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ABSTRACT: The purpose of this observational study was to investigate the relationship between splanchnic and renal blood flow during infrarenal aortic cross-clamp (XC) and postoperative gastrointestinal perfusion and function.
Descending aortic blood flow (DABF) was continuously monitored with an oesophageal Doppler monitor (Cardio-Q, Deltex Ltd, Chichester, UK) in 31 patients undergoing elective abdominal aortic aneurysm repair. Cardiac output (CO) was determined by indocyanine green dilution before, during, and after XC. Perioperative gastrointestinal perfusion was assessed by gastric intramucosal pH (pHi, Tonocap, GE Healthcare, Helsinki, Finland). Postoperative gastrointestinal recovery was assessed by the number of postoperative days until the patient successfully resumed solid food intake. The relationship between the mean DABF during XC and gastric pHi after XC release and postoperative gastrointestinal recovery was analysed with Spearman's correlation coefficient.
accounted for ∼ 55% of CO during XC and significantly decreased during XC, despite arterial pressure remaining within an optimal range. There were two distinct relationships between DABF during XC and gastric pHi after XC release. Gastric pHi steeply and linearly declined when indexed DABF was below 0.82 litre min(-1) m(-2). Above this critical value, there was no linear relationship between them. The duration of postoperative gastrointestinal dysfunction was inversely correlated with the mean DABF during XC. The best cut-off value of the mean indexed DABF during XC to prevent prolonged gastrointestinal dysfunction was 1.2 litre min(-1) m(-2).
Decreased DABF during XC associates splanchnic hypoperfusion after XC release and delayed recovery of gastrointestinal function.
BJA British Journal of Anaesthesia 04/2012; 108(6):936-42. · 4.24 Impact Factor
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ABSTRACT: Monitoring cardiac output (CO) is important for the management of patient circulation in an operation room (OR) or intensive care unit (ICU). We assumed that the change in pulse wave transit time (PWTT) obtained from an electrocardiogram (ECG) and a pulse oximeter wave is correlated with the change in stroke volume (SV), from which CO is derived. The present study reports the verification of this hypothesis using a hemodynamic analysis theory and animal study. PWTT consists of a pre-ejection period (PEP), the pulse transit time through an elasticity artery (T<sub>1</sub>), and the pulse transit time through peripheral resistance arteries (T<sub>2</sub>). We assumed a consistent negative correlation between PWTT and SV under all conditions of varying circulatory dynamics. The equation for calculating SV from PWTT was derived based on the following procedures. 1. Approximating SV using a linear equation of PWTT. 2. The slope and y-intercept of the above equation were determined under consideration of vessel compliance (SV was divided by Pulse Pressure (PP)), animal type, and the inherent relationship between PP and PWTT. Animal study was performed to verify the above-mentioned assumption. The correlation coefficient of PWTT and SV became r = -710 (p <; 0.001), and a good correlation was admitted. It has been confirmed that accurate continuous CO and SV measurement is only possible by monitoring regular clinical parameters (ECG, SpO2, and NIBP).
Engineering in Medicine and Biology Society (EMBC), 2010 Annual International Conference of the IEEE; 10/2010
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ABSTRACT: Elderly patients frequently fall asleep during spinal anesthesia without sedatives. We investigated effects of spinal anesthesia on electroencephalogram (EEG) in elderly patients. Elderly patients were randomly assigned. Patients in Group C (n = 8) received an epidural catheter with no anesthetics as control; patients in Group S (n = 8) received spinal anesthesia. Subsequently, processed EEG data were monitored for 5 minutes. Spinal anesthesia induced significant decreases in 90% spectral edge frequency (SEF90), whereas the control group had no change in SEF90. It was concluded that spinal anesthesia induces decreased SEF90, indicating suppressed cortical activity in early phases of sensory blockade in elderly patients.
Acta anaesthesiologica Belgica 02/2008; 59(1):15-7.
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ABSTRACT: We have prepared DPP-hematin (DPP=2, 3, 5, 7, 8, 10, 12, 13, 15, 17, 18, 20-dodecaphenylporphyrin), and characterized it by
Mössbauer and magnetic measurements. It is concluded that DPP-hematin is most likely a monomer, as is expected from the distorted
nonplanar structure of the porphyrin, in contrast to usual hematins: hematins derived from usual porphyrins are μ-oxo dimers.
12/2007: pages 309-312;
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ABSTRACT: Although it has side effects, succinylcholine is still widely used in rapid sequence induction. The aim of the present study is to evaluate the effects of pretreat ment with magnesium and precurarization of vecuroni um on succinylcholine-induced fasciculation and subse quent tracheal intubation-induced hemodynamic changes during rapid sequence induction. Fifty-five patients were allocated to three groups by a blinded randomization: Group M received saline 100 ml with magnesium 40 mg x kg(-1) for 5 min at 6.5 min before induction and sub sequently administered saline 1-2 ml at 1.5 min before induction; Group V received saline 100 ml for 5 min at 6.5 min before induction and subsequently administered vecuronium 0.02 mg x kg(-1) at 1.5 min before induction; Group C received saline 100 ml for 5 min at 6.5 min before induction and then saline 1-2 ml at 1.5 min before induction. Fasciculation scores and mean percent changes of heart rate, systolic blood pressure and rate pressure product between baseline and after induction were significantly lower in group M than those in group C and group V. Pretreatment with magnesium is more effective to limit succinylcholine-induced fasciculation and subsequent tracheal intubation-induced hemody namic changes in rapid sequence induction compared with vecuronium pretreatment, although magnesium does not prevent the elevation of serum potassium con centration after induction.
Acta anaesthesiologica Belgica 02/2006; 57(3):253-7.
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ABSTRACT: Iron(III) complexes of highly saddled dodecaphenylporphyrin, Fe(DPP)X (X=Cl, Br or I) have been prepared and characterized
by Mössbauer, UV–Vis and magnetic measurements. The Mössbauer spectra, recorded at temperatures from 5 to 300 K, contain two
components A and B. Component A is attributed to iron(III) in a spin-admixed (S=3/2, 5/2) state. The UV–Vis spectra of solution samples of these complexes exhibit broad and red-shifted absorption bands.
The effective magnetic moments derived from the molar magnetic susceptibilities measured by modified Gouy method at 298 K
for X=Cl, Br and I are 5.52, 5.10 and 4.28 μB, respectively.
Hyperfine Interactions 11/2004; 156-157(1):265-272. · 0.21 Impact Factor
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ABSTRACT: Recent evidence indicates that sevoflurane treatment before prolonged ischaemia reduces infarct size in normal hearts, mimicking ischaemic preconditioning. We examined whether exposure to sevoflurane before brief ischaemia, inducing a 'stunned myocardium', provided such protective effects in an isolated working heart from normal or septic rats.
With institutional approval, 91 rats were randomly allocated into one of either caecal-ligation and perforation (CLP: n=50) or sham (Sham: n=41) procedure groups 24 h before the study. After determination of baseline measurements, including cardiac output (CO), myocardial oxygen consumption (mVO(2)) and cardiac efficiency (CE; CO x peak systolic pressure/mVO(2)), each isolated heart was perfused with or without 2% sevoflurane for 15 min before global ischaemia (pre-ischaemia). After 15 min ischaemia and 30 min reperfusion, all hearts were assessed for functional recovery of myocardium (post-reperfusion).
During the pre-ischaemia period, 2% sevoflurane caused a significant reduction of CO in the CLP group compared with the Sham group. During the post-reperfusion period, both CO (16.9 vs 11.0 ml min(-1)) and CE (11.2 vs 7.7 mm Hg ml(-1) ( micro l O(2))(-1)) was higher in the sevoflurane-treated vs -untreated hearts from CLP rats, and was accompanied by lower incidence of reperfusion arrhythmia compared with control hearts (8 vs 32%). In contrast, 2% sevoflurane did not provide cardioprotective effects in normal rats.
The current study demonstrates that pre-treatment with sevoflurane minimizes myocardial dysfunction and the incidence of reperfusion arrhythmia after brief ischaemic insults in septic hearts.
BJA British Journal of Anaesthesia 01/2003; 89(6):896-903. · 4.24 Impact Factor
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ABSTRACT: Laparoscopic surgery causes a reduction in hepatic blood flow due to a number of factors, including raised intra-abdominal pressure, the neurohumoral response to surgical stress and the effect of patient position. The clinical significance of the phenomenon is not fully understood. Plasma concentrations of alcohol dehydrogenase (AD) and glutathione S-transferase (GST), which are concentrated in the centrilobular acinus of the liver, sensitively reflect hepatic hypoperfusion, and can be used to monitor reductions in hepatic blood flow. We compared perioperative AD, GST, aspartate aminotransferase (AST, normal range 14-32 IU litre(-1)) and alanine aminotransferase (ALT, normal range 8-41 U litre(-1)) concentrations in patients undergoing laparoscopic cholecystectomy or laparoscopic colectomy to study how patient position and surgical manipulation of the liver affect hepatocellular integrity during laparoscopy. There were significant postoperative increases in AD and GST in the cholecystectomy group [mean (SD) peak concentration 10.8 (4.7) U litre(-1) and 113 (55) microg litre(-1) respectively]. Although the duration of pneumoperitoneum was longer in the colectomy group, there were no comparable perioperative increases in AD and GST in this group [peak concentration 4.0 (4.0) U litre(-1) and 33 (35) microg litre(-1) respectively]. AST and ALT on the first postoperative day were significantly higher in the laparoscopic cholecystectomy group (41 and 34 U litre(-1) respectively) than in the laparoscopic colectomy group (24 and 18 U litre(-1); P<0.05 for each). These results indicate that patient position and the effects of surgical manipulation of the liver affect perioperative hepatic perfusion significantly.
BJA British Journal of Anaesthesia 11/2001; 87(5):774-7. · 4.24 Impact Factor
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ABSTRACT: Heme oxygenase 1 (HO-1), induced by a variety of stressors, provides endogenous carbon monoxide (CO) and bilirubin, both of which play consequential roles in organs. The current study aimed to examine whether induction of HO-1 and its by-products modulated endothelial interaction with circulating leukocytes and platelets evoked by sevoflurane anesthesia in vivo.
Rats, pretreated with or without hemin, were anesthetized with sevoflurane in 100% O2, and lungs were mechanically ventilated. Platelets labeled with carboxyfluorescein diacetate succinimidyl ester and leukocyte behavior in mesenteric venules were visualized during sevoflurane anesthesia at 1,000 frames/s using intravital ultrahigh-speed intensified fluorescence videomicroscopy. To examine the mechanisms for the effects of HO-1 on leukocyte and platelet behavior, these studies were repeated with superfusion of either CO, bilirubin, or Nomega-nitro-L-arginine methyl ester (L-NAME).
As reported previously, the elevation of sevoflurane concentration evoked adhesive responses of leukocytes, concurrent with platelet margination and rolling. Pretreatment with hemin, a HO-1 inducer, prevented such sevoflurane-elicited changes in the microvessels. These changes were restored by zinc protoporphyrin IX, a HO inhibitor, and repressed by CO but not by bilirubin. During sevoflurane anesthesia, however, nitric oxide suppression by L-NAME deteriorated microvascular flows irrespective of the presence or absence of the HO-1 induction.
These results indicate that endogenous CO via HO-1 induction attenuates sevoflurane-induced microvascular endothelial interactions with leukocytes and platelets, although local nitric oxide levels appear to dominate microvascular flow in situ.
Anesthesiology 08/2001; 95(1):192-9. · 5.36 Impact Factor
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A Ishizaka,
M Watanabe,
T Yamashita,
Y Ogawa,
H Koh,
N Hasegawa,
H Nakamura,
K Asano,
K Yamaguchi,
M Kotani,
T Kotani,
H Morisaki, J Takeda,
K Kobayashi,
S Ogawa
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ABSTRACT: A noninvasive bronchoscopic microsampling (BMS) probe was developed to sample biochemical constituents of the epithelial lining fluid in small airways.
Observational, controlled study.
Intensive care unit of academic medical center. PATIENTS AND PROCEDURE: BMS was applied in a control group of seven patients who had hemoptysis or small solitary peripheral nodules but no hypoxemia or other signs of acute inflammation and in four patients with acute respiratory distress syndrome (ARDS), to test whether BMS can ascertain the presence of acute pulmonary inflammation without complications.
Complications, including a significant decrease in arterial oxygen saturation, were observed neither during nor after BMS. In the ARDS group, albumin, lactate dehydrogenase, interleukin-6, basic fibroblast growth factor, and neutrophil elastase concentrations in epithelial lining fluid were significantly higher (p <.0001, p =.012, p <.0001, p <.0001, and p <.0001, respectively) than in the control group. Serial BMS was safely performed in one patient with ARDS, allowing us to observe a correlation between changes in the concentration of inflammation-related biochemical markers and clinical course of the disease.
These results suggest that BMS is safe and useful to monitor pulmonary biochemical events in ARDS.
Critical Care Medicine 04/2001; 29(4):896-8. · 6.33 Impact Factor
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ABSTRACT: Because it is postulated that gut is important via bacterial translocation in the development of the systemic inflammatory response and multiple organ dysfunction, the preservation of gut integrity is a therapeutic goal for physicians who care for critically ill patients. The aim of the current study was to evaluate whether epidural anesthesia prevented gut injury and subsequent translocation of endotoxin during acute progressive hypoxia in rabbits.
After the placement of an epidural catheter, 18 male rabbits, anesthetized with buprenorphine-midazolam, were allocated randomly to two groups: 0.5% lidocaine (group E) and saline (group C) groups. The solutions (0.4 ml/kg) were injected epidurally, followed by continuous infusion (0.1 ml x kg(-1) x h(-1)) during the study period. Portal blood flow, portal endotoxin concentrations, and intramucosal pH (pHi) of the ileum were measured at baseline and during two stages of progressive hypoxia (fraction of inspired oxygen [Fio2] = 0.15 and 0.10).
In both study groups, the portal blood flow was preserved to a similar extent during acute hypoxia. However, pHi was reduced to a lesser extent in group E (7.33 +/- 0.12 versus 7.22 +/- 0.12 at an Fio2 of 0.15 and 7.13 +/- 0.15 versus 7.03 +/- 0.12 at an Fio2 of 0.10; mean +/- SD, P < 0.01), concurrently with lower portal endotoxin concentrations (P < 0.05) compared with group C.
The current study showed that epidural anesthesia slowed the progression of intestinal ischemia during acute hypoxia, subsequently preventing translocation of endotoxin through the gut mucosa.
Anesthesiology 02/2001; 94(2):263-9. · 5.36 Impact Factor
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ABSTRACT: A 76-year-old woman with thoracic aortic aneurysm involving distal aortic arch was scheduled for graft replacement from ascending to proximal aortic arch with endovascular stent graft to descending aorta. Surgical procedures were performed under median sternotomy with hypothermic systemic circulation arrest and selective cerebral perfusion. The stent graft composed of 30 mm Gianturco Z stent and 27.5 mm woven Dacron graft was introduced into the descending aorta under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Ascending and proximal aortic arch replacement was then performed with four branched woven Dacron graft. The aortic pathology was confirmed by TEE and the extent of the aneurysmal lesion was defined. TEE was also useful to find the dislodgement of the stent graft after deployment. This surgical technique, being less invasive than conventional thoracotomy, would be indicated for elderly patients with distal aortic arch aneurysm. TEE is the vital imaging technique for placement of the stent graft, as well as for intraoperative cardiac monitoring.
Masui. The Japanese journal of anesthesiology 12/2000; 49(11):1254-6.
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ABSTRACT: We examined the alterations of peripheral vascular responses following ischemic insult during perioperative period of esophagectomy. Increase of palm blood flow after vascular occlusion, i.e., reactive hyperemia (RH), measured by near-infrared spectroscopy (NIRS) was employed to assess forearm vascular responses. The measurements of RH were performed in esophagectomized patients (n = 12) before induction of anesthesia and postoperatively until the next day of extubation in comparison with normal volunteers (n = 11). After esophagectomy, the RH, which was comparable with those in volunteers, was depressed by 50% on 1 POD, and did not recover until the third POD. In particular, patients receiving laparoscopy-assisted surgery showed less decrease of RH than those receiving the standard open laparotomy. These results suggest that vascular responses to increase blood flow against ischemic insult is depressed following esophagectomy.
Masui. The Japanese journal of anesthesiology 11/2000; 49(10):1082-7.
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ABSTRACT: We report anesthetic experience of two patients for endoscopic removal of thyroid tumor by new surgical approach. A subplatysmal air pocket, which had been created by using a subcutaneous dissector, was maintained by insufflating carbon dioxide (CO2) at an insufflation pressure of 6 mmHg. In one patient, the arterial CO2 pressure increased from 29 mmHg to 44 mmHg, and in another patient from 31 mmHg to 36 mmHg. We did not experience any symptoms of sustained CO2 absorption such as severe hypercarbia, acidosis, and massive subcutaneous emphysema. The patients were discharged on the fifth and the fourth postoperative day with no complications. The advantages of this endoscopic surgery include little postoperative pain, quick recovery, and short hospital stay after operation. However, possible occurrence of intraoperative hypercarbia during endoscopic surgery must be considered, and continuous monitoring of ventilation by end-tidal CO2 or arterial CO2 pressure is mandatory.
Masui. The Japanese journal of anesthesiology 09/2000; 49(8):896-8.
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ABSTRACT: To compare the hemodynamic effects of milrinone during weaning from cardiopulmonary bypass (CPB) in patients with a low pre-CPB cardiac index (CI) <2.5 L/min/m2) and in patients with a high pre-CPB CI (> or =2.5 L/min/m2).
Prospective, randomized, double-blind study.
University hospital.
Forty-eight patients scheduled for elective coronary artery bypass graft surgery.
Patients were divided into 4 groups: (1) low pre-CPB CI/placebo, (2) low pre-CPB CI/milrinone, (3) high pre-CPB CI/placebo, and (4) high pre-CPB CI/milrinone. Patients received a loading dose of 20 microg/kg of milrinone followed by an infusion of 0.2 microg/kg/min or placebo 15 minutes before the anticipated weaning time.
In the low pre-CPB CI/ placebo group, low CIs and high systemic vascular resistances (SVRs) were observed after CPB. High doses of dopamine and dobutamine were needed, and infusion of epinephrine was used in 5 of the 12 patients for hemodynamic support. Milrinone improved CI and reduced SVR in the low pre-CPB CI/milrinone group. Norepinephrine was needed to maintain an adequate systemic blood pressure in 6 of the 12 patients, however. In the high pre-CPB CI/placebo group, satisfactory CIs and SVRs were observed during weaning from CPB with low doses of dopamine and dobutamine. Milrinone significantly increased CI and decreased SVR in the high pre-CPB CI/milrinone group: 10 of the 12 patients had CIs above the upper limit of normal, and 7 patients had SVRs below the lower limit of normal.
Milrinone was effective during weaning from CPB in patients with a low pre-CPB CI. Milrinone in combination with norepinephrine was a good alternative to epinephrine for the treatment of myocardial dysfunction after CPB.
Journal of Cardiothoracic and Vascular Anesthesia 09/2000; 14(4):367-73. · 1.64 Impact Factor
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ABSTRACT: Since the first report in 1979, the number of patients with latex allergy has progressively increased. We experienced an anesthetic management of a 3 year-old child who underwent the repair of anal atresia. The first operation was performed in newborn period. After the surgery, the patient developed skin rash and the loss of consciousness every time anal irrigation was made with latex-containing catheter. Latex-allergy was diagnosed at the age of 3 years, with the positive skin test by latex extract. It took enormous time and efforts to find out the possibility of latex-contamination in a wide variety of medical equipments and supplies to prevent allergic reaction during perioperative period. In this patient, perioperative cause was uneventful. It is suggested that preoperative preparation is essential and caution should be also paid to prevent allergic reaction in daily life.
Masui. The Japanese journal of anesthesiology 08/2000; 49(7):777-81.
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M Iwade,
M Nomura,
T Yamada,
A Oumi,
S Kashimoto,
H Yoshioka,
T Kikuchi,
K Fujimoto,
O Honda,
M Seki,
T Ishiguro, J Takeda
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ABSTRACT: We have conducted a joint research project to investigate the incidence of ischemic heart disease in patients for noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. From September to November 1997 we had 7288 patients scheduled to undergo noncardiac surgery in the 8 departments of anesthesiology. Of these patients, 228 (3.1%) patients had ischemic heart disease, and 30 of them (13.2%) developed perioperative cardiac events. Critical cardiac events, including perioperative myocardial ischemia and lethal arrhythmia, occurred in 7 of these patients. In our region of Japan, 3-4% of surgical patients tend to develop ischemic heart disease and 3.1% of them demonstrated severe cardiac complications perioperatively. Compared with United States we encounter fewer surgical patients with ischemic heart disease, but the risk of developing perioperative cardiac complications in such patients is almost the same for both countries.
Masui. The Japanese journal of anesthesiology 08/2000; 49(7):796-801.
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T Yamada,
M Nomura,
M Iwade,
A Omi,
S Kashimoto,
H Yoshioka,
T Kikuchi,
K Fujimoto,
O Honda,
M Seki,
T Ishiguro, J Takeda
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ABSTRACT: We designed a joint research project to investigate the incidence of ischemic heart diseases in patients undergoing noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. Of the 8358 surgical patients in the 8 departments of anesthesiology between March 1997 and June 1997, 328 (3.9%) had ischemic heart diseases. Among the 328 patients, 54 (16.4%) developed perioperative cardiac events, including myocardial infarction (3 patients) and either lethal or potentially dangerous dysrhythmias (51 patients). Preoperative cardiac assessments were performed while the anesthetic techniques including intensive monitoring and perioperative prophylactic therapy were also employed. Patients with ischemic heart diseases received various types of preoperative evaluation to identify the degree of coronary artery disease and to assess the overall cardiac function. The patients were monitored using a multilead electrocardiogram, an arterial line, a central venous catheter, a pulmonary artery catheter, and by transesophageal echocardiography intraoperatively. Therapeutically, isosorbide, nitroglycerin, beta-blockers, calcium channel blockers, and/or nicorandil were administered to prevent perioperative ischemia. So far, no generally accepted management strategies have been established in patients with cardiovascular disorders based on large-scale outcome trials in Japan. Therefore, nationwide large multicenter trials are awaited with interest in order to establish helpful guidelines to improve the perioperative management and to reduce ischemia in cardiac patients undergoing noncardiac surgery.
Masui. The Japanese journal of anesthesiology 07/2000; 49(6):673-9.
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ABSTRACT: We describe a 42-yr-old woman scheduled for emergency cesarean section who had sudden cardiopulmonary arrest just before induction of general anesthesia. Hypermagnesemia, caused by accidental overdose of magnesium sulfate during transportation to the operating room, was the primary cause of this life-threatening event. Anesthetic management after such events and a brief summary of the literature regarding iatrogenic hypermagnesemia in obsteric patients are provided.
Journal of Clinical Anesthesia 06/2000; 12(3):224-6. · 1.21 Impact Factor
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ABSTRACT: We anesthetized a 10-year-old girl with hypohidrotic ectodermal dysplasia for an ophthalmic surgery. Ectodermal dysplasia involves the abnormalities of ectodermal tissues and has a triad; hypohidrosis, a lack of teeth, and the scarcity of hair. Hyperthermia may occur due to the defect of sweat glands. Therefore, the body temperature must be monitored continuously. Respiratory tract infection occurs frequently due to the absence of seromucosal glands. We recommend humidifying the inspired gases during the operation. Tracheal intubation may be difficult because of maxillary and/or mandibular abnormalities. We conclude that the particular care should be taken such as the management of the body temperature, preparation for the difficult airway and the humidification of respiratory tract.
Masui. The Japanese journal of anesthesiology 05/2000; 49(4):414-6.
