Biomedical subjects

A Matsuki

Publications and source records attributed to A Matsuki.

At least 253 records · Page 14Linked to original sources

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--13. Application for pediatric patients].

Total intravenous anesthesia with droperidol, fentanyl, and ketamine (FK) was administered to 56 pediatric surgical patients ranging in ages from 5 to 15 years to evaluate their hemodynamics during anesthesia, post-operative hepatic as well as renal functions, and post-operative sedation as well as analgesia. These data were compared with those of the patients who underwent almost the same surgical procedures under enflurane-N2O anesthesia. The post-operative s-GOT, s-GPT, BUN, creatinine levels were not elevated significantly as compared with pre-operative levels in the FK group. As compared with those patients who received enflurane anesthesia, the blood pressure in the FK groups was higher by 15-30 mmHg, but it was stable during anesthesia without any complications. Their post-operative sedation and analgesia were better in the FK group than in the enflurane group and the complications such as nausea and vomiting were observed less frequently in the FK patients than in the patients who received anesthesia with ketamine alone reported in literatures. The data described above suggest that this method of anesthesia deserves further detailed clinical trials for pediatric patients.

Adolescent↗

PubMed1991

[Plasma alpha-human atrial natriuretic polypeptide levels during surgery for pheochromocytoma].

We measured plasma alpha-human atrial natriuretic polypeptide (alpha-hANP) and catecholamine concentrations during anesthesia and surgery for pheochromocytoma in five patients ranging in ages from 19 to 69. Plasma catecholamine concentrations and systemic blood pressure increased extremely during surgical manipulation of the tumor, while plasma alpha-hANP levels did not change even during surgical manipulation or after removal of the tumor as compared with preanesthetic values. Our findings suggest that plasma alpha-hANP levels were unchanged during anesthesia and surgery for human pheochromocytoma.

Adrenal Gland Neoplasms↗

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--7. Effects on natural killer cell activity].

Twenty four patients who underwent ophthalmic surgery were studied to evaluate activities of natural killer (NK) cells during and following total intravenous anesthesia with droperidol, fentanyl and ketamine. They were divided into three equal groups according to anesthetic methods employed. In enflurane group, anesthesia was induced with thiopental 5 mg.kg-1 and succinylcholine 1 mg.kg-1, and maintained with 1-2% enflurane, nitrous oxide (50%) and oxygen (50%). In original NLA group, anesthesia was induced as above and maintained with droperidol 0.15 mg.kg-1, fentanyl 5-10 micrograms.kg-1, nitrous oxide (70%) and oxygen (30%). The patients of total intravenous anesthesia group received droperidol 0.15 mg.kg-1, ketamine 2 mg.kg-1 and succinyl-choline 1 mg.kg-1 for induction of anesthesia, and then were given fentanyl 5-15 micrograms.kg-1, ketamine 2 mg.kg-1.hr-1 and oxygen (30%) for the maintenance of anesthesia. Vecuronium was given to every patient of the three groups for intraoperative muscle relaxation. Hartmann's solution was used at a speed of 5 ml.kg-1.hr-1. Peripheral venous blood 10 ml was drawn on six occasions during and after the surgery for the measurement of NK cell activities and endocrine response as judged by plasma catecholamine and cortisol levels. NK cell activities decreased significantly on the first post-operative day in enflurane group, but no significant differences were found among three groups in NK cell activities. The data suggest that inhaled anesthetics should not be easily employed for patients with depressed immune response, malignant disease and prolonged surgery.

Anesthesia, Intravenous↗

PubMed1991

[Severe bradycardia and hypotension during spinal anesthesia: a report of five cases without morbidity].

We reported five cases of sudden onset of bradycardia and hypotension during spinal anesthesia in which measurable parameters of the patients were monitored continuously by inter-operating-room local area network system. In the first two cases, episodes of bradycardia and hypotension were caused by incomplete spinal blockade. In the third patient, severe bradycardia was preceded by gradual decrease of heart rate following high spinal blockade. In the last two cases of high spinal anesthesia, no remarkable change of the heart rate was observed before sudden onset of bradycardia and hypotension. All five patients were easily and adequately treated and they showed no signs of hypoxia. We would like to emphasize the importance of adequate and continuous monitoring during spinal anesthesia.

Adolescent↗

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--8. Hepatic and renal functions following prolonged surgical operation of over 10 hours].

Forty-four patients were studied to evaluate their postoperative hepatic and renal functions on 2nd to 4th and 7th to 10th postoperative days as judged by serum GOT, GPT, BUN and creatinine levels. The patients were divided into two groups. Twenty two patients received total intravenous anesthesia with droperidol, fentanyl and ketamine (FK group). The remaining 22 patients were given conventional enflurane-nitrous oxide anesthesia. The two groups were comparable concerning age, body weight, sex distribution, performed operation, operation time and anesthesia time. In the total intravenous group, fluid given and urine output were significantly larger than those of the enflurane group, and the amounts of blood loss and blood given tended to be greater but insignificantly in the total intravenous group than in the enflurane group. In both groups, postoperative S-GOT levels increased significantly and those of the enflurane group were significantly higher than those of the FK group on 2nd to 4th postoperative days. In the enflurane group, postoperative S-GPT levels were significantly higher, but those of the FK group were not. S-GPT on 2nd to 4th postoperative days of the enflurane group were significantly higher than those of the FK group. As to serum BUN and creatinine, no significant differences were observed between the two groups. These data suggest that FK is much more beneficial than enflurane anesthesia to protect hepatic functions, particularly when it is applied for prolonged surgical procedures.

Anesthesia, Intravenous↗

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--9. Control of intraoperative hypertension with diltiazem].

Intraoperative hypertension over 160 mmHg systolic and sinus tachycardia over 100 bpm are often observed during total intravenous anesthesia with droperidol, fentanyl and ketamine. Fifty-seven surgical patients who developed hypertension over 160 mmHg systolic during various operative procedures under this type of anesthesia were given diltiazem intravenously to overcome the situation. Their blood pressure and heart rate decreased soon after the administration of diltiazem. The rate pressure product was reduced significantly. Neither preoperative hypertension nor difference of doses between 5 mg and 10 mg of diltiazem had any significant relationship with hypotensive effect of intravenous diltiazem. But the higher the systolic-pressure was just before the administration of diltiazem, the more effective diltiazem was. No adverse effects with this drug was observed. We can conclude that intravenous diltiazem in a dose of 5 mg or 10 mg may be repeatedly given to overcome hypertension or sinus tachycardia during this type of anesthesia without any adverse effects.

Anesthesia, Intravenous↗

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--3. Pharmacokinetics during prolonged continuous ketamine infusion].

A simple and precise method has been developed for the analysis of plasma ketamine and its metabolites using gas chromatography with flame ionization detection after elution by trifluoroacetic dehydride. Seven surgical patients who received total intravenous anesthesia with droperidol, fentanyl and ketamine anesthesia over 5 hours were the subjects of the study. During the anesthesia, ketamine levels were from 1.0 to 2.0 micrograms.ml-1. After the termination of ketamine infusion, their levels decreased gradually. Metabolites I levels were elevated gradually to about twofold of that of ketamine and remained high. Metabolite II was detected in only two patients and their levels were under 0.2 micrograms.ml-1. The results of our study suggest that this type of anesthesia of prolonged duration is safe as judged by the present pharmacokinetic study.

Adult↗

PubMed1991

[An emergency cesarean section using general anesthesia for a patient with schizophrenia].

A 27 year-old female in 39th week gestation with schizophrenia underwent an emergency Cesarean section using general anesthesia. A diagnosis of schizophrenia was made two years previously, since then oral anti-psychotic drugs such as chlorpromazine had been given to her. In June 1989 she suddenly became excited and generalized muscle rigidity was observed without any triggering episodes. Her excitement was so marked that we had to administer intramuscular levomepromazine 75 mg and diazepam 10 mg to her, but they failed to sedate her adequately. Emergency Cesarean section was scheduled to overcome this situation. Spinal or epidural anesthesia was not indicated because of her vigorous excitement, and anesthesia was induced with thiopental 350 mg and succinylcholine 40 mg. Induction-delivery time was 12 minutes. Pentazocine 30 mg in combination with nitrous oxide was given for the maintenance of anesthesia. Plasma levomepromazine levels were 46.9 ng.ml-1 in the mother and 11.3 ng.ml-1 in the umbilical vein, respectively. The baby's Apgar score was 9 and 1 min and 9 at 5 min after the delivery. The baby developed slight generalized tremor until next day, probably due to effect of levomepromazine given before the Cesarean section. The patient was discharged without any cardiorespiratory trouble and her baby has been doing well so far.

Adult↗

PubMed1991

[A clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--2. Pharmacokinetics following the end of continuous ketamine infusion].

Ten surgical patients who received various operative procedures including abdominal surgery and ENT surgery were the subjects of the pharmacokinetic study of total intravenous anesthesia with droperidol, fentanyl and ketamine. Six arterial samples were taken through an indwelling catheter in the left radial artery to measure plasma levels of ketamine and its metabolites by means of gas liquid chromatography. Two hours following the end of the ketamine infusion, plasma ketamine levels decreased to 14% of the control value (0.81 micrograms.ml-1), while metabolite I (K1) was still about 1.8 micrograms.ml-1 in the plasma. The control value of plasma ketamine just before the end of its infusion had not any significant relationship with the total dose of ketamine, total dose of fentanyl, blood loss or fluid given. The results of our study suggest that long continuous ketamine infusion would be safe as judged by its pharmacokinetics.

Adult↗

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--4. Control of intraoperative hypertension with nicardipine].

Intraoperative hypertension over 160 mmHg systolic observed during total intravenous anesthesia with droperidol, fentanyl and ketamine was treated with intravenous nicardipine in 50 surgical patients. Nicardipine was given intravenously in a bolus of either 0.5 mg or 1.0 mg to treat the intraoperative hypertension. Systolic and diastolic blood pressures decreased soon after administration of nicardipine without simultaneous sinus tachycardia. Thus rate pressure product was also reduced significantly. Neither preoperative hypertension, nor systolic blood pressure just before the administration of nicardipine had any significant relationship with hypotensive effect of intravenous nicardipine. We did not experience any adverse reaction with the drug. We conclude that intravenous nicardipine in a dose of 0.5-1.0mg can be given repeatedly to overcome hypertension observed during this method of anesthesia.

Adolescent↗

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--5. An anesthetic experience of a pediatric patient with severe epilepsy].

A 6-year-old girl with severe epilepsy received an orthopedic surgery of the right hand under new total intravenous anesthesia with droperidol, fentanyl and ketamine. For the induction of anesthesia, droperidol 0.25 mg.kg-1, fentanyl 5.0 micrograms.kg-1 and ketamine 2.0 mg.kg-1 was administered intravenously. She was intubated and ventilated manually throughout the operative procedure to maintain the end tidal CO2 between 4.5 and 5.5%. For the maintenance of anesthesia, ketamine was given continuously at a rate of 2.0 mg.kg-1.hr-1. Intraoperative muscle relaxation was obtained with vecuronium bromide. The patient recovered from anesthesia uneventfully. The total doses of droperidol, fentanyl, ketamine and vecuronium were 8.75 mg, 1.0 mg, 210 mg and 7.5 mg, respectively. Neither epileptic seizure, nor any other adverse effects with anesthetics was observed during and after anesthesia and surgery. We conclude that this method of anesthesia for epileptic patients may deserve further detailed study.

Anesthesia, Intravenous↗

PubMed1991

[A review of recent advances in total intravenous anesthesia].

Recent articles on total intravenous anesthesia (TIVA) were reviewed. The definition of TIVA is a combination of hypnotic agent, analgesic drugs and muscle relaxants, excluding simultaneous administration of any inhaled drugs. Anesthesia with single and massive doses of narcotic drugs such as fentanyl for cardiac anesthesia is not described in this paper. About thirty articles on TIVA which appeared in the journals of our specialty for three years from 1988 through 1990 were reviewed. In these papers, midazolam, ketamine, propofol were employed as the hypnotic agents, and fentanyl, alfentanyl, or sufentanyl were administered for analgesia during surgery. Based on pharmacokinetic studies, continuous intravenous administration of these agents are strongly recommended and infusion pumps with or without computer may be used for this purpose. The reviewer has developed a new TIVA using droperidol, fentanyl and ketamine 2 micrograms.kg-1.hr-1 and has applied it for over 800 cases excluding cardiac surgery and craniotomy. This combination of the drugs is considered the best, because propofol, alfentanyl and sufentanyl are not available in Japan so far. TIVA has many advantages over inhaled anesthesia and it can be easily employed not only in the modern sophisticated situations but also in so-called field conditions. We anesthesiologists should be much more familiar with this method of anesthesia.

Analgesics↗

PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl, and ketamine--6. Effects on postoperative liver function].

We have developed a new method of total intravenous anesthesia with droperidol, fentanyl, and ketamine, and have administered it to more than 700 surgical patients. We studied whether this method of anesthesia would influence postoperative liver function or not. A total of sixty elective surgical patients were the subjects of this study. Thirty patients underwent total hysterectomy under either the total intravenous anesthesia (15 patients) or modified neurolept-anesthesia with pentazocine (15 patients). The remaining 30 patients underwent gastrectomy under either this total intravenous anesthesia (15 patients) or enflurane-N2O anesthesia (15 patients). The hepatic function was evaluated as judged by s-GOT, s-GPT, ALP, gamma-GPT and total bilirubin levels, before anesthesia and during the first to third postoperative day. The patients for gastrectomy under enflurane-N2O anesthesia had significantly increased postoperative gamma-GPT levels compared with the patients of total intravenous anesthesia. Any other variables showed no significant difference among groups. We consider that this method of total intravenous anesthesia has no adverse effects on postoperative liver function as compared with other usual anesthetic methods.

Anesthesia, Inhalation↗

PubMed1991

[Effect of induced hypotension with prostaglandin E1 or trimetaphan on endocrine functions in surgical patients].

Twenty patients who underwent surgery of hip joint under enflurane anesthesia were studied to evaluate the effect of induced hypotension with prostaglandin E1 or trimetaphan on endocrine functions. Ten patients were given prostaglandin E1 and the remaining ten patients were given trimetaphan intravenously to maintain systolic blood pressure at about 80 mmHg. There were no significant differences between the two groups concerning plasma level of ACTH, cortisol, TSH, T3, T4, epinephrine and dopamine. However a significant difference in plasma norepinephrine levels was observed between them. Plasma norepinephrine levels after start of hypotension increased by 50% in the prostaglandin E1 group, but decreased by 50% in the trimetaphan group, when compared with each pre-hypotensive level. The data obtained suggest that the prostaglandin E1 would not influence ACTH-cortisol and thyroid functions, but may have a tendency to increase plasma norepinephrine levels in hypertensive patients complicated with pheochromocytoma.

Endocrine Glands↗

PubMed1990

[Prostaglandin D2-endogenous regulator of physiological sleep-inhibited CRF-induced ACTH secretion from rat anterior pituitary cells].

Delta sleep-inducing peptide (DSIP) is described as being an endogenous sleep factor. This DSIP inhibits ACTH release induced by CRF from rat anterior pituitary tissue. Prostaglandin D2 (PGD2) is regarded as another endogenous sleep factor. However, little information has been accumulated concerning the involvement of PGD2 in the regulation of hormone secretion from the anterior pituitary. It was, therefore, interesting to observe the effect of PGD2 on ACTH release from rat anterior pituitary cells. Rat anterior pituitary cells were obtained by enzymatic digestion of the pituitary gland of male Wister rats. The cell pellet was suspended in Hank's balanced salt solution containing 0.1% BSA and distributed in a 800 microliter aliquot to 12 x 75mm glass tubes. The samples were preincubated for 90 min. in a 37 degrees C waterbath under 5% CO2/95% O2. After preincubation, aliquots of various concentrations of CRF, PGD2 and PGE2 were added in a 100 microliter volume and incubated for 4 hr. ACTH in the incubation medium was determined by radioimmunoassay. 0.01-1.0nM CRF significantly increased the ACTH release from rat anterior pituitary cells in a dose dependent manner. Each concentration of 0.1, 1, 2nM PGD2 or PGE2 had no effect on basal ACTH levels. 2nM PGD2 showed a significant inhibition of the CRF-induced ACTH secretion from rat anterior pituitary cells. Similarly, 2nM PGE2 significantly inhibited the CRF-induced ACTH release from rat anterior pituitary cells. The magnitude of the inhibitory effect of PGE2 was slightly higher than that of PGD2. From these results, we concluded that PGD2 inhibited CRF-induced ACTH secretion at the level of pituitary gland.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗

PubMed1990

Decreased glucose utilization during prolonged anaesthesia and surgery.

We studied the influence of prolonged anaesthesia and surgery on glucose metabolism by means of the euglycaemic insulin clamp method in eight patients who underwent prolonged surgery. Eleven patients who underwent surgery of short duration served as a control group. Plasma concentrations of catabolic hormones were measured simultaneously. Glucose utilization during prolonged anaesthesia, (PA) group, was lower than that in the control group (P less than 0.01) (glucose utilization 7.59 +/- 0.73 mg.kg-1.hr-1 in the control group vs 4.03 +/- 0.71 mg.kg-1.hr-1 in PA group respectively). There were no significant differences in plasma catecholamine and glucagon concentrations between the PA and control groups. Plasma-free fatty acid levels increased significantly in the PA group before the euglycaemic insulin clamp (free fatty acid level: 0.496 +/- 0.053 mmol.L-1 in the control group, vs 0.834 +/- 0.103 mmol.L-1 in the PA group at the pre-clamp period, P less than 0.01). Tissue resistance to exogenous insulin increased during prolonged anaesthesia and surgery although there were no significant changes in plasma catabolic hormone levels.

Adult↗

PubMed1990

Intra-operative pulmonary embolism after intravesical instillation of formalin.

Intra-operative pulmonary embolism is a rare and severe complication which is difficult to diagnose. A case is reported in which this condition occurred after intravesical instillation of formalin during radical cystectomy under general anaesthesia. Formalin may be related to formation of intravascular thrombi and result in pulmonary embolism.

Anesthesia, General↗

PubMed1990

[Treatment of priapism with intracavernous injection of etilefrine hydrochloride].

A case of priapism following epidural anesthesia was reported. A 67 year old man received epidural anesthesia for the transurethral resection of a malignant bladder tumor. Epidural anesthesia which he had wanted to receive was given through the L3 to L4 intervertebral space with 18 ml of 2% lidocaine. The penile erection occurred while he was prepared and draped. Additional 8 ml of 1% lidocaine failed to overcome it and the operation cancelled. After this episode, he had anesthesia on 5 occasions in 2 years. General anesthesia was given 3 times without penile erection, but epidural block was tried on 2 occasions, which was followed by penile erection. For the penile erection, intracavernous injection of etilefrine hydrochloride was effective and surgical procedure could be done smoothly. The mechanism of priapism remained unclear but imbalance of the autonomic nervous system may be a involved. This case suggests that intracavernous injection of etilefrine hydrochloride is effective for treatment of penile erection during transurethral surgery.

Aged↗