Biomedical subjects
W Ueda
Publications and source records attributed to W Ueda.
Intra-articular injection of warmed lidocaine improves intraoperative anaesthetic and postoperative analgesic conditions.
BACKGROUND: Although local anaesthesia for knee arthroscopy is a well-documented procedure, arthroscopy under local anaesthesia is often interrupted because of intolerable discomfort and pain. Warming local anaesthetic solutions may increase its anaesthetic effect. We tested whether intra-articular injection of warmed lidocaine solution could improve intraoperative anaesthetic and postoperative analgesic conditions. METHODS: Patients in the warmed group received 20 ml warmed (40 degrees C) lidocaine 1% intra-articularly 20 min before surgery. The patients in the control group received 20 ml room-temperature (25 degrees C) lidocaine 1% intra-articularly 20 min before surgery. During surgery, the patients reported pain on a visual analogue scale (VAS). RESULTS: The median VAS pain score was 1.5 (range, 0.0-3.0) in the warmed lidocaine group and 5.0 (4.0-8.0) in the control group (P<0.001). The median intra- and postoperative analgesic requirements in the control group were significantly greater than that in the warmed group. CONCLUSION: Warmed lidocaine injected intra-articularly provides improved intraoperative anaesthetic and postoperative analgesic conditions for patients undergoing knee arthroscopy.
Pre-anesthetic presence of an injured dam influences pups' locomotor behavior during emergence from anesthesia in rats.
BACKGROUND: Pre-anesthetic mother-infant interaction is an important factor for smooth emergence of pediatric anesthesia. In many mammalian species, disruptions of the mother-infant relationship cause psychological and behavioral changes. This study was to investigate whether or not pre-anesthetic presence of an injured dam has an impact on locomotor behavior of rat pups. METHODS: We used a video-tracking system to test the effects of pre-anesthetic relations between pups and their dams on pups' locomotor behavior during emergence from general anesthesia, in 40 3-week-old Sprague-Dawley male rats. Pups were divided into two groups: pups housed with a dam (n = 20) and those housed with an injured dam (n = 20). Pups were anesthetized with 1.2% halothane for 30 min. At emergence, we recorded their locomotor behavior for 15 min. RESULTS: Pre-anesthetic manipulation to dams significantly increased the distance traveled by pups. However, the manipulation did not cause any difference in the maximum velocity. CONCLUSION: Pre-anesthetic presence of an injured dam influenced pups' locomotor behavior at emergence from anesthesia.
Pre-anesthetic maternal separation increases pups' locomotor behavior during emergence from anesthesia in rats.
BACKGROUND: Problematic behavior at emergence from anesthesia in children, partly linked with maternal separation, is a major problem in pediatric anesthesia. In humans, as well as in many other mammalian species, such separation causes psychological and behavioral changes. This study was to investigate whether or not pre-anesthetic maternal separation has a similar effect on rat pups. METHODS: This study was conducted on 66 3-week-old Sprague-Dawley male rats. The rats were divided into two groups; pups housed with a dam (n = 33) and those housed without (n = 33). Pups were anesthetized with 1.2% halothane for 30 min. Afterwards we recorded their locomotor behavior at emergence from general anesthesia using a video tracking system. RESULTS: Pre-anesthetic maternal separation significantly increased the maximum velocity and the distance traveled by pups at the emergence. CONCLUSION: Pre-anesthetic maternal separation influenced pups' locomotive behavior at emergence.
Preoperative stellate ganglion blockade prevents tourniquet-induced hypertension during general anesthesia.
BACKGROUND: Prolonged and excessive inflation of pneumatic tourniquets leads to a hyperdynamic circulatory response. Sympathomimetic activity is an important factor in tourniquet-induced hypertension. Stellate ganglion block specifically blunts sympathetic efferent nerves and prevents hypertension induced by sympathomimetic stimulation. The present study was performed to investigate the effects of stellate ganglion block (SGB) on arterial pressure and heart rate during prolonged tourniquet use under general anesthesia. METHODS: Twenty patients scheduled for knee arthroscopy were either treated with 10 ml of 1% lidocaine for SGB (SGB group; n = 10), or intramuscular injection (IM group; n = 10) before tourniquet inflation. Comparisons of systolic and diastolic arterial pressure and heart rate were made before and after the induction of anesthesia, 10 min after the lidocaine treatment, every 5 min during the first 60 min after tourniquet inflation, and immediately before and 5 min following deflation. The maximum values of the circulatory variables were compared. RESULTS: Tourniquet inflation caused increases in the circulatory variables in both groups. Systolic arterial pressure in the SGB group was significantly lower than that in the IM group after 55 min of tourniquet inflation. Diastolic arterial pressure also was significantly lower in the SGB group immediately before the deflation. The maximum values of the three hemodynamic variables were significantly lower in the SGB group. Arterial pressure significantly decreased after tourniquet deflation in the IM group. CONCLUSION: Ipsilateral SGB attenuated the hyperdynamic response mediated by prolonged tourniquet inflation during knee arthroscopy.
Rhinorrhea by nasal fentanyl.
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Syringe labels using an empty drug ampoule.
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Haemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anaesthesia.
We measured the haemodynamic effects of changing from the supine position to the lateral decubitus (lateral) position, and then to the kidney rest lateral decubitus (kidney) position in 12 patients undergoing nephrectomy under isoflurane anaesthesia. Eight control patients undergoing pulmonary surgery remained in the lateral position. The lateral position produced no significant changes. In the kidney position, however, significant reductions occurred in the mean arterial (P < 0.01), right atrial (P < 0.05) and pulmonary artery wedge pressures (P < 0.01). There were also significant reductions in cardiac index (from 3.04 (SD 0.21) to 2.44 (0.26) litre min-1 m-2, P < 0.01) and stroke volume index (from 40 (5) to 31 (5) ml beat-1 m-2, P < 0.01). The systemic vascular resistance index increased significantly (P < 0.05). Cardiac output was probably reduced by a decrease in venous return and an increase in systemic vascular resistance.
Induction of anaesthesia in the lateral decubitus position in morbidly obese patients.
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Abrupt onset of adrenal crisis during routine preoperative examination in a patient with unknown Addison's disease.
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Norepinephrine for cardiopulmonary resuscitation during epidural block.
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Increased production of interleukin-10 by human blood monocytes stimulated with Mycobacterium avium-intracellulare complex.
Macrophages produce various cytokines in response to mycobacteria, including interleukin 10 (IL-10) and tumor necrosis factor alpha (TNF-alpha). IL-10 has been shown to down-regulate numerous macrophage functions, including microbicidal activity against intracellular bacteria and parasites. IL-10 also inhibits interferon-gamma (IFN-gamma) production and antigen-specific proliferation of Th1 cells mediating immunologic resistance to mycobacterial infection. In contrast, TNF-alpha activates macrophages and may augment their mycobacterial activity. In this study, peripheral blood mononuclear cells (PBMC) or blood monocytes obtained from healthy tuberculin reactors were stimulated in vitro with heat-killed Mycobacterium tuberculosis or heat-killed M. avium-intracellulare complex (MAC) to produce IL-10 and TNF-alpha. We studied a total of 26 clinical isolates of M. tuberculosis and 28 isolates of MAC. MAC-stimulated PBMC and monocytes released significantly larger amounts of IL-10 than those cells stimulated with M. tuberculosis. However, there was no difference in induction of TNF-alpha production between MAC and M. tuberculosis. When TNF-activity was neutralized by the addition of anti-TNF-alpha mAb in culture, MAC still induced more IL-10 secretion than did M. tuberculosis. These findings suggest that increased production of IL-10 by MAC-stimulated monocytes may play a role in the intractable disease caused by these organisms.
[A case of pheochromocytoma incorrectly diagnosed before and during surgery].
In a patient with an adrenal tumor, although norepinephrine levels in the blood and urine were abnormally high, findings in CT and 131 I-MIBG scintigraphy denied pheochromocytoma. The preoperative diagnosis was metastatic adrenal tumor. The surgical manipulation of the tumor increased the blood pressure from 110/60 to 210/110 mmHg. However, intraoperative microscopic examination in frozen section excluded again possibility of pheochromocytoma. Later, findings in the permanent specimen confirmed that the tumor was pheochromocytoma. The problem of this case was that each specialist made judgment only on the subject of his own interest without considering of the patient's status as a whole. Anesthesiologist should have the ability to make preoperative assessment of a patient by using all available information with his unbiased mind.
Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys.
BACKGROUND: In the authors' clinical experience, preschool children are more likely to show delirium after sevoflurane than are older children. METHODS: Sixty-three preschool boys aged 3-5 yr (classified as American Society of Anesthesiologists [ASA] physical status I), and 53 school-age boys aged 6-10 yr (ASA physical status I) who underwent minor urologic surgery were randomly assigned to receive either halothane or sevoflurane, thus creating four groups: preschool-halothane (n = 32), preschool-sevoflurane (n = 31), school-halothane (n = 27), and school-sevoflurane (n = 26). Anesthesia was induced by inhalation of halothane or sevoflurane in oxygen and was maintained at 1 minimum alveolar concentration of each agent throughout surgery. For intra- and postoperative analgesia, caudal block with 0.5-1.0 ml/kg 0.25% plain bupivacaine and topical infiltration with 3-5 ml 1% lidocaine were provided for all patients. Recovery characteristics and incidence of delirium on emergence were compared among the four groups. RESULTS: Two patients in the preschool-halothane group, one in the preschool-sevoflurane group, and one in the school-halothane group were excluded from the comparison because of insufficient analgesia or agitation before induction. In both age groups, the time to emergence from sevoflurane was significantly faster (about 3 min) than from halothane. The incidence of delirium during recovery in the preschool-sevoflurane group (40%) was significantly greater than that in the other groups (preschool-halothane, 10%; school-halothane, 15.4%; school-sevoflurane, 11.5%). CONCLUSION: Sevoflurane provided quicker emergence and early recovery compared with halothane, but the incidence of delirium was greater in preschool boys after sevoflurane.
Differences in hormonal responses to preoperative emotional stress between preschool and school children.
BACKGROUND: The behavior of children under emotional stress differs according to whether they are of preschool or school age. METHODS: To examine the effect of age on hormonal responses to preoperative emotional stress, we measured the concentrations of catecholamines (adrenaline and noradrenaline) and cortisol in 56 healthy boys before surgery. RESULTS: Among preschool boys (3-5 years old), those showing anxious behavior showed significantly higher cortisol, adrenaline, and noradrenaline concentrations in the blood circulation than those not showing such behavior (P < 0.0001, P < 0.0001 and P < 0.005, respectively). However, among the schoolboys (6-11 years old), anxiety was associated only with the cortisol concentration (P < 0.01). CONCLUSION: Hormonal responses to preoperative emotional stress in preschool boys differ from those in schoolboys.
Unsuspected pheochromocytoma of the urinary bladder.
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Ephedrine-induced increases in arterial blood pressure accelerate regression of epidural block.
We investigated the hypothesis that ephedrine-induced increases in blood pressure accelerate the regression of epidural block. In patients undergoing minor gynecologic surgery, we performed lumbar epidural blockade using 2% lidocaine containing 1:200,000 epinephrine to which was added 0.1 mg of fentanyl. Eighty minutes after the epidural injection, we started an ephedrine infusion to increase the systolic blood pressure by 20% in 10 min and maintained the value for the following 20 min. Then we compared the proximal extent of sensory analgesia at 80 min with that at 140 min. Ephedrine significantly (P = 0.001) hastened the regression of sensory analgesia. We conclude that an ephedrine-induced blood pressure increase accelerates regression of epidural blockade.
Local anesthetics enhance nitric oxide production by human peripheral neutrophils.
Various neutrophil functions are suppressed by local anesthetics. We studied the effect of local anesthetics on nitric oxide (NO) generation in human peripheral neutrophils. Lidocaine and other local anesthetics stimulated NO generation in resting neutrophils. Canavanine, an NO synthase inhibitor, inhibited NO generation. Lidocaine and the other local anesthetics enhanced formylmethionyl-leucyl-phenylalanine (FMLP) or phorbol myristate acetate (PMA)-induced NO generation. These findings suggest that NO mediates various pharmacological effects of the local anesthetics on the host defense mechanism and the control of blood pressure.