Biomedical subjects

Tomoki Nishiyama

Publications and source records attributed to Tomoki Nishiyama.

At least 19 recordsLinked to original sources

PubMed2006

Pulse oximeters demonstrate different responses during hypothermia and changes in perfusion.

PURPOSE: Several new pulse oximeters using updated algorithms are marketed as being resistant to motion and hypoperfusion. The purpose of this study was to compare the performance of three pulse oximeters under conditions of hypothermia and altered perfusion. METHODS: Ten male volunteers were enrolled in this study after Institutional approval and obtaining informed consent. The probe of the Dolphin 2100, Nellcor N-595, or Masimo SET radical version 4.2 was attached to the left index finger. Time from 'power on' to acquire the pulse wave and oxygen saturation (SpO2), time from the application of air tourniquet with 250 mmHg on the upper arm to loss of pulse wave and SpO2, and time from the release of the tourniquet to acquire the pulse wave and SpO2 were measured. Then, the patient's left hand and arm were cooled gradually to 27 degrees C dermal temperature in a room at 19 degrees C. The temperatures at loss of the pulse wave and SpO2 were recorded. RESULTS: The Nellcor N-595 was the slowest to detect SpO2 and pulse wave at 'power on'. The Masimo SET showed pulse wave and SpO2 longer than the other two monitors after 'tourniquet on'. The Nellcor N-595 was the fastest to show pulse wave and SpO2 following tourniquet release. CONCLUSION: The Masimo SET was the slowest to respond to the changes in perfusion, and the Nellcor N-595 responded the fastest. However, the Nellcor N-595 was the slowest to show SpO2 and pulse wave at 'power on'.

Adult↗

PubMed2006

Analgesic effects of systemic midazolam: comparison with intrathecal administration.

PURPOSE: Midazolam has antinociceptive effects when administered intrathecally, while its effects associated with systemic administration remain controversial. In the present study, the antinociceptive properties of systemically vs intrathecally administered midazolam were investigated in a rat model of thermal and inflammatory pain. METHODS: One hundred seventy-six (n = 8 animals per dose escalation) male Sprague-Dawley rats were instrumented with lumbar intrathecal catheters. Tail withdrawal in response to thermal stimulation, or paw flinching and shaking in response to sc hind paw formalin injection were compared following intrathecal injection of midazolam (1, 3, 10, 30, or 100 microg in 10 microL) or ip administration (3, 30, 300, or 3,000 microg in 300 microL). Saline 10 microL or 300 microL was used as a control. Behavioural side effects and motor disturbance were also examined. RESULTS: Intrathecal administration of midazolam increased tail flick latency dose dependently (P < 0.05) with a 50% effective dose (ED50) of 1.60 microg, whereas ip administration did not increase latency. Both intrathecal and ip routes of administration decreased the number of paw flinches in both phases 1 and 2 of the formalin test (P < 0.05). The ED50s were 1.26 microg [confidence interval (CI), 0.35-3.18 microg], (phase 1) and 1.20 microg (CI, 0.29-3.71 microg), (phase 2) with intrathecal administration, and 11.6 microg (CI, 2.5-19.3 microg), (phase 1) and 52.2 microg (CI, 18.3-102.7 microg), (phase 2) with ip administration. CONCLUSION: Systemically administered midazolam induced antinociception for inflammatory pain only, while intrathecal administration elicited antinociceptive effects on both acute thermal and inflammatory-induced pain.

Analgesics↗

PubMed2006

Effects of a protease inhibitor, ulinastatin, on coagulation and fibrinolysis in abdominal surgery.

PURPOSE: Ulinastatin is well known to inhibit the activity of polymorphonuclear leukocyte elastase (PMNE). The PMNE concentration correlates with the activities of coagulation and fibrinolysis. The purpose of the present study was to investigate the effects of ulinastatin, a protease inhibitor, on coagulation and fibrinolysis in abdominal surgery. METHODS: Thirty patients, aged 40 to 70 years, with American Society of Anesthesiologists (ASA) physical status I or II, scheduled for major abdominal surgery, were enrolled. Anesthesia was induced with midazolam and thiopental, and was maintained with sevoflurane, nitrous oxide in oxygen, and an epidural block. An infusion of ulinastatin, 6000 units x kg(-1) in 30 min, was started 1 h after the start of surgery in the ulinastatin group (15 patients). In the control group (15 patients), no protease inhibitors were infused. White blood cell count; platelet count; prothrombin time; activated partial thromboplastin time; and plasma concentrations of PMNE, antithrombin (AT), fibrin/fibrinogen degradation product (FDP), fibrinogen, plasminogen, plasmin-(alpha2) plasmin inhibitor complex (PIC), and thrombin-antithrombin complex (TAT) were measured before, at the end of, and 12 h after surgery. RESULTS: TAT, PIC, and FDP after surgery were significantly lower in the ulinastatin group than in the control group. AT was decreased in the control group but not in the ulinastatin group, with significant differences between the two groups. CONCLUSION: Ulinastatin could inhibit coagulation and fibrinolysis in abdominal surgery.

Abdomen↗

PubMed2006

Comparison between neurotropin and mepivacaine for stellate ganglion injection.

Neurotropin, a nonproteinaceous extract from the inflamed skin of rabbits inoculated with vaccinia virus, is reported to decrease pain effectively when used for stellate ganglion (SG) injection. We compared the effects of neurotropin SG injection with those of mepivacaine on pain relief, as well as comparing the side effects. One hundred and eighty-eight SG injections in 15 patients (5 with postherpetic neuralgia and 10 with sudden deafness) were performed either with 1% mepivacaine 6 ml or with neurotropin 3 ml combined with saline 3 ml in turn. Fifteen min before and after the injection, the pain score, according to a visual analog scale (VAS; only in patients with postherpetic neuralgia); blood pressure; and heart rate were checked, and the number of procedures with Horner's sign was determined. VAS scores decreased significantly with both injections. Horner's sign was observed on the block side in all procedures with the mepivacaine injection, but it was seen in only 48 procedures with the neurotropin injection. Blood pressure and heart rate did not change. In conclusion, the SG injection of neurotropin decreased the VAS score in postherpetic neuralgia to the same extent as mepivacaine. The incidence of Horner's sign was significantly lower with neurotropin than with mepivacaine.

Adult↗

PubMed2006

Effects of the electrode temperature of a new monitor, TCM4, on the measurement of transcutaneous oxygen and carbon dioxide tension.

The transcutaneous measurement of oxygen (tcP(O2)) and carbon dioxide (tcP(CO2)) tensions may serve as a surrogate of arterial oxygen (Pa(O2)) and carbon dioxide (Pa(CO2)) tensions, respectively. We investigated the effects of the electrode temperature of a new device, TCM4, on the measurement of tcP(O2) and tcP(CO2). Twenty-five patients scheduled for major lower abdominal surgery were enrolled. The electrode of the TCM4 was attached to the chest, with its temperature set to 37 degrees C, 40 degrees C, 42 degrees C, 43 degrees C, or 44 degrees C. tcP(O2), tcP(CO2), end-tidal carbon dioxide tension (Et(CO2)), Pa(O2), and Pa(CO2) were simultaneously measured at various Et(CO2) levels and inhaled oxygen concentrations. The times required for stabilization of the tcP(O2) and tcP(CO2) values were measured. A Bland-Altman plot was used to compare the two measurements. The time required for stabilization was shorter with a higher electrode temperature, but the shortest time was still more than 150 s. TcP(O2) correlated well with Pa(O2) at 43 degrees C and 44 degrees C. TcP(CO2) correlated well with Pa(CO2) and Et(CO2) at 43 degrees C. The bias and limits of agreement were larger with lower electrode temperature for TcP(O2)--Pa(O2), tcP(CO2)--Pa(CO2), and tcP(CO2)-Et(CO2). We concluded that the electrode of the TCM4 should be heated to at least 43 degrees C to measure tcP(O2) and tcP(CO2). However, the absolute values of tcP(O2) and tcP(CO2) could not be used as surrogate measurements of Pa(O2) and Pa(CO2), respectively.

Adult↗

PubMed2006

Antithrombin can modulate coagulation, cytokine production, and expression of adhesion molecules in abdominal aortic aneurysm repair surgery.

We investigated the effects of antithrombin on coagulation, fibrinolysis, and production of cytokines and adhesion molecules in abdominal aortic aneurysm repair surgery. Sixteen patients for Y-shaped graft replacement of abdominal aortic aneurysm were divided into an antithrombin group and a control group. In the antithrombin group, 3000 U antithrombin was infused over 30 min before heparin administration and 24 h later. White blood cell counts, platelet counts, prothrombin time ratio, and serum concentrations of antithrombin, polymorphonuclear leukocyte elastase, interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor-alpha, and adhesion molecules, and variables of coagulation and fibrinolysis were measured before surgery, at the end of surgery, and 1 and 2 days after surgery. The antithrombin concentration decreased in the control group, whereas it increased in the antithrombin group with significant differences between the groups. Prothrombin time ratio, concentrations of d-dimer, thrombin-antithrombin complex, and intercellular adhesion molecule-1 increased only in the control group and polymorphonuclear leukocyte elastase, IL-6, tumor necrosis factor-alpha, and vascular cell adhesion molecule-1 increased in both groups. They were significantly less in the antithrombin group except for intercellular adhesion molecule-1. In conclusion, antithrombin could decrease hypercoagulation and inflammatory activation during abdominal aortic aneurysm surgery, which may decrease adverse events.

Aged↗

PubMed2006

[A case of sudden occurrence of complete left bundle branch block during emergency surgery].

We experienced a case of sudden occurrence of complete left bundle branch block during emergency surgery. A 59-year-old man suffered from facial bone fracture and eye ball injury. Repair of facial bone and removal of eye ball surgery were scheduled. Chest X-ray, echocardiography, blood counts and laboratory data were within normal limits. Awake intubation was performed. Anesthesia was maintained with 2-3% sevoflurane in 1 l x min(-1) of oxygen and 2 l x min(-1) of nitrous oxide. After induction of anesthesia, tracheostomy was performed with combined use of local anesthesia with 6 ml of 1% lidocaine with 1/200000 epinephrine. Then removal of eye ball surgery was started and finished uneventfully. During repair of facial bone fracture, we found an unexpected complete left bundle branch block. After rapid infusion of 1000 ml acetic Ringer's solution, the complete left bundle branch block disappeared. After surgery, mannitol administration at the previous hospital was noticed. Complete left bundle branch block in this case might have been induced by hypovolemia and hyperpotassemia due to osmotic diuresis by mannitol.

Bundle-Branch Block↗

PubMed2006

[Anesthetic management of a morbidly obese patient with mental retardation].

We report successful anesthetic management of a morbidly obese patient with mental retardation employing inhalation induction with sevoflurane in sitting position and epidural catheterization using ultrasound sonography. Inhalation induction with sevoflurane keeps spontaneous respiration and induction in sitting position may provide a greater margin of safety for airway control. Therefore, this method of induction is useful for morbidly obese patient. Regional anesthesia in an obese patient can be technically challenging because of difficulties in identifying the useful body landmarks. We successfully used ultrasound sonography to identify spinous process and could insert an epidural catheter at the right place.

Adult↗

PubMed2005

The use of a supercooling refrigerator improves the preservation of organ grafts.

Current medical transplantation confronts major problems such as the shortage of donors and geographical restrictions that inhibit efficient utilization of finite donor organs within their storage lives. To overcome these issues, expanding organ preservation time has become a major concern. We investigated whether a strategy which best preserves organ grafts can be achieved by the use of a newly developed refrigerating chamber, which is capable of establishing a supercooled and unfrozen state stably by generating an electrostatic field in its inside. When adult rat organs such as heart, liver, and kidneys were stored in the supercooled conditions, the levels of major biochemical markers leaked from the preserved organs were significantly lower than in the ordinary hypothermic storage. No apparent tissue damages were observed histologically after the supercooled preservation. Our results suggest that the use of this supercooling refrigerator improves organ preservation and may provide an innovative technique for human organ transplantation.

Animals↗

PubMed2005

Effects of a 5-HT2A receptor antagonist, sarpogrelate on thermal or inflammatory pain.

The effects of intrathecally and systemically administered 5-hydroxytriptamine (5-HT)(2A) receptor antagonist, sarpogrelate on acute thermal or formalin induced pain were examined. Male Sprague-Dawley rats with lumbar intrathecal catheters were tested with their tail withdrawal response to thermal stimulation (tail flick test) or their paw flinching and shaking response by subcutaneous formalin injection into the hind paw (formalin test) after intrathecal or intraperitoneal administration of sarpogrelate. 5-HT(2A) receptor agonist was used to antagonize the effects of sarpogrelate. In the tail flick test, only intraperitoneal administration induced analgesia. In the formalin test, both intrathecal and intraperitoneal administration were analgesic. The analgesic effects were inhibited by pretreatment with 5-HT(2A) receptor agonist. Motor disturbance and behavioral side effects were not observed. In conclusion, sarpogrelate might be analgesic on inflammatory induced acute and facilitated pain by intrathecal or systemic administration. However, only systemic administration could be effective on thermal induced acute pain.

Analgesics↗

PubMed2005

Cardiac output by PulseCO is not interchangeable with thermodilution in patients undergoing OPCAB.

PURPOSE: To investigate the reliability of cardiac output assessed by arterial pressure waveform (PulseCO) in comparison with bolus thermodilution measurements in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS: 23 patients who underwent OPCAB were enrolled in this study. After premedication with oral diazepam 10 mg, anesthesia was induced with midazolam, fentanyl and vecuronium. After induction, radial artery and pulmonary artery catheters were inserted. Cardiac output was measured simultaneously by the PulseCO and the bolus thermodilution method using the Vigilance monitor: 1) after sternotomy, 2) after opening the mediastinum, and 3) at the end of surgery. The PulseCO was calibrated initially with cardiac output determined by the thermodilution method after induction of anesthesia. RESULTS: The correlation coefficients between the two techniques at the three measurement periods were: 1) R2 = 0.49, 2) R2 = 0.52, 3) R2 = 0.55. The limits of agreement (bias +/- 2 SD of bias) were: 1) 0.71 +/- 2.66, 2) 0.30 +/- 1.97, 3) 0.76 +/- 3.85 L.min(-1). CONCLUSIONS: Cardiac output by PulseCO is not interchangeable with cardiac output measured by thermodilution in patients undergoing OPCAB.

Aged↗

PubMed2005

Hemodynamic and catecholamine response to a rapid increase in isoflurane or sevoflurane concentration during a maintenance phase of anesthesia in humans.

PURPOSE: The purpose of this study was to compare hemodynamic and catecholamine changes due to a sudden increase in inhalation anesthetic concentrations (isoflurane and sevoflurane) during surgery. METHODS: Thirty patients aged 40-70 years scheduled for lower abdominal surgery were anesthetized with either isoflurane or sevoflurane with nitrous oxide and epidural block. During surgery the isoflurane or sevoflurane concentration was kept at 0.5 minimum alveolar concentration (MAC) (end-tidal concentration) for 15 min. Then the isoflurane or sevoflurane concentration (inhalation concentration) was changed to 1.5 MAC and maintained at that level for 10 min. Thereafter, it was decreased to 0.5 MAC for 10 min. Blood pressure, heart rate, and plasma concentrations of epinephrine and norepinephrine were measured. RESULTS: The blood pressure decreased significantly in both groups after increasing the anesthetic concentration, and it increased after decreasing the concentration. The decrease in systolic blood pressure was significantly larger in the isoflurane group. The heart rate increased significantly after increasing the anesthetic concentration only in the isoflurane group. Plasma concentrations of epinephrine and norepinephrine increased significantly in the isoflurane group, whereas the epinephrine concentration (but not the norepinephrine concentration) decreased in the sevoflurane group. CONCLUSION: During surgery a sudden increase in isoflurane concentration induced larger changes in hemodynamics and sympathetic nerve activity than sevoflurane.

Abdomen↗

PubMed2005

Comparison of the intracuff pressures of three different tracheostomy tubes.

The purpose of this study was to compare the cuff pressures of three tracheostomy tubes, MERA sofit CLEAR, Blue Line Tracheostomy Tube, and Tracheosoft. Each tracheostomy tube with an internal diameter of 7.0 mm was put into a plastic column. The cuff was then inflated with air to seal the column, and the column was filled with water. The air in the cuff was withdrawn gradually and the cuff pressure at the point of water leakage was measured. Six columns of different size were used. In columns with an internal diameter of 18-21 mm, the water leakage pressure was lower in the following order: MERA sofit CLEAR < Tracheosoft < or = Blue Line Tracheostomy Tube. A mongrel dog was tracheotomized, and each tracheostomy tube with an internal diameter of 7.5 mm was intubated. The cuff air was increased by 1 ml from 4 ml to 10 ml, and the intracuff pressure was then measured. The intracaff pressure of the Blue Line Tracheostomy Tube was the highest at the same cuff volume, and that of the Tracheosoft was next. Based on these results, the MERA sofit CLEAR was found to maintain most safely the lowest intracuff pressure to seal the trachea among the three tracheostomy tubes tested.

Animals↗

PubMed2005

How to decrease pain at rapid injection of propofol: effectiveness of flurbiprofen.

PURPOSE: Many studies have been conducted on how to decrease propofol injection pain, but none has been completely successful. In the present study, the most effective method was investigated by adding lidocaine or a nonsteroidal antiinflammatory drug or by changing the solvent. METHODS: A total of 250 patients scheduled for general anesthesia were divided into five groups. Anesthesia was induced with intravenous administration of flurbiprofen 50 mg followed immediately by propofol in a long-chain triglyceride (LCT) 2 mg.kg(-1) (flurbiprofen group, n = 50), flurbiprofen 50 mg followed by propofol LCT 2 mg.kg(-1) 1 min later (flurbiprofen 1 group, n = 50), 2% lidocaine 40 mg followed immediately by propofol LCT 2 mg.kg(-1) (lidocaine group, n = 50), propofol LCT 2 mg.kg(-1) alone (LCT group, n = 50), or propofol in a mixture of medium-chain triglyceride (MCT) and LCT 2 mg.kg(-1) (MCT/LCT group, n = 50). Pain at injection was assessed 10 and 20 s after starting the propofol infusion. RESULTS: The numbers of patients with severe and mild pain were larger in the order: LCT group (10 and 31 patients, respectively) > flurbiprofen 1 group (3 and 19) > or = MCT/LCT group (1 and 14) > or = lidocaine group (2 and 11) > flurbiprofen group (0 and 0). CONCLUSIONS: Flurbiprofen 50 mg i.v. just before propofol injection completely abolished propofol injection pain. When it was administered 1 min before propofol injection it was less effective.

Adult↗

PubMed2005

Blood flow velocity of the femoral vein with foot exercise compared to pneumatic foot compression.

STUDY OBJECTIVE: To compare the effects of foot exercise with an intermittent pneumatic foot compression (IPC) device on blood flow velocity of the femoral veins. DESIGN: Prospective, controlled study. SETTING: General intensive care unit of a university hospital. PATIENTS: 20 patients on bed rest in the intensive care unit. INTERVENTIONS: Patients were divided into 2 groups: group A, foot exercise (n = 10); and group B, IPC device (n = 10). The foot exercise was done once by a nurse for 5 minutes with the dorsiflexion of the ankle (15 times per minute) in group A patients. The IPC device (A-V Impulse System, compression setting: 130 mm Hg for 3 seconds followed by a resting period of 60 seconds) was used for 2 hours in group B. MEASUREMENTS: Peak blood flow velocity of the femoral vein was measured using the ultrasound unit with a 7.5-MHz linear array probe (ALOKA SSD-5500) at 0, 5, 15, 30, 60, and 120 minutes. MAIN RESULTS: Peak blood flow velocities in both groups increased significantly vs the control values during the study. At 5 minutes, group A showed a significant increase in the peak blood flow velocity compared with group B. CONCLUSIONS: Foot exercise by a nurse for 5 minutes was equally or more effective compared with the IPC device in increasing peak blood flow velocity of the femoral vein. The effect of the 5-minute foot exercise lasted for 2 hours.

Aged↗

PubMed2005

Stress hormone changes in general anesthesia of long duration: isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia.

STUDY OBJECTIVE: There are few comparative studies of stress hormone changes during general anesthesia with long duration between isoflurane-nitrous oxide and sevoflurane-nitrous oxide anesthesia. We investigated perioperative changes of stress hormone in these two anesthetic methods with duration of more than 10 hours. DESIGN: Prospective study. SETTING: Operating room and high care unit of a university hospital. PATIENTS: Twenty patients with ASA physical status I or II for surgery for laryngeal or pharyngeal cancer with expected duration of more than 10 hours. INTERVENTIONS: Anesthesia was induced with midazolam, thiopental, and vecuronium and was maintained with sevoflurane (sevoflurane group) or isoflurane (isoflurane group) with nitrous oxide 4 L/min in oxygen 2 L/min. MEASUREMENTS AND MAIN RESULTS: Plasma concentrations of epinephrine, norepinephrine, cortisol, adrenocorticotropic hormone, and anti-diuretic hormone (ADH); serum concentrations of glucagon and insulin; and blood glucose concentration were measured before inhalation of anesthetics, after 5 and 10 hours, and at 1, 6, and 12 hours after the end of inhalation. Epinephrine and norepinephrine concentrations increased continuously during and after surgery in the isoflurane group whereas it increased only after surgery in the sevoflurane group. Both concentrations were higher in the isoflurane group during anesthesia. Cortisol increased continuously whereas adrenocorticotropic hormone increased only during surgery. Anti-diuretic hormone increased with its peak during surgery and the isoflurane group had significantly higher values than the sevoflurane group. Glucose increased both during and after surgery, insulin increased only after surgery, and glucagon decreased during surgery in both groups. CONCLUSIONS: In inhalation anesthesia with the duration of more than 10 hours, isoflurane-nitrous oxide and sevoflurane-nitrous oxide had the same effects on stress hormone changes except for epinephrine, norepinephrine, and ADH. Epinephrine, norepinephrine, and ADH concentrations were higher in isoflurane-nitrous oxide anesthesia.

Adrenocorticotropic Hormone↗

PubMed2005

A comparison of the rate of bacterial contamination for prefilled disposable and reusable oxygen humidifiers.

BACKGROUND: Prefilled disposable oxygen humidifiers are considered to prevent nosocomial pneumonia in hospital wards. However, their usefulness in intensive care units (ICUs) has not yet been established. In this study, we evaluated and compared contamination in prefilled disposable oxygen humidifiers and that in reusable oxygen humidifiers. METHODS: Six oxygen outlets in the ICU were used. Prefilled disposable oxygen humidifiers and reusable oxygen humidifiers were attached to each wall-mounted oxygen outlet using a 2-way connector. Nonsterile nasal cannulae and tubes were connected to the humidifiers through which 5 L/min of oxygen was delivered continuously. Water samples (5 mL) from each humidifier were collected on the first day and every 7 days thereafter for a period of 56 days. Each water sample was incubated aerobically at 35 degrees C for 48 hours and observed daily for bacterial growth. RESULTS: Bacterial growth was observed only once in one sample from each humidifier type. Gram-positive cocci, 40 colony-forming units in the disposable oxygen humidifier and 10 colony-forming units in the reusable oxygen humidifier, were detected. Dust was observed from the 35th day onward only in the reusable oxygen humidifier. CONCLUSION: In the ICU, bacterial contamination does not occur in oxygen humidifiers even after 56 days of continuous use. However, dust does accumulate in the reusable oxygen humidifier after 35 days of continuous use.

Equipment Contamination↗

PubMed2005

Spinal cord blood flow change by intravenous midazolam during isoflurane anesthesia.

We investigated the effects of IV midazolam on spinal cord blood flow in 32 cats anesthetized with isoflurane. Cats underwent laminectomy, and the lumbar spinal cord was exposed. A platinum electrode was inserted stereotaxically into the spinal cord to a depth of 1 mm-2 mm lateral to midline at L2. Arterial blood pressure, heart rate, and spinal cord blood flow (using the hydrogen clearance method) were measured before and at 5, 15, 30, 60, 90, and 120 min after an IV bolus of midazolam (0, 1, 2, or 4 mg/kg in saline 5 mL; n = 8 cats per dose). Arterial blood pressure was not affected by 0 or 1 mg/kg of midazolam but was decreased for 30 min by 2 or 4 mg/kg of midazolam. Heart rate did not change. Spinal cord blood flow was increased for 90 min by midazolam 1 mg/kg and for 15 min by midazolam 2 mg/kg but was not changed by midazolam 4 mg/kg. In conclusion, 1 mg/kg of midazolam increased feline spinal cord blood flow without changing arterial blood pressure. In contrast, a larger dose of midazolam (4 mg/kg) did not change spinal cord blood flow but substantially decreased arterial blood pressure during isoflurane anesthesia.

Adjuvants, Anesthesia↗