Biomedical subjects

Y Okutsu

Publications and source records attributed to Y Okutsu.

At least 19 recordsLinked to original sources

PubMed1992

Continuous negative extrathoracic pressure ventilation, lung water volume, and central blood volume. Studies in dogs with pulmonary edema induced by oleic acid.

The effect of continuous positive-pressure ventilation (CPPV) on extravascular lung water volume has been investigated, but there is only one report which studied the effect of continuous negative extrathoracic pressure ventilation (CNETPV). The effect of CNETPV on central blood volume (CBV) has not been studied. Changes in intrathoracic pressure by CNETPV may alter lung water volume and CBV. In this study the effects of CNETPV on lung water volume and CBV were compared with those of intermittent positive-pressure ventilation (IPPV) and CPPV in dogs with pulmonary edema induced by oleic acid. Nine mongrel dogs were anesthetized and given oleic acid at 0.06 ml/kg intravenously to induce pulmonary edema; CNETPV was applied with a cuirass and a negative thoracic pressure ventilator (Kimura OKT-100) for 1 h. Extravascular lung water volume (as extravascular thermal volume [EVTV]) and CBV were estimated with the double-indicator dilution method using thermal-sodium; PEEP and continuous negative extrathoracic pressure were matched to produce the same increments in FRC. The EVTV increased during CNETPV but did not change during CPPV. The CBV decreased during CPPV but did not change during CNETPV. An increase of transmural pulmonary microvascular pressure was thought to be one of the reasons for the increase in EVTV with CNETPV.

Animals↗

PubMed1992

[Effect of hypotensive anesthesia on tissue oxygen tension of the heart, kidney and liver].

The effects of hypotensive anesthesia by prostaglandin E1 (PGE1: 8 dogs) or trimetaphan (TMP: 8 dogs) on tissue oxygenation were studied in 16 mongrel dogs anesthetized with pentobarbital. Mean blood pressure (MBP), heart rate (HR), cardiac output (CO), blood gases (BG), the blood flow and tissue oxygen tension of the heart, the kidney and the liver were measured. The blood flow and oxygen tension were measured by electromagnetic flowmeters and by polarographic oxygen electrodes respectively. PGE1 or TMP was injected intravenously to decrease MBP by 30%. MBP, CO, HR and BG of PGE1 were not significantly different with those of TMP. Coronary blood flow decreased for 12% with PGE1 and for 33% with TMP. Though blood flows of the renal and the hepatic arteries were well maintained with PGE1, they decreased for 36% and 34% respectively with TMP. Oxygen tensions of the myocardium (both outer and inner layers) and the liver were well maintained with PGE1. But with TMP, oxygen tension decreased for 23% in outer layer, for 16% in inner layer and for 31% in the liver. Oxygen tension of the kidney remained unchanged with PGE1 and TMP. The results suggest that PGE1 is more useful for the maintenance of the tissue oxygenation than TMP during hypotensive anesthesia.

Anesthesia↗

PubMed1992

[Effect of carbon dioxide (hypocapnia and hypercapnia) on regional myocardial tissue oxygen tension in dogs with coronary stenosis].

Carbon dioxide (CO2) has been well documented to act as a potent vasodilator of coronary vessels under normal conditions. But there is little data available on the effect of CO2 on the collateral perfusion of patients with coronary insufficiency. We studied the effects of CO2 on the myocardial tissue PO2 in anesthetized dogs with critical coronary stenosis. Twelve mongrel dogs were anesthetized with pentobarbital and ventilated with 100% O2 to maintain normocapnia. Electromagnetic blood flow (BF) probe was applied on the left anterior descending artery (LAD). Regional myocardial PO2 was measured at two different sites using two pairs of monopolar polarographic needle electrodes; one inserted in the epicardial (EPI) layer, and the other in the endocardial (ENDO) layer. These were placed in the regions supplied by LAD and circumflex. Following the baseline recording, critical stenosis of LAD was produced by adjusting a copper-wire clamp occluder until LADBF was reduced by 50%. After a stable normocapnic ventilation, hypocapnia was produced by hyperventilation. To induce hypercapnia, exogenous CO2 was added to the inspired gas stepwise until end-tidal CO2 fraction reached 10%. Hypocapnia resulted in a significant reduction in myocardial PO2 in both EPI and ENDO non-stenotic areas, while hypercapnia increased these PO2 values dose-dependently. After coronary stenosis, hypocapnia resulted in a small but significant reduction of PO2 in endocardial ischemic area. Hypercapnia did not induce any sign of reduced regional myocardial PO2 or evidence of regional or intramural "steal" phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

[CO diffusing capacity during continuous negative extra-thoracic pressure].

Eight healthy males were studied to compare CO diffusing capacity (DLCO) during spontaneous breathing with that during continuous negative extra-thoracic pressure (CNETP). Mean DLCO was 33.0 +/- 5.1 ml.min-1.mmHg-1 during spontaneous breathing and 33.5 +/- 4.5 ml.min-1.mmHg-1 during CNETP with an end-expiratory negative extra-thoracic pressure (EENETP) of -20 cmH2O, and there was no significant difference between them (P less than 0.05). Pulmonary capillary blood volume, which was measured only in a male, was 76.7 ml during spontaneous breathing and 80.5 ml during CNETP. This change dose not seem to be significant. The results suggest that the effect of pulmonary diffusing capacity changes during EENETP on improvement of oxygenation may not be significant.

Adult↗

PubMed1991

[Effect of arterial carbon dioxide tension on regional myocardial tissue oxygen tension in the dog].

We investigated the effects of arterial carbon dioxide tension on the myocardial tissue oxygen tensions of subepicardium and subendocardium in the anesthetized dogs. The study was done in fourteen open-chest mongrel dogs, weighing 13 +/- 1 kg, anesthetized with sodium pentobarbital (30 mg.kg-1 iv), and mechanically ventilated with 100% oxygen to maintain normocapnia. End tidal CO2 fraction (FECO2) was monitored continuously by capnograph. Regional myocardial tissue PO2 was measured using a monopolar polarographic needle electrode. Two pairs of combined needle sensors were carefully inserted, one in the epicardial and the other in the endocardial layer of the beating heart. Electromagnetic blood flow probe was applied on the left anterior descending artery (LAD). After a stable normocapnic ventilation, hypocapnia was induced by increasing the respiratory rate, and this mechanical hyperventilation was kept fixed throughout the experiments. To induce hypercapnia, exogenous carbon dioxide was added to the inspired gas step-wise until FECO2 reached 10%. Hypocapnic hyperventilation (PaCO2: 22 mmHg) invariably resulted in a significant reduction of coronary blood flow (LADBF) and left ventricular myocardial tissue PO2 in both epicardial and endocardial layers, while addition of carbon dioxide to the inspired gas (hypercapnic hyperventilation) reversed the change by increased LADBF and arterial PaCO2 in a dose-dependent manner. These results indicate that injudicious and severe hypocapnic hyperventilation may induce impaired myocardial tissue perfusion and oxygenation although normal cardiac output and arterial blood oxygenation are maintained.

Animals↗

PubMed1991

[The ventilatory response to CO2 during end-expiratory negative extra-thoracic pressure and PEEP].

The effects of end-expiratory negative extra-thoracic pressure (EENETP) and PEEP on the ventilatory response to CO2 were studied in seven healthy volunteers. The changes in functional residual capacity during EENETP -20 cmH2O and PEEP 5 cmH2O were 13.9 and 12.9 ml.kg-1, respectively. The slopes of CO2 response (minute ventilation/end-tidal CO2) during ZEEP, EENETP and PEEP were 0.913, 0.622, 0.693 l.min-1.mmHg-1, respectively. The slopes during EENETP and PEEP were significantly decreased. These results indicate that EENETP and PEEP could worsen the CO2 response in patients with respiratory failure, especially, with chronic obstructive pulmonary disease in which functional residual capacity is increased.

Adult↗

PubMed1991

[Is ventilatory anaerobic threshold useful for preoperative assessment?].

The anaerobic threshold (VAT), obtained by measurement of ventilatory volume and by expiratory gas analysis, and the anaerobic threshold (LAT), obtained directly from the lactic acid value in the blood, were compared and evaluated during exercise load in 25 patients with mitral valve disease. Exercise loading was performed with an ergometer using a multistep method of increases of 5 W (Group A, 11 cases) or 10 W (Group B, 14 cases) per minute. The oxygen uptake value at the points of 0.5 mmol.l-1 and 1.0 mmol.l-1 increase in the lactic acid values when compared with the starting values were designated as 0.5 LAT and 1.0 LAT. VAT was found in 4 of 11 (36%) patients in Group A and in 12 of 14 (86%) patients in Group B and the ratio obtained was significantly higher in Group B than in A. The 0.5 LAT values for Group A and B were 2.4 +/- 0.5 and 2.2 +/- 0.3, respectively. The 1.0 LAT values were 2.9 +/- 0.7 and 2.7 +/- 0.4, and among the two groups no significant difference was found concerning 0.5 LAT or 1.0 LAT. VAT was seen in 16 or 25 patients and the average VAT value of the 16 was roughly at the midpoint between the average values for 0.5 LAT and 1.0 LAT. Therefore in patients in which VAT was seen with the expiratory gas method, VAT and LAT values were basically equivalent. However, in Group A, VAT was seen in only 4 of 11 patients and it is a fact that it is difficult to find VAT without a suitable exercise load.

Anaerobic Threshold↗

PubMed1991

[Respiratory flow and chest wall motion during negative extrathoracic pressure ventilation in human volunteers].

Respiratory flow and chest wall motion during negative extrathoracic pressure ventilation (NETPV) were compared with those during spontaneous breathing in 8 healthy male volunteers. Chest wall motion was evaluated by separate measurement of the changes in the cross sectional area of rib cage and abdomen, using respiratory inductive plethysmograph. During NETPV, expiratory flow was characterized by a large peak and a rapid decline at the early expiratory phase. NETPV increased the relative contribution of rib cage motion to tidal ventilation, and induced the abdominal paradoxical movements at inspiration in two volunteers. These results indicate that NETPV augments rib cage motion rather than abdominal motion, and this altered mechanics of chest wall may change intrapulmonary distribution of inspired gas.

Adult↗

PubMed1990

Effects of continuous negative extrathoracic pressure ventilation on renal function and alpha-atrial natriuretic peptide in normal individuals.

Continuous negative extrathoracic pressure ventilation (CNETPV) may induce atrial distention by augmenting venous return, resulting in the increased secretion of atrial natriuretic peptide (ANP) and natriuresis. To clarify this hypothesis, we investigated the effect of CNETPV on renal function and plasma ANP level. Nine male healthy volunteers were studied during three successive 60-minute periods under (1) spontaneous breathing, (2) CNETPV with continuous negative extrathoracic pressure of -10 cm H2O, and (3) spontaneous breathing again. Continuous negative extrathoracic pressure ventilation induced a transient increase in plasma ANP level, but changes in plasma ANP level were not statistically significant. Although there was no significant difference in urine volume and urinary sodium excretion among three successive periods, a slight but significant increase in creatinine clearance was noticed during CNETPV. These results indicate that CNETPV with continuous negative extrathoracic pressure of -10 cm H2O does not induce the major change in ANP secretion and renal function in normal subjects.

Adult↗

PubMed1990

[A study on the utility of flumazenil for patients in the ICU].

Flumazenil, a specific antagonist of benzodiazepines, was administered to adult patients receiving treatment at ICU, and its utility to hasten recovery from sedation was evaluated in 40 patients and its usefulness for differential diagnosis of sedated conditions was also evaluated in 5 patients. The efficacy rate for recovery from sedation induced by benzodiazepines was 85.0%. Moreover, flumazenil was considered to be useful for differentiation of sedated conditions when causes were unknown. Depression of respiration improved in association with improvement of consciousness level. In some patients an elevation in blood pressure was also observed with improved consciousness.

Adult↗

PubMed1990

[The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs].

To investigate the effect of carbon dioxide on the myocardial oxygenation during hemorrhagic shock, myocardial oxygen tension and coronary flow were measured during normocapnia, hypocapnia and hypercapnia. Eight adult mongrel dogs were anesthetized with pentobarbital, intubated and ventilated mechanically with 100% oxygen to maintain normocapnia. Then their chest was opened. An electromagnetic blood flow probe was applied on the left anterior descending artery. Two pairs of combined polarographic needle electrodes were carefully inserted, one pair in the epicardial layer, and the other in the endocardial layer of the heart. The animals were progressively bled in increments of 35-40ml.kg-1 (body weight). Hypocapnia was produced by increasing respiratory rate, and then normocapnia and hypercapnia were induced by adding the exogenous carbon dioxide. Hypocapnia decreased the coronary flow, and myocardial oxygen tension in outer and inner layer. On the contrary, hypercapnia increased them. It is possible that hypocapnia may compromise the oxygenation of the myocardium during hemorrhagic shock.

Animals↗

PubMed1990

[The tidal volume, arterial blood gas and functional residual capacity changes during negative extra-thoracic pressure ventilation and positive airway pressure ventilation].

Eight patients, of ASA physical status I or II soon after total knee replacement under general anesthesia, were studied to compare negative extra-thoracic pressure ventilation (NETPV) with positive airway pressure ventilation (PAPV). The measured parameters during the two ventilatory modes were tidal volume, arterial blood gas and functional residual capacity change (delta FRC). Tidal volume obtained during NETPV was 60 to 80% of that during PAPV at the same absolute values of peak pressure. delta FRC obtained during NETPV was 30 to 40% of that during PAPV at the same absolute values of end-expiratory pressure. A decrease in the esophageal pressure was 4 to 11cmH2O at an end-expiratory negative extra-thoracic pressure of -10 to -20 cmH2O. When the patients were ventilated with the same values of minute ventilation on NETPV and PAPV, there was no significant difference in blood gas values. These findings suggest that efficiency of NETPV is less than that of PAPV at the same absolute working pressure but pulmonary gas exchange of NETPV is almost equal to that of PAPV at the same minute ventilation in the normal lung.

Aged↗

PubMed1990

[Effects of negative extra-thoracic pressure ventilation on respiratory system and hemodynamics in normal dogs].

The effects of negative extra-thoracic pressure ventilation (NETPV) on respiratory system and hemodynamics were examined in ten normal dogs. Changes of the parameters obtained during intermittent NETPV (INETPV), and NETPV with negative end-expiratory pressure (CNETPV) were compared with those during IPPV and CPPV. Animals' chests and upper abdomens were confined in an acryl box. In INETPV and CNETPV, the dogs were ventilated with the negative extra-thoracic pressure ventilator (Kimura, OKT-100). Positive and negative pressure ventilation was carefully matched for tidal volume and the increase in FRC obtained with PEEP and the end-expiratory negative extra-thoracic pressure (EENETP). EENETP of -11.6 cmH2O produced the same FRC change as PEEP of 10.6 cmH2O did. Gas exchanges did not differ in any modes. INETPV did not change any hemodynamic parameters without PAP. In CNETPV, heart rate increased, and CVP, cardiac index (CI) and stroke volume (SV) decreased significantly (P less than 0.05), but tmCVP and tmPCWP did not change. The decreases of CI and SV (100----89.1, 88.8%) in CNETPV were significantly smaller when compared with CPPV (100----78.8, 74.5%). In CPPV, meanBP, CVP, tmCVP, tmPCWP, CI, SV changed significantly. The mechanisms of the decrease of CI and SV by CNETPV seemed to be different from those by CPPV.

Animals↗

PubMed1990

[Effects of negative extra-thoracic pressure ventilation on extravascular lung water volume and central blood volume in normal dogs].

In negative extra-thoracic pressure ventilation (NETPV), lung water volume and central blood volume (CBV) could increase because of increased venous return and intensified negative interstitial pressure. The effects of NETPV on the extravascular lung water and CBV were examined in ten normal dogs by the double-indicator method using Na and cold water. The lung water volume measured by the method (EVTV) was compared with the lung water volume measured by the gravimetric method (EVLW) in 17 dogs. EVTV did not show any significant change in any ventilation modes compared with IPPV. CBV decreased from 21.9 ml.kg-1 to 19.2 ml.kg-1 in CPPV compared with IPPV (P less than 0.05). EVTV correlated well (r = 0.91, P less than 0.001) with EVLW. In normal dogs, NETPV did not change the lung water volume and CBV. NETPV dogs do not seem to have any disadvantage in respect of lung water volume compared with conventional positive pressure ventilations.

Animals↗

PubMed1989

[Effects of carbon dioxide (hypocapnia and hypercapnia) on tissue blood flow and oxygenation of liver, kidney and skeletal muscle in the dog].

UNLABELLED: We investigated the effects of carbon dioxide on the splanchnic visceral organs (liver and kidney) as well as skeletal muscle in the anesthetized dog. Thirty two adult mongrel dogs were anesthetized with sodium pentobarbital, intubated and ventilated mechanically with 100% oxygen to maintain normocapnia. After laparotomy, miniature Clark-type polarographic oxygen electrodes were placed on the surfaces of liver, kidney and rectus femoris muscle. Electromagnetic blood flow (BF) probes were also applied to hepatic artery (HA), portal vein (PV), left renal artery (RA) and left femoral artery (FA). After a stable normocapnic ventilation, the hypocapnia was produced by increasing respiratory rate, and the hypercapnia was induced by adding the exogenous carbon dioxide. RESULTS: Hyperventilation resulted in a significant decrease in HABF, PVBF, liver surface PO2 and kidney surface PO2 in parallel with the decreased PaCO2, but these parameters increased dose dependently when the carbon dioxide was added to the inspired gas (hypercapnic hyperventilation). On the contrary, FABF and skeletal muscle surface PO2 increased by hypocapnia and decreased during hypercapnia. Neither PaCO2 or cardiac output showed any significant change during the entire experiment. Arterial PCO2 appears to exert significant effects on both splanchnic and skeletal muscle perfusion as well as corresponding changes in tissue oxygenations. It is possible that injudicious and prolonged hypocapnic hyperventilation may seriously compromise splanchnic organ perfusion and oxygenation.

Animals↗

PubMed1989

[The effects of hypocapnia and hypercapnia on tissue surface PO2 in hemorrhaged dogs].

To investigate the effects of carbon dioxide on the local blood flow during hemorrhagic shock, the tissue surface PO2 of liver, kidney and femoral muscle was measured during normocapnia, hypocapnia and hypercapnia. Eight adult mongrel dogs were anesthetized with pentobarbital, intubated and ventilated mechanically with 100% oxygen to maintain normocapnia. After laparotomy, miniature clark-type polarographic oxygen electrodes were placed on the surface of the liver, kidney and femoral muscle. The animals were hemorrhaged via arterial catheter to a mean arterial blood pressure of 50mmHg. The hypocapnia was produced by increasing respiratory rate and the hypercapnia was induced by adding the exogenous carbon dioxide. Hypocapnia decreased the liver and kidney surface PO2, and increased the muscle surface PO2. On the contrary, hypercapnia increased the liver and kidney surface PO2 and decreased the muscle surface PO2. So, it is possible that hypocapnia may compromise the oxygenation of the liver and kidney in the hemorrhagic shock.

Animals↗

PubMed1989

[Which factors affect the liver function most after gastrectomy in the gastric cancer patients?].

We examined the factors which influence the postoperative liver function in the gastric cancer patients who received gastrectomy by a particular surgeon. One hundred and five patients had no history of liver diseases, no blood transfusions, and no infection after the operation. They also had normal liver function preoperatively. They were anesthetized with halothane-nitrous oxide oxygen or enflurane-nitrous oxide oxygen with epidural anesthesia by the same group of anesthesiologists. GOT was followed for one month after the operation to evaluate the liver function. In 44 patients, GOT went up to above 50 IU.l-1. The maximal GOT correlated with low hemoglobin level on the 1st postoperative day, the duration of hypotension below 80 mmHg of the systolic blood pressure, and duration of the operation. These results suggest that special attention should be paid to correct hemoglobin level and to avoid hypotension during anesthesia.

Adult↗

PubMed1989

[Evaluation of the performance of a negative extra-thoracic pressure ventilator (OKT-86)].

We evaluated the performance of a new negative extra-thoracic pressure ventilator (OKT-86, which was designed by the authors) applying it on ten patients with ASA Physical Status I (mean body weight: 54.4 +/- 12.1 kg) during anesthesia. Uneven distribution of negative extra-thoracic pressure was not observed within the chamber that a patient was wearing. Tidal volumes of more than 10ml.kg-1 were obtained at a respiratory rate of 10 or 16 breath.min-1 and a peak negative extra-thoracic pressure of -18 to -20 cmH2O. The values of delta FRC were 5.4 and 11.9 ml.kg-1 at continuous negative extra-thoracic pressure of -5 and -10 cmH2O, respectively, and these values were three times as those of the conventional cuirass ventilator. Consequently, sufficient tidal volumes and delta FRC were obtained using OKT-86.

Adult↗