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Biomedical subjects

O Kemmotsu

Publications and source records attributed to O Kemmotsu.

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

[Pharmacodynamics of vecuronium in the kidney transplant recipient and the patient with normal renal function].

Pharmacodynamics of vecuronium were evaluated in seven kidney transplant recipients and compared with seven patients with normal renal function. Vecuronium 0.12 mg.kg-1 was used for the initial dose and 0.03 mg.kg-1 for the second dose for each patient under general anesthesia with either isoflurane, sevoflurane or halothane plus nitrous oxide after induction by thiamylal. The effect of vecuronium was evaluated by a muscle relaxation monitor. The time to the maximum blockade (onset time) and the time of 25% recovery of the first twitch height (duration time) were measured after each administration of vecuronium in patients of both groups. The onset times after the initial and second doses were similar in both groups (180.0 +/- 15.5 sec for recipients versus 185.7 +/- 14.9 sec for patients of normal renal function). However, duration was significantly longer in recipients than in patients of normal renal function. Durations after the initial and second doses were 130 +/- 19 min for the initial dose and 86 +/- 12 min for the second dose in recipients, whereas they were 51 +/- 5 min and 37 +/- 5 min in patients of normal renal function. The prolonged durations of vecuronium in the kidney transplant recipient were speculated to be mainly due to delayed elimination of the drug and effect of cyclosporin, an immunosuppressive agent in the recipients. These results suggest that the titrated administration of vecuronium by keen monitoring of muscle relaxation is needed in the kidney transplant recipient to avoid unnecessary prolongation in duration of action.

Adolescent↗
PubMed1993

[Postoperative pain relief by preanesthetic administration of buprenorphine suppository in elective mastectomy].

Seventy female patients scheduled for elective mastectomy were divided into three groups: Buprenorphine suppository (BPS) 0.4 mg group (n = 29); BPS 0.2 mg (n = 23) group; and control (scopolia extract and tannic acid suppository) group (n = 18). Suppositories were administered rectally to patients of each group one hour before induction of anesthesia. Plasma buprenorphine concentrations, sedation scores at entering the operating room, postoperative pain scores and side effects were evaluated. There were no significant differences in sedation effects of suppository among the three groups. Although there were significant differences in pain scores except at the time when patients left the operating room between BPS 0.2 mg group and the control group, postoperative pain relief in BPS 0.2 mg group was judged not enough. However, postoperative pain relief was more satisfactory in the BPS 0.4 mg group. Plasma concentrations of the BPS 0.4 mg group were higher than those of the BPS 0.2 mg group. Although nausea and vomiting were observed in 5 patients (17.2%) of the BPS 0.4 mg group and 4 patients (17.4%) of the BPS 0.2 mg group, respiratory depression and changes in blood pressure and heart rate were not observed in all groups. In conclusion, preanesthetic administration of the BPS 0.4 mg seemed to be useful for postoperative pain relief after elective mastectomy.

Adolescent↗
PubMed1993

Correlative study of behavior and synaptic events during halothane anesthesia in the lamprey.

Behavioral anesthetic effects of halothane were compared with neurophysiological data obtained from monosynaptically coupled, single axon-giant neuron pairs in the isolated central nervous system of the lamprey in vitro. Based on the assumption that the number of halothane molecules at the site of anesthetic action is determined by molar concentration of the bath, depths of anesthesia were characterized in terms of synaptic events. The concentration producing anesthesia in 50% (AC50) and 95% (AC95) of the animals were 0.32 and 0.51 mM, respectively. With these concentrations, the depression of glutamate (GLUT)-mediated synaptic excitation remained less than 50%. Maximum suppression of the excitatory synaptic transmission was observed in the presence of 1.7 mM halothane which would be equivalent to the inhalation of 5.5% of this agent at 37 degrees C. At these concentrations, postsynaptic membranes did not respond to the bath-applied GLUT agonists. The decrease of agonist-induced responses to almost the same extent as excitatory postsynaptic potential (EPSP) amplitudes in the presence of halothane argues against a presynaptic mechanism affecting transmitter release. Persistent voltage-gated Na+ channel function at concentrations less than 2.4 mM is evidence against the involvement of this mechanism at these levels of anesthesia. The present results suggest that with depths between AC50 and AC95, anesthesia is associated with a partial reduction of sensitivity of the postsynaptic membrane to the excitatory amino acid transmitters.

Anesthesia, Inhalation↗
PubMed1993

[Accidental subdural catheterization discovered after postoperative respiratory depression].

A 65-year-old man scheduled for gastrectomy was anesthetized with nitrous oxide combined with continuous epidural lidocaine. At the end of the operation, morphine 2 mg diluted in 0.25% bupivacaine 5 ml was injected through the epidural catheter. Seventy minutes later, the patient developed life-threatening respiratory depression which was antagonized by naloxone. The patient requested no analgesic during the first 26 postoperative hours. The respiratory depression in this patient was assumed to be caused by epidural morphine. Then subdural catheterization was confirmed radiologically. This was discovered to have resulted from migration of the epidural catheter into the subdural space. Subdural injection of morphine may have resulted in higher cerebrospinal fluid levels than the levels obtained after epidural injection. Subdural catheterization is a complication of epidural anesthesia that probably occurs more frequently than previously recognized. In postoperative patients receiving epidural morphine, their respiratory status should be monitored closely for hours.

Aged↗
PubMed1992

Regional differences in skin blood flow and temperature during total spinal anaesthesia.

Three patients were studied to determine the changes in regional skin temperature and blood flow during extensive sympathetic blockade following total spinal anaesthesia (TSA). Skin temperature was measured at the right upper arm, the right anterior chest at the nipple level, the right hand and the foot, using infrared thermography. Skin blood flow of the right upper arm (C6 area) was measured with a laser Doppler flowmeter. The temperature of the truncal area, arm and leg decreased by 1 degree C following TSA, whereas the temperature of the hand and foot increased by 3 degrees C. The mean blood flow in three patients decreased to 26.1, 61.4, 51.7% of the control values 15 min after TSA. Our results indicate that extensive sympathetic nervous blockade during total spinal anaesthesia induces regional different changes in skin temperature and decrease in truncal skin blood flow.

Anesthesia, Spinal↗
PubMed1992

Does propofol enhance GABA-mediated inhibition?

The effects of propofol on synaptic transmission were characterized and compared with pentobarbital in the rat hippocampal slice preparation. Hippocampal CA1 population spike after stimulation of Schaffer collaterals indicated that the postsynaptic response was primarily mediated by non-N-methyl-D-aspartate class glutamate receptors since it was abolished by the presence of 6,7-dinitroquinoxaline-2,3-dione (DNQX). Propofol and pentobarbital depressed CA1 population spike amplitude in a dose dependent fashion. Dose-response curves for population spike amplitudes were determined for propofol and pentobarbital and the concentrations producing a half-maximum response (ED(50)) were 110 microM and 160 microM for propofol and pentobarbital, respectively. By contrast, when GABA A-mediated inhibition was blocked by addition of 100 microM pictotoxin, propofol, in concentrations up to 400 microM had no significant effect on population spike amplitudes. These results suggest that propofol attenuates synaptic transmission in the central nervous system in part by enhancing GABA A-mediated inhibition and not by depressing glutamate-mediated excitation, as occurs with pentobarbital.

Journal Article↗
PubMed1992

Hemodynamic effects of nicardipine-induced hypotension during enflurane/nitrous oxide anesthesia in man.

Hemodynamic effects of nicardipine-induced hypotension during enflurane/nitrous oxide were evaluated in 10 surgical patients. An infusion of nicardipine was titrated to maintain mean arterial pressure at 60 to 70 mmHg under enflurane 1.5 to 2.0 vol% and nitrous oxide 60 vol%. Mean arterial pressure was well controlled with the nicardipine infusion, whereas cardiac index increased with decreased systemic vascular resistance. Heart rate increased concomitantly with decreased blood pressure, which indicated that enflurane 1.5 to 2.0 vol% did not suppress baroreceptor reflex during nicardipine administration. However, rate-pressure-product was not increased by the nicardipine. Right and left ventricular systolic work indices were not increased by the nicardipine. Right ventricular ejection fraction was not also changed by the nicardipine. Although serum norepinephrine level increased during the nicardipine infusion, the values remained within physiological ranges. Our results suggest that nicardipine-induced hypotension may be safely performed during enflurane/nitrous oxide anesthesia because neither ventricular work nor myocardial oxygen demand was increased by nicardipine.

Journal Article↗
PubMed1992

Differential sensitivity of diabetic rat papillary muscles to negative inotropic effects of oxybarbiturates versus thiobarbiturates.

The negative inotropic effects of oxybarbiturates and thiobarbiturates were examined in papillary muscles isolated from streptozotocin-induced diabetic rats and in papillary muscles from age-matched control rats. The muscles from diabetic rats exhibited less negative inotropic responses to pentobarbital and secobarbital than the muscles from control rats. Conversely, the negative inotropic responses to thiopental and thiamylal were significantly enhanced in diabetic muscles. Differences in sensitivity to pentobarbital between control and diabetic muscles became less marked by treatment with ouabain or by lowering [Na+]o. Enhancement of the negative inotropic effect of thiamylal observed in diabetic muscles remained unchanged with these treatments. In both control and diabetic muscles, the negative inotropic effect of pentobarbital was completely reversed by increasing [Ca2+]o, but the effect of thiamylal was only partially reversed. These results suggest a difference in mechanism of action involved in establishment of the negative inotropic effects of oxybarbiturates vs thiobarbiturates. Oxybarbiturates appear to exclusively reduce the influx of extracellular Ca2+, whereas thiobarbiturates appear to affect Ca2+ movements at the Ca2+ storage sites in addition to the Ca2+ influx inhibition.

Animals↗
PubMed1992

[Low reactive-level laser therapy near the stellate ganglion for postherpetic facial neuralgia].

Low reactive-level laser therapy near the stellate ganglion was given for a 68-year-old female with postherpetic neuralgia, suffering from burning pain in the right forehead for 11 years. Stellate ganglion block and supraorbital nerve block with oral medication were not effective to relieve this pain. The laser irradiation induced warm sensation in her face followed by an excellent pain relief. Thermograms illustrated a remarkable increase from 30.6 degrees C to 31.5 degrees C in temperature of her right face. The irradiation near the right carotid artery also had the similar effect. The results imply that the irradiation with low reactive-level laser of the stellate ganglion and/or the carotid artery increases a facial blood flow and relieves facial neuralgia.

Aged↗
PubMed1992

[Polarized light irradiation near the stellate ganglion in a patient with Raynaud's sign].

Polarized light irradiation near the stellate ganglion was performed in a 55-year-old female with Raynaud's sign. She was suffering from cold and numb pain in bilateral fingers for 1 year. Stellate ganglion block and low reactive-level laser therapy near the stellate ganglion were not sufficient to relieve this symptom. Polarized light irradiation near the stellate ganglion induced a sting stimulation and warm sensation in her hands. Thermograms revealed a remarkable increase in temperature of her hands. The results imply that polarized light irradiation near the stellate ganglion increases blood flow of forearms and relieves Raynaud's sign.

Female↗
PubMed1992

[ICU syndrome].

Explore the source record for details and available documents.

Adolescent↗
PubMed1992

[Direct observation of the epidural space by the superfine fiberscope].

The anatomy of the epidural space was examined in 82 patients 3 to 90 years old who had indications of epidural anesthesia. The superfine fiberscope with an outer diameter of 0.8 mm was utilized for this study. It was advanced through 18 gauge Tuohy needle inserted into the epidural space. All findings were documented by videography. The epidural space was located at the thoracic intervertebral space (52 patients), at the lumbar interspace (27 patients) and at the caudal space (3 patients), using an 18-gauge Tuohy needle with either median or paramedian approach. The epidural space was identified by either hanging drop or loss of resistance method. 65 of 82 cases gave a clear view of epidural space. The epidural space presented as either a space that opened widely or a space that was occupied with large masses of fat. Vessels were encountered on the dura and the flaval ligaments, as well as in the connective tissue. Large amounts of connective tissue were present in all cases. No complications, such as accidental dural puncture, epidural hematoma, infection, nerve injury attributed to this technique were observed.

Adolescent↗
PubMed1992

[Pneumonia due to aspiration of povidone-iodine during anesthesia--a case report].

We report a case of pneumonia secondary to aspiration of povidone-iodine, which was used as an oral antiseptic. The patient was 17 y.o. female (body weight: 70 kg) who underwent a transsphenoidal resection of pituitary adenoma. Although she had a history of asthma during her childhood, no asthmatic attacks occurred for the past 10 yrs. After satisfactory anesthesia induction and tracheal intubation, 60 ml of 0.7% povidone-iodine solution was used to clean the oral cavity by a surgeon. Insufficient sealing by the cuff occurred after suturing the tube, which had made a needle hole in the cuff. Arterial oxygen saturation dropped to 90% and an increased resistance in the lungs was noted. The trachea was reintubated and she was transferred to the ICU. Her chest X-ray revealed signs of pneumonia and atelectasis in the right upper lobe. Mechanical ventilation with PEEP and periodical bronchial toilet were performed during her stay in the ICU for 42 hrs. A week was needed for the improvement of her X-ray findings. Although povidone-iodine is thought to be safe and affective antiseptics, severe complications from its aspiration may occur in patients whose airways are sensitive as observed in this case.

Adolescent↗
PubMed1992

[Measurement of functional residual capacity by sulfur hexafluoride washout].

An open circuit tracer gas washout method for measurement of functional residual capacity (FRC) during mechanical ventilation is described and tested. The system employed a piezo-valve for dispensing sulfur hexafluoride (SF6) gas, a fast response infrared SF6 analyzer, Servo 900-C ventilator and a computer. The piezo-valve unit delivers SF6 into the airway in proportion to instantaneous inspiratory flow so that inspiratory SF6 concentration was held constant regardless of the inspiratory flow pattern. The washin concentration was approximately 0.6% which was so low that the supply of other gases was hardly influenced. The amount of SF6 at the end of a washin was calculated during washout by signals of expired SF6 concentration and expired flow. The results obtained in model lungs were accurate and reproducible; mean difference (limits of agreements) was 14 +/- 48ml (M +/- 2SD) in the range between 0.5 and 3.0 liters. Comparison with helium dilution methods in 24 healthy subjects gave a regression equation: y = 0.98x + 56, r = 0.98. The mean difference of the values between the two methods was 21 +/- 142 ml (M +/- 2SD). The authors conclude that the system is quite useful in determining FRC of the patients under mechanical ventilation.

Functional Residual Capacity↗
PubMed1992

[Valve injury: a new complication of internal jugular vein cannulation].

Although internal jugular vein cannulation is performed commonly, most physicians are not aware of existence of the internal jugular venous valve. This is the only valve between the right atrium of the heart and the brain, and it has an important role of preventing retrograde blood flow and increased back pressure to the brain. In this study, anatomic appearance of human internal jugular valves is described, and the competence of these valves is assessed. We examined also a safe approach to percutaneous cannulation of the internal jugular vein to avoid this complication. In the cadaveric subjects, the internal jugular vein with its valve was removed at the time of autopsy. In the living subjects, to examine the movement of this valve, endoscopic visualization utilizing the superfine fiberscope, and ultrasound techniques were applied. Next, to detect the competence of the jugular venous valve, transvalvular pressure gradients were measured. Nineteen internal jugular valves were obtained from 20 cadaveric subjects. These valves were situated directly above the termination of the internal jugular vein into the inferior bulb. The opening and closing of the valve were easily visualized with both superfine fiberscope and real-time ultrasound technique. Patients with competent valves showed transvalvular pressure gradients of 50-100 mmHg during cough-induced high intrathoracic pressure. Internal jugular venous valve is located 0.5-2.0 cm above the union of the subclavian and internal jugular veins, and the central approach performed at the summit of the cervical triangle has been shown to have a risk of injuring the internal jugular venous valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization, Peripheral↗