[Show abstract][Hide abstract] ABSTRACT: Isoflurane has a pharmacological preconditioning effect against ischemia in the heart and brain, but whether this also occurs in the kidney is unclear. In this study, we investigated pharmacological preconditioning by isoflurane in the rat kidney. In the isoflurane preconditioning group (1.5% isoflurane for 20 min before renal ischemia) serum creatinine (1.2 +/- 0.7 and 1.1 +/- 0.2 mg/dL) and blood urea nitrogen (99 +/- 29 and 187 +/- 31 mg/dL) were significantly smaller at 24 and 48 h after reperfusion than in the nonpreconditioning group (creatinine; 2.4 +/- 1.2 and 2.9 +/- 0.9 mg/dL, urea; 62 +/- 19 and 79 +/- 20 mg/dL). We also investigated the intracellular signal transduction involved in isoflurane preconditioning in the kidney. The activities of the stress protein kinases, JNK and ERK but not p38, were significantly less in the kidneys of the preconditioning group than in those of the nonpreconditioning group (P < 0.05). We conclude that isoflurane has a preconditioning effect against renal ischemia/reperfusion injury when administered before ischemia. Inhibition of the protein kinases, JNK and ERK, might be involved in the mechanisms of isoflurane preconditioning.
[Show abstract][Hide abstract] ABSTRACT: Neostigmine causes airway smooth muscle contraction through the direct stimulation of muscarinic receptors and the activation of phosphatidylinositol (PI) responses. Ketamine attenuates airway smooth muscle contraction. It is not clear whether ketamine attenuates neostigmine-induced airway smooth muscle contraction by inhibiting the PI response. This study was designed to examine the effects of ketamine on neostigmine-induced contractile and PI responses of the rat trachea.
Thirty male Wistar rats weighing 250-350 g were used. In the experiment on the contractile response, active contraction was induced with 1 microM neostigmine in the presence or absence of ketamine. In the experiment on the phosphatidylinositol response, the trachea slices were incubated with [3H]myo-inositol, 1 microM neostigmine, or 100 microM aluminum fluoride, and ketamine. The formation of [3H]inositol monophosphate (IP1), a degradation product of the phosphatidylinositol response, was measured with a liquid scintillation counter. Statistical significance (P < 0.05) was determined by analysis of variance.
Neostigmine 1 microM caused tracheal ring contraction. This contraction was attenuated by ketamine dose-dependently and reached resting tension at 100 microM. Neostigmine- and aluminum fluoride-induced IP1, accumulation was also attenuated by ketamine.
The results suggest that ketamine attenuates neostigmine-induced contractile responses, at least in part, through the inhibition of phospholipase C coupled with G protein in the PI response.
Journal of Anesthesia 05/2003; 17(2):104-7. DOI:10.1007/s005400300025 · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to clarify whether prostaglandin E1 (PGE(1)) or corticosteroid could increase blood flow in the nerve root because neurologic symptoms in spinal stenosis may be based on the vascular insufficiency in the nerve root. Fifty-seven patients undergoing lumbar diskectomy were randomly assigned to one of three groups. Each group received one of three protocols for intravenous injection: 10 mL of saline solution, group A (n = 19); 10 mL of PGE(1) (20 microg) solution, group B (n = 19); and 10 mL of dexamethasone (8 mg) solution, group C (n = 19). After lumbar diskectomy, a probe for laser Doppler flowmetry was placed directly on the lumbar nerve root. Nerve root blood flow (RBF) velocity and mean arterial pressure (MAP) were measured before injection (T0), 5 minutes after the start of injection (T1), 10 minutes after the start of injection (T2), and 10 minutes after the end of injection (T3). In groups A and C, these did not change throughout the time course. In group B, MAP decreased significantly at T1 (92%; P <.001), T2 (89%; P <.0001), and T3 (91%; P <.0001), while RBF velocity increased significantly at T1 (125%; P <.05), T2 (128%; P <.05), and T3 (121%; P <.05) compared with T0. The values in group B were different from those in group A (P <.05) and group C (P <.05) at T1 and T2. The results show that intravenous injection of low-dose PGE(1), but not corticosteroid, increases RBF velocity after lumbar diskectomy.
[Show abstract][Hide abstract] ABSTRACT: To investigate the effects of the perineural injection of lidocaine or corticosteroids on radicular blood flow during spinal surgery.
After lumbar discectomy, a probe for laser Doppler flowmetry was placed directly on the 4th or 5th lumbar nerve root. Thirty patients undergoing lumbar discectomy were randomly assigned to one of three groups. Each group received one of three protocols for a perineural injection to the nerve root: 1.0 mL 0.9% saline in group A, 1.0 mL 1% lidocaine in group B or 1.0 mL dexamethasone (4 mg) in group C. Measurements included radicular blood flow, mean arterial pressure, haemoglobin concentration, percutaneous oxygen saturation and end-tidal carbon dioxide tension. Radicular blood flow was measured by laser Doppler flowmetry before the injection and 15 min after these injections. The three groups were similar with respect to mean arterial pressure, haemoglobin concentration, percutaneous oxygen saturation and end-tidal carbon dioxide tension.
Radicular blood flow did not change after the injection in any of the groups.
The results suggest that the perineural injection of 1% lidocaine or dexamethasone does not affect radicular blood flow during lumbar discectomy.
European Journal of Anaesthesiology 03/2001; 18(2):70-4. DOI:10.1097/00003643-200102000-00002 · 2.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Effects of dopamine and dobutamine on renal function and urinary excretion of prostaglandin E2 (UPGE) were studied in 21 elderly patients who underwent abdominal surgery. Fractional sodium excretion (FeNa), creatinine clearance (Ccr), urinary volume (UV, ml.kg-1.min-1) and UPGE were measured on the first and second postoperative day. These patients were divided into three groups: i.e. C (control), DA (dopamine) and DB (dobutamine) groups. Group DA received dopamine 2 mcg.kg-1.min-1 beginning at six o'clock on the first postoperative day. Group DB received dobutamine 2 mcg.kg-1.min-1. There were no significant differences in UV and UPGE among these three groups. Ccr was significantly higher on the second postoperative day than that on the first postoperative day in DA group. FeNa in DA group was higher than in C group on the second postoperative day. The relationship between UPGE and UV was not determined. These results suggest that DA improve renal functions in the elderly.
Masui. The Japanese journal of anesthesiology 03/2001; 50(2):122-6.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of controlled hypotension combined with acute hypervolemic or normovolemic hemodilution on the splanchnic perfusion in the clinical setting.
Randomized, prospective study.
Inpatient surgery at Nagasaki Rosai Hospital.
28 ASA physical status I and II patients scheduled for total hip arthroplasty.Interventions: Patients were randomly divided into two groups. Group A (n = 14) received controlled hypotension with acute normovolemic hemodilution (ANH). Group B (n = 14) received controlled hypotension with acute hypervolemic hemodilution (HHD). ANH was produced by drawing approximately 1000 mL of blood and replacing it with the same amount of 6% hydroxyethyl starch solution (HES). HHD was produced by preoperative infusion of 1000 mL of 6% HES without removing blood. The final hematocrit values were 24+/-2% (mean +/- SD) in Group A and 25+/-3% in Group B. Controlled hypotension was induced with prostaglandin E1 (PGE1) to maintain mean arterial blood pressure at 55 mmHg for 80 minutes.
Measurements included the gastric pH (pHi), the arterial blood pH (pHa), and plasma lactate. These indices were measured before hemodilution, after hemodilution, 80 minutes after starting hypotension, 60 minutes after recovery from hypotension, and on the first postoperative day. The value of pHi was measured by tonometric method.
The pHa and lactate values showed no change in either group A or group B throughout the time course. Gastric pHi values in group A showed a significant decrease from 7.424+/-0.033 to 7.335+/-0.038 (p<0.05) after hemodilution, whereas it showed no further decrease at 80 minutes after starting hypotension and 60 minutes after recovery from hypotension. The pHi values in group B showed no significant decrease after hemodilution and no further change at 80 minutes after starting hypotension.
HHD does not impair splanchnic perfusion, whereas ANH might cause impairment. Controlled hypotension with prostaglandin E1 would not impair splanchnic perfusion in combination with either HHD or ANH.