Full Stomach Research Articles

新しいβ１選択性β遮断薬塩酸ｂｅｖａｎｔｏｌｏｌの日本人健常成人における薬物動態と薬理作用

Clinicopharmacological study of bevantolol, a newly developed β1-selective β-blockingagent was carried out in Japanese healthy male volunteers. The pharmacokinetics, pharmacodynamics, and safety were investigated after single and once-daily repeated oraladministration of 100 mg and 200 mg of bevantolol. The following results were obtained.(1) The time to the maximum plasma concentration (tmax) on an empty stomach was about 0.7 hr and the elimination half-life in α-phase (t1/2α) and in β-phase (t1/2β) were about 1. 4 hr and 9 to 10 hr, respectively. The area under the plasma concentration curve (AUC) and the maximum plasma concentration (Cmax), which showed about a threefold interindividual variation, were about two times greater after the 200 mg dose than after the100 mg dose.(2) On a full stomach, tmax was prolonged to 2 hr. No sign of accumulation was noted after seven days of once-daily repeated doses.(3) The reduction in resting blood pressure after dosing of bevantolol was mild, while pulse rate decreased singnificantly. Fall in blood pressure after postural change from supine to standing position was not evident.(4) Exercise-induced tachycardia and increase in rate-pressure product were significantly attenuated by bevantolol. A high correlation existed between the percent reduction [%R] HR in exercise-induced tachycardia and the logarithm of the plasma concentration of bevantolol.(5) Resting fingertip blood flow measured by venous occlusion plethysmography did not decrease after repeated doses of 100 mg of bevantolol.(6) Regarding subjective symptoms, complaints of headache, dull headache, and gastrointestinal disturbance were noted in some subjects. No profound influence was recognized on the clinical laboratory data. After repeated doses of 100 mg of bevantolol, one subject developed transient loss of consciousness accompanied by a fall in blood pressure and pulse rate. Therefore, careful attention should be paid when the drug isused.

Pharmacologic Aids to Intubation and the Rapid Sequence Induction

Endotracheal intubation usually can be performed in the emergency setting without the use of pharmacologic adjuncts. However, local airway anesthesia lessens patient discomfort, and the use of sedation and muscle relaxants occasionally may be necessary. Rapid sequence induction of general anesthesia adds benefits as well as risks to airway management; used in the circumstance of a full stomach combined with open eye injury or closed head injury associated with raised intracranial pressure, it should be practiced only by physicians appropriately trained and skilled at the procedure.

Monitorage continu chez l'adulte de la saturation artérielle en oxygène durant l'apnée qui suit l'intubation

Twenty ASA I or II patients were studied to assess the safety of oxygenation for 4 min prior to intubing, so as to prevent the hypoxaemia related to tracheal intubation. The arterialized capillary blood saturation (S po 2) was continuously monitored with a pulse oximeter Nellcor 100 equipped with a finger probe. Patients spontaneously breathed oxygen (F io 2 = 1) while anaesthesia was induced with pancuronium bromide, thiopentone and fentanyl. Following apnoea, ventilation was manually controlled during 4 min (F io 2 = 1). The values of S po 2 were recorded before induction, at the end of the 4 min oxygenation period and after 5 min of apnoea. An arterial blood sample was withdrawn at the end of apnoea and analysed immediately using an OSM 2b hemoximeter. Apnoea was interrupted in case of desaturation below 95 %, new arrhythmia or haemodynamic instability (blood pressure ± 20 % of control value). Mean saturation (± SD) before oxygenation was 98.6 ± 1.35 %. After oxygenating for 4 min, all the S po 2 reached 100 %. After the 5 min apnoea period, no saturation was below 95 % (x̄ ± SD = 98.89 ± 1.66); at this time, S ao 2 and S po 2 did not significantly differ (p < 0.001). In one case, apnoea had to be interrupted, because of the occurrence of arrhythmias, unrelated to a blood gas disorder (P ao 2 = 225 mmHg; P aco 2 = 34 mmHg; S ao 2 = 100 %; pH = 7.44). This study confirmed the efficacy and safety of oxygenating for 4 min before intubation. Pulse oximetry appeared to be a reliable non invasive monitoring technique, useful in difficult circumstances, i.e. induction of poor risk patients, full stomach, blind intubation as well as in training for intubation.

Post-weaning growth performance, carcass characteristics and preliminary heritability estimates for some carcass traits of two types of Sudan Desert sheep on intensive feeding

SummaryTwenty-five male Shugor, 25 female Shugor, 25 male Watish and 25 female Watish lambs, individually fed for 57 days, were used to study post-weaning growth performance and carcass composition of these breed types when subjected to a period of intensive feeding.Means and standard error of means of daily gain on experiment were 191·0±5·81, 166·0±5·81, 150·0±5·81 and 134·0±5·81 g for Shugor males, Watish males, Shugor females and Watish females, respectively. The means and S.E. for feed conversion ratio (FCR) were 5·79±0·190, 7·30±0·190, 7·47±0·190 and 8·00±0·190 in the same order. Shugor and male lambs had better gain (P &lt; 0·001) and FCR (P &lt; 0·01)than Watish and female lambs respectively.Shugor had heavier slaughter weight and cold carcass weight than Watish (P &lt; 0·01). Males were superior to females in slaughter weight, carcass weight and dressing percentage (P &lt; 0·01). No difference was detected in lean, fat or bone percentage between breed type or sex (P &lt; 0·05). Males had larger muscle area (P &lt; 0·001) than females. On the other hand, females had more percentage kidney knob and channel fat (P &lt; 0·001) and thicker fat depth (P &lt;0·01) than males. Shugor were superior (P &lt; 0·01) in fat depth to Watish.Percentage non-carcass components showed that females had more percentage omental and mesenteric fat (P &lt; 0·001) and percentage full stomach (P &lt; 0·01). Breed type and sex showed significant effect (P &lt; 0·001) on percentage liver.In linear measurements, Shugor had greater carcass length and femur length (P &lt; 0·01). Males had bigger circumference of buttocks and chest depth (P &lt; 0·001).For carcass joints as a percentage of side weight, the only clear effect of breed type was on percentage loin (P &lt; 0·05). Males had bigger percentage middle neck (P &lt; 0·001) and shoulder and percentage scrag (P &lt; 0·01) than females, whereas females had higher percentage loin and chump.Heritability estimates of some carcass traits, admittedly based on limited numbers, ranged from 0·32 (S.E. 0·183) for leg to 0·18 (S.E. 0·180) for loin weights. Linear carcass measurements showed low heritability of around 0·10 (S.E. 0·160).

Enzyme-substitution therapy with the yeast Saccharomyces cerevisiae in congenital sucrase-isomaltase deficiency.

Sucrase-isomaltase deficiency is an inherited disaccharidase deficiency that leads to malabsorption of sucrose, with resulting diarrhea and abdominal distention and cramps. We investigated the sucrose-splitting effect of viable yeast cells in eight children with congenital sucrase-isomaltase deficiency, by means of the sucrose hydrogen breath test. This test is based on the fact that hydrogen is released from the malabsorbed sucrose by the colonic microflora. We found that 0.3 g of lyophilized Saccharomyces cerevisiae, given after loading with 2 g of sucrose per kilogram of body weight, reduced hydrogen excretion in all patients, on average by 70 percent, in parallel with a complete loss or evident reduction of clinical symptoms. In vitro, lyophilized and fresh S. cerevisiae (fresh baker's yeast) had appreciable sucrase activity, a low isomaltase and maltase activity, and virtually no lactase activity. The sucrase activity was more inhibited by undiluted than by diluted gastric juice. We conclude that patients with congenital sucrase-isomaltase deficiency who intentionally or unintentionally consume sucrose can ameliorate the malabsorption by subsequently ingesting a small amount of viable yeast cells, preferably on a full stomach.

Caecal size and function in the rock elephant shrew Elephantulus myurus (insectivora, macroscelididae) and the namaqua rock mouse Aethomys namaquensis (Rodentia, Muridae)

1. 1. The relative size of the digestive organs and the function of the caeca of an insectivorous elephant shrew Elephantulus myurus (Macroscelididae) and of a herbivorous rodent Aethomys namaquensis (Muridae) were compared. 2. 2. Both species had similar body mass but A. namaquensis had a significantly heavier total digestive tract, full stomach, and caecum and a longer large intestine and caecum than E. myurus. 3. 3. Both species had similar total volatile fatty acid (VFA) concentration and VFA % composition although A. namaquensis had a significantly higher % of n -butyric acid. Both had a similar caecal nh 3-n concentration. 4. 4. The presence of a functional caecum in E. myurus supports the view that Macroscelididae have evolved from ancestral herbivores and not from insectivores.

Conditions d'intubation avec le vécuronium à partir d'un protocole de préinjection

Different protocols based on the priming principle have been proposed so as to enable rapid tracheal intubation with vecuronium. The conditions of such an intubation have been assessed in 47 ASA I or ASA II patients, with an empty stomach, using a priming dose of 0.01 mg · kg −1, followed by a second injection of 0.1 mg · kg −1 after a short interval of 4 min. An intubation score was defined using a nerve stimulator (Relaxograph Datex), by measuring the twitch in comparison with a reference value, as well as time before intubation for four groups of patients. Good intubation scores with a twitch approaching 50 % was obtained in all and, in the same way, for a fifth group of patients, intubated in an arbitrary manner 60 s after the second dose of vecuronium. These results can be compared with those obtained by other authors using a different protocol. Nevertheless, this method does not match perfectly that of suxamethonium. Taking into account the side-effects and above all the inhalation risk existing after a priming dose, is it opportune to use this technique for the anaesthesia of a patient with a full stomach ?

Individual Difference Correlates and Measures of Predisposition to Obesity and to Anorexia

A questionnaire of eating and related habits was developed and factor analyzed to yield verbal report measures of predisposition to obesity, binge eating, physical activity, and predisposition to anorexia. The latter was composed of three intercorrelated components: food phobia, inability to eat, and abhorrence of full stomach (vomiting). Predisposition to obesity correlated .42 with binge eating and –.55 with the ponderal index (a measure of the elongated-rounded quality of body shape). Predisposition to anorexia correlated .14 with predisposition to obesity, showing that those predisposed to anorexia had a weak tendency to perceive themselves as prone to gain weight. However, contrary to clinical observations, predisposition to anorexia did not correlate significantly with binge eating or with physical activity. Across the entire sample, binge eating correlated .15 with abhorrence of full stomach (vomiting) showing that the incidence of bulimia is very low. A three-dimensional temperament framework and its associated measures of trait pleasure-displeasure, arousability, and trait dominance-submissiveness was used to explore personality correlates of eating habits. Predisposition to obesity was associated with arousability, and secondarily, with submissiveness, indicating anxious or dependent temperament types to be prone to obesity. Both binge eaters and those predisposed to anorexia exhibited unpleasant, arousable, and submissive (i.e., anxious) temperament characteristics. Physical activity was associated with trait dominance and trait pleasure; that is, relaxed or exuberant temperament qualities. Compared with males, females were significantly more predisposed to obesity, binge eating, and anorexia.

Paralysie récurrentielle et syndrome de Claude Bernard-Horner après blocage interscalénique du plexus brachial

The association of a recurrent laryngeal block with a Horner's syndrome occurred in one patient after right interscalene brachial plexus block. Hoarseness was the main clinical symptom of recurrent paralysis and lasted 4 h. The subsequent course was totally uneventful and required no specific treatment. But the interscalene route of brachial plexus block may be potentially hazardous in the patient with a full stomach.

Medical indications for regional anaesthesia

Although many specialists in internal medicine think that they should help influence the choice of anaesthetic technique, the decision between regional and general anaesthesia in any given medical condition and surgical procedure is best left to the attending anaesthetist. Many factors influence the choice of anaesthesia.* These include patient attitude, size and metabolic-physiologic status, anaesthetist skills, accessory personnel and facilities, operative site and duration of operation, and therapeutic and diagnostic considerations. Recent additions and advances in anaesthetic drugs and techniques for general anaesthesia, the increasing number of otherwise well-trained anaesthetists who have limited experience with regional techniques, and the inherent suspicion and fear of surgeons and their patients toward blocks have conspired to limit the use of regional anaesthesia, l As a result, appropriate and optimal use of local anaesthetics is often neglected, resulting in even less inclination to consider regional techniques. The economic pressure to use operating theatre time for the maximum number of cases also mitigates against regional anaesthesia, which, especially in less experienced hands, often takes longer than general anaesthesia. It is interesting to note that among anaesthetists, 68 per cent of 3,498 respondents in a survey preferred regional anaesthesia for themselves} Reasons cited by them for choosing regional anaesthesia included ease of administration, lower incidence of major intraoperative or postoperative complications, avoidance of the toxic effects of some general anaesthetic agents, provision of excellent operating conditions, pleasant recovery, and less difficulty in the recovery room. Regional anaesthesia may be preferred in outpatients, emergency surgery without extensive haemorrhage, patients with a full stomach, surgery in the prone position, geriatric patients, hot and dry climates or high altitude, and surgery where patient co-operation is required. 3 Local techniques may also be selected in patients with certain disease states: diabetes, hypertension, coronary artery disease, congestive heart failure, cerebrovascular accidents, respiratory disease, and urinary tract disease. In contrast, preference may be given to general anaesthesia in young, unco-operative or uncomprehending patients, hysterical patients, patients with a history of malingering, certain nervous system diseases, anaemias, coagulopathies, skin infections, and septicaemia. There are few controlled scientific studies which attempt to determine the relative advantages of either form of anaesthesia. Recent data have demonstrated the merits of regional anaesthesia with respect to haemodynamic considerations, metabolic effects, postoperative patient care, and relative morbidity and mortality. 4 Cardiovascular depression is less and metabolic stress responses are better obtunded. 5 Postoperatively there is improved pulmonary function, better pain control, and earlier ambulation and discharge. 6 Mortality rates have been shown to be slightly lower in regional anaesthesia. 7,s Nevertheless, large scale epidemiologic studies need to be done to further elucidate the relative advantages of regional and general anaesthetic techniques.

Use of Esophageal Balloon for Anesthetic Induction of Full Stomach Patients

Use of Esophageal Balloon for Anesthetic Induction of Full Stomach Patients

Anaesthetic Accidents

Safe, accident-free anaesthesia is a prerequisite for the application of surgical treatment. While it is conceded that accidents do occur in clinical anaesthesia, it is arguable that deaths, when attributable to anaesthesia, are usually the result of error or lack of skill on the part of the anaesthetist and, as such, are basically preventable. The sources of accident and error during inhalation anaesthesia are examined in terms of the pattern of interaction between anaesthetist, patient and apparatus. The latter subset of the system which includes the means of storage, distribution and measurement of flow of respirable and anaesthetic gases and vapours to the patient, together with the means of providing pulmonary ventilation, are highlighted for the number of sites of potential technical failure and accident they embrace. An answer to the question ‘How safe is anaesthesia today?' is sought in a brief review of the most recent surveillance studies of anaesthesia associated mortality. While differences between studies in structure, case inclusion, classification and assessment criteria render invalid any but the very broadest comparisons and inferences, evidence from these studies seems to suggest that, associated with surgery, there is an incidence of death attributable to anaesthesia of between 0.07 to 0.2 per 1000 anaesthetics. This represents a primary anaesthetic responsibility for approximately 2 per cent of total surgical operative mortality. Examination of the patterns of anaesthetic mortality in the studies reviewed reveals much agreement in the identification of the commoner accident and risk situations. These are: 1.complications of endotracheal intubation; 2.relaxant related postoperative problems; 3.inadequate postoperative supervision; 4.the full stomach; 5.failure to secure circulatory homeostasis; 6.apparatus and technical accident/failure which is the commonest cause of ‘critical incident' but which seldom causes death; 7.hurry, inattentiveness, carelessness and fatigue, which are the factors that most commonly adversely affect the anaesthetist's performance. In short the causes of death attributable to anaesthesia have changed little with time. They are basically simple and follow failure to observe elementary precautions together with a lack of clinical alertness.

Anesthetic care of pediatric surgical patients.

Some technical aspects of intraoperative anesthetic care of pediatric surgical patients are discussed. Recent concepts of premedicant, anesthetic and muscle relaxant drugs as related to the pediatric patient are presented. Endotracheal intubation is an integral part of the pediatric anesthetic management. Adequacy of fluid and blood replacement is emphasized. Most current pediatric anesthetic systems incorporate the "T piece" principle. Maintenance of a near normal PaCO2 could be accomplished by allowing partial rebreathing during controlled ventilation. Current status of three useful techniques is presented: deliberate hypotension, hemodilution, and the rapid induction-intubation technique for children with a full stomach. Anesthetic considerations of special problems, such as neurosurgery or cardiac surgery and monitoring, are not discussed.

The effect of thiopentone and fazadinium on intraocular pressure.

Intraocular pressure was measured in twenty-four patients using an applanation tonometer, after using thiopentone and fazadinium as induction agents. No significant rise in intraocular pressure above resting levels was noted before or after tracheal intubation, and it is suggested that this combination of induction agents should be satisfactory for general anaesthesia of a patient with a perforating eye injury who presents with a full stomach.

Pitfall in the ct diagnosis of abdominal abscess—The full stomach

A case is presented to illustrate that the CT appearance of the unenhanced full stomach may be misinterpreted as an abdominal abscess in the appropriate clinical setting. The need for administering oral contrast material prior to the study is emphasized.

Metoclopramide and the gastro‐oesophageal sphincter

AnaesthesiaVolume 34, Issue 1 p. 81-82 Free Access Metoclopramide and the gastro-oesophageal sphincter John G. Brock-Utne, John G. Brock-Utne Department of Anaesthesia, Stanford University Medical Center, Stanford, U.S.A.Search for more papers by this author John G. Brock-Utne, John G. Brock-Utne Department of Anaesthesia, Stanford University Medical Center, Stanford, U.S.A.Search for more papers by this author First published: January 1979 https://doi.org/10.1111/j.1365-2044.1979.tb04887.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Brock-Utne, J.G., Dow, T.G.B., Welman, S., Dimopoulos, G.E. & Moshal, M.G. (1978) The effect of metoclopramide on the lower oesophageal sphincter in late pregnancy. Anaesthesia and Intensive Care, 6, 26. 2 Haddad, J.K. (1970) Relation of gastroesophageal reflux to yield sphincter pressures. Gastroenterology, 58, 175. 3 Hey, V.M.F., Cowley, D.J., Ganguli, P.C., Skinner, L.D., Ostick, D.G. & Sharp, D.S. (1977) Gastro-oesophageal reflux in late pregnancy. Anaesthesia, 32, 372. 4 Davies, J.A.H. & Howells, T.H. (1973) Management of anaesthesia for the full stomach case in the casualty department. Postgraduate Medical Journal, 49 (Suppl. 4), 58. 5 Dundee, J.W. & Clark, R.S.J. (1973) The pre-medication and anti-emetic action of metoclopramide. Postgraduate Medical Journal, 49 (Suppl. 4), 34. 6 Howard, F.A. & Sharp, D.S. (1973) Effect of metoclopramide on gastric emptying during labour. British Medical Journal, 1, 446. 7 Laitinen, S., Mokka, R.E.M., Valanne, J.V.I. & Larmi, T.K.I. (1978) Anaesthesia induction and lower oesophageal sphincter pressure. Acta Anaesthesiologica Scandinavica, 22, 16. Citing Literature Volume34, Issue1January 1979Pages 81-82 ReferencesRelatedInformation

Topical Anesthesia and Intubation

To the Editor.— Cohen and Levinsky (236:562, 1976) warned that care should be exercised... when food is ingested within 60 minutes following the use of topical anesthetics in the pharynx. They pointed out that orally administered topical anesthetic agents may interfere with the pharyngeal stage of swallowing and lead to aspiration. A similar admonition applies to the use of topical anesthesia before performing an awake orotracheal intubation in an individual with a full stomach. I have witnessed aspiration in a patient whose pharynx and glottis were sprayed with a topical anesthetic prior to intubation with the patient awake. Topical anesthesia should be applied only to the lower lip and the outer half of the tongue prior to performing such orotracheal intubation. Spraying the base of the tongue may inadvertently anesthetize the pharynx and the glottis, particularly if the patient inhales during the spraying.

Food to Nurture the Mind

Wouldn't it be nice if all children could begin their learning in school in the relaxed mood that a good meal, in good company, creates? They would be so much more receptive to what their teachers want them to learn. If, as we are told, an army marches on its stomach, how much more this is true for an army of children, to whom a full stomach alone gives the courage to do battle with and to conquer the challenges of learning. This, the psychological impact of eating, of how we eat, and of how we eat together, as different from what we eat, has received far too little attention.

Prostaglandin F2 aifa Infusion and Halothane Anaesthesia

The cardiovascular reaction to infusion of prostaglandin F2 alfa was examined in seven patients during N2O-jalothane anaesthesia. As in the non-anaesthetized individual, no changes in blood pressure, pulse rate, CVP or ECG occurred during anaesthesia, but a great reflux of enteric juice to the ventricle was noticed only 2-3 min after the beginning of the hormone infusion. It is concluded that prostaglandin F2 alfa may be safely given to patients who are going to be anaesthetized, but the patients must be considered as having a full stomach and therefore treated as such.

Intestinal duplication. A report of two cases.

Abstract Two cases of intestinal duplication occurring in neonates are described, the first a gastric duplication, the second a rectal duplication, both diagnosed radiologically before operation. These sites are uncommon as this lesion is most frequently associated with the ileum or oesophagus. The gastric duplication was attached to the greater curvature with a small intrathoracic extension. It did not communicate with the stomach. The child presented at two weeks with signs of an upper intestinal obstruction. A plain film and barium meal snowed a large, soft tissue mass with the shape of a full stomach in the left hypochondrium displacing the stomach to the right. An IVP was normal. The rectal duplication presented at one month with constipation and a prolapsing cystic mass. A barium enema showed the extent of the lesion and a cyst puncture that it did not communicate with the intestine. An X ray of the lumbar spine and sacrum did not show an associated defect.