Biomedical subjects

Ju Mizuno

Publications and source records attributed to Ju Mizuno.

At least 19 recordsLinked to original sources

PubMed2007

Age and sex-related differences in dose-dependent hemodynamic response to landiolol hydrochloride during general anesthesia.

OBJECTIVE: Landiolol hydrochloride is a new ultra-short-acting beta(1)-adrenergic receptor blocking agent that is used for patients with tachycardia during general anesthesia. The hemodynamic response to a beta-adrenergic receptor blocking agent is generally dependent on the subject. In the present investigation we investigated the effects of age and sex on the hemodynamic response to different doses of landiolol. METHODS: Following a persistence of tachycardia for more than 1 min, landiolol was infused at 0.03125, 0.0625 and 0.125 mg kg(-1) min(-1) for 1 min followed by 0.01, 0.02 and 0.04 mg kg(-1)min(-1) for 10 min in groups L, M and H, respectively. Heart rate (HR), systolic (sBP) and diastolic blood pressure (dBP) were recorded each minute during the procedure. The respective changes were evaluated using logistic analysis with the equation Y(t) = p + (q - p)/[1 + exp {4m/(q - p))(k - t)}], where p, q, m and k indicate the upper asymptote, lower asymptote, maximum slope and time at the maximum slope. RESULTS: Parameters q and k for HR in group H were smaller than those in group L, whereas the parameters for sBP and dBP were unchanged among the three groups. Parameter q for HR in group H decreased with age of the patient. There was no significant difference in the landiolol-induced change in HR between males and females. CONCLUSION: The hemodynamic response to landiolol is reliably modeled by the logistic function, especially in terms of HR. Landiolol causes a rapid and dose-dependent decrease in HR, whereas landiolol-induced changes in sBP and dBP are independent of dose. The landiolol-induced decrease in HR becomes larger with aging, but shows no sex difference. The logistic model may be useful for studying hemodynamic responses to landiolol based on age and sex differences, and may allow development of an improved monitoring system. IMPLICATION STATEMENT: The logistic function reliably represents the hemodynamic responses to landiolol. Landiolol reduces HR rapidly and in a dose-dependent manner whereas landiolol-induced changes in sBP and dBP are independent of dose. A larger decrease in HR is caused by landiolol in elderly patients, but there is no sex difference in the landiolol-induced change in HR.

Adrenergic beta-Antagonists↗

PubMed2007

Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy.

PURPOSE: We describe a complication of epiduroscopy with encephalopathy and rhabdomyolysis associated with the contrast medium iotrolan. CLINICAL FEATURES: A 76-yr-old man with failed back surgery syndrome underwent epiduroscopy. Sufficient lysis could not be achieved in the epidural space above the level of L4 due to dense adhesions and scar tissue. After epidural injections of iotrolan and mepivacaine, he developed motor weakness and hypoesthesia in both legs, which lasted for three hours. He also became confused, agitated, disoriented, and developed neck stiffness and tremors involving the head and legs. Computed tomography revealed diffuse contrast enhancement within the intracranial cerebrospinal fluid (CSF) spaces, indicating an intraoperative dural tear. Marked increases in serum creatinine phosphokinase and myoglobin indicated subsequent acute rhabdomyolysis. Crystalloid infusion and semi-recumbent positioning facilitated iotrolan absorption from the CSF, and the patient recovered uneventfully. CONCLUSIONS: Dural tear during epiduroscopy may allow access of contrast media into the CSF. Neurotoxicity secondary to iotrolan within the CSF was a likely contributing factor to the encephalopathy and subsequent rhabdomyolysis. This is an instructive example of the importance of diagnosing inadvertent dural tear during epiduroscopy under iotrolan, for avoidance of adverse events such as encephalopathy and rhabdomyolysis.

Acute Disease↗

PubMed2006

Starling-effect-independent lusitropism index in canine left ventricle: logistic time constant.

The logistic time constant (tau(L)) has been proposed as a better index of the rate of left ventricular (LV) relaxation or lusitropism than the conventional monoexponential time constant (tau(E)). However, whether and how the Frank-Starling effect influences tau(L) remains to be elucidated. We compared the effect of LV volume (LVV) loading on both logistic and monoexponential fittings. The isovolumic LV relaxation pressure curves from the maximum negative time derivative of pressure (-dP/dt(max)) were analyzed at 3 different end-points at 4 LVVs of 10, 12, 14, and 16 mL in 8 excised, cross-circulated canine hearts. We found that the logistic fitting was superior to the monoexponential fitting at all LVVs and end-points. LVV loading did not affect tau(L) but affected tau(E) slightly. Although the advancing end-point increased both tau(L) and tau(E), the increases were significantly smaller for tau(L) than for tau(E) at all LVVs. Moreover, the changes in both the amplitude constants and nonzero asymptotes with the advancing end-point were significantly smaller for the logistic fitting than for the monoexponential fitting. We conclude that tau(L) served as a more reliable index of lusitropism that is independent of the change in LVV loading or the Frank-Starling effect.

Animals↗

PubMed2006

[Postponed or canceled drug challenge tests and side effects of the test drug--a report of four cases].

Drug challenge test (DCT) is performed to evaluate chronic pain pharmacologically and determine its medical treatment. One test drug is administered in one day for DCT and characterization of the test drug. Four patients developed side effects of the test drugs for DCT in whom other drug tests were postponed or canceled. A 58-year-old man with multiple arthritis of rheumatic arthritis and fibromyalgia had headache, nausea, and vomiting all day after ketamine test. A 76-year-old man with chronic general pain and failed back surgery syndrome had vomiting and abdominal discomfort two hours after morphine test and had redness and itching on his bilateral forearms the following day. A 78-year-old man with chronic lumbar and right lower limb pain due to L 4-5 lumbar disc herniation and postherpetic neuralgia felt dizzy, fell down and bruised on his lower back and left knee twelve hours after morphine test. A 32-year-old woman with chronic pelvic pain had skin eruption on her thigh the day after phentolamine test. Although the amount of the test drug in DCT is small and its half-life is short, long-term side effects might occur. We should decrease the amounts or frequencies of ketamine and morphine, and administer them taking long intervals before other tests.

Adult↗

PubMed2006

[Powder-induced anaphylactic shock following use of powdered latex gloves during gynecological open laparotomy].

A 42-year-old woman with hysteromyoma underwent total abdominal hysterectomy under general and epidural anesthesia. Three years before, she had undergone resection of lipoma on her left shoulder under local anesthesia uneventfully. She had no previous history of hypersensitivity. General anesthesia was induced by intravenous injection of fentanyl, propofol, and vecuronium followed by inhalation of nitrous oxide, oxygen, and sevoflurane. Lidocaine and fentanyl were injected through a lumbar epidural catheter. After the start of open laparotomy, there was a sudden onset of hypotension. Administrations of ephedrine and phenylephrine, and volume loading were ineffective. Moreover, she showed profound hypotension, tachycardia, oxygen desaturation, decreased endtidal carbon dioxide and increased airway pressure. She broke out in a sweat with flushing on her chest and upper extremities. Therefore, we interrupted the surgery, checked her arterial blood gas analysis, performed echocardiography, and inserted a pulmonary artery catheter. We made a diagnosis of anaphylactic shock and administered methylprednisolone, albumin, epinephrine, norepinephrine, and dopamine to treat the circulatory collapse. The gynecologists changed their surgical gloves from a powdered-latex type to a powder-free latex type, and the surgery was resumed. She responded well to appropriate emergent therapy and all vasopressor drugs were gradually decreased and eventually stopped. After the end of the surgery, she recovered completely from the signs and symptoms of shock. Later, we found a high level of plasma latex protein-specific IgE antibody and confirmed the events as anaphylactic shock due to latex. We assumed that the anaphylactic shock was powder-induced latex allergy following use of powdered latex gloves in this case. Latex allergy should be suspected if an anaphylactic reaction or shock accompanied by circulatory collapse, respiratory failure, and skin symptoms of unknown origin occurs during surgery. As women more often come into contact with household articles containing latex, we suspect that women are prone to developing sensitivity towards latex. We recommend that powder-free or latex-free surgical gloves should be available not only for patients with a high risk of developing latex allergy, but also for patients indicated for gynecological open laparotomy.

Adult↗

PubMed2006

[Post-brain angiographic asymptomatic pulmonary embolism diagnosed before general anesthesia].

A 58-year-old man was scheduled for resection of a brain tumor. He had undergone brain angiography two days before the operation. His right femoral artery punctured for the insertion of a catheter, had been compressed with a sponge for six hours after the brain angiography. He had gone without food for 13 hours and drink for 11 hours before entering the operating room. He was given 2.5 mg of midazolam im as premedication. Though we found his SpO2 value decreased to 88-90%, he did not complain of any clinical symptoms. Arterial blood gas (ABG) analysis showed PaO2 of 60 mmHg with room air. We asked him to take deep breaths for five minutes, but his ABG analysis continued to show hypoxia. Therefore, his scheduled operation was canceled in order to investigate the cause of hypoxia. As chest enhanced computed tomography revealed thrombosis of 3 cm in length in the A 3 artery of his right lung, we diagnosed pulmonary embolism and treated it with continuous intravenous injection of heparin. Pulmonary thromboembolism in this case might have been due to femoral vein compression, vein congestion during extended periods of bed rest after the brain angiography, deep leg vein thrombosis produced by femoral artery injury, and dehydration before the operation. Care has to be taken for the onset of pulmonary embolism after angiography through the femoral artery. Measurement of SpO2 is useful for the early diagnosis of asymptomatic pulmonary embolism.

Anesthesia, General↗

PubMed2006

[Information and consent sheet of caudal block in the University of Tokyo Hospital].

Caudal block with a local anesthetic through the hiatus sacralis has been performed in patients with chronic low back pain, lower limb pain, anal pain, and pelvic pain due to spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, postherpetic neuralgia, peripheral vascular disease, complex regional pain syndrome and so on. We prepar- ed an information and consent sheet on caudal block in The University of Tokyo Hospital. In the information sheet, we included disease, purpose, methods, outcome, accidental complications of caudal block, other treatments, progress on unperformed case, questions and answers, influence of rejection, and doctor's name. We experienced some cases of boring pain, deterioration of low back pain and lower limb pain, headache, nausea, hypertension, hypotension, and tachycardia as accidental complications of caudal block. In describing some accidental complications, we included boring pain, high intracranial pressure, dural puncture, nerve injury, infection, hemorrhage, embolism, allergy, and heart, lung, brain, liver, and kidney failures. Further, we could refer to the accidental complications of epidural block. However, the rate of each accidental complication has not been known in detail. We should survey the outcome and accidental complication of caudal block prospectively in multiple facilities and provide the patients with useful information.

Anesthesia, Caudal↗

PubMed2006

[Preload and ventricular lusitropism; logistic and monoexponential function fittings].

A logistic function has been found to fit the isovolumic left ventricular (LV) relaxation pressure curve and the isometric relaxation force curve of the papillary muscle much more precisely than the conventional monoexponential function. Therefore, the logistic time constant (tauL) has been proposed as a better index of the rate of cardiac relaxation or lusitropism than the conventional monoexponential time constant (tauE). Many investigators have reported that tauE changes with preloading. We analysed and compared the effect of LV volume (LVV) loading on both logistic and monoexponential fittings and their time constants of the isovolumic LV relaxation pressure curve in the excised, cross-circulated canine hearts. We found that the logistic fitting was superior to the monoexponential fitting at any LVV. LVV loading did not affect tauL at all but affected tauE slightly. The logistic fitting more reliably characterises the lusitropism than the monoexponential fitting, and tauL, serving as a more reliable ventricular lusitropism index, is independent of changes in LVV loading or the Frank-Starling effect.

Anesthesia↗

PubMed2006

[Acute popliteal arterial occlusion during extracorporeal circulation].

A 79-year-old man underwent aortic arch replacement for thoracic aortic aneurysm. He had a history of smoking, coronary stenting for ischemic heart disease and replacement with artificial blood vessel for abdominal aortic aneurysm. Anesthesia was induced and maintained with midazolam, fentanyl, sevoflurane, and vecuronium. A 20 gage catheter was placed in the right radial artery and a 22 gage catheter in the left posterior tibial artery. Total circulatory arrest under profound hypothermia and retrograde cerebral perfusion were performed using extracorporeal circulation. After finishing anastomosis with artificial blood vessel, he was weaned from extracorporeal circulation. The pressure in the left posterior tibial artery was maintained at 15 mmHg, although the blood pressure in the right radial artery increased gradually. Then, the pressure in the left femoral artery in the operative field was the same as the pressure in the right radial artery. Therefore, we suspected the arterial line occlusion of the left posterior tibial artery. After the operation, we found the left leg and foot pale and cold with no pulsation on the left popliteal, dorsal pedis, and posterior tibial arteries. Further, acute left popliteal arterial occlusion was assessed by means of Doppler and left lower extremity angiography. We immediately performed the balloon-catheter embolectomy. However, as he developed compartment syndrome on the left lower limb due to reperfusion injury postoperatively, fascitomy was performed. On the 58th postoperative day, he was discharged from our hospital. Measurement by Doppler is useful for the early diagnosis of the lower leg arterial occlusion.

Aged↗

PubMed2006

[Nurse anesthetist in France].

We present the system of nurse anesthetist (Infirmier Anesthésiste Diplômé d'Etat: IADE) in France to the community of Japanese anesthesiologists. This French system with 70 years' history is older than the Japan Society of Anesthesiologists itself. There are 7000 nurse anesthetists in France now and the number of nurse anesthetists increases by 450-500 each year. Training to become a nurse anesthetist requires at least two years' experience as a general nurse and the general nurse must pass an examination after two years' special training in an anesthetistic nurse school to acquire the national certification. The nurse anesthetist's profession is regulated by French law. They work in a team with certified anesthesiologists. They can perform many kinds of anesthetic tasks including tracheal intubation and insertion of arterial catheter under the responsibility and supervision of certified anesthesiologists. The nurse anesthetists are not allowed to perform spinal, epidural, conduction and local anesthesia, although they can maintain these anesthesia and control these methods, e.g., by injecting local anesthetic agents through epidural catheter, following a specified prescription. The nurse anesthetists are not allowed to insert central venous and pulmonary artery catheters, although they can manage them. They are allowed to administer inhalation anesthetic agents, and inject venous anesthetic agents, muscle relaxants, their antagonists, and opioids by their own initiatives, but the decision for the use of catecholamine and emergency drugs is reserved to certified anesthesiologists. The nurse anesthetists perform other tasks preparing and checking anesthetic agents and equipment such as anesthetic machine, monitor, and defibrillator everyday, and sometimes use autologous blood recovery systems. The relationship between the certified anesthesiologist and the nurse anesthetist is marked by mutual respect, confidence and cooperation at each step of the anesthetic management, from induction to recovery of anesthesia. We believe that it is very safe for the patients to undergo anesthesia performed by nurse anesthetists under the control of certified anesthesiologists. We suggest that the introduction of the system equivalent to the French concept and improved training of nurse anesthetists can be the solution to overcome our current shortage of certified anesthesiologists in Japan.

France↗

PubMed2005

[Regional discrepancies of numbers of anesthesiologists and certified training hospitals in Japan].

BACKGROUND: We reported previously the existence of regional discrepancies in the numbers of anesthesiologists to the general population, the numbers of all medical doctors and hospital beds in Japan. In the present study, we investigated the regional discrepancies of the numbers of anesthesiologists and hospitals with department of anesthesiology from medical facility's point of view in Japan. METHODS: We compared the numbers of regular members, Board Certified Anesthesiologists (BCAs) and Certified Training Hospitals (CTHs) of the Japan Society of Anesthesiologists (JSA) to the general hospitals among forty-seven prefectures and nine Districts of JSA. Moreover, we compared the numbers of the general hospitals and CTHs to the general population. RESULTS: There were significant correlation coefficients between the number of the general hospitals and the number of JSA regular members or BCAs or CTHs, and the general population and the number of the general hospitals or CTHs in all prefectures. The mean number of JSA regular members per one general hospital was 0.96 persons and the maximum difference among all prefectures (MDAP) was 4.0 times. Tokyo District of JSA had the largest numbers (1.96 persons) of JSA regular members per one general hospital and the maximum difference among all Districts (MDAD) was 2.8 times. The mean number of BCAs per one general hospital was 0.54 persons and the MDAP was 4.2 times. Tokyo District of JSA had the largest numbers (1.01 persons) of BCAs per one general hospital and the MDAD was 2.6 times. The percentage of CTHs to all general hospitals was 9.1% and the MDAP was 5.4 times. The MDAD was 1.9 times. The mean number of the general hospitals per one hundred thousands population was 7.25 facilities and the MDAP was 4.3 times. Kyushu District of JSA had the largest numbers (11.50 facilities) but Tokai District of JSA had the smallest numbers (5.24 facilities) of the general hospitals per one hundred thousands population and the MDAD was 2.1 times. The mean number of CTHs per one hundred thousands population was 0.66 facilities and the MDAP was 3.3 times. Hokkaido District of JSA had the largest numbers (0.93 facilities) and Chugoku-Shikoku District of JSA had the second largest numbers (0.87 facilities) but Tokai District of JSA had the smallest numbers (0.45 facilities) of CTHs per one hundred thousands population and the MDAD was 2.1 times. CONCLUSIONS: There are remarkable regional discrepancies in the numbers of anesthesiologists and CTHs to the general hospitals and in the number of CTHs to the general population in Japan. We suspect that the regional discrepancies in the field of anesthesiology would influence the quality and form of corresponding clinical practice.

Anesthesiology↗

PubMed2005

[Sinus arrest during laryngoscopy for induction of general anesthesia with intravenous fentanyl and propofol].

A 43-year-old woman with Plummer's disease underwent left thyroid lobectomy without premedication using ambulatory electrocardiogram monitoring under general anesthesia. Anesthesia was induced with an intravenous bolus of fentanyl 100 microg, lidocaine 40 mg, propofol 80 mg and vecuronium 7 mg. As she moved 5 min after induction of anesthesia, fentanyl 100 microg and propofol 30 mg were administered additionally. After positive pressure ventilation by mask for 8 min, heart rate decreased from 71 beats x min(-1) to 48 beats x min(-1), and laryngoscopy was performed. When the tip of the laryngoscope was pressed on the base of the tongue and on lifting the epiglottis, the electrocardiogram showed RR interval prolongation and gradually going to sinus arrest. The laryngoscope was removed immediately and mask ventilation was performed. The heart beat resumed at 5.5 sec after sinus arrest. Atropine 0.5 mg was given intravenously and heart rate increased to 50 beats x min(-1). Additionally atropine 0.25 mg increased heart rate to 70 beats x min(-1). The second laryngoscopy was performed uneventfully. We consider this phenomenon as a result of vagovagal reflex. Fentanyl and propofol, by reducing sympathetic tone to a greater extent than parasympathetic tone, decrease blood pressure and heart rate, and predispose to a parasympathetic response for noxious stimulation. This case indicates that intravenous injection of atropine must be immediately used for bradycardia during laryngoscopy for induction of general anesthesia with fentanyl and propofol.

Adult↗

PubMed2004

[Regional differences in the number of anesthesiologists in Japan].

BACKGROUND: We have known the existence of regional differences in the number of medical doctors and the manpower shortage of anesthesiologists in Japan. METHODS: In the present investigation, we compared the number of regular members and Board Certified Anesthesiologists (BCA) of the Japan Society of Anesthesiologists (JSA) among prefectures and the Districts of JSA. RESULTS: Tokyo and Chugoku-Shikoku Districts of JSA had larger numbers of regular members of JSA per one hundred thousands population compared with Tokai, Kanto-Koshinetsu, and Tohoku Districts of JSA (the maximum difference among prefectures (MDAP) = 3.0 times and the maximum difference among the Districts (MDAD) = 2.4 times). Chugoku-Shikoku and Kyushu Districts of JSA had greater numbers of BCA per one hundred thousands population compared with Tokai, and Kanto-Koshinetsu Districts of JSA (MDAP = 3.1 times and MDAD = 2.5 times). Hokkaido District of JSA had the largest percentages of both members of JSA and BCA to all medical doctors [(MDAP = 2.3 times and MDAD = 1.7times) and (MDAP = 2.6 times and MDAD = 2.0 times), respectively)]. Tokyo District of JSA had the largest numbers of both members of JSA and BCA per one thousand hospital beds [(MDAP = 3.4 times and MDAD = 2.5 times) and (MDAP = 3.2 times and MDAD = 2.2 times), respectively)]. The regional differences in the number of regular members of JSA were bigger than those of the medical doctors (per one hundred thousands people (MDAP = 2.2 times and MDAD = 1.6 times) and per one thousand hospital beds (MDAP = 2.4 times and MDAD = 2.3 times), respectively]. CONCLUSIONS: There are remarkable regional differences in the number of regular members and BCA of JSA among prefectures and the Districts of JSA. We suspect that the regional differences in the number of anesthesiologists would affect the quality and system of corresponding clinical practice.

Anesthesiology↗

PubMed2004

[A case of giant thyroid tumor with tracheal stenosis].

A 61-year-old female underwent resection of a giant thyroid tumor, and tracheal stenosis ensued. She had cough, dyspnea, and palpitation in the supine position. The giant thyroid tumor was of the size of 11 x 12 cm and the diameter of trachea was 8 x 6 mm at 3.5 cm below the vocal cord, at which point the trachea was the narrowest on cervical computed tomography. The peak expiratory flow rate from the flow-volume curve was 2.94 l x sec(-1) (% predicted value 55.2%) in the upright position. We were concerned about difficult airway management. Oro-tracheal intubation with an armored tube (ID 7.5 mm) was performed after intravenous midazolam 2 mg and fentanyl 50 microg, 4% lidocaine spray 2 ml with oxygen 6 l x min(-1) inhalation keeping spontaneous breathing and consciousness. Anesthesia was induced and maintained with intravenous propofol, fentany, vecuronium and nitrous oxide in oxygen to keep the bispectral index between 40 and 60. The extracted thyroid tumor was 620 g in weight. A careful preoperative evaluation of the airway using ultrasonography, CT, MRI, laryngoscopy, bronchoscopy and respiratory function test, especially peak expiratory flow rate of the flow-volume curve is important in such a case of a giant thyroid tumor. Intubation under conscious sedation with midazolam and fentanyl is useful for a patient with a giant thyroid tumor and tracheal stenosis.

Anesthesia, General↗

PubMed2004

[Anesthetic management in a patient with Cornelia de Lange syndrome].

An eight-year-old boy with Cornelia de Lange syndrome underwent left inguinal hernioplasty and orchiopexy under general anesthesia. The patient with Cornelia de Lange syndrome had severe primordial growth failure with muscle-skeletal system such as cleft palate, micrognathia, and micromelia of the extremities and mental retardation as well as characteristic faces such as deep supercilia, etc. We suspected difficulty of endotracheal intubation due to this syndrome. Anesthesia was induced with intravenous injection of atropine 0.1 mg and ketamine 10 mg followed by inhalation of nitrous oxide 3 l x min(-1), oxygen 3 l x min(-1), and sevoflurane 5% without any muscle relaxant. Although his neck and temporomandibular joint were stiff, his trachea was intubated orally without difficulty with a 4.5 mm ID tracheal tube using a Macintosh laryngoscope. Anesthesia was maintained uneventfully by bolus intravenous injection of ketamine 5 mg and inhalation of oxygen and sevoflurane 2-3% with mechanical ventilation. The anesthetic management in a patient with Cornelia de Lange syndrome should be carried out with careful preoperative evaluation of physical status, and especially the difficult endotracheal intubation should be kept in mind. Induction of general anesthesia with injection of ketamine followed by inhalation of sevoflurane without muscle relaxant is a safe method in Cornelia de Lange syndrome.

Anesthesia, Inhalation↗

PubMed2003

[Septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage].

We report a case of septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage (PTAD). A 70-year-old male patient was admitted to our outpatient department of internal medicine with general fatigue, dullness of bilateral shoulders and extremities, appetite loss, weight loss, headache, and vertigo. Laboratory tests showed severe inflammatory indications, anemia, and high values of hepatobiliary enzymes and blood sugar. Abdominal ultrasonography and enhanced CT showed a pyogenic liver abscess of 10 cm in diameter at S 6-7 in the right hepatic lobe. The patient's condition deteriorated suddenly that night. From the results of abdominal ultrasonography and enhanced CT, we made diagnosis of septic shock associated with pyogenic liver abscess. Emergency abdominal ultrasound-guided PTAD was performed under local anesthetic. Postoperatively, the antibiotic was infused daily through a PTAD tube into the liver abscess space. He recovered and his laboratory tests improved gradually. On abdominal ultrasonography and enhanced CT, the liver abscess disappeared by 19th postoperative day, and PTAD tube was removed. There was no complication during PTAD treatment. We conclude that patients in septic shock should undergo further examinations immediately and treatment of the infected tissue should be started as soon as possible. PTAD may be an additional effective procedure for pyogenic liver abscess in septic shock. Furthermore, local antibiotic lavage through a PTAD tube into the liver abscess space may be an important supplementary method in the management of the illness.

Aged↗

PubMed2003

[Bronchospasm during upper gastrointestinal endoscopy under sedation].

We experienced a case of bronchospasm during upper gastrointestinal endoscopy under sedation. An 80-year-old man came to our hospital with abdominal distension with pain, nausea and vomiting. He has the history of splenectomy, cholecystectomy for hemolytic anemia and thyroidectomy for thyroid cancer, surgery for bilateral shoulder joints and diabetes. Abdominal X-ray suggested obstruction of the small intestine. On the third hospital day, gastrointestinal endoscopy was scheduled for insertion of a long ileus tube. Under sedation with diazepam 10 mg and local anesthesia of the pharynx with lidocaine spray 24 mg, the endoscope was inserted and when it reached the esophageal-gastrojunction, respiratory rate increased to 30 breaths.min-1 with expiratory stridor. The endoscope was removed immediately. He was oro-tracheally intubated and artificially ventilated. On the fourth hospital day, he was extubated under bronchoscopy. No abnormalities were observed in the trachea, vocal cord, pharynx and larynx. Later, it was revealed that he had a history of hoarseness and dysphasia. His left recurrent nerve and cervical nerve had been resected with thyroid and right cervical nerve anastomosed to the rest of the left recurrent nerve. The insertion of upper gastrointestinal endoscope might have induced bronchospasm stimulating distal esophageal afferent vagal reflex partly by regurgitation of gastric acid under sedation.

Aged↗

PubMed2003

[Sedation with intravenous midazolam during upper gastrointestinal endoscopy--changes in hemodynamics, oxygen saturation and memory].

BACKGROUND: Cardiorespiratory adverse effects are often observed in patients undergoing upper gastrointestinal endoscopy with sedation. In this study, we examined hemodynamics, oxygen saturation and memory during upper gastrointestinal endoscopy under sedation with intravenous midazolam. METHODS: Eight healthy outpatients without any obvious complications received intravenous midazolam 5 mg for sedation for upper gastrointestinal endoscopy. Blood pressure, heart rate and percutaneous arterial oxygen saturation (SpO2) were measured before, during and after endoscopy. After the arousal by intravenous flumazenil, we inquired the patients about the level of memory during the endoscopy. RESULTS: Blood pressure decreased significantly two minutes after midazolam administration, but increased significantly after the insertion of an endoscope which was not different from the control value. Heart rate increased significantly one and three minutes after the insertion of the endoscope. SpO2 decreased significantly after midazolam administration and stayed at around 95%. No patients remembered the procedure. CONCLUSIONS: Sedation with intravenous midazolam during upper gastrointestinal endoscopy is useful to control the cardiovascular responses, and to obtain amnesia. However, a decrease in SpO2 should be watched carefully.

Adult↗