grade fever, and consistent with chronic respiratory tract infection.
    The major anesthetic problems of this disease include a persistent peni-tubal leak, a potential occurence of the aspiration pneumonia, and the abnormal flaccidity and easy collapsability of the bronchial walls.
    We managed this patient with the special tube which had low pressure, high volume cuff. It is concluded that the special attention must be given for the patient with this disease during the perioperative period.
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  • Kaoru KIHARA, Naoto NAGATA, Yoshihumi TAKEHARA, Hiroshi ADACHI, Yoichi ...
    1987 Volume 7 Issue 1 Pages 93-99
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    Renal function and damage during extracorporeal circulation (ECC) were studied in 20 patients (adult: 11, child: 9) who were scheduled for elective open heart surgery. The excretion of urinary γ-glutamyl transpeptidase (γ-GTP) and N-acetyl-β-D-glucosaminidase (NAG), which were mainly located in the renal proximal tubular cells, were measured with creatinine clearance (Ccr), free water clearance (CH2O), and fractional excretion of sodium (FENa).
    In adult group, Ccr decreased by about 30% during and after ECC compared with before ECC, and the excretion of urinary γ-GTP and NAG increased about 2.5 and 10 times respectively. The former was correlated with urinary flow rate, but the latter was not. FENa also increased. The excretion of these enzymes and FENa gradually decreased, but the higher values were remained in intensive care unit. In child group, the change of these parameters were also similar with those in adult group.
    These results suggest that the probable damage of the renal proximal tubular cells happen with impaired renal function during ECC.
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  • Naoto NAGATA, Kaoru KIHARA, Yoshifumi TAKEHARA, Hiroshi ADACHI
    1987 Volume 7 Issue 1 Pages 100-105
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    In 46 patients, renal function was studied mainly with the excretion of urinary enzymes during surgery.
    We chosed N-acetyl-β-D-glucosaminidase (NAG) and γ-glutamyl-transpeptidase (γ-GTP) as urinary excretory enzyme from proximal tubules. Creatinine clearance (Ccr) and free water clearence (CH2O), fractional sodium excretion (FENa) were measured simultaneously. The urinary excretion of NAG and γ-GTP were 0.36+0.058U/hr, 0.71+0.069U/hr, respectively. The mean excretory values of urinary enzymes in these operative patients were almost equal to normal values of healthy subjects.
    It was suggested that the renal proximal tubular would not be impaired during surgery. In the five patients below 70mmHg in systolic blood pressure, the excretion of NAG and γ-GTP were elevated, compared with the patient induced hypotensive anesthesia.
    The damage of the renal proximal tubular cells seemed to be existed in these hypotensive patients.
    γ-GTP could be affected by other factors as well as by proximal injuries. These factors seemed to be included diuretics, urine volume, Ccr and soon. As NAG would not be affected by these factors, NAG seemed to be more reliable index than γ-GTP.
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  • Shohei TAKEDA, Teruaki TOMARU, Kazuyuki SERADA, Toyoaki KAGAWA, Kumiko ...
    1987 Volume 7 Issue 1 Pages 106-113
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    We investigated endocrinic responses of controlled hypotension by induced adenosine triphos-phate (ATP) with and without pretreatment of dipyridamole (intracellular uptake inhibitor of ATP) in 29 female patients recieved hip arthroplasty.
    8 patients(group 1) were recieved controlled hypotension by ATP alone and 12 patients(group 2) by ATP with the pretreatment of dipyridamole (0.2mg/kg). The remaining 9 patients (group 3), who did not recieved controlled hypotension, served as control. All patients recieved neuroleptanesthesia, consisting of droperidol, fentanyl, pancuronium, and nitrous oxide. Systolic arterial blood pressure was maintained at 80mmHg for 60 minutes in hypoten-sive group.
    We measured plasma concentration of cathecholamine, cortisol, uric acid, inorganic phosphate(breakdown products of ATP), and plasma renin activity(PRA).
    Main results are as follow. (1) pretreatment of dipyridamole reduced requirement of ATP from 0.32mg/kg/min. (group 1) to 0.09mg/kg/min. (group 2). (1) According to the dose of ATP, plasma concentration of adrenaline and PRA were decreased, whereas plasma concentration of cortisol was increased. (3) As for plasma concentration of uric acid in group 1 and 2 increased significantly compared with in group 3. but plasma concentration of uric acid in group 2 was less than that in group 1.
    From these results, controlled hypotension by ATP with the pretreatment of dipyridamole can be used safely, so as to attenuate the dose of ATP and consequently reduced the breakdown products of ATP.
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  • Yoshimitsu SANJO, Kazuyuki IKEDA
    1987 Volume 7 Issue 1 Pages 114-124
    Published: February 15, 1987
    Released on J-STAGE: December 11, 2008
    JOURNAL FREE ACCESS
    We developed 9-compartments pharmacokinetics simulator using commercially available spread sheet software. The main features are type-less input of monitoring data in operating room and graphic plotting with X-Y plotter. We compared the measured values in sevoflurane's clinical phase study with predicted values from our simulator. Measured vs. predicted mean values from 5 volunteers were as following. About FA/FI at 1 hour after the start of anesthesia it was 0.88 vs, 0.86 and about the response time to verbal comands it was 10.7 vs. 11.1min. Both parameters correlated well.
    From our simulations we predicted followings. FA/FI rise rapidly nealy like N2O, but the brain concentration rise much slower than N2O. The reason comes from the difference between alveolar and brain concentration introduced by the different λ Tissue/Gas of both anesthetics. Sevoflurane's vaporiser shoud not be setting on the level over 2.5 MAC for its safty and effective usage in clinical stage.
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