The Isolation and Biochemical Characterization of the Mitotic Apparatus of Dividing Cells.
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Journal Article↗
Biomedical subjects
K Dan
Publications and source records attributed to K Dan.
Anesthetic management of a patient with Bartter's syndrome.
Bartter's syndrome is a rare disorder characterized by normal or low arterial blood pressure (BP), despite marked elevation in plasma renin activity, angiotensin II (Ang-II), and aldosterone, along with hypokalemic metabolic alkalosis. Perioperative changes in the cardiovascular and renin-angiotensin-aldosterone (RAA) systems in Bartter's syndrome patients are not well understood. We managed a 44-year-old Japanese man with rectal cancer and Bartter's syndrome complicated by renal dysfunction. He underwent anterior resection of the rectum with general anesthesia (50% nitrous oxide-oxygen with 0.5% to 0.8% isoflurane, supplemented with intravenous midazolam and butorphanol). Epidural morphine was given postoperatively. Although BP tended to be lower (75/35 to 110/60 mmHg) during surgery, there were no profound perioperative hemodynamic derangements. Plasma renin activity. Ang-II, and aldosterone values were highest during surgery. These responses of the RAA system to anesthesia and surgery were the same as previously noted in otherwise healthy surgical patients.
Adult↗
Bactericidal activity of 0.5% bupivacaine with preservatives on microorganisms in the human skin flora.
BACKGROUND AND OBJECTIVES: The bactericidal activity of 0.5% bupivacaine with preservatives at body temperature and at room temperature is not known. We studied the bactericidal activity of 0.5% bupivacaine with 0.08% methyl para-oxybenzoate and 0.02% propyl para-aminobenzoate as preservatives and of the preservatives alone at 37 degrees C and at room temperature on two strains of methicillin-resistant Staphylococcus aureus, two strains of methicillin-susceptible S. aureus, and one strain each of Staphylococcus epidermidis and Escherichia coli. METHODS: The pathogen was exposed to 0.5% bupivacaine with preservatives or to the preservatives alone for 1, 3, 6, 12, and 24 hours at 37 degrees C and at room temperature. The inocula from these suspensions were cultured for 48 hours at 37 degrees C after the antimicrobial activity of bupivacaine was inactivated by 1:1,000 dilution with physiological saline. RESULTS: The 1- through 12-hour exposures of four strains of S. aureus to 0.5% bupivacaine with preservatives at room temperature reduced the mean colony count by 24.2%, 49.2%, 71.3%, and 89.6%, respectively, and the exposure at 37 degrees C reduced the count by 74.1%, 95.2%, 99.9%, and 99.8%, respectively. The differences for 1- through 12-hour exposures were significant (P < .001). The percentage kill in the strains of E. coli and S. epidermidis was significantly higher than that in the strains of S. aureus at all exposure times at room temperature (E. coli, P < .001; S. epidermidis, P < .0001) and at 1- and 3-hour exposures at 37 degrees C (E. coli, P < .001; S. epidermidis, P < .0001). The bactericidal activity of the preservatives was markedly lower that that of 0.5% bupivacaine with preservatives (P < .0001). CONCLUSIONS: The bactericidal activity of 0.5% bupivacaine with preservatives is stronger at body temperature than at room temperature; the bactericidal activity may be due, to a large extent, to bupivacaine rather than to the preservatives; and S. aureus is more resistant to the bactericidal activity of bupivacaine than are S. epidermidis and E. coli.
Anesthetics, Local↗
Blood flow velocity changes in carotid and vertebral arteries with stellate ganglion block: measurement by magnetic resonance imaging using a direct bolus tracking method.
BACKGROUND AND OBJECTIVES: Stellate ganglion block (SGB) leads to vasodilation of the head and neck, as a result of a regional sympathetic blockade. However, in such cases, controversy remains concerning changes in cerebral and extracerebral blood flow in the head. We estimated the effect of SGB on blood flow in the head by measuring the blood flow velocity in cervical vessels, using magnetic resonance imaging and the direct bolus tracking method. This noninvasive method is free from potential artifacts of bones and other connective tissues. METHODS: Seven adult patients with acute or chronic pain in the head or neck underwent SGBs, using an anterior paratracheal approach with 6-8 mL of 1% mepivacaine (3 right and 4 left SGBs). Blood flow velocity in common carotid and vertebral arteries (CCA and VA) was measured simultaneously before and after SGB, using the direct bolus tracking method. RESULTS: On the side of SGB, blood flow velocity in CCA significantly increased (P < .002), whereas velocity in VA was unchanged after SGB. On the side contralateral to the SGB, significant changes in blood flow velocity in CCA and VA were never observed. CONCLUSIONS: Blood from the VA flows primarily to cerebral vessels, whereas that from CCA goes to both cerebral and extracerebral vessels. Given the presumed differences in blood flow distribution through the VA and CCA, we assume that the observed CCA blood flow increases, ipsilateral to the SGB, primarily as a result of vasodilation of extracerebral vessels and independent of changes in brain blood flow.
Acute Disease↗
High thoracic epidural block relieves acute herpetic pain involving the trigeminal and cervical regions: comparison with effects of stellate ganglion block.
BACKGROUND AND OBJECTIVES: Stellate ganglion block can promptly relieve acute herpetic pain (AHP) involving the trigeminal and cervical regions. However, repeated blocks are needed to maintain pain relief in most patients with severe AHP. Because continuous epidural block is easily performed using an indwelling catheter, we compared the effect of high thoracic epidural block with that of stellate ganglion block to relieve moderate-to-severe AHP involving these regions. METHODS: Six patients received stellate ganglion blocks and seven patients received high thoracic epidural blocks. Six milliliters 1% of mepivacaine was given to each patient. Acute herpetic pain was evaluated before and up to 60 minutes after the blocks, using a visual analog scale (VAS) of pain. RESULTS: There was no significant difference in VAS pain scores before the blocks between the groups, but there were significant (P < .05) decreases in VAS pain scores for both groups between 10 and 60 minutes after the blocks. There were no significant differences in VAS pain scores between the groups after the blocks. CONCLUSIONS: High thoracic epidural block was as effective as stellate ganglion block in relieving moderate-to-severe AHP involving the trigeminal and cervical regions.
Acute Disease↗
Disappearance of wheezing during epidural lidocaine anesthesia in a patient with bronchial asthma.
BACKGROUND AND OBJECTIVES: Local anesthetics in blood absorbed from the epidural space attenuate bronchial hyperreactivity to chemical stimuli. However, it is not documented whether local anesthetics at clinically relevant concentrations improve active wheezing in patients with bronchial asthma. CASE REPORT: We managed a 60-year-old man with bronchial asthma and active wheezing under continuous epidural anesthesia using plain lidocaine. The wheezing gradually diminished 20 minutes after the epidural injection of 13 mL 2% lidocaine and completely disappeared over 155 minutes during continuous epidural injection of 2% lidocaine (6 mL/h). The plasma concentrations of lidocaine in arterial blood during the epidural anesthesia ranged from 2.5 to 3.9 microg/mL. Wheezing reappeared 55 minutes after termination of the continuous epidural injection of lidocaine. The plasma concentration of lidocaine at this time was 1.9 microg/mL. CONCLUSIONS: At clinically relevant concentrations, lidocaine in the blood absorbed from the epidural space may improve bronchospasm in patients with bronchial asthma.
Anesthesia, Epidural↗
Low-dose thoracic epidural anesthesia induces discrete thoracic anesthesia without reduction in cardiac output.
The sensory spread and hemodynamic effects of low-dose thoracic epidural anesthesia were closely studied in 13 elective preoperative patients undergoing thoracotomy. An epidural catheter was inserted at the T4-5 or T5-6 intervertebral space and 5 ml 0.5% plain bupivacaine was injected. Cardiac output was measured by suprasternal Doppler method in all patients and also by thermodilution method with a Swan-Ganz catheter in six subjects. The cardiac outputs measured by suprasternal Doppler (Y) and thermodilution (X) methods showed a high correlation (Y = 0.74X + 0.99, r = 0.90, n = 24). Cephalad and caudad levels of hypesthesia at 15 minutes after bupivacaine injection were C8.4 +/- 2.1 (mean +/- SD) and T7.8 +/- 2.6, and those of anesthesia, T1.9 +/- 2.4 and T5.7 +/- 2.6, respectively. After epidural injection of 0.5% plain bupivacaine, a mean decrease in heart rate of 12 was observed in 15 minutes, which while clinically insignificant, was statistically significant (p less than 0.001). The decreased heart rate returned to control level after endotracheal intubation. Mean arterial blood pressure decreased slightly and only a slight elevation was seen after endotracheal intubation. Cardiac index and pulmonary capillary wedge pressure were essentially unchanged during the study period. Central venous pressure increased gradually and significantly, but within the normal range. Pulmonary vascular resistance slightly decreased in 15 minutes and returned to the control level after endotracheal intubation. Thus, low-dose thoracic epidural anesthesia was associated with minimal cardiovascular changes.
Aged↗
Extensive application of epidural anesthesia and analgesia in a university hospital: incidence of complications related to technique.
BACKGROUND AND OBJECTIVES: The authors report the role of epidural anesthesia and analgesia (EAA) and the incidence of epidural puncture-related complications in a university hospital in Japan. METHODS: Epidural anesthesia and analgesia was the major (39.7%) technique when administering 40,010 anesthetics. For the upper and the lower abdominal procedures, EAA was the major anesthetic technique in 79.5%, and 71.1% of these were carried out without potent inhaled anesthetics or long-acting muscle relaxants, and without endotracheal intubation. RESULTS: Epidural anesthesia and analgesia-related complications included failure to produce anesthesia on the first attempt (4.1%), bleeding/intravascular cannulation (0.67%), unintentional dural puncture (0.61%), paresthesia (0.16%), and local anesthetic toxicity (0.12%). CONCLUSIONS: The incidence of EAA-related complications was greater with lumbar than with thoracic puncture. Four patients had transient neuropathy related to epidural puncture, but no serious neurologic complications occurred.
Analgesia, Epidural↗
Bactericidal activity of clinically used local anesthetics on Staphylococcus aureus.
BACKGROUND AND OBJECTIVES: The rate of onset of antimicrobial activity of local anesthetics is unknown. Similarly, whether the activity is bactericidal or bacteriostatic is also unknown. The antimicrobial activity of local anesthetics with preservatives has not been studied. This study investigated the rate and potency of the antimicrobial activity of 0.125%, 0.25%, and 0.5% bupivacaine, 2.0% mepivacaine and 2.0% lidocaine with preservatives, and 2.0% lidocaine without preservatives on two strains of methicillin-resistant Staphylococcus aureus. METHODS: The pathogen was exposed to each local anesthetic for 1, 3, 6, 12, and 24 hours at room temperature. The inocula from these suspensions were diluted to 1:1,000 with physiological saline to inactivate the antimicrobial activity of the local anesthetics and then were cultured for 24 hours at 37 degrees C on agar plates. RESULTS: Lower colony counts were observed with a 3-hour or longer exposure to 0.5% bupivacaine in both strains of S. aureus (P < .05). The 3-hour exposure reduced the count by approximately 60%, the 6-hour exposure by 70%, and the 24-hour exposure by more than 99%. The bactericidal activity was lowest with 0.125% bupivacaine and 2.0% mepivacaine. CONCLUSIONS: Antimicrobial activity was observed shortly after exposure of S. aureus to local anesthetics and appeared to be bactericidal rather than bacteriostatic. However, the observed bactericidal activity, although it developed rapidly, may be insufficient to account for the low incidence of epidural infection related to epidural cannulation.
Anesthetics, Local↗