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Biomedical subjects

O Takaki

Publications and source records attributed to O Takaki.

At least 19 recordsLinked to original sources
PubMed1997

[Efficacy of lidocaine tape for venous cannulation in children].

We evaluated whether lidocaine tape (3 X 5 cm, contained 18 mg of lidocaine) could reduce pain caused by venous cannulation in children during anesthetic induction. One hundred and thirty-five children scheduled for elective surgery were randomly assigned to three groups according to the application time of the tape (30 min, 60 min and 120 min). Pain assessment was made by using our pain score (0: no response, 1: slight agitation, 2: strong agitation, at the venous cannulation). The effect of pain reduction (pain score 0 and 1) was found in 81 % of all patients. Especially in the group of 120 min, the effect was remarkable. Only 6.7% of all patients had slight adverse effects including skin redness and itching. In another 25 patients (weighing 3.5-30 kg), plasma concentration of lidocaine were measured 120 min after application of a piece of this tape. Arterial blood was sampled at 30 and 120 min after the tape was removed. Plasma lidocaine levels were always below 0.8 mcg.ml-1 In conclusion, the lidocaine tape may be useful and safely applicable for venous cannulation in children.

Administration, Cutaneous↗
PubMed1995

Optimal placement of CVP catheter in paediatric cardiac patients.

For correct monitoring of central venous pressure (CVP) the tip of the CVP catheter should be placed in the superior vena cava (SVC). Since there is no useful guide for the optimal depth of insertion of CVP catheter in children undergoing cardiovascular surgery, we examined the relationship between the depth of the CVP catheter and easily measured body-size variables, such as age, weight and height, and then created a guide for the optimal placement of the paediatric population. The CVP catheterization was performed through the right internal jugular vein by the high approach. The position of the catheter tip was determined by the wave form of the CVP tracing and the depth of insertion was assessed by the external marking on the catheter at the cannulation site. The position of the catheter tip, determined by postoperative AP chest x-ray, was identified by the level of thoracic vertebra (T) corresponding to the position of the catheter tip. We analyzed the relationship between the depth of the catheter and patient's age, weight and height by linear regression analysis. The position of tip was normally distributed from T1 to T7 and the tips were centralized at levels of T3, T4 and T5 which anatomically correspond to SVC. The r values between the catheter depth and the three factors at each level were comparable, although the correlation between the depth of catheter and height was best. A simple guide for placement of the catheter tip at T3, T4 and T5 levels as a function of patient's height was created.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1994

[Anesthetic management and neurological outcomes of patient for open heart surgery with infective endocarditis and neurological complications].

No reports have focused on neurological outcomes after open heart surgery of patients with infective endocarditis (IE) and neurological complications. We evaluated parameters related to anesthetic management and neurological outcomes. The subjects analyzed were 24 patients who had undergone valvular surgeries under hypothermic cardiopulmonary bypass from April 1978 to December 1990. The patients were divided into two groups according to the interval between onset of neurological complication and the time of operation: 1) acute group (within one month before the surgery: n = 11, 9.4 +/- 9 days; means +/- SD) and 2) chronic group (more than one month before the surgery: n = 13, 120 +/- 80 days). After heart surgery, 5 patients in the acute group showed newly developed neurological abnormality including death from hemorrhagic transformation, hemiplegia or aphasia. No patients in the chronic group had newly developed neurological abnormality related to the surgery. In the neurologically deteriorated patients of the acute group, interval from the onset of neurological complication to surgery was 3.5 +/- 4.5 days, whereas that of the remainders of the acute group was significantly longer (14.4 +/- 9.0 days). Intraoperative events and anesthetic management of these patients were also analyzed. However, there were no significant differences in the parameters such as cerebral perfusion pressure, arterial PaCO2, doses of anesthetics and use of vasopressors. Our results suggest that the most important factor which may influence neurological outcome was the interval between the onset of neurological abnormality and the time of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Maintenance doses of vecuronium and pancuronium during hypothermic cardiopulmonary bypass].

In 31 patients undergoing coronary artery bypass grafting, we investigated the maintenance doses of pancuronium and vecuronium during hypothermic cardiopulmonary bypass. For all patients, the height of the first twitch of the train-of-four (T1) was measured with evoked electromyogram. During operation, T1 was kept from 5 to 15 per cent of control. Infusion doses of both muscle relaxants were controlled with a personal computer. During hypothermic cardiopulmonary bypass (body temperature 28 degrees C), requirement of both muscle relaxants decreased for about 90 per cent compared with pre bypass values. We consider that the prolongation of neuromuscular blockade is attributable to hypothermia rather than to other factors of cardiopulmonary bypass. After rewarming, maintenance dose of vecuronium remained about a half of the dose required in pre-bypass period. It suggests that elimination of vecuronium from liver and kidney is hindered not only during hypothermia but also after rewarming.

Cardiopulmonary Bypass↗
PubMed1993

[Does rate of urine flow influence the difference between bladder temperature and nasopharyngeal temperature during cardiac surgery with cardiopulmonary bypass?].

Recently, bladder temperature (BT) monitoring is employed instead of rectal temperature because it is possible to keep the probe clean. The relationship between BT and core temperature is different in patients with steady state compared with those with rapid changes in temperatures. This study evaluated BT compared with nasopharyngeal temperature (NPT) reflecting brain temperature during cardiac surgery with induced hypothermia using cardiopulmonary bypass. During the steady state, after induction of anesthesia and immediately before cooling or rewarming, BT was equivalent to NPT independent of urine flow rate. In rapid cooling or rewarming phase of cardiopulmonary bypass, BT was not equivalent to NPT. BT preceded NPT in case of a very high urine flow rate, and with a lower urine flow rate delayed BT lagged behind NPT. During rapid changes in core temperature during cardiopulmonary bypass, the difference of BT to NPT depends on urine flow rate.

Adult↗
PubMed1993

[Monitoring of peripheral tissue oxygenation with near infrared spectrophotometry during abdominal or iliac aortic cross-clamping surgery].

Peripheral tissue oxygenation was monitored with near infrared spectrophotometry during abdominal or common iliac aortic cross-clamping surgery. Six patients who had abdominal aortic aneurysm (AAA) and eight patients who had aortic sclerotic occlusive disease (ASO) were studied. At the beginning of cross-clamping, oxyhemoglobin was decreasing and deoxyhemoglobin was increasing in all AAA patients. Average of 37 minutes following cross-clamping of abdominal aorta, both hemoglobin values were stabilized. On the other hand, changes in both hemoglobin values were delayed or missing in ASO patients. The results suggest that the duration from cross-clamping to stabilization is related to co-lateral blood flow. During operation, monitoring of peripheral blood flow with near infrared spectrophotometry is useful for detection of peripheral ischemia and for the estimation of postoperative local blood flow.

Aorta, Abdominal↗
PubMed1993

Anesthetic management of patients undergoing bilateral unifocalization.

We report on the anesthetic management of eight patients undergoing unifocalization for pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries. Unifocalization was performed separately on the right and left lungs in the lateral decubitus position. During unifocalization, pulmonary blood flow to the nondependent lung is interrupted and arterial oxygenation is dependent solely on the blood flow to the dependent lung. Thus, PaO2 and SaO2 decreased significantly and PaCO2 increased significantly during unifocalization, as compared with before and after unifocalization. When these values are compared between first and second stage of unifocalization, SaO2 during second stage was lower than during first stage. Although PaO2, PaCO2, and pH during second stage tended to be worse than during first stage, the differences did not reach statistical significance. During unifocalization, especially in second stage, to prevent deterioration of these arterial gas variables, pulmonary blood flow had to be increased by frequent administration of catecholamine. In addition, bicarbonate infusion was also used to prevent progressive metabolic acidosis due to hypoxia during unifocalization. Because anticoagulant therapy was required during unifocalization, airway bleeding was a common complication.

Adolescent↗
PubMed1992

Clinical evaluation of cerebral oxygen balance during cardiopulmonary bypass: on-line continuous monitoring of jugular venous oxyhemoglobin saturation.

To prevent brain damage during cardiopulmonary bypass (CPB), adequate cerebral perfusion for cerebral oxygen demand should be maintained. We monitored jugular venous oxyhemoglobin saturation (SjO2), which reflects the overall balance of cerebral oxygen supply and demand, continuously in 12 patients undergoing cardiac surgery. We examined whether this balance is disrupted during CPB, and if so, analyzed critical factors that affect this phenomenon. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, SjO2 did not change, and it was stable during the hypothermic period of CPB. On the other hand, a significant reduction in SjO2 was observed during the rewarming period, and SjO2 had an inverse linear correlation with nasopharyngeal temperature. Furthermore, the percent decrease of SjO2 was significantly related to "rewarming speed" (an average increase in temperature per minute). Our results indicate that temperature change during the rewarming period is a critical factor affecting the balance of cerebral oxygen supply and demand during CPB.

Adult↗
PubMed1992

Internal jugular vein catheterization in infants undergoing cardiovascular surgery: an analysis of the factors influencing successful catheterization.

Central venous catheterization for pressure monitoring and drug administration is often important in the anesthetic management of infants undergoing cardiovascular surgery. We examined the effects of patient age, weight, and central venous pressure and the experience of the anesthesiologist on the rate of successful catheterization and catheterization time of the internal jugular vein (IJV) in a prospective study. We studied 106 infants undergoing IJV catheterization for cardiovascular surgery over a 7-mo period at our institution. We catheterized the IJV by the high approach. The direct venipuncture or the Seldinger method was used according to the patient's weight. Overall successful catheterization rate was 97.2%, and the average catheterization time was 353 +/- 21 s (mean +/- SEM). Complications included arterial puncture in 12 cases (11.3%), hematoma formation in four cases (3.8%), and catheter malposition in two cases (1.9%), but pneumothorax was not observed. When a patient was younger than 3 mo or weighed less than 4.0 kg, successful catheterization rate decreased significantly to 81.3% and 78.6%, respectively. Catheterization time was inversely correlated with both age and weight, whereas central venous pressure did not affect either successful catheterization rate or catheterization time. We were unable to demonstrate that the experience of the anesthesiologist plays a significant role in the success or complication of the catheterization procedure. Our results indicate that IJV catheterization by the high approach is a reliable and useful technique in infants, and that the weight and age of the patient significantly influence the rate of successful catheterization.

Age Factors↗
PubMed1992

[Effects of hypothermia with cardiopulmonary bypass on posterior tibial nerve somatosensory evoked potentials in man].

Somatosensory evoked potential after posterior tibial nerve stimulation (PTN-SEP), as well as nasopharyngeal, bladder and plantar temperature were recorded in ten patients during cardiac surgery with hypothermic cardiopulmonary bypass. There was a best negative correlation between latencies (P27, P40 and the interpeak latency between P40 and P27 (P40-P27)) and nasopharyngeal temperature, but no correlation was found between latencies and plantar temperature during cooling and rewarming (27-37 degrees C) with cardiopulmonary bypass. No correlation was found between changes in amplitude and temperature. The slope of linear regression line of latencies versus nasopharyngeal temperature was -1.05 msec.degrees C-1 for P27 (r = -0.93), -1.47 msec.degrees C-1 for P40 (r = -0.95) and -0.43 msec.degrees C-1 for P40-P27 (r = -0.78). This study suggests that nasopharyngeal temperature measurement is required to aid the interpretation of PTN-SEP changes during hypothermia.

Adult↗
PubMed1992

[A computerized anesthesia record system: four years' experience].

A computerized anesthesia record system is in routine use for cardiovascular procedures in our operating rooms. This system is implemented on an NEC PC-9801 personal computer and automatically collects hemodynamic variables from a polygraph as well as from intraoperative laboratory reports via RS-232C ports. Events such as intubation can be entered manually using a standard keyboard. Since the introduction of the system in 1987, the system has been used in 90 percent of the total cases performed and 2941 electronic data files were recorded in a four-year period. Excluding some short procedures for which the system was not used, failure to store records on disks resulted from system errors due to power-line troubles in the operating rooms as well as users' omission to command the system. User-acceptance of event entry was poor. In 74 percent of the cases, not a single event was entered. Advantage of an automated anesthesia record system over a hand-written record is being recognized. Wide-spread use of such a system will require ergonomic design of the system and man-machine interfaces suitable for use in an operating room.

Anesthesiology↗
PubMed1992

[The change in cerebral blood flow during hypotensive anesthesia induced by prostaglandin E1].

We investigated the effect of prostaglandin E1 (PGE1)--induced hypotension during sevoflurane anesthesia on the cerebral blood flow (CBF), autoregulation and internal jugular venous O2 tension (PjO2) in 8 patients undergoing neurosurgery. Although the mean arterial pressure decreased from 95.3 +/- 3.8 mmHg (mean +/- SD) to 63.6 +/- 8.0 mmHg by continuous intravenous infusion of PGE1, CBF did not change significantly (97.2 +/- 10.6% of control value). During hypotensive anesthesia, autoregulation was well maintained in all patients, and the values of PjO2 did not suggest brain hypoxia at all. The results indicate that hypotensive anesthesia induced by PGE1 and sevoflurane is a safe and a reliable method for neuroanesthesia.

Adult↗
PubMed1991

Anaesthetic management of phaeochromocytoma associated with tricuspid atresia.

The anaesthetic management of a patient with phaeochromocytoma, tricuspid atresia and pulmonary vascular stenosis is reported. The patient received no preoperative preparation with adrenergic blockers. Anaesthesia was induced and maintained with fentanyl, diazepam and sevoflurane. Intraoperative blood pressure was controlled with sodium nitroprusside, sevoflurane, phentolamine, and propranolol. For hypotension after resection of the tumour norepinephrine was required. This patient did not have a systemic to pulmonary shunt procedure performed, so the maintenance of pulmonary blood flow in the presence of haemodynamic instability during operation for phaeochromocytoma was a major concern. Monitoring of oxyhaemoglobin saturation (SpO2) with a pulse oximeter was considered to be useful because SpO2 may reflect pulmonary flow. During serious haemodynamic disturbances due to the manipulation of the tumour, the heart rate was inversely correlated with SpO2, but the relationship between mean arterial pressure and SpO2 was weak. Therefore, control of heart rate appeared to be more important than control of blood pressure in this case.

Adolescent↗
PubMed1991

[Leukocyte removability of a newly developed filter, RC-100, in rapid transfusion].

Leukocyte-depleted blood products are currently a burning issue in transfusion medicine. As methods for depleting leukocytes, the bedside filters are shown to have a high removal rate and several kinds of them are in use. We investigated the leukocytes removal rate of a new filter RC-100 (Pall Co., Glen Cove, NY) under the condition of rapid rate of transfusion during operations. In flow rates of 30, 60, 100 ml.min-1, the removal rate of leukocytes for CRC were 99.9 +/- 0.06, 100.0 +/- 0.00 and 99.4 +/- 0.20% respectively, and for WB 100.0 +/- 0.00, 99.9 +/- 0.10 and 99.1 +/- 0.70%, respectively. The recovery rates of erythrocytes were not significantly decreased for CRC and for WB in all flow rates. These results suggest that RC-100 could be useful either for CRC and for WB even with the rapid flow rate under 100 ml.min-1.

Blood Transfusion↗