Shigemasa Ikeda

Intraoperative autologous blood salvage with cardiac surgery: An analysis of five years' experience in more than 3,000 patients

STUDY OBJECTIVE To analyze intraoperative autologous salvage of shed mediastinal blood and subsequent transfusion in cardiac surgery. DESIGN Retrospective statistical analysis. SETTING University hospital. PATIENTS Three thousand twenty two patients undergoing cardiac surgery from 1984 to 1988. INTERVENTIONS A review of anesthesia and transfusion records of all patients who underwent intraoperative salvage of shed blood and autologous transfusion using the Sorenson Receptal Auto Transfusion System (ATS) with saline wash prior to reinfusion in cardiac surgery. MEASUREMENTS AND MAIN RESULTS The salvaged blood volume ranged from 36 to 2,795 ml, with a mean of 321 +/- 222 ml (SD). Eighteen percent of patients did not receive any homologous blood products during their hospitalization. Patients who received only salvaged autologous transfusion were younger, had higher preoperative hemoglobin and hematocrit values, had a larger body surface area, and had shorter surgeries compared with patients who received only homologous blood or both autologous and homologous blood. More blood products were given to patients who received salvaged autologous blood compared with those who did not. Patients who underwent normovolemic hemodilution prior to extracorporeal circulation with subsequent reinfusion received significantly fewer blood products. Ten preoperative and four intraoperative variables significantly influenced the salvaged volume. Previous cardiac surgery was the most significant preoperative variable, and repair of ventricular septal defect produced by myocardial ischemia was the most significant intraoperative variable. CONCLUSION Considering the average salvaged volume and its current autologous transfusion-related expense, autologous blood salvage is potentially an economic benefit. Perioperative blood conservation requires a considerable commitment from surgeons, anesthesiologists, perfusionists, and intensive care physicians to be effective.

Cerebral blood flow velocity during repeatedly induced ventricular fibrillation.

STUDY OBJECTIVE To investigate the effect of induced ventricular fibrillation and defibrillation on cerebral blood flow (CBF) was investigated using a transcranial Doppler. DESIGN Prospective clinical study. SETTING University hospital. PATIENTS 12 ASA physical status III and IV patients who underwent implantable cardioverter defibrillator placement during general anesthesia. INTERVENTIONS Cerebral blood flow velocity was measured repeatedly during induced ventricular fibrillation and subsequent defibrillation. MEASUREMENTS AND MAIN RESULTS The mean flow velocity in the middle cerebral artery was measured using a transcranial Doppler. The mean flow velocities decreased significantly immediately after ventricular fibrillation was induced, but they returned to preventricular fibrillation levels immediately after successful defibrillation. Repeatedly induced ventricular fibrillations have no cumulative detrimental effect on the CBF velocity. CONCLUSIONS Repetitively induced ventricular fibrillation and defibrillation during the insertion of implantable cardioverter defibrillator did not show any detrimental changes in CBF. Transcranial Doppler may be a more sensitive device than other currently available cerebral monitors to detect changes in cerebral circulation during a brief episode of ventricular fibrillation and defibrillation.

Preoperative aspirin and heparin therapy does not increase perioperative blood loss and blood product requirements in coronary artery bypass graft surgery

AbstractPurpose. The effects of preoperative aspirin (ASA) and/or heparin therapy on perioperative blood loss and transfusion requirements were studied in patients undergoing primary coronary artery bypass graft (CABG) surgery using perioperative blood cell salvaging techniques. Methods. The amounts of perioperative blood loss and transfusion requirements were recorded in four groups of patients, based on the preoperative medication: ASA group (51 patients), heparin group (33 patients), and ASA plus heparin group (38 patients), as well as a control group (49 patients who received neither of these medications). Results. There were no significant differences among the four groups in cardiopulmonary bypass time, aortic cross clamp time, or the number of coronary artery grafts performed. Postoperative blood loss was highest in the ASA group, followed by the control, the ASA + heparin, and the heparin groups. Neither postoperative blood loss nor transfusion requirements showed significant differences among the four groups. Simultaneous administration of heparin with ASA also did not increase the blood loss or transfusion requirements. Conclusion. Preoperatively administered aspirin and/or heparin did not significantly increase perioperative blood loss or the total amount of transfusion requirements. It is not necessary to delay elective CABG if blood cell salvaging techniques are used.

Measurement of blood cyanide with a microdiffusion method and an ion-specific electrode.

The use of a cyanide ion-specific electrode in combination with the Conway microdiffusion method was modified for the measurement of cyanide concentration in human red blood cells and plasma. With our modified method, the optimal pH of cyanide isolation from red blood cells and plasma was investigated. Cyanide recovery from red blood cells increased with decreasing pH. The maximal recovery of 96.9 +/- 2.6% was obtained at a pH of less than 1. Cyanide recovery from plasma, however, peaked at a pH between 7 and 8, and further changes in pH reduced the recovery rate. The maximal recovery rate from plasma was 74.1 +/- 1.5%. In previous studies, cyanide isolations from both plasma and red blood cells were carried out at a pH of less than 1. This study shows that cyanide isolation from plasma should be performed at a pH between 7 and 8.

Triple knotting of a central venous catheter.

A case of unusual triple knotting of a central venous catheter inserted through the left basilic vein is reported. The catheter with intact triple knots could be withdrawn without an invasive maneuver. A possible cause of triple knotting was discussed in regard to the anatomic configuration of the central veins. This case emphasizes that a central venous catheter should not be advanced if resistance is encountered.

TRACHEAL TUBE CUFF VOLUME CHANGES DURING EXTRACORPOREAL CIRCULATION

Changes in the volume of tracheal tube cuffs were examined during extracorporeal circulation to determine the influence of the composition of the inspired gases and of the gas within the cuff. The study was carried out on 90 patients who underwent coronary artery bypass grafting. When the cuff contains nitrous oxide at the start of extracorporeal circulation, the cuff volume decreases during bypass regardless of the composition of the inspired gases. When the cuff is filled with air or 100 per cent oxygen at the start of extracorporeal circulation and the inspired gas mixture consists of nitrous oxide and oxygen the cuff volume increases. When the cuff is deflated and then refilled with either room air or oxygen at the beginning of the extracorporeal circulation and the lungs are inflated with oxygen, the cuff volume change is minimal during bypass. This combination of gas prevents any undesirable change in the cuff volume. It appears desirable to monitor the tracheal tube cuff volume or pressure and to maintain a constant pressure and volume during bypass to prevent deflation and silent aspiration associated with cuff deflation, as well as to avoid mucosal damage due to excessive pressure in the cuff.RéSUMéLes changements de volume du ballonnet des tubes trachéaux ont été étudiés pendant la circulation extracorporelle pour déterminer les effets de la composition des gaz inspirés et des gaz du ballonnet. Cette étude a porté sur 90 patients qui subissaient un pontage aortocoronarien.Lorsque le ballonnet contenait du protoxyde d’azote au début de la circulation extracorporelle, le volume du ballonnet a diminué pendant le pontage quelque soit la composition de gaz inspiré. Lorsque le ballonnet est vérifié d’air ou d’oxygène, le volume du ballonnet est dégonflé et ensuite empli soit avec de l’air ou de l’oxygène au début de la circulation extracorporelle et que les poumons sont ventilés à l’oxygène, le changement de volume du ballonnet est minime pendant le pontage. Ce mélange de gaz prévient tout changement indesirable du volume du ballonnet. II semble désirable de monitoriser le volume ou la pression du ballonnet du tube trachéal et de maintenir un volume ou une pression constante pendant le pontage pour éviter la déplation et I’aspiration silencieuse associée à la déflation du ballonnet, aussi bien pour éviter d’endommager la muqueuse trachéale par pression excessive par le ballonnet.

In vitro cyanide release from sodium nitroprusside in various intravenous solutions

The concentration of cyanide, a toxic metabolite of sodium nitroprusside, in solutions other than 5% dextrose in water, has not been reported. In this study, cyanide ion levels were measured by a cyanide ion-specific electrode in 250 ml of six different intravenous solutions (5% dextrose in water, 10% dextrose in water, distilled water, 0.9% sodium chloride, and lactated Ringers solution with and without 5% dextrose) exposed to 300 foot candles of fluorescent light for72 hours after sodium nitroprusside was dissolved in each solution. The rates of the increase incyanide ion concentration in all six solutions were fairly constant between 4 and 24 hours. At 24 hours, there were no statistically significant differences in cyanide ion concentration among the six solutions. After 24 hours, the rate of the increase in cyanide ion concentration in the electrolyte solutions decreased more than that in the nonelectrolyte solutions. At 72 hours, theelectrolyte-containing solutions had statistically significant lower mean cyanide ion concentrations than 5% dextrose, often the recommended diluent for sodium nitroprusside. There was no difference in mean cyanide ion concentration between lactated Ringers solution with and without 5% dextrose. Solutions containing electrolytes are preferable to 5% dextrose for the dilution of sodium nitroprusside.

Government account for relief in occupied area : A Japanese physician's journey to a new medical specialty

THE origin of anesthesiology in Japan can be traced to 1804, when a physician named Seishu Hanaoka (1760– 1835) operated for breast cancer during general anesthesia by orally administering Tsusensan, a mixture of alkaloids and belladonnas extracted from several plants. In 1855, 9 yr after Morton’s demonstration of ether anesthesia in Boston, Massachusetts, Seikei Sugita (1817– 1859) administered ether anesthesia. Despite this early introduction, there was no formal academic department of anesthesiology in 1945, at the end of World War II. In the early 1950s, Japanese professors of surgery, who realized the importance of modern anesthesia for safely performing neurosurgical and thoracic procedures, desired to establish academic departments of anesthesiology. One of these was Kentaro Shimizu, M.D. (1903– 1987; Professor, Department of Surgery, University of Tokyo, Tokyo, Japan), a neurosurgeon trained at the University of Illinois (Chicago, Illinois) from 1940 to 1942 and a professor of surgery at the University of Tokyo. Present-day Japanese anesthesiology began when the first independent Department of Anesthesiology was founded at that university in 1952. A little known U.S. government program of the early 1950s may claim credit for stimulating development of modern anesthesiology in Japan. The impact of this early program on Japanese anesthesiology has been notable and worthy of description.

The Unitarian Service Committee medical mission: contribution by the United States to Post-World War II Japanese anesthesiology.

IN Japan, as in many countries at the end of World War II, there was no organized anesthesiology service until the University of Tokyo founded its independent Department of Anesthesiology in 1952. Before then, the administration of anesthesia had been largely relegated to junior surgeons. A little-known program of the Unitarian Service Committee Medical Mission fostered the development of modern anesthesiology in Japan. The impact of the program on Japanese medicine, particularly anesthesiology, has been notable and is the subject of this article.

American anesthesiologists' contribution to post-World War II global anesthesiology: the Unitarian Service Committee's medical missions

Beginning in 1946, the Unitarian Service Committees Medical Mission sent 10 distinguished anesthesiologists to 13 different countries to teach anesthesiology. The details and impact of that mission are the subject of this article.