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Biomedical subjects

H Mitsuhata

Publications and source records attributed to H Mitsuhata.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Continuous epidural buprenorphine for postoperative pain relief after thoracotomy].

To evaluate postoperative analgesia and side effects of epidural buprenorphine, 60 patients after thoracotomy were divided into 6 groups. All patients received a bolus epidural administration of buprenorphine 0.1 mg in 8 ml of 0.25% bupivacaine. Following this epidural bolus, 10 patients in each group were given 0.25% bupivacaine alone (group A), buprenorphine 5 micrograms in 1 ml of 0.25% bupivacaine (group B), buprenorphine 8 micrograms in 1 ml of 0.25% bupivacaine (group C), buprenorphine 12 micrograms in 1 ml of 0.25% bupivacaine (group D), buprenorphine 15 micrograms in 1 ml of 0.25% bupivacaine (group E) or buprenorphine 18 micrograms in 1 ml of 0.25% bupivacaine (group F) with a portable disposable device at a rate of 1 ml.h-1 for 48 h. The percentages of patients who did not need additional narcotics for the first 24 hours postoperatively in group A, B, C, D, E, and F were 20%, 40%, 30%, 50%, 60%, and 70%, respectively. Those for the second 24 hours postoperatively in each group were 40%, 50%, 70%, 60%, 90%, and 90%, respectively. No significant difference in the incidence of side-effect was found among 6 groups. We concluded that optimal epidural doses of buprenorphine for post-thoracotomy pain relief are 15 and 18 micrograms.h-1 in the first and second 24 hours postoperatively, respectively.

Adult↗
PubMed1995

[Postoperative analgesia service by continuous epidural infusion with buprenorphine].

We examined the analgesic efficacy and side effects of continuous epidural infusion with buprenorphine in 340 surgical patients. The patients received epidural injection of 0.1 mg of buprenorphine in 8 ml of 0.25% bupivacaine immediately after surgery. The patients who underwent thoracotomy or intraabdominal surgery were subsequently infused with buprenorphine 15 micrograms in 1 ml of 0.25% buprenorphine at a rate of 1 ml.h-1 for 48 h. In the other kinds of surgery, patients were infused with buprenorphine 8 micrograms in 1 ml of 0.25% buprenorphine at a rate of 1 ml.h-1 for 48 h. The patients who did not need additional narcotics were 68% and 83% on the postoperative day 1 and 2, respectively. Visual analogue scale (VAS) was 22 +/- 2 mm at rest and 43 +/- 2 mm at movement on the postoperative day 1. Corresponding values on the postoperative day 2 were 16 +/- 2 mm and 37 +/- 2 mm, respectively. Nausea and vomiting were found in 12.4% of the patients.

Adolescent↗
PubMed1995

[Spinal anesthesia for oophorectomy in a patient with pulmonary lymphangiomyomatosis accompanied by hypochondriasis].

A 41-year-old woman with pulmonary lymphangiomyomatosis had been scheduled for bilateral oophorectomy which led to amelioration of the pulmonary pathology. The discrepancy between her dyspnea on exertion and lung function tests suggested that she had a marked tendency toward hypochondria. Therefore, we chose spinal anesthesia because of its technical simplicity, rapid onset, and effectiveness of some sedatives used perioperatively. Surgery was performed uneventfully. The anesthetic method mentioned above did not worsen respiratory function perioperatively. Spinal anesthesia is thought to be appropriate anesthesia for patients with pulmonary lymphangiomyomatosis, if feasible.

Adult↗
PubMed1995

[Usefulness of measurement of mast cell tryptase for differential diagnosis of anaphylaxis and anaphylactoid reaction].

We described a case of anaphylaxis diagnosed by the evaluation of plasma mast cell tryptase and a case of anaphylactoid reaction. In a patient undergoing pulmonary lobectomy, anaphylaxis, showing the elevation of plasma tryptase, was provoked by physiological glue for hemostasis during the operation. During the operation, cardiovascular collapse occurred suddenly, at which time the cause was not diagnosed. After completion of the operation and removal of drapes, diffuse urticaria with wide erythema on the torso and the upper extremity was noticed. Suspecting allergic adverse reaction, plasma tryptase was measured 2h and 5h after the start of the episode, showing 34.6 ng.ml-1 at 2h and 15.3 at 5h. Because these elevations of plasma tryptase indicated degranulation of mast cells, evaluation of the causative drugs was performed 7 weeks after the episode. Physiological glue was confirmed to be causative drug. In another patient for total hysterectomy and bilateral oophorectomy, adverse reaction occurred after completion of the operation and extubation. Increase in plasma histamine concentration to 4.94 ng.ml-1 that could induce systemic reaction was noticed; however, concentrations of plasma tryptase 25 min, 3h and 7h after the episode were not elevated. This finding indicated that the adverse reaction was not based on degranulation of mast cell, and was anaphylactoid reaction provoked by nonspecific histamine-release. In conclusion, measurement of plasma tryptase is a useful method for differential diagnosis of anaphylaxis and anaphylactoid reaction.

Aged↗
PubMed1995

[Reevaluation of protective effect of mild hypothermia on brain ischemia following massive bleeding].

Mild hypothermia was speculated to have protected the brain from ischemic damage attributed to hypotension in two patients who had suffered massive bleeding. One patient developed hypotension below 40 mmHg of systolic pressure for 2 hr 30 min during hemi-hepatectomy. The patient's body temperature fell spontaneously to 31 degrees C and was maintained at about 31 degrees C during hypotension because a large amount of cold blood and fluid were given. Another patient injured by traffic accident developed hypotension below 40 mmHg of systolic pressure for 30 min. The patient was placed in hypothermic state of 33 degrees C by surface cooling immediately after induction of anesthesia. After the completion of surgery, no neurological deficit was found in either patient. Mild hypothermia is a useful and valuable method for protecting the brain during accidental profound hypotension.

Adult↗
PubMed1995

[Efficacy of the artificial ventilation for the treatment of IgE-mediated anaphylactic shock in dog].

To evaluate efficacy of artificial ventilation with 100 % oxygen for treatment of IgE-mediated anaphylaxis, we compared survival of control ventilated dogs with one of dogs with spontaneous ventilation. Fourteen dogs sensitized to Toxica canis were randomly assigned to two groups: spontaneous respiration group (Group S, n = 8) and artificial ventilation group (Group A, n = 6). All dogs were anesthetized with pentobarbital. In Group S, all dogs breathed spontaneously with constant flow of 4 l.min-1 of oxygen. Spontaneous respiration maintained an end-tidal CO2 level between 40 and 50 mmHg. In Group A, the dogs, paralyzed with pancuronium, were ventilated mechanically with 100 % oxygen, and the tidal volume was adjusted to maintain an end-tidal CO2 level between 35 and 40 mmHg. After measurements of pulmonary resistance (RL), dynamic compliance (Cdyn), and circulatory parameters at baseline, Ascaris suum antigen was administered intravenously into the systemic circulation to induce IgE-mediated anaphylaxis. RL, Cdyn and circulatory parameters were recorded continuously for 120 min after antigen challenge. Analysis of arterial blood gases was done throughout the study. Survival rates were 100 % and 50 % in Group A and Group S, respectively. In 7 of 8 dogs in Group S, apnea was observed during the period of 1 min to 5 min after antigen challenge, and the apnea continued during the period of 30s to 22 min. Four dogs died during the period of 20 min to 30 min after antigen challenge. In both groups, RL increased significantly and Cdyn decreased significantly after antigen challenge.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylaxis↗
PubMed1995

[Anesthesia in a patient with history of multiple drug allergies].

A 38-year-old woman was admitted for intranasal ethmoidectomy. She had a history of serious anaphylactic reactions, including respiratory distress, hypotension and unconsciousness, to nonsteroidal anti-inflammatory drugs (Loxonin, Niflan) and antibiotics (Kefral, Minomycin). Preoperative intradermal skin tests against anesthesia-related drugs showed positive reactions to succinylcholine and vecuronium. After bilateral maxillary nerve block with 0.5 % bupivacaine (negative intradermal test) 3 ml, anesthesia was induced with diazepam, nitrous oxide, oxygen and sevoflurane. Trachea was intubated smoothly without muscle relaxants. Anesthesia was maintained with nitrous oxide, oxygen and sevoflurane 0.5-1 %. The anesthesia and postoperative course of this patient were uneventful. To confirm the initiation of allergic reaction to anesthetics used in the patient, serum histamine, tryptase, and complement 1, 3 and 4 factors were measured at 3 points: preoperatively, immediately after the induction, and after extubation. They showed normal levels. These results showed that no allergic reaction occurred perioperatively. In conclusion, the valuable information was provided for the choice of anesthetics by thorough evaluation of the past history and intradermal testing.

Adult↗
PubMed1994

Methylmethacrylate bone cement does not release histamine in patients undergoing prosthetic replacement of the femoral head.

This study was designed to see if methylmethacrylate monomer bone cement released histamine in 13 patients undergoing total hip replacement surgery with a cemented prosthesis, compared with seven control patients receiving a cementless porous-coated prosthesis. Blood samples for plasma concentrations of histamine were obtained before the start of anaesthesia, immediately before insertion of methylmethacrylate bone cement into the shaft of the femur in the cemented fixation group or before insertion of the femoral component of the prosthesis in the cementless fixation group, and 15, 30 and 60 min after the start of implantation of the prosthesis. In both groups, changes in plasma histamine did not differ significantly from baseline before implantation of cement. There were no significant differences between groups. We conclude that methylmethacrylate bone cement does not release histamine during total hip replacement surgery.

Aged↗
PubMed1994

Sevoflurane and isoflurane protect against bronchospasm in dogs.

BACKGROUND: Halothane and isoflurane have been shown to be effective in reversing bronchoconstriction; however, the effects of sevoflurane have not been well defined. We studied whether sevoflurane, compared with isoflurane, attenuates bronchospasm in dogs. METHODS: Twenty-four dogs sensitized to Ascaris suum were assigned to three groups: control (n = 8), sevoflurane (n = 8), or isoflurane (n = 8). In all dogs, anesthesia was induced with pentobarbital. In the sevoflurane and isoflurane groups, the volatile anesthetics were administered at an end-tidal anesthetic concentration of 1 MAC throughout the study. After measurement of pulmonary resistance (RL) and dynamic pulmonary compliance (Cdyn) at baseline, A. suum antigen was administered intravenously into the systemic circulation to induce anaphylaxis, and RL and Cdyn were recorded continuously for 120 min after antigen challenge. RESULTS: Effects on RL and Cdyn were maximal 5 min after the start of systemic administration of antigen in all groups. Both 1 MAC sevoflurane and 1 MAC isoflurane significantly attenuated the increase in RL provoked by antigen challenge, but the attenuation from 10 to 15 min after challenge in the sevoflurane group was not significantly different from that in the control group. There was no significant difference in RL between sevoflurane and isoflurane. For both sevoflurane and isoflurane, attenuation of the decrease in Cdyn was not statistically significant. There was no significant difference in Cdyn between sevoflurane and isoflurane. CONCLUSIONS: Sevoflurane is as effective as isoflurane in attenuating bronchoconstriction associated with anaphylaxis in dogs. Sevoflurane may be a useful alternative to halothane, enflurane, or isoflurane in the treatment of bronchospasm in asthma or anaphylaxis.

Anesthetics↗
PubMed1994

Production of nitric oxide in anaphylaxis in rabbits.

To verify production of nitric oxide (NO) in anaphylaxis, we measured NO in peripheral tissue in anaphylactic rabbits using an NO-sensitive electrode. Rabbits were sensitized to horse serum, which was later administered over 10 s into the systemic circulation to induce anaphylaxis. Blood pressure (BP), central venous pressure (CVP), heart rate, and NO were recorded continuously for 80 min after antigen challenge. The NO-sensitive electrode was placed between the superficial abdominal fascia and the rectus abdominis fascia. The NO concentration increased to 3000-4800 pA (about 3-4.8 microM NO) within 4 min after initiation of anaphylaxis, at which time BP was decreased and CVP increased; however, NO production was continuously observed 30-60 min after antigen challenge, during which time changes in BP and CVP were not correlated with changes in NO concentration. In conclusion, NO production can be detected using an NO-selective electrode in anaphylactic rabbits.

Anaphylaxis↗
PubMed1994

[The effects of continuous interpleural vs. epidural infusion for postoperative pain relief following thoracotomy].

We studied whether continuous interpleural infusion of bupivacaine would be effective in alleviating pain after thoracotomy compared with effect of continuous epidural infusion of bupivacaine and buprenorphine. Twenty patients who had received thoracotomy and lobectomy were randomly divided into two groups to receive continuous interpleural infusion (IP group) of 0.5% bupivacaine at the rate of 5 ml.h-1 or continuous epidural infusion (E group) of 0.25% bupivacaine and 0.025 buprenorphine at the rate of 1 ml.h-1. The patients assessed their level of pain using a 100 mm visual analog scale (VAS) at rest and on coughing or changing the posture, verbal descriptor pain scale (VDPS), and times of supplemental analgesic. Assessment was performed at 7 points (mornings and evenings) for 3 postoperative days. In the evening of the day of surgery, VAS at rest in IP group was significantly higher than one in E group, but VASs at rest were similar in both groups from the first postoperative day to the third postoperative day. VAS on coughing or changing the posture in IP group was significantly higher than in E group in the evening of the day of surgery, and VASs on coughing or changing the posture in IP group were higher than in E group for 3 postoperative days. Supplemental analgesics were administered significantly more often than in E group in the evening of the first postoperative day. We conclude that continuous interpleural infusion does not give better analgesia than continuous epidural infusion after thoracotomy.

Adult↗
PubMed1994

[Changes in plasma concentrations of human hepatocyte growth factor before and after major intra-abdominal surgery under nitrous oxide-sevoflurane anesthesia].

The measurements of human hepatocyte growth factor (hHGF) in plasma and liver function tests were performed in 23 patients before and after major intra-abdominal surgery under nitrous oxide-sevoflurane anesthesia. Plasma concentrations of hHGF in 12 patients with normal liver function (Group 1) and in 11 patients with liver dysfunction (Group 2) were 0.34 +/- 0.07 and 0.44 +/- 0.12 ng.ml-1 (mean +/- SD) before the surgery, respectively. After the surgery, plasma concentration of hHGF remained unchanged in Group 1, but significantly increased to 0.61 +/- 0.32 ng.ml-1 in Group 2. Other routine laboratory data reflecting hepatic functions remained unchanged in both groups. These results suggest that liver damage during surgery and anesthesia occurs more likely in patients with liver dysfunction than in patients with normal liver function, and hHGF can be a more sensitive indicator of hepatic damage than conventional liver function tests.

Abdomen↗
PubMed1994

[Effects of repeated sevoflurane anesthesia on hepatic and renal function in a pediatric patient].

A 10-yr-old boy with an injured lower extremity received sevoflurane anesthesia 5 times within 40 days. Laboratory tests for hepatic and renal function i.e., serum transaminase (glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, gamma-glutamyl transpeptidase), serum cholinesterase, plasma protein, serum cholinesterase, serum bilirubine, serum lactic dehydrogenase, serum prothrombin time, blood urea nitrogen, serum creatinine, beta 2-microglobulin, N-acetyl-D-glucosamidase and 24 hr-creatinine clearance remained within normal ranges throughout his perioperative period. Repeated sevoflurane anesthesia did not exert any adverse effect on hepatic and renal function in this patient.

Anesthesia, Inhalation↗
PubMed1994

[Effect of indomethacin as an adjunct to postoperative pain relief by continuous epidural infusion of bupivacaine and buprenorphine].

We examined the analgesic effects of indomethacin as an adjunct to postoperative epidural analgesia in 40 patients who underwent upper abdominal surgery. Twenty patients in control group were epidurally given 0.1 mg of buprenorphine in 8 ml of 0.25% bupivacaine immediately after surgery and subsequently infused 15 micrograms buprenorphine in 1 ml of 0.25% bupivacaine at a rate of 1 ml.h-1 for 48 h. The remaining 20 patients were rectally given 50 mg of indomethacin in addition to the same epidural method described above. The patients who did not need additional narcotics in the control and indomethacin groups were 45% and 80%, respectively (P < 0.05). In upper abdominal surgery, postoperative pain relief by epidural buprenorphine and bupivacaine plus rectal indomethacin was more effective than that by epidural buprenorphine and bupivacaine.

Abdomen↗
PubMed1994

[Usefulness of continuous intra-arterial blood gas monitoring in a patient undergoing tracheal transection and reconstruction].

Usefulness of a new continuous intra-arterial blood gas monitoring system (PB3300, Puritan-Bennett, Carlsbad, California) was evaluated in a patient with tracheal cancer who was undergoing tracheal transection and reconstruction. The PB3300 detected continuous changes in pH, PaCO2, and PaO2 during the surgical intervention and provided reliable information to take appropriate therapeutic measures. PB3300 was superior to pulse oximetry because the latter can not detect changes in PaO2 more than 100 mmHg accompanying pulmonary dysfunction caused by surgical procedures. We conclude that the PB3300 is a useful monitor when used during anesthetic management of the patient who needs frequent arterial blood gas analyses.

Aged↗
PubMed1994

[Effects of intravenous and intramuscular atropine on bradycardia during spinal anesthesia].

The effects of intravenous and intramuscular atropine on pulse rate have been studied in 40 patients undergoing gynecological surgery. Intramuscular atropine 0.5 mg was administered 30 min before induction of spinal anesthesia in 20 patients (i.m. group). Intravenous atropine 0.5 mg was administered immediately after induction of spinal anesthesia in 20 patients (i.v. group). Decrease in heart rate after spinal block was significantly less in i.v. group than in i.m. group. Although no one in i.v. group was given an additional atropine, 10% of the patients in i.m. group was given an additional atropine for bradycardia. Authors conclude that intravenous atropine has more significant effect on prevention of bradycardia during spinal anesthesia compared with intramuscular atropine.

Anesthesia, Spinal↗