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H Mitsuhata

Publications and source records attributed to H Mitsuhata.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Evaluation of the efficacy of a leukocyte depletion filter].

We evaluated the efficacy of a leukocyte depletion filter (Pall RC 100) during operation. Clinically necessary blood was transfused to replace blood loss during the operation. Kinds of transfused blood and speed of transfusion were selected by clinical need. One leukocyte depletion filter was used at most for 4 units of transfused pack (200 ml). Blood samples were taken before and after the filtration to measure white blood cell (WBC), red blood cell (RBC), platelet and hematocrit. Blood samples before filtration and after filtration with white blood cell excluded, were examined by automated hematology analyzer (Coulter counter). White blood cell after filtration was counted by the hemacytometer method using Hauser chamber. The method of multiple linear regression was applied in order to estimate the removal rate of WBC and recovery rate of RBC. The independent variables were categorized in the following 3 sets: the age of transfused blood (day), duration of transfusion (min) and transfused volume (ml). Removal rates of WBC when 1, 2, 3 or 4 units were passed per filter, were 99.99% +/- 0.028%, 99.89% +/- 0.224%, 99.12% +/- 1.519% and 97.81% +/- 2. 866%, respectively. Removal rate of WBC when 4 units were passed per filter, was significantly lower compared with the rate when fewer units were passed. Recovery rates of RBC when 1, 2, 3, or 4 units were passed per filter, were over 99.5%, and there were no significant differences among 4 examined points. Only three variables, the age of transfused blood, duration of transfusion and transfused volume, showed a significant correlation with the removal rate of WBC.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1993

[Evaluation of a pressure and volume-relief instrument (modified Brandt's rediffusion system) to prevent increase in endotracheal tube cuff pressure].

Nitrous oxide diffuses into the endotracheal tube cuff and then overexpand the cuff. This causes upper airway obstruction and trauma in intubated patient during general anesthesia. We evaluated the efficacy and a safety of a pressure and volume-relief instrument (modified Brandt's rediffusion system), which can easily be made by ourselves, to prevent increases in endotracheal tube cuff pressure. Fourteen intubated patients under general anesthesia with nitrous oxide and oxygen were randomly allocated into two groups: in one group (control group, n = 7), endotracheal tube cuffs were inflated by air at time of intubation; in other group (rediffusion group, n = 7), tube cuffs were inflated by air and thereafter a pressure and volume-relief instrument (modified Brandt's rediffusion system) was attached to the end of pilot balloon. Pressure of endotracheal tube cuffs was monitored and recorded until the extubation. Time interval until the pressure of tube cuffs increased more than 23 mmHg, which inhibit the local circulation on the tracheal cartilage, in rediffusion group (274.7 +/- 95.9 min) was significantly longer than the duration in control group (64.7 +/- 23.5 min). We conclude that the rediffusion instrument is effective and safe to prevent the rise in the pressure of an endotracheal tube cuff.

Evaluation Studies as Topic↗
PubMed1992

[Prostaglandin E1 infusion fails to inhibit the increase of serum granulocyte elastase and myeloperoxidase and the decrease of plasma angiotensin converting enzyme in patients undergoing open-heart surgery].

We studied whether prostaglandin E1 (PGE1) could inhibit the increase of serum granulocyte elastase (GEL) and myeloperoxidase (MPO), and the decrease of plasma angiotensin converting enzyme (ACE) induced by oxygenator in 19 patients undergoing open-heart surgery. The patients were randomly allocated into 2 groups: one group (PGE1 group, n = 9) received a continuous infusion of PGE1 at a rate of 30 ng.kg-1.min-1 during cardiopulmonary bypass (CPB), and the other group (control group, n = 10) received saline infusion. GEL, MPO and ACE were measured serially at 8 points: before induction of anesthesia (as baseline), immediately before initiation of CPB, 10 min after initiation, 60 min after initiation, immediately after the end of CPB, 60 min after CPB, 120 min after CPB, and on the first postoperative day. Serum levels of GEL and MPO during 120 min after the end of CPB in both groups increased significantly compared with the baseline values. There was no significant difference between the two groups. Plasma levels of ACE in both groups decreased significantly immediately after the end of CPB compared with values taken 10 min after the initiation of CPB. There was no significant difference between the groups. We conclude that the infusion of PGE1 30 ng.kg-1.min-1 failed to inhibit the increase of GEL as well as MPO, and the decrease of ACE.

Aged↗
PubMed1992

[Postoperative pain relief by continuous epidural infusion of bupivacaine and buprenorphine].

Continuous postoperative pain relief produced by epidural block with bupivacaine and buprenorphine was evaluated in 12 patients after thoracotomy, 19 patients after upper abdominal surgery, and 14 patients after lower abdominal surgery. Patients initially received 8 ml of 0.25% bupivacaine and 0.1 mg of buprenorphine at recovery room in operating theater and continuously received the mixture of 0.25% bupivacaine and 5 micrograms.ml-1 buprenorphine at a rate of 1 ml.h-1 using a portable pump. About fifty percent of the patients did not need additional narcotics during 48 postoperative hours. About ninety percent of the patients needed one additional narcotics during 48 postoperative hours. The authors conclude that epidural analgesia with the mixture of bupivacaine and buprenorphine produces satisfactory postoperative pain relief.

Abdomen↗
PubMed1992

[The epidemiology and clinical features of anaphylactic and anaphylactoid reactions in the perioperative period in Japan].

In an attempt to review the Japanese epidemiology of the anaphylactic and/or anaphylactoid reactions in the perioperative period, we investigated 105 cases with clinical features of anaphylactic and/or anaphylactoid reaction, which are reported in the Japanese anesthesiology-related journals from 1952 to 1990. Eighty-nine percent of the cases were reported during the last decade. There were 66 males and 34 females. The majority of the patients were below 60 years of age, and most of the patients were in their teens and fifties. Ninety percent of the patients had no past history of drug-induced allergy nor tendencies of atopy. Ninety-four percent of the patients recovered completely without any sequelae, and 0.95 percent of them recovered with serious complications. Deaths occurred in 4.67% of the patients. Most frequent clinical signs were cardiovascular (91.4%) and cutaneous (84.8%) manifestations. Respiratory, signs appeared in 41% of the patients. Patients are frequently unconscious and covered with drapes, and early signs and symptoms of anaphylaxis can be masked. In 25% of the patients cardiovascular collapse, including cardiac arrest and undetected blood pressure, appeared as the first noticeable sign. Causative drugs were confirmed immunologically in 5.7% of the patients. In other cases, causative drugs were presumed based on clinical course. Causative drugs and presumed causative drugs were varied, including blood and blood products (24 cases), intravenous anesthetics (19 cases), local anesthetics (15 cases), and muscle relaxants (9 cases), which were used generally in the perioperative period.

Adolescent↗
PubMed1992

[Pulmonary reaction after protamine reversal of heparin in goats and rabbits].

Protamine reversal of heparin is often associated with severe hemodynamic side-effects, including pulmonary hypertension in cardiovascular surgery. However, the precise mechanism of this transient pulmonary hypertension is not clear. Recently, it was reported that pulmonary intravascular macrophages (PIM) react avidly with and phagocytize various foreign particles (liposome, latex, red cells). Sheep, goat and pig have a large population of PIM, but rabbit, rat and human have few. To investigate whether the pulmonary reaction after protamine reversal is related to PIM, we compared the pulmonary reaction after protamine reversal between goats and rabbits. We also studied it in patients for cardiac surgery. Protamine sulphate (2 mg.kg-1) was injected in 2.5 min into femoral artery at five min after heparin sodium (200 IU.kg-1) injection in goats and rabbits. Mean pulmonary arterial and peak airway pressures increased significantly after protamine reversal in goat. On the other hand, in rabbit and human, mean pulmonary arterial and peak airway pressures showed no significant changes. Goat was far more sensitive to protamine reversal than rabbit and human. We conclude that PIM may be the main cause of the pulmonary reaction after protamine reversal.

Animals↗
PubMed1992

[Evaluation of efficacy of a disposable monitor for surface temperature (PROCHECKER) compared with thermography].

We evaluated efficacy of a disposable monitor for surface temperature (PROCHECKER) compared with thermography. Changes in surface temperature after epidural block with mepivacaine 1% were measured using both PROCHECKER and thermography. Measured areas were regions of bilateral Th 4, 6, 8, 10, 12 and along the midmammary line. The surface temperatures on all areas were measured before, 15 min after and 30 min after the epidural block. Discrepancies of the temperatures measured by the two methods were found in 16.7% of all measured areas, and discrepancies in changes in the temperature were found in 6.7%. In conclusion, a disposable monitor for surface temperature (PROCHECKER) is effective and sensitive to measure changes in the temperature.

Disposable Equipment↗
PubMed1992

[The epidemiology and clinical features of anaphylactic and anaphylactoid reactions in the perioperative period in Japan: a survey with a questionnaire of 529 hospitals approved by Japan Society of Anesthesiology].

In an attempt to review the Japanese epidemiology of the anaphylactic and/or anaphylactoid reactions in the perioperative period, we surveyed 529 hospitals approved by Japan Society of Anesthesiology with a questionnaire about drug-induced immediate adverse reactions. Recovery rate of questionnaires was 15% (80 hospitals in 529 hospitals), and 28 cases of anaphylaxis or anaphylactoid reaction were reported. Most patients were in their teens and twenties. Male were 10, and female were 12 (unknown gender; 6). Reaction occurred during the induction of anesthesia in 28.6% of the patients, and during the maintenance of anesthesia in 67.9%. Seventy-five percent of the patients had no past history of drug-induced allergy nor tendencies of atopy. Most frequent clinical signs were cardiovascular (85.7%) and cutaneous (100%) manifestations. Respiratory signs appeared in 42.9% of the patients. Patients were frequently unconscious and covered with drapes, and there is a potentially danger of masking early signs and symptoms of anaphylaxis. In most of the patients, cardiovascular collapse appeared as the first noticeable sign. Causative drugs were confirmed only immunologically in one patient. In other cases causative drugs were presumed based on clinical courses. Anaphylaxis and anaphylactoid reaction are important causes of morbidity and mortality. The incidence in Japan was 0.01% (1:10,000) and the mortality was 4.76%.

Adolescent↗
PubMed1992

[Continuous epidural infusion of bupivacaine and buprenorphine for postoperative pain relief].

The efficacy for postoperative analgesia and side-effect of combined epidural infusion of bupivacaine and buprenorphine in comparison with each of these drugs alone were evaluated in 150 patients. All patients received initially bupivacaine 8 ml and buprenorphine 0.1 mg. In a random order, epidural infusion of 5 micrograms.ml-1 buprenorphine 1 ml.h-1 (group A; n = 50), 0.25% bupivacaine 1 ml.h-1 (group B; n = 50), or a combination of the two drugs 1 ml.h-1 (group C; n = 50) was continued for 48 h by a portable disposable device. The analgesic efficacy in group C was superior to that in group A or group B. No significant difference in the incidence of side-effect was found among the three groups. We conclude that epidural analgesia with the combination of buprenorphine and bupivacaine is safe, and easy to manage, giving pain relief superior to that provided by each of these drugs alone.

Adult↗
PubMed1992

[Thermographic assessments of the sympathetic blockade after stellate ganglion block (no. 3)--the block at the base of the 6th cervical transverse process].

We attempted to define effects of stellate ganglion block (SGB) at the base of 6th cervical transverse process by evaluating extent and degree of sympathetic blockade after SGB using the infrared thermography. Ten healthy volunteers (7 females, 3 males, age 26.0 years) were subjects of this study. Two different volumes (5 or 10 ml) of 1% plain mepivacaine were used (B5 group and B10 group). We performed SGB twice using two different volumes in all subjects on different day. Thermography was performed before and 30 minutes after SGB. On thenar and hypothenar, change of skin temperature in the B10 group tended to be higher compared with the B5 group. There were no significant differences in forehead or cheek temperature between the two groups. The thermographic whole hot area pattern on the ipsilateral hand after SGB in B10 group (60%) tended to be more frequent compared with the B5 group (40%). All subjects showed Horner's sign. No severe side-effect occurred in either group, but complaints of dysphagia appeared more frequently in the B10 group (80%) than in B5 group (40%). The change of skin temperature on thenar and hypothenar after B5 was significantly larger than that after the SGB at the top of the anterior tubercle of 6th cervical transverse process (P less than 0.05). In conclusion, B10 had more effect on lower cervical and upper thoracic sympathetic nerves than B5, but it also had a significant incidence of dysphagia feeling. Concerning the effect of the lower cervical and upper thoracic sympathetic block, B5 was superior to the SGB at the top of the anterior tubercle of 6th cervical transverse process.

Adult↗
PubMed1992

[Intravenous patient-controlled analgesia with pethidine for the treatment of postoperative pain in patients undergoing upper abdominal surgery].

Intravenous patient-controlled analgesia (PCA) with pethidine (standard technique of self-administration of pethidine) for the treatment of postoperative pain in 10 patients who had undergone abdominal surgery was evaluated. Serum pethidine concentration also was measured in order to evaluate the suitability of dose of pethidine. After an operation, intravenous PCA pump (CADD-PCA, Model 5200 PXC, Pharma Deltec) was attached to intravenous line with a basal infusion rate of 50 mg.12 h-1 of pethidine, and set to administer pethidine 5 mg intravenously by rapid bolus no more frequently than once every 20 min until 72 hours postoperatively. Verbal descriptor score, doses of pethidine, serum level of pethidine and side effect were evaluated each 12 hour period until 72 postoperative hours. Pain scores within 36 postoperative hours were comparable and stable analgesia was obtained throughout 72 postoperative hours. In only two cases out of 9 pain score improved according to the elevation of serum pethidine concentration. We conclude PCA with pethidine is effective for postoperative pain in patients after upper abdominal surgery, but administered doses in this study is not enough to achieve complete relief of postoperative pain in view of the serum level of pethidine.

Abdomen↗
PubMed1992

[Activation of complement and serial changes of anaphylatoxin (C3a, C5a) in patients for open-heart surgery using a membrane oxygenator].

Activation of complement and serum changes in anaphylatoxin (C3a and C5a) were studied in 8 patients who underwent open-heart surgery using a membrane oxygenator. C1 esterase inhibitor (C1-EI), C3, C5, CH50, C3a and C5a were measured serially at 7 points. C1-EI, C3, and C5 were measured by single radial immunodiffusion, CH50 by Mayer's method, and C3a and C5a by radioimmunoassay. Levels of C1-EI, C3 and C5 decreased significantly from 10 min after initiation to 120 min after the end of CPB compared with base line values. Degree of activation of complement increased in proportion to duration of CPB. Significant decreases of C3 and C5 continued until first postoperative day. Level of C3a increased significantly 10 min after initiation of CPB, and gradually increased till immediately after the end of CPB, when the level was maximum (4625 +/- 560 ng.ml-1) among 7 points. Level of C3a decreased gradually till 120 min after end of CPB. C5a was not detected during whole course. No patient showed respiratory distress of pulmonary edema. In conclusion, membrane oxygenator activated classical pathway of complement at 10 min after initiation of CPB. C3a increased significantly from 10 min after initiation of CPB to 120 min after end of CPB, but C5a was not detected at all during the whole course. The significant activation of complement continued till first postoperative day.

Aged↗
PubMed1992

[Attenuation of cardiovascular response to laryngoscopy and tracheal intubation with bolus injection of diltiazem].

Effect of diltiazem on cardiovascular response to laryngoscopy and tracheal intubation was studied in 20 patients without hypertension and 10 patients with hypertension to be operated on under general anesthesia. The patients were divided into three groups: the first group without hypertension (group C, n = 10) received saline as control, the second group without hypertension (group N, n = 10) received bolus injection of diltiazem, and the third group with hypertension (group H, n = 10) received bolus injection of diltiazem. Diltiazem was administered 2 min before intubation at a dose of 0.2 mg.kg-1 as a bolus injection. Changes of mean blood pressure, rate pressure product, pressure rate quotient in group H and N decreased significantly compared with group C. Changes of heart rate were comparable among the three groups. Complications were not remarkable except one case in which systolic pressure decreased to 80 mmHg. The results suggest that bolus injection of diltiazem at a dose of 0.2 mg.kg-1 attenuates cardiovascular response to laryngoscopy and tracheal intubation without serious complications.

Aged↗
PubMed1992

[Is a portable disposable pump useful in managing postoperative pain?].

In order to find out the effectiveness of continuous epidural infusion with a portable disposable pump (Baxter Infusor) in management of post-operative pain, a comparative study was made on a continuous epidural infusion method with a syringe pump versus a twice-a-day intermittent epidural infusion method. Study 1: With 41 patients who underwent thoracic/abdominal surgery between June, 1991 and September, 1991, researches were conducted on the effects of pain relief, methods for postoperative pain relief and weaning course from confinement to bed. The degree of pain examined at five points--at 4 hours, 12 hours, 16 hours, 24 hours and 28 hours postoperatively--indicated a significantly lower level in the Infusor group, compared with the intermittent infusion group (P less than 0.05). In terms of time required for anodyne administration, the Infusor group required significantly less time compared with the intermittent infusion group (P less than 0.05). As for weaning from bedriddenness, a tendency of earlier weaning was observed in the Infusor group, compared with the other two groups. Study 2: With a total of 37 people who were involved in postoperative management described in Study 1, including 8 surgeons and 29 surgery-ward nurses, an investigation was made through a questionnaire concerning their assessment on the 3 methods of anodyne infusion employed in Study 1. Among doctors, the evaluation of the Infusor method was remarkably high, compared with the intermittent infusion method (P = 0.001). When the syringe pump method and the intermittent method were compared, the evaluation of the syringe pump method was significantly higher (P less than 0.05). The evaluation by nurses, on the other hand, was remarkably higher on the infusion method than on the other two methods (P = 0.0001). Based on the results of the two studies summarized above, the Infusor method is considered to be most effective for pain control among the three methods.

Analgesia, Epidural↗
PubMed1992

[A case of pneumomediastinum caused by closed tracheal injury during the game of Kendo (Japanese fencing)].

A patient was injured accidentally on his neck during the game of Kendo (Japanese fencing). After his neck injury, he continued to play Kendo because there was no symptom at that time. Starting 10 minutes after the injury, swelling as well as pain on the neck and dyspnea developed gradually. After the admission to the emergency room, computed tomography revealed pneumomediastinum. Nasal endotracheal intubation was performed gently under fiberscopy. Dyspnea and pneumomediastinum improved gradually during the 6 days after the admission. A patient who has received a closed injury on his neck without immediate symptoms or signs must be observed closely because the absence of symptoms or signs does not guarantee the absence of the injury of the trachea.

Adolescent↗
PubMed1992

[The effects of induced hypotension with sevoflurane and PGE1 on liver functions during neurosurgery].

The effects of induced hypotension with sevoflurane and PGE1 (Group S) on liver functions during neurosurgery that can avoid direct invasion of the liver were retrospectively studied in 35 cases, in comparison with 8 cases of isoflurane and PGE1 induced hypotension (Group I). GOT, GPT and gamma-GTP increased slightly in both groups 1 day and 1 week after operation, but they returned to preoperative levels 1 month later. ChE decreased in both groups, and the decrease was greater in group S. Three cases in Group S (8.6%) and one case in Group I (12.5%) showed GOT or GPT over 100 and there was no significant difference in the two groups. Hypotensive anaesthesia induced with sevoflurane and PGE1 in neurosurgery, as that induced with isoflurane and PGE1, has little effect on postoperative liver functions.

Aged↗
PubMed1992

[Evaluation of efficacy of maximum surgical blood order schedule (MSBOS) in the operating room].

We evaluated efficacy of maximum surgical blood order schedule (MSBOS) using analysis of cross-match to transfusion ratio (C/T ratio) during 1 year after applying MSBOS to operations in our operating room. The MSBOS used was based on our trial reported in 1990. Compared with preoperative prepared blood units before application of MSBOS, C/T ratio decreased from 4.76 to 3.44, and cross matched blood units decrease from 476 units to 344 units (about 72%) per 100 packs of transfused blood. We conclude that application of MSBOS is effective and useful for saving preoperative prepared blood. Analysis with C/T ratio was very useful to recognize the present status of preparations of blood for surgery preoperatively. MSBOS should be re-evaluated regularly because of changes of operative environment such as surgeon, operative method, preoperative condition of patients, and so on.

Blood Transfusion↗