Biomedical subjects

A Isshiki

Publications and source records attributed to A Isshiki.

13 recordsLinked to original sources

PubMed1992

[Cardiovascular effects of, and catecholamine response to, high dose fentanyl or NLA in patients for valve replacement].

We measured the cardiovascular effect of, and catecholamine and other hormonal responses to, anesthetic doses of fentanyl and original NLA in 25 patients for open heart surgery. The patients were randomly divided into three groups (group N, F30, F75). During induction, in group N; droperidol 0.25 mg.kg-1 and fentanyl 5 micrograms.kg-1, in group F30; fentanyl 30 micrograms.kg-1, and in group F75; fentanyl 75 micrograms.kg-1 were administered intravenously. Additional fentanyl was administered at a rate of 100 to 200 micrograms.h-1. Droperidol 0.25 mg.kg-1 was administered in group N when cardiopulmonary bypass (CPB) was disconnected. Plasma samples were assayed for norepinephrine, epinephrine, ACTH and cortisol before and after induction, during sternotomy, 60 minutes after institution of CPB, after weaning from CPB, and before as well as after extubation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and rate pressure product (RPP) were calculated simultaneously at the blood samplings. In all groups, no remarkable change in cardiovascular dynamics was observed. CPB was associated with marked increases in catecholamines, but high dose fentanyl in dose of 75 micrograms.kg-1 was able to suppress epinephrine level more than in group N. In high dose fentanyl group (F30, F75) ACTH was within normal ranges, even during CPB. The results suggest that high dose fentanyl is a complete anesthetic in patients for cardiac surgery. But a large dose of fentanyl causes small decreases in heart rate and arterial blood pressure. Our data indicate that group F30 is an attractive anesthetic technique for patients with valvular disease.

Adrenocorticotropic Hormone↗

PubMed1991

[Changes in granulocyte elastase caused by the use of ulinastatin during anesthesia for renal transplantation].

In patients with renal failure, releases of chemical mediators having inhibitory influences on organs and circulatory system have been observed. Therefore, in long-term dialysis patients, it is necessary to consider the biocompatibilities of the equipment for dialysis. On 13 cases of renal transplantations, we measured the pre- and post-operative changes of granulocyte elastase (GE) and evaluated the effect of ulinastatin. The renal transplanted patients receiving a long-term dialysis showed higher GE values than that of normal patients even before the operation. During the anesthesia, GE increased gradually and further increased after the operation. In patients given ulinastatin during anesthesia, the increase in GE during the operation was suppressed but an increase after the operation was observed. The renal transplanted patients are easily infectible. Therefore, it is useful to measure GE pre- and post-operatively for earlier diagnosis of the postoperative infection and septicemia. The administration of ulinastatin can inhibit the increase of GE. It seems that ulinastatin increases renal blood flow and improves renal function.

Adult↗

PubMed1991

[A comparison of induced hypotensive anesthesia using trimetaphan, prostaglandin E1 and nicardipine for neurosurgery].

We performed hypotensive anesthesia using trimetaphan, prostaglandin E1, or nicardipine for eighteen patients undergoing cerebral aneurysm clipping. We measured the hemodynamic parameters (systolic arterial pressure, diastolic arterial pressure, and heart rates), concentration of catecholamines in blood (epinephrine, norepinephrine), blood platelet counts, and aggregation of blood platelets, before induction of anesthesia, before induced hypotension, during hypotension, after hypotension, and at the end of operation. Hypotension was produced rapidly, and hemodynamics was stable with any of the three drugs. In trimetaphan group, however, recovery time of arterial pressure was longer than in other two groups. There was no significant change of catecholamine during induced hypotension in prostaglandin E1 and nicardipine groups. However, in trimetaphan group, concentration of norepinephrine in blood decreased significantly during hypotension. No significant change was observed in either platelet count or platelet aggregation. These results suggest that trimetaphan has an effect to suppress excretion of stress hormones, and prostaglandin E1 and nicardipine have no influence on blood catecholamine levels and aggregation of platelet. We consider that nicardipine is useful as a hypotensive drug for neurosurgery.

Alprostadil↗

PubMed1990

[Hemodynamic changes with sufentanil-oxygen anesthesia for open heart surgery--a comparison of patients with beta-blocking medication or without it].

We investigated hemodynamic changes in patients undergoing coronary artery bypass grafting (CABG) and valve replacement. The former had been medicated with beta-blocking agent until the morning of operative day. On the other hand, the latter received no medication. We measured systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate, and rate pressure product (RPP) at the following five points; before induction of anesthesia, immediately before intubation, immediately after intubation, one minute after skin incision and one minute after sternotomy. In both groups, SAP and DAP decreased significantly after induction; heart rate did not change during our study; and RPP decreased significantly after skin incision. There were no significant differences between the group with beta-blocking agent and the group without it. These results suggest that beta-blocking agents exert no influence in our study, and sufentanil-oxygen anesthesia produce hemodynamic stability for open heart surgery.

Adrenergic beta-Antagonists↗

PubMed1990

[Use of vecuronium bromide for anesthesia for renal transplantation].

We used vecuronium on 7 patients for renal transplants and recorded the muscle relaxant effect using an Anesthesia and Brain Monitor; we also compared them with patients with normal renal function. Results show that there were no significant differences between renal transplant patients and patients with normal renal functions in regard to the time of appearance of effect, duration of effect and recovery rate but the effect was somewhat prolonged in the renal transplant patients. Therefore, although vecuronium is said to be a muscle relaxant with little renal dependency, and it is used on renal transplant patients with renal insufficiency, the possibility of a prolonged effect must be considered. It is important to monitor continuously by a muscle relaxant monitor, grasp adequately the conditions of muscle relaxation, and observe carefully the postoperative respiratory conditions.

Adult↗

PubMed1990

[Comparison of sufentanil and fentanyl anesthesia for coronary artery bypass grafting--changes in stress hormones].

We compared the changes in hemodynamics and stress hormones in 30 patients who received for CABG operation either sufentanil-oxygen or fentanyl-oxygen anesthesia. The mean doses of fentanyl and sufentanil for intubation were 1.66 +/- 0.69 mg and 0.35 +/- 0.14 mg respectively and mean total doses were 6.91 +/- 1.14 mg and 1.68 +/- 0.38 mg, or 21.4 micrograms.kg-1.hr-1 and 4.5 micrograms.kg-1.hr-1 respectively. SAP decreased significantly immediately before intubation in both groups. Immediately after intubation, a significant intergroup difference (P less than 0.05) was noted. The changes in DAP and MAP were almost similar to those of SAP. This study demonstrates that sufentanil-oxygen anesthesia gave more stable hemodynamic parameters before and after intubation. Especially no significant changes in heart rate occurred immediately after intubation and with CABG operation, thus preventing the increase in rate pressure product during procedure. Sufentanil anesthesia did attenuate more effectively the stress hormones release than high dose fentanyl anesthesia, but neither sufentanil nor fentanyl anesthesia could prevent the increases in these hormones postoperatively.

Aged↗

PubMed1989

[Hemodynamic changes before and after anesthesia for renal transplantation].

Renal transplantation has come into use as a treatment for renal insufficiency, but infusion management before and after anesthesia for this operation is important. In order to prevent acute necrosis of the uriniferous tubules and to obtain urine outflow in early postoperative stage, a recent practice has been to give rapid infusions of large amounts of fluid, starting during the anastomosis of the renal vessels. We gave a large amount of intraoperative fluid to six patients undergoing transplantation of cadaver kidneys. A Swan-Ganz catheter was inserted into the pulmonary artery and infusion management was performed so as to maintain the pulmonary arterial pressure above 15 mmHg and the pulmonary capillary wedge pressure above 10 mmHg. The cardiac output increased as a result, and no pulmonary edema was seen. We believe that our method of infusion management using a Swan-Ganz catheter is a useful technique in such cases.

Adult↗

PubMed1989

[Changes in catecholamine and immunoglobulin during anesthesia for cardiac surgery--a comparison of valve replacement and aorto-coronary bypass surgery].

During a period of extracorporeal circulation, which represents a massive invasion for the body, the patient is in a state of controlled shock. In this study, we examined changes in catecholamines and immunoglobulins in patients grouped according to whether they underwent valve replacement or aorto-coronary bypass surgery. Anesthesia was induced with fentanyl, and cardiopulmonary bypass in all patients was carried out using a bubble-type heart-lung machine. The epinephrine and norepinephrine levels increased during the procedures, but those patients having aorto-coronary bypass surgery showed milder rises than valve replacement patients. IgA, IgG and IgM all dropped as well, but the change in IgG was the greatest, and the decreases were more marked in valve replacement patients than in aorto-coronary bypass patients. It was concluded that, since reactions were different according to the disorder present and were reflected in the variations in catecholamine and immunoglobulin levels, great care is necessary when the patient is removed from the heart-lung machine.

Anesthesia↗

PubMed1987