Biomedical subjects

Akihiko Nonaka

Publications and source records attributed to Akihiko Nonaka.

11 recordsLinked to original sources

PubMed2006

[Efficacy of subcutaneous patient-controlled analgesia using pentazocine for major abdominal surgery in elderly patients].

BACKGROUND: Subcutaneous patient-controlled analgesia (PCA) may be an alternative method for pain control in patients without an epidural catheter. The authors evaluated the efficacy and safety of subcutaneous PCA using pentazocine for postoperative analgesia after major abdominal surgery. METHODS: Sixty-three patients scheduled for major abdominal surgery were analyzed retrospectively. Patients were classified into three groups by age; under 65 years of age (Group 1, n = 23) ; 65-75 years (Group 2, n = 30); over 75 years (Group 3, n = 10). Anesthesia was induced with propofol and was maintained with isoflurane-nitrous oxide inhalation. All patients received 30-45 mg of pentazocine before incision. At the end of surgery, subcutaneous pentazocine PCA was begun at a rate of 0.5 ml x hr(-1). Given regimen was pentazocine 240-390 mg and droperidol 5 mg with 1% lidocaine, and the total amount of dose was 40 ml. Postoperative pain control was assessed using a 5 rating verbal pain score (VPS) and a visual analog pain scale (VAS). RESULTS: Subcutaneous PCA of pentazocine provided adequate analgesia over 70% of the patients studied. There were no differences between the three groups regarding VPS and VAS. There are no severe complications. CONCLUSIONS: Subcutaneous PCA of pentazocine is a simple, safe, and effective method to control postoperative pain after major abdominal surgery. Effectiveness of subcutaneous PCA of pentazocine did not depend on age of patients.

Abdomen↗

PubMed2006

[Comparison of pentazocine and fentanyl in total intravenous anesthesia using propofol].

BACKGROUND: Pentazocine may be an alternative for fentanyl during total intravenous anesthesia (TIVA) using propofol. The authors compared the efficacy and safety of pentazocine for analgesics in TIVA using propofol. METHODS: Eighty-nine patients scheduled for mastectomy were analyzed retrospectively. Patients were classified into two groups by used analgesics; pentazocine (Group P, n = 34) and fentanyl (Group F, n = 55). Anesthesia was induced with propofol, using target controlled infusion method, and ketamine 20-50 mg, and was maintained with propofol infusion and increments of fentanyl or single dose of pentazocine with 40% oxygen in air. Postoperative pain was assessed using a visual analogue pain scale (VAS). RESULTS: There were no differences in the patient background between both groups. Systolic as well as diastolic blood pressure and heart rate were not different between both groups during surgery. The maintenance dose of propofol was not different between the two groups. Awakening time in about 80% of patients was within 15 minutes and is not different between the two groups. There were no differences between the two groups regarding VAS. There are no severe complications. Incidence of nausea and vomiting was not different between the two groups. CONCLUSIONS: The results suggest that pentazocine would provide a stable hemodynamic state, rapid recovery and an effective postoperative pain relief to the same degree as with fentanyl in TIVA with propofol.

Adult↗

PubMed2005

[Anesthetic management by total intravenous anesthesia with propofol, pentazocine and ketamine].

BACKGROUND: The authors evaluated the efficacy of anesthetic management by total intravenous anesthesia with propofol, pentazocine and ketamine. METHODS: Thirty-five patients for mastectomy were anesthetized by propofol, pentazocine and ketamine. Patients were divided into two groups by age; one is patients under 61 years of age and the others are patients above 61 years. Analysis was made retrospectively. Anesthesia was induced with propofol and ketamine and was maintained with propofol infusion and intermittent administration of vecuronium with 40% oxygen in air. Pentazocine was administrated as a bolus dose before incision. RESULTS: There were no differences in the patient background except age and height between the two groups. After induction of anesthesia, systolic and diastolic blood pressures decreased compared with those before induction in both groups. Systolic and diastolic blood pressures and heart rate increased after tracheal intubation, but the hemodynamics remained stable after the start of surgery. The induction and maintenance doses of propofol were not different between the two groups. Patients above 61 years had smaller dosage of pentazocine compared with those in patients under 61 years. The dosage of ketamine was not different between two groups. Awakening time in about 80% of patients was within 15 minutes and is not different between the two groups. Postoperative pain relief was good in both groups. Incidence of nausea and vomiting was 25% and was not the different between the two groups. CONCLUSIONS: Total intravenous anesthesia with propofol, pentazocine and ketamine would be useful to stabilize hemodynamic state, to obtain rapid recovery and to provide effective postoperative pain relief.

Adult↗

PubMed2005

[Efficacy of continuous subcutaneous pentazocine infusion for the postoperative analgesia in lower abdominal surgery].

BACKGROUND: Continuous subcutaneous infusion (CSI) of analgesics may be an alternative for pain control in patients without an epidural catheter. The aim of this study was to investigate the efficacy of CSI using pentazocine in lower abdominal surgery with inhalation anesthesia or with total intravenous anesthesia. METHODS: One hundred forty-seven patients scheduled for gynecological abdominal surgery were analyzed retrospectively. Anesthesia was induced with propofol and was maintained with propofol infusion or isoflurane-nitrous oxide inhalation. All patients received 30-75 mg of pentazocine before incision. At the end of surgery, CSI of pentazocine was begun at a rate of 0.5 ml x hr(-1) x Given regimen was pentazocine 240-390 mg and droperidol 5 mg with 1% lidocaine, and the total amount of dose was 40 ml. RESULTS: Over 80% of patients were assessed to have effective pain relief and minimum side effects. Patients were classified into two groups by anesthetics during anesthesia; propofol, pentazocine, ketamine group (PPK group, n = 61); nitrous oxide, isoflurane, pentazocine group (GOI group, n=88). There were no differences between the two groups regarding postoperative pain relief, while total dose of pentazocine used during anesthesia were lower in GOI group than PPK group. CONCLUSIONS: In patients undergoing lower abdominal surgery, CSI of pentazocine provided effective postoperative pain relief and effectiveness did not depend on anesthetics during anesthesia.

Abdomen↗

PubMed2005

[Effect of esmolol on cardiovascular responses induced by scopolamine butylbromide].

BACKGROUND: Scopolamine butylbromide (hyoscine-N-butylbromide, HB) is an anticholinergic drug used as a smooth muscle relaxant, and is used even in some surgical procedures during general anesthesia. HB also causes an increase in heart rate as a side effect. The authors evaluated the efficacy of esmolol on hemodynamic changes induced by HB in major abdominal surgery under inhalation anesthesia. METHODS: Seventeen patients for major abdominal surgery were randomly assigned to control group (C group, n = 9) or to esmolol group (E group, n = 8). Anesthesia was induced with propofol and was maintained with isoflurane-nitrous oxide inhalation and intermittent administration of fentanyl and vecuronium. At the time of bowel anastomosis, 20 mg of HB was administrated as an antispasmodic. In E group, esmolol 0.6 mg x kg(-1) was administered immediately after HB administration. RESULTS: There were no differences in the patient background between the two groups. At 1 to 10 minutes after HB administration, heart rate increased significantly compared with that at pre-administration in C group, while there was no significant change in heart rate in E group. Heart rate in E group was significantly lower than that in C group at 2 and 3 minutes after HB administration. Blood pressure was not significantly changed in both groups during the observation period. CONCLUSIONS: The simultaneous administration of HB and esmolol was useful for heart rate control after HB administration.

Adrenergic beta-Antagonists↗

PubMed2004

[Successful control of rapid heart rate with atrial flutter by intravenous administration of esmolol in a patient after total correction of the tetralogy of Fallot].

A 30-year-old woman with atrial flutter after surgical correction of tetralogy of Fallot, underwent gynecological procedure under general anesthesia. Because she had been noted to have atrial flutter and heart failure at 8 weeks' gestation, she was scheduled for dilatation and curettage. Chest X-ray film showed cardiomegaly and pulmonary congestive changes. ECG showed atrial flutter with 3:2 atrio-ventricular conduction rate and complete right branch block. She was anesthetized with propofol infused with target-controlled infusion system, fentanyl and 66% of nitrous oxide under close monitoring and appropriate respiratory management. The quantity of hemorrhage was about 850 ml, and hypovolemia was treated with volume infusion and the use of vasoactive drugs. Soon after emergence from anesthesia, atrial flutter with 1:1 A-V conduction (> 230 bpm) occurred suddenly. Esmolol hydrochloride, 30 mg, was administered. Despite the relatively low doses, rapid control of heart rate was possible in a few minutes and the atrial flutter returned to 2:1 conduction. Although atrial flutter had continued until the discharge, tachyarrhythmia was no longer observed and the heart resumed sinus rhythm 3 month after the operation. The present case suggests that esmolol can be used effectively and safely for controling atrial flutter with rapid ventricular response in a patient after surgical correction of tetralogy of Fallot.

Adrenergic beta-Antagonists↗

PubMed2004

[Intermittent complete left bundle branch block during general anesthesia].

We report a case of intermittent complete left bundle branch block (CLBBB) which occurred during general anesthesia. An 83-year-old female was scheduled for upper lobectomy of the right lung under general anesthesia. Her preoperative 12-lead ECG showed atrial fibrillation and ST-depression in V4-6. Anesthesia was induced with propofol and pentazocine, and maintained with 0.5-1.5% isoflurane, 0-50% nitrous oxide in oxygen under close monitoring and appropriate respiratory management. The operation was performed uneventfully. Several minutes after the end of surgery, on converting her into the supine position from the left lateral decubitus position, widened QRS complexes, later diagnosed as CLBBB, appeared on ECG. At that time, heart rate was 92 beats x min(-1). After the administration of esmolol hydrochloride, heart rate decreased rapidly in a few minutes and ECG returned to normal conduction from CLBBB. We diagnosed this as rate-dependent intermittent CLBBB. Although intermittent CLBBB continued until the next day, the patient was asymptomatic and cardiac enzymes were within normal ranges. The intermittent CLBBB, which occasionally occurs during anesthesia, makes the diagnosis of myocardial ischemia and acute myocardial infarction difficult. The present case suggests that esmolol can be used effectively and safely to distinguish CLBBB as a benign disorder from myocardial ischemia in a patient with CLBBB.

Adrenergic beta-Antagonists↗

PubMed2003

[Anesthetic management in a patient complicated with left coronary artery-left ventricular fistulae].

We have experienced anesthetic management for posterior lumbar interbody fusion in a 76-year-old female with left coronary artery-left ventricular fistulae. She was admitted to our hospital because of chest pain and was found to have left coronary artery-left ventricular fistulae 6 months before this operation. The electrocardiogram at rest showed T-wave inversions in leads V3-V6. Selective coronary angiography showed the contrast medium streaming into the left ventricle via a maze of fine vessels from the distal left anterior descending coronary artery. Cardiac catheterization revealed left ventricular end-diastolic pressure of 30 mmHg and mean pulmonary capillary wedge pressure of 16 mmHg. Anesthesia was induced with intravenous propofol 60 mmHg, fentanyl 0.1 mg and vecuronium 6 mg, and maintained with 50% nitrous oxide and isoflurane (0.5-1.5%) in oxygen with meticulous intravenous administration of fentanyl. Cardiac function was evaluated with Swan-Ganz catheter during anesthesia. Dopamine and prostaglandin E1 ware continuously infused intravenously to decrease high afterload and maintain cardiac output. The operative and post-operative courses were uneventful. Coronary artery-left ventricular fistulae are extremely rare and can cause myocardial ischemia from coronary steal. A careful management with meticulous anesthetic care is emphasized for patients with coronary artery-left ventricular fistulae.

Aged↗

PubMed2002

[Pre-treatment with ketamine reduces incidence and severity of pain on propofol injection].

The purpose of this study was to evaluate the effect of pre-treatment with ketamine on the reduction of pain during injection of propofol in adult patients. We conducted a prospective, randomized, double-blinded trial. Forty-three patients were randomly allocated to one of two groups according to the agents administered before hand; Group C, normal saline 2 ml and Group K, 1% ketamine 2 ml. The pain on injection was rated as none, mild, moderate, or severe. Sixty-eight percent of patients in the C group experienced pain, while 33% of patients experienced pain in the K group. Thirty-six percent of patients in the C group complained moderate to severe pain but only 9% of patients in the K group. The mechanisms of prevention by ketamine of the pain on propofol-injection could not be clarified from our study, but it may be related to central effects of ketamine. In conclusion, ketamine pre-treatment before propofol administration significantly reduces incidence and severity of pain associated with propofol injection.

Adult↗

PubMed2002

[Pretreatment with lidocaine accelerates onset of vecuronium-induced neuromuscular blockade].

The purpose of this study was to investigate the effect of pre-treatment with lidocaine on the onset of vecuronium-induced neuromuscular block in a randomized, double-blinded trial. Thirty-one patients were randomly allocated to one of two groups according to the agents administrated 3 min prior to vecuronium injection; Group C, normal saline 0.75 ml.kg-1 and Group L, 2% lidocaine 1.5 mg.kg-1. Anesthesia was induced with propofol 1.5 mg.kg-1 followed by continuous infusion at 8 mg.kg-1.hr-1. Neuromuscular blockade was evaluated with accelerometry, which measured a train-of-four (TOF) pattern of abductor policies muscle. The disappearance of the first response in TOF was regarded as onset of neuromuscular block. Changes in systolic and diastolic arterial pressure (SBP, DBP) and heart rate (HR) were measured before and after tracheal intubation. Times to onset of neuromuscular blockade induced by vecuronium in Group L and Group C were 115 +/- 20 sec and 174 +/- 45 sec, respectively. After tracheal intubation, SBP, DBP and HR in both groups increased compared with those before tracheal intubation, but the changes were not significant. Changes in SBP, DBP and HR did not differ between Group L and Group C. The mechanisms by which lidocaine reduced the time to onset of neuromuscular block caused by vecuronium could not be clarified from our study, but this may be related to pre- and post-junctional effects of lidocaine at neuromuscular junction. In conclusion, administration of lidocaine prior to tracheal intubation reduces the time to onset of neuromuscular block caused by vecuronium, but does not attenuate changes in blood pressure and heart rate caused by tracheal intubation.

Adolescent↗

PubMed2002

[Compartment syndrome in a young male caused by acute alcoholic rhabdomyolysis].

We report a case of young male who developed compartment syndrome of his left leg caused by rhabdomyolysis following a heavy binge of alcohol. The laboratory data on his admission revealed extremely elevated serum levels of CPK (108,021 IU.l-1). The serum levels of potassium and creatinine were within normal ranges. He also had myoglobinuria. He required fasciotomy after admission. Diuretics and a large volume of fluids were given to prevent the renal failure. His postoperative course was uneventful. The direct toxic effects of alcohol and the prolonged ischemia of his lower leg induced by acute alcoholic intoxication, are thought to have played a major role in the triggering of the acute rhabdomyolysis. Acute alcoholic rhabdomyolysis should be considered in any intoxicated patient who presents muscle tenderness and weakness. The early recognition and prompt treatment are essential to prevent serious complications.

Adult↗