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Biomedical subjects

Sumio Hoka

Publications and source records attributed to Sumio Hoka.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Anesthetic management of patients with interstitial cystitis during intravesical resiniferatoxin therapy].

The management of patient with interstitial cystitis (IC) remains a challenge because no single agent has proven effective. IC is a chronic sterile inflammatory disease of the bladder of unknown etiology characterized by urinary frequency, urgenecy, nocturia and lower abdominal pain. We experienced anesthetic management of five patients with IC during intravesical resiniferatoxin (RTX) therapy. RTX is associated with irritative urinary symptom during bladder instillation. The patients with IC had bladder instillation with 100 ml of 10(-8) M RTX solution for 30 min. The first patient received combined spinal-epidural anesthesia (CSEA), and the others general anesthesia. The patient with regional anesthesia had no critical troubles related to circulatory status during the procedure, but increases of blood pressure after instillation of RTX were observed in two patients receiving general anesthesia. In spite of the increase in blood pressure during general anesthesia, regional anesthesia should not be used, because the effect of RTX on the spinal cord has to be maintained.

Administration, Intravesical↗
PubMed2005

[Cranial subdural hematoma after inadvertent dural puncture at epidural anesthesia].

Intracranial subdural haematoma has been reported to be an exceptionally rare complication of accidental dural puncture. An accidental lumbar dural puncture occurred in a 36-yr-old male undergoing orthopedic knee surgery. On the morning after the operation, the patient complained of severe occipital headache, although this was relieved with loxoprofen and rest. This was assumed to be a postdural puncture headache (PDPH) because it had a postural component (it was worse on sitting up). On the third day after the operation, the patient developed a severe diffuse headache together with nausea, which did not subside with analgesia and bed rest. Magnetic resonance imaging of the head showed a small acute subdural hematoma in the bilateral temporooccipital region with no mass effect. The patient was conscious and oriented. There was no focal neurological deficit. The patient was managed conservatively with bed rest and intravenous fluids. His condition improved without surgical decompression and was discharged on the 40 th day after the operation. Severe and prolonged PDPH shoud be considered as a warning sign of an intracranial complication.

Adult↗
PubMed2005

[Comparison of propofol LCT and propofol MCT/LCT regarding the injection pain at different sites and the memory].

BACKGROUND: Incidence and intensity of pain on intravenous injection of propofol LCT were compared with those of propofol MCT/LCT. METHODS: Eighty adult patients scheduled to receive general anesthesia were divided into two groups, propofol LCT (Group L, AstraZeneca) and propofol MCT/LCT (Group M, Maruishi Pharmaceutical). The peripheral vein was inserted with an 18 gauge intravenous catheter at the dorsal hand, the wrist, or the anterior brachial region. Propofol 2.0 mg x kg(-1) was injected at the speed of 5 mg x sec(-1). Noninvasive arterial blood pressure, heart rate, a BIS value and a degree of pain were measured. We used chi2 analysis and Wilcoxon t-test for statistical evaluation. RESULTS: There was a significantly larger incidence of injection pain in the Group L than the Group M (70% vs. 30%). The pain at the brachial region was significantly less as compared with the wrist or the dorsal hand in both groups. The ratio of patients having the memory of pain on the next day to those complaing the injection pain was 50% in the Group L and 36% in the Group M. There were no significant differences between the two groups in changes in BIS values and doses of propofol necessary for the loss of consciousness. CONCLUSIONS: The results suggest that propofol MCT/LCT elicits less pain on injection than propofol LCT. The injection pain is less at the brachial region than the wrist or the hand. Amnesia of pain may be obtained both with propofol MCT/ LCT and propofol LCT.

Anesthesia, General↗
PubMed2004

Faster oscillometric manometry does not sacrifice the accuracy of blood pressure determination.

Faster oscillometry enables one to track rapid pressure changes. We therefore examined whether it was possible to shorten the measurement time without sacrificing accuracy. We accelerated and linearized cuff deflation and determined systolic and diastolic pressure values by the appearance and disappearance of oscillometric waves based on the interpolated cuff pressure-oscillometric wave amplitude relationship. The accuracy of faster oscillometry was examined by comparing correlations between invasive radial and oscillometric brachial pressure with either the conventional or the faster oscillometry in 23 patients (32+/-16 measurement pairs). Faster oscillometry shortened the measurement time from 27.7+/-3.5 s to 17.1+/-2.6 s. Neither pressure levels nor heart rate altered the time required for measurement. Bland-Altman analysis indicated that mean and standard deviation of difference between oscillometric and invasive systolic pressure was comparable (conventional, 2.1+/-7.5 mmHg; faster, 1.4+/-7.3 mmHg) without correlations between difference and average of systolic pressure. Similar differences (conventional, 5.0+/-6.8 mmHg; faster, 4.9+/-5.8 mmHg) and lack of correlations were also found for diastolic pressure. In conclusion, we succeeded in shortening the oscillometric measurement time to approximately 60% of the original time without sacrificing accuracy. This was achieved by acceleration and linearization of cuff deflation and by interpolation of the relationship between cuff pressure and oscillometric wave amplitude.

Adolescent↗
PubMed2004

[Application of a PDE III inhibitor, olprinone, for fast track pediatric cardiac surgery].

BACKGROUND: We examined the effects of olprinone (OLP), a PDE III inhibitor, on the time to extubation and on the hemodynamics in infants and children undergoing fast track cardiac surgery. METHODS: Nineteen consecutive children undergoing fast track cardiac surgery were recruited in this study. In the first five children, chlorpromazine (CPZ) was administered conventionally for the purpose of vasodilation during the cardiac surgery (CPZ group). In the latter fourteen children, OLP (50 micrograms.kg-1) was administered 30 minutes prior to the weaning from cardiopulmonary bypass (CPB) as a substitute of CPZ (OLP group). Hemodynamic parameters were stored as data at the period of pre-CPB, post-CPB, and at the end of the surgery. Plasma concentration of OLP was measured 30 minutes after CPB. RESULTS: In the OLP group, mean time to extubation was 28.2 min, which is shorter than that in CPZ group (250.4 min). Mean arterial pressure at the end of the surgery was higher in OLP group than in CPZ group. Other hemodynamic variables were not different between the two groups. Plasma concentration of OLP was 22.4 ng.ml-1, which is within the therapeutic window. CONCLUSIONS: The administration of OLP enables us to perform an immediate early extubation and provides stable hemodynamics. OLP would be useful in children undergoing fast track cardiac surgery.

Cardiac Surgical Procedures↗
PubMed2004

[Masseter muscle rigidity after suxamethonium during induction and postoperative abortive malignant hyperthermia in a patient with esophageal achalasia].

A 38-year-old man diagnosed as esophageal achalasia developed masseter muscle rigidity after intravenous suxamethonium during anesthetic induction. Anesthesia was maintained with intravenous agents and epidural blockade, while the masseter muscle rigidity continued. After the surgery, his body temperature increased to 38.8 degrees C concomitantly with the appearance of myoglobinuria suggesting the occurrence of abortive malignant hyperthermia. These symptoms were dissolved by dantrolene administration. He was later proved to be negative with CICR test.

Adult↗
PubMed2004

[Do Japanese express pain as Western people do?].

As pain is an unpleasant experience, sensorial and emotional, it may possess a different meaning in a different society with its own culture and history. Pain in English has the meaning of punishment in the verbal origin. However, pain in Japanese, which is called "itami", means extraordinary state of something without containing the meaning of punishment. The Japanese who originally have view of life of empathy and assimilation with the nature, have tended not to regard the pain as the object being overcome. Thus, the Japanese may have been capable to give a unique message to the West, regarding the treatment of pain.

Cross-Cultural Comparison↗
PubMed2004

[Bispectral index monitoring in fast track pediatric cardiac surgery].

BACKGROUND: We evaluated the changes in the bispectral index (BIS) as a potential indicator of level of consciousness in infants and children undergoing fast track cardiac surgery. METHODS: Twenty-one children undergoing fast track cardiac surgery were recruited into this study. Anesthesia was maintained with inhaled sevoflurane and intravenous fentanyl 10 microg x kg(-1). Cardiopulmonary bypass (CPB) with mild hypothermia and an immediate tracheal extubation protocol were used. BIS was recorded throughout the operation. RESULTS: In average, BIS was kept almost under 70 with 0.5-3.0% of sevoflurane. During rewarming from mild hypothermia, BIS increased temporarily over 70 in about a half of children. We, therefore, treated them by increasing sevoflurane concentration. Nineteen children were extubated in the operating room, and two patients were extubated in ICU within three hours after surgery. CONCLUSIONS: BIS was kept within the level of adequate sedation during surgery. However, since the increase in BIS during the rewarming phase could reflect light anesthesia, caution should be taken around this phase.

Anesthesia, Inhalation↗
PubMed2004

[Two tracheal tubes inserted for endotracheal tube replacement in a patient with severe obstructive sleep apnea: a case report].

A 34-year-old obese, small-jawed and short-necked woman, had severe obstructive sleep apnea syndrome (OSAS) with bronchial asthma. A surgical removal of a lingual tumor using a laser knife was scheduled under general anesthesia with sevoflurane. A small diameter tracheal tube for laser surgery (internal diameter (ID) of 5.5 mm) was used. The tube was inserted using bronchofiberscopy under spontaneous respiration. Extubation was designed to be performed when the patient resumed adequate spontaneous respiration and was awake. However, her ventilation deteriorated postoperatively as spontaneous breathing continued (PaO2 98 mmHg, PaCO2 88 mmHg at FIO2 1.0). This seemed to have been induced by worsened patient-ventilator synchrony and increased airway resistance due to the use of a small diameter tube. We decided to replace the tube with the one with larger diameter. An ID 7.5 mm tube was inserted with the use of fiberscope through the opening of the vocal cord while the tube for laser surgery was left in space. After confirming that the two tubes were inserted securely, the tube for laser surgery was withdrawn. The patient's ventilation improved significantly afterwards and the extubation was performed successfully. Our method for replacing a tracheal tube seemed to be effective and safe.

Adult↗
PubMed2003

Overexpression of Ca2+-permeable AMPA receptor promotes delayed cell death of hippocampal CA1 neurons following transient forebrain ischemia.

To examine the role of Ca(2+) entry through AMPA receptors in the pathogenesis of the ischemia-induced cell death of hippocampal neurons, we delivered cDNA of Q/R site-unedited form (GluR2Q) of AMPA receptor subunit GluR2 in the hippocampus by using an HVJ-liposome-mediated gene transfer technique. Two days prior to transient forebrain ischemia, we injected an HVJ-liposome containing cDNA of the GluR2Q-myc fusion gene into a rat unilateral hippocampus. In the absence of ischemic insult, overexpression of Ca(2+)-permeable GluR2Q did not cause any neurodegeneration in the cDNA-injected hippocampus. In ischemic rats, overexpression of Ca(2+)-permeable GluR2Q markedly promoted ischemic cell death of CA1 pyramidal neurons, while complete rescue of CA1 pyramidal neurons from ischemic damage occurred in the hippocampal hemisphere opposite the GluR2Q expression. Overexpression of the Q/R-site edited form (GluR2R) of subunit GluR2 did not affect the ischemia-induced damage of CA1 pyramidal neurons. From these results, we suggest that the Ca(2+)-permeability of AMPA receptors does not have a direct contribution to glutamate receptor-mediated neurotoxicity but has a promotive action in the evolution of ischemia-induced neurodegeneration of vulnerable neurons.

Animals↗
PubMed2003

Quantitative analysis of left ventricular regional wall motion with color kinesis during abdominal aortic cross-clamping.

OBJECTIVES: The authors aimed to establish a technique for quantitative analysis of regional wall motion abnormality (RWMA) using color kinesis (CK) of transesophageal echocardiography (TEE) in surgical patients. This technique was used to determine whether RWMAs develop de novo after infrarenal aortic cross-clamping in patients undergoing vascular surgery with a preoperative dipyridamole thallium stress test (DTST). DESIGN: An observational study. SETTING: University hospital. PARTICIPANTS: Thirty-eight patients undergoing infrarenal abdominal aortic aneurysm resection or aortofemoral bypass. MEASUREMENTS AND MAIN RESULTS: CK images of the left ventricle (LV) were obtained from the midventricular transgastric short-axis view before and after infrarenal aortic cross-clamping using TEE and analyzed off-line using custom software. The predictive value of the category "reversible perfusion defect" (RD) was also estimated from DTST for predicting new RWMAs with CK. CK analysis is suitable for clinical use based on the comparison with conventional two-dimensional echocardiogram measurements and interobserver variability. CK analysis showed all 7 patients with persistent perfusion defects on DTST had RWMAs. New RWMAs occurred in 2 of 9 patients with RD and in 2 of 15 patients with normal DTST, indicating that there was no significant difference between RD and normal DTST in the incidence of new RWMAs. CONCLUSIONS: A new method is available for clinical use, which is capable of visualizing RWMAs. These results suggest that new RWMAs introduced by aortic cross-clamping occur irrespective of the risk as assessed by preoperative DTST. CK with the new analysis method might be a useful tool to quantitatively evaluate RWMAs during surgery.

Aorta, Abdominal↗
PubMed2003

[Perioperative cardiovascular complications in patients with hypertrophic cardiomyopathy].

BACKGROUND: The aim of this study was to examine the incidence of cardiac complications in patients with hypertrophic cardiomyopathy (HCM) during noncardiac surgery. METHODS: A retrospective study was made for surgical patients in the period of 1989-2000 at Kitasato University Hospital. RESULTS: Thirty out of 66000 patients were preoperatively diagnosed as HCM. Sixty percent of the HCM patients had one or more perioperative cardiovascular complications. There were perioperative congestive heart failure in 3 patients (10%), and myocardial ischemia in 4 patients (13%). However, there were no myocardial infarction, no life-threatening dysarrthythmia and no cardiac death. Factors which appeared to be associated with the perioperative cardiovascular complications were the type of HCM (HOCM), major surgery, general anesthesia and preoperative medication with a beta-blocker or a calcium channel blocker. CONCLUSIONS: It is suggested that patients with HCM undergoing noncardiac surgery have a high incidence of cardiac complications such as congestive heart failure and myocardial ischemia.

Adult↗
PubMed2003

[Postoperative recurrence of venous thromboembolism in patients with episodes of preoperative thromboembolism].

BACKGROUND: Venous thromboembolism (VTE) has become a major health problem in Japan. METHODS: We examined, postoperative recurrence of VTE in patients with preoperative venous thromboembolic events and evaluated factors that are relevant to the occurrence of postoperative VTE. RESULTS: Forty-four cases out of 38500 had been diagnosed preoperatively as having VTE in the period of 1995-2001 at Kitasato University Hospital. Postoperative VTE was detected in four patients (9%) out of these 44 cases. Patients who had thrombophilia (antiphosholipid syndrome) or recent episode of VTE within 1 month were higher in the incidence of postoperative recurrence of VTE than the others. Temporary infra-vena cava filters were placed to prevent pulmonary thromboembolism in twelve patients. In 8 of the patients, thrombi were detected in or at the filter before explantation. Three patients (7%) had undergone thrombolysis therapy. Postoperative VTE was not found in patients who had already received anticoagulant therapy (warfarin) for 3 or more months. CONCLUSIONS: It is concluded that newly developed VTE occurred perioperatively in 9% of patients with preoperative VTE, and that thrombophilia and a recent episode of VTE were considered as risk factors of perioperative VTE. Temporary infra-vena cava filters are a valuable device for prevention of postoperative pulmonary thromboembolism.

Adult↗
PubMed2003

[Postoperative analgesia using continuous lumbar epidural infusion of ropivacaine in comparison with bupivacaine].

BACKGROUND: Epidural bupivacaine infusion is a commonly used technique for postoperative analgesia because of its motor-sparing properties. Recently a new long acting local anesthetic, ropivacaine, has become available. The aim of this study was to investigate the efficacy of ropivacaine and bupivacaine with regard to postoperative analgesia when administered continuously into the lumbar epidural space. METHODS: All patients were ASA I II and undergoing ipsi-lateral leg orthopedic surgery with epidural or combined spinal-epidural anesthesia. Patients were randomly assigned to following three groups: 0.1% ropivacaine (0.1 R); 0.2% ropivacaine (0.2 R); 0.125% bupivacaine (0.125 B). At the end of surgery, continuous infusion was begun at a rate of 6 ml.hr 1 after a bolus epidural administration of 5 ml of 0.2% ropivacaine in R groups and 0.25% bupivacaine in B group. Sensory and motor block, blood pressure, pulse rate, verbal pain score (VPS), analgesic consumption were assessed at 20 min, 1, 3, 10-20 hrs following the beginning of continuous infusion. RESULTS: Vital signs were stable at every measuring point in all groups. In 0.1 R group (n = 20), the spread of sensory block at 3 hrs after infusion was lower than 0.2 R group (n = 19), and VPS during the study was higher than 0.125 B group (n = 17). Bromage scale after 3 hrs was higher in 0.2 R group compared with 0.125 B group. The degree of sensory and motor block gradually decreased, resulting in little difference between the groups. When epidural anesthesia was spread over the surgical area throughout the study, 0.2 R or 0.125 B was sufficiently relieved from postoperative pain. CONCLUSIONS: After leg orthopedic surgery, 6 ml.hr-1 of 0.2 R or 0.125 B provided enough postoperative analgesia when the spread of anesthesia covered the operated area. 0.2 R would be better compared to 0.125 B in continuous epidural infusion for postoperative analgesia due to less systemic toxicity, even though it accompanies a little more intense motor block.

Adult↗
PubMed2003

[A case of delayed diagnosis of pulmonary thromboembolism in a patient with mitral stenosis undergoing cesarean section].

Cesarean section was performed under general anesthesia in a 38-year-old patient with congestive heart failure due to severe mitral stenosis. During surgery, pulmonary hypertension, right ventricular distension and the dissociation of PETCO2 and PaCO2 were observed. However, pulmonary thromboembolism (PTE) was proved after the operation when she developed severe hypotension in the intensive care unit. Although she recovered once from circulatory unstability with the use of percutaneous cardiopulmonary support (PCPS) and she could be weaned from PCPS at the 4th postoperative day, she died from tracheal bleeding and recurrent cardiopulmonary collapse 22nd day after the surgery. It should be noted that the increasing dissociation of PETCO2 and PaCO2 may be an early sign of PTE even in a patient with severe mitral stenosis and pulmonary hypertension.

Adult↗