Takuro Taniyama

Usefulness of forced diuresis for acute boric acid poisoning in an adult

Background: Boric acid is generally not recognized as a poisonous substance. However, boric acid has potentially fatal actions such as hypotension, metabolic acidosis and oliguria. Death may result from circulation collapse and shock.

Effects of olprinone, a new phosphodiesterase inhibitor, on gastric intramucosal acidosis and systemic inflammatory responses following hypothermic cardiopulmonary bypass

Background: Phosphodiesterase (PDE) III inhibitors have both an inotropic and a peripheral vasodilatory effect, and also inhibit the activation of macrophages. Thus a newly developed PDE III inhibitor, olprinone, could modify gastric intramucosal pH (pHi), systemic oxygen consumption, and systemic inflammatory responses in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

Changes in end-tidal CO2 level following tourniquet deflation during orthopedic surgery

We studied the changes in end-tidal CO2 (ETCO2) and systemic responses after tourniquet deflation in spontaneously breathing and ventilation-controlled patients during orthopedic surgery of both the upper and/or the lower extremities. In most patients, increases in ETCO2, heart rate, and PaCO2, as well as decreases in blood pressure and pH were observed. In every spontaneously breathing patient, the respiratory rate began to increase before the ETCO2 reached a maximum. Arterial blood gas analysis suggested that the increase in ETCO2 closely reflected the increase in PaCO2. Our study yielded new information on the ETCO2 changes as follows: 1) the time for ETCO2 level to reach a peak (peak time) was almost constant despite the considerable differences in the increases in ETCO2 both in spontaneous breathing and ventilation-controlled groups and the peak time in the former group was shorter than that in the latter group; and 2) it was suggested that the increase in ETCO2 in the spontaneously breathing patients was smaller than that in ventilation-controlled patients when both patients were subjected to the same conditions on tourniquet time and tourniqueted area. Our data showed that the increase in ETCO2 (or PaCO2) can be large and prolonged in some situations. Thus, we recommend continuous ETCO2 monitoring and the proper hyperventilation at tourniquet deflation in order to minimize any adverse effects of acidosis.

Enantioselective determination of thiamylal in human serum by high-performance liquid chromatography

Thiamylal, a widely used anesthetic drug, has two enantiomers. We developed a novel and simple method for measuring thiamylal enantiomers in human serum using reversed-phase high-performance liquid chromatography. R(+)- and S(-)-Thiamylal were separated using a chiral mobile phase containing beta-cyclodextrin, and detected at the range of 50 ng/ml-25 micrograms/ml in serum. The relative standard deviations of R(+)- and S(-)-thiamylal were 3.4-8.7% and 2.8-8.7% for the intra-day assay, and 2.8-12.0% and 2.8-13.0% for the inter-day assay. This method may be applied to enantioselective pharmacokinetic studies of thiamylal.

Does the Transient Decrease in Mixed Venous Oxygen Saturation and Jugular Venous Hemoglobin Saturation During the Rewarming Phase in a Cardiopulmonary Bypass Merely Reflect a Recovery of the Metabolic Rate? A Case Report

Maintaining the balance between oxygen supply and demand during a cardiopulmonary bypass (CPB) is a key issue in the anesthetic management of cardiovascular surgery. Although many reports have described this balance at a constant, low body temperature, little is known about the balance during the cooling and the rewarming phase of CPB. Nakajima et al. [1] reported that jugular venous hemoglobin saturation (SjO2) decreased during the rewarming phase of CPB, and that rapid rewarming produced a pronounced decrease in SjO2. We analyzed retrospectively the intraoperative changes in SjO2, mixed venous oxygen saturation (SVO2), and oxygen consumption (VO2) in three patients who underwent reconstruction of the thoracic aorta, two of whom developed postoperative neurological deficits.

An increase in plasma concentrations of granulocyte elastase during and after bench surgery of the live

Elastase released from granulocytes has been shown to be involved in a variety of disorders: adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation and ischemiajreperfusion injur-ies<. the involvement of granulocytes in reperfusion injuries has been established in almost all organs including the liver. A primary non-function of grafts, which still disturbs successful orthotopic liver transplantation, has been thought to be partly caused by an activation of granulocytes, resulting in a production of active oxygen and a release of proteases. Riess et al. reported changes in plasma granulocyte elastase concentration in 10 patients undergoing liver transplantation7 • They observed an abrupt rise in granulocyte elastase concentration in plasma after reperfusion. We measured granulocyte elastase concentration in the plasma of

Coronary artery spasm immediately following extubation of the trachea

It is now generally accepted that coronary artery spasm plays an important role in the genesis of myocardial ischemia<. Perioperative coronary artery spasm appears to be observed most frequently after myocardial revascularization in patients undergoing coronary artery bypass surgery3,4,5. In this report, we present a case of coronary artery spasm in noncardiac surgery, which occurred just after extubation of the trachea.