Biomedical subjects
Y-C P Arai
Publications and source records attributed to Y-C P Arai.
The effect of intrathecal fentanyl added to hyperbaric bupivacaine on maternal respiratory function during Cesarean section.
BACKGROUND: Subarachnoid blockade with local anesthetics induces respiratory depression. Although the addition of fentanyl to bupivacaine has become popular in subarachnoid blockade for Cesarean section, there is no information on the effect of intrathecal fentanyl on maternal spirometric respiratory function in parturients undergoing Cesarean section. METHODS: We tested the effect of the addition of intrathecal fentanyl to hyperbaric bupivacaine on maternal spirometric performance in 40 consenting parturients undergoing Cesarean section. The parturients were randomized into two groups: those receiving 2.0 ml of hyperbaric bupivacaine 0.5% and 0.4 ml of saline intrathecally and those receiving 2.0 ml of hyperbaric bupivacaine and 0.4 ml of fentanyl (20 microg) intrathecally. We performed spirometry on arriving at the operation room and 15 min after subarachnoid blockade. RESULTS: Subarachnoid blockade with bupivacaine significantly decreased the peak expiratory flow rate, but did not induce significant changes in vital capacity and forced vital capacity. The addition of intrathecal fentanyl to bupivacaine improved the quality of subarachnoid blockade, but did not lead to a deterioration in respiratory function compared with intrathecal bupivacaine alone. CONCLUSIONS: The addition of intrathecal fentanyl to hyperbaric bupivacaine did not lead to a deterioration in maternal spirometric respiratory function in parturients undergoing Cesarean section.
Intra-articular injection of warmed lidocaine improves intraoperative anaesthetic and postoperative analgesic conditions.
BACKGROUND: Although local anaesthesia for knee arthroscopy is a well-documented procedure, arthroscopy under local anaesthesia is often interrupted because of intolerable discomfort and pain. Warming local anaesthetic solutions may increase its anaesthetic effect. We tested whether intra-articular injection of warmed lidocaine solution could improve intraoperative anaesthetic and postoperative analgesic conditions. METHODS: Patients in the warmed group received 20 ml warmed (40 degrees C) lidocaine 1% intra-articularly 20 min before surgery. The patients in the control group received 20 ml room-temperature (25 degrees C) lidocaine 1% intra-articularly 20 min before surgery. During surgery, the patients reported pain on a visual analogue scale (VAS). RESULTS: The median VAS pain score was 1.5 (range, 0.0-3.0) in the warmed lidocaine group and 5.0 (4.0-8.0) in the control group (P<0.001). The median intra- and postoperative analgesic requirements in the control group were significantly greater than that in the warmed group. CONCLUSION: Warmed lidocaine injected intra-articularly provides improved intraoperative anaesthetic and postoperative analgesic conditions for patients undergoing knee arthroscopy.
Pre-anesthetic presence of an injured dam influences pups' locomotor behavior during emergence from anesthesia in rats.
BACKGROUND: Pre-anesthetic mother-infant interaction is an important factor for smooth emergence of pediatric anesthesia. In many mammalian species, disruptions of the mother-infant relationship cause psychological and behavioral changes. This study was to investigate whether or not pre-anesthetic presence of an injured dam has an impact on locomotor behavior of rat pups. METHODS: We used a video-tracking system to test the effects of pre-anesthetic relations between pups and their dams on pups' locomotor behavior during emergence from general anesthesia, in 40 3-week-old Sprague-Dawley male rats. Pups were divided into two groups: pups housed with a dam (n = 20) and those housed with an injured dam (n = 20). Pups were anesthetized with 1.2% halothane for 30 min. At emergence, we recorded their locomotor behavior for 15 min. RESULTS: Pre-anesthetic manipulation to dams significantly increased the distance traveled by pups. However, the manipulation did not cause any difference in the maximum velocity. CONCLUSION: Pre-anesthetic presence of an injured dam influenced pups' locomotor behavior at emergence from anesthesia.
Comparison of a combination of midazolam and diazepam and midazolam alone as oral premedication on preanesthetic and emergence condition in children.
BACKGROUND: Preanesthetic anxiety and emergence agitation are major challenges for anesthesiologists in pediatric anesthesia. Thus, midazolam has been used as premedication for children. However, midazolam alone is not effective for emergence agitation. The present study tested the effect of a combination of midazolam and diazepam on the preanesthetic condition and emergence behavior in children. METHODS: Forty-two children were allocated to one of three groups: the NoPre group received no premedication; the Mi group received midazolam 0.5 mg kg(-1) orally; and the Mi + Di group received midazolam 0.25 mg kg(-1) and diazepam 0.25 mg kg(-1) orally. When anesthesia was induced with 7% sevoflurane in 100% oxygen, qualities of mask induction and sedation were rated. Anesthesia was maintained with sevoflurane (3-5%) in 100% oxygen. During emergence from anesthesia, the score of the child's emergence behavior was rated. RESULTS: Children in the Mi and Mi + Di groups were more sedated than those in the NoPre group. A combination of midazolam and diazepam provided a better quality of mask induction, when compared with no premedication. Also, the children in the Mi + Di group were less agitated than those in the other groups during the emergence. CONCLUSION: Children in the Mi + Di group were significantly more sedated at induction of anesthesia and less agitated during emergence from anesthesia.
Pre-anesthetic maternal separation increases pups' locomotor behavior during emergence from anesthesia in rats.
BACKGROUND: Problematic behavior at emergence from anesthesia in children, partly linked with maternal separation, is a major problem in pediatric anesthesia. In humans, as well as in many other mammalian species, such separation causes psychological and behavioral changes. This study was to investigate whether or not pre-anesthetic maternal separation has a similar effect on rat pups. METHODS: This study was conducted on 66 3-week-old Sprague-Dawley male rats. The rats were divided into two groups; pups housed with a dam (n = 33) and those housed without (n = 33). Pups were anesthetized with 1.2% halothane for 30 min. Afterwards we recorded their locomotor behavior at emergence from general anesthesia using a video tracking system. RESULTS: Pre-anesthetic maternal separation significantly increased the maximum velocity and the distance traveled by pups at the emergence. CONCLUSION: Pre-anesthetic maternal separation influenced pups' locomotive behavior at emergence.
Preoperative stellate ganglion blockade prevents tourniquet-induced hypertension during general anesthesia.
BACKGROUND: Prolonged and excessive inflation of pneumatic tourniquets leads to a hyperdynamic circulatory response. Sympathomimetic activity is an important factor in tourniquet-induced hypertension. Stellate ganglion block specifically blunts sympathetic efferent nerves and prevents hypertension induced by sympathomimetic stimulation. The present study was performed to investigate the effects of stellate ganglion block (SGB) on arterial pressure and heart rate during prolonged tourniquet use under general anesthesia. METHODS: Twenty patients scheduled for knee arthroscopy were either treated with 10 ml of 1% lidocaine for SGB (SGB group; n = 10), or intramuscular injection (IM group; n = 10) before tourniquet inflation. Comparisons of systolic and diastolic arterial pressure and heart rate were made before and after the induction of anesthesia, 10 min after the lidocaine treatment, every 5 min during the first 60 min after tourniquet inflation, and immediately before and 5 min following deflation. The maximum values of the circulatory variables were compared. RESULTS: Tourniquet inflation caused increases in the circulatory variables in both groups. Systolic arterial pressure in the SGB group was significantly lower than that in the IM group after 55 min of tourniquet inflation. Diastolic arterial pressure also was significantly lower in the SGB group immediately before the deflation. The maximum values of the three hemodynamic variables were significantly lower in the SGB group. Arterial pressure significantly decreased after tourniquet deflation in the IM group. CONCLUSION: Ipsilateral SGB attenuated the hyperdynamic response mediated by prolonged tourniquet inflation during knee arthroscopy.