RESUMO
BACKGROUND: Hypercapnia causes dilation of cerebral vessels and increases cerebral blood flow, resulting in increased intracranial pressure. Sevoflurane is reported to preserve cerebrovascular carbon dioxide reactivity. However, the contribution of inhaled anesthetics to vasodilatory responses to hypercapnia has not been clarified. Moreover, the cerebrovascular response to desflurane under hypercapnia has not been reported. We examined the effects of sevoflurane and desflurane on vasodilatory responses to hypercapnia in rats. METHODS: A closed cranial window preparation was used to measure the changes in pial vessel diameters. To evaluate the cerebrovascular response to hypercapnia and/or inhaled anesthetics, the pial vessel diameters were measured in the following states: without inhaled anesthetics at normocapnia (control values) and hypercapnia, with inhaled end-tidal minimal alveolar concentration (MAC) of 0.5 or 1.0 of either sevoflurane or desflurane at normocapnia, and an MAC of 1.0 of sevoflurane or desflurane at hypercapnia. RESULTS: Under normocapnia, 1.0 MAC, but not 0.5 MAC, of sevoflurane or desflurane dilated the pial arterioles and venules. In addition, under both 1.0 MAC of sevoflurane and 1.0 MAC of desflurane, hypercapnia significantly dilated the pial arterioles and venules in comparison to their diameters without inhaled anesthetics. The degrees of vasodilation were similar for desflurane and sevoflurane under both normocapnia and hypercapnia. CONCLUSIONS: Desflurane induces cerebrovascular responses similar to those of sevoflurane. Desflurane can be used as safely as sevoflurane in neurosurgical anesthesia.
Assuntos
Animais , Ratos , Anestesia , Anestésicos , Arteríolas , Dióxido de Carbono , Circulação Cerebrovascular , Hipercapnia , Pressão Intracraniana , Vasodilatação , VênulasRESUMO
BACKGROUND@#Hypercapnia causes dilation of cerebral vessels and increases cerebral blood flow, resulting in increased intracranial pressure. Sevoflurane is reported to preserve cerebrovascular carbon dioxide reactivity. However, the contribution of inhaled anesthetics to vasodilatory responses to hypercapnia has not been clarified. Moreover, the cerebrovascular response to desflurane under hypercapnia has not been reported. We examined the effects of sevoflurane and desflurane on vasodilatory responses to hypercapnia in rats.@*METHODS@#A closed cranial window preparation was used to measure the changes in pial vessel diameters. To evaluate the cerebrovascular response to hypercapnia and/or inhaled anesthetics, the pial vessel diameters were measured in the following states: without inhaled anesthetics at normocapnia (control values) and hypercapnia, with inhaled end-tidal minimal alveolar concentration (MAC) of 0.5 or 1.0 of either sevoflurane or desflurane at normocapnia, and an MAC of 1.0 of sevoflurane or desflurane at hypercapnia.@*RESULTS@#Under normocapnia, 1.0 MAC, but not 0.5 MAC, of sevoflurane or desflurane dilated the pial arterioles and venules. In addition, under both 1.0 MAC of sevoflurane and 1.0 MAC of desflurane, hypercapnia significantly dilated the pial arterioles and venules in comparison to their diameters without inhaled anesthetics. The degrees of vasodilation were similar for desflurane and sevoflurane under both normocapnia and hypercapnia.@*CONCLUSIONS@#Desflurane induces cerebrovascular responses similar to those of sevoflurane. Desflurane can be used as safely as sevoflurane in neurosurgical anesthesia.
RESUMO
For the dispensing of Kampo formulas, only an adult dose is described by conventional formulary. Therefore a child's dose is often prescribed by reducing instructions for the fraction-times of an adult dose. However, it is necessary to study whether the content of Kampo-extract pharmaceutical preparations at a child's dose, are similar to decoctions prepared by reducing the dose of crude drugs, and reducing the quantity of water by fraction-times. Therefore it was compared whether the constituents of a decoction liquid at an adult dose, were equal to those of a child's dose. In the decoction method of our clinic, adult doses are decocted with an initial 600mL quantity of water to half volume, as per the normal decoction method, whereas children's doses are reduced to 2/3 or 1/3 times that of adult dose, and decocted to half of the early-stage quantity of water that they are with adults. In the present study, three Kampo formulas which have been used frequently in our clinic and have different prescription weights i.e., Oren-gedoku-to (9g), Keishi-bukuryo-gan-ryo (20g), and Juzen-taiho-to (33g) were studied. When child and adult doses were compared, a difference was noted in pH, extraction rate and extracted constituents. Extraction rates for a child's dose of Oren-gedoku-to and Juzen-taiho-to were lower than that of an adult dose. Extraction rates of component gradients? ferulic acid in Oren-gedoku-to, pae-oniflorin in Keishi-bukuryo-gan-ryo, and paeoniflorin and liquiritin in Juzen-taiho-to? for a child's dose were lower than those of an adult dose. However, extraction rates of component gradients? albiflorin in Keishi-bukuryo-gan-ryo and albiflorin and trans-cinnamic acid in Juzen-taiho-to ? for a child's dose (quantity of 1/3 times) were higher than those of an adult dose. These results suggest that the content of a decoction, which was prepared by reducing an adult dose to the fraction-time of a child's dose, is not the same as reducing the amount of Kampo-extract pharmaceutical preparation to the fraction-time of a child's dose.
RESUMO
Recently, the number of physicians using Kampo (Japanese traditional herbal) medicines has been increasing in Japan, and it is becoming more common for pharmacists to dispense Kampo medicines. As Kampo medicines become more popular, in addition to extract formulae, the use of decocting formulae that are more suited to each patient's predisposition and symptoms has increased. Therefore, more pharmacists are dispensing such decocting formulae. However, dispensing decocting formulae can be a complicated task. The risk of dispensing errors is not small. In present paper, we examined preventive measures based on investigations of errors involving decocting formulae in our Kampo clinic. From 1990 to 1999, there were 54 cases in which errors were found after patients received their medicines, and 44 of these cases were dispensing errors. To prevent such errors, in addition to having the knowledge of Kampo medicine and medicinal herbs that is needed for dispensing decocting formulae, it is also necessary to understand the contents of the prescription. The most important preventive measures are to re-inspect the weight and contents of the prescription after preparing it, and to do a final inspection of the medicine contents with the patient. It is expected that this report will play a role in preventing dispensing errors of Kampo medicines by pharmacists.
RESUMO
In general hospitals or clinics, medical treatment and instruction in medical therapies and nursing are carried out by the medical staff (doctors, pharmacists and nurses) on hand. It is necessary to understand overall trends in patient illness, in addition to personal information, in order to practice medical care comprehensively. For these reasons we analyzed popular medicines, patient make up, and major disease distributions at our own Kampo clinic institute, for patients admitted since 2001.<br>34% of our patients were male and 66% were female. The majority of these patients were between 20 to 30 years old or, 50 to 70 years old. There were few patients, either male or female, in their 40s. As for major disease distribution, atopic dermatitis was most common among both males and females. Next in line were cold sensations and endometriosis, for females, while respiratory organ diseases such as bronchial asthma or nasal inflammation, and Alzheimer's disease were most common, for males.<br>Among major disease types, atopic dermatitis was treated with Oren-gedoku-to (JTDN: Japanese Traditional Drug Name) and Ogi-kenchu-to (JTDN), while diabetes was treated with Hachi-mi-gan (JTDN) and Seishin-renshi-in (JTDN). Cold sensations were treated with Toki-shigyaku-ka-goshuyu-shokyo-to (JTDN) and Toki-shakuyaku-san (JTDN), while hypertension was treated with Cho-to-san and Saiko-ka-ryukotsu-borei-to (JTDN).<br>The present report contains information useful for diagnosis with Kampo medicines, as well as instruction in the nursing and use of these medications by doctors, pharmacists and nursing staff. This report may be utilized in order to administer appropriate medical care for patients.
RESUMO
Kampo medicines containing Bupleuri Radix (Sho-saiko-to and Sho-saiko-to plus Fossilia ossis mastodi and Ostreae testa) were decocted with four kinds of mineral waters and tap water, and the extracts were analyzed for saikosaponin contents by HPLC. The results indicated that the yield of the extracted materials was the largest when Kampo medicines were decocted with the hard water compared with other mineral water extracts. However, the same extract contained the smallest amount of saikosaponin b<sub>2</sub> of those tested. Extractions made with the mineral waters having a weakly acidic or weakly alkaline nature gave similar yields of the extracted materials and saikosaponin b<sub>2</sub> contents.<br>Present results suggest a possibility that decoction using a hard water significantly affects extraction of certain ingredients in Kampo medicine.