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Biomedical subjects

K Amaha

Publications and source records attributed to K Amaha.

At least 37 records · Page 2Linked to original sources
PubMed1998

Amrinone improves right ventricular ejection fraction and oxygen delivery without deterioration of extravascular lung water in canine oleic acid pulmonary injury.

Fourteen mongrel dogs were anaesthetized and mechanically ventilated with oxygen. After oleic acid was administered intravenously, amrinone 1 mg/kg was intravenously administered to one group followed by a continuous infusion of 10 micrograms/kg/min for one hour (amrinone group, n = 7). Isovolumetric saline was administered to the control group (n = 7). Amrinone slightly lowered PaO2 but significantly increased oxygen delivery and improved gastric intramucosal pH (pHi) during the first 30 minutes (7.33 +/- 0.13) compared with the control group (7.21 +/- 0.06, P < 0.05). The pHi remained higher in the amrinone group (7.30 +/- 0.15) than in the control group (7.16 +/- 0.06, P < 0.05) after the drug was withdrawn. Extravascular lung water was significantly augmented after oleic acid injection and sustained in all animals for the remainder of the study.

Amrinone↗
PubMed1998

Tracheal intubation through the intubating laryngeal mask airway (LMA-Fastrach) in patients with difficult airways.

The intubating laryngeal mask airway was used in 31 adult patients in whom tracheal intubation was known or suspected to be difficult. The intubating laryngeal mask airway was successfully inserted in 30 patients and provided a clinically patent airway. In the remaining one patient it was impossible to insert the device correctly. Tracheal intubation through the device was successful in 28 of 30 patients (93%). These results suggest that the intubating laryngeal mask airway has a potential role for tracheal intubation in adult patients with difficult airways.

Adolescent↗
PubMed1998

The combination of partial liquid ventilation and inhaled nitric oxide in the severe oleic acid lung injury model.

STUDY OBJECTIVES: To elucidate the efficacy of the combination of inhaled nitric oxide (NO) and partial liquid ventilation (PLV) in ARDS. DESIGN: Prospective, randomized, controlled study. SETTING: A research laboratory at a university medical center. SUBJECTS: Thirty-two rabbits. INTERVENTIONS: Animals were anesthetized and ventilated via tracheostomy (tidal volume=40 mL; respiratory rate=25 breaths/min; fraction of inspired oxygen=0.99). After 0.08 mL/kg (0.071 g/kg) oleic acid was administered via the central venous route, animals were randomly divided into the following four groups depending on the ventilatory mode: (1) Gas ventilation (GV)-control group: GV was continued throughout the study; (2) GV-NO group: NO inhalation (10 ppm) was performed under GV; (3) PLV-control group: PLV using perflubron (15 mL/kg) was continued until the end of the study; and (4) PLV-NO group: NO inhalation (10 ppm) was performed under PLV. MEASUREMENTS AND RESULTS: NO inhalation improved PaO2 in the PLV-NO group (from 133+/-20 to 167+/-23 mm Hg; p=0.0008), but not in the GV-NO group (from 67+/-6 to 63+/-9 mm Hg), although pulmonary vascular resistance decreased both in the GV-NO (from 4,604+/-328 to 4,337+/-322 dyne x s x cm(-5); p=0.0116) and the PLV-NO group (from 4,727+/-665 to 4,112+/-560 dyne x s x cm(-5); p=0.0036). (Data were expressed as mean+/-SEM.) CONCLUSION: PLV augmented the effect of inhaled NO on pulmonary gas exchange. The combination of PLV and NO inhalation could be effective in severe ARDS.

Animals↗
PubMed1998

Beneficial effect of atrial natriuretic peptide on pulmonary gas exchange in patients with acute lung injury.

STUDY OBJECTIVES: The purpose of this study was to investigate the effect of i.v. infusion of atrial natriuretic peptide (ANP) on hemodynamics, pulmonary gas exchange, and urine volume during mechanical ventilation with positive end-expiratory pressure (PEEP) in patients with acute lung injury. DESIGN: Prospective, randomized, comparable study. SETTING: ICU of a university hospital. PATIENTS: Forty patients with moderate acute lung injury (lung injury score > or = 2.0) who required mechanical ventilation with PEEP were studied. INTERVENTIONS: The patients were randomly divided into two groups: ANP group (n=20) and control group (n=20). The ANP group received genetic recombination alpha-human ANP (carperitide) at the rate of 0.1 microg/kg/min for 24 h. The control group did not receive ANP. MEASUREMENTS AND RESULTS: Hemodynamic and blood gas parameters, and urine volume were measured at baseline, 3 h, and 24 h after initiating the ANP infusion. Plasma ANP concentrations markedly (p<0.01) increased from 112.0+/-27.0 to 1,868.3+/-385.3 pg/mL after 24 h in the ANP group, whereas they remained unchanged in the control group. In the ANP group, hemodynamic parameters did not change, but PaO2/FIO2 (fraction of inspired oxygen) and thoracic compliance significantly (p<0.01) increased at 24 h after initiating the ANP infusion, associated with significant (p<0.01) decreases in lung injury score and shunt. Urine volume significantly (p<0.01) increased during 0 to 3 h after initiating the ANP infusion. In the control group, hemodynamics, pulmonary gas exchange, and urine volume did not significantly change during the study period. There were significant differences in PaO2/FIO2 (24 h), thoracic compliance (24 h), lung injury score (24 h), and urine volume (3 h) between the two groups. CONCLUSION: The results suggest that ANP infusion induces diuresis and improves pulmonary gas exchange in patients with acute lung injury during mechanical ventilation with PEEP.

Aged↗
PubMed1998

[Anesthetic management of abdominal gunshot wound--a report of three cases].

This is a case report of anesthetic management of abdominal gunshot wound. Two patients had upper abdominal wound involving the liver and the inferior vena cava. They died of uncontrolled bleeding. Third patient had lower abdominal injury involving the ascending colon and small intestine. The patient survived the injury and showed good recovery. In a case of the abdominal gunshot injury, prompt diagnosis and laparotomy are mandatory. Multiple intravenous routes are necessary in the upper part of the body for massive infusion and transfusion. Unusual hemostasis methods such as atrio-caval shunt or abdominal clamping of the aorta must be considered in case of injury in the inferior vena cava.

Abdominal Injuries↗
PubMed1998

[Anesthetic management of a patient with protein C deficiency associated with pulmonary thromboembolism].

A patient with protein C deficiency associated with massive pulmonary embolism underwent open heart tromboembolectomy. The operation was successfully performed under cardiopulmonary bypass using a usual dose of heparin 3 mg.kg-1. The effect of heparin was successfully reversed by the administration of protamine sulfate 6 mg.kg-1. Perioperative administration of fresh frozen plasma or protein C concentrates might be necessary to manage hypercoagulability in a patient with protein C deficiency.

Adult↗
PubMed1998

[Usefulness of the intubating laryngeal mask airway for cases with predicted difficult intubation].

We evaluated the usefulness of the intubating laryngeal mask airway (ILMA) in patients who were predicted to have possible difficult airway. Patients with possible difficult airway were defined as those with limited head extension, Mallampati's classification of grade IV, thyro-mental distance < 4 cm, or Cormack grade III-IV on the laryngoscopy. The control group was consisted of the patients without these conditions or impaired mouth opening. Insertion of the ILMA was successfully performed in all patients of both groups. In the group of possible difficult airway, 83% of patients were intubated through the ILMA successfully, and in the control group, 86%. We conclude that the ILMA may become an additional tool in patients with difficult intubation.

Adult↗
PubMed1997

Train-of-four and double burst stimulation fade at the great toe and thumb.

PURPOSE: We compared probabilities of tactile detection of fade in response to train-of-four (TOF), double burst stimulation3.3 (DBS3.3), and DBS3.2 at the great toe with those at the thumb. METHODS: One hundred and thirty adult patients anaesthetized with nitrous oxide, oxygen, isoflurane, and fentanyl were studied. At varying degrees of neuromuscular block caused by vecuronium, an observer determined the presence or absence of fade in response to TOF DBS3.3, or DBS3.2 at the great toe and that at the thumb. The relationship between T1/T0 or TOF ratio (T4/T1) measured at the great toe and that at the thumb was also examined. RESULTS: When TOF ratios were 0-0.10, 0.11-0.20, 0.21-0.30, 0.31-0.40, 0.41-0.50, 0.51-0.60, 0.61-0.70, and 0.71-1.00, the probabilities of detection of fade in response to TOF at the great toe (thumb) were 77 (100), 66 (100), 58 (96), 52 (77), 39 (38), 26 (23), 2(4), and 0(0)%, respectively (P < 0.05 at TOF ratio 0-0.40). Similarly, the probabilities of detection of fade in response to DBS3.3 at the great toe were lower than at the thumb when TOF ratios were 0.21-0.80, and those in response to DBS3.2 at the great toe were lower than at the thumb when TOF ratios were 0.61-0.80. A dose relationship was observed between T1/T0 or TOF ratio at the great toe and that at the thumb. CONCLUSION: This study suggests that the probability of tactile detection of fade in response to TOF, DBS3.3, or DBS3.2 at the great toe is less than that at the thumb. The present results may be because the flexor hallucis brevis muscle is more resistant to non-depolarizing neuromuscular relaxant than the adductor pollicis muscle and that the ratio of fade in response to neurostimulation at the great toe is higher than at the thumb.

Adult↗
PubMed1997

Increased plasma concentrations of brain natriuretic peptide in patients with acute lung injury.

PURPOSE: This study was performed to elucidate the pathophysiological role of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) in acute lung injury. MATERIALS AND METHODS: We sequentially measured plasma concentrations of immunoreactive BNP and ANP in 10 patients (mean age, 63 years (with acute lung injury and compared those with hemodynamic parameters and pulmonary functions. RESULTS: Plasma concentrations of immunoreactive BNP and ANP were markedly elevated at entry into the study. Plasma BNP concentrations during the early course (3 days) showed significant (P < .01) positive correlations with systemic vascular resistance index (r = .708) and pulmonary vascular resistance index (r = .573), but a negative correlation with cardiac index (r = .608). Plasma ANP concentrations showed a significant (P < .05) positive correlation with pulmonary capillary wedge pressure (r = .398). Plasma BNP in 4 patients who died and 1 patient with acute renal failure remained elevated during the entire hospital length of stay (12 days). CONCLUSION: These findings suggest that circulating BNP plays an important role in acute lung injury along with ANP as a compensatory mechanism for cardiac dysfunction accompanied by increased systemic vascular resistance index and pulmonary vascular resistance index. Circulating BNP may be a sensitive humoral marker for the degree of ventricular dysfunction associated with acute lung injury.

Acute Disease↗
PubMed1997

Evaluation of residual neuromuscular block using train-of-four and double burst stimulation at the index finger.

We examined the percentage of tactile detection of fade in response to train-of-four (TOF), double burst stimulation3,3 (DBS3,3), or DBS3,2 at the index finger compared with that at the thumb during continuous infusion of vecuronium. One hundred five adult patients were studied. At TOF ratios (T4/T1) of 0.41-0.70, fades in response to TOF were more frequently identified by tactile means at the index finger than at the thumb (58% vs 26%, P < 0.05). Similarly, at TOF ratios of 0.61-0.90, fades in response to DBS3,3 were more frequently detected at the index finger than at the thumb (55% vs 15%, P < 0.05), and at TOF ratios of 0.81-1.00, the percentage of detection of fade in response to DBS3,2 was higher at the index finger than at the thumb (72% vs 40%, P < 0.05). In addition, baseline displacement of the index finger or thumb during tactile assessment of fade in response to neurostimulation was measured videographically. The baseline displacement of the index finger was significantly less than that of the thumb (P < 0.05). In summary, the percentage of tactile detection of fade in response to neurostimulation at the index finger is higher than at the thumb, and the absence of fade in response to DBS3,3 at the index finger is a good indicator of adequate recovery from neuromuscular block. This is probably because of the smaller baseline displacement of the index finger.

Adult↗
PubMed1997

Effects of carboxy-PTIO on systemic hemodynamics, liver energetics, and concentration of liver metabolites during endotoxic shock in rabbits: a 31P and 1H magnetic resonance spectroscopic study.

OBJECTIVE: To investigate the effects of 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (carboxy-PTIO), a nitric oxide scavenger, on the lipopolysaccharide-induced hypotension, hepatocellular dysfunction, and liver damage in endotoxic rabbits. DESIGN: Experimental, comparative study. SETTING: Laboratory of a university hospital. SUBJECTS: Eighteen Japanese white rabbits (3.0 to 3.2 kg body weight) anesthetized with ketamine-xylazine were studied. INTERVENTIONS: We randomly divided the rabbits into three groups: saline controls (group 1, n = 5); animals receiving lipopolysaccharide (400 micrograms/kg) alone (group 2, n = 8); and animals receiving lipopolysaccharide plus carboxy-PTIO at a rate of 0.17 mg/kg/min for 3 hrs (group 3, n = 5). Blood gases and mean arterial pressure (MAP) were monitored. In vivo phosphorus-31 magnetic resonance spectra were continuously obtained every 30 mins. In addition, the livers were sampled and underwent fractionation at 7 hrs after lipopolysaccharide administration. The hydrophilic and hydrophobic extracts from the livers were analyzed by in vitro hydrogen-1 and phosphorus-31 magnetic resonance spectroscopy. MEASUREMENTS AND MAIN RESULTS: After the administration of lipopolysaccharide, the first phase of decrease in MAP within 30 mins was followed by partial recovery within the next 30 mins. In group 2, MAP started to decrease progressively within 180 mins after lipopolysaccharide administration (second phase) and decreased by 33% from the baseline value to 49 +/- 9 mm Hg at 420 mins. In contrast, the infusion of carboxy-PTIO significantly attenuated the second decrease in MAP (68 +/- 10 mm Hg, at 420 mins). In group 2, a slow and progressive decrease in adenosine triphosphate (ATP) and increase in inorganic phosphate concentrations occurred from 120 mins after lipopolysaccharide administration, and continued throughout the observation period. These changes were accompanied by a progressive decrease in intracellular pH. On the other hand, in group 3, there were no significant changes in ATP and inorganic phosphate concentrations compared with the controls from 120 to 360 mins after lipopolysaccharide administration. Moreover, restorations of both arterial and hepatocellular acidosis were observed in group 3. The differences of the degree of liver damage--as determined by the total amount of phospholipid, free fatty acids concentration, and membrane fluidity--were not significant among the three groups. Three of eight rabbits in group 2 died within 7 hrs, but no animal in the other two groups died during the study. CONCLUSIONS: The results of this study indicate that the infusion of carboxy-PTIO: a) prevented the delayed hypotension associated with endotoxic shock in rabbits; b) returned the hepatocellular ATP concentrations nearly to the level of the controls and alleviated hepatocellular acidosis; c) normalized various hydrophilic metabolites, such as lactate and alanine in the liver; and d) did not exacerbate liver injury after the administration of lipopolysaccharide. These findings indicate that carboxy-PTIO, a nitric oxide scavenger, may have a positive vasopressor effect during hypodynamic septic shock without exacerbating liver injury.

Acidosis↗
PubMed1997

Beneficial effect of carboxy-PTIO on hemodynamic and blood gas changes in septic shock dogs.

BACKGROUND: Nitric oxide (NO) production following bacterial infection may play a physiological role in the host defense mechanism due to its antimicrobial activity. However, excess production of NO in severe infection such as sepsis has been implicated in the pathogenesis of septic shock. To determine whether a nitronyl nitroxide NO scavenger compound could prevent the hemodynamic and blood gas alterations in sepsis, bacterial lipopolysaccharide (LPS: 250ng/kg/min) was administered for 2 h in anesthetized dogs with or without infusion of carboxy-2-phenyl-4, 4, 5, 5-tetramethylimidazoline-1-oxyl-3-oxide (carboxy-PTIO: 0.1 mg/kg/min) for 1 h. Control animals received isotonic saline instead of LPS with or without carboxy-PTIO. RESULTS: Infusion of LPS caused a marked decrease in mean arterial pressure (MAP), metabolic acidosis, and hypoxia. These effects were reversed by co-administration of carboxy-PTIO, without affecting other hemodynamic parameters. In control animals, neither hemodynamic nor blood gas parameters changed with or without carboxy-PTIO. CONCLUSION: These results indicate that carboxy-PTIO attenuates LPS-induced hypotension, metabolic acidosis, and hypoxia by scavenging excess NO from the circulation without affecting NO synthase (NOS) activity. An NO scavenger, carboxy-PTIO, may be preferable to non-selective NOS inhibitors for the treatment of human septic shock.

Journal Article↗
PubMed1997

[The effect of low-rose prostaglandin E1 on circulation, respiration and body temperature during surgical anesthesia].

We investigated the effects of low-dose prostaglandin E1 (PGE1) on circulation, respiration, and body temperature during surgical anesthesia. We studied 109 adult patients undergoing upper abdominal operations under thoracic epidural combined with inhalational anesthesia. Patients were divided into 2 groups; Control group (n = 42) and PGE1 group (n = 67). In PGE1 group, PGE1 infusion was started at the rate of 0.02 microgram.kg-1.min-1 before the induction of anesthesia and was terminated at the end of surgery. There were no differences between the groups in demographic, anesthetic and surgical characteristics. After treatment with PGE1, arterial pressure decreased slightly but significantly, resulting in lower arterial pressure in PGE1 group than in control group before the induction of anesthesia. After the induction of anesthesia, however, arterial pressure decreased significantly in both groups, and the differences in arterial pressure between the groups were not observed any more during surgery. Heart rate was not different between the groups throughout the study period. Intraoperative urine output was greater in PGE1 group than in control group. PaO2/FIO2 ratio was not different between the groups both before and during anesthesia. Rectal temperature remained slightly but significantly lower in PGE1 group throughout surgery. Rectal-to-palm temperature gradient tended to be smaller in PGE1 group 1 hour after the induction of anesthesia. Low-dose PGE1 reduced arterial pressure. However, the difference in arterial pressure between the groups was so small that the difference disappeared during surgery. Meanwhile, low-dose PGE1 increased urine output, suggesting that renal blood flow was better-maintained with PGE1. In spite of several investigations reporting an unfavorable effect of PGE1 on PaO2, low dose PGE1 did not affect PaO2 in this study. Finally low-dose PGE1 reduced core temperature, though slightly, probably through redistribution of the body heat.

Adult↗
PubMed1997

[The effect of low-dose prostaglandin E1 on intra- and post-operative renal function].

We investigated the effects of low-dose prostaglandin E1 (PGE1) on intra- and post-operative renal function in 109 adult patients undergoing upper abdominal surgery. Anesthesia was maintained with a combination of thoracic epidural combined with inhalational anesthesia. Sixty-seven patients received PGE1 at a rate of 0.2 microgram.kg-1.min-1 throughout surgery. Forty-two patients, who did not receive PGE1, served as control. Pre- and post-operative renal function was evaluated with serum levels of BUN and creatinine (Cr), while intra-operative renal function was evaluated mainly with urine output and urine flow rate during anesthesia. Urinary Na excretion and creatinine clearance (Ccr) were determined during surgery in limited cases. Urine output and urine flow rate during anesthesia were greater in PGE1 group than in control group, whereas infusion volumes and infusion rates were not different between the groups. In PGE1 group, urine flow rate was greater during surgery than before surgery, while in control group, it was unchanged. Na excretion during anesthesia was also greater in PGE1 group than in control group. In control group, Na excretion and Ccr were smaller during surgery than before surgery, while in PGE1 group, they were unchanged. Postoperative serum BUN and creatinine levels were not different between the groups. Decreased Na excretion and decreased Ccr in control group indicated that renal function was depressed during surgery, whereas unchanged Ccr, unchanged Na excretion and increased urine flow rate in PGE1 group indicated that renal function was well-maintained during surgery with PGE1. Low-dose PGE1 thus prevented depression of renal function during surgical anesthesia.

Abdomen↗
PubMed1997

[The effect of low-dose prostaglandin E1 on intra- and post-operative liver function].

We investigated the effects of low-dose prostaglandin E1 (PGE1) on intra- and post-operative liver function in 109 adult patients undergoing upper abdominal surgery. Patients were divided into 2 groups; Control group (n = 42) and PGE1 group (n = 67). In PGE1 group, PGE1 was infused throughout surgery at a rate of 0.02 microgram kg-1 min-1. In both groups, anesthesia was maintained with a combination of inhalational and thoracic epidural anesthesia. Epidural anesthesia was maintained with 1.5% lidocaine infused epidurally at a constant rate (8 +/- 2 ml.hr-1). The continuous epidural infusion of lidocaine was initiated before surgery and discontinued at the end of surgery. Preoperative and postoperative liver function was evaluated with blood chemistry examination. Intraoperative liver function was evaluated in 84 patients (33 in control group and 51 in PGE1 group) by measuring plasma lidocaine concentration. Plasma lidocaine concentration was determined 1 and 3 hours after the initiation of lidocaine infusion and 0 and 2 hours after its termination. There were no differences between the groups in doses and infusion rates of lidocaine. In both groups, lidocaine concentration increased progressively as infusion was continued. Lidocaine concentration was significantly lower in PGE1 group than in control group at the end of the infusion. In 22 patients in control group and 35 in PGE1 group who received high-dose lidocaine (> 8 mg.kg-1), lidocaine concentration remained significantly lower in PGE1 group than in control group throughout the infusion period. The difference in lidocaine concentrations between the groups increased progressively as infusion was continued, though the doses and the infusion rates of lidocaine were not different between the groups. Postoperative liver function did not differ between the groups. Because removal of lidocaine from blood to liver parallels hepatic blood flow, the lower plasma lidocaine concentration in PGE1 group indicated that hepatic blood flow was higher and liver function was better-maintained with PGE1 during anesthesia and surgery. Low dose PGE1 thus improved intraoperative liver function during upper abdominal surgery.

Abdomen↗
PubMed1997

[The effect of low-dose prostaglandin E1 on serum and urinary fluoride concentrations in patients anesthetized with sevoflurane].

We investigated the effects of low-dose prostaglandin E1 (PGE1) on serum and urinary concentrations of inorganic fluoride in 39 adult patients undergoing upper abdominal surgery. Anesthesia was maintained with a combination of N2O-O2-sevoflurane and thoracic epidural anesthesia. Twenty-two patients received infusion of PGE1 at a rate of 0.02 micrograms.kg-1.min-1 throughout surgery. Seventeen patients served as control by not receiving PGE1. Serum inorganic fluoride concentrations (FB) were determined before the induction of anesthesia and 0, 2 and 24 hours after the end of anesthesia. Urinary inorganic fluoride concentrations (FU) were determined before the induction of anesthesia, and 0, 24 and 48 hours after the end of anesthesia. These was no difference between PGE1 group and control group in anesthetic dose (MAC hours) of sevoflurane. In both groups, FB peaked at the end of anesthesia. In PGE1 group, UB peaked at the end of anesthesia, while in control group, it peaked 24 hours after anesthesia. There were differences between groups neither in FB nor in FU throughout the study period. The relationships between anesthetic dose and fluoride concentrations, however, differed significantly between the groups. In control group FB values of 0, 2 and 24 hours after anesthesia correlated positively with MAC hours, respectively, while in PGE1 group they did not. Similarly in control group, FU values of 24 and 48 hours after anesthesia correlated positively with MAC hours, respectively, while in PGE1 group, they did not. Thus in patients receiving high-dose sevoflurane, FB and FU tended to be lower in PGE1 group than in control group. In contrast, in PGE1 group, urinary excretion of fluoride during surgery correlated positively with MAC hours, while in control group, it did not. Urinary fluoride excretion during surgery was significantly greater in PGE1 group than in control group. These results suggested that PGE1 might prevent elevation of serum and urinary fluoride concentrations in patients receiving high-dose sevoflurane. This effect might result from enhanced urinary excretion of fluoride with PGE1.

Abdomen↗