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Biomedical subjects

H Toyooka

Publications and source records attributed to H Toyooka.

At least 19 recordsLinked to original sources
PubMed1998

Thoracic epidural block attenuates cardiovascular response to apnea in rabbits.

PURPOSE: Apnea is one of the potential complications during anaesthesia. If sympathetic nerve activity is blocked by epidural anaesthesia, circulatory responses to apnea might change. Our objective was to assess the potential modifying effects of epidural anaesthesia on the cardiovascular responses to apnea in the animals. METHODS: Twenty rabbits anaesthetised with pentobarbital (25 mg.kg-1 i.v., 8 mg.kg-1.hr-1) and pacuronium bromide (0.2 mg.kg-1.hr-1 i.v.) were randomly assigned to one of two groups: control (n = 10) and epidural (n = 10). In the control group, 0.6 ml saline, and in the epidural group, 0.6 ml lidocaine 1% was injected into the epidural space respectively. After mechanical ventilation with FIO2 0.4, apnea was induced by disconnecting the anaesthetic circuit from the endotracheal tube, and mean arterial pressure (MAP), heart rate (HR), and time to cardiac arrest were measured. RESULTS: Before apnea MAP was lower in the epidural than in the control group (73 +/- 10 vs 91 +/- 10 mmHg, P < 0.05). Heart rate was not different between groups (264 +/- 36 vs 266 +/- 24 bpm). Mean arterial pressure increased in the control group after apnea, but not in the epidural group. The time to cardiac arrest was less in the epidural group than in the control group (420 +/- 67 vs 520 +/- 61 sec, P < 0.05). Heart rate decreased markedly after apnea in the control group whereas it decreased gradually in the epidural group. CONCLUSION: Thoracic epidural anaesthesia attenuated cardiovascular response to apnea and reduced the time to cardiac arrest.

Anesthesia, Epidural↗
PubMed1998

Calcium channel blockers attenuate cardiovascular responses to tracheal extubation in hypertensive patients.

PURPOSE: Hypertensive patients exhibit exaggerated cardiovascular responses to tracheal extubation. This study was undertaken to examine the inhibitory effects of calcium channel blockers, nicardipine and diltiazem, on haemodynamic changes after tracheal extubation. METHODS: Sixty hypertensive patients (ASA physical status II) undergoing elective orthopaedic (upper and lower extremity) surgery received, in a randomized, double-blind manner, 30 micrograms.kg-1 nicardipine, 0.2 mg.kg-1 diltiazem or saline (as a control) (n = 20 of each) i.v. before tracheal extubation. Changes in heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) were measured before and after tracheal extubation. RESULTS: The HR, MAP and RPP increased after tracheal extubation in the control group (P < 0.05). The increases in these haemodynamic variables were attenuated with nicardipine or diltiazem. The inhibitory effects of diltiazem on these cardiovascular responses to tracheal extubation were greater than those of nicardipine (HR; 86 +/- 7 vs 101 +/- 10, RPP; 11,437 +/- 1,575 vs 14,675 +/- 2,874, mean +/- SD, P < 0.05). CONCLUSION: Compared with nicardipine, administration of diltiazem produced greater attenuating the circulatory responses to tracheal extubation in hypertensive patients.

Adult↗
PubMed1998

Prophylactic antiemetic therapy with granisetron-droperidol combination in patients undergoing laparoscopic cholecystectomy.

PURPOSE: A relatively high incidence of postoperative nausea and vomiting (PONV) occurs in patients undergoing laparoscopic cholecystectomy. This study was undertaken to compare the efficacy of granisetron-droperidol combination with each drug alone for the prevention of PONV after laparoscopic cholecystectomy. METHODS: In a randomized, double-blind manner, 150 female inpatients received 3 mg granisetron (Group G), 1.25 mg droperidol (Group D) or 3 mg granisetron plus 1.25 mg droperidol (Group GD)(n = 50 for each) i.v. immediately before the induction of anaesthesia. The same standard general anaesthetic technique, which consisted of isoflurane and nitrous oxide in oxygen, was used. Nausea, vomiting and safety assessments were performed continuously during the first 24 hr after anaesthesia. RESULTS: Complete response, defined as no PONV and no administration of rescue antiemetic medication, was 86% in Group G, 64% in Group D and 98% in Group GD (P = 0.03 vs Group G, P = 0.001 vs Group D). No clinically adverse events were observed in any group. CONCLUSION: Granisetron-droperidol combination is more effective than each antiemetic alone in the prevention of PONV after laparoscopic cholecystectomy.

Adult↗
PubMed1998

Prevention of PONV with granisetron, droperidol or metoclopramide in patients with postoperative emesis.

PURPOSE: A high incidence of postoperative nausea and vomiting (PONV) has been noted in patients with a history of postoperative emesis. This study was undertaken to compare the efficacy of granisetron, droperidol and metoclopramide, in the prevention of PONV in such patients undergoing general anaesthesia for major gynaecological surgery. METHODS: In a randomised, double-blind study, 90 female patients received 2.5 mg granisetron, 1.25 mg droperidol or 10 mg metoclopramide (n = 30 of each) i.v. immediately before induction of anaesthesia. The same standard general anaesthetic technique, which consisted of isoflurane in nitrous oxide and oxygen, was used. Nausea, vomiting and safety assessments were performed continuously during the first 24 hr after anaesthesia. RESULTS: The incidence of PONV was 20% with granisetron, 57% with droperidol and 60% with metoclopramide (P < 0.05; overall Fisher's exact probability test). No clinically adverse events were observed in any group. CONCLUSION: Granisetron is more effective than droperidol or metoclopramide in preventing PONV in female patients with a history of postoperative emesis.

Adult↗
PubMed1998

Cardiovascular responses to tracheal extubation or LMA removal in children.

PURPOSE: This study was designed to investigate the cardiovascular effects related to tracheal extubation or laryngeal mask airway (LMA) removal in children. METHODS: Sixty children, ASA physical status 1, 4-10 yr of age, undergoing minor elective surgery (inguinal hernia and phimosis) were allocated randomly to have their surgery performed with endotracheal intubation (Group ET, n = 30) or LMA (Group LMA, n = 30) and were studied for cardiovascular responses related to extubation or LMA removal. Changes in heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before and 1, 2, 3, 5, and 10 min after tracheal extubation or LMA removal when the patients were awake. RESULTS: The maximal changes in HR, SBP and DBP were less in Group LMA than in Group ET during the observation period (HR; 12 vs 26, SBP; 14 vs 28, DBP; 9 vs 13, median, P < 0.05). CONCLUSION: Laryngeal mask airway removal elicited less haemodynamic change than tracheal extubation in paediatric patients.

Blood Pressure↗
PubMed1998

Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children.

The current study was designed to determine the anaesthetic induction time required for tracheal intubation (TimeEI) with equipotent inspired concentrations of 5% sevoflurane and 2.5% halothane in oxygen. TimeEI that prevents 50% and 95% of patients from coughing and gross purposeful muscular movements after intubation was defined as TimeEI50 and TimeEI95, respectively. Thirty-six patients aged 1-7 years were enrolled in the study. Anaesthesia was induced via mask and when TimeEI attained a predetermined value, intubation was performed using an uncuffed tube. Each TimeEI at which tracheal intubation was attempted was predetermined according to the up-and-down method. When intubation was accomplished without gross purposeful muscular movements, it was considered a smooth intubation. Determination with this method revealed that TimeEI50 and TimeEI95 for the sevoflurane/halothane groups were 147/214 s and 194/255 s, respectively. In conclusion, it is possible to determine TimeEI using an inspired sevoflurane concentration of 5% and halothane 2.5% in oxygen. The technique with 5% sevoflurane seems more practical for paediatric anaesthesia induction in busy clinical situations.

Anesthetics, Inhalation↗
PubMed1998

Efficacy of thoracic epidural analgesia following laparoscopic cholecystectomy.

This study was undertaken to determine whether epidural analgesia has any benefit for post-operative pain relief in patients undergoing laparoscopic cholecystectomy. Patients were randomly assigned to receive post-operative epidural analgesia with a morphine-bupivacaine combination (Group A, n = 22) or placebo (saline) (Group B, n = 22). The same standard general anaesthetic technique, which consists of nitrous oxide and isoflurane in oxygen was used. Analgesia was assessed using visual analogue pain scores (0-10 cm). The evaluation was carried out 24 and 48 h post-operatively. At 24 h after anaesthesia, pain scores in Group A (2.3 +/- 1.2) were lower than those in Group B (4.4 +/- 1.5) (P < 0.05). However, at 48 h post-operatively, no difference in scores was observed between the two groups. In conclusion, epidural analgesia with a morphine-bupivacaine combination improves pain relief during the first 24 h following laparoscopic cholecystectomy.

Adult↗
PubMed1998

Comparison of granisetron and droperidol in the prevention of vomiting after strabismus surgery or tonsillectomy in children.

This prospective, randomized, double-blinded study evaluated the antiemetic efficacy of granisetron and droperidol in 80 ASA physical status I children, aged 4-10 years, undergoing strabismus surgery or tonsillectomy with or without adenoidectomy. After anaesthetic induction, the patients received either granisetron (40 micrograms.kg-1, n = 40) or droperidol (50 micrograms.kg-1, n = 40) intravenously. The incidence of vomiting during the first 24h after anaesthesia was 15% and 38% after administering granisetron and droperidol, respectively (P = 0.02). The requirement for rescue antiemetic therapy for the treatment of two or more episodes of vomiting was 0% with granisetron and 18% with droperidol (P = 0.001). In conclusion, granisetron was superior to droperidol in reducing the incidence and frequency of postoperative vomiting in paediatric patients.

Adenoidectomy↗
PubMed1998

Prevention of postoperative nausea and vomiting in female patients during menstruation: comparison of droperidol, metoclopramide and granisetron.

The incidence of postoperative nausea and vomiting (PONV) is high in women during menstruation. We have compared the efficacy of droperidol, metoclopramide and granisetron in the prevention of PONV in female patients during menstruation undergoing major gynaecological surgery. In a randomized, double-blind study, 120 patients received droperidol 25 micrograms kg-1, metoclopramide 0.2 mg kg-1 or granisetron 40 micrograms kg-1 (n = 40 in each group) i.v. immediately before induction of anaesthesia. A standard general anaesthetic technique and postoperative analgesia were used throughout. There was a complete response, defined as no PONV and no administration of rescue medication, during the 24-h observation period in 45% of patients in the droperidol group, 38% in the metoclopramide group and 70% in the granisetron group (P = 0.021 vs droperidol, P = 0.003 vs metoclopramide). There was no difference in the incidence of adverse events between groups. We conclude that the prophylactic antiemetic efficacy of granisetron was superior to that of droperidol or metoclopramide for prevention of PONV in women during menstruation.

Adult↗
PubMed1998

Prevention of postoperative nausea and vomiting with a combination of granisetron and droperidol.

UNLABELLED: In this randomized, double-blind study, we compared the efficacy and safety of granisetron plus droperidol with each antiemetic alone for preventing postoperative nausea and vomiting (PONV) in 150 female patients scheduled for elective major gynecological surgery. Patients were randomly assigned to receive i.v. either granisetron 2.5 mg (Group G), droperidol 1.25 mg (Group D), or granisetron 2.5 mg plus droperidol 1.25 mg (Group GD) immediately before the induction of anesthesia (n = 50 in each group). A standard anesthetic technique and postoperative analgesia were used. Complete response, defined as no PONV and no administration of rescue antiemetic medication during the first 24 h after anesthesia, was 84% in Group G, 54% in Group D, and 96% in Group GD (P = 0.046 versus Group G, P = 0.001 versus Group D). No clinically important adverse effects were observed in any group. In conclusion, the combination of granisetron and droperidol is more effective than each antiemetic alone for complete response in patients undergoing general anesthesia for major gynecological surgery. IMPLICATIONS: We compared the efficacy of granisetron plus droperidol with each antiemetic alone for the prevention of nausea and vomiting after gynecological surgery. The granisetron/droperidol combination was the most effective against these emetic symptoms.

Adult↗
PubMed1998

Granisetron prevents nausea and vomiting during spinal anaesthesia for caesarean section.

BACKGROUND: Nausea and vomiting during spinal anaesthesia for caesarean section are common and unpleasant complications. This study was undertaken to evaluate the efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for prophylactic treatment of nausea and vomiting in parturients undergoing nonemergent caesarean section under spinal anaesthesia. METHODS: In a randomized, double-blind, placebo-controlled trial, 100 patients, 21-38 years, received either placebo (saline) or granisetron at 3 different doses (20 micrograms.kg-1, 40 micrograms.kg-1 or 80 micrograms.kg-1) (n = 25 for each) intravenously immediately after clamping of the foetal umbilical cord. Nausea, vomiting and safety assessments were performed during spinal anaesthesia for caesarean section. RESULTS: The treatment groups were similar with regard to maternal characteristics and operative management. The incidence of nausea and vomiting was 64%, 52%, 14% and 12% after administration of placebo and granisetron in a dose of 20 micrograms.kg-1, 40 micrograms.kg-1 and 80 micrograms.kg-1, respectively (P < 0.05; overall Fisher's exact probability test). No clinically important adverse effects were observed in any group. CONCLUSION: Prophylactic use of granisetron in a minimum dose of 40 micrograms.kg-1 is effective for preventing nausea and vomiting during spinal anaesthesia for caesarean section.

Adult↗
PubMed1998

Prevention of nausea and vomiting in female patients undergoing breast surgery: a comparison with granisetron, droperidol, metoclopramide and placebo.

BACKGROUND: Breast surgery is associated with a relatively high incidence of postoperative nausea and vomiting (PONV). This study was undertaken to evaluate the efficacy of granisetron, droperidol and metoclopramide for preventing PONV after breast surgery. METHODS: In a randomized, double-blind, placebo-controlled trial, 120 female patients received granisetron 40 micrograms.kg-1, droperidol 1.25 mg, metoclopramide 10 mg or placebo (saline) (n = 30 for each) intravenously immediately before the induction of anaesthesia. A standard general anaesthetic technique was employed throughout. Postoperatively, during the first 24 h after anaesthesia, the incidence of PONV and adverse events was recorded. RESULTS: The incidence of PONV was 17% with granisetron, 37% with droperidol, 43% with metoclopramide and 50% with placebo (P < 0.05; overall Fisher's exact probability test). The incidence of adverse events was not different among the groups. CONCLUSION: Granisetron is highly effective for reducing the incidence of PONV in female patients undergoing breast surgery. Droperidol and metoclopramide are ineffective in this population.

Adult↗
PubMed1998

Detrimental effect of a non-selective nitric oxide synthase inhibitor on the energy state of the liver following acute endotoxemia in rabbits.

BACKGROUND: The effect of nitric oxide synthase (NOS) inhibitors in septic shock is very controversial. It is known that the administration of NOS inhibitors to normal subjects itself increases pulmonary vascular resistance with a concomitant decrease of cardiac output. Therefore, the hypothesis was tested that the detrimental effects of a non-selective NOS inhibitor on liver energetics in a rodent model of endotoxemia are mediated by the adverse pulmonary circulatory effect of the drug itself. METHODS: Twenty anesthetized rabbits were instrumented and two separate experiments (a magnetic resonance spectroscopic study and a hemodynamic study) were performed under similar conditions. Animals were assigned randomly to either a control group (group 1; animals received lipopolysaccharide (LPS) at a dose of 400 microg/kg alone) or a treatment group (group 2; animals received NG-nitro-L-arginine methyl ester (L-NAME) at a dose of 7.5 mg/kg, 75 min after administration of LPS). RESULTS: In group 1, slight decreases in hepatic adenosine triphosphate (ATP) value were observed. In group 2, the decreases in ATP values were more prominent than those observed in group 1. LPS produced an acute drop in mean arterial pressure (MAP) with a concomitant increase in pulmonary vascular resistance (PVR) and a reduction in the cardiac output (CO) at 30 min after LPS. The administration of L-NAME caused a transient increase in MAP with a concomitant increase in systemic vascular resistance at 2 h after LPS. However, these changes in PVR and CO were more prominent than in group 1. CONCLUSION: These results suggest that alterations within the pulmonary circulation may be a contributing factor which was responsible for the non-selective NOS inhibitor-induced acute hepatic energy derangement after LPS.

Acute Disease↗
PubMed1998

Preoperative oral granisetron prevents postoperative nausea and vomiting.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a commonly observed adverse effect of anaesthesia. This study was designed to evaluate the efficacy of granisetron administered orally for preventing PONV in female patients undergoing major gynaecological surgery. METHODS: In a prospective, randomized, placebo-controlled, double-blind study, 120 patients received orally either placebo or granisetron (1 mg, 2 mg or 4 mg) (n = 30 for each) 1 h before surgery. The same standard general plus regional anaesthetic technique was employed throughout. Postoperatively, during the first 24 h after anaesthesia, the incidence of PONV and adverse events was recorded by nursing staff. RESULTS: The incidence of PONV was 47% with placebo, 37% with granisetron 1 mg, 10% with granisetron 2 mg and 10% with granisetron 4 mg (P < 0.05; overall Fisher's exact probability test). No difference in the incidence of adverse events was observed among the groups. CONCLUSION: Preoperative oral granisetron in a minimum dose of 2 mg is effective for preventing PONV after major gynaecological surgery.

Administration, Oral↗
PubMed1998

Anti-emetic efficacy of prophylactic granisetron, droperidol and metoclopramide in the prevention of nausea and vomiting after laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled trial.

This study evaluates the prophylactic anti-emetic efficacy of granisetron, droperidol and metoclopramide, for the prevention of post-operative nausea and vomiting in female patients undergoing elective laparoscopic cholecystectomy. The patients were randomly assigned to one of four groups (n = 30 for each group): granisetron 3 mg, droperidol 1.25 mg, metoclopramide 10 mg and placebo (saline). These medications were given immediately before the induction of anaesthesia. During the first 24 h after anaesthesia, the incidence of post-operative nausea and vomiting was 13, 30, 33 and 37% after administration of granisetron, droperidol, metoclopramide and placebo, respectively (P < 0.05, overall Fisher's exact probability test). No clinically important adverse effects were observed in either group. Our results suggest that granisetron is a better anti-emetic than droperidol or metoclopramide for the prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy when compared with a placebo.

Adult↗
PubMed1998

[Continuous intra-arterial blood gas monitoring during bronchopulmonary lavage for pulmonary alveolar proteinosis].

We report a clinical experience of continuous intra-arterial blood gas monitoring (PARATREND 7:P 7) during bronchopulmonary lavage. A 47-year-old, 86-kg male was suffering from myelodysplastic syndrome associated with alveolar proteinosis. Bronchopulmonary lavage was scheduled to alleviate the symptom. P 7 and a continuous cardiac output monitor were used with an EKG monitor, a pulse oximeter, and a esophageal stethoscope. Anesthesia was maintained using sevoflurane and fentanyl. The patient's trachea was intubated with a double-lumen endobronchial tube (39-F Broncho-cath; Mallinckrodt, Ireland). After denitrogenation and degassing, warmed isotonic saline was infused into his left lung. The volume chosen was 2,200 ml which approximated the sum of the patient's functional residual capacity and tidal volume. The lowest point of PO2 appeared at the point 'degassed'. P 7 showed a consecutive rise of PO2 associated with infusion of large volume of saline. Although the response to change in PO2 of P 7 is slower than pulse oximeter, frequent blood sampling can be avoided. We think that P 7 with pulse oximeter are useful for the safe management of pulmonary lung lavage.

Anesthesia, Intravenous↗