Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

The Department of Respiratory Medicine of Nippon Medical School Hospital and the Working Committee of Clinical Simulation Laboratory have held training sessions for chest tube drainage since 2007. The training program consists of the preparation of a training manual, a small-group session, and a review of the process of chest tube drainage using a checklist of steps after the session. A total of 21 medical interns of Nippon Medical School Hospital participated in training sessions from April 2010 through February 2011. A questionnaire survey at the end of the session revealed that most participants rated highly both the explanations given by the instructors and the descriptions in the manual for comprehensibility. Only 3 interns felt that they had successfully acquired the clinical skill, and the other 18 interns felt that they had somewhat acquired the skill. Research after the interns had completed the program of the department showed that 80% of interns had performed chest tube drainage for patients during the rotation. The interns assessed the training program as useful, and some interns felt they could perform the skill with confidence or without anxiety. Other systematic programs of skill training for medical interns are recommended to ensure definite acquisition of basic skills. (J Nippon Med Sch 2012; 79: 403-408)

DOI： 10.1272/jnms.79.403

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Context Some anaesthetics exert an inhibitory effect on the response of the carotid body to low oxygen tension. However, the effect of dexmedetomidine on the carotid body response has not been reported.
Objective To investigate the effect of dexmedetomidine on carotid body activity. The hypothesis is that dexmedetomidine does not have an inhibitory effect on the response of the carotid body to low oxygen tension.
Design Animal experimental study in vitro. Ten carotid bodies surgically removed from male New Zealand white rabbits were tested.
Setting Research laboratory of Nippon Medical School, Tokyo, Japan, from July 2008 to February 2010.
Intervention The carotid body was perfused with three different concentrations of dexmedetomidine (0.1, 1.0 and 10 nmol l(-1)). The contribution of alpha(2)-adrenergic receptors was evaluated by addition of 1.0 nmol l(-1) yohimbine, an a2-adrenergic receptor antagonist.
Main outcome measures The differences in carotid sinus nerve activity between high oxygen tension (baseline) and low oxygen tension (peak) were analysed.
Results At all three concentrations, dexmedetomidine did not depress the baseline and peak activity of the carotid body, whereas 0.1nmol l(-1) dexmedetomidine facilitated the response to low oxygen tension stimulation. The differences in carotid sinus nerve activity between baseline (pO(2) 80.4 +/- 9.1 kPa) and peak (pO(2) 22.1 +/- 2.6 kPa) were 140 +/- 70 Hz in controls and 266 +/- 116 Hz with 0.1nM dexmedetomidine (P < 0.05). This increase was not shown in the presence of 1.0 nmol l(-1) yohimbine.
Conclusion Dexmedetomidine does not depress the activity of the carotid body under high oxygen tension or the response to low oxygen tension, whereas 0.1 nmol l(-1) dexmedetomidine facilitates this response via a2-adrenergic receptor activation. Eur J Anaesthesiol 2012; 29: 570-576 Published online 6 September 2012

DOI： 10.1097/EJA.0b013e328356fba5

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER TOKYO  

In many countries, patients are generally allowed to have clear fluids until 2-3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of oral rehydration therapy until 2 h before surgery.
Three hundred low-risk patients scheduled for morning surgery in six university-affiliated hospitals were randomly assigned to an oral rehydration solution (ORS) group or to a fasting group. Patients in the ORS group consumed up to 1,000 ml of ORS containing balanced glucose and electrolytes: 500 ml between 2100 the night before surgery and the time they woke up the next morning and 500 ml during the morning of surgery until 2 h before surgery. Patients in the fasting group started fasting at 2100 the night before surgery. Primary endpoints were gastric fluid volume and pH immediately after anesthesia induction. Several physiological measures of hydration and electrolytes including the fractional excretion of sodium (FENa) and the fractional excretion of urea nitrogen (FEUN) were also evaluated.
Mean (SD) gastric fluid volume immediately after anesthesia induction was 15.1 (14.0) ml in the ORS group and 17.5 (23.2) ml in the fasting group (P = 0.30). The mean difference between the ORS group and fasting group was -2.5 ml. The 95% confidence interval ranged from -7.1 to +2.2 ml and did not include the noninferior limit of +8 ml. Mean (SD) gastric fluid pH was 2.1 (1.9) in the ORS group and 2.2 (2.0) in the fasting group (P = 0.59). In the ORS group, mean FENa and FEUN immediately after anesthesia induction were both significantly greater than those in the fasting group (P < 0.001 for both variables). The ORS group reported they had been less thirsty and hungry before surgery (P < 0.001, 0.01).
Oral rehydration therapy until 2 h before surgery is safe and feasible in the low-risk Japanese surgical population. Physicians are encouraged to use this practice to maintain the amount of water in the body and electrolytes and to improve the patient's comfort.

DOI： 10.1007/s00540-011-1261-x

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In organized orientation programs for newly recruited medical interns of the Nippon Medical School Hospital, the working committee of the clinical simulation laboratory introduced a laboratory training session that was designed to improve the clinical skills of the medical interns. The session consisted of 6 training courses, comprising internal examination, tracheal intubation, auscultation of heart sounds, bandaging and the collection of samples of venous and arterial blood. Medical interns rotated to a new course every 30 minutes and did practical trainings in each of the 6 skills. A total of 36 newly recruited medical interns participated in the training session. The majority of medical interns took part in the practical training actively and positively. The session was efficiently carried out from the standpoints of human resources and the teaching hours involved. A post training questionnaire survey, completed by the medical interns, revealed that many of them valued the sessions for comprehensibility of the instructions, the descriptions in the manual and the content of the training
however, only 21% thought that they had successfully acquired the clinical skills. Medical interns must continually engage in self-training to steadily acquire basic clinical skills. The convenience of a clinical simulation laboratory, together with the reinforcement of the education of clinical skills during internship, is necessary to strengthen the educational benefits of the training session.

DOI： 10.1272/jnms.77.209

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Protective effects of each cardiovascular drug on major organ functions are reviewed. Based on these effects, proper use of the drugs is presented. It is probable that norepinephrine and dobutamine have the most protective effect against major organ dysfunctions. It has been shown that perioperative beta- blocker administration reduces cardiovascular complications. Nicorandil is likely to have ischemic preconditioning properties. In case of hypotension, low doses of noradrenaline should be administered first, and then dobutamine should be added. In case of systolic dysfunction, low doses of dobutamine should be chosen first, and then noradrenaline, and finally olprinone could be added. In case of hypotension and systolic dysfunction, a combination of norepinephrine and dobutamine is the first choice. Then adrenaline could be added. When ischemic heart disease exists, nicorandil should be given. When decreasing or stabilizing heart rate is required, an ultra-short acting beta-blocker, such as lan- diolol, is recommended. To maintain hypotension in a certain situation, prostaglandin E 1 is better to use than nicardipine, diltiazem, and nitroglycerin. It is important to administer the drugs focusing on postoperative complications and outcome.

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Other Link： http://search.jamas.or.jp/link/ui/2009151517

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Aim: The present study was designed to assess whether prophylactic use of bicarbonated Ringer's solution ameliorates metabolic acidosis in patients undergoing aortic surgery. Methods: Twenty patients undergoing elective infrarenal aortic aneurysm repair were randomly assigned to receive either bicarbonated Ringer's solution or acetated Ringer's solution. The pH, PaCO 2, and base excess (BE) were measured before surgical incision (T0), 5 min before reperfusion (T1) , 5 min after reperfusion (T2), and 30 min after reperfusion (T3). Data were compared between the two groups. Results: Both pH and BE initially showed a slight decrease in both groups during clamping. After unclamping of the aorta, an additional decrease in pH was observed in both groups (T0 to T2, and T3). There were no significant differences in pH between the groups throughout the study period. Conclusions: Aortic cross-clamping leads to the development of metabolic acidosis, with a decrease in pH and BE. The effect of administration of bicarbonated infusion fluid during elective abdominal aortic surgery had not significant compared with that of acetated Ringer's solution with respect to acid-base homeostasis.

DOI： 10.1272/jnms.72.364

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO  

Objective: To study several markers of myocardial injury in relation to aortic cross-clamping and cardiopulmonary bypass (CPB) after coronary artery bypass graft (CABG) surgery.
Design: Prospective observational study.
Setting: University hospital.
Participants: Thirty adult patients who underwent elective CABG surgery with aortic cross-clamping and CPB.
Measurements and Main Results. Serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), troponin-T (TnT), myosin light chain I (MLCl), and MB isoenzyme of creatine kinase (CK-MB), as markers of myocardial injury, were measured after induction of anesthesia for baseline values, then again at the end of surgery and on postoperative days 1, 3, and IL-6, IL-8, and CK-MB levels were significantly elevated in the early postoperative stage. TnT significantly increased from the, end of surgery to postoperative day 5. MLCl increased also but later than TnT. Aortic cross-clamping time correlated positively with peak TnT (r = 0.51, p < 0.05), TnT level on postoperative day 1 (r = 0.69, p < 0.01), and MLCl level on postoperative day 5 (r = 0.45, p < 0.05). CPB time was correlated only with peak TnT (r = 0.47, p < 0.05).
Conclusions: The increase in TnT level is strongly related to aortic cross-clamping. Copyright 2002, Elsevier Science (USA). All rights reserved.

DOI： 10.1053/jcan.2002.125150

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We evaluated changes in dementia rating scale scores in the revised version of Hasegawa's dementia scale (HDS-R), and rated dementia, 2 days before and 7 days after surgery in the elderly patients with femoral neck fracture. The 50 patients examined ranged in age from 70 years to 101 years. A perfect score in the HDS-R is 30 points, and a score below 20 points strongly suggests dementia. The results were as follows. In septuagenarian and octogenarian patients, the scale score was higher after surgery than the value before the surgery. Although the preoperative and postoperative scores of the patients who had been under epidural anesthesia were not significantly different, the score of patients who had been under general anesthesia was higher in the postoperative period than in the preoperative period. In octogenarian patients, there was a negative correlation between 'postoperative score minus preoperative score' and 'the number of the days from suffering fracture to surgery'. These results showed that general anesthesia is more advantageous than epidural anesthesia from the viewpoint of the intellectual faculty in septuagenarian and octogenarian patients with femoral neck fracture, and it is within the bounds of possibility that the intellectual faculty may decline if an octogenarian patient is operated after a long delay from the occurrence of fracture. To prevent this decline, patients must be operated on as soon as possible.

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

We investigated whether dry-type dressings for fixing epidural catheters are effective in preventing infection in 140 adult patients who underwent abdominal surgery. Drytype dressings (N=86) and film dressings (non-dry type) (N=54), selected as the control, were used at random to fix epidural catheters. Four or five days after surgery, the epidural catheter was removed and bacterial culture of the catheter was carried out. The bacterial contamination rate was significantly higher when the film dressing (nondry type) (11.1%) was used than when the dry-type dressing (1.2%) was used. These results suggest that the dry-type dressing for fixing epidural catheters has an advantage over the non-dry type in preventing bacterial contamination.

DOI： 10.2199/jjsca.14.329

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

2012年,日本麻酔科学会から術前絶飲食ガイドラインが公表された.本邦の複数施設による共同研究などの研究データに基づき作成され,その内容は欧米のガイドラインと比較して同等のものとなっている.術前絶飲食の目的の一つは麻酔導入時の誤嚥予防である.したがって実際の経口摂取後の胃内容量を確認することによりガイドラインの妥当性を評価することができるので,ガイドライン公表後に行われた経口摂取後の胃内容量を評価した研究を参考にその妥当性を検証した.これらの研究からわかることは,現在のガイドラインでは安全性が十分に担保されていること,術前の経口摂取制限をさらに緩められる可能性があることである.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01620&link_issn=&doc_id=20170529170009&doc_link_id=%2Fci4jjsca%2F2017%2F003703%2F009%2F0331-0336%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2017%2F003703%2F009%2F0331-0336%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本循環制御医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Other Link： http://search.jamas.or.jp/link/ui/2009057471

Language：Japanese  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(公社)日本臨床工学技士会  

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Language：Japanese   Publisher：克誠堂出版(株)  

著者等の施設で前立腺全摘出術を施行した28症例を腹腔鏡下前立腺全摘術(腹腔鏡群)18例と恥骨後式前立腺全摘術(開腹群)10例の2群に分け、麻酔方法・出血量・輸血量・自己血準備量と使用量及び輸液量について後方視的に比較検討した。その結果、麻酔方法は全例で全身麻酔と硬膜外麻酔を併用したが、腹腔鏡群に比べ開腹群で亜酸化窒素の使用症例が有意に多く、硬膜外麻酔の穿刺部位・初回投与量は両群間に有意差を認めなかった。出血量・自己血使用量・輸液量はいずれも開腹群に比べ腹腔鏡群の方が有意に少なく、開腹群では2例に他家血輸血を施行した。開腹群では執刀時に比して輸血前Hb値が有意に低下しており、腹腔鏡群では症例数が少ないため統計学的検討は行わなかった。その他の項目については両群間に有意差を認めなかった。以上より術式による麻酔方法の違いは亜酸化窒素の使用が腹腔鏡群で少ないだけであり、10例中5例では亜酸化窒素に代わり空気が使用されており、したがって適切な循環管理がなされていれば麻酔方法は従来通りでよいと考えられた。

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Background : For anesthetic management of traditional open prostatectomy, preparation for hemorrhage is necessary. However, it has been considered that the amount of bleeding under laparoscopic prostatectomy is less than that of traditional open surgery. Methods : The amount of bleeding and autologous blood preparation, fluid balance, and anesthetic management were investigated in patients who had undergone laparoscopic or open prostatectomy at the Nippon Medical School Hospital between June, 2004 and November, 2005, retrospectively. The difference of these aspects between the two surgical method groups was evaluated. Results : Thirty-two patients underwent prostatectomy in the investigation period. In these patients, 4 patients were excluded due to incomplete anesthesia record or change of surgical method. The amount of bleeding, and both amount of autologous blood preparation and transfusion in the laparoscopic surgery were less than those in the open surgery. There were no significant differences in the fluid balance and amount of urine output between the two groups. Conclusions : We conclude that preparation of autologous blood transfusion is necessary for the traditional open prostatectomy, but not for the laparoscopic prostatectomy.

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

  As main circulatory support systems, the Intra-Aortic Balloon Pumping (IABP) , the Percutaneous CardioPulmonary Support (PCPS) , and the Left or Right Ventricular Assisted Devices are available in operating rooms. In particular, IABP and PCPS are important devices for anesthesiologists to be skilled and experienced with since they are used often in the perioperative state. IABP increases coronary flow by diastolic augmentation, and decreases afterload of the left side of the heart by systolic unloading, while PCPS assists the systemic circulatory flow with a closed circuit consisting of a centrifugal pump and an artificial lung. Each of them can be applied individually, but it is better to use them in combination with each other to obtain the maximum desired effects on systemic circulation and oxygenation of patients. Also, adequate monitoring is required for good and safe handling of these devices. The role of anesthesiologists in managing a patient with circulatory support systems in the perioperative state is to stabilize circulation, preserve systemic oxygenation, and manage risk and safety. Described here are the mechanisms and points of note for each system to accomplish this role of anesthesiologists.

DOI： 10.2199/jjsca.27.665

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Language：English   Publisher：BLACKWELL PUBLISHING  

Electroconvulsive therapy (ECT) is an effective and safe treatment for a variety of neuropsychiatric disorders. Premedication with atropine has been recommended in order to avoid bradycardia and transient asystole induced by ECT. In contrast, some other arrhythmias can happen such as atrial flutter and fibrillation. But ventricular tachycardia is rare. Reported herein is a case of incessant non-sustained ventricular tachycardia, possibly triggered by atropine premedication.

DOI： 10.1111/j.1440-1819.2007.01708.x

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Language：English   Publisher：SPRINGER  

Purpose Negative-balance isolated pelvic perfusion (NIPP) is used to administer high doses of anticancer drugs such as cisplatin to patients with advanced cancer of the pelvic region. Although the drugs are intended to be specifically delivered to the pelvis, their leakage into the systemic circulation can cause acute renal failure. This study examines the loading volume required for preservation of renal function during anesthesia of NIPP.
Methods Pelvic cancer patients were assigned to NIPP according to its enrollment criteria. Patients with heart failure, uncontrollable hypertension, renal failure, pulmonary disease or contraindication for the contrast media were excluded. We compared the current anesthesia management regime with a previous protocol, with regard to the loading volume and renal function as assessed by the calculated glomerular filtration rate (GFR). The correlation between the total loading volume and the GFR ratio (GFR after NIPP/GFR before NIPP) was evaluated to define adequate volume loading.
Results The GFR ratios were 0.86 +/- 0.29 and 1.12 +/- 0.25 for the previous and current procedures, respectively. The regression line showed that a minimum loading volume of 28.8 ml kg(-1)h(-1) was required to maintain a GFR ratio of >= 1.
Conclusions A large volume infusion preserves the GFR despite high-dose cisplatin administration by NIPP.

DOI： 10.1007/s00432-007-0217-x

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Other Link： http://search.jamas.or.jp/link/ui/2008069219

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The hypothalamic-pituitary-adrenal axis is an essential component for the maintenance of homeostasis following trauma. Major surgical trauma often induces overwhelming inflammatory responses leading to sepsis and organ dysfunction. This study was designed to evaluate the adrenal responses both before and after various degrees of surgical trauma and to determine the incidence of postoperative relative adrenal insufficiency resulting in the marked inflammatory response often associated with postoperative complications. Fifty-one surgical patients were divided into groups who underwent major, moderate, and minor surgeries. Before the operation and during resting conditions, a short corticotropin (ACTH) stimulation test was performed in each patient. The postoperative concentrations of serum Cortisol, interleukin (IL)-6, IL-10, C-reactive protein (CRP), and plasma ACTH were measured. Fifty of 51 patients were identified as responders to ACTH. The postoperative Cortisol levels were the same as those obtained by ACTH stimulation in highly and moderately stressful surgeries. The increases in postoperative IL-6 and CRP levels were greatest with major surgery, intermediate with moderate surgery, and least with minor surgery. Furthermore, plasma ACTH levels increased after major and moderate surgeries
however, there was no significant differences in postoperative serum IL-10 levels. Systemic inflammatory response syndrome (SIRS) was found in 11 of 17 patients (64.7%) who underwent major surgery and in 4 of 16 patients (25%) who underwent moderate surgery (p=0.037). The duration of SIRS was significantly longer in patients undergoing major surgery (62 ± 20 hrs) than in patients undergoing moderate surgery (21 ± 3 hrs. p=0.038). Postoperative complications were more frequent in patients undergoing major surgery (41.2%) than in patients undergoing moderate surgery (6.3%, p=0.039). Furthermore, there were significant differences in the length of the postoperative stay among the three groups (p&lt
0.01). One nonresponder had serious postoperative inflammatory complications. These results suggest that a short ACTH stimulation test performed preoperatively is a helpful method for determining the maximal Cortisol response to surgical trauma and to identify high-risk individuals and that a relative postoperative adrenal insufficiency may be closely related to the decreased Cortisol secretion following major surgical trauma.

DOI： 10.1272/jnms.74.274

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Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

動脈カテーテル留置による血圧測定に期待されることは、継続的かつ同時的血圧測定、頻回の採血、圧波形から得られる診断的情報などである。すなわち、神経反射や出血などに迅速に対処するために不可欠な、正確かつ即時的な圧のモニタリングである。同時に求められているのが、危険・合併症の予兆のモニタリングである。この意味でのモニタリングの対象は、循環変動とは異なるものに起因する圧・圧波形の変化である。動脈カテーテル留置部位の選択に際しては、体循環のモニタリングと危険・合併症の予兆のモニタリングが最大限に可能となるようにすることはもちろん、合併症に関する知識も重要となる。(著者抄録)

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Language：Japanese   Publisher：日本臨床麻酔学会  

DOI： 10.2199/jjsca.27.268

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Language：Japanese   Publisher：メヂカルフレンド社  

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Other Link： http://search.jamas.or.jp/link/ui/2007139006

Language：Japanese   Publisher：メディカ出版  

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Other Link： http://search.jamas.or.jp/link/ui/2007176731

Language：Japanese   Publisher：メディカ出版  

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Other Link： http://search.jamas.or.jp/link/ui/2007176729

Language：Japanese   Publisher：メディカ出版  

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Other Link： http://search.jamas.or.jp/link/ui/2007176728

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The authors applied near-infrared low-level laser irradiation (LLLI) directed to the stellate ganglion (SG) and to the common carotid artery (CCA), and compared the effects on central retinal artery blood flow using color pulse Doppler sonography. In 10 healthy volunteers, LLLI (0.92 W, 1 : 1 duty cycle, 10 min) to both the SG and CCA significantly increased peak systolic blood velocity in the ophthalmic artery (p&lt
0.001, each) and central retinal artery (p&lt
0.001, each) without changes in vessel resistance. Irradiation to the CCA produced a stronger effect than that to the SG in the ophthalmic artery (p=0.007) and central retinal artery (p=0.031). These data suggest that LLLI to the SG or to the CCA is a useful therapy for increasing the retrobulbar blood flow, with irradiation directed to the CCA being more effective than that directed to the SG in clinical settings.

DOI： 10.1272/jnms.74.23

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Language：Japanese   Publisher：日本臨床麻酔学会  

DOI： 10.2199/jjsca.27.61

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Language：English   Publisher：Medical Association of Nippon Medical School  

Background: Left ventricular (LV) diastolic function has received much attention recently. However, few studies have evaluated LV diastolic function in the perioperative period. The aim of this study was to elucidate perioperative changes in diastolic function using tissue Doppler imaging (TDI) in patients undergoing repair of an infrarenal abdominal aortic aneurysm (AAA). Methods: Eight patients undergoing repair of an infrarenal AAA were studied prospectively using transesophageal echocardiography. Doppler echocardiographic examinations were performed before the surgical procedure (T1), immediately before aortic unclamping (T2), 30 minutes after aortic unclamping (T3), and at the end of surgery (T4). Results: Pulmonary edema developed in two patients on postoperative day 1. These two patients had the lowest early diastolic mitral annular velocity (Ea) of the study group at the end of surgery. The ratio of the peak velocity of early mitral inflow (E) to the peak velocity of atrial inflow was significantly decreased at T3 and T4. The systolic ejection velocity was significantly decreased at T3, but returned to the baseline value at T4. The Ea was significantly decreased at T3 and T4. The E/Ea ratio showed a progressive rise and was significantly increased at T3 and T4. Conclusions: In patients undergoing repair of an infrarenal AAA, the Ea derived using TDI decreases at T3 and is still reduced at T4. The E/Ea ratio, which is used to estimate LV filling pressures, is significantly increased at T3 and T4. Further research is required to confirm the development of diastolic dysfunction and determine its possible association with increased postoperative morbidity and mortality.

DOI： 10.1272/jnms.74.393

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Epidural anesthesia attenuates surgical stress responses, such as the immune reaction and the pituitary hormone response. In the present study, we investigated the leukocyte response to initial surgical stimulation during upper abdominal surgery. Twenty adult patients (American Society of Anesthesiologists physical status I-II) undergoing elective upper abdominal surgery were randomly assigned to an epidural anesthesia group or a general anesthesia group. An epidural catheter for postoperative pain relief was inserted into all patients before induction. In the epidural anesthesia group, patients obtained preemptive analgesia from Th4 to Th12 with 2% mepivacaine, whereas general anesthesia was maintained with 2 L of oxygen, 4 L of nitrous oxide, and 1% to 3% isoflurane. Changes in the leukocyte count and leukocyte subset distribution were determined before induction (baseline), immediately after induction, 5 minutes after induction, 5 minutes after skin incision, and 5 minutes after peritoneal incision. The changes were significantly different between the groups throughout the observation period (p&lt
0.0001). The general anesthesia group demonstrated an increase in the leukocyte count compared with the baseline data 5 minutes after skin incision and 5 minutes after peritoneal incision (p&lt
0.01). Moreover, these counts were significantly higher in the general anesthesia group than in the epidural anesthesia group (p&lt
0.05). The subset distributions were also significantly different between the groups throughout the observation period (p&lt
0.0001). In the general anesthesia group, neutrophils decreased and lymphocytes increased significantly compared with baseline (p&lt
0.05). Moreover, lymphocyte distribution was significantly higher in the general anesthesia group than in the epidural anesthesia group 5 minutes after peritoneal incision. Thus, anesthesia modifies the early response of leukocytes to surgical stress. The link between the early leukocyte response to surgery and postoperative outcome is the next subject of investigation.

DOI： 10.1272/jnms.73.4

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Language：English   Publisher：BLACKWELL PUBLISHING  

Although the contribution of the gamma-aminobutyric acid (GABA) receptor system in peripheral chemosensation is unclear, immunohistochemistry has demonstrated the presence of GABA-ergic receptors in mammalian carotid bodies. We hypothesized that an activation of the carotid body GABA receptors would counteract the depolarizing effect of hypoxia.
The carotid body with arterial supply and the carotid sinus nerve was removed en bloc from New Zealand White rabbits and placed in a perfusion chamber. The carotid body preparation was perfused via the cut common carotid artery with a modified Tyrode's solution at a rate of 3.5-4.5 ml/min with a constant pressure of 45 cmH(2)O. The carotid sinus nerve firing frequency (Hz) was recorded at two different oxygen tension levels during perfusion with midazolam of 1, 10 and 100 mu g/l.
The frequency was decreased by midazolam in a dose-dependent manner (n = 8). Firing frequencies (mean +/- SEM) at the low oxygen tension level decreased from 643.13 +/- 67.2 Hz in the control to 554.5 +/- 67.7 Hz (P = 0.054 vs. control), 509.01 +/- 100.5 Hz (P < 0.012 vs. control) and 422.6 +/- 77.3 Hz (P < 0.001 vs. control) during perfusion with midazolam of 1, 10 and 100 mu g/l, respectively.
Midazolam depresses carotid body chemoreceptor activity in a dose-dependent manner.

DOI： 10.1111/j.1399-6576.2005.00896.x

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Combined spinal epidural anesthesia is widely used for Caesarean section. Bolus administration of an epidural initial dose introduces the risk of drug flux from the epidural space to the subarachnoid space, and the volume effect of the initial dose may cause epidural top-up and extension of subarachnoid blockade. These problems may be avoided if the initial dose is not administered. This study investigated whether epidural continuous infusion without an initial dose (continuous group) can decrease postoperative pain as well as an epidural continuous infusion with an initial dose (initial dose group). Sixty-one patients undergoing elective Caesarean section were randomly assigned to the initial dose group or the continuous group. Twenty patients undergoing emergency Caesarean section with spinal anesthesia (spinal group) were also investigated to confirm that epidural block is effective for postoperative pain. Data in this study were obtained retrospectively from each patient. s records. Between the initial dose group and the continuous group, there was no significant difference in the number of times flurbiprofen or pentazocine were used for postoperative pain relief. However, the number of times that pentazocine was used was significantly higher in the spinal group than in other groups. This finding suggests that an epidural initial dose is unnecessary for postoperative pain relief in combined spinal epidural anesthesia for Caesarean section.

DOI： 10.1272/jnms.73.70

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DOI： 10.1272/jnms.73.4

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BACKGROUND: Although the contribution of the gamma-aminobutyric acid (GABA) receptor system in peripheral chemosensation is unclear, immunohistochemistry has demonstrated the presence of GABA-ergic receptors in mammalian carotid bodies. We hypothesized that an activation of the carotid body GABA receptors would counteract the depolarizing effect of hypoxia. METHODS: The carotid body with arterial supply and the carotid sinus nerve was removed en bloc from New Zealand White rabbits and placed in a perfusion chamber. The carotid body preparation was perfused via the cut common carotid artery with a modified Tyrode's solution at a rate of 3.5-4.5 ml/min with a constant pressure of 45 cmH2O. The carotid sinus nerve firing frequency (Hz) was recorded at two different oxygen tension levels during perfusion with midazolam of 1, 10 and 100 microg/l. RESULTS: The frequency was decreased by midazolam in a dose-dependent manner (n = 8). Firing frequencies (mean +/- SEM) at the low oxygen tension level decreased from 643.13 +/- 67.2 Hz in the control to 554.5 +/- 67.7 Hz (P = 0.054 vs. control), 509.01 +/- 100.5 Hz (P < 0.012 vs. control) and 422.6 +/- 77.3 Hz (P < 0.001 vs. control) during perfusion with midazolam of 1, 10 and 100 microg/l, respectively. CONCLUSION: Midazolam depresses carotid body chemoreceptor activity in a dose-dependent manner.

DOI： 10.1111/j.1399-6576.2005.00896.x

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Aim: The present study was designed to assess whether prophylactic use of bicarbonated Ringer's solution ameliorates metabolic acidosis in patients undergoing aortic surgery. Methods: Twenty patients undergoing elective infrarenal aortic aneurysm repair were randomly assigned to receive either bicarbonated Ringer's solution or acetated Ringer's solution. The pH, PaCO 2, and base excess (BE) were measured before surgical incision (T0), 5 min before reperfusion (T1) , 5 min after reperfusion (T2), and 30 min after reperfusion (T3). Data were compared between the two groups. Results: Both pH and BE initially showed a slight decrease in both groups during clamping. After unclamping of the aorta, an additional decrease in pH was observed in both groups (T0 to T2, and T3). There were no significant differences in pH between the groups throughout the study period. Conclusions: Aortic cross-clamping leads to the development of metabolic acidosis, with a decrease in pH and BE. The effect of administration of bicarbonated infusion fluid during elective abdominal aortic surgery had not significant compared with that of acetated Ringer's solution with respect to acid-base homeostasis.

DOI： 10.1272/jnms.72.364

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Aim: The present study was designed to assess whether prophylactic use of bicarbonated Ringer's solution ameliorates metabolic acidosis in patients undergoing aortic surgery. Methods: Twenty patients undergoing elective infrarenal aortic aneurysm repair were randomly assigned to receive either bicarbonated Ringer's solution or acetated Ringer's solution. The pH, PaCO 2, and base excess (BE) were measured before surgical incision (T0), 5 min before reperfusion (T1) , 5 min after reperfusion (T2), and 30 min after reperfusion (T3). Data were compared between the two groups. Results: Both pH and BE initially showed a slight decrease in both groups during clamping. After unclamping of the aorta, an additional decrease in pH was observed in both groups (T0 to T2, and T3). There were no significant differences in pH between the groups throughout the study period. Conclusions: Aortic cross-clamping leads to the development of metabolic acidosis, with a decrease in pH and BE. The effect of administration of bicarbonated infusion fluid during elective abdominal aortic surgery had not significant compared with that of acetated Ringer's solution with respect to acid-base homeostasis.

DOI： 10.1272/jnms.72.364

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1213/01.ANE.0000173762.12938.37

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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DOI： 10.1213/01.ANE.0000173762.12938.37

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Language：Japanese   Publisher：社団法人日本循環器学会  

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Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

DOI： 10.1111/j.1399-6576.2004.00358b.x

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：BLACKWELL MUNKSGAARD  

DOI： 10.1111/j.1399-6576.2004.00360.x

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Clonidine premedication prevents tourniquet pain and reduces sympathetic nerve activity. We evaluated hemodynamic changes and catecholamine release following tourniquet deflation during spinal anesthesia in patients who received oral clonidine premedication. The final analysis included 24 otherwise healthy patients undergoing lower-limb surgery randomly assigned to two groups: those receiving approximately 5 μg/kg of oral clonidine 1 hr before anesthesia (clonidine group, n = 12), and those receiving no premedication (control group, n = 12). After lumbar anesthesia, a tourniquet was applied for approximately 60 minutes to each patient. Electrocardiogram, arterial blood pressure, and consumption of butorphanol for tourniquet pain were monitored. Blood samples were obtained at different times to measure serum concentration of catecholamine. In the clonidine group, mean blood pressure decreased from 87 ± 7 mmHg at baseline to 65 ± 10 mmHg after tourniquet deflation (P &lt
0.05). This peak reduction of mean blood pressure in the clonidine group was significantly lower than in the control group. After receiving clonidine premedication, the plasma noradrenaline concentrations in the clonidine group were significantly lower than those in the control group. Noradrenaline concentration increased in the control group from 162.3 ± 89.2 pg/mL before tourniquet deflation to 199.3 ± 95.7 pg/mL afterward (P &lt
0.01), but there was no significant change in noradrenaline concentration after tourniquet deflation in the clonidine group. We conclude that oral clonidine premedication exacerbated the reduction in mean blood pressure following tourniquet deflation by inhibiting noradrenaline release.

DOI： 10.1272/jnms.71.44

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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DOI： 10.1272/jnms.71.44

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DOI： 10.1007/s00540-004-0240-x

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Purpose. Activation of purinoceptors may improve neuropathic pain. Accordingly, the effects of systemic ATP infusion were assessed in patients with postherpetic neuralgia (PHN). Methods. Eight patients with PHN lasting over 3 months were enrolled. Initially, patients received the vehicle (20% dextrose) or ATP (at a dose of 1 mg·kg-1 in 20% dextrose) infused intravenously for 60 min on two separate occasions in a single-blinded manner. The levels of spontaneous continuous pain, paroxysmal pain, and tactile allodynia were assessed by a visual analogue scale (VAS), and tactile hypesthesia was assessed by Semmes-Weinstein monofilament before and after infusion. Subsequently, the eight patients received an ATP infusion (1 mg·kg-1 in 20% dextrose) once a week for 5-12 weeks in an open-label manner, and changes in the above parameters were assessed. Results. In the initial study, VAS for spontaneous continuous pain and tactile allodynia decreased significantly with ATP infusion but not with placebo infusion. After repeated ATP infusions for 5-12 weeks, the median VAS for spontaneous continuous pain, paroxysmal pain, and tactile allodynia decreased significantly from 32.1 to 13.0, from 46.9 to 17.5, and from 49.5 to 15.6 respectively. However tactile hypesthesia did not improve significantly. Conclusion. This study demonstrated that repetitive intravenous ATP infusion could improve spontaneous continuous pain and paroxysmal pain, as well as improving tactile allodynia, but did not influence tactile hypesthesia. © JSA 2004.

DOI： 10.1007/s00540-004-0240-x

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Background: Cardiogenic pulmonary edema is a frequent cause of respiratory failure. We investigated whether milrinone improved lung compliance. Methods: We selected 10 patients with respiratory failure due to severe cardiogenic pulmonary edema to receive mechanical ventilation. Patients were administered a bolus injection of milrinone (50 μgkg-1) over 10 min, followed by continuous intravenous infusion (0.5 μgkg-1min-1). Lung compliance, blood gas values, hemodynamic parameters, and sample plasma milrinone levels were assessed over 120 min after the onset of the continuous infusion of milrinone. Results: Ten min following milrinone infusion, dynamic compliance (Cdyn) and static compliance (Cst) increased from 37 ± 12 to 42 ± 12mlcmH2O-1 and from 40 ± 13 to 45 ± 12 mlcmH2O-1, respectively (P < 0.01). Plasma milrinone levels reached a therapeutic level for vasodilator and positive inotropic effect at 10 min after milrinone infusion. A significant decrease in mean pulmonary artery pressure and pulmonary artery wedge pressure occurred simultaneously with an increase in respiratory system compliance. However, an increase in cardiac index Was observed later than these changes. There were significant correlations between the mean pulmonary artery pressure and Cdyn (r = -0.39, P < 0.01) and Cst (r= -0.38, P < 0.01). Conclusions: Milrinone-induced improvement in lung compliance along with an improvement of hemodynamics was found together with an inverse relationship between compliance and mean pulmonary artery pressure. © Acta Anaesthesiologica Scandinavica.

DOI： 10.1034/j.1399-6576.2003.00124.x

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Background: Cardiogenic pulmonary edema is a frequent cause of respiratory failure. We investigated whether milrinone improved lung compliance. Methods: We selected 10 patients with respiratory failure due to severe cardiogenic pulmonary edema to receive mechanical ventilation. Patients were administered a bolus injection of milrinone (50 μgkg-1) over 10 min, followed by continuous intravenous infusion (0.5 μgkg-1min-1). Lung compliance, blood gas values, hemodynamic parameters, and sample plasma milrinone levels were assessed over 120 min after the onset of the continuous infusion of milrinone. Results: Ten min following milrinone infusion, dynamic compliance (Cdyn) and static compliance (Cst) increased from 37 ± 12 to 42 ± 12mlcmH2O-1 and from 40 ± 13 to 45 ± 12 mlcmH2O-1, respectively (P < 0.01). Plasma milrinone levels reached a therapeutic level for vasodilator and positive inotropic effect at 10 min after milrinone infusion. A significant decrease in mean pulmonary artery pressure and pulmonary artery wedge pressure occurred simultaneously with an increase in respiratory system compliance. However, an increase in cardiac index Was observed later than these changes. There were significant correlations between the mean pulmonary artery pressure and Cdyn (r = -0.39, P < 0.01) and Cst (r= -0.38, P < 0.01). Conclusions: Milrinone-induced improvement in lung compliance along with an improvement of hemodynamics was found together with an inverse relationship between compliance and mean pulmonary artery pressure. © Acta Anaesthesiologica Scandinavica.

DOI： 10.1034/j.1399-6576.2003.00124.x

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Language：Japanese   Publisher：医学図書出版  

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Other Link： http://search.jamas.or.jp/link/ui/2004013137

Language：Japanese   Publisher：社団法人日本循環器学会  

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Language：English   Publisher：Medical Association of Nippon Medical School  

Proinflammatory cytokines have been implicated in mediating respiratory failure associated with major surgery. We investigated the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress and the association of cytokine levels, such as interleukin-6 (IL-6) and interleukin-8 (IL-8), with oxygenation after esophagectomy. We studied 17 patients who underwent subtotal esophagectomy. Seven patients (steroid group) were chosen at random to be given methylprednisolone (10 mg/kg) and 10 patients (control group) to be given saline intravenously before operation. Plasma and bronchoalveolar lavage fluid (BALF) IL-8 levels in the control group were significantly higher than those in the steroid group. In both groups, plasma IL-6 levels were significantly higher than those in BALF, but in contrast, BALF IL-8 levels were significantly higher than plasma levels of IL-8 postoperatively. The PaO2/FiO2 ratio was significantly reduced in the control group. The PaO2/FiO2 ratio of the control group had significantly lower values than that of the steroid group. There was significant correlation between BALF IL-8 levels and the PaO2/FiO2 ratio postoperatively. We conclude that preoperative administration of methylprednisolone may attenuate postoperative reduction of arterial oxygen saturation by suppressing the release of cytokines.

DOI： 10.1272/jnms.70.16

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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DOI： 10.1272/jnms.70.16

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Language：Japanese   Publisher：へるす出版  

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Other Link： http://search.jamas.or.jp/link/ui/2003103157

Language：English   Publisher：WILEY-BLACKWELL  

Background: Vecuronium depresses carotid body chemosensitivity during hypoxia. We hypothesized that this is caused by inhibition of cholinergic transmission of the carotid body.
Methods: The carotid body with its sinus nerve was removed en bloc from thiopentone-anaesthetized adult male New Zealand rabbits and perfused in vitro with modified Tyrodes buffer solution at constant perfusion pressure, temperature, a buffer pH of 7.4 and normocapnia. Chemoreceptor discharge and spike frequencies (fx) were recorded from the whole sinus nerve after administration of 500mug nicotine, given as duplicated controls and thereafter following 30 min perfusion of equipotent concentrations of atracurium (28.1 muM) or vecuronium(10 muM), after 30 min of neostigmine perfusion. (9.2 muM) and finally after 30min wash-out with buffer solution only. A short-lasting hypoxic test 0 was performed before and at the end of the experimental period to confirm the responsiveness and validity of the preparation.
Results: Atracurium (n = 7) and vecuronium (n = 6) reduced chemoreceptor responses to nicotine by 70+/-30% and 66+/-19% (SEM) (P&lt;0.05). Chemoreceptor discharges showed full recovery after neostigmine in the atracurium group and partial recovery in the vecuronium group (P&lt;0.05). Finally, after wash-out the chemoreceptor responses to nicotine had fully recovered in both groups.
Conclusion: Atracurium and vecuronium in equipotent concentrations block nicotine-induced chemoreceptor responses of the carotid body.

DOI： 10.1034/j.1399-6576.2002.460503.x

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Language：English   Publisher：WILEY-BLACKWELL  

Background: Vecuronium depresses carotid body chemosensitivity during hypoxia. We hypothesized that this is caused by inhibition of cholinergic transmission of the carotid body. Methods: The carotid body with its sinus nerve was removed en bloc from thiopentone-anaesthetized adult male New Zealand rabbits and perfused in vitro with modified Tyrodes buffer solution at constant perfusion pressure, temperature, a buffer pH of 7.4 and normocapnia. Chemoreceptor discharge and spike frequencies (fx) were recorded from the whole sinus nerve after administration of 500 μg nicotine, given as duplicated controls and thereafter following 30 min perfusion of equipotent concentrations of atracurium (28.1 μM) or vecuronium(10 μM), after 30 min of neostigmine perfusion (9.2 μM) and finally after 30 min wash-out with buffer solution only. A short-lasting hypoxic test was performed before and at the end of the experimental period to confirm the responsiveness and validity of the preparation. Results: Atracurium (n = 7) and vecuronium (n = 6) reduced chemoreceptor responses to nicotine by 70 ± 30% and 66 ± 19% (SEM) (P<0.05). Chemoreceptor discharges showed full recovery after neostigmine in the atracurium group and partial recovery in the vecuronium group (P<0.05). Finally, after wash-out the chemoreceptor responses to nicotine had fully recovered in both groups. Conclusion: Atracurium and vecuronium in equipotent concentrations block nicotine-induced chemoreceptor responses of the carotid body. © Acta Anaesthesiologica Scandinavica 46 (2002).

DOI： 10.1034/j.1399-6576.2002.460503.x

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DOI： 10.1053/jcan.2002.125150

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DOI： 10.1053/jcan.2002.125150

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Language：Japanese   Publisher：真興交易(株)医書出版部  

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Language：English   Publisher：SCANDINAVIAN UNIVERSITY PRESS  

Objective: To evaluate the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress.
Design: Prospective randomised study.
Setting: University hospital, Japan.
Subjects: 30 patients undergoing resection of oesophageal carcinoma.
Interventions: 15 patients (group 1) were randomised to be given methylprednisolone (30 mg/kg) and 15 patients (group 2) to be given saline intravenously before operation.
Main outcome measures: Outcome, length of stay in the intensive care unit (ICU), metabolic response, and oxygenation.
Results: Patients given methylprednisolone had a mean stay in the ICU of 5.1 +/- 1.0 days compared with 8.2 +/- 4.5 days in the saline group (p &lt; 0.01). 5 patients in the saline group compared with 0 in the methylprednisolone group developed postoperative complications (p = 0.02). Plasma norepinephrine and arginine vasopressin levels in methylprednisolone group were significantly lower than those in the saline group (p &lt; 0.05). The PaO2:FiO(2) ratio in the saline group was significantly lower than that in the experimental group (p &lt; 0.01).
Conclusion: Preoperative methylprednisolone may facilitate the postoperative management of surgical patients.

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Objective: To evaluate the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress.
Design: Prospective randomised study.
Setting: University hospital, Japan.
Subjects: 30 patients undergoing resection of oesophageal carcinoma.
Interventions: 15 patients (group 1) were randomised to be given methylprednisolone (30 mg/kg) and 15 patients (group 2) to be given saline intravenously before operation.
Main outcome measures: Outcome, length of stay in the intensive care unit (ICU), metabolic response, and oxygenation.
Results: Patients given methylprednisolone had a mean stay in the ICU of 5.1 +/- 1.0 days compared with 8.2 +/- 4.5 days in the saline group (p &lt; 0.01). 5 patients in the saline group compared with 0 in the methylprednisolone group developed postoperative complications (p = 0.02). Plasma norepinephrine and arginine vasopressin levels in methylprednisolone group were significantly lower than those in the saline group (p &lt; 0.05). The PaO2:FiO(2) ratio in the saline group was significantly lower than that in the experimental group (p &lt; 0.01).
Conclusion: Preoperative methylprednisolone may facilitate the postoperative management of surgical patients.

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Language：English   Publisher：MUNKSGAARD INT PUBL LTD  

Background: Decrease in lung compliance is one of the major causes of respiratory failure. We investigated whether amrinone could improve lung compliance.
Methods: We selected 20 consecutive patients with respiratory failure due to severe cardiogenic pulmonary edema to receive mechanical ventilation. Patients were administered a bolus injection (1 mg . kg(-1)) over 10 min followed by continuous intravenous infusion (10 mu g . kg(-1) . min(-1)) of amrinone. Lung compliance, blood gas values, hemodynamic parameters, and sample plasma amrinone levels were assessed over a 120-min period after the onset of the continuous infusion of amrinone.
Results: Ten min following amrinone infusion, dynamic compliance (Cdyn) and static compliance (Cst) increased from 30+/-11 to 36+/-12 ml/cm H2O and from 37+/-12 to 42+/-13 ml/cm H2O, respectively (P&lt;0.01). Plasma amrinone levels reached a therapeutic level as vasodilator and positive inotropic effects at 10 min after amrinone infusion. The significant change in mean pulmonary artery pressure and pulmonary artery wedge-pressure occurred later than the change in compliance of respiratory system. However, there were significant correlations between the mean pulmonary artery pressure and Cdyn (r=0.36, P&lt;0.01) and Cst (r=0.44, P&lt;0.01), as well as between plasma amrinone levels and Cdyn (r=0.30, P&lt;0.05) and Cst (r=0.41, P&lt;0.01).
Conclusions: Amrinone-induced improvement in lung compliance was considered mainly to be due to an increase in the number of functioning lung units by improvement of the hemodynamics and a direct positive effect of amrinone on respiratory muscle contraction. (C) Acta Anaesthesiologica Scandinavica 41 (1997).

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Language：English   Publisher：MUNKSGAARD INT PUBL LTD  

Background: Decrease in lung compliance is one of the major causes of respiratory failure. We investigated whether amrinone could improve lung compliance.
Methods: We selected 20 consecutive patients with respiratory failure due to severe cardiogenic pulmonary edema to receive mechanical ventilation. Patients were administered a bolus injection (1 mg . kg(-1)) over 10 min followed by continuous intravenous infusion (10 mu g . kg(-1) . min(-1)) of amrinone. Lung compliance, blood gas values, hemodynamic parameters, and sample plasma amrinone levels were assessed over a 120-min period after the onset of the continuous infusion of amrinone.
Results: Ten min following amrinone infusion, dynamic compliance (Cdyn) and static compliance (Cst) increased from 30+/-11 to 36+/-12 ml/cm H2O and from 37+/-12 to 42+/-13 ml/cm H2O, respectively (P&lt;0.01). Plasma amrinone levels reached a therapeutic level as vasodilator and positive inotropic effects at 10 min after amrinone infusion. The significant change in mean pulmonary artery pressure and pulmonary artery wedge-pressure occurred later than the change in compliance of respiratory system. However, there were significant correlations between the mean pulmonary artery pressure and Cdyn (r=0.36, P&lt;0.01) and Cst (r=0.44, P&lt;0.01), as well as between plasma amrinone levels and Cdyn (r=0.30, P&lt;0.05) and Cst (r=0.41, P&lt;0.01).
Conclusions: Amrinone-induced improvement in lung compliance was considered mainly to be due to an increase in the number of functioning lung units by improvement of the hemodynamics and a direct positive effect of amrinone on respiratory muscle contraction. (C) Acta Anaesthesiologica Scandinavica 41 (1997).

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Language：English   Publisher：PROF SCI PUBL  

We have recently reported that continuous administration of butorphanol into the brachial plexus neurovascular sheath provided superior analgesia compared with that obtained with continuous i.v. administration. Furthermore, we found that analgesia was most pronounced when a mixture of mepivacaine and butorphanol was given and that butorphanol alone ranked next. In this study, we increased the dose of butorphanol, compared with that used in our previous reports, and an initial bolus dose of butorphanol was administered into the brachial plexus neurovascular sheath just after surgery had ended. Thereafter, postoperative pain relief was estimated. In patients undergoing upper extremity surgery with continuous axillary brachial plexus block, group A received a bolus of 1 ml of physiological saline with 1.5% mepivacaine, 10 ml into the brachial plexus sheath followed by a continuous brachial plexus infusion of 0.5% mepivacaine with butorphanol 6 mg at a rate of 144 ml/ 72 h. Group B was given a bolus of butorphanol 1 mg (1 ml) with 1.5% mepivacaine, 10 ml into the brachial plexus sheath and a continuous brachial plexus infusion of 0.5% mepivacaine with butorphanol 6 mg at a rate of 144 ml/72 h. After operation, VAS scores did not differ between the two groups. The time to first use of supplementary analgesia did not differ significantly between the two groups and there were no significant differences in the number of patients who required supplementary analgesia. These results indicate that continuous butorphanol 2 mg day-1 with 0.5% mepivacaine provided sufficient postoperative analgesia after upper limb surgery.

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We have recently reported that continuous administration of butorphanol into the brachial plexus neurovascular sheath provided superior analgesia compared with that obtained with continuous i.v. administration. Furthermore, we found that analgesia was most pronounced when a mixture of mepivacaine and butorphanol was given and that butorphanol alone ranked next. In this study, we increased the dose of butorphanol, compared with that used in our previous reports, and an initial bolus dose of butorphanol was administered into the brachial plexus neurovascular sheath just after surgery had ended. Thereafter, postoperative pain relief was estimated. In patients undergoing upper extremity surgery with continuous axillary brachial plexus block, group A received a bolus of 1 ml of physiological saline with 1.5% mepivacaine, 10 ml into the brachial plexus sheath followed by a continuous brachial plexus infusion of 0.5% mepivacaine with butorphanol 6 mg at a rate of 144 ml/72 h. Group B was given a bolus of butorphanol 1 mg (1 ml) with 1.5% mepivacaine, 10 ml into the brachial plexus sheath and a continuous brachial plexus infusion of 0.5% mepivacaine with butorphanol 6 mg at a rate of 144 ml/72 h. After operation, VAS scores did not differ between the two groups. The time to first use of supplementary analgesia did not differ significantly between the groups and there were no significant differences in the number of patients who required supplementary analgesia. These results indicate that continuous butorphanol 2 mg day(-1) with 0.5% mepivacaine provided sufficient postoperative analgesia after upper limb surgery.

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Language：Japanese   Publisher：克誠堂出版  

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We have reported recently that continuous administration of butorphanol into the brachial plexus sheath provided analgesia of a quality superior to that of continuous i.v. administration. In the present study, we have compared postoperative pain relief produced by continuous infusion of one of three types of solution into the axillary sheath: opioid alone, local anaesthetic alone or a mixture of local anaesthetic and opioid. In patients undergoing upper extremity surgery with continuous axillary brachial plexus block, we injected one of the three solutions into the axillary neurovascular sheath: butorphanol 2 mg (group B), 0.5% mepivacaine alone (group M) and 0.5% mepivacaine-butorphanol (group MB); the volume of each solution was 50 mi, administered at a rate of 50 ml per 24 h. At 3 h after operation, visual analogue scale (VAS) scores were significantly higher in group M than in group MB (P &lt; 0.01), and higher in group B than in group MB (P &lt; 0.05).

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We have reported recently that continuous administration of butorphanol into the brachial plexus sheath provided analgesia of a quality superior to that of continuous i.v. administration. In the present study, we have compared postoperative pain relief produced by continuous infusion of one of three types of solution into the axillary sheath: opioid alone, local anaesthetic alone or a mixture of local anaesthetic and opioid. In patients undergoing upper extremity surgery with continuous axillary brachial plexus block, we injected one of the three solutions into the axillary neurovascular sheath: butorphanol 2 mg (group B), 0.5% mepivacaine alone (group M) and 0.5% mepivacaine-butorphanol (group MB); the volume of each solution was 50 ml, administered at a rate of 50 ml per 24 h. At 3 h after operation, visual analogue scale (VAS) scores were significantly higher in group M than in group MB (P < 0.01), and higher in group B than in group MB (P < 0.05).

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Language：English   Publisher：PROF SCI PUBL  

In a randomized, double-blind, controlled study, we have compared two groups of patients receiving either continuous systemic i.v. or continuous brachial plexus infusion of butorphanol for analgesia after operations on the upper extremities. Twenty-two patients undergoing elective upper extremity surgery were allocated randomly to one of two groups to receive either butorphanol i.v. and saline injected into the brachial plexus sheath (i.v. group) or butorphanol injected into the brachial plexus sheath and saline i.v. (brachial plexus group). After surgery on the upper extremity under continuous axillary brachial plexus block, each patient received a continuous infusion of butorphanol either i.v. or into the brachial plexus sheath at a dose of 83.3 mu g h(-1). Concurrently, a saline infusion was given via the alternate route. Patients rated their pain on a 10-cm visual analogue scale (VAS). VAS scores in the two groups did not differ up to 6 h and 24 h after operation. From 9 h until 24 h after operation, pain scores were significantly higher in the i.v. group than in the brachial plexus group. The VAS score 9 h after operation was 3.3 (SD 2.7) in the i.v. group and 0.6 (0.9) in the brachial plexus group (P &lt; 0.01); 12 h after operation 2.7 (1.8) in the i.v. group and 0.6 (0.9) in the brachial plexus group (P &lt; 0.01); 18 h after operation 1.7 (1.0) in the i.v. group and 0.7 (1.0) in the brachial plexus group (P &lt; 0.05); and 24 h after operation 3.2 (2.4) in the i.v. group and 0.7 (1.2) in the brachial plexus group (P &lt; 0.01). We conclude that continuous injection of butorphanol into the brachial plexus sheath provided superior analgesia compared with continuous i.v. injection.

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Language：English   Publisher：PROF SCI PUBL  

In a randomized, double-blind, controlled study, we have compared two groups of patients receiving either continuous systemic i.v. or continuous brachial plexus infusion of butorphanol for analgesia after operations on the upper extremities. Twenty-two patients undergoing elective upper extremity surgery were allocated randomly to one of two groups to receive either butorphanol i.v. and saline injected into the brachial plexus sheath (i.v. group) or butorphanol injected into the brachial plexus sheath and saline i.v. (brachial plexus group). After surgery on the upper extremity under continuous axillary brachial plexus block, each patient received a continuous infusion of butorphanol either i.v. or into the brachial plexus sheath at a dose of 83.3 micrograms h-1. Concurrently, a saline infusion was given via the alternate route. Patients rated their pain on a 10-cm visual analogue scale (VAS). VAS scores in the two groups did not differ up to 6 h and 24 h after operation. From 9 h until 24 h after operation, pain scores were significantly higher in the i.v. group than in the brachial plexus group. The VAS score 9 h after operation was 3.3 (SD 2.7) in the i.v. group and 0.6 (0.9) in the brachial plexus group (P < 0.01); 12 h after operation 2.7 (1.8) in the i.v. group and 0.6 (0.9) in the brachial plexus group (P < 0.01); 18 h after operation 1.7 (1.0) in the i.v. group and 0.7 (1.0) in the brachial plexus group (P < 0.05); and 24 h after operation 3.2 (2.4) in the i.v. group and 0.7 (1.2) in the brachial plexus group (P < 0.01). We conclude that continuous injection of butorphanol into the brachial plexus sheath provided superior analgesia compared with continuous i.v. injection.

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