Journal of anesthesia
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Journal of anesthesia · Jan 1990
The effects of ulinastatin on cardiac and hepatic energy metabolism in rats subjected to hypovolemic shock.
Ulinastatin is a trypsin inhibitor extracted from human urine. In this study the effects of ulinastatin on myocardial and hepatic tissue concentrations of creatine phosphate (CP), ATP, ADP, AMP, lactate, pyruvate, and glycogen have been investigated in rats which were in hemorrhagic shock state. Hypovolemia was induced by bleeding from the femoral artery, and systolic blood pressure was maintained 40 mmHg for 25 min, then ulinastatin 50,000 units.kg(-1) in saline or saline vehicle was intravenously administered. ⋯ The myocardial tissue CP level was higher in ulinastatin-treated group than that of control group, whereas no significant difference in energy charge between two groups. The hepatic tissue level of AMP, lactate and L/P ratio was lower in ulinastatin-treated group than that of control group, however, no significant difference was found in hepatic tissue level of ATP, ADP and energy charge. From these results it is concluded that ulinastatin can improve the energy metabolism of myocardium to some extent, but not of the liver in rats with hypovolemic shock.
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Journal of anesthesia · Sep 1989
Effects of various catecholamines on high-energy phosphates of rat liver and brain during hemorrhagic shock measured by 31P-NMR spectroscopy.
The effects of dopamine, epinephrine and norepinephrine on energy metabolism as well as intracellular pH in rat liver and brain during hemorrhagic shock were examined by in vivo 31P-NMR spectroscopy. The hemorrhagic shock was induced by arterial bleeding to a mean arterial pressure (MAP) of 30-40 mmHg. Upon the induction of hemorrhagic shock, there was a dramatic fall in adenosine triphosphate (ATP) and a rise in inorganic phosphate (Pi) in the liver. ⋯ After infusion of the above catechollamines following 10 min of hemorrhagic shock, MAP increased to 90-100% of its control value. Only dopamine improved hepatic energy metabolism, whereas brain energy metabolism was not affected by any of them. This suggests that dopamine protects liver function during hemorrhagic shock without affecting brain energy metabolism.
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Journal of anesthesia · Sep 1989
Anesthesia for a patient with recessive dystrophic epidermolysis bullosa.
Two different anesthetic methods were employed for a patient with recessive dystrophic epidermolysis bullosa (R-DEB). One was plexus brachial block in combination with ketamine infusion. ⋯ In the later, however, some blisters were newly formed on the region where the anesthesist's fingers were attached to hold a face mask. Although mask anesthesia was considered to be not always suitable for patients with DEB, we chose it because tracheal intubation may cause more serious damage to the upper airway leading to airway obstruction.
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Journal of anesthesia · Mar 1989
A new technique of identifying the epidural space "dripping infusion method".
We developed a new visual technique o identifying the epidural space, using the hydrostatic pressure produced by a suspended micro-drip intravenous apparatus. When the needle pierces the ligamentum flavum, the resistance to positive pressure disappears and the saline in the apparatus flows freely into the epidural space. Thus, the entry of the needle point into the epidural space is visually confirmed by the appearance of dripping flow in the drip bulb (dripping infusion sign). ⋯ In the remaining 11 patients (2.2%), a false dripping infusion sign appeared at the more superficial site than expected. If the pressure waveform in the epidural space is analyzed, the correct positioning of the needle can be easily confirmed. We believe that this method is one of the most accurate visual methods of identifying the epidural space and useful for teaching the epidural blockade to students and residents.