Search PubMed⌕ Search

Biomedical subjects

K Shibutani

Publications and source records attributed to K Shibutani.

At least 19 recordsLinked to original sources
PubMed2005

Pharmacokinetic mass of fentanyl for postoperative analgesia in lean and obese patients.

BACKGROUND: We previously proposed dosing weights for fentanyl, termed 'pharmacokinetic mass', that span the total body weight (TBW) range from 40 to 210 kg. In this study, we examined the relationships among fentanyl doses needed to achieve postoperative analgesia, corresponding plasma fentanyl concentrations, and pharmacokinetic mass in lean and obese patients undergoing abdominal surgery. METHODS: A total of 69 patients were studied, with TBW ranging from 48 to 181 kg. Fentanyl infusion was used during surgery. After surgery, fentanyl infusion rates were titrated to achieve analgesia without significant respiratory depression. Plasma fentanyl concentrations were measured when an apparent steady analgesic state was obtained. Comparisons were made for dosing requirements and effective plasma concentrations for 37 lean patients (body mass index < 30, TBW < 85 kg) and 33 obese patients (body mass index > 30, TBW > or = 85 kg). RESULTS: The average fentanyl dose (microg h(-1)) required to achieve and maintain analgesia over the 4 h postoperative period had a non-linear relationship to TBW; in comparison, fentanyl dose had a strong linear relationship to pharmacokinetic mass: dose (microg h(-1)) = 1.22 x pharmacokinetic mass - 7.5; r = 0.741, P < 0.001. Based on results from our earlier study, the corresponding values of TBW and pharmacokinetic mass are: 52 kg--52 kg; 70 kg--65 kg; 100 kg--83 kg; 120 kg--93 kg; 140 kg--99 kg; 160 kg--104 kg; 180 kg--107 kg; 200 kg--109 kg. In the group comparisons, there was no statistically significant difference in the postoperative fentanyl dose per unit of pharmacokinetic mass between lean and obese patients. The plasma concentration of fentanyl required for analgesia was approximately 1.5 ng ml(-1), and was similar in the two groups. CONCLUSION: The relationship between dose and pharmacokinetic mass, compared with that of dose vs TBW, may provide confidence for the use of pharmacokinetic mass as a dosing approximation for fentanyl. Fentanyl dose based on TBW may cause overdosing in obese patients.

Adult↗
PubMed2000

Bilateral Jejuno-mesenteric flap for reconstruction of complicated pharyngoesophageal defect.

The surgical management of an infectious and fistulous wound with a pharyngoesophageal tumor is one of the greatest challenges for head and neck and plastic surgeons. The free jejunal transfer has been the standard technique for pharyngoesophageal reconstruction, and the free omental flap has been one of the most reliable methods for reconstructing contaminated wounds. A jejuno-mesenteric flap is suitable for such complicated wounds. Pharyngoesophageal defects are reconstructed by the jejunum, and contaminated and heavily irradiated neck wounds are covered with the mesenteric flaps connected with a revascularized jejunum. The technique described here possesses the advantages of both a free jejunal flap and an omentum flap. Therefore, it is a reliable method for reconstructing the pharyngoesophageal defects of complicated wounds.

Esophageal Neoplasms↗
PubMed2000

[A questionnaire survey of the panel discussion at the annual meeting of the Japan Society of Anesthesiologists].

Two hundred questionnaire sheets were distributed to the audience of the panel discussion session titled "Progresses of balanced anesthesia" at the annual meeting of the Japan Society of Anesthesiologists. The audience was requested to rate their interest to the program and also rate the usefulness of the presentations by each panel. One hundred and seventeen questionnaire sheets (58%) were returned. Eighty five % of the returned survey expressed interests in the program. Forty three % expressed their interests in altering their anesthesia techniques along the line of the recommendation by the panels. These data suggest that the program met the educational need of the audience. Questionnaire survey may be useful in identifying the need of the members, and thus helpful in planning future meetings of the society.

Anesthesiology↗
PubMed1997

A possible immunosuppressant, cycloprodigiosin hydrochloride, obtained from Pseudoalteromonas denitrificans.

Cycloprodigiosin hydrochloride (cPrG.HCl), a member of the prodigiosin family, is a red pigment obtained from the marine bacterium Pseudoalteromonas denitrificans. cPrG.HCl markedly suppressed 3H-thymidine incorporation by concanavalin A stimulated murine splenocytes but had little effect on lipopolysaccharide dependent 3H-thymidine incorporation, indicating that cPrG.HCl acts as a selective inhibitor of T cell proliferation in the same way as other members of the prodigiosin family. cPrG.HCl inhibited the proliferation of the PMA stimulated Jurkat cells through an apoptotic process. Intriguingly, cPrG.HCl inhibited the H+ translocation by vacuolar type ATPase in chromaffin granule membranes without any effect on either its ATPase activity nor on the membrane conductance of phospholipid bilayers, suggesting that cPrG.HCl selectively uncouples H+ translocation from the ATPase reaction rather than acting as a non-specific ionophore. Since crystalline cPrG.HCl is highly stable, it raises the possibility of its therapeutic use as an immunosuppressant.

Animals↗
PubMed1994

Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output?

In anesthetized patients, acute decreases in cardiac output (CO) are often reflected as decreases in end-tidal CO2 tension (PETCO2), but the quantitative relationship between the changes in CO and the changes in PETCO2 is uncertain. We hypothesize that a quantitative relationship can be demonstrated if timing of the measurements in each episode of hemodynamic perturbation is standardized. In 24 patients undergoing abdominal aortic aneurysm surgery with constant ventilation, we prospectively performed 33 measurements of CO, PETCO2, and CO2 elimination (VECO2) within 10 min of hemodynamic changes. The percent decrease in PETCO2 directly correlated with the percent decrease in CO (slope = 0.33, r2 = 0.82). Also, the percent decrease in VECO2 correlated with the percent decrease in CO similarly (slope = 0.28, r2 = 0.84). The changes in PETCO2 and VECO2 following hemodynamic perturbation were parallel. This finding suggests that decreases in PETCO2 quantitatively reflect the decreases in CO2 elimination.

Aged↗
PubMed1992

Effects of fentanyl-diazepam-pancuronium anesthesia on heart rate variability: a spectral analysis.

The effects of induction of anesthesia with fentanyl, 62.1 +/- 7.9 micrograms/kg, diazepam, 0.21 +/- 0.08 mg/kg, and pancuronium on beat-to-beat heart rate variations were studied in seven patients undergoing cardiac surgery. Spectral analysis was used to determine the intensity of the variations in each of the two main frequency bands in which variations are known to occur: (1) high-frequency band, mediated by the parasympathetic nervous system, at the frequency band of respiration, and (2) the low-frequency band, mediated by both sympathetic and parasympathetic nervous systems, at 0.04-0.12 Hz. Both the mean low- and high-frequency band areas were significantly decreased after induction of anesthesia. The ratio of high-to-low frequency band areas increased significantly after induction of anesthesia, from 45% to 62% (P less than 0.05). These results suggest that fentanyl-diazepam-pancuronium anesthesia decreases total autonomic nervous system activity and alters the balance between parasympathetic and sympathetic activities. Thus, spectral analysis of heart rate variations during anesthesia may provide a quantitative measure of assessing the activity of the autonomic nervous system.

Adult↗
PubMed1992

[A case with hepatocellular carcinoma effectively treated by continuous hepatic arterial infusion of etoposide, epirubicin and CDDP].

A 53-year-old man who suffered from advanced hepatocellular carcinoma (HCC) was treated with hepatic arterial infusion (HAI) of Etoposide, Epirubicin and CDDP. Treatment consisted of a continuous HAI of Epirubicin (50 mg/body, day 1.7), CDDP (75 mg/body, day 2.8) and Etoposide (80 mg/body, day 4-6). He had two series of infusions and was treated by transarterial embolization using CDDP powder (100 mg) added to lipiodol and aluminum stearate as suspension following HAI. The tumor regression rate was about 60% after HAI, but the remaining tumor seemed to be almost necrotic. AFP and PIVKA-II reached the normal range after TAE. We could not find lipiodol accumulated in tumor on CT carried out eight weeks after TAE. No recurrence has been noticed in the following 8 months. Toxicity was not so severe and was well tolerated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Chondrosarcoma of the parapharyngeal space.

Chondrosarcoma is rarely found arising in the head and neck region. An unusual case arising in the parapharyngeal space in a male is reported and the differential diagnosis, pathology and treatment are discussed.

Adult↗
PubMed1990

The changes in brain surface, intracerebral tissue, and transconjunctival oxygen tension during hypo- and hyperventilation.

To evaluate the validity of organ surface oxygen tension monitoring for assessment of cerebral perfusion, the oxygen tension in brain surface (Pbs(O)(2)), intracerebral tissue (Pic(O)(2)), and conjunctiva (Pcj(O)(2)) were measured simultaneously during hypo- and hyperventilation in dogs, and the comparative study was done. Pbs(O)(2) and Pic(O)(2) significantly increased during hypoventilation and decreased during hyperventilation. And the values of Pbs(O)(2) and Pic(O)(2) were correlated to the corresponding Pa(CO)(2) values significantly ( P << 0.001 in each case). On the contrary, Pcj(O)(2) did not change significantly during hypo- and hyperventilation. These findings indicate that Pbs(O)(2) as well as Pic(O)(2) could reflect the changes in cerebral perfusion caused by induced hyper- and hypocapnia but that Pcj(O)(2) could not.

Journal Article↗
PubMed1990

[Dentist's understanding on dental anesthesiology--on the basis of a questionnaire on post-graduation study].

We set out a questionnaire for 400 participants of the seminar, to investigate the thoughts of dental practitioners and dentists on duty with regard to the post-graduation study and training in particular, to dental anesthesiology. The results obtained were as follows. 1. Almost all of the dental practitioners felt necessary to receive the post-graduation study and training to brush up their techniques. 2. The dental practitioners felt defective in actual techniques prepared by post-graduation trainings now under way, and they desired a particular training in an actual technique specific to an emergency therapy. 3. Seminars for re-education they desired to attend were those related to anesthesia in majority, followed by prosthetics, maintenance and periodontosis, orthodontics, and surgery, implantodontics, and pedodontics. 4. Major curriculums of anesthesiology they desired to receive were systemic management, resuscitation, how to apply the first-aid medicine, and treatment for shock states. The number of those participants who desired to receive these curriculums was help or above of all members, followed by those in dental psychosomatic disease, treatment for senile patients and acupuncture anesthesia. 5. It was unexpected that those who had been aware of the concept of authorized dental anesthesiologist were confined to 54% of the participants. This led us to consider that clinical dentist should be re-educated regarding the system for authorized anesthesiologist. 6. Major participants answered nothing with regard to the advocated curriculums we questioned, so that it was postulated that none felt unsatisfactory of the advocated curriculums at present.

Anesthesia, Dental↗
PubMed1990

[Judgement on students' exercise for resuscitation using a manikin for CPCR exercise (1st report)].

We performed the training for resuscitation using dental students and used a manikin for CPCR Exercise before and after the training to investigate the result obtained. The results were as follows. 1. Although cases in which too much or too little ventilation in amount was judged showed no significant changes before and after the training, those judged too much in ventilation amounted to approx. 1/5 and those judged too little were approx. 1/2 of the total subjects. This suggests that it is preferable to instruct the students to maintain sufficient ventilation when allowing them to exercise artificial breathing of CPCR. But the instruction is somewhat difficult to take because inhibition of gastric distention should be taken into account. 2. Although no changes were shown before and after the training by cases judged too deep in the depth of thoracic oppression, the number of those cases amounted to approx. 4/5 of the total subjects. Cases judged too shallow in depth of thoracic oppression, on the other hand, were significantly decreased from approx. 4/5 before training to approx. 2/3 after training, suggesting that improvement of the shallow oppression initially made is easy rather than to improve the oppression unduly deepened. Accordingly, it appears effective for students to avoid undue oppression when they are trained. 3. Thoracic oppression at a correct position was increased significantly to approx. 1/5 of the total cases, although most of the subjects were in error to choose a correct position for thoracic oppression before training.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiopulmonary Resuscitation↗