Biomedical subjects
S Dohi
Publications and source records attributed to S Dohi.
End-tidal carbon dioxide monitoring during awake blind nasotracheal intubation.
STUDY OBJECTIVE: To test the usefulness of the end-tidal carbon dioxide monitor in facilitating awake blind nasotracheal intubation in patients with potentially difficult airways. DESIGN: Randomized, controlled comparison of regimen. SETTING: Inpatient surgery clinic at a university hospital. PATIENTS: Sixty-one consecutive patients with potentially difficult airways. INTERVENTIONS: After airway anesthesia with 4% lidocaine was administered to all patients, either fentanyl and diazepam (n = 30) or fentanyl alone (n = 31) was given intravenously before the awake blind nasotracheal intubation procedure. MEASUREMENTS AND MAIN RESULTS: End-tidal carbon dioxide concentration, arterial blood pressure, heart rate, and arterial oxygen saturation (by pulse oximeter) were measured in each patient during the awake blind nasotracheal intubation procedure. The day after anesthesia and surgery, each patient was asked to assess the degree of discomfort experienced during the procedure. In 54 of 61 patients, the end-tidal carbon dioxide monitor facilitated awake blind nasotracheal intubation. End-tidal carbon dioxide was significantly higher in patients given both fentanyl and diazepam than in those given fentanyl alone (7.4% +/- 1.4% vs 5.9% +/- 0.9%, respectively; p less than 0.05), but no patient in either group recalled the awake intubation as extremely uncomfortable. CONCLUSIONS: Monitoring of end-tidal carbon dioxide is useful and valuable in both facilitating blind nasotracheal intubation and avoiding profound hypoventilation.
Nonrespiratory rhythmic fluctuations in systemic arterial pressure in anesthetized humans.
STUDY OBJECTIVE: To clarify the frequency of nonrespiratory rhythmic fluctuations in systemic arterial pressure (vasomotor waves) and to identify the clinical conditions in which the vasomotor waves develop in humans under anesthesia. DESIGN: Retrospective analysis of collected data. SETTING: Inpatient surgery clinic at a university hospital. PATIENTS: Five hundred thirteen consecutive ASA physical status II-V patients. INTERVENTIONS: Direct arterial pressure monitoring and general anesthesia, including high-dose fentanyl, enflurane, enflurane plus fentanyl, cervical or thoracic epidural, and lumbar epidural anesthesia. MEASUREMENTS AND MAIN RESULTS: Among the anesthesia techniques used, vasomotor waves occurred most frequently in patients anesthetized with high-dose fentanyl (31.1%) and least frequently in those with high-level epidural blockade (7.4%). As a result of multiple logistic analysis, the contributing factors to the appearance of vasomotor waves were the institution of cardiopulmonary bypass (CPB) and the patient's age. It is also a novel finding that nearly one-third of the vasomotor waves developed in patients under stable hemodynamic conditions. CONCLUSIONS: Vasomotor waves are a common phenomenon in relatively high-risk patients during general anesthesia. The appearance of vasomotor waves is significantly related to CPB and patient age.
Clonidine premedication reduces maternal requirement for intravenous morphine after cesarean delivery without affecting newborn's outcome.
BACKGROUND AND OBJECTIVES: The alpha(2)-agonist clonidine has several benefits for patients undergoing surgery. During and after elective cesarean delivery (C-section), we assessed the condition of parturient and neonate when one half of the parturients were pretreated with oral clonidine. METHODS: Forty-six consenting parturients were studied in a randomized, double-blinded manner. Preanesthetic medication was atropine and famotidine with or without clonidine 4 microg/kg. After baseline measurements in parturients and fetuses, combined spinal and epidural anesthesia was established (1.6 mL of 0.5% tetracaine diluted with 10% dextrose in water). C-section was performed while breathing oxygen spontaneously (3 L/min) through a facemask. After delivery, neonates were assessed at 1 and 5 minutes, and the condition of mother and neonate was observed for 48 hours. RESULTS: Parturients receiving clonidine showed no hemodynamic instability during and after C-section, and while their visual analog scale (VAS) scores, verbal descriptive scale (VDS) scores, and sedation scores did not differ from those without clonidine, they needed significantly less patient-controlled analgesia (PCA) morphine for postoperative pain for the first 2 days (P < .01). Fetal heart rate, umbilical artery and vein pH and gas tensions, and the Apgar-scores of the newborns showed no intergroup differences. No neonatal depression or bradycardia was observed for 48 hours after delivery. CONCLUSION: The present results indicate that oral clonidine reduces the PCA morphine requirement after C-section without compromising the condition of the fetus or newborn. Further study including larger number of patients would be needed before we conclude that oral clonidine for parturients is safe for their newborns.
Interaction between intravenous lidocaine and epinephrine on hemodynamics and plasma potassium homeostasis in dogs anesthetized with halothane.
To delineate some clinical features of an accidental intravascular injection of local anesthetic solution containing epinephrine during the attempt of regional block, the interaction between intravenous lidocaine and epinephrine on hemodynamics and potassium homeostasis was investigated in halothane-anesthetized dogs using three types of combination of lidocaine and epinephrine. These included 1% plain lidocaine (10 mg/kg), 1% lidocaine-epinephrine solution (10 mg/kg-5 micrograms/kg) and epinephrine-normal saline solution (1:200,000, 5 micrograms/kg). Although lidocaine did not produce any changes in systemic or pulmonary hemodynamics, epinephrine and lidocaine-epinephrine solution produced transient multifocal premature ventricular contractions associated with huge hemodynamic changes. Lidocaine-epinephrine solution caused a 43% increase in mean arterial pressure, a 107% increase in mean pulmonary artery pressure and a 244% increase in pulmonary capillary wedge pressure (p less than 0.05). These changes did not differ from those observed following epinephrine. In contrast, stroke volume decreased significantly to 70% of control after lidocaine-epinephrine, while neither epinephrine nor lidocaine produced a significant change. Lidocaine did not affect plasma potassium concentration, whereas both epinephrine and lidocaine-epinephrine produced significant increase in plasma potassium concentration (K+; 2.0 +/- 0.7 mEq/l with epinephrine and 1.8 +/- 1.2 mEq/l with lidocaine-epinephrine), which subsequently decreased to below control.
[Hormone secretion by the duodenum on the 1st portion of the jejunum; its importance in the physiology of digestion].
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