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Biomedical subjects

H Mitsuhata

Publications and source records attributed to H Mitsuhata.

At least 127 records · Page 7Linked to original sources
PubMed1991

Changes in the plasma histamine concentration after the administration of vecuronium bromide.

Clinical symptoms of anaphylactoid reaction to muscle relaxants vary from localized flush to cardiovascular collapse. Vecuronium bromide is reported to have very little histamine releasing property. However, there are some reports of anaphylaxis or anaphylactoid reaction to vecuronium. We studied plasma histamine concentration after the intravenous injection of vecuronium to confirm the histamine release. Twenty patients were randomly allocated to one of two groups, each group comprising of 10 patients: one group was to receive vecuronium 0.1 mg.kg(-1) and the other 0.2 mg.kg(-1) using the priming principle. Blood samples were taken prior to and 1, 3, 5, 8 and 13 min after the administration of vecuronium. The plasma histamine concentration was measured by radioimmunoassay with monoclonal antibody. There were no significant changes in plasma histamine concentration over 13 min after the administration of vecuronium compared with the baseline value. There were also no significant differences between these two groups. We concluded that vecuronium up to 0.2 mg.kg(-1) did not change the plasma histamine concentration in the patients having no previous history of allergy or atopic tendencies.

Clinical Trial↗
PubMed1991

Effect of controlled mechanical ventilation without positive end-expiratory pressure on right ventricular function after coronary artery bypass graft surgery.

To evaluate the changes in right ventricular function during controlled mechanical ventilation (CMV) without positive end-expiratory pressure (PEEP) and during spontaneous breathing, we compared right ventricular ejection fraction (RVEF), right ventricular end-diastolic volume index (RVEDVI), and right ventricular end-systolic volume index (RVEDVI) using a thermodilution technique after coronary artery bypass graft surgery. Patients were divided into two groups on the basis of changes in RVEDVI from CMV to spontaneous breathing: group U (n = 6) consisted of patients whose RVEDVI increased during spontaneous breathing compared with mechanical ventilation, group D (n = 3) consisted of patients whose RVEDVI decreased during spontaneous breathing compared with mechanical ventilation. PVRI values during CMV in group D were significantly larger than those in group U. Patients in group U showed no increase in RVEDVI, or decrease in RVEF during CMV without PEEP. However, the remaining 3 patients in group D showed an increase in RVEDVI and a decrease in RVEF during CMV. Mean PAP, RAP, RV systolic pressure, RV end-diastolic pressure, PWP, HR, and mean arterial pressure in both groups were comparable, and showed no significant difference at each of the measured points by 24 hrs postoperatively. Then, RVEF, RVEDVI and RVESVI measured by thermodilution technique is useful in evaluating ventricular function at bedside in ICU.

Journal Article↗
PubMed1991

[Effect of endotoxin on plasma angiotensin-converting enzyme in dogs].

We calculated angiotensin converting enzyme (ACE) index (ACE/CO) to exclude the influence of pulmonary perfusion and investigated the relationship among ACE, ACE index, hemodynamic changes in 6 endotoxin dogs. Systemic arterial pressure and cardiac output (CO) decreased significantly after 3 mg.kg-1 of endotoxin administration, but neither pulmonary arterial pressure nor pulmonary arterial wedge pressure changed. Lung wet/dry ratio was higher. Although endotoxin administration caused the pulmonary capillary endothelial damage in this experiment, plasma ACE showed a nonsignificant increase. The main reason may be related to the reduction of surface area of pulmonary capillary endothelial cells caused by the decrease in cardiac output. The increased ACE index lasted for 15 to 90 min and began to return to baseline at 120 min after endotoxin administration. We conclude that ACE index is more useful than plasma ACE as an early marker of the pulmonary capillary endothelial damage induced by endotoxin.

Animals↗
PubMed1991

[The effects of prostaglandin E1 on myeloperoxidase and alpha 1-protease inhibitor in head-neck surgery].

To investigate whether prostaglandin E1 (PGE1) 30 ng.kg-1.min-1 inhibits the release of lysosomal enzyme from granulocytes by surgical stimuli, we measured myeloperoxidase and alpha 1-protease inhibitor (alpha 1-PI) in 32 patients for head neck surgery. The patients were divided into two groups; no PGE1 infusion group (C group) and PGE1 30 ng.kg-1.min-1 infusion group (P group). PGE1 was infused intravenously using a syringe pump during operation. MPO and alpha 1-PI were measured at 4 points: before induction of anesthesia, before surgery, 4 hours after the start of surgery or the infusion of PGE1, and on the first postoperative day. MPO was maintained at significantly higher levels during and after surgery in both groups. alpha 1-PI decreased significantly during operation and increased for 10% in the first postoperative day in both groups. There were no significant differences between groups in MPO and alpha 1-PI levels. We conclude that the infusion of PGE1 30 ng.kg-1.min-1 did not completely inhibit the release of lysosomal enzyme from granulocytes by surgical stimuli.

Aged↗
PubMed1991

[Effect of continuous infusion of diltiazem on cardiovascular responses to laryngoscopy and intubation].

We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received continuous infusion of either diltiazem 10 micrograms.kg-1.min-1, 40 micrograms.kg-1.min-1 or saline as control group during 20 min before induction. Heart rate, arterial pressure, rate pressure product (RPP), pressure rate quotient (PRQ) were measured starting 20 min before induction to 3 min after tracheal intubation. The increases in arterial pressure and RPP following tracheal intubation were reduced significantly in patients receiving diltiazem 40 micrograms.kg-1.min-1, but they were not reduced in patients receiving diltiazem 10 micrograms.kg-1.min-1 compared with control. We conclude that continuous infusion of diltiazem during 20 min before induction is effective for preventing the increases in arterial pressure and RPP following tracheal intubation, and the optimal infusion rate is from 10 to 40 micrograms.kg-1.min-1.

Aged↗
PubMed1991

[General anesthesia and surgery inhibited natural killer cell cytotoxicity in patients with cancer or benign disease undergoing upper abdominal surgery].

In this study, effect of enflurane anesthesia combined with epidural analgesia on natural killer cell cytotoxicity (NKCC) was investigated in 20 patients. Patients were divided into two groups: the first group with adenocarcinoma of stomach (Group 1); the second with cholecystolithiasis (Group 2). Four samples were taken; 1) on arrival at operating room; 2) during anesthesia and 1 hour after skin incision; 3) on 1st postoperative day; and 4) on 4th or 5th postoperative day. NKCC was determined with a chromium release assay against K 562 cell. NKCC was already significantly higher before induction in Group 1 compared with Group 2 and normal value. In Group 1, NKCC decreased significantly compared with baseline during operation, but in group 2 NKCC was unchanged during operation. NKCC in group 2 was inhibited significantly less than Group 1 during 5 postoperative days, while NKCC was significantly inhibited postoperatively in both groups compared with the baseline. We conclude that enflurane anesthesia combined with epidural analgesia and surgery did not decrease NKCC below normal value during operation, but it was significantly inhibited during 5 postoperative days in both groups. There were differences in responses to stress of anesthesia and surgery between patients with and without cancer.

Adenocarcinoma↗
PubMed1991

[Effects of ulinastatin on granulocyte elastase and fibronectin in patients undergoing cardiopulmonary bypass].

We investigated the effects of ulinastatin on the increase of granulocyte elastase (GEL) and the decrease of fibronectin (FN) after cardiopulmonary bypass (CPB) in 30 patients undergoing cardiopulmonary bypass. Ulinastatin 300,000 units were given immediately after the induction of anesthesia (U1) or during CPB (U2). GEL increased by 20 times after CPB. GEL was lower in U2 than those in other groups. FN increased by 7-13% after CPB in U1 but decreased in other groups. FN decreased by 21-13% on the first postoperative day in three groups. There was a close relationship between CPB time and increase of GEL in the control group (no ulinastatin given) (y = 18.5 x -833, r = 0.751), between CPB time and increase of FN in U1 (y = 1.4 x -163.4, r = 0.683) or increases of GEL and FN in the control group (y = 0.068 x -202.6, r = 0.812). From these results, we recommend that ulinastatin should be given after the induction of anesthesia and during CPB, to keep a favorable host defense function after CPB.

Adult↗
PubMed1991

[Effects of local anesthetics upon human natural killer cytotoxicity in vitro].

Effects of 3 local anesthetics, bupivacaine, mepivacaine and lidocaine, upon natural killer cytotoxicity were studied in vitro. Mononuclear cell layer was recovered by Ficoll-Paque sedimentation from heparinized venous blood obtained prior to the induction of anesthesia. The mononuclear cells were divided into three groups: control group was incubated in medium only: low concentration group incubated in medium with 2.0 micrograms.ml-1 of mepivacaine (n = 20) or lidocaine (n = 20), or 0.5 micrograms.ml-1 of bupivacaine (n = 21); high concentration group in medium with 20 micrograms.ml-1 of mepivacaine or lidocaine, or 5 micrograms.ml-1 of bupivacaine. These three groups were incubated simultaneously in humidified atmosphere with 5% CO2 in incubator for 2 hours. NK cell cytotoxicity was determined in a chromium release assay against K 562 cell as a target cell. An effector to target cell ratio of 40:1 was used. Comparison among 3 local anesthetics showed no significant difference at high concentration, but a significant difference at low concentration. This was due to the differences between bupivacaine and lidocaine. Neither bupivacaine nor mepivacaine inhibited % NK cytotoxicity at both low and high concentrations compared with control. Lidocaine significantly inhibited % NK cytotoxicity at low concentration, but did not inhibit at high concentration compared with control. We concluded that neither bupivacaine nor mepivacaine inhibited % NK cytotoxicity at concentration of clinical dose compared with control in vitro, but lidocaine inhibited % NK cytotoxicity at a concentration of 2.0 micrograms.ml-1 compared with control.

Bupivacaine↗
PubMed1991

[Continuous intravenous pethidine infusion for analgesia after upper abdominal surgery: a randomized, prospective double-blind comparison with continuous epidural infusion of pethidine].

We conducted a randomized double-blind controlled study comparing patients receiving continuous intravenous pethidine infusion with those receiving continuous epidural infusion for postoperative analgesia after upper abdominal surgery. Twenty patients scheduled for upper abdominal surgery were randomized into 2 groups: IV Group (n = 10) received 100 mg.24 h-1 of pethidine intravenously and saline epidurally, Epi Group (n = 10) received 100 mg.24 h-1 of pethidine epidurally and saline intravenously. During 24-hour postoperatively, verbal descriptor pain scale, sedative scale, respiratory rate, pulse rate and blood pressure were evaluated at each 2 hours. During 72-hour postoperatively, visual analogue pain scale (added at 6-hour postoperatively), supplemental doses of pethidine, and side effects were evaluated at each period of 12 hours. There was no significant difference in the rating of analgesia in either group during 72-hour postoperatively. However in the first 12 hours postoperatively, VAS in Epi Group tended to be lower than that in IV Group. There was no respiratory depression in either group. We conclude that continuous intravenous infusion of 100 mg.24h-1 of pethidine was effective for postoperative analgesia after upper abdominal surgery without major side effects, and almost the same analgesic effect was obtained as compared with continuous epidural analgesia.

Abdomen↗
PubMed1991

[The effect of continuous epidural infusion of a combination of 1% mepivacaine and buprenorphine for post-operative pain relief].

Using a portable 2 ml.hr-1 type infusor (Baxter Infusor), the effect of continuous epidural infusion for post-operative pain relief for 72 hours was studied in 32 patients after upper abdominal surgery. The patients were randomly allocated into four groups: Group 1 (n = 8) received continuous epidural infusion of 1% mepivacaine and buprenorphine 0.2 mg (48 ml.hr-1); group 2 (n = 8) 1% mepivacaine and buprenorphine 0.4 mg (48 ml.hr-1); Group 3 (n = 8) saline and buprenorphine 0.2 mg (48 ml.hr-1); Group 4 (n = 8) saline and buprenorphine 0.4 mg (48 ml.hr-1). The effect was evaluated at intervals of 12-hour until 72 hours postoperatively. Patients received supplemental buprenorphine intramuscularly as needed. In each period during the 12 to 72-hour after operation, the percentage of the patients who needed no supplemental buprenorphine was 62.5-100%, which is higher than during the 0 to 12-hour (25.0%). The percentage of the patients who showed no pain on coughing and changing in position in Group 1 and 2 was higher than in Group 3 and 4 in each period (P less than 0.05 12-24 and 36-72 hr). Continuous epidural infusion using Baxter Infusor with the combination of 1% mepivacaine and buprenorphine is effective for alleviating postoperative pain during the 12 to 72 hours after the operation, and for prevention of pulmonary complications.

Abdomen↗
PubMed1991

[The evaluation of incremental positive end-expiratory pressure on right ventricular hemodynamics as determined by the thermodilution technique].

Effects of incremental positive end-expiratory pressure (PEEP) on right ventricular (RV) hemodynamics were studied in 10 patients undergoing coronary artery bypass grafting, abdominal aneurysmectomy and partial hepatectomy, using Swan-Ganz catheter mounted with the rapid response thermistor. PEEP was increased from 0 (baseline) to 15 cmH2O with increment of 5 cmH2O, and right ventricular ejection fraction (RVEF), RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), and cardiac output (CO) were computed with a thermodilution technique at each PEEP. At 15 cmH2O PEEP, RVEF, RVEDVI and RVESVI were comparable with the baseline, while right arterial pressure, RV peak systolic pressure and mean pulmonary arterial pressure increased significantly compared with the baseline. Increased afterload of RN caused by PEEP did not affect RV contractility. Decreased cardiac and stroke volume indices were attributed to the decrease of preload caused by the increase of intrathoracic pressure. We conclude that PEEP at 5 to 15 cmH2O does not influence right ventricular hemodynamics, and RVEDV is a reliable index to monitor RV hemodynamics instead of right arterial pressure to determine optimal PEEP.

Aged↗
PubMed1991

[Ventricular arrhythmia associated with the use of an electrosurgical unit in a patient with a Swan-Ganz catheter].

We experienced short-run type ventricular arrhythmia associated with use of electrosurgical unit (ESU) in a patient with a Swan-Ganz catheter. Leakage current was not detected from the body of the five different devices used in this study. Nevertheless, there is a possibility of leakage current to the electrode of the intra-cardiac catheter thereby exciting the myocardium, because the grounding of the five devices used simultaneously on the patient were not of EPR system. The other possibility, that is the occurrence of pulse direct current voltage by rectification of high frequency current at the contact point of electrosurgical knife's tip and vital organ is a speculation but not underlined by a definite proof. In summary, the cause of ventricular arrhythmia associated with the use of ESU could not be identified in the present case. It must always be remembered that whatever safety measures may be prescribed for electrical instruments, a complete prevention of EMI is impossible. Also it must be stressed that whenever many devices are used simultaneously on a patient, EPR system is very important for avoiding electrical hazard.

Arrhythmias, Cardiac↗
PubMed1991

[Continuous intravenous infusion of pethidine or buprenorphine for postoperative analgesia].

Efficacy of continuous intravenous infusion for postoperative analgesia was evaluated in 20 patients who had undergone abdominal surgery for 72 hours postoperatively. The patients were randomly allocated to two groups: one group received continuous intravenous infusion of buprenorphine at 0.2 mg.24 hr-1 using a non-electronic, portable infusor 0.5 ml.hr-1 type (Baxter), while the other received infusion of pethidine at 50 mg.hr-1. During the first 12 postoperative hours, the frequency of "Fair" rating which indicated need of supplemental analgetics was significantly higher than the later 12-hour period until 72 hours in both groups. However, although during the first 12 hours continuous intravenous infusion was inadequate to alleviate postoperative pain compared with other 12-hour period, no patient received supplemental analgesics more than 2 times. During the 24 to 72 postoperative hours, 70% of cases needed no supplemental analgesics to alleviate postoperative pain. Continuous intravenous infusion of 0.2 mg.hr-1 buprenorphine or 50 mg.hr-1 pethidine was inadequate for postoperative analgesia during immediately after the operation to 36 hours postoperatively, especially during the first 12-hour period. However, this infusion was effective during 36 to 72 postoperative hours. There was no significant difference between buprenorphine group and pethidine group.

Aged↗
PubMed1991

[The effects of prostaglandin E1 on the granulocyte elastase, white blood cells and platelets in head-neck surgery].

We studied whether prostaglandin E1 (PGE1) inhibits the granulocyte elastase increase, white blood cell increase and platelet decrease caused by surgical stimuli in 30 head-neck surgical patients. The patients were divided into a group of no PGE1 infusion (C group) and two groups of PGE1 infusion (infusion of 10 ng.kg-1.min-1 in P 10 group and infusion of 30 ng.kg-1.min-1 in P 30 group). PGE1 was infused intravenously using a syringe pump during operation. The granulocyte elastase, white blood cells and platelets were measured at 4 points: before induction of anesthesia, before surgery, 4 hours after the start of surgery or the infusion of PGE1, and on the first postoperative day. Granulocyte elastase was maintained at significantly higher levels during and after surgery in 3 groups. White blood cells correlated with granulocyte elastase in 3 groups (especially in C group; Granulocyte elastase = 1.48 X white blood cells + 23.5, r = 0.672). Platelets decreased significantly in the first postoperative day in C and P 10 group. PGE1 has a tendency to inhibit dose-dependently the postoperative decrease in platelets. We conclude that 30 ng.kg-1.min-1 infusion of PGE1 did not inhibit granulocyte elastase release from white blood cells, but has a tendency to inhibit postoperative platelet decrease.

Aged↗
PubMed1991

[Statistical analysis of tracheobronchial foreign bodies].

Incidence of foreign body aspiration in tracheobronchial tree is rare, however the foreign body aspiration can lead to severe illness and even death if not diagnosed and treated promptly. We retrospectively analyzed forty five patients who underwent ventilation bronchoscope under general anesthesia for suspected aspirated foreign bodies in our hospital. In thirty eight patients, foreign body was confirmed in tracheobronchial tree, while in seven patients foreign body was not confirmed with bronchoscope. The thirty eight patients ranged in age from 10 months to 73 years; the peak incidence of foreign body aspiration occurred in children under 3 years of age. Twenty five of thirty eight patients were male. Food or food derivatives were the causative agents in 68% of the patients, with 65% due to a portion of peanut. The foreign body was located in the right and left bronchus with almost equal frequency. The main symptoms were coughing (72%), wheezing (53%), and dyspnea (25%). The radiographic abnormality was seen in eighteen of thirty eight patients. A radio-opaque material was seen in 18%. Children at age 6 years of younger (90%) had been witnessed to choke on identifiable foreign body, but only 40% were diagnosed within 24 hours. Twelve of these children were treated unnecessarily for asthma, pneumonia, or so on. We conclude that it is most important to take history carefully considering the possibility of foreign body aspiration in the patients with coughing, wheezing, or dyspnea.

Adolescent↗