Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks.

[Reversal of neuromuscular blockade and complications of remaining blocking effect].

We Japanese anesthesiologists can now use rocuronium as well as vecuronium. Although the onset of rocuronium is more rapid, the non-depolarizing neuromuscular blocking (NMB) agent has similar characteristics of duration and recovery compared to vecuronium. Reversal of NMB is therefore essential to recover patients safely.

Urinary bladder and oesophageal temperatures correlate better in patients with high rather than low urinary flow rates during non-cardiac surgery.

Background And Objective: To investigate the effect of urinary flow rate on the urinary bladder temperature, we compared the accuracy and precision of urinary bladder temperature with oesophageal temperature at both high and low urine flow rates.

Methods: Twenty-four patients ASA physical status I or II who were undergoing tympanoplasty were randomly assigned to two groups with different intravenous fluid volumes: high (10 mL kg(-1) h(-1), n = 12) and low (3 mL kg(-1) h(-1), n = 12). General anaesthesia was induced with propofol and maintained with sevoflurane (1.

Isovolaemic haemodilution decreases the shivering threshold in rabbits.

Background And Objective: The inhibition of thermoregulatory control by anaesthesia is manifested by reduced vasoconstriction and shivering thresholds. As intraoperative bleeding can result in haemodynamic changes, including vasoconstriction, we investigated the effect of experimental bleeding on the shivering threshold in rabbits.

Methods: Twenty-four rabbits were randomly assigned to one of three treatment strategies: (1) no blood removal (control), (2) 5 mL kg(-1) isovolaemic blood removal and (3) 10 mL kg(-1) isovolaemic blood removal.

Acute normovolemic hemodilution for radical retropubic prostatectomy and radical cystectomy.

Objectives: Radical retropubic prostatectomy (RRP) and radical cystectomy (RCx) are well tolerated and widely performed. Because intraoperative blood loss is one of the most common problems, we performed acute normovolemic hemodilution (ANH) to prevent allogenic blood transfusion (ABT). In this study we tried to clarify the safety, effectiveness and problems of ANH at urologic operations.

[Effect of aging on preoperative oxidative stress].

We investigated the effect of aging on preoperative oxidative stress by measuring serum hydroperoxide values in 35 patients who underwent elective surgery under general anesthesia. A small amount of blood was withdrawn through an intravenous catheter and serum hydroperoxide values were measured using the Free Radical Analytic System (FRAS4). Aging and oxidative stress are significantly and positively correlated (P < 0.

The usefulness of an earphone-type infrared tympanic thermometer for intraoperative core temperature monitoring.

Background: In this study we sought to determine the usefulness of a novel earphone-type infrared tympanic thermometer (IRT) for core temperature monitoring during surgery.

Methods: Two groups of patients were studied under different surgical conditions. The first group consisted of 18 adult patients (ASA I or II) who had been scheduled for elective surgery under general anesthesia.

Analysis of the composition of 'original' and generic sevoflurane in routine use.

Background: Original sevoflurane (Sevofrane) contains a small amount of water, which can inhibit the production of hydrofluoric acid. Hydrofluoric acid is highly pungent, and sevoflurane that contains a high concentration of hydrofluoric acid is not suitable for volatile induction of anaesthesia. Recently, generic sevoflurane (Sevoness) has become available in some countries.

Inhibitory effects of the alpha-2 adrenergic agonists clonidine and dexmedetomidine on enhanced airway tone in ovalbumin-sensitized guinea pigs.

Background And Objective: The alpha-2 adrenergic agonists clonidine and dexmedetomidine are used as an antihypertensive and a sedative, respectively. The aim of this study was to determine the effects of these agonists on ovalbumin-sensitized airway tone in guinea pigs.

Methods: The animals were divided into two groups: control and sensitized.

Anesthetic practice in Japan: past, present, and future.

Significant progress has been made over the past 20 years in the development of anesthetic agents and anesthetic monitors. Due to progress in the development of medical devices and the establishment of an effective medical system, advanced age alone is no longer a contraindication for surgery. However, despite approval of the volatile anesthetic sevoflurane, Japan is lagging behind other developed countries with regard to anesthetic agents.

[Usefulness of an earphone-type infrared tympanic thermometer for intraoperative core temperature monitoring].

Background: Thermometers widely used intraoperatively are invasive and non-hygienic. We developed an earphone-type infrared tympanic thermometer and evaluated its usefulness as a core temperature monitor.

Methods: Sixteen adult patients who required nonabdominal surgery under general anesthesia were enrolled in this study.

Effects of the Chinese herbal medicines Bupleuri radix, Ginseng radix, and Zingiberis rhizoma on lymphatic vessel activity in rats.

The aim of the present study was to determine the effects of the Chinese herbal medicines Bupleuri radix, Ginseng radix and Zingiberis rhizoma on spontaneous lymphatic vessel activity. The effect of each herbal medicine on in vivo lymphatic flow was examined by injection of dye into the femoral regions of rats after feeding with the herbal medicines. In an in vitro study, spontaneous changes in diameter of the rat thoracic duct were monitored, and each segment was exposed to each herbal medicine.

Different inhibitory effects of sevoflurane on hyperreactive airway smooth muscle contractility in ovalbumin-sensitized and chronic cigarette-smoking guinea pig models.

Background: The authors hypothesized that sevoflurane had different inhibitory effects on hyperreactive airway smooth muscle contractility in different types of hyperreactive airway models.

Methods: The effects of sevoflurane on hyperreactive airways in ovalbumin-sensitized and chronic cigarette-smoking guinea pig models were investigated by measuring (1) total lung resistance, (2) smooth muscle tension and intracellular concentration of free Ca, (3) voltage-dependent Ca channel activity, and (4) cyclic adenosine monophosphate levels.

Results: Ovalbumin and muscarinic airway hyperreactivity was seen in ovalbumin-sensitized animals.

[Intraoperative cardiac arrest due to coronary vasospasm after tourniquet release--a case report].

A 55-year-old man with no past history of ischemic heart disease underwent open reduction and internal fixation of the right arm because of an open fracture. Under general anesthesia with brachial plexus block, the operation was started after the upper arm had been pressurized at 280 mmHg by tourniquet. The patient had cardiac arrest 15 min after the tourniquet release, and was resuscitated by CPR.

Preferable inotropic action of procaterol, a potent bronchodilator, on impaired diaphragmatic contractility in an intraabdominal septic model.

Intraabdominal sepsis can lead to acute respiratory failure, and concomitant diaphragmatic dysfunction may be aggravated by sepsis-induced airway hyperreactivity. We previously reported that isoproterenol, a nonselective beta-adrenoceptor agonist, increased diaphragmatic contractility and accelerated recovery from fatigue during sepsis. The purpose of this study was to demonstrate the direct inotropic effect of a potent bronchodilator and beta(2)-selective adrenoceptor agonist, procaterol, on fatigued diaphragmatic contractility in an intraabdominal septic model.

Performance of three systems for warming intravenous fluids at different flow rates.

This study compared the intravenous fluid warming capabilities of three systems at different flow rates. The devices studied were a water-bath warmer, a dry-heat plate warmer, and an intravenous fluid tube warmer Ambient temperature was controlled at 22 degrees to 24 degrees C. Normal saline (0.

Anandamide absorption by direct hemoperfusion with polymixin B-immobilized fiber improves the prognosis and organ failure assessment score in patients with sepsis.

Purpose: Direct hemoperfusion (DHP) with polymixin B-immobilized fiber (PMX) has been reported to be effective for patients with septic shock. The aim of this study was to clarify the mechanism of PMX-DHP effect on septic shock.

Methods: The following parameters were measured in septic shock patients who were treated with PMX-DHP: survival rate, sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE-II) score, and plasma concentrations of cannabinoids [anandamide (ANA) and 2-arachidonyl glyceride (2-AG)], cytokines [interleukin (IL)-6, IL-8, IL-10], transforming growth factor beta (TGF-beta), and calcitonin gene-related peptide (CGRP)].

Comparative study between propofol in a long-chain triglyceride and propofol in a medium/long-chain triglyceride during sedation with target-controlled infusion.

This study was performed to compare the pharmacological characteristics of propofol in an emulsion of both medium- and long-chain triglycerides (MCT/LCT) with those of propofol in an LCT emulsion, by measuring the sedative level and the plasma concentration of propofol during sedation using a target-controlled infusion (TCI) technique. Forty ASA 1 or 2 adult patients who required spinal anaesthesia for surgery were enrolled in this study. The patients were divided into two groups: a propofol LCT group (n = 20) and a propofol MCT/LCT group (n = 20).

The type of carbon dioxide absorbent has no relation to the concentration of carbon monoxide in the breathing circuit during low-flow isoflurane anaesthesia in smoking and non-smoking subjects.

The present study was designed to investigate the concentrations of carbon monoxide (CO) in the anaesthetic circuit and of arterial carboxyhaemoglobin (COHb) during low-flow isoflurane anaesthesia in smoking and non-smoking subjects using three kinds of cardon dioxide (CO2) absorbent. Thirty smoking and 30 non-smoking subjects were selected for this study, and these two groups were each divided into three groups according to the type of CO2 absorbent used (Wakolime A, Drägersorb Free, and Amsorb). Anaesthesia was maintained with 1.

[A trial of introduction of portfolio to elective clinical clerkship in anesthesiology].

Background: Portfolio as one of the educational techniques was introduced to elective clinical clerkship (CC) of Anesthesiology in Sapporo Medical University School of Medicine in the 2003 fiscal year.

Methods: Fourteen medical students who elected Anesthesiology CC for 3 weeks had a duty to study and feed back their CC everyday by writing portfolio, and the attending checked and fed back their portfolio every week. At the end of the CC, questionnaire surveys by 5 step Likert measure and group discussion were conducted to determine the evaluation by students of the portfolio in Anesthesiology CC.