Akira Hashiguchi

Evaluation of the central nervous function in resuscitated comatose patients by multilevel evoked potentials

Multilevel evoked potentials were examined in 17 patients who became comatose after cardiac arrest and resuscitation. In 4 patients, the P1 through N3 components of the somatosensory evoked cerebral potential (SECP) were present altogether within 100 ms after the ischemic insults. They all subsequently regained consciousness, though three of them developed intelligence and motor disturbances to some extent. In 11 patients who regained consciousness, or remained in a vegetative state, the evoked potentials which reflect brainstem functions, such as the auditory evoked brainstem potential, the R1 wave of the orbicularis oculi reflex and the slow positive wave of the somatosensory evoked brainstem potential, were recognized. The somatosensory evoked spinal potential and spinal monosynaptic reflex showed normal appearances in the state of vegetation and even after the determination of brain death. The measures of SECP could be useful in predicting restoration of consciousness.

A comparative study of transdermal 10% lidocaine gel with and without glycyrrhetinic acid monohemiphthalate disodium for pain reduction at venous cannulation

The clinical benefits of transdermal 10% lidocaine base gels with and without 3% glycyrrhetinic acid monohemiphthalate disodium (GAMHPh) for reduction of pain at venous cannulation were compared in a randomized, double-blind fashion in 24 surgical patients. After about 60 min of occlusive transdermal application, the mean pinprick pain score (1.3 ± 1.5) in the GAMHPh group (n = 12), graded by noting the number of painful pinpricks out of five, was significantly less than that (2.5 ± 1.7) in the control group (n = 12) (P < 0.05). Twelve patients (eight in the GAMHPh group and four in the control group) who had a pinprick score less than 1 underwent venous cannulation without intradermal injection of a local anesthetic. The pain score at venipuncture, graded by the patients on a scale of 5, was significantly less in the GAMHPh group than that in the control group (1.9 ± 1.1 vs 3.3 ± 1.0, P < 0.05). Erythema observed in 8 of the 24 patients was the only adverse local reaction. Addition of 3% GAMHPh to the lidocaine gel is useful in promoting transdermal lidocaine aosorption.

Anesthesia for cesarean delivery in a pregnant woman with acute hepatic failure

IMPLICATIONS A case of reactivation of hepatitis B and development of fulminant hepatic failure in a pregnant hepatitis B virus carrier is reported. Although the occurrence or reactivation of hepatitis B in pregnancy are rare and usually not considered to be medical indications for termination of pregnancy, decisions regarding delivery and liver transplantation must be made if severe hepatic failure develops.

Skin Pretreatments for Shortening Onset of Dermal Patch Anesthesia With 3% Ga Mhph 2na-10% Lidocaine Gel Mixture

Three types of skin pretreatments (stripping with adhesive tape, scrubbing with Skin-Pure jelly, and cleaning with benzine) were studied in 21 volunteers to determine whether the pretreatments could shorten the application period of transdermal 3% GA MHPh 2Na-10% lidocaine gel. Before application of the gel, each subject received skin pretreatment on the volar surface of one forearm. Then, the lidocaine gel soaked in a round sponge was applied on both the pretreated area of the forearm and the unpretreated contrast area of the other forearm. A pain score was obtained from each subject at 30, 45, 60, and 75 min after placement of the dermal patch by noting the number of painful pinpricks of five delivered. The mean pain scores on the pretreated side were significantly lower at 30,45, and 60 min in the stripping study group and at 45 and 60 min in the cleaning study group, compared with the corresponding scores on the unpretreated side (P < 0.05). skin pretreatments, such as stripping and cleaning, are useful for shortening the onset of the dermal patch anesthesia.

Dermal patch anaesthesia for venous cannulation with 10% lignocaine gel containing glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter

The clinical efficacy of transdermal 10% lignocaine gel mixture containing 3% w/w glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter was evaluated at venous cannulation in 17 paediatric (6–11 years) and 17 adult (29–65 years) patients. After about 60 min of occlusive application, the mean (SD) pinprick pain score was 0.7 (0.7) in the paediatric group, compared with 1.4 (1.3) in the adults (p < 0.05). Twenty‐five patients (14 children and 11 adults) who had a pinprick score of 0 or 1 underwent venous cannulation without intradermal local anaesthetic. The mean (SD) pain scores at venepuncture showed no significant differences between children and adults.

Periodic abnormal fluctuations of blood pressure, heart rate and skin blood flow appearing in a resuscitated comatose patient

Fluctuations with a period of several tens of seconds, so called third-order waves, were recognized in the blood pressure, heart rate and Laser Doppler skin blood flow of a comatose patient following cardiac arrest and resuscitation. The waves fluctuated with an abnormally high amplitude and were apparently synchronous with each other. These abnormal fluctuations appeared continuously over 6 h on the day of resuscitation, while their periodicity gradually lengthened. The patient remained in a comatose state for the next 4 days. During that period, functional signs of the sympathetic nervous system, such as peripheral vasomotion and perspiration, were also absent. However, on the 6th post-resuscitation day, when the patient exhibited signs of restoring consciousness, he also regained some sympathetic function. This patient subsequently recovered full consciousness, although abnormalities of intelligence and motor function remained to some extent.

Evaluation of the penetration depth of transdermally applied 3% GA MHPh 2Na-10% lidocaine gel in man

In order to estimate the penetration depth of transdermal 3% GA MHPh 2Na-10% lidocaine gel mixture, the following physiological functions of the skin were examined before and after a 60 min occulusive application of the gel in 16 adult volunteers.Thermal sweat expulsins ceased completely on the gel-treated ventral surface of one forearm in all the first 5 subjects, though it continued on the untreated contrast area of the other forearm. Sympathetic skin response (SSR) was also no longer induced on the gel-treated middle finger in 1 of another 3 subjects and was severely depressed in the other 2 subjects, while the SSR on the untreated index finger appeared constantly.Vasomotion of the skin circulation on another 3 subjects, remained unaffected on both the gel-treated and the untreated fingers. Extraction of a leg-hair in the treated area did not induce pain sensation in all the last 5 subjects.In addition to the transcellular main roots, some of the transcutaneously applied gel seems to penetrate deeply into the skin through the appendageal roots such as the eccrine sweat glands and the pilosebaceous glands.

Simultaneous laser-doppler flowmetry of canine spinal cord and cerebral blood flow: Responses to\(Pa_{CO_2 } \) and blood pressure changes

AbstractWe observed the relative changes of both spinal cord blood flow (local SCBF) and local cerebral blood flow (local CBF) using independent laser-Doppler flowmeters (LDF) in 12 dogs under N2O(50%)-O2-enflurane(1.0%) anesthesia. The dorsal surface of the lumbar spinal cord and the parietal surface of the brain were partially exposed. Two fine LDF probes were placed between the exposed surfaces and the dura maters at each site. Both local SCBF and local CBF decreased simultaneously with hyperventilation and incresed with hypoventilation within several seconds. The local SCBF responses to

Intraoperative management of a patient undergoing extracorporeaI liver surgery (Bench surgery)

Pa_{CO_2 }