Biomedical subjects

Tomoki Nishiyama

Publications and source records attributed to Tomoki Nishiyama.

59 records · Page 4Linked to original sources

PubMed2002

Accidental overdose of midazolam as intramuscular premedication.

We report two cases of overdoses of intramuscular midazolam used as a premedication. Both cases had no resedation or complications, but the accidents happened as a result of a resident and nurse's lack of experience with midazolam. The intramuscular doses, given at four times the normal quantity, fortunately caused no harm in our cases. However, the situations suggest that we should carefully check the dosage and review the correct procedures, even when using a drug that is considered to be familiar with most practitioners.

Adjuvants, Anesthesia↗

PubMed2002

The median approach to transsacral epidural block.

UNLABELLED: Transsacral epidural block may be useful for surgery or cancer pain affecting the rectal, anal, or urethral region. The procedure through the dorsal sacral foramen is difficult because of the long insertion route. We investigated whether the transsacral epidural block could be simplified by using a median approach instead of a lateral approach through the foramen. Thirty patients for transurethral resection of bladder tumor had a catheter placed 5 cm cephalad at S2-3 (15 patients) or caudal (15 patients) epidural space using a 19-gauge Tuohy needle by the median approach. Lidocaine 2% 15 mL was administered for anesthesia. Anesthesia level (sensory block to cold), hemodynamics, and side effects were compared between the two approaches. The success rate of anesthesia was 87% for transurethral resection of bladder tumor (proximal anesthesia level higher than T10) and 100% for the sacral region (S1-5) in both groups. The highest level of anesthesia (median, T8 in the S2-3 group and T9 in the caudal group) was obtained in 20 min in both groups. No side effects were observed. We conclude that the median transsacral epidural approach is technically feasible in adults and presents an alternative to caudal block. IMPLICATIONS: The median approach to transsacral epidural block has been described in children. We found that it is technically feasible in adults and presents an alternative to caudal block for procedures on the rectal, anal, or urethral region.

Aged↗

PubMed2002

[High dose L-dopa infusion during general anesthesia for gastrectomy in a patient with parkinsonism].

A 68-year-old man with parkinsonism was scheduled for gastrectomy. Levodopa 1400 mg, droxidopa 300 mg and bromocriptine-mesylate 7.5 mg had been administered orally per day to control the symptom before surgery. On the day before surgery, oral medication was stopped and intravenous infusion of levodopa 100 mg.h-1 was started. Without any premedication but with levodopa infusion, anesthesia was induced with thiopental 175 mg and fentanyl 0.05 mg. Tracheal intubation was facilitated with vecuronium 6 mg and an epidural catheter was inserted. Anesthesia was maintained with O2, N2O and sevoflurane, combined with epidural block using mepivacaine. When blood pressure decreased, phenylephrine but not ephedrine was effective to increase blood pressure. Intravenous infusion of levodopa was continued for 19 days with decreasing doses from 8th postoperative day when injection of levodopa into the intestinal tube was started. On the 53rd day, he left the hospital without any complications. Serum concentrations of levodopa during and after surgery were 50 to 100 times higher than the therapeutic levels. However, he developed no complications, which suggests a wide safety range of levodopa. In conclusion, high dose levodopa infusion was effective in controlling the symptoms of Parkinsonism during general anesthesia.

Aged↗

PubMed2002

[A simple lightweight device for measurement of low hemoglobin concentrations: the Hemo Cue Low Hemoglobin Photometer].

To determine low hemoglobin concentrations in the washed fluid is useful for calculation of blood loss and that in the supernatant is also useful for evaluation of hemolysis during extracorporeal circulation or in the blood preparations. The HemoCue Low Hemoglobin Photometer is a new lightweight device, which is easily movable anywhere and is able to determine hemoglobin concentration in low ranges (0.03-3.00 g.dl-1). We investigated the accuracy and reliability of the HemoCue Low Hemoglobin Photometer. Blood samples were diluted with saline containing heparin into six tubes. The hemoglobin concentrations of each diluted sample were measured by the HemoCue Low Hemoglobin Photometer, and were compared with the calculated values. A high positive correlation was found between the values measured by the HemoCue Low Hemoglobin Photometer (Y) and the calculated values (X); Y = 1.047 X, r = 0.999, P < 0.0001. It took only 11-54 seconds (mean value: 31.4 seconds) for the measurement. It is concluded that the HemoCue Low Hemoglobin Photometer is a reliable and useful device for measurement of low hemoglobin concentration.

Evaluation Studies as Topic↗

PubMedDate not supplied

The A-line ARX index may be a more sensitive detector of arousal than the bispectral index during propofol-fentanyl-nitrous oxide anesthesia: a preliminary investigation.

PURPOSE: To compare changes in the A-line ARX index (AAI) by the Alaris AEP monitor(TM) with those of the bispectral index (BIS) during propofol-fentanyl-nitrous oxide anesthesia. METHODS: Eighty female patients undergoing partial mastectomy were randomly allocated to AAI or BIS (40 per group). Anesthesia was induced with propofol 2 mg x kg(-1) and fentanyl 3 micro g x kg(-1) during the inhalation of oxygen. A laryngeal mask airway (LMA) #3 was inserted. Anesthesia was maintained with propofol 4 mg x kg(-1) x hr(-1), fentanyl 1 micro g x kg(-1) given at the start of surgery, and nitrous oxide 4 L x min(-1) in oxygen 2 L x min(-1). Blood pressure, heart rate, and AAI or BIS were monitored, including recovery time of the index after disturbance by electrocautery. RESULTS: The AAI but not the BIS increased significantly with LMA insertion and skin incision, while blood pressure and heart rate did not change. The BIS decreased from 87 +/- 7 to 30-60 while the AAI decreased from 75 +/- 8 to 10-25 during anesthesia. The increase of the AAI was larger than that of the BIS at recovery from anesthesia. The variation of the index was smaller in the AAI than in the BIS. Recovery time of the index after electrocautery was significantly longer in the BIS group (21 +/- 9 sec) than that in the AAI group (5 +/- 3 sec). CONCLUSIONS: During propofol-fentanyl-nitrous oxide anesthesia, the AAI responded to LMA insertion or surgical incision, but not the BIS, and the AAI had smaller variations. The AAI recovered faster from the disturbance by electrocautery than the BIS. Thus, the AAI may be a more sensitive and useful detector of arousal than the BIS.

Adult↗