Biomedical subjects

A Matsuki

Publications and source records attributed to A Matsuki.

At least 55 records · Page 3Linked to original sources

PubMed2001

Comparison of initial distribution volume of glucose and plasma volume in thoracic fluid-accumulated patients.

OBJECTIVE: We have reported that initial distribution volume of glucose indicates the central extracellular fluid volume in the presence of fluid gain or loss. The purpose of this study was to describe changes in initial distribution volume of glucose, plasma volume determined by the indocyanine green dilution method (PV-ICG), and thoracic fluid content by thoracic electrical bioimpedance in patients with or without apparent thoracic fluid accumulation in the absence of pleural effusion. We also sought to test whether initial distribution volume of glucose rather than PV-ICG mirrors thoracic fluid content. DESIGN: Prospective, clinical study. SETTING: General intensive care unit. PATIENTS: Eleven consecutive patients with apparent thoracic fluid accumulation as judged by thoracic fluid content >0.05/ohm and underlying pathology and 20 consecutive acute myocardial infarction patients within 24 hrs after its onset were selected for study. None of the acute myocardial infarction patients had thoracic fluid content >0.05/ohm. INTERVENTIONS: Five grams of glucose and 25 mg of indocyanine green were administered simultaneously to calculate initial distribution volume of glucose and PV-ICG daily for the fluid-accumulated patients, and the same dosages were administered to the acute myocardial infarction patients immediately after their admission to the intensive care unit after percutaneous coronary angioplasty. Only the data on the day of the maximal and minimal thoracic fluid content in the fluid-accumulated patients were used for the study. The relationship between these two fluid volumes and thoracic fluid content was evaluated in the two patient groups. MEASUREMENTS AND MAIN RESULTS: Initial distribution volume of glucose and thoracic fluid content rather than PV-ICG and thoracic fluid content moved together in the same direction in each fluid-accumulated patient. Neither pulmonary artery occlusion pressure, central venous pressure, nor PV-ICG produced a better correlation with cardiac index when compared with initial distribution volume of glucose in patients with or without thoracic fluid accumulation. CONCLUSIONS: We suggest that initial distribution volume of glucose rather than PV-ICG is a better indicator of the intrathoracic blood volume status, even although intravenously administered glucose cannot stay in the intravascular compartment.

APACHE↗

PubMed2001

Intraoperative prostaglandin E1 improves antimicrobial and inflammatory responses in alveolar immune cells.

OBJECTIVE: Anesthesia and surgery decrease antimicrobial and increase proinflammatory functions of alveolar immune cells. Thus, anti-inflammatory agents that do not further suppress antimicrobial functions are required. We tested the hypothesis that intraoperative prostaglandin E1 (PGE1) suppresses proinflammatory responses and prevents the reduction in antimicrobial responses of alveolar immune cells. DESIGN: Prospective, randomized, controlled, double-blind study. SETTING: University hospital. PATIENTS: A total of 40 patients undergoing elective orthopedic surgery under propofol/fentanyl anesthesia. INTERVENTION: In double-blind fashion, the patients received PGE1 from the beginning to the end of surgery (PGE1 group, n = 20) or nothing (control group, n = 20). METHODS AND MAIN RESULTS: Alveolar immune cells were harvested by bronchoalveolar lavage immediately after induction of anesthesia; 2, 4, and 6 hrs after induction of anesthesia; and at the end of surgery. We measured opsonized and nonopsonized phagocytosis. Microbicidal activity was evaluated to directly kill Listeria monocytogenes in alveolar macrophages. Finally, we determined the expression of proinflammatory cytokines including interleukin (IL)-1beta, IL-8, interferon-gamma, and tumor necrosis factor-alpha, and that of anti-inflammatory cytokines (IL-4 and IL-10) by semiquantitative polymerase chain reaction. Nonopsonized and opsonized phagocytosis and microbicidal activity of alveolar macrophages decreased and the expression of genes for all pro- and anti-inflammatory cytokines increased significantly over time in both groups. Starting 2-4 hrs after induction of anesthesia, the increases in gene expression of proinflammatory cytokines were 1.5-3 times smaller in the PGE1 than in the control group. Starting 6 hrs after anesthesia, the increase in gene expression of IL-10 was 1.5-3 times greater in the PGE1 than in the control group. Intraoperative decreases in phagocytic and microbial activities were the same in the two groups. CONCLUSION: Intraoperative PGE1 not only suppressed proinflammatory responses, but also protected antimicrobial functions of alveolar macrophages, possibly because PGE1 is mostly inactivated in the pulmonary intravascular space. Our results suggest that intraoperative PGE1 protects the pulmonary immune defense in alveolar immune cells.

Adult↗

PubMed2001

Effect of 6-hydroxydopamine on host resistance against Listeria monocytogenes infection.

Recent studies have shown that immunocompetent cells bear receptors of neuropeptides and neurotransmitters and that these ligands play roles in the immune response. In this study, the role of the sympathetic nervous system in host resistance against Listeria monocytogenes infection was investigated in mice pretreated with 6-hydroxydopamine (6-OHDA), which destroys sympathetic nerve termini. The norepinephrine contents of the plasma and spleens were significantly lower in 6-OHDA-treated mice than in vehicle-treated mice. The 50% lethal dose of L. monocytogenes was about 20 times higher for 6-OHDA-treated mice than for vehicle-treated mice. Chemical sympathectomy by 6-OHDA upregulated interleukin-12 (IL-12) and tumor necrosis factor-alpha (TNF-alpha) production in enriched dendritic cell cultures and gamma interferon (IFN-gamma) and TNF-alpha production in spleen cell cultures, whereas chemical sympathectomy had no apparent effect on phagocytic activities, listericidal activities, and nitric oxide production in peritoneal exudate cells and splenic macrophages. Augmentation of host resistance against L. monocytogenes infection by 6-OHDA was abrogated in IFN-gamma(-/-) or TNF-alpha(-/-) mice, suggesting that upregulation of IFN-gamma, IL-12, and TNF-alpha production may be involved in 6-OHDA-mediated augmentation of antilisterial resistance. Furthermore, adoptive transfer of spleen cells immune to L. monocytogenes from 6-OHDA-treated mice resulted in untreated naive recipients that had a high level of resistance against L. monocytogenes infection. These results suggest that the sympathetic nervous system may modulate host resistance against L. monocytogenes infection through regulation of production of IFN-gamma, IL-12, and TNF-alpha, which are critical in antilisterial resistance.

Adoptive Transfer↗

PubMed2001

The mechanism of cell death in human cultured colon adenocarcinoma cell line COLO 201 induced by beta-D-N-acetylglucosaminyl-p-nitrophenol.

COLO 201, human colon adenocarcinoma cells were incubated with artificial primers, p-nitrophenyl-glycoside derivatives at 1.0 mmol (mM) in the medium containing 10% fetal bovine serum to detect sugar chain elongation. However, when p-nitrophenyl-beta-N-acetylglucosamine (beta-GlcNAc-PNP) was added, the medium changed color to yellow and the cells were dead. To explain this finding, the cells were incubated with 1.0 mM each of beta-GlcNAc-PNP and 4-methylumbelliferyl-beta-N-acetylglucosamine, then the number of living cells was measured in a time course. In beta-GlcNAc-PNP, the living cells were decreased at 24 hours. The cells were survived with N-acetylglucosamine, whereas in the presence of p-nitrophenol (PNP) the living cells were decreased. It was suggested that PNP released from beta-GlcNAc-PNP induced the cell death. Activity of beta-D-N-acetylglucosaminidase was detected in fetal bovine serum. It was shown that PNP induced the cell death in time-and-dose dependent manner. Genomic DNA from COLO 201 analyzed by agarose gel electrophoresis was fragmentated. PNP analogues were tested for toxicity, and the results suggested that the phenolic OH-group linked to benzene ring and nitro-group linked to the structure in para-form (PNP) was the most effective.

Acetylglucosamine↗

PubMed2001

Expression and immunolocalization of AQP6 in intercalated cells of the rat kidney collecting duct.

The expression and localization of AQP6 were examined in rat kidneys. In the kidney compartments, the expression was more intense in the outer medulla than in the cortex or inner medulla, and was negative in the glomerulus. During development, the AQP6 mRNA expression in the kidney was not detected in the fetus, but was recognized at birth, increased gradually by 4 weeks of age, and was unchanged thereafter. In situ hybridization demonstrated significant signals for AQP6 mRNA along the outer and inner medullary collecting ducts. Since the localization of the AQP6 mRNA-expressing cells was comparable to that of immunoreactive H+ ATPase-bearing cells in the collecting duct, they were identified as intercalated cells. No AQP6 mRNA signals were recognizable in other cells in the kidneys, including glomerular cells. No glomerular expression of AQP6 mRNA was confirmed by RT-PCR using total RNA extracted from the glomeruli. Immunohistochemistry using an antibody raised against recombinant rat AQP6 protein could localize the immunoreactivity in a population of collecting duct cells. Serial section observations indicated that the AQP6-immunoreactive cells corresponded to H+ ATPase bearing intercalated cells.

Animals↗

PubMed2001

[An immediately post-operative death of a patient undergoing right external carotid artery-posterior cerebral artery bypass].

We experienced an immediately post-operative death due to rupture of a giant basilar aneurysm four hours after right external carotid artery-posterior cerebral artery bypass surgery. As we had had preanesthetic discussions with neurosurgeons repeatedly, they did not seek for a cause of the death on our anesthetic management. However, in general, not few surgeons believe that many postsurgical complications may be mainly due to anesthetic management but not to surgery as they believe that their surgical procedures are always faultless. Therefore, we should have a wealth of anesthetic knowledge to respond to any surgeon's questions regarding anesthetic management and to precisely explain a causal relation between postsurgical complications and anesthesia. In addition, we should have frequent discussions with surgeons on postsurgical management in sick patients. These may reduce misapprehensions of surgeons, patients and their family for anesthesia.

Anesthesia, General↗

PubMed2001

[Marked bradycardia during anesthetic induction treated with temporary cardiac pacing in a patient with latent sick sinus syndrome].

A 59 year-old woman with latent sick sinus syndrome was scheduled to undergo ophthalmic surgery including phacoemulsification and aspiration, vitrectomy, photocoagulation and intraocular lens under general anesthesia. Preoperative ECG showed sinus rhythms of 77 bpm without bradycardia or a sinus pause. Total intravenous anesthesia with propofol, fentanyl, ketamine and vecuronium was employed for the induction of anesthesia immediately followed by severe bradycardia with a rate of 36-40 bpm including sinus arrest and atrio/nodal escaped beats. Intravenous atropine was ineffective to restore the heart rate and then urgent temporary pacing was successfully applied to overcome bradycardia. The patient recovered uneventfully from anesthesia. She complained of being dizzy and faint with prominent bradycardia due to sick sinus syndrome three months after the surgery. Therefore she underwent permanent cardiac pacemaker implantation successfully. Temporary pacing is mandatory when anesthesia is given to surgical patients with latent sick sinus syndrome.

Anesthesia, General↗

PubMed2001

[Combination of acute normovolemic hemodilution technique with preoperative autologous blood donation prevented allogeneic blood transfusion against 4000 g surgical blood loss in a patient undergoing left partial nephrectomy].

A 41-year-old male patient with well-controlled hypertension underwent a partial nephrectomy under total intravenous anesthesia with propofol, fentanyl and ketamine. To avoid allogeneic blood transfusion, preoperative autologous blood donation (400 g) a week before the surgery and acute normovolemic hemodilution (800 g) after induction of anesthesia were performed. As surgical blood loss was more than 4000 g, blood hemoglobin (Hb) level decreased to 6.4 g.dl-1. However, as intraoperative hemodynamics was relatively stable with no ischemic changes in ECG and arterial blood gas analysis did not show metabolic acidosis, autologous blood transfusion was withheld till hemostasis had been done. After returning the autologous blood, Hb increased to 9.4 g.dl-1. On the 2nd postoperative day, Hb decreased to 7.6 g.dl-1. As the patient's vital signs did not show any severe complications, blood transfusion was not performed. Then, the Hb level increased gradually to 13.9 g.dl-1, 3 month later without allogenic blood transfusion. In addition, any postoperative complications by low Hb level were not recognized so far. This case suggests that combination of autologous transfusion techniques may be effective to avoid allogeneic blood transfusion even against massive hemorrhage. However, to avoid disadvantage of these technique, we should always evaluate preoperative patient conditions.

Adult↗

PubMed2001

[New studies on the history of anesthesiology--(7). What anesthetics were given to soldiers of the fifth regiment rescued from death march on Mount Hakkoda?].

Two hundred and ten soldiers belonging to the fifth regiment of the Japanese Imperial Army started their march on Mount Hakkoda in the early morning of January 23rd, 1902. In the afternoon, they unfortunately met with a bad weather of violent gale, heavy snowfall and biting coldness to lose their way to proceed to a small village Tashiro. In the following several days, many soldiers were frozen to death and only seventeen were rescued. They were brought to the Aomori Military Hospital for admission. Among them the First Lieutenant Kuraishi and two officers were almost free from frost bite but the Major Yamaguchi died next day and a soldier died two days after his admission without any surgical treatment. The remaining eleven underwent amputation of their frostbitten extremities under general anesthesia by open drop method with a mixture of chloroform and ether, because chloroform anesthesia per se was considered much more injurious than ether to patients with poor physical status. The Military Hospital announced that the Major Yamaguchi had died due to sudden cardiac arrest, but a lay view that he had committed suicide with his gun has widely prevailed, particularly since Jiro Nitta, a novelist, referred to it in his novel "Death March on Mount Hakkoda" in 1971. According to newly discovered manuscripts written by a military surgeon Ki-ichi Murakami who served in the rescue services, both hands of the Major Yamaguchi were heavily frostbitten and his fingers were strongly flexed unable to move the trigger of his gun. Considering situations including the dates of Sadae Nakahara's visit to Aomori who was a military surgeon of the Yamagata Military Hospital, the mysterious content of a telegram to Gentaro Kodama, the War Minister, from the General Shobun Tachimi, the 8th division commander and the sudden closure of the Hospital on February 2nd, when the Major Yamaguchi died, there is a possibility that high concentrations of chloroform vapour might have been compulsorily administered to the Major Yamaguchi to cause him cardiac arrest, which the executive members of the Japanese Imperial Army would have secretly expected.

Anesthesia, General↗

PubMed2001

[New study on the history of anesthesiology (8)--Etymological consideration on a Japanese word "Masui"].

The author briefly describes etymology of a Japanese word "Masui" ([symbol: see text]) and discusses why this word has not been correctly understood by lay people as well as Japanese anesthesiologists. The word "Masui" was coined by Seikei Sugita in 1850 when he translated Dutch edition of Schelesinger's monograph on ether anesthesia into Japanese. Therefore the word is not of Chinese origin and has subsequently been exported to China and the countries of Korean peninsula. Although half a century has elapsed since the first Department of Anesthesiology was established at the Tokyo University Faculty of Medicine, social acceptance for our specialty has not adequately and widely been achieved. The author thinks that one of the causes for this inadequate acceptance is that the correct Japanese words of "Masuika-gaku" and "Masuika-i" for Anesthesiology and Anesthesiologists were not coined and the incorrect words as "Masuigaku" and "Masui-i" have been used. Not a small number of Japanese anesthesiologists still employ the words "Masuigaku" and "Masui-i" without any special reasons.

Anesthesiology↗

PubMed2001

[A case of long-term respiratory management following resection of a huge facial hemangioma].

A 49 year-old-woman was scheduled for resection of a huge hemangioma of the face and neck region. After the resection, severe edema developed on the tongue, larynx, and pharynx even leaving no space between the tracheal tube and these tissues. Prolonged respiratory management with endotracheal tube intubation was needed to maintain the upper airway for more than three weeks. Tracheostomy was performed 27 days after the operation. Two weeks later, the edema of the upper airway subsided. Thereafter her clinical course was uneventful, and she was discharged 22 days after the tracheostomy. Resection of a huge facial and neck hemangioma should be carefully managed as it can be followed by unexpected severe postoperative upper airway edema leading to suffocation.

Edema↗

PubMed2000

Intrathecal methylprednisolone for intractable postherpetic neuralgia.

BACKGROUND: There is no effective treatment for intractable postherpetic neuralgia. Because there is evidence that postherpetic neuralgia has an inflammatory component, we assessed treatment with intrathecally administered methylprednisolone to reduce pain in patients with this disorder. METHODS: We enrolled 277 patients who had had intractable postherpetic neuralgia for at least one year, 270 of whom were followed for two years. The patients were randomly assigned to receive intrathecal methylprednisolone and lidocaine (3 ml of 3 percent lidocaine with 60 mg of methylprednisolone acetate, 89 patients), lidocaine alone (3 ml of 3 percent lidocaine, 91 patients), or no treatment (90 patients) once per week for up to four weeks. Each weekly dose was injected into the lumbar intrathecal space. Pain was evaluated before randomization, at the end of the treatment period, and then four weeks, one year, and two years later. Samples of cerebrospinal fluid were obtained for measurement of interleukin-8 before and at the end of the treatment period. RESULTS: There was minimal change in the degree of pain in the lidocaine-only and control groups during and after the treatment period. In the methylprednisolone-lidocaine group, the intensity and area of pain decreased, and the use of the nonsteroidal antiinflammatory drug diclofenac declined by more than 70 percent four weeks after the end of treatment. No complications related to intrathecal methylprednisolone were observed. Before treatment, the concentrations of interleukin-8 in the cerebrospinal fluid were inversely related to the duration of neuralgia in all the patients (r=-0.49, P<0.001). In the patients who received methylprednisolone, interleukin-8 concentrations decreased by 50 percent, and this decrease correlated with the duration of neuralgia and with the extent of global pain relief (P<0.001 for both comparisons). CONCLUSIONS: The results of this trial indicate that the intrathecal administration of methylprednisolone is an effective treatment for postherpetic neuralgia.

Aged↗

PubMed2000

Barbiturates inhibit K(+)-evoked noradrenaline and dopamine release from rat striatal slices--involvement of voltage sensitive Ca(2+) channels.

The cellular target site(s) for anaesthetic action remain unclear. In rat striatal slices we have previously demonstrated that K(+)-evoked noradrenaline (NA) and dopamine (DA) release is mediated predominantly via P/Q-type voltage sensitive Ca(2+) channels (VSCC). Using this model of Ca(2+) dependent transmitter release we have evaluated the effects of anaesthetic and non-anaesthetic barbiturates. Rat brain striatal slices were incubated in the absence and presence of barbiturate for 10 min at 37 degrees C. The slices were then incubated for 6 min with 40 mM KCl. All anaesthetic barbiturates produced a concentration-dependent inhibition of K(+)-evoked NA and DA release. Non-anaesthetic barbiturate, barbituric acid was ineffective. The pIC(50) for NA and DA release (thiopental: 4.90+/-0.13 and 5.00+/-0.10, pentobarbital: 4.39+/-0.07 and 4.43+/-0.14, phenobarbital: 3.85+/-0.08 and 3.59+/-0.10, respectively) correlated with lipid solubility (NA: r(2)=0.999, DA: r(2)=0.987). We therefore suggest that barbiturates inhibit catecholamine release via an interaction with P/Q VSCC further implicating this channel in anaesthetic action.

Anesthetics↗

PubMed2000

The initial distribution volume of glucose rather than indocyanine green derived plasma volume is correlated with cardiac output following major surgery.

OBJECTIVES: To determine whether the initial distribution volume of glucose (IDVG) rather than plasma volume or blood volume is correlated better with cardiac output during the 4 days following major surgery. DESIGN AND SETTING: Prospective clinical investigation in the general intensive care unit of a university hospital. PATIENTS AND METHODS: 31 consecutive patients who underwent radical surgery for esophageal carcinoma were enrolled. Continuous thermodilution cardiac output monitor was placed in the operating room. Indocyanine green (ICG; 25 mg) and glucose (5 g) were administered simultaneously to calculate IDVG and plasma volume determined using the ICG dilution method. Blood volume was also calculated from plasma volume ICG and hematocrit. Those volumes were measured on admission to the ICU and daily on the first 3 postoperative days. The relationships between each volume and cardiac index (CI), and between routine clinical variables and CI were evaluated. RESULTS: IDVG had a linear correlation with CI in the early postoperative days (r = 0.71, n = 124, p < 0.000001). Measurements of neither the plasma volume nor the blood volume yielded a better correlation with CI than did IDVG (r = 0.45, n = 124, p < 0.000001, and r = 0.23, n = 124, p < 0.01, respectively). No correlation was found between pulmonary artery wedge pressure and CI or between central venous pressure and CI. CONCLUSIONS: Our results indicate that IDVG rather than intravascular volume is correlated with cardiac output. We suggest that IDVG has potential as an alternative indicator of cardiac preload following major surgery.

Adult↗

PubMed2000

Glucose dilution can detect fluid redistribution following phentolamine infusion in dogs.

OBJECTIVE: We have recently reported that the initial distribution volume of glucose (IDVG) reliably measures the central extracellular fluid (ECF) volume in the presence of fluid gain or loss. However, it is not clear if IDVG consistently reflects central-ECF volume when redistribution of fluid occurs in the absence of fluid gain or loss. This study was designed to investigate changes in fluid volumes during phentolamine infusion in dogs. DESIGN: Prospective animal study. SETTING: Institutional animal research laboratory. SUBJECTS: Fourteen anesthetized and ventilated mongrel dogs. INTERVENTIONS: Anesthetized animals were mechanically ventilated and received infusions of normal saline (n = 7) or phentolamine (10 microg kg min) (n = 7). Plasma volume was estimated using the indocyanine green (ICG) dilution method (PV-ICG) and IDVG was calculated using a one-compartment model by simultaneous administration of ICG 0.5 mg/kg and glucose 100 mg/kg before, during, and after infusion of either drug. MEASUREMENTS AND RESULTS: PV-ICG during infusion was not different between groups. However, IDVG significantly decreased (P < 0.05) following phentolamine infusion when compared with normal saline infusion. CONCLUSION: Our results suggest that IDVG rather than PV-ICG consistently measures central extracellular fluid volume, even when redistribution of fluid occurs.

Adrenergic alpha-Antagonists↗

PubMed2000

Effect of linear polarized light radiation on impaired mitochondrial oxidative phosphorylation in skeletal muscle.

PURPOSE: The aim of this study was to investigate the effect of linear polarized light radiation (LPLR) on mitochondrial oxidative phosphorylation impaired by hemorrhagic shock or Escherichia coli lipopolysaccharide (LPS) in skeletal muscle. METHODS: We studied the effect of LPLR on mitochondrial function of skeletal muscle by using a model of mitochondria impaired by hemorrhage or LPS. The oxygen uptake in states 3 and 4, the respiratory control ratio (RCR), and the adenosine diphosphate-to-oxygen ratio (ADP/O) were measured with a Clark oxygen electrode. RESULTS: Oxygen uptake in states 3 and 4, RCR, and ADP/O were significantly decreased by hemorrhage for 4 h and by LPS treatment for 12 h. Oxygen uptake in states 3 and 4 impaired by hemorrhage increased significantly from 40.1 +/- 3.2 to 60.1 +/- 5.4 nmol O(2).min(-1).mg protein(-1) after LPLR, and oxygen uptake in state 4 decreased significantly from 22.8 +/- 2.4 to 17.7 +/- 1.5 nmol O(2).min(-1).mg protein(-1) after LPLR. RCR and ADP/O were also significantly increased from 1.8 +/- 0.3 and 0.9 +/- 0.2 to 3.4 +/- 0.3 and 1.5 +/- 0.1, respectively, by LPLR. Oxygen uptake in states 3 and 4 impaired by LPS was improved from 46.6 +/- 5.1 and 21.0 +/- 1.9 to 53.8 +/- 6.2 and 17.9 +/- 2.3 nmol O(2).min(-1).mg protein(-1), respectively following LPLR. RCR and ADP/O were also elevated significantly from 2.2 +/- 0.2 and 0.9 +/- 0.2 to 3.0 +/- 0.3 and 1.4 +/- 0.2, respectively, after LPLR. CONCLUSION: LPLR improved mitochondrial oxidative phosphorylation of skeletal muscle impaired by hemorrhagic shock or E. coli LPS.

Journal Article↗

PubMed2000

Inhibition of the cortisol response to surgical stress in chronically depressed patients.

STUDY OBJECTIVE: To evaluate whether the pituitary-adrenal and catecholamine response to surgical stress is modified in chronically depressed patients. DESIGN: Prospective, controlled study. PATIENTS: 25 ASA physical status I and II depressed patients taking chronic antidepressant therapy and 25 control patients undergoing orthopedic surgery of the extremities. INTERVENTIONS: All patients received anesthesia induction with thiopental 5 mg/kg and suxamethonium 1 mg/kg intravenously (IV) and were maintained with 1.5% to 2.0% isoflurane in nitrous oxide (70%) and oxygen (30%). MEASUREMENTS AND MAIN RESULTS: Plasma cortisol concentration (27.7 +/- 3.6 microg/dL) in chronic depressed patients at 60 minutes after the skin incision was not significantly higher than that (23.9 +/- 2.7 microg/dL) before the induction, although plasma cortisol concentration in the control group significantly increased. Plasma norepinephrine concentration at 60 min after the skin incision in depressed patients with more symptoms of depression was significantly higher than that of patients with less symptoms of depression. CONCLUSION: The cortisol response to surgical stress in depressed patients was inhibited and norepinephrine response to surgical stress was increased in depressed patients with more symptoms of depression.

Adrenocorticotropic Hormone↗

PubMed2000

Use of an EEG-bispectral closed-loop delivery system for administering propofol.

Closed-loop control of propofol delivery was instituted in three patients who received a propofol infusion as part of: (Case 1) general "balanced" anesthesia, (Case 2) total intravenous anesthesia, and (Case 3) monitored anesthesia care. The bispectral index was the input variable used in a proportioned, integral and differential controller to determine the infusion rate of propofol required to maintain a stable level of hypnosis (Cases 1 and 2) or sedation (Case 3). This feedback control system provided intraoperative hemodynamic stability and a prompt recovery from the sedative-hypnotic effects of propofol.

Adjuvants, Anesthesia↗