Biomedical subjects

A Matsuki

Publications and source records attributed to A Matsuki.

At least 217 records · Page 12Linked to original sources

PubMed1993

[Clinical study on intraoperative hyperketonemia in non-diabetic surgical patients under general anesthesia].

We measured plasma 3-hydroxybutyrate (3-OHBA) concentrations in 925 non-diabetic surgical patients who underwent various surgical procedures under various types of general anesthesia. Lactated Ringer's solution only was used as an intraoperative fluid. Among them, 46 patients (4.9%) developed high 3-OHBA levels of over 500 microM.l-1 during surgery. The causes of observed hyperketonemia would be surgical stress and preoperative fasting irrespective of 8 types of general anesthesia. Blood glucose, lactic acid, base excess and pH were not influenced by hyperketonemia. Prolonged recovery from anesthesia was not observed in any patients with hyperketonemia. Without any specific treatments, plasma 3-OHBA levels were unchanged or rather decreased in 70% of the patients whose 3-OHBA levels were over 500 microM. The results suggest that hyperketonemia below 500 microM.l-1 is not always disadvantageous in nondiabetic patients under general anesthesia.

3-Hydroxybutyric Acid↗

PubMed1993

[Clinical study on total intravenous anesthesia with droperidol, fentanyl, and ketamine--18. Effect on peripheral circulation as judged by core-peripheral temperature gradient].

Effect of total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK) on peripheral circulation was studied by examining core-peripheral temperature gradient in twenty five patients who underwent abdominal surgery. A core temperature probe was attached on the forehead and peripheral probe on the palm of the hand of the side on which the blood pressure cuff was not applied. The temperature gradient was less than three degrees centigrade in 60% of the patients and the gradient was significantly less as compared with that of isoflurane anesthesia even at 300 minutes after the start of surgical operation. This advantage would have been caused by such factors as circulatory stimulating effect of ketamine, sympathetic blocking effect by droperidol and adequate postoperative analgesia by fentanyl and norketamine, a metabolite of ketamine. The results suggest that DFK would exert a beneficial effect on peripheral circulation, particularly during prolonged surgical procedures.

Abdomen↗

PubMed1993

[Anxiolytic effect of preoperative showing of "anesthesia video" for surgical patients].

Over 60% of preoperative surgical patients are reported to suffer from preoperative anxiety. Since 1986, an anesthesia video, explaining our routine anesthesia procedures has been shown to elective surgical patients preoperatively at our clinic. In 1990, as our anesthesia method was modified, we revised this video and evaluated the effect of this video on their preoperative anxiety. Female patients, in general, have much more anxiety than male patients, and the female patients of 30-59 years of age were the most anxious about their surgical operations not about anesthesia per se. The patients who were to undergo a major surgery, such as gynecological patients also belonged to the most anxious patient group. After demonstrating the video any patient group including gynecological patients of 30-59 years of age was less anxious about the upcoming anesthesia and surgery.

Adolescent↗

PubMed1993

[Intensive care of a postpartum patient complicated with HELLP syndrome].

We reported our intensive care experience of a postpartum patient with HELLP syndrome. We administered haptoglobin immediately after the delivery in order to prevent renal insufficiency following hemoglobinuria. Continuous veno-venous hemofiltration was undertaken and plasma exchange was also employed to overcome hepatorenal insufficiency. After these procedures an improvement was observed in her hepatic and renal functions. Administration of haptoglobin and blood purification would be beneficial for patients complicated with HELLP syndrome.

Adult↗

PubMed1993

[Perioperative management of patients on long-term administration of psychotropic drugs].

We experienced perioperative management of thirty two surgical patients complicated with either schizophrenia or depression on long-term administration of psychotropic drugs during a period of three years from 1989 through 1991. They underwent various operative procedures under either general anesthesia or epidural anesthesia. Mental confusion was most frequently encountered in immediate postoperative period. The longer the patients had been treated with psychotropic drugs, the more postoperative complications were observed. We lost four patients within two weeks postoperatively. They all underwent laparotomy and had been treated with psychotropic drugs for a prolonged period. No significant association between the types of anesthesia and postoperative complications was observed. Surgical patients on long-term administration of psychotropic drugs should be managed carefully particularly during postoperative period.

Adult↗

PubMed1993

[EEG pattern during total intravenous anesthesia with droperidol, fentanyl and ketamine].

We evaluated EEG pattern during total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK). Four surgical patients, ranged in age from 35 to 43, were the subjects of this study. Two male underwent oral or orthopedic surgery and the other two female patients underwent gynecological surgery. They were all free from hepato-renal dysfunction and central nervous system disorders. For the induction of anesthesia, droperidol 0.06-0.1 ml.kg-1, fentanyl 2-4 micrograms.kg-1, and ketamine 1.0-1.5 mg.kg-1 were slowly administered intravenously. A total dose of 5-15 micrograms.kg-1 of fentanyl was given intravenously with continuous infusion of ketamine 2 mg.kg-1.h-1 during the surgical procedure. The total amounts of fentanyl and ketamine administered were 4.9-22.2 micrograms.kg-1 and 240-340 mg.kg-1, respectively. We used HZI'Brain Function Monitoring system to evaluate their EEG patterns. When adequate depth of anesthesia was obtained as clinically evaluated by vital signs, theta wave pattern was dominant on the EEG tracings in any of these patients. DFK anesthesia would provide a stable anesthetic course, if those drugs are administered adequately considering vital signs including systemic blood pressure, heart rate, lacrimation and involuntary muscle movements of the face and extremities.

Adult↗

PubMed1993

[Effects of ketamine on pituitary-adrenal axis in rats].

We examined the effects of ketamine (20 mg.kg-1) on plasma ACTH, Comp. B, aldosterone and ir-ANP levels in unstrained rats. We divided rats into two groups, saline group as control (saline group) and ketamine group (ketamine treated rats). Plasma samples were taken before ketamine or saline infusion to determine a pre-treatment value, and samples were also taken at 15, 30, 60 minutes after the infusion. ACTH, aldosterone and ir-ANP were measured by radioimmunoassay. Comp. B was determined by a fluorometric method. We obtained the following results: 1) Plasma ACTH levels increased significantly in the ketamine group, while there was no such a marked increase in the saline group. The slight increase in ACTH in the saline group could have resulted from handling during i.v. infusion or psychic stress; 2) Plasma corticosterone and aldosterone levels increased markedly in both groups. However, the magnitude of the adrenocortical response was significantly greater than in the saline group; 3) Plasma ir-ANP showed no significant change in both groups. These results suggest that ketamine stimulated pituitary-adrenal axis, and the adrenal stimulation produced by ketamine are greater than those induced by the stress of handling or psychic stress.

Adrenocorticotropic Hormone↗

PubMed1993

[Hemodynamic and endocrine responses to prostaglandin E1 induced hypotension during enflurane anesthesia in surgical patients--evaluation by transesophageal echocardiography].

This study was undertaken to find a relationship between cardiac function indices and endocrine functions during prostaglandin E1 induced hypotension in surgical patients. Thirteen patients who underwent either orthopedic or gynecologic surgery were the subjects of the study. Systolic blood pressure decreased to 80 torr with prostaglandin E1 infusion (0.5-2 micrograms.kg-1 x min-1) under enflurane-N2O anesthesia. The cardiac function were judged by transesophageal echo-cardiography. Plasma ANP and ADH levels were measured by radioimmunoassay. Significant reductions in the left atrial diameter and A/R and significant increases in cardiac output were observed, but there were no significant changes in fractional shortening and pulmonary vein flow. Plasma ANP concentrations decreased significantly from 45.3 +/- 5.1 pg.ml-1 (mean +/- SE) of pre-hypotension to 32.6 +/- 2.2 pg.ml-1 of control, but plasma ADH levels increased significantly during hypotension (P < 0.05). We could not find any significant correlation between the cardiac function indices and plasma hormone levels. Transesophageal echocardiography is an excellent monitor during induced hypotension. It is difficult to predict the ANP and ADH levels by measuring cardiac function as judged by TEE.

Adult↗

PubMed1993

[Effects of intravenous infusion of isosorbide dinitrate on hemodynamics during anesthesia and surgery].

Ninety nine patients with ischemic changes of the heart on preoperative and intraoperative ECG tracings were studied to evaluate effects of intravenous infusion of isosorbide dinitrate on hemodynamics during anesthesia and surgery. These patients ranging in ages from 24 to 80 years were administered intravenous isosorbide dinitrate at a rate of either 0.5 or 1 microgram.kg-1 x min-1 during anesthesia and surgery. Arterial blood pressure was not influenced with intravenous isosorbide dinitrate at the speed of 0.5 microgram.kg-1 x min-1 during anesthesia and surgery. The arterial pressure of the patients decreased slightly but significantly 30 min after the start of 1 microgram.kg-1 x min-1 of isosorbide dinitrate infusion, but it recovered to the control level at the end of administration of isosorbide dinitrate. Heart rate was unchanged with intravenous isosorbide dinitrate during anesthesia and surgery in both groups, except a mild increase at the end of isosorbide dinitrate infusion of 1 microgram.kg-1 x min-1. Arterial blood oxygen tension showed no decrease during the administration of isosorbide dinitrate and no adverse reactions associated with administration of the drug was detected in this study. Significant improvement of ischemic changes on ECG tracings were observed in about 25% of the patients who received 1 micrograms.kg-1 x min-1 of intravenous isosorbide dinitrate.

Adult↗

PubMed1993

[Clinical study of total intravenous anesthesia with droperidol, fentanyl and ketamine--effects of nicardipine, diltiazem and nifedipine on intraoperative hypertension].

Effects of Ca ion channel blockers, nicardipine, diltiazem and nifedipine on intraoperative hypertension were evaluated clinically in ninety surgical patients who received various surgical procedures under total intravenous anesthesia with droperidol, fentanyl and ketamine. When the systemic blood pressure exceeded 160 mmHg systolic at least for ten minutes, even though they received a total dose of 10-15 micrograms.kg-1 of fentanyl, one of the following three antihypertension drugs was administered:nicardipine 0.5-1.0 micrograms i.v., diltiazem 5-10 mg i.v. and nifedipine 5-10 mg intranasally. The effects were evaluated by measuring the systemic blood pressure, heart rate and rate pressure product, before the administration as well as 5, 15, 20 and 30 minutes after the administration. Following the injection of the drug a significant 10-20% reduction in the mean systemic blood pressure was observed in the nifedipine group, while less decrease was observed in the diltiazem and nicardipine groups. The mean heart rate in the nifedipine group increased slightly, while a slight decreases was observed in the other two groups. Therefore the rate pressure product was reduced significantly in three groups, but there was no significant difference among them. No adverse episodes such as ischemic changes on E.K.G. and deterioration of the cardiovascular system were encountered in any patients. We conclude that any of these drugs, particularly nifedipine would be appropriate to control hypertension during total intravenous anesthesia with droperidol, fentanyl and ketamine.

Anesthesia, Intravenous↗

PubMed1993

[Plasma levels of isosorbide dinitrate and its metabolites during intravenous infusion in surgical patients--effect of preoperative administration of isosorbide dinitrate].

Nineteen patients with ischemic heart disease were studied to determine plasma levels of isosorbide dinitrate (ISDN) and its metabolites, isosorbide-2-mononitrate (2-ISMN) and isosorbide-5-mononitrate (5-ISMN) for 6 hrs during intravenous administration of ISDN, using gas chromatography. Differences in plasma levels of these substances were also evaluated in patients with or without preanesthetic medication of ISDN. These patients ranging in ages from 42 to 80 years were administered ISDN intravenously at a rate of 1 micrograms.kg-1 x min-1 during anesthesia and surgery. Preanesthetic administration of ISDN consisted of transdermal application of 40 mg dose. Surgery included gastrectomy, pneumonectomy, extended cholecystectomy, radical mastectomy and so on under either enflurane anesthesia or neuroleptanesthesia. Plasma ISDN levels increased and reached a plateau 3 hrs after the start of intravenous infusion of ISDN in patients of both groups. Plasma 2-ISMN levels increased gradually and reached a plateau 5 hrs after the commencement of intravenous administration of ISDN in patients of both groups. Plasma 5-ISMN levels increased gradually reaching the peak 6 hrs after the start of intravenous infusion of ISDN in both groups. Plasma ISDN, 2-ISMN and 5-ISMN levels were slightly higher in patients who received preanesthetic ISDN than in those who did not receive preanesthetic ISDN. However, there were no statistical differences in plasma ISDN or 2-ISMN levels between the groups except prior to the infusion. On the contrary, plasma 5-ISMN levels were significantly higher in patients who received preanesthetic ISDN than in those who did not receive preanesthetic ISDN for 3 hrs after the start of the infusion.

Adult↗

PubMed1993

[Excessive nitrous oxide exhalation by postoperative patients in the recovery room].

Expired nitrous oxide from patients in the recovery room is considered to be the major source of air pollution. We measured expired concentrations of nitrous oxide in three patients and three volunteers. After only 5 minute inhalation of 50% nitrous oxide, it took over 2 hours for exhaled N2O concentration to decrease to 25 ppm in volunteers and after 30 minute inhalation, it took over 4 hours. The patients inhaled 50% nitrous oxide for 60, 165, 150 minutes, respectively and all patients expired nitrous oxide, the concentrations of which exceed 100 ppm over 3 hours. As to the patient who inhaled nitrous oxide for 150 minutes, expired nitrous oxide over 25 ppm was detected 10 hours after the end of anesthesia, and it was 4 ppm even after 20 hours. Any personnel including anesthesiologists and nurses working in the operating room can be exposed to high concentrations of nitrous oxide exceeding the permissible limit of 25 ppm, whenever they take care closely of their patients. We do not have any effective measures to protect us from this kind of air pollution except employing total intravenous anesthesia.

Adult↗

PubMed1993

[A case report of total intravenous anesthesia for renal transplantation].

A 20-year-old female patient with chronic renal failure received renal transplantation under total intravenous anesthesia with droperidol, fentanyl and ketamine. Anesthesia was induced with droperidol 12.5 mg, fentanyl 100 micrograms, ketamine 100 mg and vecuronium bromide 5 mg, and maintained with fentanyl and ketamine. Ketamine was given continuously at a rate of 2.0 mg.kg-1.h-1. After the renal artery and vein of the donor kidney were anastomosed with the patient's internal iliac artery and vein, the urine output of 7.7 ml.min-1 was obtained. The patient recovered from anesthesia smoothly and her postoperative course was uneventful. Although plasma epinephrine, cortisol and ADH levels showed significant changes during anesthesia mainly due to surgical stress, they returned to normal values after the end of operation. We conclude that this method of anesthesia would be a choice for renal transplantation.

Adult↗

PubMed1993

[An emergency operation for a Jehovah's Witness with ruptured thoracic saccular aneurysm].

A 49-year-old male "Jehovah's Witness" was transferred to our hospital with hypotension, abdominal pain, and abdominal distension, and a diagnosis of ruptured thoracic saccular aneurysm was made. He and his family insisted on having an emergency operation for his ruptured aneurysm without blood transfusion. After an intensive discussion among the patient, his family, surgeons, and the director of the hospital, we performed the operation without blood transfusion. The operation using cardiopulmonary bypass took about five hours under enflurane anesthesia, but he died of circulatory collapse fifteen hours after the end of operation. As there may be various opinions concerning how we should take care of Jehovah's Witness patients, we have to manage them case by case.

Adult↗

PubMed1993

[Anesthetic experience of emergency cesarean section for a patient with myotonic dystrophy].

We report an anesthetic experience of a 28-year-old female patient complicated with myotonic dystrophy who underwent emergency Cesarean section due to threatened abortion. Anesthesia was induced with intravenous thiopental followed by topical spray of 4% lidocaine 5 ml to intubate trachea and maintained with neuroleptanesthesia with droperidol, fentanyl and nitrous oxide in oxygen. No muscle relaxant was used. The course of anesthesia and emergence from anesthesia were uneventful. However, the female infant, with Apgar score of 1 point at five minutes after delivery, died due to multiple organ failure three weeks after the delivery. Anesthetic management of a patient with myotonic dystrophy was also discussed with a literature review.

Abortion, Threatened↗

PubMed1992

Adsorption of sevoflurane by soda-limes.

Dry soda-lime adsorbs significant quantities of halothane, thus influencing on the speed of the induction of anaesthesia with the agent and also on the recovery from anesthesia. Sevoflurane is a new inhaled anesthetic. Although the chemical degradation of sevoflurane with soda-lime has been studied, no information is available about its adsorption by soda-lime. This issue can not be neglected clinically. Two different soda-limes were placed in saturated vapour of sevoflurane for 17 hours to weight adsorbed sevoflurane. Then soda-limes adsorbing sevoflurane was sealed in a test tube after air-drying for 1) 0 min, 2) 10 min, 3) 30 min and 4) 17 hours. The vapour phase of sevoflurane in the test tube at various temperatures were determined using gas chromatography. Sevoflurane vapour concentrations in the test tubes increased in a temperature-dependent manner. Those in the conventional soda-lime were higher than those in the new soda-lime under any experimental conditions. Sevoflurane was released from soda-limes even after air-drying for 17 hours. These results show that much amount of sevoflurane is adsorbed by soda-limes and is released easily in the air. Thus there is a possibility for our patients to inhale unexpected inhaled anesthetics, if we use our anesthetic machine repeatedly.

Journal Article↗

PubMed1992

[Autonomic nervous function and plasma catecholamine levels of perioperative patients treated with antipsychotic drugs].

The RR intervals on ECG and the coefficient of variation of R-R interval (CV) and perioperative plasma catecholamine levels were measured in patients receiving long-term administration of antipsychotic drugs. CV was significantly reduced (P less than 0.05) in patients on antipsychotic drugs. Preoperative plasma catecholamine levels increased significantly and elevation of plasma catecholamine levels on the first postoperative day was less than that of the control group. These findings suggest that the patients on antipsychotic drugs have disturbed autonomic nervous function. Therefore, a careful perioperative care is mandatory.

Adult↗

PubMed1992

[A relationship between plasma ANP concentration and hemodynamics during PEEP--evaluation by transesophageal ECHO cardiography].

This study was undertaken to find which cardiac function indices as judged by transesophageal ECHO cardiography (TEE) would accurately predict the plasma ANP levels during PEEP. Fourteen patients who underwent orthopedic surgery were the subjects of the study. PEEP 10 cmH2O or 15 cmH2O was added with a PEEP valve during mechanical ventilation under general anesthesia. The cardiac function indices were measured using a 5 MHz TEE probe and plasma ANP levels were evaluated by radioimmunoassay. There were significant reductions in the left atrial diameter, cardiac output and pulmonary venous flow during PEEP, while A/R and CVP were significantly increased. The plasma ANP concentration decreased significantly from 39.2 +/- 4.8 pg.ml-1 at pre PEEP period to 26.8 +/- 3.1 pg.ml-1 at PEEP 15 cmH2O (mean +/- SE, P less than 0.05). However, we could not find any significant correlation between the cardiac function indices and ANP levels. The secretion of ANP from the heart is regulated mainly by stretch tension of the atrium. PEEP increases the pericardial pressure. Therefore, it seems to be difficult to predict the stretch tension of the atrium using TEE under PEEP.

Adult↗