Masui. The Japanese journal of anesthesiology
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Historical Article
[Yale anesthesiology: a reflection on Professor Kitahata's days].
Professor Luke Masahiko Kitahata was a professor of anesthesiology, Yale University in the United States of America. He had been employed in Yale University for 33 years, from 1964 to 1997, and acted as the chairman of the department of anesthesiology from 1973 to 1982. ⋯ The number of Japanese fellows who were trained by Professor Kitahata is more than sixty. He rendered many services for the development of anesthesiology in Japan.
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Perioperative myocardial ischemia is one of the most important complications associated with significant risk of perioperative cardiac event. Ischemic preconditioning is a phenomenon in which single or multiple brief periods of ischemia have been shown to protect the myocardium against a more prolonged ischemic insult, the result of which is a marked reduction in myocardial infarct size, severity of myocardial stunning, or incidence of cardiac arrhythmias. Myocardial stunning is a clinically important ischemia-reperfusion injury described as a prolonged postischemic contractile dysfunction of myocardium salvaged by reperfusion. ⋯ The cardioprotective effect of volatile anesthetics has been supported by some clinical studies. Although the cellular mechanism of anesthetic preconditioning is not fully investigated, possible mechanism involves adenosine, adenosine receptors, the ATP-dependent potassium (K(ATP)) channels, protein kinase C, reactive oxygen species and other mediators or substances. Further, mitochondrial K(ATP) channels play the central role in anesthetic preconditioning.
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Common inhaled and intravenous anesthetics except the barbiturate are recommended for the patients with bronco-constrictive lung disease because of their bronco-dilating property. However there are pharmacological potency differences between individual anesthetics. The halogenated inhaled anesthetics and propofol exert antiinflammatory effect on acute lung injury and acute respiratory distress syndrome in the laboratory level, but further study is required for future clinical application. These anesthetics also have an organ protective effect on the ischemia reperfusion lung injury, and their clinical application is expected in the lung transplantation surgery.
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In this review article, hepatocyte injury by volatile anesthetics, effects of anesthetics on hepatic perfusion, protection offered by either ischemic preconditioning or anesthetic preconditioning against hepatic ischemia-reperfusion injury and effects of anesthetics on sepsis-induced hepatic injury are discussed. Halothane poses significant risk of immunologically-mediated hepatocyte injury and disturbances of hepatic blood supply. ⋯ Several animal studies demonstrate that volatile anesthetics offer more protection against ischemia-reperfusion injury than intravenous anesthetics. On the contrary, intravenous anesthetics may be more protective against sepsis-induced hepatic injury than volatile anesthetics.