Hideo Horikawa

The hemostatic effect of deacetylated chitin membrane on peritoneal injury in rabbit model

In this study, we determined the effect of 80% deacetylated chitin (DAC-80) membrane on postsurgical bleeding after visceral and parietal peritoneal abrasion. Japanese white rabbits underwent a midline laparotomy followed either by a bilateral peritoneal sidewall abrasion (4×4 cm) or an abrasion of liver surface (3×2 cm). The injured surface was then covered with a 0.2 mm thick DAC-80 membrane. On postsurgical day 2, the rabbits were sacrificed and the amounts of postsurgical bleeding was determined by quantitating the number of red blood cells recovered in 50 ml peritoneal lavage fluid. The DAC-80 membrane was found to reduce postsurgical bleeding after the abrasion of liver surface (treated with DAC-80 membrane: 2.9±0.8; control: 24.6±5.9×108 cells/peritoneal cavity, P<0.005). This same hemostatic activity was not observed after application in the peritoneal sidewall abrasion model. We also measured plasminogen activator activity (PA) and urokinase inhibitory (PAI) activity in the spent culture media of macrophages recovered from the postsurgical peritoneal exudate. The DAC-80 membrane reduced the PA secretion from postsurgical macrophages after liver surface abrasion (treated with DAC-80: 2.8±0.7; control: 3.9±0.9 mPU/ml). The DAC-80 membrane also showed similar effects on PA secretion after peritoneal sidewall abrasion. No significant effects were found in the secretion of PAI by postsurgical macrophages in both surgical models.These findings suggest that the DAC-80 membrane may have hemostatic activity through the modulation of fibrinolytic activity of peritoneal exudative macrophages.

A clinical study of postoperative infections following open-heart surgery: occurrence and microbiological findings in 782 cases.

A total 782 consecutive patients underwent open-heart surgery with CPB between January, 1979 and December, 1988, at the Yamagata University Hospital. We assessed the incidence of postoperative infections in relation to age, the duration of surgery and antibiotic prophylaxis, and examined the causative organisms, after which the types of infecting flora were compared between the 1st period, from 1979 to 1983 and the 2nd period, from 1984 to 1988.Postoperative infection occurred in 104 of the 782 patients (13.3 per cent); in the form of a wound infection in 41 (5.2 per cent), pneumonia in 33 (4.2 per cent), urinary tract infection in 9 (1.2 per cent), prosthetic valve endocarditis in 6 (0.8 per cent), and other infections in 15 (1.9 per cent). Patients aged under 12 months or over 60 years showed a higher incidence of infection, being 17.4 per cent and 19.2 per cent, respectively. Patients who underwent an operation of over 8 hours duration also had a significantly higher incidence compared to those whose operation time was less than 4 hours, being 32.9 per cent and 6.3 per cent, respectively (p<0.0001). There was no significant difference in the incidence of postoperative infection between patients given or not given preoperative prophylaxis. A total 123 species of organisms were isolated from the 104 patients, 52.8 per cent being gram-negative bacteria (GNB), and 43.9 per cent grampositive bacteria (GPB), and a remarkable increase in the incidence of GPB was seen in the 2nd period compared to the 1st period from 31.7 per cent to 50.0 per cent.There has been a recent increase in the number of high risk patients compromised by the severity of an underlying disease. Thus, to control infection, the surgical environment and aseptic technique seem more important than antibiotic prophylaxis.

Absence of efficacy of ultrasonic two-way Doppler flow detector in routine percutaneous arterial cannulation

mark a point distal and a point proximal to the above marking along the course of the artery. The puncture site was disinfected with alcohol. Puncture was performed relying on the markings, without palpating the artery. Logistic regression analysis was used for statistical analysis. The dependent variables were “success” and “failure.” The independent variables were using or not using the ultrasonic two-way flow detector, sex, age, body mass index (BMI), systolic blood pressure (SBP), and hemoglobin (Hb). The significance level was 5%. The mean age of the patients was 62.2 11.8 (SD) years in group D and 64.1 11.9 years in group C. The male-to-female ratio was 43 :29 in group D and 59 :35 in group C. The BMI was 22.7 3.6 in group D and 23.0 3.6 in group C. The SBP was 104 14mmHg in group D and 105 18mmHg in group C. The Hb level was 12.4 1.6 g·dl 1 in group D and 12.6 1.8g·dl 1 in group C. In one patient each in groups C and D, the radial artery could not be accessed, even after multiple punctures (classified as “discontinued” in Table 1, but included as “failure” for statistical analysis). Irrespective of whether or not the flow detector was used, the first puncture was successful in over 80% of the patients. Access to the artery was obtained by two or more punctures in approximately 98% of the patients (Table 1). Sex was the only factor significantly influencing “success” (Table 2). We used logistic regression analysis, a multivariate analysis, in the present study because we had great doubts about the conclusion reached from simple regression analysis of only two groups “using” or “not

Usefulness of ultrasonic two-way Doppler flow detector in percutaneous arterial puncture in patients with hemorrhagic shock

1. As with conventional arterial puncture, place a pillow under the dorsum of the hand and extend the wrist. 2. Identify the arterial pulse using the probe tip. 3. Use an office clip to mark the position of the strongest pulse sound. 4. Mark a point distal and a point proximal along the course of the artery. 5. Disinfect the puncture site with alcohol. 6. Relying on the markings, perform the puncture without palpating the artery. Usefulness of ultrasonic two-way Doppler flow detector in percutaneous arterial puncture in patients with hemorrhagic shock

Influence of Carbon Dioxide on Respiratory Function during Posterior Retroperitoneoscopic Adrenalectomy in Prone Position

Objective: To evaluate the influences of CO₂ insufflation on changes in blood gas analysis and end tidal CO₂ tension (PetCO₂) during posterior retroperitoneoscopic adrenalectomy in the prone position. Methods: Arterial blood gas analysis and measurements of PetCO₂ were carried out during CO₂ insufflation in 16 patients who underwent posterior retroperitoneoscopic adrenalectomy in the prone position (PRA group). The results were compared to 10 patients who underwent open posterior adrenalectomy (OPA group). Ventilation was artificially controlled during the study period in all cases. Results: Arterial pH, PaCO₂, PetCO₂ and PaO₂ were not significantly different between the PRA and OPA groups. However, the PaCO₂–PetCO₂ gradient in the PRA group was significantly higher than that in the OPA group (p < 0.01). Conclusion: Transperitoneal absorption of CO₂ occurs in patients undergoing retroperitoneoscopy in the prone position. The alveolo-arterial CO₂ gradient may be the only parameter which indicates the absorption of CO₂ during PRA.

Effects of midazolam on the threshold of lidocaine-induced seizures in the dog--comparison with diazepam.

The anticonvulsive effect of midazolam was compared with that of diazepam in ten dogs. Lidocaine-induced seizure waves on the electroencephalogram were used to observe the suppressive effect of the drugs. Midazolam, 0.2 mg·kg−1, was found to possess a stronger suppressive effect against lidocaine-induced seizures than the same dose of diazepam. These two drngs showed to possess similar effects on cerebral and systemic circulations and cerebral metabolism during seizures.

Perioperative management of lobectomy in a patient with hypertrophic obstructive cardiomyopathy treated with dual-chamber pacing

previously. A routine chest roentgenogram taken during an annual check-up showed a suspicious shadow. The patient was referred to another hospital for a complete medical evaluation. Left lung cancer was diagnosed. His electrocardiogram (ECG) showed a negative T wave in leads V5 and V6, indicating a pattern of old septal and inferior myocardial infarction with mild left ventricular (LV) hypertrophy. Furthermore, epicardial echocardiography (EE) revealed interventricular septal hypertrophy (ISH) and LV outflow hypertrophy, without deterioration of LV wall motion but with mild mitral regurgitation (MR). His cardiac index (CI), ejection fraction (EF), and EE-derived LV-Ao PG were 3.85 l·min 1·m 2, 86%, and 72 mmHg, respectively. Finally, HOCM accompanied with MR were diagnosed. The patient was scheduled for right upper lobectomy in the same hospital without any specific medical treatment for HOCM prior to surgery. The patient was premedicated with intramuscular atropine (0.5 mg) and hydroxyzine (50mg) prior to the induction of anesthesia. On arrival at the operating theater, his heart rate was 78 beats·min 1, and his systolic and diastolic blood pressure showed 132/86mmHg. After the placement of an epidural catheter via the thoracic segment T8/9, anesthesia was induced with bolus intravenous (iv) fentanyl (0.8μg·kg 1) and propofol (1mg·kg 1), as well as with continuous infusion of propofol (10mg·kg 1·h 1), followed by vecuronium (0.03 mg·kg 1). Hypotension (60 mmHg) and profound bradycardia (35 beats·min 1) were observed after anesthesia was induced. Hypotension was controlled rapidly both by volume replacement and intermittent administration of bolus iv methoxamine (1mg), whereas bradycardia persisted at less than 40 beats·min 1. The anesthetists discontinued the induction of anesthesia and cancelled the operation. Ten minutes later, the heart rate of the patient gradually recovered to a level of 50 beats·min 1. Oral atenolol (50mg·day 1) and disopyramide (300 mg·day 1) were started immediately

A bullard laryngoscope holder for bedside use

Use of the Bullard laryngoscope (BL; Circon Corporation, Stanford, CT, USA) is a trustworthy countermeasure when endotracheal intubation is expected or found to be difficult [1]. Ease of handling is important for the effective employment of the BL. However, the BL itself is rather hard to handle due to its peculiar anatomical shape. A temporary holding aid is required to facilitate the bedside use of the BL. We specifically designed a helpful holder, named the Bullard mate, to put beside the BL temporarily before and after endotracheal intubation. It is made of stainless steel and is composed of a basal seat and a vertical pole (Fig. 1). The two portions of the BL body lean against the two hooks connected to the vertical pole. The root of the ocular arm is fixed firmly, and in contrast, the laryngeal blade is held lightly. It is designed neither for attaching the BL in the middle of intubation nor for storing the BL on the shelf. It keeps the styletted tube clean and safe before intubation and also holds the BL smeared with a patient’s saliva after the intubation has been completed. The Bullard mate can be sterilized readily in its normal configuration and is easily transportable to a bedside setting, which enhances its convenience during use in daily clinical anesthesia. We have used the Bullard mate easily and safely in endotracheal intubation by means of the BL in more than 860 adult patients. We believe that it is a valuable aid for anesthetists during the bedside use of the BL.

Cardiac arrest following induction of anesthesia in a patient with acute massive pulmonary thromboembolism

Patients with massive pulmonary thromboembolism (PE) occasionally develop acute right ventricular dysfunction followed by circulatory collapse or sudden death. Early diagnosis and aggressive treatment of this condition are therefore essential [1]. The present report is a case of cardiac arrest following induction of anesthesia for pulmonary thrombectomy in a patient with acute massive PE after lobectomy.

A comparison of sympathetic adrenal nerve responses to intravenous high-dose morphine and fentanyl administration in rats.

We compared the effects of intravenous morphine (5 mg·kg−1) and fentanyl, (50μg·kg−1) on systolic blood pressure (SBP), heart rate (HR), and efferent sympathetic adrenal nerve action potentials (SANA) in rats. We also determined the extent of the reflex responses of these parameters of 9% carbon dioxide (CO2) challenge during the above narcotic anesthesia. In the morphine group, SBP was elevated and the elevated levels were maintained, while changes in SBP in the fentanyl group were not significant. In the morphine group, SANA showed initial stimulation and subsequent depression, while in the fentanyl group, SANA showed sustained depression. CO2 challenge induced only very small changes in SBP and HR, suggesting that during high-dose narcotic anesthesia the hypercapnic stimulus may not be reflected in circulatory parameters. In both groups, hypercapnia increased SANA to 30% of the baseline values from the pre-challenge level. However, these values were only 91% and 56% of the baseline value in the morphine and the fentanyl, groups, respectively.