Biomedical subjects

R Okutani

Publications and source records attributed to R Okutani.

At least 55 records · Page 3Linked to original sources

PubMed1990

[A case of spinal anesthesia in a 104-year-old woman].

We gave spinal anesthesia for a super-aged patient (104 year-old female) who underwent insertion of prosthesis for femoral neck fracture. One point eight ml of 0.3% dibucaine was used as local anesthetic, and the analgesic below Th10 level was obtained. To monitor the respiratory and circulatory functions during operation, pulse-oximeter and invasive arterial pressure were used. Dopamine and metaraminol were given to prevent hypotension and the operation was completed uneventfully. This anesthetic experience suggests that, for the anesthesia of a super-aged patient it is mandatory not only to clearly identify the complications and the physical features of the patient but also to explain to the patient the anesthetic as well as operative procedures. Besides, we have to manage elderly patients receiving spinal anesthesia carefully, considering intraoperative problems as well as the possibility of resorting to general anesthesia.

Aged↗

PubMed1990

[Anesthetic considerations for hepatic resection using veno-venous bypass].

Anesthetic experience of 4 cases of hepatic resection using veno-venous bypass was reported. Non-forced bypass (passive shunt) was used in case 1. Hepatic resection was performed while supporting hemodynamic stability during the subsequent anhepatic phase using pump-driven veno-venous bypass (active shunt) in case 2-4. Various problems arose in each case. In the non-forced bypass case, hypotension during the bypass created a problem; whereas, hypothermia was pronounced during bypass in the pump-driven bypass cases. Massive transfusion due to bleeding, hypocalcemia, and unintentional hypothermia after veno-venous bypass precipitated heart failure. Attention should therefore be directed toward, (1) preparation for massive transfusion, (2) measurement and correction of the plasma calcium ion concentration, (3) maintenance of body temperature, and (4) hemodynamic control with a Swan-Ganz catheter and an inferior vena cava catheter. Extracorporeal bypass using a pump-driven veno-venous bypass (Bio-pump) and splanchnic decompression system via the portal system appear to be advantageous.

Aged↗

PubMed1990

[Anesthetic management of coronary artery bypass graft operation in a patient with hypothyroidism].

We experienced the anesthetic management of coronary artery bypass graft operation (3 vessels) in a patient with hypothyroidism. Prior to the operation, the substitution therapy for thyroid hormone was performed, but thyroid function could not be normalized. From 30 minutes after starting cardiopulmonary bypass, edema appeared on four limbs. Also, edema of intestinal tract and the distended abdomen was observed. By administering T4 preparation intravenously edema diminished within about 2 hours without exhibiting any change in ECG findings and hemodynamics. This case may suggest that the intraoperative substitution of thyroid hormone is a safe and effective method in a patient with hypothyroidism.

Aged↗

PubMed1989

Variations in hemodynamic and stress hormonal responses in open heart surgery with buprenorphine/diazepam anesthesia.

The use of buprenorphine-diazepam-N2O (60%)-O2 anesthesia in open heart surgery was investigated. The authors examined the hemodynamic changes produced and the response of stress hormones. Twenty adult patients with atrial septal defects undergoing surgical correction were studied in two groups of 10, receiving either 6 micrograms/kg of buprenorphine (B6) or 12 micrograms/kg of buprenorphine (B12) for the induction of anesthesia. Both groups received a subsequent dose of 6 micrograms/kg of buprenorphine with the commencement of extracorporeal circulation (ECC). With surgery, mean arterial pressure showed a transient increase in both groups and thereafter was stable. Heart rate in the B6 group was increased from the onset of surgery to the day after, while the B12 group showed no significant change. Filling pressures showed no change in either group. Plasma catecholamine concentrations in the B6 group, in contrast to the B12 group, increased significantly from midoperation to after completion of the operation (ECC 10 minutes, B6 group v B12 group: plasma norepinephrine 616 +/- 231 v 195 +/- 38 pg/mL, plasma epinephrine 1385 +/- 392 v 572 +/- 132 pg/mL, P less than 0.05). Plasma ADH levels in both groups rose with the commencement of surgery, reaching a peak at ECC 10 minutes (B6 group 88.1 +/- 8.4 v B12 group 124.4 +/- 27.2 pg/mL). However, in contrast to plasma catecholamines, the antidiuretic hormone (ADH) levels in the B12 group remained higher until the first postoperative day. Therefore, patients who received the larger dose of buprenorphine had better control of hemodynamics and catecholamines, but a greater elevation of plasma ADH levels.

Adult↗

PubMed1989

[The role of catecholamine content in human platelets; clinical implications in patients with pheochromocytoma].

UNLABELLED: This study examined if the platelet catecholamine content (CA) in healthy adults and patients with adrenal tumors reflected the activity of the sympatho-adrenomedullary system. RESULTS: (1) In 44 healthy adults, platelet norepinephrine (NE) levels ranged from 72 to 1175 pg.mg-1.protein-1 (mean: 473pg.mg-1.protein-1) and platelet epinephrine (E) levels ranged from 23 to 273 pg.mg-1.protein-1 (mean: 68 pg.mg-1.protein-1). These were used as normal ranges for this study. (2) In patients with adrenal tumors, plasma CA level, urinary CA elimination and platelet CA content were higher in patients with pheochromocytoma than in those with other adrenal tumors. Mean platelet NE and E levels for patients with pheochromocytoma were 2188 and 336 pg.mg-1.protein-1, respectively. These results indicate that a large amount of CA is contained in platelets (particularly in patients with pheochromocytoma), and that platelet CA level is very useful for preoperative diagnosis of pheochromocytoma. The results also suggest that platelet CA level closely reflects the activity of the sympatho-adrenomedullary system.

Adrenal Gland Neoplasms↗

PubMed1989

[A case of reexpansion pulmonary edema during fenestration of a giant hepatic cyst].

We experienced a case of reexpansion pulmonary edema during the fenestration of giant hepatic cyst. The patient was a 56 year-old female who had been suffering from dyspnea due to a large abdominal mass for 3 months. The preoperative chest X-ray revealed remarkable elevation of diaphragm (right third and left fifth intercostal spaces). The result of blood gas analysis showed hypoxemia and respiratory compensation for metabolic acidosis. By the drainage of 12L of the cyst fluid for 30 minutes during operation, bloody and foamy bronchial secretion spurted out. Vigorous respiratory management using PEEP was promptly started and continued postoperatively in ICU. The endotrachial tube was withdrawn on the 2nd postoperative day. The ratio of protein in airway secretion in to plasma protein was 0.78, and it appeared that the pulmonary edema was mainly caused by increased permeability of pulmonary capillary vessels.

Cysts↗

PubMed1988

Quantitative determination of atracurium in human plasma using high-performance liquid chromatography.

The authors have established a new method for extraction and determination of atracurium in human plasma that employs a reversed phase high-performance liquid chromatography (HPLC). This method made use of a fluorescent spectrophotometer at an excitation wavelength of 240 nm and an emission wavelength of 310 nm. The mobile phase was made of a phosphate buffer, distilled water and acetonitrile (20V : 30V : 50V). The analytical column used was a Little Champ C(18). In a Bond Elute C(18) extraction column, which had been prewashed with a phosphate buffer and a 50% methanol solution, atracurium was extracted from acidified plasma samples using a mixture of methanol and phosphate buffer. A standard curve was prepared by the internal standard method using metocurine. A high linear correlation between atracurium concentration and the ratio of the atracurium peak height to the metocurine peak height was observed (r = 0.9994). The lowest threshold for detection of atracurium was 15 ng/ml. When the plasma concentrations of atracurium were determined in 2 clinical cases, t(1/2Alpha) was 2.10 and 1.73 min and t(1/2Beta) was 15.57 and 21.57 min, respectively. These results indicate that this method of extraction and determination is appropriate for studying the pharmacokinetics of atracurium because it allows a high reproducibility, and provides an extremely accurate, simple and quick analysis.

Journal Article↗

PubMed1988

Effect of hypothermic hemodilutional cardiopulmonary bypass on plasma sufentanil and catecholamine concentrations in humans.

The effect of hypothermic hemodilutional cardiopulmonary bypass (CPB) on plasma sufentanil and catecholamine concentrations was studied in four groups of ten patients each, receiving four different doses of sufentanil. Samples for measurement of sufentanil were obtained before CPB, at 15, 30, and 45 minutes of CPB, during rewarming, immediately after and 15, 60, and 240 minutes after CPB. In addition, in groups III and IV, which received the highest dose of sufentanil, blood samples were also obtained for measurement of plasma levels of epinephrine and norepinephrine. Sufentanil concentration decreased in all groups with the start of CPB (group I, 2.92 +/- 0.2 to 2.04 +/- 0.2; group II, 3.30 +/- 0.3 to 1.51 +/- 0.2; group III, 7.08 +/- 0.7 to 3.45 +/- 0.3; group IV, 10.33 +/- 0.5 to 4.59 +/- 0.5 ng/ml). No further decreases occurred during CPB but increases occurred with rewarming. The first measurement after CPB approached the concentration before CPB (group I, 2.82 +/- 0.3; group II, 2.56 +/- 0.5; group III, 4.42 +/- 0.4; group IV, 6.10 +/- 0.4 ng/ml). Norepinephrine concentrations demonstrated a wide variability with no significant changes. Epinephrine levels increased significantly during rewarming in both groups (group III, 141 +/- 23 to 279 +/- 79 pg/ml; P less than 0.05; group IV, 105 +/- 24 to 267 +/- 68 pg/ml, P less than 0.05). The stability of plasma sufentanil concentrations during CPB suggest that no measurable metabolism or excretion occurred. The increase with rewarming and after CPB suggest significant sequestration.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthetics↗

PubMed1988