Kozo Yokoyama

Displacement of the Endotracheal Tube Caused by Change of Head Position in Pediatric Anesthesia: Evaluation by Fiberoptic Bronchoscopy

Displacement of the endotracheal tube (ETT) caused by flexion and extension of the neck and the placement of a tongue depressor was investigated in 10 small children between the ages of 16 and 19 mo by means of a fiberoptic bronchoscope.The ETT tip moved a mean distance of 0.9 cm toward the carina with flexion and 1.7 cm toward the vocal cords with extension of the neck. After the placement of a tongue depressor, the ETT tip, which had once moved toward the vocal cords with neck extension, was displaced a mean distance of 1.2 cm toward the carina. Our results demonstrate that endobronchial intubation and accidental extubation could occur after significant changes of the head position and careless placement of a tongue depressor in small children. (Anesth Analg 1996;82:251-3)

Effects of ketamine on dopamine metabolism during anesthesia in discrete brain regions in mice: comparison with the effects during the recovery and subanesthetic phases

The effects of ketamine on the levels of dopamine (DA), norepinephrine (NE), 5-hydroxytryptamine (5-HT, serotonin) and their metabolites were examined in discrete brain regions in mice. A high dose of ketamine (150 mg/kg, i.p.) did not change DA metabolism in the frontal cortex, nucleus accumbens, striatum and hippocampus, but did decrease it in the brainstem during anesthesia. In contrast, during recovery from the ketamine anesthesia, the high dose increased the level of homovanillic acid (HVA) in all brain regions. A low subanesthetic dose of ketamine (30 mg/kg, i.p.) increased the concentrations of both 3,4-dihydroxyphenylacetic acid (DOPAC) and HVA only in the nucleus accumbens. The DA level was not affected by any ketamine treatment. During ketamine anesthesia, the content of 3-methoxy-4-hydroxy-phenylglycol (MHPG) was decreased in the brainstem, whereas during recovery from anesthesia, the MHPG level was increased in the frontal cortex, nucleus accumbens and brainstem. The NE content was not altered in any region by ketamine treatment. The concentration of 5-hydroxyindoleacetic acid (5-HIAA) was reduced in the frontal cortex, striatum, hippocampus and brainstem during ketamine anesthesia. The 5-HT level was unaltered in all regions except the brainstem where it was reduced. In contrast, after anesthesia, the concentrations of both 5-HT and 5-HIAA were increased in the striatum. During the subanesthetic phase, however, the levels of NE, 5-HT and their metabolites were unchanged. These neurochemical results are consistent with the electrophysiological findings that a high dose of ketamine does not change the basal firing rates of nigrostriatal DA neurons during anesthesia, while low subanesthetic doses significantly increase those of ventral tegmental DA neurons.

Does the Murphy eye reduce the reliability of chest auscultation in detecting endobronchial intubation

UNLABELLED Bilateral breath sounds are routinely auscultated after endotracheal intubation to verify that the endotracheal tube (ETT) tip is properly positioned. We conducted the present study to ascertain whether the eye of the Murphy tube has an influence on the reliability of auscultation of breath sounds in detecting endobronchial intubation. Twenty patients undergoing scheduled oral and maxillofacial surgery participated in this study. After the induction of general anesthesia, either the Magill tube or the Murphy tube was inserted through the nose into the trachea. The fiberoptic bronchoscope was inserted through the ETT, and the distance from the nares to the carina of the trachea was measured. When breath sounds from the left side of the chest changed and disappeared while the ETT was being advanced, the distance from the nares to the ETT tip was measured. Unilateral auscultatory change was not observed until the ETT tip was advanced beyond the carina and inserted 1.5+/-0.4 cm into the right mainstem bronchus when the Magill tube was used and 2.0+/-0.4 cm when the Murphy tube was used (P < 0.01). Breath sounds disappeared when the ETT tip was further advanced up to 3.2+/-0.3 cm from the carina. We demonstrated that the eye of the Murphy tube reduces the reliability of chest auscultation in detecting endobronchial intubation. IMPLICATIONS The Murphy eye was designed to allow ventilation of the lung when the bevel of the endotracheal tube is occluded. We demonstrated that the eye of the Murphy tube reduces the reliability of chest auscultation in detecting endobronchial intubation.

Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation

PurposeTo describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).Clinical featuresWe investigated four female patients (age 42.8 ± 26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints.Linear polarized near infrared radiation using Super Lizer™ was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J·cm−2 at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation.TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3 ± 2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.ConclusionApplication of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and noninvasive short-term treatment.RésuméObjectifDécrire un nouveau traitement de courte durée pour la douleur de l’articulation temporo-mandibulaire (ATM) affectée par la polyarthrite rhumatoïde (PAR).Éléments cliniquesNous avons évalué quatre femmes (42,8 ± 26,0 ans) souffrant de polyarthrite rhumatoïde touchant une seule ATM. Les patientes ont reçu un traitement antirhumatismal comme l’aurothiomalate de sodium qui n’a pas affecté d’autres articulations.Des radiations linéaires polarisées dans le proche infrarouge ont été appliquées à l’aide du Super Lizer™, une fois par semaine avec ou sans mouvement mandibulaire, sur les zones cutanées unilatérales sus-jacentes à la cavité glénoïde du temporal, au tubercule articulaire antérieur, au muscle masséter et au bord postérieur de la branche montante de la mandibule. La durée de la radiation était, à chaque point, de deux secondes suivies d’un arrêt de dix secondes par cycle et d’une intensité d’environ 138 J·cm−2 selon une longueur d’onde de 830 nm.La distance intermaxillaire a été mesurée lors de l’ouverture maximale de la bouche en l’absence et en présence de douleur avant et après chaque traitement. De plus, les scores subjectifs de douleur à l’ATM ont été enregistrés à l’échelle visuelle analogue lors de l’ouverture maximale de la bouche avant et après chaque irradiation.La douleur de l’ATM est disparue après quatre traitements seulement. De plus, l’ouverture maximale de la bouche sans douleur à la suite de l’irradiation a été améliorée chez trois patientes selon une moyenne de 5,3 ± 2,1 mm. Cependant, dans un cas, l’ouverture précédant l’irradiation ne s’est pas améliorée malgré le fait que la douleur de l’ATM liée à la PAR avait disparu.ConclusionLapplication de radiations linéaires polarisées dans le proche infrarouge à des patients affectés par des douleurs à l’ATM, influencées par la PAR, constitue un traitement de courte durée, efficace et non effractif.

Temporomandibular joint pain analgesia by linearly polarized near-infrared irradiation.

Objective: The objective of this study was to describe a pilot treatment of temporomandibular joint pain by linearly polarized near-infrared irradiation. Design: A prospective clinical study. Setting: University teaching hospital. Patients: Patients comprised 20 women (mean age ±SD: 26.6 ± 15.2 years) with unilateral temporomandibular pain. The patients had already received other conservative treatments, but temporomandibular pain did not attenuate. Intervention: Linearly polarized near-infrared irradiation with the Super Lizer was used. Results: The painless interincisal distance of the mouth opening, which is one of the objective parameters of temporomandibular dysfunction, and the visual analogue scale of the affected temporomandibular joint before treatment were 33.4 ± 6.5 mm and 5.0 ± 2.7 points, respectively. Pilot linearly polarized near-infrared irradiation was applied weekly to the skin areas overlying four painful points. The present treatment alleviated temporomandibular pain after the patients had received only four weekly irradiation treatments, with final measured values of the visual analogue scale being 1.4 ± 1.6 points. The final painless mouth-opening distance increased by 7.6 ± 4.6 mm compared with the first measured distance without complications. Conclusion: This pilot treatment using the Super Lizer provided relief from temporomandibular pain over a period of 4 weeks.

Influence of Linearly Polarized Near-Infrared Irradiation on Deformability of Human Stored Erythrocytes

OBJECTIVE To investigate the influence of linearly polarized near-infrared irradiation using the Super Lizer trade mark on deformability of human erythrocytes. BACKGROUND DATA Not only low-powered laser but also linearly polarized near-infrared beams have some biostimulation effects on various tissues. There were some reports of erythrocyte deformability improved by low-powered He-Ne laser irradiation. MATERIALS AND METHODS Human erythrocyte samples stored for three weeks were adjusted to 30% hematocrit. Erythrocyte deformability presented as the filter filtration rate was measured. RESULTS There was no difference of the filter filtration rate between control group without irradiation and the group of 125 mJ/cm(2) exposure level at a wavelength of 830 nm. However, the groups of 625 and 1,250 mJ/cm(2) exposure levels at a wavelength of 830 nm showed higher filter filtration rates compared to the control group. CONCLUSION Linearly polarized near-infrared irradiation in a range of 625-1,250 mJ/cm(2) exposure level at a wavelength of 830 nm improved deformability of human stored erythrocytes.

Alleviation of refractory neuralgia after mandibular osteomyelitis by inferior alveolar nerve block with a combination of Neo VitacainTM and dexamethasone - Report of a case

AbstractThe case of a 65-year-old man, who developed refractory pain in the right mandible after surgery for osteomyelitis, is described. Neuralgia did not respond to carbamazepine, but a single dose of 25 mg diclofenac sodium proved effective, albeit for a short term. Two millilitres Neo VitacainTM contains 2 mg dibucaine hydrochloride and 6 mg sodium salicylate. Long-term relief was attained with 2.0 ml Neo VitacainTM combined with 2 mg dexamethasone administered by injection to the right mandibular foramen.

Evaluation of iontophoresis therapy with Neo-VitacainTM and dexamethasone for trigeminal neuralgia

AbstractIn place of superficial trigeminal nerve branch blocks, we designed iontophoresis therapy with Neo-VitacainTM and dexamethasone for trigeminal neuralgia and evaluated its efficacy. This therapy was well tolerated and accepted by all patients due to the lack of side effects and painless administration. Pain management with this treatment was very effective.