S Ogawa

Nihon University, Edo, Tōkyō, Japan

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Publications (33)42.95 Total impact

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    ABSTRACT: The aim of this study is to compare the infusion rates required to maintain a constant neuromuscular block and the reversibility of rocuronium at the corrugator supercilii muscle (CSM) and the adductor pollicis muscle (APM). We randomly allocated 30 female patients into two groups of 15 patients each to monitor neuromuscular block at either the CSM or the APM. After induction of anaesthesia and laryngeal mask insertion, contraction of the CSM to the facial nerve stimulation or that of the APM to the ulnar nerve stimulation was quantified using an acceleromyograph during 1.0-1.5% end-tidal sevoflurane anaesthesia. All the patients received a bolus of 1 mg/kg rocuronium. When the first twitch (T1) of train-of-four (TOF) recovered to 10% of the control, rocuronium infusion was commenced and maintained at T1 of 10% of the control at the CSM or APM for 120 min. Immediately after rocuronium infusion was discontinued, the time required for 0.04 mg/kg neostigmine-facilitated recovery to a TOF ratio of 0.9 was recorded. Rocuronium infusion dose after a lapse of 120 min was significantly larger in the CSM than in the APM [7.1 (2.3) vs. 4.7 (2.6) microg/kg/min; P=0.001]. The time for facilitated recovery was shorter in the CSM than in the APM [11.4 (3.8) vs. 16.2 (6.0) min; P=0.016]. A larger rocuronium infusion dose was required to maintain a constant neuromuscular block at the CSM. Neostigmine-mediated reversal was faster at the CSM.
    Acta Anaesthesiologica Scandinavica 08/2009; 53(10):1336-40. · 2.36 Impact Factor
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    ABSTRACT: The aim of this study was to examine the efficacy of epidurally administered mepivacaine on recovery from vecuronium-induced neuromuscular block. Eighty patients were randomly assigned to one of two study groups. They were either given epidurally a bolus of 0.15 ml kg(-1) of mepivacaine 2%, followed by repetitive injections of 0.1 ml kg(-1) h(-1) throughout the study, or were not given epidurally. General anaesthesia was induced and maintained with fentanyl, propofol and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg kg(-1) and monitored using acceleromyographic train-of-four (TOF) at the adductor pollicis. Patients in each treatment group were randomized to receive neostigmine 0.04 mg kg(-1) at 25% recovery of the first twitch of TOF or to recover spontaneously to a TOF ratio of 0.9. The effect of epidural mepivacaine on speed of spontaneous and facilitated recovery of neuromuscular function was evaluated. The time from administration of vecuronium to spontaneous recovery to a TOF ratio of 0.9 was significantly longer in the epidural mepivacaine group [105.4 (14.2) min] as compared with the control group [78.5 (9.1) min, P < 0.01]. Neostigmine administered at 25% of control in T1 shortened recovery from neuromuscular block, however the time required for facilitated recovery to a TOF ratio of 0.9 in the epidural group was significantly longer than that in the control group [7.6 (1.6) min vs 5.8 (2.1) min, P < 0.01]. In clinical anaesthesia, it should be recognized that epidurally administered mepivacaine delays considerably the TOF recovery from neuromuscular block.
    BJA British Journal of Anaesthesia 12/2007; 99(5):721-5. · 4.24 Impact Factor
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    ABSTRACT: This study was designed to recognize the importance of normalizing postoperative acceleromyographic train-of-four (TOF) ratio by the baseline TOF value obtained before neuromuscular block for ensuring adequate recovery of neuromuscular function. In 120 patients, TOF responses of the adductor pollicis to the ulnar nerve stimulation were monitored by acceleromyography (AMG) during anaesthesia using propofol, fentanyl and nitrous oxide. Control TOF stimuli were administered for 30 min. A TOF ratio measured at the end of control stimulation was regarded as a baseline value. Neuromuscular block was induced with vecuronium 0.1 mg kg(-1) and was allowed to recover spontaneously. Duration to a TOF ratio of 0.9 as calculated by AMG (DUR-raw 0.9) was compared with that of 0.9 as corrected by the baseline TOF ratio (i.e. 0.9 x baseline TOF ratio; DUR-real 0.9). Baseline TOF ratios ranged from 0.95 to 1.47. The average TOF ratios observed every 5 min were constant throughout control stimulation from at time zero mean (SD) [range]; 1.11 (0.09) [0.94-1.42] to at 30 min 1.13 (0.11) [0.95-1.47]. The DUR-real 0.9 was 91.0 (18.0) [51.3-131.0] min and was significantly longer than the DUR-raw 0.9 (81.2 (16.3) [41.3-123.0] min). Baseline TOF ratios measured by AMG are usually more than 1.0 and vary widely among patients. Therefore a TOF ratio of 0.9 displayed postoperatively on AMG does not always represent adequate recovery of neuromuscular function and should be normalized by baseline value to reliably detect residual paralysis.
    BJA British Journal of Anaesthesia 02/2006; 96(1):44-7. · 4.24 Impact Factor
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    ABSTRACT: Ropivacaine, a new long acting local anaesthetic of amide type is structurally related to mepivacaine and bupivacaine. This study was designed to compare the in vitro potency and neurotoxicity of ropivacaine with those of other commercially available local anaesthetics using an isolated rabbit vagus nerve model. Ropivacaine dose-dependently suppressed the evoked compound action potentials of A beta nerve and C nerve components. Minimum concentration of ropivacaine for producing complete suppression of the compound action potentials of all components was 0.008%. Electron microscopic observation showed that ropivacaine did not destroy any peripheral nervous structures in concentrations up to 0.75%. When the neurotoxic effect of ropivacaine was compared, in terms of risk ratio (clinically used concentration/concentrations producing 2 hr irreversible block), with that of commercially available local anesthetics, the rank oder was dibucaine, tetracaine, lidocaine, bupivacaine and ropivacaine.
    Masui. The Japanese journal of anesthesiology 01/2002; 50(12):1308-15.
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    ABSTRACT: The purpose of this study was to quantify the relationship between the dose-response curve of vecuronium and duration of exposure to an end-tidal concentration of 1.7% sevoflurane in 67% nitrous oxide and oxygen. Forty adult patients, in groups of 10, were allocated randomly to receive vecuronium by a cumulative dose method at intervals of 15 min (group 15), 30 min (group 30), 60 min (group 60) or 90 min (group 90) after starting inhalation of sevoflurane. Neuromuscular function was monitored by acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation. Dose-response curves were constructed by least-squares regression analysis and the effective doses of vecuronium (ED50, ED90 and ED95) were estimated and compared between groups. Mean (SEM) ED50, ED90 and ED95 were 16.8 (0.5), 32.6 (1.7) and 40.9 (2.4) micrograms kg-1, respectively, in group 15; 10.6 (1.0), 20.8 (1.7) and 26.2 (2.2) micrograms kg-1, respectively, in group 30; 11.2 (1.1), 21.7 (1.6) and 27.3 (1.8) micrograms kg-1, respectively, in group 60; and 11.0 (1.1), 21.7 (1.6) and 27.5 (1.9) micrograms kg-1, respectively, in group 90. The values obtained in group 15 were significantly higher than those in the other three groups (P < 0.05). The results indicate that the duration of sevoflurane anaesthesia influences the dose-response of vecuronium and 30 min inhalation of 1.7% end-tidal concentration is sufficient to achieve a stable potentiating effect.
    BJA British Journal of Anaesthesia 12/2000; 85(5):732-4. · 4.24 Impact Factor
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    ABSTRACT: Preoperative patients have various kinds of anxiety. However we do not know much about their psychological burden. Therefore, we investigated types of their anxiety with questionnaires prior to operation and analyzed them according to their anesthetic method, type of surgery and age. Concerning anesthetic methods, patients' anxiety varied depending on their histories of anesthesia, anesthetic method previously received and age. Concerning the type of surgery, patients scheduled to undergo abdominal and cardiac surgery had more intense anxiety. Patients scheduled for gynecological surgery were anxious about the accident which might be induced by anesthesia. A large number of patients scheduled for orthopedic surgery were anxious about postoperative pain. Concerning patients' age, patients whose ages ranged from 10s to 50s were anxious about pain. While, in patients over 60s, their anxiety was focussed on giving trouble to their surrounding people. Patients whose age was 10 to 19 had anxiety about their anesthetic method. Anesthesiologists should recognize that preoperative patients have various kinds of anxiety. It is important for us to examine the patients appropriately according to their psychological and physical condition.
    Masui. The Japanese journal of anesthesiology 09/2000; 49(8):913-9.
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    ABSTRACT: We evaluated vecuronium-induced neuromuscular block in both arms of a patient with cerebral palsy and hemiplegia. A remarkable resistance to vecuronium was observed in the hemiplegia side compared with cerebral palsy side. Complete recovery from neuromuscular block should be assessed in the cerebral palsy side that shows a delayed recovery.
    Anesthesia & Analgesia 09/2000; 91(2):492-3. · 3.30 Impact Factor
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    ABSTRACT: A randomized, double-blind, controlled study was designed to evaluate the effect of presurgical local infiltration of bupivacaine in the surgical field on postsurgical wound pain relief and analgesic requirements in 28 healthy patients scheduled for laparoscopic gynecologic examinations. After induction of general anesthesia by routine methods, the patients were randomly divided into two groups. In the bupivacaine (B) group (n = 15), patients were injected with 5 ml of 0.25% bupivacaine at each incisional area (four sites, total of 20 ml) approximately 15 minutes before skin incision. In the control (C) group (n = 13), the surgical field was injected with an equal volume of physiologic saline solution (four sites, total of 20 ml). Postsurgical wound pain at rest was evaluated by a 10-cm visual analog pain scale at 1, 10, 24, and 72 hours and 1 month after surgery. The patients were interviewed via telephone 1 month after hospital discharge for re-evaluation of resting pain. The results indicated that the incidence of postsurgical wound pain for up to 10 hours after surgery in group B was significantly lower (p < 0.05) than in group C. Pain intensity ranged from mild to moderate (2-5 cm). In addition, the mean visual analog pain scale pain intensity was significantly less for group B (0.31 +/- 0.85 cm) than for group C (2.62 +/- 2.06 cm) for up to 10 hours after surgery (p < 0.05). The number of patients who requested analgesics and complained of sleep disturbances was significantly higher in group C (p < 0.05). The mean cumulative dose of diclofenac sodium at 24 hours was significantly (p < 0.05) lower in group B (6.67 +/- 17.6 mg) than in group C (30.8 +/- 25.3 mg). Prolonged postsurgical wound pain persisting 1 month after surgery was observed in one patient in group C. It is concluded that presurgical infiltration of 0.25% bupivacaine in the surgical field is a useful method for decreasing postsurgical wound pain for up to 10 hours and analgesic consumption for up to 24 hours after laparoscopic gynecologic examination.
    Clinical Journal of Pain 03/2000; 16(1):12-7. · 2.55 Impact Factor
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    ABSTRACT: An 11-year-old girl with spondyloepiphyseal dysplasia congenita in the spine was scheduled for virectomy under general anesthesia. She had slight scoliosis in the thoracic and lumbar spine, moderate funnel chest and slight thoracic kyphosis. Preoperative laboratory data were within normal range and her intelligence was normal. Her Mallanpathi's score, however, was Grade 3 and effective mandibular length/posterior depth of mandible ratio was 3.48 on the lateral view of head X-ray. From these data, difficult intubation was expected. Although anesthesia was induced uneventfully using thiamylal and vecuronium, her vocal cord was not visualized under laryngoscope. Using cricoid pressure procedure, slightly left-shifted vocal cord was exposed. However a 26 Fr. size endotracheal tube without cuff was too large and finally a 22 Fr. tube was inserted. During the operation patient's general condition was stable and the operation was finished without any episodes. She did not have any complications in the postoperative period. In a case of SDC, pathological changes in laryngotracheal resion should be examined and evaluated preoperatively and difficult intubation should also be always taken into account.
    Masui. The Japanese journal of anesthesiology 02/2000; 49(1):62-5.
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    ABSTRACT: We investigated the effect of d-tubocurarine (d-Tc), pancuronium (PAN), vecuronium (VEC), and rocuronium (ROC) on the autonomic nervous system in cats by measuring changes in the invasive mean arterial pressure (MAP), heart rate (HR), and heart rate variability following four administrations of each drug at 2.ED95. Heart rate variability analysis was used to assess the effects of the drugs on sympathetic and parasympathetic nervous system function using low-frequency (0.04-0.22 Hz) component (LF) and high-frequency (0.22-0.60 Hz) component (HF). Comparisons of the HR, MAP, LF, HF, and LF/HF ratio before and after drug administration were made for each drug. The administration of d-Tc caused a significant decrease in MAP and a significant increase in HR accompanied by increase in LF, HF, and LF/HF ratio. The increases in the LF, HF and LF/HF ratio appeared to be related to the mean abrupt enhancement of sympathetic and parasympathetic nervous system function caused by changes in circulatory dynamics. PAN caused a significant increase in HR, and a significant decrease in the HF, which we thought were related to suppression of cardiac parasympathetic function. Neither VEC nor ROC produced a significant change in any of the parameters and were considered to have no significant effect on the autonomic nervous system.
    Masui. The Japanese journal of anesthesiology 01/2000; 48(12):1294-301.
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    ABSTRACT: We have quantified the potentiating effects of 1.7% sevoflurane (n = 12) on vecuronium-induced neuromuscular block and compared the results with those obtained during balanced anaesthesia with propofol (n = 12) or midazolam (n = 12) in 36 patients. Neuromuscular function was monitored using an accelerograph and the train-of-four responses of the adductor pollicis muscle to ulnar nerve stimulation. Vecuronium 0.1 mg kg-1 was administered as an intubating dose, and maintenance doses of 0.02 mg kg-1 were administered on three occasions when T1/T0 had recovered to 25%. Thereafter, spontaneous recovery was monitored until complete. Times to 25% recovery of T1/T0 (DUR25) after an intubating dose of vecuronium did not differ between groups (mean 44.2 (SD 18.7) min for sevoflurane, 38.3 (7.5) min for propofol and 35.5 (9.5) min for midazolam). DUR25 values after each maintenance dose were 29.8 (9.5) min, 30.3 (10.4) min and 31.6 (10.7) min during sevoflurane anaesthesia, and were significantly longer than values for propofol (21.7 (6.0) min, 21.5 (5.8) min and 21.9 (5.8) min) and midazolam (20.0 (5.9) min, 19.3 (7.7) min and 19.8 (8.0) min) (P < 0.05) in each case). Recovery index25-75% and interval from T1/T0 = 25% to T4/T1 = 0.7 after the final dose of vecuronium were significantly prolonged by sevoflurane (28.3 (13.2) min and 42.7 (16.4) min) compared with propofol (17.6 (6.1) min and 26.6 (9.8) min) or midazolam (16.3 (9.4) min and 26.0 (10.2) min) (P < 0.05 in each case).
    BJA British Journal of Anaesthesia 09/1999; 83(3):485-7. · 4.24 Impact Factor
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    ABSTRACT: During partial neuromuscular blockade indirect repetitive nerve stimulation causes fade in the response of the muscle. We studied the intensity of the fade induced by intravenous administration of three steroidal muscle relaxants, and investigated the mechanism of fade by comparing with results obtained during partial blockade with animal toxins and vesamicol. In 60 cats, we measured the fade in the compound action potentials of the gastrocnemius muscle evoked by repetitive sciatic nerve stimulation at 100 Hz during partial neuromuscular blockade with rocuronium, vecuronium, pancuronium, alpha-bungarotoxin, mu-conotoxin and vesamicol, respectively. Profound fade was induced by all three non-depolarising muscle relaxants (rocuronium=vecuronium<pancuronium) and by vesamicol, in contrast to alpha-bungarotoxin and mu-conotoxin which induced no fading. Our results suggest that non-depolarising muscle relaxant-induced fade is caused by an inhibitory effect on acetylcholine release. Pancuronium seems to have a higher potency of presynaptic inhibition of acetylcholine release than both rocuronium and vecuronium.
    Acta Anaesthesiologica Scandinavica 07/1999; 43(6):658-62. · 2.36 Impact Factor
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    ABSTRACT: Two techniques for evaluating human baroreflex sensitivity (BRS), i.e. the sequence technique and the cross-spectral technique, were compared during the following four different body positions; 6 degrees head-down tilt (HDT), supine (Sup), 60 degrees head-up tilt (HUT) and upright (Upr). The sequence technique is based on the slope of linear regression between beat-to-beat RR intervals and systolic blood pressures. The cross-spectral technique is based on the cross-spectral analysis of RR interval and systolic blood pressure variabilities, and the estimates of BRS were computed separately for the low-frequency region (0.04-0.15 Hz) and the high-frequency region (0.15-0.5 Hz). The BRS obtained by the sequence technique had a significant correlation to that obtained by the cross-spectral technique for the low-frequency region in HDT, Sup and HUT, but not in Upr. There was a significant correlation between the BRS obtained by the sequence technique and that obtained by the cross-spectral technique for the high-frequency region in every body position. It became clear that the sequence technique is mutually related to the cross-spectral technique for the high-frequency region, but not necessarily identical to the cross-spectral technique for the low-frequency region. Moreover, a comparison was also made between the baroreceptor activating sequence and the deactivating sequence in the sequence technique during the four different body positions. Although the estimates of BRS of the activating sequence and the deactivating sequence were similar in every body position, the numbers of their sequences were progressively separated in the order of HDT, Sup, HUT and Upr. The numbers of the activating sequence and the deactivating sequence in the sequence technique were found to be separated in a sympathetically dominant condition.
    Journal of the Autonomic Nervous System 03/1999; 75(2-3):164-70.
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    ABSTRACT: Neuromuscular inhibitory effects of propofol were investigated in 7 cats using muscular compound action potential (mCAP) elicited from the gastrocnemius muscle by sciatic nerve stimulation. A rectangular pulse of supramaximal strength and duration of 0.2 msec was applied serially to the sciatic nerve at 0.1 Hz during the experiments, and mCAPs obtained from the gastrocnemius muscle were recorded. After obtaining a constant mCAP amplitude, a series of 8 consecutive mCAPs (M 1-8) evoked by repetitive stimulation at 100 Hz was recorded, and M 8/M 1 amplitude ratio (M 8 amplitude/M 1 amplitude.100%) was calculated as the control value. After control variables had been obtained, initial dose of 2.5 mg.kg-1 of propofol was administered intravenously followed by continuous infusion with incremental dosages of 10, 20, 50 and 100 mg.kg-1.hr-1 of each 30 minute duration. The effects on mCAPs evoked by single and 8 consecutive repetitive stimulation were observed in each period. The depression of single mCAP amplitudes and fading responses in the M 8/M 1 amplitude ratios were not observed at any infusion rate. Our results suggest that propofol has no influence on neuromuscular transmission in cats when administered intravenously at 10 times of human clinical infusion doses.
    Masui. The Japanese journal of anesthesiology 01/1999; 47(12):1433-6.
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    ABSTRACT: Effects of isoflurane on the reflex activity of the sympathetic nervous system were investigated in 35 cats by observing alteration of the amplitudes of somato-sympathetic medullary reflex potentials. A and C-reflex potentials, which are induced from lumbar sympathetic trunk by electric stimulation of ipsilateral femoral nerve are known to arise from A-fiber group and C-fiber group, respectively. One or two percent isoflurane in oxygen was administered for 30 minutes, because it is known that I MAC of isoflurane in cats is 1.61%. The amplitude and latency of the potentials were measured during and after inhalation of the test drug, and the results were presented as percentage change from that at prior levels of inhalation as control. The results were as follows. (1) The amplitudes of A- and C-reflex potentials were suppressed dose-dependently in rats with intact brain. (2) The amplitudes of both potentials increased by decerebration at midbrain level. (3) In decerebrate cats, the amplitudes of both potentials at each inhaled concentration were suppressed to the similar levels at inhalation of 2% isoflurane in intact cats, although a slight difference between intact and decerebrated cats was observed with A-potentials during inhalation of 1% isoflurane. (4) The latencies were prolonged slightly in A-reflex potentials, only in intact cats at both concentrations. (5) Blood pressure decreased during inhalation of the test drug in every condition, but their dose-dependencies were evident only in intact cats. (6) Selective suppression of C-reflex potential by inhalation of isoflurane could not be demonstrated. These results suggest that isoflurane has a strong suppressive effect on sympathetic reflex center in medulla oblongata with was demonstrated by greater degree of suppression of the reflex responses in decerebrate cats than that in intact animals. It was concluded that the effect of isoflurane on sympathetic nervous system is similar to that of halothane.
    Masui. The Japanese journal of anesthesiology 07/1998; 47(6):678-89.
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    ABSTRACT: We investigated the post-operative delirium in elderly patients of over 65 years of age. This investigation consisted of two studies, a prospective study and a retrospective study. In the prospective study, we evaluated the incidence of post-operative delirium and the incidence of post-operative delirium was estimated pre-operatively using State-Trait Anxiety Inventory (STAI) and Mini Mental State Examination (MMSE) in 24 patients scheduled for elective surgery under general anesthesia in the period from Nov. 1995 to Oct. 1996. In the retrospective study, we selected patients with post-operative delirium from 1600 patients who had undergone scheduled and emergency operation under general anesthesia in the same period as in the prospective study and analyzed the incidence of post-operative delirium and background of these patients. Twenty four patients in the prospective study were excluded from the retrospective study. In the prospective study, although post-operative delirium was observed in 2 cases (8.3%), no specific changes were observed in anxiety state and the ability of recognition. In the retrospective study, post-operative delirium was observed in 22 cases (1.37%). In these patients, several factors such as blood transfusion, emergency operation, dehydration, thrombosis of the superior mesenteric artery, history of ischemic heart disease, brain infarction and atrial fibrillation were thought to be major risk factors triggering post-operative delirium. In this study we could not conclude that STAI or MMSE are useful to estimate the incidence of post-operative delirium preoperatively. However, our result suggests that we should be careful about the incidence of post-operative delirium in elderly patients with pre-operative risk factors as mentioned above.
    Masui. The Japanese journal of anesthesiology 04/1998; 47(3):290-9.
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    ABSTRACT: We investigated the analgesic effect of dextromethorphan (DM), a non-selective NMDA receptor antagonist, in 25 patients with postherpetic neuralgia (PHN). We administered DM 45mg.day-1 orally for 14 days and then 90mg.day-1 for next 14 days. Decrease in pain intensity and alleviation of allodynia were observed in 9 patients (36%). Side effects with no severe cases occurred in 8 patients (32%) and these were mainly digestive symptoms. We concluded that DM might be useful to treat PHN with allodynia probably due to central sensitization.
    Masui. The Japanese journal of anesthesiology 06/1996; 45(5):629-33.
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    ABSTRACT: Neuromuscular inhibitory effects of three volatile anesthetics were compared using muscular compound action potential (CAP) which was elicited from gastrocnemius muscle by sciatic nerve stimulation in cats. The amplitude of CAP evoked by 0.1 Hz single stimulation and eight repetitive stimulation (RS8) with frequencies ranged from 2 to 100 Hz were recorded as control values. After obtaining the control values, 0.5, 1, 1.5 and 2 MAC of halothane (n = 5), isoflurane (n = 7) or sevoflurane (n = 10) were administered respectively for 30 minutes and the single CAP amplitude and the responses evoked by RS8 were observed. Only after the inhalation of sevoflurane 2MAC, mean single CAP amplitude was depressed significantly to 82.6% of control. Under halothane and isoflurane anesthesia, the depression of single CAP amplitude was not observed at any concentration. Additionally, the most prominent fading responses were observed in sevoflurane-inhaled cats when the results obtained by 100Hz-RS8 were compared under 2MAC of three different anesthetic agents. Our results suggest that sevoflurane has the most potent neuromuscular inhibitory effect through both post- and presynaptic inhibitory mechanisms.
    Masui. The Japanese journal of anesthesiology 06/1996; 45(5):599-607.
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    ABSTRACT: A 6-year-old female with disturbance of consciousness (JCS: 3 points) due to hyperammonemia caused by ornithine transcarbamylase deficiency is presented. She underwent an emergency insertion of a catheter for peritoneal dialysis under general anesthesia. Anesthesia was induced by intravenous administration of thiamylal sodium and maintained with inhalation of sevoflurane and oxygen after tracheal intubation. One percent mepivacaine was infiltrated around the surgical field to diminish the dose of sevoflurane. The operation proceeded uneventfully, although her consciousness could not recover rapidly to the normal level during the emergence from anesthesia. Peritoneal dialysis was started immediately after the operation and her consciousness recovered to the normal level gradually during the following six days with decreasing plasma ammonia levels. Ten days later, extirpation of the peritoneal catheter was scheduled. The course of anesthesia and operation was uneventful using the same anesthetic method as with the former anesthesia. In the anesthetic management for a patient with ornithine transcarbamylase deficiency, we have to be careful about the nitrogen balance, which can be affected by the kind and doses of anesthetic drugs, to avoid hyperammonemia. From this point of view, local anesthesia combined with general anesthesia might be useful to prevent the serum ammonia level from increasing.
    Masui. The Japanese journal of anesthesiology 06/1996; 45(5):642-5.
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    ABSTRACT: Cowden syndrome is a rare syndrome of chromosome abnormalities presenting with polyposis of digestive tracts, characteristic skin eruption and neuromuscular disorders. A 56-year-old male patient with Cowden syndrome underwent upper abdominal surgery under general anesthesia followed by post-operative epidural analgesia with buprenorphine. Proposed total gastrectomy was not performed because of massive invasion of carcinoma in the abdominal cavity and gastrojejunostomy was done instead. The anesthesia was satisfactory with inhalation of nitrous oxide and enflurane with intravenous vecuronium. Neuromuscular monitoring with electric twitch-responses of the hand showed normal patterns throughout the anesthesia. The recovery from anesthesia and neuromuscular blockade was prompt. Intermittent epidural buprenorphine, twice a day (0.2 mg of buprenorphine in 9 ml of normal saline for one time) was started just after the recovery of anesthesia and continued for four days. Delirium occurred two days after beginning epidural buprenorphine and disappeared three days after its discontinuation. The patient died 52 days after the operation from obstructive jaundice and sepsis. The delirium, therefore, seems to have been caused by buprenorphine possibly due to its impaired metabolism by the liver. Although we did not experience any abnormal neuromuscular reactions to vecuronium or anesthetic agents, it is important to perform preoperative neuromuscular examinations and peri-operative monitoring in the anesthetic management of a patient with this syndrome.
    Masui. The Japanese journal of anesthesiology 03/1995; 44(2):282-5.

Publication Stats

152 Citations
42.95 Total Impact Points


  • 2000–2002
    • Nihon University
      • Department of Dental Anesthesiology
      Edo, Tōkyō, Japan
  • 1990–2000
    • Tokyo Medical University
      • Department of Anesthesiology
      Edo, Tōkyō, Japan