Kazushige Murakawa

Effects of vasopressors on renal tissue gas tensions during hemorrhagic shock in dogs

Effects of dopamine, epinephrine, and norepinephrine on renal tissue gas tension changes during hemorrhagic shock in dogs were investigated. The changes in the renal tissue gas tension were determined by the use of a Teflon membrane mass spectrometer. The animals were bled to a mean arterial pressure (MAP) of 50 mm Hg and maintained for one hour. Then, vasopressors were administered to maintain the MAP above 100 mm Hg. After the infusion of dopamine, the renal tissue oxygen tension (PrO2) was elevated for 20 min and tissue CO2 tension (PrCO2) decreased for 70 min. Neither PrO2 nor PrCO2 returned to the control levels. When epinephrine was infused, there was an initial slight transient rise in PrO2, which decreased gradually while PrCO2 decreased for 30 min and then gradually rose. When norepinephrine was infused, there was also an initial slight transient elevation in PrO2 which then decreased, while PrCO2 decreased transiently and then rose rapidly. These results suggest that although dopamine was the most useful vasopressor for improving renal tissue gas exchange during hemorrhagic shock, it did not restore completely oxygen delivery.

The effects of temporary spinal cord stimulation (or spinal nerve root stimulation) on the management of early postherpetic neuralgia from one to six months of its onset.

Objective:  We examined the efficacy of temporary spinal cord stimulation involving the insertion of only a needle and quadripolar lead into the epidural space and applied using an extracorporeal stimulation generator for a few weeks of early postherpetic neuralgia from one to six months of its onset.

A Prospective, Open-Label, Multicenter Study to Assess the Efficacy of Spinal Cord Stimulation and Identify Patients Who Would Benefit

Objective:  To identify patients likely to benefit from spinal cord stimulation (SCS).

Spinal Cord Stimulation for Treatment of Leg Pain Associated With Lumbar Spinal Stenosis

Spinal cord stimulation (SCS) is expected to have analgesic effects in patients with neuropathic pain, ischemic pain, or mixed pain. The type of leg pain caused by lumbar spinal stenosis (LSS) is considered as mixed pain, which is expected to respond to SCS. However, there is no established view on the usefulness of SCS in the management of this type of pain. Therefore, we aimed at evaluating the efficacy of SCS against leg pain associated with LSS.

Improved oxygen delivery to the fetus during cesarean section under sevoflurane anesthesia with 100% oxygen.

AbstractPurpose. To assess the potential benefits of sevoflurane with 100% oxygen in cesarean section in terms of oxygen delivery to the fetus, neonatal depression, and uterine contractility. Methods. Thirty-six patients undergoing elective cesarean section were enrolled. After thiamylal induction, 0.7% sevoflurane–60% nitrous oxide–40% oxygen anesthesia was administered in group G1 (n = 9), and 1.7% sevoflurane–100% oxygen anesthesia was administered in group G2 (n = 9). Spinal anesthesia under oxygen nasal prong was used in group SP (n = 18). Results. At delivery, the Po2 values in the maternal artery and the umbilical vein and artery (MA, UV, UA) of group G2 (474 ± 50, 43 ± 9, 32 ± 9 mmHg, respectively) were significantly greater than those in groups G1 (228 ± 46, 31 ± 4, 23 ± 5 mmHg, respectively) and SP (147 ± 21, 30 ± 7, 18 ± 7 mmHg, respectively). The So2 in the UA of group G2 (56 ± 17 %) was also greater than that in groups G1 (34 ± 10 %) and SP (32 ± 10 %). The sevoflurane concentrations at delivery in the MA, UV, and UA in group G2 were almost threefold higher than those in group G1, whereas all the newborns in the three groups had Apgar scores of 8 or more at 5 min, and the intraoperative blood loss did not differ among the groups. Conclusion. Sevoflurane anesthesia with 100% oxygen in elective cesarean delivery improves oxygen delivery to the fetus without severe neonatal depression, prolonged uterine relaxation, or increased blood loss.

Stellate ganglion block for facial palsy.

Although the cause of Bell’s palsy has still not been clarified, its main pathophysiology is thought to be due to ischemic conditions of the facial nerves in the temporal bone. Since there is an extremely strong relationship between the pathophysiology of Bell’s palsy and circulatory disorders of the nutrient blood vessels in the facial nerves, the main emphasis of the conservative treatment of this disorder by chemotherapy is aimed at circulatory improvement. On the other hand, at the pain clinic, improved blood flow to the facial nerve by stellate ganglion block (SGB) therapy is employed in treating patients with Bell’s palsy. Its efficacy has already been adequately confirmed. The improved blood circulation during treatment of Bell’s palsy by SGB is thought to be brought about by a vasculatory dilatation action due to the blocking effects on the sympathetic nerve. However, the detailed mechanism has not been adequately studied. Therefore, we report the effects of SGB on the common carotid artery blood flow volume and tissue blood flow volume in facial nerve tissue in patients at the acute stage of Bell’s palsy and in experimental animals.

Cancer pain management modalities and positioning of oxycodone

Cancer pain management is centered on opioid therapy. In Japan, 3 types of strong opioid are available for treatment; therefore it is important to use them according to the characteristics of each drug and dosage form. Particularly, oxycodone is suitable as first-line choice of opioid, which can also be employed as opioid switching when symptoms of the central nervous system is manifested following the use of oral morphine. Furthermore, opioid responsiveness should be taken into account when opioid therapy is carried out; assessment of the analgesic effect is particularly important. Recently, we tried to select suitable treatment modalities by speculating on the pathologic conditions of pain relative to the responsiveness to morphine and causes of pain. In the case of pain with low response to morphine, it was possible to attain good pain control not only by opioid therapy but also by a combination of opioid therapy and nerve block therapy. In cancer pain treatment, appropriate assessment of pathologic conditions of pain and selection of adequate and accurate treatment modalities are essential for improvement of the effect of pain relief.

Renal tissue gas tensions during hemorrhagic shock

AbstractTo evaluate the development of renal hypoxia during hemorrhagic shock, fourteen dogs were induced in this study. The animals were divided equally into a group in which mean arterial pressure (MAP) was kept at 50 mmHg (group 1), and into another where MAP was kept at 40 mmHg for 180 min (group 2). Renal tissue gas tensions were determined by a mass spectrometer. In the 50-mmHg group, renal tissue oxygen tension (

EFFECTS OF ELECTRICAL STIMULATION OF CERVICAL SYMPATHETIC TRUNKS ON MICROCIRCULATION IN THE FACIAL NERVE

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