Michiaki Sadanaga

Fundamental patterns and characteristics of the laser-doppler skin blood flow waves recorded from the finger or toe

Three different components, Basic Wave (BW), Cardiac Wave (CW) and Reflex Wave (RW), among the laser-Doppler (L-D) skin blood flow waves on the finger- or toe-tip, were studied in 32 healthy volunteers. The cycle of the rhythmic BW was 8.1 +/- 1.7.min-1 and was independent of respiratory movements. The BW was synchronous with the baseline fluctuation in the digit-photoplethysmogram. Power spectral analysis of rhythmic fluctuations in the simultaneously recorded R-R interval on ECG, systolic blood pressure, and L-D skin blood flow disclosed that the BW was correspondent with the Mayer wave, i.e., low frequency component. The cycle of the CW was consistent with the heart rate and was superimposed on the BW. The RW was a transient marked reduction in blood flow, which was induced by a deep inspiration or various sensory stimuli. A sympathetic skin response on the palm and a venoconstrictive response on the occluded arm were observed concomitantly with the RW. Good synchronization was observed in each component of the L-D skin flow waves between the fingers and toes. These findings suggest that the BW and the RW on the finger- or toe-tip are predominantly driven by tonic and reflex phasic activities of descending sympathetic outflows via the supraspinal center, respectively.

Cardiopulmonary-cerebral resuscitation by using cardiopulmonary bypass through the femoral vein and artery in dogs.

Twenty-seven dogs, divided into three groups, were subjected to a normothermic ventricular fibrillation (VF) cardiac arrest of 15 min and resuscitated by using cardiopulmonary bypass through the femoral veins and artery (F-F bypass). Group I (n = 15): Cardiac beating did not return in any dogs during an initial 3-min conventional cardiopulmonary resuscitation, but it returned 5.2 +/- 3.8 min (mean +/- S.D.) after the successive initiation of the F-F bypass in all dogs, except in one with bypass trouble. Intermittent burst waves appeared on the electroencephalogram and continuous waves returned, 90.0 +/- 24.7 min and 130.7 +/- 28.1 min after the start of resuscitation, respectively. Values of blood glucose, lactate and potassium 5-15 min after the F-F bypass were significantly higher than those before induction of VF, while those of blood pH, base excess, hemoglobin, hematocrit, platelet and serum protein decreased significantly. Group II (n = 7): Both local cerebral (CBF) and myocardial blood flow (MCBF) returned to the pre-arrest level soon after the initiation of the F-F bypass, even though spontaneous cardiac beating was not yet restored. Closed or open chest cardiac massage could not produce as much blood flow as the F-F bypass did. In the early stage of restoration of spontaneous circulation, temporary interruption of the bypass led to a decrease in both local CBF and MCBF. Group III (n = 5): Spontaneous circulation was restored in all five dogs 5.2 +/- 1.1 min after the institution of the F-F bypass, which was continued for 164 +/- 30 min under mild hypothermia. After intensive care for a subsequent 6-36 h, the animals barked, moved their forelegs and could drink water. The mean neurological deficit score (normal: 0, brain death: 500) was 100.6. However, macroscopic examination of the brain in two dogs with prominent recovery revealed atrophy of the central gyrus and microscopic examination revealed injuries of the vulnerable neurons of the brain.

Effects of neural blockade and general anesthesia on the laser-Doppler skin blood flow waves recorded from the finger or toe

Effects of neural blockade and general anesthesia on the basic wave (BW) and the reflex wave (RW) among the laser-Doppler (L-D) skin blood flow waves recorded on the finger or toe were studied in 2 volunteers and 42 patients. The BW was continuous, rhythmic and independent of respiratory movements. The RW, which was induced by a deep inspiration or a snapping sound, was a transient marked reduction in blood flow. The BW was almost flattened and the RW was no longer induced at the finger under complete wrist block (n = 2), or under cervical or upper thoracic epidural anesthesia extended caudally over T7 (n = 2). On the other hand, the BW was still detected with reducing frequency and the RW could be provoked with one exception at the finger on the side with a sympathetic ganglion block at the C6 vertebral level (n = 14). The BW and RW at the toe were retained under lumbar subdural anesthesia (n = 6) as well. However, under the combination of lumbar subdural anesthesia and lower thoracic epidural anesthesia extending rostrally over T4 (n = 6), both the BW and the RW disappeared at the toe. In the course of deepening nitrous oxide/enflurane anesthesia (n = 10), the BW gradually reduced in frequency until it was almost flattened, and it became difficult to provoke the RW. L-D flowmetry of the finger or toe could be a useful clinical measure for detecting the presence or absence of sympathetic function controlling cutaneous vasomotion.

Effects of systemic cooling and rewarming on the evoked spinal cord potentials and local spinal cord blood flow in dogs.

Changes in evoked spinal cord potential (ESCP) and in local spinal cord blood flow (local SCBF) were measured simultaneously in eight dogs in the course of systemic cooling and rewarming using a water mattress. PaCO2 was maintained at 35-40 mm Hg (temperature-uncorrected values) by adjusting ventilatory volume every 1 degree C change of esophageal temperature under N2O (60%)-O2-isoflurane (1.15%) anesthesia. Local SCBF and arterial blood pressure decreased and ESCP latencies increased linearly with the decrease in body temperature to 23-24 degrees C. The conductive ESCPs (non-synaptic components) showed temporary augmentation in amplitude before eventual decrease under cooling. These showed a tendency to return to the precooling baselines after the initiation of rewarming. These results demonstrate that conductive ESCPs could be available for intraoperative monitoring of spinal function under hypothermia down to 23-24 degrees C.

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.

A case of colonic gas explosion caused by electrocautery.

A 70-year-old female with disturbed consciousness was admitted on the suspicion of liver cirrhosis, and potal embolism was detected. Since hepatic encephalopathy repeatedly occured thereafter, bypassing of the splanchnic vein and the umbilical vein was planned. Anesthesia was induced by thiamylal 250 mg IV and endotracheal intubation was performed using soccinylcoline 60 mg IV. Anesthesia was maintained with nitrous oxide (50%)oxygen-enflurane (0.5~1.5%) at a total flow of 4 [·minI • Pancuronium was used for muscle relaxation when necessary. The planned bypass operation proceeded without problems for about 9 hr until closure of the abdomen. However, the entire intestine was

Cardiovascular responses to fiberoptic intubation: a comparison of orotracheal and nasotracheal intubation.

We compared the cardiovascular responses between nasal and oral intubation with a fiberoptic bronchoscope under the combination of neuroleptic analgesia (NLA) and topical anesthesia. The 16 patients studied were divided into 2 groups: the nasal intubation group (N group: 8 patients) and the oral intubation group (O group: 8 patients). There were significant changes in systolic, diastolic and mean arterial pressures in the N group and in the pressure rate quotient in the O group. Diastolic arterial pressure and heart rate were significantly higher in the N group than in the O group before induction of general anesthesia. The rate pressure product (RPP) was significantly higher in the N group than in the O group at some points during the procedure. The individual RPP in both groups was relatively stable except for one patient in the N group, who had a marked increase in RPP during the procedure. We conclude that, under the combination of NLA and topical anesthesia, the cardiovascular responses to oral fiberoptic, intubation are less severe than those to the nasal approach. The oral approach is recommended, especially in patients with coronary artery disease, taking into consideration of the cardiovascular responses to fiberoptic intubation.

To-and-fro veno-venous extracorporeal lung assist for newborns with severe respiratory distress

A veno-venous to-and-fro bypass method through a single blood access for extracorporeal lung assist with an artificial membrane lung is introduced. A premature newborn with severe respiratory distress was treated with this method. A 12 Fr. single lumen catheter with a spiral-embedded thin-wall, 0.25 mm in wall thickness, was placed in the right internal jugular vein. Venous blood was withdrawn and oxygenated blood returned alternately through the same catheter. Thus both carotid arteries and other large veins were kept intact. During the extracorporeal bypass, the patient was put on intermittent mandatory ventilation of 2 times/min for lung rest providing adequate arterial blood gases, and he survived.

Spinal function monitoring by evoked spinal cord potentials in aortic aneurysm surgery

Evoked spinal cord potentials (ESCPs) were monitored in 12 patients who underwent repair of thoracoabdominal aortic aneurysm with a high risk of spinal ischemia. A pair of bipolar catheter electrodes were introduced into the epidural space, one at the level of the C5-T2 vertebrae and the other at the level of T11-L2. Conductive mixed ESCP in seven patients, conductive sensory ESCP in one patient, and segmental descending ESCP in three patients were observed by applying a rectangular electric current to one of each pair of epidural electrodes and recording through the other. Segmental ESCP in response to posterior tibial nerve stimulation was observed in one patient. Following aortic cross-clamping, the I wave of conductive mixed ESCPs gradually decreased in amplitude with latency prolongation in five of the seven patients and disappeared in one of these five; transient augmentation of amplitude was observed before eventual decline in four of these five patients. The N wave of segmental descending ESCP subsequently flattened in two of the three patients and the N1 wave of segmental ESCP in the one patient. Three of the four patients in whom the ESCPs disappeared during aorta clamping recovered the ESCPs after declamping and showed no neurological disorders postoperatively. Intraoperative ESCP monitoring appears to be useful to detect spinal cord ischemia in the early stage and to alert surgeons and anesthesiologists so that timely resuscitative steps can be taken.

Perioperative management of two patients with respiratory problems undergoing Abdominal surgery with high spinal anesthesia.

Choice of anesthetic technique; regional anesthesia vs. general anesthesia is still controversial in patients with impaired pulmonary function undergoing laparotomy. We are often concerned that positive pressure ventilation or endotracheal inhalation of dry anesthetic gases may exacerbate preexisting respiratory problems. For a patient breathing by himself preoperatively, it is the most undesirable consequence to be forced to leave an endotracheal tube for mechanically assisted ventilation for an extended time in the postoperative course. The present report describes successful perioperative management of two patients with respiratory problems undergoing abdominal surgery. We administered a combination of high spinal anesthesia for surgery and epidural analgesia for postoperative pain for the patients. Monitorings of arterial oxygen saturation with a pulse oxymeter (SP02) and endo-tidal car-