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Volume 7 (1987)
- Issue 6 Pages 445-
- Issue 4 Pages 355-
- Issue 3 Pages 259-
- Issue 2 Pages 127-
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Volume 7, Issue 4
Displaying 1-13 of 13 articles from this issue
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[in Japanese]1987 Volume 7 Issue 4 Pages 355-373
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSDownload PDF (7619K) -
Yoh HORIMOTO, Mutsumi YOSHIZAWA, Junko YOSHIZUMI, Shinta KATOH1987 Volume 7 Issue 4 Pages 374-378
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSSM, a female newborn weighing 2712g, was born at 35 weeks gestation, after a pregnancy complicated by hydramnios. She was intubated immediately by a neonatologist because of apparent cyanosis and severely retracted respiration and it was ascertained that a gastric tube could not be passed into the stomach. Afterward she was transferred to our institution with a presumptive diagnosis of an C-type esophageal atresia with tracheoesophageal fistula. Then the gastrostomy and radical operation was scheduled at 8.5hrs of age. The morphologic abnormality could not be disclosed until her larynx had been observed by us, anesthesiologists. The operation was postponed and substituted for fiberscopic examination, which demonstrated that a laryngotracheoesophageal cleft extended to 1cm proximal to the carina. The cervical esophagostomy and tracheoplasty was planned on the 14th day of age. Attension was directed toward the establishment of an secure airway during right thoracotomy. One lung ventilation was performed with a tube of 2.5mm I.D. placed 1cm distal to the carina of the left main bronchus in order not to block the left upper lobe branch. During operation PaO2 could be maintained above 150mmHg except transient hypoxia, presumably due to the compression on the dependent lung by the surgical manipulation.View full abstractDownload PDF (1765K) -
Sumi SASAKI, Hiroshi OKADA, Kazutoshi OKADA, Reiji WAKUSAWA1987 Volume 7 Issue 4 Pages 379-382
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 28 year-old female patient with Shoulder Hand Syndrome who revealed resistant to the aggressive treatment of stellate ganglion block combined with continuos epidural block.
Then, intravenous regional sympathectomy with 20mg of guanethidine and 5ml of 2% lidocaine was administered every 3-4 days for 5 times totally, which successfully relieved her pain.View full abstractDownload PDF (412K) -
Noriko DEKAMO, Yasuo KAWASHIMA, Nobuhiro SATOH, Kazuhiro KANEKO, Kyoko ...1987 Volume 7 Issue 4 Pages 383-386
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA 55-year-old man, who suffered from mediastinitis due to the necrotized colon replaced after esophageal resection, developed severe acute respiratory failure.
Postoperative palsy of the right phrenic nerve also contributed to the ventilatory failure. He was on a Servo 900B Ventilator for 46 days. Weaning from the mechanical ventilation was extremely diffcult because of the postoperative restrictive changes developed in the lung and the pleura. Finally intermittent IMV, that is IMV and CPAP alternatively with gradual increase in the duration for the latter, could wean the patient from the respirator. Contributing factors to survival would be mainly the positive surgical intervention for the infectious foci, daily irrigation with a large amount of salin solution and nutritional support with IVH. Before his discharge from the hospital, he received two more operations for the reconstruction of the esophagus for next 22 months without any trouble.View full abstractDownload PDF (915K) -
Yoshihiro HIRABAYASHI, Yuriko YOSHIZAWA, Sohzaburoh INOUE1987 Volume 7 Issue 4 Pages 387-391
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSAnesthetic experiences of three patients with primary hyperparathyroidism in multiple endocrine neoplasia (MEN) type 1 were reported. When treating an indivudual component of MEN type 1, anesthesiologists should be aware that lesions in other endocrine organs may exist at the same time and that, furthermore, the lesion in each gland may be multicentric. In patients with multiple grandular involvement, order of treatment depends on the severity of each lesion. Severe hypercalcemia in primary hyperparathyroidism, life-threating symptoms due to pancreatic endocrine tumors and a progressive visual field defect due to the pituitary tumor should be treated first, and the other lesions would be treated sequentially. In parathyroid surgery, it is essential to prevent the serum calcium level from elevating to critical level. Intravenous infusion therapy with normal saline and administration of furocemide aided decreasing the serum calcium level. In the period following sub-total removal of parathyroid glands, oral medication with calcium lactate and vitamin D suffices. In this report, anesthetic problems in MEN type 1 were also discussed.View full abstractDownload PDF (599K) -
Hideo IWASAKA, Kuniko OKADA, Yoshio HAYANO, Kazuo TANIGUCHI, Natsuo HO ...1987 Volume 7 Issue 4 Pages 392-396
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSPulmonary lavage of a 53 year-old female with pulmonary corpora amylacea is reported. Pulmonary corpora amylacea is a very rare disease of the lungs, in which laminated bodies occupy many of the alveoli. Effective treatments of this disease have not been established. So we lavaged the right lung of this patient as same as the pulmonary proteinosis.
During lung lavage, blood gas levels in the patient change rapidly and extensively following the instillation and drainage of large volume of lavaged fluid, while it is not easy to pursue the rapid changes by ordinary intermittent blood gas analysis. Therefore in our patient, we monitored continuous mixed venous oxygen saturation (SVO2). In the results, we concluded that lung lavage will be able to become an effective therapy for pulmonary corpora amylacea, and continuous mixed venous oxygen saturation monitoring is useful to detect hypoxemia earlier during lung lavage.View full abstractDownload PDF (915K) -
Yoshikazu SATOH, Yoko KITA, Hidekazu YUKIOKA, Akira ASADA, Mitsugu FUJ ...1987 Volume 7 Issue 4 Pages 397-402
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA case of Extracorporeal Shock Wave Lithotripsy (ESWL) in a patient of DVI mode for Sick Sinus Syndrome was presented. Generally a patient with a cardiac pacemaker has been regarded as unsuitable for ESWL because the effect of the shock waves on the function of pacemakers was still unknown. In the presented case the ESWL was successfully performed on the patient with turning off the pacemaker and supplementation of intravenous isoproterenol and phenylephrine under epidural anesthesia.View full abstractDownload PDF (730K) -
Masahiko ARAKI, Tatuhiro OKA, Tadanobu MIZUGUCHI1987 Volume 7 Issue 4 Pages 403-408
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe have experienced a sudden inability of ventilation during general anesthesia in a patient of idiopathic scoliosis. Lateral chest radiography, CT scanning of the chest and bronchoscopy disclosed that the lower trachea and two main bronchi were compressed by the sternum and vertebral bodies because of loss of normal kyphosis of the thoracic spinal column. There were observed however, no shortness of breath or any respiratory involvement preoperatively. This sudden occurrence was presumably attributed to weakness of the tracheal wall induced by long-term compression, effects of anesthetic drugs and/or muscle relaxants, change of ventilatory pattern from normal respiration to controlled ventilation, and ventilatory unevenness caused by more marked stricture in the right main bronchus.
Thoracic deformity (torsion and kinking) in patients with scoliosis is a key factor that makes preoperative evaluation of the patients' condition difficult. Therefore, in order to prevent such hazardous events, it is crucial to understand the three-dimensional configuration of the thoracic structure in those patients from findings of chest radiographs and chest CT scanning images.
In patients with scoliosis, especially with lordoscoliosis, occlusion of the airways might occur and we have to be aware of its possibility during general anesthesia and after corrective surgery.View full abstractDownload PDF (2320K) -
Shinta KATO, Kimimasa SHIKAKURA, Keiji KAYA, Souji ISHIKAWA1987 Volume 7 Issue 4 Pages 409-413
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSA33-year-woman with intrathoracic tumor (4.5kg), fell into dyspnea suddenly, caused by compression of the trachea with the tumor. Emergency operation was undergone. Awake intubation in semi-sitting position in which her airway was most patent, was performed and anesthesia was maintained with enflurane and fentanyl. Muscle relaxant was not administered until the tumor was removed.
Postoperatively, during 20 days, mechanical ventilation had been continued, due to the occurrence of respiratory complications, such as atelectasis and lung edema.
Two months after the operation, she was recovered completely and discharged in stable condition.View full abstractDownload PDF (1288K) -
Evaluation by continuous measurement of the pressure near the superior bulbus of the internal jugular veinHiraku SHIMOMURA, Masaji MATSUURA, Sachiko MIZUNO, Hiroshi KIMURA, Ren ...1987 Volume 7 Issue 4 Pages 414-418
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSEarly diagnosis and the prevention of the development of air enbolism are important when neurosurgery is performed in the sitting position. The authors studied the effect of jugular vein compression as a prophylactic measure of air embolism in two cases. The effect was evaluated by continuous measurement of the pressure near the superior bulbus of the internal jugular vein (IJVP). The neck was compressed until the IJVP was slightly positive. We also studied the effect of abdominal compression and positive end -expiratory pressure (PEEP10cmH2O) as compared with neck compression. The results were as follows: 1) Air embolism could be prevented by neck compression. 2) Neck compression easily raised the IJVP above atmospheric pressure. 3) Abdominal compression and PEEP could not increase the IJVP above atmospheric pressure. Therefore, it was concluded that only neck compression was effective for raising the IJVP enough for the prevention of air embolism. Measurement of the IJVP may be useful for evaluating air embolism prophylaxis.View full abstractDownload PDF (1001K) -
Hotaka KUMANO, Makoto NISHIWADA, Naoko ISHIMURA1987 Volume 7 Issue 4 Pages 419-425
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSTo prevent hypertension following coronary artery bypass surgery, we administered morphine after cardiopulmonary bypass.
29 patients undergoing coronary artery bypass surgery received high dose fentanyl anesthesia. In 19 patients of these, group FM, 0.3-1.7mg/kg morphine was administered after cardiopulmonary bypass, while in 10 patients group F, morpine was not administered. Between these two groups, we compared maximum values of heart rate, systolic and diastolic blood pressure, and rate pressure product(RPP)in the perioperative period.
In the first postoperative period (0-6 hours after operation), patients in group FM had lower systolic blood pressure (P<0.01), and lower RPP(P<0.05) than those in group F, both statistically significant.
Morphine, administered after cardiopulmonary bypass, is effective in preventing hypertension in the early post-operative period of coronary artery bypass surgery.View full abstractDownload PDF (682K) -
Hideyuki MASHIO, Makoto IMAI, Yasuyuki GOTO, Osamu KENMOTSU1987 Volume 7 Issue 4 Pages 426-436
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSWe applied several kinds of pulse oxymeters (Minolta SM-32, Nellcor N-100, Ohmeda BIOX3700 or BIOX III) to one patient and recoded arterial oxygen suturation simultaneously in case of intratracheal intubation/extubation, tracheal succion and bronchofiberscopy, low oxygen inhalation, apnea (breath hold), artificial stimuli made upon probes etc.
After that, in these conditions, We noticed different performance about obtained oxygen saturation values between pulse oxymeters.
So, practical evaluations of aceuracy and stability of the devices applied on unstable states must be required.View full abstractDownload PDF (3137K) -
Hiroshi MORISAKI, Gen'ichi SUZUKI, Noriko MIYAZAWA, Yukou KIICHI, Toru ...1987 Volume 7 Issue 4 Pages 437-440
Published: July 15, 1987
Released on J-STAGE: December 11, 2008
JOURNAL FREE ACCESSThe effects of inverse ratio ventilation (IRV) is controvertial. There are few reports with respect to IRV in children. In 20 healthy children with body weight below 20kg IRV and positive end-expiratory pressure ventilation (PEEP) was performed during urological surgery under fentanyl-nitrous oxide-oxygen anesthesia.
We analysed arterial and mixed venous blood gases and caluculated oxygen content difference and intrapulmonary shunt. IRV and PEEP were not effective on gas exchange parameters during the whole procedure except the value of PaCO2 in the group IRV (1.7:1) FIO2 0.5. No remarkable influence on circulation was also observed in the all studied groups. Ineffectiveness of IRV and PEEP partly came from that the subjects were healthy children with enough reserved function in cardio-respiratory systems. Other reasons would be many factors during operation such as surgical stimuli, general anesthesia influenced on the pulmonary circulation.View full abstractDownload PDF (391K)
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