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Language：Japanese   Publisher：Japan Society of Pain Clinicians  

DOI： 10.11321/jjspc.24-0032

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Language：Japanese   Publisher：Japanese Society of Cardiovascular Anesthesiologists  

<p>　Significant pulmonary valve regurgitation after congenital heart disease surgery in adults is being observed increasingly. Since 2010, transcatheter pulmonary valve implantation (TPVI) is being performed in the United States in patients with a history of multiple operations, who are considered at high risk for open heart surgery. The Harmony? Transcatheter Pulmonary Valve System (Medtronic Japan, Inc., [Harmony TPV]) was introduced into clinical practice in Japan in March 2023. It is a transcatheter implantation system that uses a porcine pericardial bioprosthetic valve attached to a self-expandable nitinol frame. Transcatheter implantation of the device is performed using a biplane X-ray angiography system. Although TPVI is minimally invasive, the caveats associated with this approach include the need for nonoperating room anesthesia management, complications attributable to poor surgical skill, procedure-related arrhythmias, and circulatory instability during valve deployment.</p><p>In this report, we describe our experience with anesthesia management in two cases of TPVI.</p>

DOI： 10.11478/jscva.2023-3-014

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

先天性心疾患術後の肺動脈弁閉鎖不全症が顕著化する成人患者が増加している。しかしながら,複数回の手術歴により,開心術のリスクが大きいと判断される症例に対し,米国では経カテーテル肺動脈弁留置術(TPVI:transcatheter pulmonary valve implantation)が2010年より行われている。本邦においては2023年3月にHarmony経カテーテル肺動脈弁システム(日本メドトロニック株式会社,以下Harmony TPV)の臨床使用が開始された。Harmony TPVは自己拡張性ニチノールフレームに取り付けられたブタ心のう膜を用いた生体弁を,バイプレーンX線血管撮影装置を用いて経カテーテル的に留置するシステムである。TPVIは低侵襲である一方,非手術室麻酔管理を要すること,術者の技術不足による合併症,手技に伴う不整脈の出現,弁展開時に循環動態が不安定となるなど注意点が多い。今回,TPVIの麻酔管理を2例経験したので,管理上の注意点を報告する。(著者抄録)

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiology  

BACKGROUND: Impella (Abiomed, Danvers, MA, USA) is a percutaneous ventricular assist device commonly used in cardiogenic shock, providing robust hemodynamic support, improving the systemic circulation, and relieving pulmonary congestion. Maintaining adequate left ventricular (LV) filling is essential for optimal hemodynamic support by Impella. This study aimed to investigate the impact of pulmonary vascular resistance (PVR) and right ventricular (RV) function on Impella-supported hemodynamics in severe biventricular failure using cardiovascular simulation. METHODS: We used Simulink® (Mathworks, Inc., Natick, MA, USA) for the simulation, incorporating pump performance of Impella CP determined using a mock circulatory loop. Both systemic and pulmonary circulation were modeled using a 5-element resistance-capacitance network. The four cardiac chambers were represented by time-varying elastance with unidirectional valves. In the scenario of severe LV dysfunction (LV end-systolic elastance set at a low level of 0.4 mmHg/mL), we compared the changes in right (RAP) and left atrial pressures (LAP), total systemic flow, and pressure-volume loop relationship at varying degrees of RV function, PVR, and Impella flow rate. RESULTS: The simulation results showed that under low PVR conditions, an increase in Impella flow rate slightly reduced RAP and LAP and increased total systemic flow, regardless of RV function. Under moderate RV dysfunction and high PVR conditions, an increase in Impella flow rate elevated RAP and excessively reduced LAP to induce LV suction, which limited the increase in total systemic flow. CONCLUSIONS: PVR is the primary determinant of stable and effective Impella hemodynamic support in patients with severe biventricular failure.

DOI： 10.1016/j.jjcc.2024.07.008

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Language：English   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-024-03380-y

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Publisher：診断と治療社  

DOI： 10.34433/og.0000000777

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Shock  

BACKGROUND: Histidine-rich glycoprotein (HRG), a potential prognostic factor in sepsis, lacks clarity regarding its relevance in septic-induced shock, disseminated intravascular coagulation (DIC), and acute respiratory distress syndrome (ARDS) pathogenesis. This study investigated the association between HRG concentrations and these critical conditions. METHODS: Blood samples were collected from 53 critically ill patients on days 1, 3, 5, and 7 after ICU admission at the Kyushu University Hospital. Daily clinical and laboratory data were recorded, and patient survival was assessed 28 days after ICU admission. RESULTS: Serum HRG concentrations were significantly reduced on days 3, 5, and 7 in patients with septic shock and DIC but not in those with ARDS. While initial HRG levels on day one were not correlated with survival, non-survivors displayed decreased HRG levels, notably on days 3, 5, and 7 post-ICU admissions. The HRG levels remained stable in survivors. A progressive decrease was associated with higher mortality rates, particularly on days 5 and 7. On day 5, an HRG level with a cutoff of 25.5 μg/mL showed a sensitivity of 0.77 and a specificity of 0.75, indicating significantly lower survival rates (log-rank test, P < 0.05). CONCLUSION: HRG presents a potential intervention for critically ill sepsis patients, providing a novel strategy to enhance outcomes. Further research is needed to explore the therapeutic potential of HRG in sepsis management.

DOI： 10.1097/SHK.0000000000002406

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Language：Japanese   Publisher：大道学館出版部  

Language：English   Publisher：JAPANESE ASSOCIATION FOR STUDY OF PAIN  

<p>Allodynia, pain induced by innocuous mechanical stimuli, is attributed to central nervous system dysfunction. We recently identified spinal dorsal horn (SDH) neuronal subsets that were captured by adeno–associated virus (AAV) vectors carrying a promoter of neuropeptide Y or prodynorphin (AAV–NpyP and –PdynP, respectively). Our previous studies demonstrated that both AAV–NpyP⁺ neuron inhibition and AAV–PdynP⁺ neuron excitation contribute to neuropathic allodynia–like behavior in rats. However, the potential interaction between these two subsets remains unknown. The present study employed tools that enable the optogenetic stimulation of touch–sensing Aβ fibers and neuronal subset–selective manipulations. Our findings revealed that the Aβ fiber–derived allodynia–like behavior in rats with AAV–NpyP⁺ neuron ablation was prevented by the simultaneous ablation of AAV–PdynP⁺ neurons. Furthermore, the removal of AAV–NpyP⁺ neurons allowed AAV–PdynP⁺ neurons to receive Aβ fiber–derived excitatory inputs. These results reveal an interaction between these subsets that are crucial for Aβ fiber–mediated allodynia.</p>

DOI： 10.11154/pain.39.40

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Publisher：克誠堂出版  

DOI： 10.18916/masui.2024050009

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：European Journal of Pain (United Kingdom)  

BACKGROUND: Autonomic nervous system dysfunction has been reported to be associated with impaired activities of daily living (ADL) among patients with chronic pain, but the association has not been fully addressed in general populations. This study cross-sectionally investigated the association between autonomic nervous system function and the presence of subjective symptoms affecting ADL in community-dwelling residents with chronic pain. METHODS: A total of 888 residents with chronic pain, aged 40-79 years, who underwent a health examination in 2017-2018 were included. Based on heart rate variability measured by fingertip pulse wave, the standard deviation of normal-to-normal intervals (SDNN), root mean square of successive RR interval differences (RMSSD), low frequency (LF) power, and high frequency (HF) power were calculated. Symptoms affecting ADL were defined as those scoring ≥1 on the modified Rankin Scale. Odds ratios (ORs) and their 95% confidence intervals (CIs) for symptoms affecting ADL were estimated using a logistic regression analysis. RESULTS: The overall prevalence of symptoms affecting ADL was 39.4%. The ORs for symptoms affecting ADL increased significantly per 1-standard-deviation decrement in log-transformed SDNN (OR 1.23 [95% CI 1.06-1.44]), RMSSD (1.25 [1.08-1.45]), LF power (1.29 [1.11-1.52]), and HF power (1.29 [1.11-1.51]) after adjusting for age, sex, education, hypertension, diabetes, serum total cholesterol level, body mass index, past medical history, current smoking, current drinking, exercise, depressive symptoms, and pain intensity. CONCLUSIONS: Decreased heart rate variability was associated with the presence of symptoms affecting ADL among individuals with chronic pain in a Japanese community. SIGNIFICANCE: Decrease in heart rate variability was associated with the presence of symptoms affecting ADL among individuals with chronic pain in a Japanese community. This article could help scientists understand the significance of autonomic nervous system dysfunction in the pathology of chronic pain. Approaches that target autonomic nervous system dysfunction may be an option to relieve or prevent symptoms affecting ADL for chronic pain sufferers.

DOI： 10.1002/ejp.2224

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

【症例】55歳の男性.現病歴:X-7年にHIV感染症と診断され,多剤併用療法を開始された.診断時より両足底部の痛みがあり,徐々に日常生活に支障が生じたことからX年当科紹介受診となった.初診時現症:常に両足底部に剣山で刺されるような痛みとしびれがあり,歩行時の数値評価スケール(numerical rating scale:NRS,0～10)は10であった.四肢末梢の温度覚と振動覚の低下がみられた.治療経過:HIV関連末梢神経障害と診断し,薬物療法を開始したが改善に乏しい状態であった.仙骨硬膜外ブロック(0.5%メピバカイン10ml)を施行したところ最大のNRS(歩行時)は7まで低下し,その状態が数週間持続した.その後も仙骨硬膜外ブロックを1回/月で継続し,X+5年のNRSは0～2となり長距離歩行も可能となった.【まとめ】HIV関連末梢神経障害はHIVウイルスによる慢性的な末梢神経炎および薬剤性末梢神経障害が原因と考えられている.本症例では仙骨硬膜外ブロックによる末梢血流改善や抗炎症作用が痛みを改善したと推測し,本ブロックは簡便で有用な治療である可能性が示唆された.(著者抄録)

Language：English   Publisher：(一社)日本疼痛学会  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Given the advances in medicine, women with Fontan circulation are now reaching childbearing age. However, data on the mode of delivery and anesthetic management of these patients are limited. We report the cases of five pregnant women with Fontan circulation. CASE PRESENTATION: The mean age at delivery was 28 ± 3 years, and the mean gestational period was 34 weeks and 3 days. Anticoagulation therapy was switched from warfarin and aspirin to continuous intravenous heparin. The modes of delivery were scheduled cesarean section (C/S) in one, emergency C/S in three, and vaginal delivery with epidural labor analgesia in one patient. Three patients underwent C/S under regional anesthesia; one received general anesthesia. The perinatal complications were heart failure, worsening valve regurgitation, and postoperative hematoma in three, four, and two patients, respectively. CONCLUSIONS: For C/S in women with Fontan circulation, regional anesthesia should be considered. Epidural labor analgesia can help prevent the decrease in pulmonary blood flow due to straining. We initiated labor analgesia or C/S with regional anesthesia at the appropriate time in four patients.

DOI： 10.1186/s40981-024-00706-3

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Language：English   Publisher：(公社)日本麻酔科学会  

オンダンセトロンが術後悪心嘔吐(PONV)の発生率を低下させ、術後早期の食事摂取に寄与するかどうかを検討した。2017年1月～2023年6月に当院で腹腔鏡下婦人科手術を受けた成人患者を後ろ向きに調べた。評価項目は、手術当日のPONV、手術翌日までのPONV、および食事摂取(手術翌日の朝食と昼食の摂取)とした。術中にオンダンセトロンを投与した患者と投与しなかった患者に分け、PONV発生率と術後食事摂取なしのオッズ比(OR)を算出した。PONVの交絡因子を調整した多変量解析を行った。患者632例(オンダンセトロン投与群:84例、中央値47歳、非投与群:548例、中央値48歳)を解析した。オンダンセトロン投与群の手術当日および翌日までのPONVの調整ORは、それぞれ0.56および0.52であった。術後食事摂取なしの調整ORは非有意であった。PONVに対するオンダンセトロンとデキサメタゾンまたは全静脈麻酔の相乗効果は認められなかった。

Language：English   Publisher：Springer Berlin Heidelberg  

症例1は24歳妊婦。肺動脈閉鎖、房室中隔欠損、総肺静脈還流異常に対するFontan手術の既往があった。硬膜外麻酔分娩で0.125%レボブピバカイン(10mL)とフェンタニル(50μg)を初回投与し、それぞれ10mL/hと1μg/hを持続投与した。妊娠期間34週で経腟分娩となった。症例2は30歳妊婦。三尖弁閉鎖に対するFontan手術の既往があった。脊髄麻酔と硬膜外麻酔を併用して妊娠期間36週に予定帝王切開を施行した。術中の中心静脈圧が10mmHgを維持するよう輸液管理を行った。術後に尿量が低下し、中心静脈圧が14mmHgに上昇したが、利尿剤の投与により改善した。症例3は29歳妊婦。三尖弁閉鎖に対するFontan手術の既往があった。妊娠34週に労作時呼吸困難と易疲労感が出現し、酸素投与を行った。妊娠35週に心不全の増悪を認め、脊髄麻酔と硬膜外麻酔の併用で緊急帝王切開を施行した。術後に在宅酸素療法を開始した。症例4は32歳妊婦。三尖弁閉鎖に対するFontan手術の既往があった。前置胎盤を伴う双胎妊娠により29週に性器から大量出血し、脊髄麻酔で緊急帝王切開を施行した。術後に在宅酸素療法を開始した。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Intensive Care Medicine Experimental  

BACKGROUND: ECPELLA, a combination of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and Impella, a percutaneous left ventricular (LV) assist device, has emerged as a novel therapeutic option in patients with severe cardiogenic shock (CS). Since multiple cardiovascular and pump factors influence the haemodynamic effects of ECPELLA, optimising ECPELLA management remains challenging. In this study, we conducted a comprehensive simulation study of ECPELLA haemodynamics. We also simulated global oxygen delivery (DO2) under ECPELLA in severe CS and acute respiratory failure as a first step to incorporate global DO2 into our developed cardiovascular simulation. METHODS AND RESULTS: Both the systemic and pulmonary circulations were modelled using a 5-element resistance‒capacitance network. The four ventricles were represented by time-varying elastances with unidirectional valves. In the scenarios of severe LV dysfunction, biventricular dysfunction with normal pulmonary vascular resistance (PVR, 0.8 Wood units), and biventricular dysfunction with high PVR (6.0 Wood units), we compared the changes in haemodynamics, pressure-volume relationship (PV loop), and global DO2 under different VA-ECMO flows and Impella support levels. RESULTS: In the simulation, ECPELLA improved total systemic flow with a minimising biventricular pressure-volume loop, indicating biventricular unloading in normal PVR conditions. Meanwhile, increased Impella support level in high PVR conditions rendered the LV-PV loop smaller and induced LV suction in ECPELLA support conditions. The general trend of global DO2 was followed by the changes in total systemic flow. The addition of veno-venous ECMO (VV-ECMO) augmented the global DO2 increment under ECPELLA total support conditions. CONCLUSIONS: The optimal ECPELLA support increased total systemic flow and achieved both biventricular unloading. The VV-ECMO effectively improves global DO2 in total ECPELLA support conditions.

DOI： 10.1186/s40635-024-00599-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Bisphosphonates may cause serious adverse events, including osteonecrosis of the jaw. This article describes a case of successful application of radiofrequency thermocoagulation for pain caused by osteonecrosis of the jaw. CASE PRESENTATION: An 86-year-old woman who had received alendronate sodium hydrate for osteoporosis was diagnosed with osteonecrosis of the right mandible after dental treatment. Despite repeated conservative and debridement treatments, the patient could not eat due to intractable pain; accordingly, her condition was debilitated. The patient was referred to our pain management clinic for radiofrequency thermocoagulation of the right mandibular nerve. Immediately after the procedure, her pain drastically improved and she could eat; moreover, the pain has not recurred for 3 years. CONCLUSION: Our findings demonstrate that minimally invasive radiofrequency thermocoagulation may have long-term effects in patients with chronic pain caused by osteonecrosis of the jaw that is refractory to conservative treatment.

DOI： 10.1186/s40981-024-00696-2

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Language：English   Publisher：Springer Berlin Heidelberg  

86歳女性。骨粗鬆症の治療のため、77歳時からアレンドロン酸ナトリウム水和物が投与されていた。歯周炎のため右下大臼歯を抜歯後、右下顎歯肉の腫脹と疼痛が持続した。口腔外科に紹介され、薬剤関連顎骨壊死と診断された。切開排膿や右下残存大臼歯の抜歯、抗菌薬投与、鎮痛剤投与量の増量を行ったが奏功せず、5ヵ月後に当ペインクリニックに紹介された。極度の疼痛で食事や睡眠がとれずQOLに支障が生じていることから、低侵襲処置として右下顎神経の高周波熱凝固療法(RFT)を施行した。RFT直後より疼痛は解消され、術後4日目で鎮痛薬を停止した。合併症はなく、予後良好で、3年の経過後も症状の再燃は認めていない。

Language：English   Publisher：Journal of Inflammation Research  

Background: Acute lung injury (ALI) is caused by a variety of illnesses, including aspiration pneumonia and sepsis. The CCR4-NOT complex is a large multimeric protein complex that degrades mRNA through poly(A) tail shortening, whereas it also contributes to regulation of transcription and translation. Cnot3 is a scaffold component of the CCR4-NOT complex and is essential for the integrity of the complex; loss of Cnot3 leads to depletion of whole complex. While the significance of cytokine mRNA degradation in limiting inflammation has been established, the roles of CCR4-NOT complex-mediated in ALI remain elusive. Methods: The effects of Cnot3 haploinsufficiency in the pathology and cytokine expression were analyzed in the mouse lungs of acid aspiration-induced acute lung injury. The decay rate and transcription activity of cytokine mRNAs under Cnot3 heterozygous deletion were analyzed in lipopolysaccharide (LPS)-stimulated mouse embryonic fibroblasts (MEFs). Results: Tamoxifen-induced heterozygous deletion of Cnot3 in adult mice (Cnot3 Hetz) did not show body weight loss or any apparent abnormality. Under acid aspiration-induced acute lung injury, Cnot3 Hetz mice exhibited increased pulmonary edema, worse lung pathologies and more severe inflammation compared with wild type mice. mRNA expression of pro-inflammatory genes Il1b and Nos2 were significantly upregulated in the lungs of Cnot3 Hetz mice. Consistently, mRNA expression of Il1b and Nos2 was upregulated in LPS-stimulated Cnot3 Hetz MEFs. Mechanistically, while heterozygous depletion of Cnot3 stabilized both Il1b and Nos2 mRNAs, the nascent pre-mRNA level of Il1b was upregulated in Cnot3 Hetz MEFs, implicating Cnot3-mediated transcriptional repression of Il1b expression in addition to destabilization of Il1b and Nos2 mRNAs. PU.1 (Spi1) was identified as a causative transcription factor to promote Il1b expression under Cnot3 haploinsufficient conditions. Conclusion: CNOT3 plays a protective role in ALI by suppressing expression of pro-inflammatory genes Il1b and Nos2 through both post-transcriptional and transcriptional mechanisms, including mRNA stability control of Spi1.

DOI： 10.2147/JIR.S468612

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

PURPOSE: Prevention of postoperative nausea and vomiting (PONV) is important to achieve DREAM (drinking, eating, mobilization). Ondansetron inhibits PONV, but its effects on postoperative food intake have not been investigated. This study aimed to examine associations between ondansetron and PONV incidence, and postoperative food intake. METHODS: This retrospective study included adult patients (n = 632) who underwent laparoscopic gynecological surgery at Kyushu University Hospital between January 2017 and June 2023. Outcomes were PONV on the day of surgery, PONV up to the day after surgery, and food intake, which was assessed for breakfast and lunch on the day after surgery. Odds ratios (ORs) for PONV incidence and postoperative no-food intake were calculated between those with and without ondansetron during surgery. Multivariable-adjusted analysis was performed using possible confounding factors for PONV. Synergistic effects of combining ondansetron with dexamethasone or total intravenous anesthesia (TIVA) were assessed. RESULTS: Multivariable-adjusted ORs for PONV on the day of surgery and up to the day after surgery were 0.56 (95% confidence interval, 0.32-0.99, p = 0.04) and 0.52 (0.30-0.93, p = 0.03), respectively, in the ondansetron group (n = 84) compared with the non-ondansetron group (n = 548). In contrast, multivariable-adjusted ORs for no-food intake of breakfast and lunch the day after surgery in the ondansetron group compared with the non-ondansetron group were not significant. Analysis of synergistic effects on PONV showed no significant interaction between ondansetron and dexamethasone or ondansetron and TIVA combinations. CONCLUSION: Ondansetron administration during surgery was significantly associated with decreased PONV risk but was not associated with food intake the day after surgery.

DOI： 10.1007/s00540-023-03295-0

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Language：Others   Publishing type：Research paper (scientific journal)   Publisher：International Scientific Information, Inc.  

BACKGROUND: Postoperative acute liver failure, a complication following spine surgery, can cause delayed emergence from total intravenous anesthesia. Here, we report a case of acute severe postoperative liver failure following posterior spinal correction and fusion in a patient with congenital scoliosis. CASE REPORT: A girl’s congenital scoliosis worsened, and posterior spinal correction and fusion was scheduled. General anesthesia was induced with sevoflurane, fentanyl, target-controlled-infusion with propofol, and rocuronium. General anesthesia was maintained using target-controlled-infusion with propofol and remifentanil. The operation was completed with no remarkable complications. The operative time was 516 min and the anesthesia time was 641 min in the prone position. Emergence from anesthesia was poor, and it took 68 min to remove the tracheal tube after discontinuation of the anesthetic agents. The patient was drowsy and was transferred to her room in a general ward without reporting any pain, nausea, or dyspnea. On postoperative day 1, the results of laboratory investigations were suggestive of acute liver failure; contrast-enhanced computed tomography revealed a poorly enhanced area in the umbilical portion of the left liver lobe portal vein, indicating ischemic liver damage. Although no additional treatment was administered for acute liver failure, the patient recovered over time, and laboratory values normalized. No other postoperative complications were observed, and the patient was discharged on postoperative day 21. CONCLUSIONS: Delayed emergence from general anesthesia may be due to acute liver failure following posterior spinal correction and fusion. There are several possible causes of postoperative liver failure, including anesthetics, prone position, and spinal surgery.

DOI： 10.12659/ajcr.941563

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Language：English   Publisher：日本循環制御医学会  

症例は60歳女性で、高血圧症であり、発達性股関節形成不全のため右人工股関節置換術(THA)を計画していた。術前の心電図で異常はみられず、麻酔前の血圧は178/101mmHg、心拍数は65bpmであった。脊髄くも膜下硬膜外併用麻酔として、デクスメデトミジン(DEX)6μg/kg/時を10分間かけて注入し、続いて鎮静のために0.4μg/kg/時を持続投与した。その後、血圧は103/60mmHg、心拍数は50bpmにそれぞれ低下した。手術がほぼ終了した時点でDEX注入を中止し、レボブピバカイン0.125%を4mL/時で持続硬膜外麻酔を開始した。その際、患者は覚醒時に肩の痛みを経験した。DEX中止から3分後、心拍数が10bpmに突然低下し、意識を失った。アトロピン0.5mgを2回静注した結果、心拍は正常な洞調律に戻り、意識を取り戻した。その後、バイタルサインは安定し、手術は終了した。手術時間は96分、麻酔時間は132分であった。この高度徐脈は、Bezold-Jarisch反射が一因であると考えられた。

Language：English   Publisher：Japan Society of Pain Clinicians  

<p>Background: Primary erythromelalgia (PE) is a rare disorder characterized by thermalgia. It is caused by mutations in voltage-gated Na channel (Nav) 1.7, which increase neuron excitability. The symptom of salt aversion in PE has not yet been reported. Case presentation: A 72-year-old woman had experienced severe frostbite since childhood. The patient developed redness as she warmed up at the age of 40 years and thermalgia as well as a salt aversion due to hypersensitivity to saltiness at the age of 70 years. She was diagnosed with PE. At the age of 72 years, we initiated treatment with stellate ganglion blocks (SGB) and epidural blocks. The symptom of salt aversion and pain in fingertips disappeared after treatment with SGB. Bilateral lumbar sympathetic ganglion blocks were performed to further attenuate pain in the tips of the toes, which disappeared after 2 months. Conclusions: We herein report the successful treatment of PE with hypersensitivity to saltiness.</p>

DOI： 10.11321/jjspc.23-0022

CiNii Research

Language：English   Publisher：(一社)日本ペインクリニック学会  

症例は72歳女性で、小児期から冬に重度の凍傷を経験していた。40歳時に接触皮膚炎および日光過敏症と診断されたが改善せず、70歳時には足指、手指、頬、耳介、舌に発赤とピリピリ感が認められた。さらに、塩味に対して感受性が高まり、塩味のものが食べられなくなった。これらの所見から味覚障害と診断された。皮膚科医と整形外科医に相談した結果、末梢神経障害との診断で神経内科医に紹介となった。神経伝導速度は正常であったが、電流知覚閾値から小径線維ニューロパチーが示唆された。CTで右下葉に肺癌が見つかり、癌性神経障害が疑われ、胸腔鏡下肺葉切除術が施行されたが、術後も症状は持続した。原発性肢端紅痛症との診断でプレガバリンとアスピリンが投与されたが、疼痛が続くため、72歳時にペインクリニック紹介となった。サーモグラフィでは足指の皮膚温が低下しており、過度の血管収縮が示唆された。アスピリンの投与を中止し、8日目に足指の痛みに対して腰部硬膜外ブロックを9週間8回行ったところ、痛みは軽減した。64日目と83日目に99.9%エタノール2mLでL2とL3の両側腰部交感神経ブロックをそれぞれ施行したところ、サーモグラフィで皮膚温上昇が認められた。両頬、耳介、指先、舌の痛みに対しては星状神経節ブロック(SGB)を18週間12回行い、疼痛が軽減した。SGBを4回施行後に食塩に対する嫌悪感も消失した。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Pharmacological Sciences  

Complex regional pain syndrome (CRPS) is an intractable chronic pain syndrome with various signs and symptoms including allodynia/hyperalgesia, edema, swelling, and skin abnormalities. However, a definitive therapeutic treatment for CRPS has not been established. In CRPS patients, inflammatory cytokines such as TNF-α and IL-1β have been shown to increase in affected areas, suggesting that these molecules may be potential therapeutic targets for CRPS. Here, we first created a novel CRPS mouse model (CRPS-II-like) via sciatic nerve injury and cast immobilization, which was characterized by mechanical allodynia, local edema, and skin abnormalities, to evaluate the pathophysiology and pharmacotherapy of CRPS. When an anti-TNF-α antibody was consecutively administered near the injured sciatic nerve of CRPS model mice, persistent allodynia and CRPS-related signs in the ipsilateral hindpaw were markedly attenuated to control levels. Perineural administration of anti-TNF-α antibody also suppressed the upregulation of inflammatory cytokines as well as the activation of macrophages and Schwann cells in the injured sciatic nerve. These findings indicate that persistent allodynia and CRPS-related signs in CRPS models are primarily associated with TNF-α-mediated immune responses in injured peripheral nerves, suggesting that perineural treatment with anti-TNF-α antibody might be therapeutically useful.

DOI： 10.1016/j.jphs.2023.06.003

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Language：English   Publisher：(公社)日本薬理学会  

マウスにて、機械的アロディニア、局所浮腫、皮膚異常で示される新規複合性局所疼痛症候群(CRPS)を坐骨神経損傷とギプス拘束により作成した。CRPSモデルマウスの損傷坐骨神経周囲に抗TNF-α抗体を連続投与すると、アロディニアと同側後肢のCRPS関連症状が顕著に低下した。抗TNF-α抗体を神経周囲に投与すると、損傷坐骨神経におけるマクロファージとシュワン細胞の活性化とともに炎症性サイトカインの上方制御を抑制した。以上より、CRPSモデルにおける持続的アロディニアとCRPS関連症状が、損傷末梢神経におけるTNF-α媒介性免疫応答と関連し、抗TNF-α抗体の神経周囲投与が治療に役立ちうると考えられた。

Language：English   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-023-03236-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

PURPOSE: Remimazolam, a newly developed ultra-short-acting benzodiazepine, provides early recovery of consciousness but its effects on memory recovery are unclear. This study examined memory recovery after emergence from general anesthesia using remimazolam. METHODS: Seventy-four patients undergoing breast surgery between October 2021 and March 2022 were enrolled and randomly assigned to receive propofol (control group) or remimazolam as general anesthetic during surgery. The primary endpoint was the number of posters patients remembered 24 h after surgery (among four posters shown after recovering from anesthesia) as an assessment of memory retention. The secondary endpoints were the recall of a numeric character patients had been shown just before anesthetic induction, as an assessment of retrograde amnesia 24 h after surgery. RESULTS: Sixty-six patients (propofol, 32; remimazolam, 34) were assessed. Patients in the remimazolam group remembered significantly fewer posters shown to them after surgery than those in the propofol group (0 [0 - 2] vs. 2 [1 - 3], p < 0.001). In the remimazolam group, the patients who received flumazenil remembered a higher number of posters than those who did not receive flumazenil (3 [1 - 4] vs. 0 [0 - 0], p < 0.001). All patients remembered all events that occurred during the preoperative period as well as the numeric character. CONCLUSION: Patients recovering from remimazolam anesthesia without receiving flumazenil do not remember events after regaining consciousness. IRB: Kyushu University School of Medicine Hospital Institutional Review Board (IRB) (approval number: 20212006). TRIAL REGISTRATION: This clinical trial was registered with the University Hospital Medical Information Network (UMIN) Center on September 28, 2021 (UMIN-CTR: UMIN000045593). IMPLICATION STATEMENT: Memory recovery is slower following emergence from remimazolam than from propofol anesthesia.

DOI： 10.1186/s40981-023-00635-7

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Language：Japanese  

Language：Japanese   Publisher：日本臨床麻酔学会  

全身吸入麻酔下に人工膝関節置換手術を行った患者を対象として,手術終了時にオンダンセトロンを投与された群(ONDA群)30症例と非投与群(CONT群)29症例の2群間で,術後悪心・嘔吐(PONV)発生率と食事摂取量について比較検討を後ろ向きに行った.術後1日目までの平均食事摂取量はONDA群で有意に多かった.PONV発生率,制吐剤使用率,iv-PCA中止率は,ONDA群で有意に低かった.PONVが発生した群では,PONV非発生群と比較して有意に術後1日目までの平均食事摂取量が少なかった.人工膝関節置換手術後の悪心・嘔吐と食事摂取量に対するオンダンセトロンの有効性が示唆された.(著者抄録)

Language：English   Publisher：Springer Berlin Heidelberg  

全身麻酔に用いるレミマゾラムが麻酔からの覚醒後の記憶回復に及ぼす影響を検討した。2021年10月～2022年3月に乳房手術を予定した20～65歳の患者を登録し、全身麻酔薬にプロポフォール(対照群)またはレミマゾラムを用いる群に無作為化した。主要評価項目は記憶保持とし、麻酔回復後に提示した4枚のポスターのうち、術後24時間時点で患者が覚えているポスター数で評価した。副次評価項目は逆行性健忘とし、麻酔導入直前に提示した数字および導入前の5つの出来事(歩行入室、ベッド移動等)を術後24時間時点で患者が想起できるかにより評価した。無作為化した70例(各群35例)のうち66例(プロポフォール群:32例、平均50.4±7.6歳、レミマゾラム群:34例、平均51.1±10.0歳)を解析した。主要評価項目のポスター数はレミマゾラム群の方がプロポフォール群より有意に少なかった[中央値0(四分位範囲0～2]対2(1～3)、p<0.001]。レミマゾラム群のうち、フルマゼニル投与患者は非投与患者より覚えていたポスター数が多かった[3(1～4)対0(0～0)、p<0.001]。全患者が術前の出来事と数字を想起できた。以上より、レミマゾラムによる麻酔で逆行性健忘は生じないが、意識回復後の記憶が保持されないことが示された。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Therapeutic Hypothermia and Temperature Management  

Avoiding redistributional hypothermia that decreases core temperature by 0.5-1.5°C within the 1st hour of surgery is difficult. The efficacy of prewarming using a forced-air warming (FAW) device with a lower-body blanket on redistribution hypothermia during epidural procedures have not been investigated. After ethics approval, 113 patients undergoing laparoscopic surgery under general anesthesia combined with epidural anesthesia were enrolled. Intervention (prewarming) group patients who were warmed from operating room entry, including during epidural anesthesia, was compared with the control group that was warmed from just before surgery started. In total, 104 patients (52, control; 52, prewarming) were analyzed. In the prewarming group, compared to the control group, the core temperature 20 minutes after anesthesia induction (36.9 ± 0.4 vs. 37.1 ± 0.4°C, p < 0.02) was significantly higher. The core temperature was higher in the prewarming group than in the control group until 3 hours after the surgery. In the prewarming group, compared to the control group, the core temperature-time integral below baseline till 180 minutes after surgery start (65.1 ± 64.0 vs. 8.1 ± 18.6°C/min, p < 0.0001) or 30 minutes after anesthesia induction (5.3 ± 6.2 vs. 2.0 ± 4.7°C/min, p < 0.0001) were significantly smaller. Postoperative shivering was comparable between the groups. Prewarming during epidural catheter insertion with a FAW device could safely prevent a core temperature decrease induced by redistribution or heat loss without additional preparation, effort, space, or time requirements.

DOI： 10.1089/ther.2022.0009

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Language：English   Publisher：日本循環制御医学会  

症例は84歳男性。肝細胞癌疑いのため硬膜外鎮痛法を併用した全身麻酔下で腹腔鏡下肝S8亜区域切除術が計画されていた。手術の2～3ヵ月前に労作時胸痛がみられ、術前心エコー、冠動脈造影CT、心臓カテーテル検査により不安定狭心症であることが判明したが、冠動脈ステント留置術の前に腹腔鏡下肝区域切除術を行うこととなった。手術開始から3時間後、肝切除中に動脈圧、SpO2、EtCO2が有意に低下し、中心静脈圧は7mmHgから14mmHgに上昇した。この時点の気腹圧は10mmHgであった。直ちに気腹法を中止し、フェニレフリン、ノルアドレナリンの単回投与により、血行動態は約15分以内に安定した。その後、手術は続行された。術後、左顔面、左上肢、下肢の不完全麻痺が認められた。手術翌日のMRIで、右大脳半球に急性脳梗塞の病変が散見された。術後20日目までリハビリテーションを行い、麻痺は改善した。

Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

<p>Background : Combined spinal-epidural(CSE)anesthesia is a frequently used technique in surgeries of the lower limbs with very low complication rates, but it can also cause severe neurological damage. We present a case of motor and sensory disturbances in both lower extremities following CSE anesthesia.</p><p>Case presentation : A 46-year-old woman underwent a transpositional acetabulor osteotomy under CSE anesthesia. The patient returned to the ward after successful surgery without any intraoperative anesthetic problems. However, motor and sensory disturbances in both lower limbs became apparent the next day. Based on physical findings, frequent spinal fluid analyses, imaging studies, and nerve conduction velocity tests, chemical meningitis and lumbar radiculitis secondary to local anesthetic administration into the subarachnoid space were diagnosed.</p><p>Conclusion : This is a rare case in which the cause of the neurological disorder following CSE anesthesia was confirmed by careful examination and investigation.</p>

DOI： 10.2199/jjsca.43.209

CiNii Research

Publisher：克誠堂出版  

DOI： 10.18916/masui.2023050006

CiNii Research

Language：Japanese  

＜最近の動向＞●周術期の抗血栓療法について「American College of Chest Physicians(ACCP)ガイドライン2022」が発表されて,休薬期間について改訂されている.●抗凝固療法に対する緊急中和に関する臨床データが報告されている.特に直接Xa阻害薬の中和剤とトロンビン複合体濃縮製剤との比較がある.●肺血栓塞栓症に対する発症後の3ヵ月間の抗凝固療法について,その遵守率とCOVID-19患者におけるその効果に関する知見が積み重ねられている.(著者抄録)

Language：Japanese  

Language：Japanese  

Language：English   Publisher：日本臨床麻酔学会  

【背景】脊髄くも膜下硬膜外併用麻酔後に両下肢運動感覚障害と膀胱直腸障害をきたした症例を報告する.【症例】46歳,女性.左股関節臼蓋形成不全に対して左寛骨臼移動術が予定され,脊髄くも膜下硬膜外併用麻酔にて問題なく手術が行われた.術翌日より両下肢の運動感覚障害が出現し,頻回の髄液検査と画像検査,症状経過から除外診断的に,局所麻酔薬による化学性髄膜炎・腰部神経根炎の診断に至った.【考察】入念な原因検索により神経障害の原因を明らかにしたまれな一例である.脊髄くも膜下硬膜外併用麻酔後の重篤な下肢神経障害の原因はさまざまであるが,その病態には化学性髄膜炎・腰部神経根炎が関与している可能性が示唆された.(著者抄録)

Language：English   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-023-03162-y

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Several new ultrasound-guided superior cervical ganglia blocks (U-SCGBs) have been proposed to overcome the shortcomings of conventional superior cervical ganglia blocks; however, their clinical utility and practicality have not yet been demonstrated. The aim of this study was to evaluate the safety and utility of a new method of U-SCGB. METHODS: We retrospectively collected data on patients who underwent U-SCGB for the treatment of headaches and orofacial pain at a single center. U-SCGB was performed by injecting 2-3 mL of 1% mepivacaine posterior to the internal carotid artery, just above the bifurcation. The Wilcoxon signed-rank test was used to compare pain scores. Numerical data are expressed as the mean ± standard error. RESULTS: The total number of U-SCGB procedures was 43. All procedures were accompanied by Horner's sign. The numerical rating scale score for pain (possible scores, 0-10) was reduced predominantly from 7.0 ± 0.7 before treatment to 4.5 ± 0.7 at the follow-up (p = 0.014). CONCLUSION: U-SCGB was considered a clinically useful and accurate treatment for headaches and orofacial pain in this study.

DOI： 10.1186/s40981-023-00613-z

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Language：English   Publisher：Springer Berlin Heidelberg  

頭痛および口腔顔面痛の治療として新たに提案されている超音波ガイドを用いた上頸神経節ブロック(U-SCGB)の安全性と有用性を評価した。2019年1月～2022年5月に頭痛と口腔顔面痛の治療としてU-SCGBを受けた患者のデータを後ろ向きに収集した。Wilcoxonの符号順位検定で、治療前と治療開始から3ヵ月後の疼痛レベルの差を評価した。患者10例(男性2例、女性8例、年齢32～69歳)で施行されたU-SCGB 43件を解析対象とした。全ての処置で、処置後にホルネル症候群が認められた。数値評価スケールで評価した疼痛スコアは、治療後に有意に減少した(平均値、治療前7.0±0.7、治療後3ヵ月時4.5±0.7、p=0.014)。有害事象は認められなかった。以上から、U-SCGBは頭痛と口腔顔面痛に対する治療として臨床的に有用であることが示唆された。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology. CASE PRESENTATION: We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3. CONCLUSIONS: Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.

DOI： 10.1186/s40981-023-00605-z

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Language：English   Publisher：Springer Berlin Heidelberg  

褐色細胞腫とパラガングリオーマに対し麻酔管理を行ったフォンタン循環患者3症例を報告した。症例1は30歳男性、症例2は35歳男性、症例3は35歳女性で、症例1と症例2は褐色細胞腫に対する右副腎摘除歴があった。パラガングリオーマの局所再発と診断され、開腹腫瘍切除を行った。症例3はパラガングリオーマに対する開腹腫瘍切除歴があった。上下大静脈肺動脈吻合転換術の術前検査で褐色細胞腫・パラガングリオーマの局所再発が偶然発見され、経後腹膜的腹腔鏡下腫瘍切除を行った。いずれの症例でも、輸液投与により術中の中心静脈圧を術前レベルに維持し、一酸化窒素の投与により肺動脈抵抗を低下させた。血圧低下の場合はノルアドレナリンやバソプレシンを投与した。いずれの症例でも予定通り手術を施行できた。

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1409210878

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)  

全身麻酔覚醒後に心因性非てんかん発作(psychogenic non-epileptic seizure:PNES)を生じた1例を経験した.症例は,34歳の女性.全身麻酔による整形外科手術を終え,帰室2時間後に全身痙攣を生じた.ジアゼパムの投与を行い,20分後に一旦痙攣がおさまったが,その後も1～3分程度の上半身優位の痙攣が継続した.痙攣以外の神経学的異常所見は認めず,頭部画像検査でも異常を認めなかった.脳波検査で,痙攣発作中もてんかん波は認めず常に覚醒脳波であったため,PNESと診断された.痙攣発作を認めた場合には治療と並行して原因検索を行い,治療抵抗性の痙攣発作が持続する場合にはPNESも念頭に置き慎重に診断と治療を進める必要がある.(著者抄録)

Language：Japanese  

＜文献概要＞●周産期の静脈血栓塞栓症はその予防が重要であり,発症を疑った場合は診断を進めるとともに呼吸・循環管理を並行して行う必要がある.●破水後より生じた分娩中の急変時は羊水塞栓症を鑑別し,マンパワーを確保するとともに迅速な心肺蘇生,呼吸・循環管理,凝固因子を含めた輸血管理が重要となる.●帝王切開は空気塞栓を発症するリスクが高く,術中に胸部絞扼感や息切れ,SpO2低下などにより空気塞栓症を疑った場合は体位変換や輸液負荷よる循環血液量の適正化を行う.

Language：English   Publisher：Japan Society of Circulation Control in Medicine  

An 84-year-old man diagnosed with hepatocellular carcinoma was scheduled to undergo laparoscopic hepatic segmentectomy under general anesthesia combined with epidural analgesia. At 3 hours after the start of the operation, his arterial blood pressure, SpO₂ and EtCO₂ significantly decreased during resection of the liver, while CVP increased from 7 mmHg to 14 mmHg. The hemodynamic status stabilized within approximately 15 minutes, with the discontinuation of pneumoperitoneum, volume loading, and a single administration of noradrenaline. Surgery was then continued. Postoperatively, incomplete paralysis of the left face, left upper, and lower limbs was observed. MRI on the day after surgery revealed scattered lesions of acute cerebral infarction in the right cerebral hemisphere. The paralysis improved with rehabilitation until postoperative day 20. It is important to recognize that laparoscopic hepatectomy is risk factor for carbon dioxide embolism and anesthesia management should be conducted with consideration of the risk of carbon dioxide embolism.

DOI： 10.11312/ccm.44.29

CiNii Research

Language：Japanese   Publisher：Japanese Pharmacological Society  

<p>Mechanical allodynia is a symptom of neuropathic pain and is elicited by tactile stimulation. Recently, we have identified a spinal dorsal horn (SDH) inhibitory interneuron subset (operated by AAV vectors including a neuropeptide Y promoter; AAV-NpyP⁺neurons) whose dysfunction is critical for neuropathic allodynia. Indeed, after peripheral nerve injury (PNI), these neurons exhibit deeper resting membrane potentials (RMP) and reduce excitability. However, the mechanism of these changes remains unclear. In this study, we show that the PNI-induced deepened RMP and hypoexcitability of AAV-NpyP⁺ neurons were normalized by SDH astrocyte-specific expression of a dominant negative form of STAT3 (dnSTAT3) that suppresses reactive state of astrocytes. Astrocytic dnSTAT3 expression also attenuated Aβ fiber-derived neuropathic allodynia. Conversely, induction of reactive state of SDH astrocytes by expressing a constitutive active form of STAT3 (caSTAT3) in normal rats resulted in reducing activity of AAV-NpyP⁺neurons and causing allodynia-like behavior. Our findings indicate that reactive astrocytes in the SDH are necessary and sufficient to cause dysfunction of AAV-NpyP⁺ neurons after PNI and neuropathic allodynia. Thus, inhibiting reactive state of astrocytes could be a new therapeutic target for neuropathic allodynia.</p>

DOI： 10.1254/jpssuppl.97.0_3-b-p-012

CiNii Research

Language：English   Publisher：Japan Society of Circulation Control in Medicine  

 Severe bradycardia and hypotension during arousal from sedation with dexmedetomidine in a patient with combined spinal and epidural anesthesia is rare. We present a case of a 60-year-old woman who underwent total hip arthroplasty (THA) under combined spinal and epidural anesthesia (CSEA). Severe bradycardia (10 bpm) and hypotension were developed at arousal from sedation with dexmedetomidine prior to the end of the surgery. At that time, she complained of shoulder pain. Cardiac rhythm was restored by the administration of atropine. She was not under high spinal anesthesia. This severe bradycardia was mainly attributed to Bezold-Jarisch reflex (BJR) with decreased preload due to the low concentration of dexmedetomidine and increased inotropic state because of severe pain. BJR may develop during arousal from sedation with dexmedetomidine under combined spinal and epidural anesthesia.

DOI： 10.11312/ccm.44.99

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Hepatectomy for patients with Fontan circulation consists of high central venous pressure and low pulmonary vascular resistance, and is challenging for physicians. CASE PRESENTATION: We performed anesthetic management for hepatectomy in three patients with Fontan circulation. Massive bleeding and transfusion as well as careful management were needed. Open abdominal surgery had to be conducted instead of laparoscopic surgery for controlling bleeding in one case. We successfully performed general anesthesia using nitric oxide and inotropes while monitoring arterial pressure and central venous pressure in all the cases. CONCLUSIONS: To maintain Fontan circulation during hepatectomy, it is important to manage central venous pressure and ensure appropriate circulatory volume.

DOI： 10.1186/s40981-022-00582-9

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Cells  

Neuropathic pain is a chronic pain condition that occurs after nerve damage; allodynia, which refers to pain caused by generally innocuous stimuli, is a hallmark symptom. Although allodynia is often resistant to analgesics, the antidepressant duloxetine has been used as an effective therapeutic option. Duloxetine increases spinal noradrenaline (NA) levels by inhibiting its transporter at NAergic terminals in the spinal dorsal horn (SDH), which has been proposed to contribute to its pain-relieving effect. However, the mechanism through which duloxetine suppresses neuropathic allodynia remains unclear. Here, we identified an SDH inhibitory interneuron subset (captured by adeno-associated viral (AAV) vectors incorporating a rat neuropeptide Y promoter; AAV-NpyP+ neurons) that is mostly depolarized by NA. Furthermore, this excitatory effect was suppressed by pharmacological blockade or genetic knockdown of α1B-adrenoceptors (ARs) in AAV-NpyP+ SDH neurons. We found that duloxetine suppressed Aβ fiber-mediated allodynia-like behavioral responses after nerve injury and that this effect was not observed in AAV-NpyP+ SDH neuron-selective α1B-AR-knockdown. These results indicate that α1B-AR and AAV-NpyP+ neurons are critical targets for spinal NA and are necessary for the therapeutic effect of duloxetine on neuropathic pain, which can support the development of novel analgesics.

DOI： 10.3390/cells11244051

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Language：English   Publisher：日本循環制御医学会  

修正型電気けいれん療法(m-ECT)中の麻酔薬投与量減少に伴う血圧の変化を調べた。2015年9月～2020年2月に1コース8回以上のm-ECTを受けた患者91名のデータを用いる後方視的研究を行った。患者を、使用した麻酔薬の種類別にプロポフォール1μg/mL+レミフェンタニル群(PR群)65名(男性40%、平均58.8±15.3歳)とプロポフォール群(P群)26名(男性46.2%、平均64.0±15.8歳)に分け、m-ECT中の血圧変化を比較した。高血圧の予防/治療目的での降圧薬(ニカルジピン1mg静注)投与は、麻酔科の判断で行った。その結果、m-ECT中の収縮期血圧が180mmHg以上の患者はPR群がP群より有意に多かった(p=0.004)。ニカルジピンの投与回数はPR群がP群に比べて有意に多かった(p=0.0004)。低用量プロポフォールとレミフェンタニルの併用はプロポフォール単剤による麻酔に比べて、m-ECT中の血圧とニカルジピンの使用回数を有意に増加させることが示された。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Clinical and Applied Thrombosis/Hemostasis  

Recombinant antithrombin gamma (rAT) is reported as an effective drug for patients with disseminated intravascular coagulation (DIC) in Japan. As the appropriate dose and targeted AT activity remain unknown, this study aimed to determine these aspects for sepsis-induced DIC. Thirty-one patients with septic shock and DIC with AT levels <70% were treated with rAT between May 2018 and December 2020. The recovery rates from DIC were 32.2% and 63.3% on day 3 and 5 post administration, respectively. Recovery and survival rates were significantly higher in patients who achieved AT activity ≥70% or 80% on day 3 post administration. Receiver operating characteristic curve analysis revealed that the cutoff values of post-treatment AT activity on day 3 for 28-day survival and 5-day recovery from DIC were 79.5% and 81.5%, respectively. Patients who did not achieve AT activity ≥80% on day 3 presented a lower base level of AT activity and lower dose supplementation. Our results suggest that targeted AT activity should be at least 70%, and ideally 80%, and sufficient doses to maintain this activity are required to achieve better outcomes.

DOI： 10.1177/10760296221135790

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Intractable chronic pain, as well as motor, sensory, and autonomic neuropathy, significantly reduces the quality of life of brachial plexus avulsion (BPA) patients. We report the successful application of cervical selective nerve root injection (CSNRI) in a patient with BPA. CASE PRESENTATION: A 40-year-old man had been diagnosed with complete left BPA due to a motorcycle accident and underwent intercostal nerve transplantation at the age of 18 years and had been experiencing pain ever since. His pain increased after fracture of the left humerus, and he was referred to our pain management clinic. As his exacerbated pain was suspected to be due to peripheral nerve hypersensitivity, we performed repetitive ultrasound-guided CSNRI (3 mL of 1% mepivacaine of each) targeted C5 and 6 intervertebral foramina, and his symptoms gradually improved. CONCLUSIONS: Repetitive CSNRI may help diagnose and treat BPA-associated peripheral neuropathic pain, even in patients diagnosed with BPA.

DOI： 10.1186/s40981-022-00574-9

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Language：English   Publisher：Springer Berlin Heidelberg  

症例は40歳男性で、18歳時にオートバイ事故により非回復性の左腕神経叢引き抜き完全損傷と診断され肋間神経移植による肘屈曲再建を受けたが、左上腕の重度疼痛が持続した。40歳時に階段で転倒して左上腕を骨折し、骨接合術を受けた後に上腕痛が悪化した。骨折から2年後、当院の疼痛管理クリニックに紹介された。疼痛はC5-6神経根支配領域の末梢神経過敏症が原因と考えられため、超音波ガイド下でC5および6椎間孔に1%メピバカイン3mLの頸椎選択的神経根注射(CSNRI)を行うと、疼痛が軽減した。週1回のCSNRIを繰り返した。その結果、数ヵ月後にQOLが大幅に改善した。当院受診から3年後、月1回の注射で疼痛の悪化はみられなかった。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Carbamoyl phosphate synthetase deficiency (CPS1D) is a urea-cycle disorder (UCD). We report successful perioperative management of pediatric living donor liver transplantation (LDLT) in a CPS1D patient. CASE PRESENTATION: A 10-year-old female patient with CPS1D underwent LDLT. Proper administration of dextrose 50% and 60 kcal/kg/day with L-arginine and L-carnitine resulted in the avoidance of intraoperative hyperammonemia induced by hypercatabolism. Serum ammonia level transiently increased to 61 mmol/L in the anhepatic phase and decreased to 44 mmol/L after reperfusion. CONCLUSIONS: We suggest anesthesia management with administration of dextrose to avoid hyperammonemia during LDLT in patients with CPS1D.

DOI： 10.1186/s40981-022-00558-9

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

【症例】68歳の男性.現病歴:胸骨正中切開による僧帽弁置換術と左内胸動脈を用いた冠動脈バイパス術後より左前腕内側と尺側手指の痺れを伴う疼痛が出現した.手術2ヵ月後には右側にも同様の症状が出現した.薬物療法が開始されたが同部位の疼痛増強や筋力低下が出現したため,手術4ヵ月後に当科紹介受診となった.初診時現症:両前腕から手指にかけての疼痛,アロディニア,手指関節拘縮,運動障害,浮腫があった.厚生労働省研究班による判定基準を満たし,複合性疼痛症候群と診断した.治療経過:薬物療法に加えて超音波ガイド下腕神経叢ブロック,リハビリテーションおよび痛みの認知教育による集学的疼痛治療を行い,両手指の疼痛や関節の拘縮,運動障害は著しく改善した.【まとめ】本症例は,胸骨正中切開後に腕神経叢損傷が生じ,その後両上肢の複合性局所疼痛症候群に移行したと考えられた.胸骨正中切開後に生じる腕神経叢損傷の危険因子は内胸動脈採取などが報告され本症例でも該当する.比較的予後良好とされるが,難治性疼痛に移行する可能性があることを認識し早期の集学的治療を考慮することが重要である.(著者抄録)

Language：English   Publisher：Springer Berlin Heidelberg  

症例は10歳女児で、7歳時にカルバモイルリン酸合成酵素欠損症と診断され、9歳時に生体肝移植を受けていた。術前検査で特記すべき異常はなかった。肝機能はChild-Pugh分類クラスAであったが、血清アンモニア値は45μmol/Lであった。術中、60kcal/kg/日に相当するブドウ糖50%、L-アルギニン、L-カルニチンを投与して、高アンモニア血症を回避した。無肝期に血清アンモニア値が一時的に61mmol/Lまで上昇したが、再灌流後に44mmol/Lまで低下し、手術終了時は50mmol/Lであった。術後、ICUに入室し、L-カルニチンとブドウ糖の投与を継続した。血清アンモニア値は術後3日目に正常範囲に低下した。経過は良好で術後3日目に一般病棟に転棟し、27日目に退院した。

Publisher：克誠堂出版(株)  

DOI： 10.18916/j01397.2022279366

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMC Anesthesiology  

BACKGROUND: Although peripherally inserted central catheters (PICCs) have been widely used, they have not been frequently used in anesthesia practice. The central venous pressure measured via PICCs are reportedly as accurate as that measured via central venous catheters (CVCs), but the findings concerning rapid infusion are unclear. This study examined whether or not pressure-resistant PICCs could be used for rapid fluid infusion.  METHODS: The in-line pressure was measured in similar-sized double-lumen catheters-4-Fr PICC (55, 45 and 35 cm) and 17-G CVC (20 and 13 cm)-at flow rates of saline decided using a roller pump system. We also examined the flow rate at an in-line pressure of 300 mmHg, which is the critical pressure at which hemolysis is considered to occur during blood transfusion. RESULTS: The pressure-resistant PICCs obtained a high flow rate similar to that of CVCs, but the in-line pressures increased in proportion to the flow rate and catheter length. Flow rates at an intra-circuit pressure of 300 mmHg were not significantly different between the 45-cm PICC and 20-cm CVC. CONCLUSION: Pressure-resistant PICCs can be used for rapid fluid infusion.

DOI： 10.1186/s12871-022-01738-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Antioxidants  

Doxorubicin (DOX) induces dose-dependent cardiotoxicity via oxidative stress and abnormal mitochondrial function in the myocardium. Therefore, a noninvasive in vivo imaging procedure for monitoring the redox status of the heart may aid in monitoring diseases and developing treatments. However, an appropriate technique has yet to be developed. In this study, we demonstrate a technique for detecting and visualizing the redox status of the heart using in vivo dynamic nuclear polarization-magnetic resonance imaging (DNP-MRI) with 3-carbamoyl-PROXYL (CmP) as a molecular imaging probe. Male C57BL/6N mice were administered DOX (20 mg/kg) or saline. DNP-MRI clearly showed a slower DNP signal reduction in the DOX group than in the control group. Importantly, the difference in the DNP signal reduction rate between the two groups occurred earlier than that detected by physiological examination or clinical symptoms. In an in vitro experiment, KCN (an inhibitor of complex IV in the mitochondrial electron transport chain) and DOX inhibited the electron paramagnetic resonance change in H9c2 cardiomyocytes, suggesting that the redox metabolism of CmP in the myocardium is mitochondrion-dependent. Therefore, this molecular imaging technique has the potential to monitor the dynamics of redox metabolic changes in DOX-induced cardiomyopathy and facilitate an early diagnosis of this condition.

DOI： 10.3390/antiox11081454

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Journal of Case Reports  

BACKGROUND Epidermolysis bullosa (EB) is a group of rare genetic conditions that can cause eruption of blisters on the skin and mucous membranes by the slightest mechanical stimulus. In these patients particular attention should be paid to potential complications, from monitoring of vital signs to anesthesia procedures in the perioperative period. CASE REPORT A 31-year-old man with EB underwent lower-leg amputation for squamous cell carcinoma. Multiple blisters and scars had appeared all over his face and body, and his extremities were contracted. The patient's mouth could open only up to approximately 5 mm, and laboratory examination showed a high inflammatory response. In addition, he had anemia and hypoalbuminemia with a serum albumin concentration of 1.4 g/dL. We planned sciatic and femoral nerve blocks with sedation for anesthesia management because of the anticipated difficulty of intubation and concern about postoperative upper-airway obstruction due to changes in the oral cavity. While protecting the skin from external force application, we performed sciatic and femoral nerve blocks (1.7 mg/kg) using 0.25% levobupivacaine, 10 mL (3.5 mg/kg) of 1% mepivacaine, and 6.6 mg of dexamethasone. Good analgesia was achieved, and the patient was stable during the operation. The patient was discharged 12 days postoperatively without additional signs of infection or new blister formation, although surgical wound healing was delayed. CONCLUSIONS For patients with EB who have had repeated blistering and scarring, even from a minor external force, attention should be paid to airway management and avoidance of additional skin damage caused by external forces.

DOI： 10.12659/AJCR.936722

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Frontiers in Molecular Neuroscience  

Mechanical allodynia (pain produced by innocuous stimuli such as touch) is the main symptom of neuropathic pain. Its underlying mechanism remains to be elucidated, but peripheral nerve injury (PNI)-induced malfunction of neuronal circuits in the central nervous system, including the spinal dorsal horn (SDH), is thought to be involved in touch-pain conversion. Here, we found that intra-SDH injection of adeno-associated viral vectors including a prodynorphin promoter (AAV-PdynP) captured a subset of neurons that were mainly located in the superficial laminae, including lamina I, and exhibited mostly inhibitory characteristics. Using transgenic rats that enable optogenetic stimulation of touch-sensing Aβ fibers, we found that the light-evoked paw withdrawal behavior and aversive responses after PNI were attenuated by selective ablation of AAV-PdynP-captured SDH neurons. Notably, the ablation had no effect on withdrawal behavior from von Frey filaments. Furthermore, Aβ fiber stimulation did not excite AAV-PdynP+ SDH neurons under normal conditions, but after PNI, this induced excitation, possibly due to enhanced Aβ fiber-evoked excitatory synaptic inputs and elevated resting membrane potentials of these neurons. Moreover, the chemogenetic silencing of AAV-PdynP+ neurons of PNI rats attenuated the Aβ fiber-evoked paw withdrawal behavior and c-FOS expression in superficial SDH neurons. Our findings suggest that PNI renders AAV-PdynP-captured neurons excitable to Aβ fiber stimulation, which selectively contributes to the conversion of Aβ fiber-mediated touch signal to nociceptive. Thus, reducing the excitability of AAV-PdynP-captured neurons may be a new option for the treatment of neuropathic allodynia.

DOI： 10.3389/fnmol.2022.911122

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Language：English   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-022-03074-3

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Language：Japanese   Publisher：日本循環制御医学会  

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Language：English   Publisher：(公社)日本麻酔科学会  

レミマゾラムによる全身麻酔中の鎮静レベルを評価する適切な指標を検討した。2020年11月～2021年1月にレミマゾラムによる全身麻酔下で乳房手術を受けた20歳以上の患者を対象とし、バイスペクトラルインデックス(BIS)、Sedline、および安静時瞳孔径を測定した。術中、BIS値40～60を保つようレミマゾラム投与量を調整した。BIS値60未満を達成できない場合は術中投与量を最大2mg/kg/hまで増量した。患者30例(平均59.3±13.9歳)を解析した。術中のBIS値およびPatient State Index(PSI)の平均値は、それぞれ50.6±9.1および43.0±11.8であった。術中の平均BIS値が60超であった患者は5例、平均PSI値が50超の患者は8例であった。術中のBISの平均スペクトルエッジ周波数(SEF)は15.3±2.5Hz、Sedlineの平均SEFは10.6±3.0Hzであった。術中の安静時平均瞳孔径は1.7±0.2mmであった。麻酔中に覚醒状態の患者はいなかった。以上から、SedlineのSEFおよび瞳孔径は、レミマゾラムによる麻酔中の鎮静レベルを確認するための補助的指標になり得ることが示唆された。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Pain  

ABSTRACT: Chronic low back pain (CLBP) is the leading cause of years lived with disability. Recently, it has been reported that CLBP is associated with alterations in the central nervous system. The present study aimed to investigate the association between CLBP and regional brain atrophy in an older Japanese population. A total of 1106 community-dwelling participants aged ≥65 years underwent brain magnetic resonance imaging scans and a health examination in 2017 to 2018. We used the FreeSurfer software for the analysis of brain magnetic resonance imaging. Chronic pain was defined as subjective pain for ≥3 months. Participants were divided into 3 groups according to the presence or absence of chronic pain and the body part that mainly suffered from pain: a "no chronic pain (NCP)" group (n = 541), "CLBP" group (n = 189), and "chronic pain in body parts other than the lower back (OCP)" group (n = 376). The brain volumes of the ventrolateral and dorsolateral prefrontal cortex, the posterior cingulate gyrus, and the amygdala were significantly lower in the CLBP group than in the NCP group after adjustment for sociodemographic, physical, and lifestyle factors and depressive symptoms. In addition, the left superior frontal gyrus was identified as a significant cluster by the Query, Design, Estimate, Contrast interface. There were no significant differences in the brain volumes of pain-related regions between the NCP and the OCP groups. The present study suggests that CLBP is associated with lower brain volumes of pain-related regions in a general older population of Japanese.

DOI： 10.1097/j.pain.0000000000002612

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Anesthesia and Analgesia  

BACKGROUND: Postreperfusion syndrome (PRS) after portal vein reperfusion during liver transplantation (LT) has been reported to cause rapid hemodynamic changes and is associated with a prolonged postoperative hospital stay, renal failure, and increased mortality. Although there are some reports on risk factors for PRS in brain-dead donor LT, there are a few reports on those in living donor LT. Therefore, we retrospectively reviewed the factors associated with PRS to contribute to the anesthetic management so as to reduce PRS during living donor LT. METHODS: After approval by the ethics committee of our institution, 250 patients aged ≥20 years who underwent living donor LT at our institution between January 2013 and September 2018 were included in the study. A decrease in mean arterial pressure of ≥30% within 5 minutes after portal vein reperfusion was defined as PRS, and estimates and odds ratio (OR) for PRS were calculated using logistic regression. The backward method was used for variable selection in the multivariable analysis. RESULTS: Serum calcium ion concentration before reperfusion (per 0.1 mmol/L increase; OR, 0.74; 95% confidence interval (CI), 0.60-0.95; P < .001), preoperative echocardiographic left ventricular end-diastolic diameter (per 1-mm increase: OR, 0.90; 95% CI, 0.85-0.95; P < .001, men [versus women: OR, 2.45; 95% CI, 1.26-4.75; P = .008]), mean pulmonary artery pressure before reperfusion (restricted cubic spline, P = .003), anhepatic period (restricted cubic spline, P = .02), and graft volume to standard liver volume ratio (restricted cubic spline, P = .03) were significantly associated with PRS. CONCLUSIONS: In living donor LT, male sex and presence of small left ventricular end-diastolic diameter, large graft volume, and long anhepatic period are associated with PRS, and a high calcium ion concentration and low pulmonary artery pressure before reperfusion are negatively associated with PRS.

DOI： 10.1213/ANE.0000000000006002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Pain Reports  

INTRODUCTION: Pain is a complex experience influenced by sensory and psychological factors. The insula is considered to be a core part of the pain network in the brain. Previous studies have suggested a relationship between the posterior insula (PI) and sensory processing, and between the anterior insula (AI) and cognitive-affective factors. OBJECTIVES: Our aim was to distinguish sensory and cognitive responses in pain-related insular activities. METHODS: We recorded spatiotemporal insular activation patterns of healthy participants (n = 20) during pain or tactile processing with painful or nonpainful movie stimuli, using a magnetoencephalography. We compared the peak latency between PI and AI activities in each stimulus condition, and between pain and tactile processing in each response. The peak latency and amplitude between different movies were then examined to explore the effects of cognitive influence. A visual analogue scale was used to assess subjective perception. RESULTS: The results revealed one clear PI activity and 2 AI activities (early and late) in insular responses induced by pain/tactile stimulation. The early response transmitted from the PI to AI was observed during sensory-associated brain activity, whereas the late AI response was observed during cognitive-associated activity. In addition, we found that painful movie stimuli had a significant influence on both late AI activity and subjective perception, caused by nonpainful actual stimulation. CONCLUSIONS: The current findings suggested that late AI activation reflects the processing of cognitive pain information, whereas the PI and early AI responses reflect sensory processing.

DOI： 10.1097/PR9.0000000000000984

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JA Clinical Reports  

BACKGROUND: Takayasu's arteritis (TA) is a chronic, progressive, inflammatory arteritis. We presented the case of cesarean section in a patient with TA. CASE PRESENTATION: A 31-year-old pregnant woman with TA underwent a planned cesarean section at 34 weeks of pregnancy. She had stenosis of the cerebral and coronary arteries and heart failure due to aortic regurgitation. Spinal anesthesia was performed. In addition to standard monitoring, arterial blood pressure in the dorsalis pedis artery and regional cerebral tissue oxygen saturation were monitored. Intraoperative arterial blood pressure was maintained using continuous infusion of noradrenaline with a careful intermittent bolus infusion of phenylephrine. All the procedures were successfully performed without significant complications. CONCLUSIONS: In a pregnant woman with TA, severe stenosis of the cerebral and coronary arteries, and heart failure due to valvular heart disease, careful anesthetic management by selecting catecholamines and assessing the perfusion pressure for critical organs is important.

DOI： 10.1186/s40981-021-00494-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

BACKGROUND: The bispectral index (BIS) value during general anesthesia with the newly developed anesthetic remimazolam is reported to be relatively high; however, the reason for this and the appropriate indicator for assessing the sedation level during remimazolam anesthesia have not been determined. In this study, the level of sedation during general anesthesia with remimazolam was evaluated using several different indicators. METHODS: Thirty patients who underwent breast surgery under general anesthesia with remimazolam were included. BIS®, Sedline® and the pupil resting diameters were measured simultaneously. The intraoperative dose of remimazolam was adjusted to obtain a BIS in the range of 40-60; if a BIS < 60 could not be achieved, the intraoperative dose was increased up to the maximal dose of 2 mg/kg/h. RESULTS: The mean intraoperative BIS and patient state index (PSI) in all patients was 50.6 ± 9.1 and 43.0 ± 11.8, respectively. Five patients showed a mean intraoperative BIS > 60 and eight patients showed mean intraoperative PSI > 50. The mean intraoperative spectral edge frequency (SEF) of BIS® or Sedline® was 15.3 ± 2.5 Hz or 10.6 ± 3.0 Hz, each. The mean intraoperative resting pupil diameter was 1.7 ± 0.2 mm. There were no patients with awareness during anesthesia. CONCLUSIONS: Processed electroencephalograms (BIS and PSI), and SEF of BIS® were relatively high during anesthesia with remimazolam, but SEF of Sedline® or pupillary diameter could be a supportive indicator to confirm sedation level during remimazolam anesthesia.

DOI： 10.1007/s00540-021-03030-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Therapeutic Hypothermia and Temperature Management  

General anesthetic agents can change the shivering threshold. Sevoflurane and desflurane are widely used as inhalational anesthetics and have also been reported to lower the shivering threshold in a dose-dependent manner. Although the comparison of postoperative shivering (POS) between total intravenous anesthesia and inhalational anesthesia has been reported, there have been no reports on a direct comparison between sevoflurane and desflurane anesthesia and the occurrence of POS in open abdominal surgery. After obtaining approval from the Ethics Review Committee (2020-261), 683 adult patients who underwent open radical surgery for uterine, cervical, or pancreatic cancer under general anesthesia using inhalational anesthetics at Kyushu University hospital between December 2012 and March 2020 were included in this retrospective study. The odds ratio (OR) for the occurrence of POS between the two groups (sevoflurane and desflurane) was calculated. Multivariable-adjusted analysis was performed using possible factors affecting POS. Furthermore, propensity score (PS) matching was conducted using these factors. The multivariable-adjusted OR for the occurrence of shivering in the desflurane group (62 occurrences/356 patients) was 1.06 (95% confidence interval [CI]: 0.69-1.62, p = 0.79) compared with the sevoflurane group (77/327, reference). Similarly, after PS matching, the crude OR for the occurrence of shivering in the desflurane group (47/210) was 1.09 (95% CI: 0.68-1.75, p = 0.72) compared with the sevoflurane group (44/210, reference). Similar results were obtained in the stratified analysis by sex and age. The occurrence of POS is not different between sevoflurane and desflurane anesthesia.

DOI： 10.1089/ther.2021.0029

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Language：English   Publisher：Springer Berlin Heidelberg  

症例は31歳女性で、23歳時に高安動脈炎と診断されていた。23歳時に左冠動脈主幹部の狭窄病変にベアメタルステント留置、24歳時に回旋枝の狭窄病変に薬剤溶出性ステント留置の手術歴があり、アスピリンとクロピドグレルの抗血栓療法を受けていた。自然妊娠し、妊娠23週に高安動脈炎に関連する心血管疾患のため当院に入院した。妊娠23週からクロピドグレルを中止した。妊娠が進行するにつれ、食後の胸部圧迫感や心拡大、心膜液貯留等の心不全の徴候が発現した。画像検査と経胸壁心エコー法にて、大動脈弁逆流による脳動脈および冠状動脈の重度狭窄を認めた。妊娠34週1日に脊髄クモ膜下麻酔にて帝王切開を施行した。標準モニタリングに加えて、足背動脈での動脈圧と心拍出量、および局所脳組織酸素飽和度(rSO2)をモニタリングした。ノルアドレナリンの持続注入を行ったが、区域麻酔薬投与直後、収縮期血圧が73mmHg、平均血圧が42mmHgに低下し、rSO2が右50%、左52%に低下した。フェニレフリンの単回投与で血圧は改善した。手術から3分後に児を娩出し、アプガースコアは1分8点、5分9点であった。術後経過は順調で、心不全の徴候は消失した。術後11日目に母子共に合併症なく退院した。

Language：English   Publisher：Japan Society of Circulation Control in Medicine  

<b>Introduction:</b> Modified electroconvulsive therapy (m-ECT) is mainly used to induce seizures. The use of anesthetic agents during m-ECT should be minimized because they could inhibit the development of seizures. Modifying the method of administration of anesthetic in combination with opioid use is known to help in reduction of the anesthetic dose. However, the effect of this dose reduction on circulatory dynamics during m-ECT has not been studied in detail. Therefore, we conducted this study to investigate the changes in blood pressure associated with anesthetic dose reduction during m-ECT. <br><b>Methods:</b> Ninety-one patients who underwent m-ECT eight or more times per course (455 m-ECT procedures in total) were included. The data were extracted retrospectively from anesthesia and electronic medical records from September 2015 to February 2020. The changes in blood pressure during m-ECT were compared between the following groups: propofol and remifentanil (PR group: remifentanil followed by propofol [1 µg/mL] based on target control infusion until loss of consciousness) and propofol alone (P group: propofol [2 µg/mL] based on target control infusion until loss of consciousness). <br><b>Results:</b> Of the 455 procedures (91 patients), 325 (65 patients) were performed in the PR group and 130 (26 patients) in the P group. Systolic blood pressure ≥180 mmHg during m-ECT was significantly more in the PR group than in the P group (73/325 vs. 14/130, p＝0.004). <br><b>Conclusion:</b> The use of a reduced dose of propofol in combination with remifentanil significantly increased blood pressure and the use of nicardipine than did propofol alone during m-ECT.

DOI： 10.11312/ccm.43.71

CiNii Research

Language：Japanese   Publisher：Japanese Pharmacological Society  

<p>Pain information transmission/processing in the spinal dorsal horn (SDH) is strongly controlled by descending neurons from the brain. One of the major neurotransmitters of descending pathways is noradrenaline (NA). Descending NAergic neurons from the locus coeruleus (LC) is known to produce analgesic effects via activation of inhibitory interneurons in the SDH. However, the identity of the inhibitory interneuron subset in the SDH is poorly understood. Recently, we have found a subset of the SDH inhibitory interneurons captured by adeno-associated viral (AAV) vectors incorporating a neuropeptide Y<i> </i>promoter (AAV-NpyP⁺) that is crucial for neuropathic allodynia. Here, we showed that this neuronal subset is a major target of spinal NA to inhibit pain information transmission/processing. Whole-cell patch-clamp recordings using spinal cord slices revealed that NA predominantly depolarizes AAV-NpyP⁺ neurons. This effect was suppressed by a pharmacological blockade and genetic knockdown of α_1B-adrenoceptor (AR) in AAV-NpyP⁺ neurons in the SDH. Furthermore, we found that the analgesic effect of duloxetine on neuropathic pain which is associated with an increase in the spinal NA level by inhibiting NA reuptake into presynaptic terminals is reduced by AAV-NpyP⁺ neuron-selective knockdown of α_1B-ARs. These results indicate that α_1B-ARs expressed in AAV-NpyP⁺ neurons would be a target of spinal NA presumably from descending LC neurons and contribute to the analgesic effect of duloxetine. Thus, spinal α_1B-ARs could be a new therapeutic target.</p>

DOI： 10.1254/jpssuppl.96.0_1-b-ss04-2

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Introduction: Postoperative nadir hemoglobin (Hb) is related to a longer length of stay for geriatric patients undergoing orthopedic surgery. We investigated whether postoperative pulse Hb (SpHb) measurement is useful for avoiding anemia and inappropriate blood transfusion after total hip arthroplasty and total knee arthroplasty. Material and Methods: This prospective randomized controlled study included 150 patients randomly assigned to receive blood transfusion, either guided by SpHb monitoring (SpHb group) or based on the surgeons' experience (control group). The target laboratory Hb value was set to >8 g/dL at postoperative day 1 (POD1). The primary endpoints were the product of total time and degree of SpHb <8 g/dL (area under SpHb 8 g/dL) during the period up to POD1 and the incidence of laboratory Hb <8 g/dL at POD1. The secondary endpoints were the amount of blood transfusion and inappropriate blood transfusion, which was defined as allogeneic blood transfusion unnecessary in a case of SpHb >12 g/dL or delayed transfusion in a case of SpHb <8 g/dL. Results: The area under SpHb 8 g/dL was 37.6 ± 44.1 g/dL-min (5 patients) in the control group and none in the SpHb group (P = .0281). There was 1 patient with Hb <8 g/dL at POD1 in the control group. There was no difference in laboratory Hb levels and the amount of blood transfusion. Forty-one patients (19 in the control group and 22 in the SpHb group) received an allogeneic blood transfusion. Among these patients, 7 in the control group and none in the SpHb group received inappropriate blood transfusion (P = .0022). Discussion: The SpHb monitoring could reduce unnoticed anemia, which may prevent complications and be useful in avoiding unnecessary and excessive blood transfusion. Conclusion: Postoperative SpHb monitoring decreased the incidence of transient, unnoticed anemia during the period up to POD1 and inappropriate blood transfusion.

DOI： 10.1177/21514593211060575

Language：Others   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00540-021-02953-5

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Continuous electroencephalogram (EEG) monitoring is useful for assessing the level of sedation and detecting non-convulsive epileptic seizures and cerebral ischemia in the intensive care unit. This report describes a case of cerebral hemorrhagic infarction diagnosed after the detection of high-amplitude slow waves on processed EEG during sedation. CASE PRESENTATION: A 68-year-old man who underwent cardiac surgery was sedated in the intensive care unit following an invasive procedure. High-amplitude slow waves appeared on processed EEG monitoring before the detection of anisocoria. Computed tomography revealed a cerebral hemorrhagic infarction. CONCLUSIONS: In the management of critically ill patients, continuous EEG monitoring with forehead electrodes may be useful in the early detection of brain lesions.

DOI： 10.1186/s40981-021-00483-3

Language：English   Publishing type：Research paper (scientific journal)  

Perioperative anaphylaxis is a severe adverse event during anesthesia that requires prompt diagnosis and treatment by physicians, including anesthesiologists. Muscle relaxants and antibiotics are the most common drugs that cause perioperative anaphylaxis in Japan, as in many countries. In addition, sugammadex appears to be a primary causative agent. Obtaining previous anesthesia records is necessary in a patient with a history of allergic reactions during anesthesia, whenever possible, to avoid recurrence of anaphylaxis. Although medical staff are likely to notice abnormal vital signs because of complete monitoring during anesthesia, surgical drapes make it difficult to notice the appearance of skin symptoms. Even if there are no skin symptoms, anaphylaxis should be suspected, especially when hypotension resistant to inotropes and vasopressors persists. For improving the diagnostic accuracy of anaphylaxis, it is helpful to collect blood samples to measure histamine/tryptase concentrations immediately after the events and at baseline. The first-line treatment for anaphylaxis is adrenaline. In the perioperative setting, adrenaline should be administered through the intravenous route, which has a faster effect onset and is secured in most cases. Adrenaline can cause serious complications including severe arrhythmias if the appropriate dose is not selected according to the severity of symptoms. The anesthesiologist should identify the causative agent after adverse events. The gold standard for identifying the causative agent is the skin test, but in vitro tests including specific IgE antibody measurements and basophil activation tests are also beneficial. The Working Group of the Japanese Society of Anesthesiologists has developed this practical guide to help appropriate prevention, early diagnosis and treatment, and postoperative diagnosis of anaphylaxis during anesthesia.Grade of recommendations and levels of evidence Anaphylaxis is a relatively rare condition with few controlled trials, and thus a so-called evidence-based scrutiny is difficult. Therefore, rather than showing evidence levels and indicating the level of recommendation, this practical guideline only describes the results of research available to date. The JSA will continue to investigate anaphylaxis during anesthesia, and the results may lead to an amendment of this practical guideline.

DOI： 10.1007/s00540-021-03005-8

Language：English   Publishing type：Research paper (scientific journal)  

Linkage between early-life exposure to anesthesia and subsequent learning disabilities is of great concern to children and their families. Here we show that early-life exposure to midazolam (MDZ), a widely used drug in pediatric anesthesia, persistently alters chromatin accessibility and the expression of quiescence-associated genes in neural stem cells (NSCs) in the mouse hippocampus. The alterations led to a sustained restriction of NSC proliferation toward adulthood, resulting in a reduction of neurogenesis that was associated with the impairment of hippocampal-dependent memory functions. Moreover, we found that voluntary exercise restored hippocampal neurogenesis, normalized the MDZ-perturbed transcriptome, and ameliorated cognitive ability in MDZ-exposed mice. Our findings thus explain how pediatric anesthesia provokes long-term adverse effects on brain function and provide a possible therapeutic strategy for countering them.

DOI： 10.1073/pnas.2107596118

Language：Japanese  

悪性カタトニアは,昏迷,無動,カタレプシーなどのカタトニアに特徴的な症状に発熱や自律神経症状を伴い,致死的になり得る症候群である。症例は53歳の女性で,統合失調症の治療中に意識障害,筋緊張亢進,発熱を来して救急搬送された。精神科病棟に医療保護入院したが,呼吸不全を呈したため応援を要請された。ICUで治療を開始し,全身管理と並行して悪性症候群や他の身体疾患の除外診断を行った。統合失調症による悪性カタトニアを疑いロラゼパムを静注したところ,意識が回復し筋緊張亢進も軽快した。悪性カタトニアを疑った場合は,全身管理や合併症への対応と並行して身体疾患の除外診断を行い,ベンゾジアゼピンによる診断的治療を行う。ロラゼパムの静注は効果発現が早いため,悪性カタトニアを疑った場合の診断的治療に有用である。(著者抄録)

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We aimed to evaluate the effect of third-generation hydroxyethyl starch (6&#37; HES 130/0.4) on hemostasis and perioperative blood loss in patients undergoing off-pump coronary artery bypass (OPCAB) with continuation of preoperative aspirin. METHODS: Forty-nine consecutive patients, who underwent OPCAB at a single institution between November 1, 2014 and March 31, 2016, were included. Coagulation tests, including thromboelastometry and clinical data of all patients, retrospectively were collected from anesthesia and medical records. RESULTS: The total amount of intraoperative crystalloid and HES was 2057.5 ± 771.6 mL (N = 32) and 1090.6 ± 645.0 mL (N = 32), respectively. In the coagulation pathway, the change ratio of fibrinogen concentration, prothrombin time, and fibrinogen thromboelastometry-maximum clot firmness (FIBTEM-MCF) significantly correlated with HES (P < 0.001, P = 0.00131, and P < 0.001, respectively), but not with crystalloid. In the coagulation pathway concerning interaction with platelets, the change ratio of platelet count, extrinsic thromboelastometry-clotting formation time (EXTEM-CFT), and EXTEM-MCF significantly were correlated with HES (P < 0.001, P < 0.001, and P < 0.001, respectively), but not with crystalloid. At chest closure, the hematocrit decreased in a dose-dependent manner with HES (P < 0.001), but not with crystalloid administration. There was an association between the change ratio of hematocrit and EXTEM-MCF (P = 0.00122). However, intra-postoperative blood loss was not correlated with HES 130/0.4 or crystalloid administration. CONCLUSION: We found that 6&#37; HES 130/0.4 prolonged coagulation testing in a dose-dependent manner due to hemodilution but did not increase blood loss in patients undergoing OPCAB with continuation of preoperative aspirin.

DOI： 10.1532/hsf.4061

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Hepatopulmonary syndrome frequently complicates end-stage liver disease. It causes hypoxemia and requires oxygen administration. Additionally, interstitial pneumonia causes hypoxemia; however, it is known to be aggravated by high-concentration oxygen administration. CASE PRESENTATION: A 71-year-old woman with hepatopulmonary syndrome and interstitial pneumonia underwent living donor liver transplantation, requiring conflicting management in terms of the inspiratory oxygen concentration. We achieved a low intraoperative fraction of inspiratory oxygen by increasing the cardiac output with intravenous catecholamines. As a result, the transplanted liver functioned well postoperatively, and the patient was discharged without exacerbation of the interstitial pneumonia. CONCLUSION: We suggest that patients with hepatopulmonary syndrome complicated with interstitial pneumonia can undergo successful living donor liver transplantation without the use of high inspiratory oxygen concentration by using catecholamines to maintain a high mixed venous oxygen saturation.

DOI： 10.1016/j.transproceed.2021.08.007

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Hyperactive dysfunction syndrome (HDS) refers to a constellation of symptoms developing from cranial nerve overactivity caused by neurovascular compression at the root entry or exit zone near the brainstem. Although the combined features of HDS are seen in the elderly, there are no reports of such cases in adolescents, to date. CASE PRESENTATION: A 17-year-old male was diagnosed with right glossopharyngeal neuralgia and treated with microvascular decompression. He experienced new-onset right facial pain later and was diagnosed with right trigeminal neuralgia, which required prompt radiofrequency thermocoagulation of the right mandibular nerve. Follow-up in the third post-treatment year revealed the absence of symptom recurrence. DISCUSSION: We report the treatment of a rare case of adolescent-onset combined HDS presenting as trigeminal and glossopharyngeal neuralgia. This report highlights the possibility of combined hyperactive dysfunction syndrome in younger age groups. It is crucial to establish a diagnosis early on for prompt management.

DOI： 10.1186/s40981-021-00465-5

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Glutaric acidemia is a type of multiple acyl-coenzyme A dehydrogenase deficiency, an inborn error in fatty acid metabolism. In patients with glutaric acidemia, during the perioperative period, prolonged fasting, stress, and pain have been identified as risk factors for the induction of metabolic derangement. This report describes the surgical and anesthetic management of a patient with glutaric acidemia. CASE PRESENTATION: A 56-year-old male patient with glutaric acidemia type 2 underwent a series of surgeries. During the initial off-pump coronary artery bypass surgery, the patient developed renal failure due to rhabdomyolysis upon receiving glucose at 2 mg/kg/min. However, in the second laparoscopic cholecystectomy, rhabdomyolysis was avoided by administering glucose at 4 mg/kg/min. CONCLUSIONS: To avoid catabolism in patients with glutaric acidemia, appropriate glucose administration is important, depending on the surgical risk.

DOI： 10.1186/s40981-021-00459-3

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: During pulmonary segmentectomy, identification of the target segment is essential. We used bronchoscopic jet ventilation (BJV) to delineate the intersegmental plane by selectively sending air into the target segment. The purpose of this study was to investigate the factors associated with BJV failure. METHODS: Data were retrospectively collected from 48 patients who underwent pulmonary segmentectomy with BJV between March 2014 and May 2019 at a single center. Data were compared between BJV succeeded cases and failed cases. RESULTS: In 13 cases (27%), BJV were unsuccessful. The Brinkman index was significantly higher in failed cases (962 ± 965 failed vs. 395 ± 415 successful, P = 0.0067). The success rate was significantly lower when BJV was applied to the posterior basal segmental bronchus (B10) (B10: 1/5 (20%) vs others: 34/43 (79%), P = 0.015). CONCLUSION: Long-term smoking and the bronchus corresponding to the posterior basal segment might make successful performance of BJV difficult.

DOI： 10.1186/s40981-021-00457-5

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. CASE PRESENTATION: A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. CONCLUSIONS: SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects.

DOI： 10.1186/s40981-021-00451-x

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We reported that 2,5-dimethylcelecoxib (DM-celecoxib), a celecoxib derivative that is unable to inhibit cyclooxygenase-2, prevented cardiac remodeling induced by sarcomeric gene mutation, left ventricular pressure overload, or β-adrenergic receptor stimulation. This effect seemed to be mediated by the inhibition of the canonical Wnt/β-catenin signaling pathway, which has been suggested to play a key role in the development of chronic kidney disease and chronic heart failure. METHOD: We investigated the effect of DM-celecoxib on cardiac remodeling and kidney injury in hypertension model mice induced by angiotensin II infusion in the absence or presence of high-salt load. RESULTS: DM-celecoxib prevented cardiac remodeling and markedly reduced urinary albumin excretion without altering blood pressure in those mice. Moreover, DM-celecoxib prevented podocyte injury, glomerulosclerosis, and interstitial fibrosis in the kidney of mice loaded with angiotensin II and high-salt load. DM-celecoxib reduced the phosphorylation level of Akt and activated glycogen synthase kinase-3, which led to the suppression of the Wnt/β-catenin signal in the heart and kidney. DM-celecoxib also reduced the expression level of snail, a key transcription factor for the epithelial-mesenchymal transition and of which gene is a target of the Wnt/β-catenin signal. CONCLUSION: Results of the current study suggested that DM-celecoxib could be beneficial for patients with hypertensive heart and kidney diseases.

DOI： 10.1097/HJH.0000000000002728

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Coronary artery spasm has rarely been reported in pediatric patients. Previous studies have reported comorbidities and risk factors for coronary artery spasms. We present the case of a complete atrio-ventricular (AV) block that occurred in the absence of other risk factors immediately after direct laryngoscopy. CASE PRESENTATION: A 2-year-old girl developed severe coronary artery spasm after direct laryngoscopy for elective laryngeal papillomatosis resection. Immediately after the initiation of laryngoscopy, complete AV block and ST elevation on lead II of the electrocardiogram were observed. These findings indicated that the complete AV block was caused by a right coronary artery spasm. CONCLUSION: Coronary artery spasm resulting in lethal arrhythmia rarely occurs in healthy pediatric patients. To the best of our knowledge, this is the first pediatric case of a severe coronary artery spasm resulting in a complete AV block due to direct laryngoscopy in a healthy patient.

DOI： 10.1186/s40981-021-00437-9

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Ionized magnesium (iMg) is considered to be the biologically active fraction of circulating total serum Mg (tMg). However, only the relationship between tMg and postoperative shivering has been studied. To our knowledge, hitherto no clinical studies have investigated the association between serum ionized magnesium concentration ([iMg]) and postoperative shivering. Therefore, we aimed to retrospectively examine this association, focusing on hypomagnesemia and depletion of [iMg]. METHODS: This retrospective study involved 421 patients who underwent pancreaticoduodenectomy under general anesthesia at our center from December 2012 to September 2019. Logistic regression analysis was performed to estimate the odds ratio (OR) for the incidence of postoperative shivering. RESULTS: Postoperative shivering developed in 111 out of 421 patients. The post-surgical concentration of [iMg] was significantly associated with postoperative shivering in the non-adjusted model, but not in the multivariable-adjusted model. In multivariable-adjusted analysis, progressive decrease of [iMg] by 0.1 mmol/L significantly increased the risk of postoperative shivering (OR: 1.64, 95&#37; CI 1.02-2.64, p = 0.04). The multivariable-adjusted OR for postoperative shivering was 3.65 (95&#37; CI 1.25-13.55, p = 0.02) in subjects with post-surgical [iMg] less than 0.6 mmol/L and decrease in [iMg] during surgery compared with those with post-surgical [iMg] more than 0.6 mmol/L and constant or increased of [iMg] during surgery. CONCLUSION: A decrease in the [iMg] during surgery was significantly associated with postoperative shivering. Subjects who had an [iMg] lower than 0.6 mmol/L post-surgery and decreased [iMg] during surgery had a significantly higher risk of postoperative shivering. Intraoperative depletion of [iMg] was significantly associated with shivering.

DOI： 10.1007/s00540-021-02914-y

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: We aimed to investigate whether 6% HES 130/0.4 was associated with postoperative reduction of estimated glomerular filtration rate (eGFR) in donor patients who underwent nephrectomy for living kidney transplantation. METHODS: This retrospective study included 213 living kidney transplant donors treated at Kyushu University Hospital in Japan from April 2014 to March 2018. Patients who were administered 6% HES 130/0.4 were allocated in the HES group (n = 108), and those who were not were allocated in the control group (n = 105). The postoperative decrements in estimated glomerular filtration rates (eGFRs) from preoperative values were calculated on postoperative days (PODs) 1, 3, and 14. Decline in kidney function (DKF) according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification were analyzed by multivariable-adjusted ordinal logistic regression to estimate odds ratios (ORs) for postoperative DKF. RESULTS: In HES group, administration amount of HES was median 9.4 [interquartile range: 8.2-14.3] ml/kg. Postoperative decrements in eGFR were similar in the control and HES groups on POD 1 (control group: mean 32.0 vs. HES group: 33.0 mL/min/1.73 m2), same as POD 3 (21.1 vs. 22.4 mL/min/1.73 m2) and POD 14 (26.0 vs. 25.9 mL/min/1.73 m2), even after adjusting for confounding factors. The multivariable-adjusted ORs for postoperative DKF did not significantly increase in the HES group on POD 1 (OR: 0.88), POD 3 (OR: 0.96), and POD 14 (OR: 0.52) compared with the control group. CONCLUSION: Six percent HES 130/0.4 is not associated with postoperative renal dysfunction in donor patients undergoing nephrectomy for kidney transplantation.

DOI： 10.1007/s00540-020-02862-z

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Previously, we found that an upward air current in the head area, induced by forced air warming (FAW), was completely counteracted by downward laminar airflow. However, this study did not include any consideration of the air-conditioner outlet layout (ACOL); hence, its impact remains unclear. METHODS: This study was performed in 2 operating rooms (ORs)-ISO classes 5 and 6, which are denoted as OR-5 and OR-6, respectively. Both ORs have distinct ACOLs. The cleanliness, or the number or ratio of shifting artificial particles was evaluated. RESULTS: During the first 5 minutes after particles generation, significantly more particles shifted into the surgical field in OR-5 when compared to OR-6 (13,587 [4,341-15,913] and 106 [41-338] particles/cubic foot, P < .0001). Notably, FAW did not increase the number of shifting particles in OR-6. The laminar airflow system fully counteracted the upward airflow caused by FAW in OR-6, where the ACOL covered the operating bed. However, this did not occur in OR-5, where the ACOL did not fully cover the operating bed. CONCLUSIONS: Regardless of cleanliness ability of OR, an ACOL that fully covers the operating bed can prevent upward airflow in the head area and reduce the number of artificial particles shifting into the surgical field, which are typically caused by FAW.

DOI： 10.1016/j.ajic.2020.06.202

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Erythropoietic protoporphyria (EPP) is a rare disorder of heme synthesis. Patients with EPP mainly show symptoms of photosensitivity, but approximately 20% of EPPs are associated with the liver-related complications. We report a case of breast cancer in a 48-year-old female patient with EPP in whom meticulous perioperative management was required in order to avoid complications resulting from this disease. CASE PRESENTATION: The patient was diagnosed with EPP at the age of 33 and had a rich family history of the disease. For right breast cancer initially considered as TisN0M0 (Stage 0), the right mastectomy and sentinel lymph node biopsy were performed, while the final stage was pT1bN0M0, pStage I. In the perioperative period, we limited the drug use and monitored light wavelength measurements. Besides, we covered surgical lights, headlights, and laryngoscope's light with a special polyimide film that filtered the wavelength of light causing dermal photosensitivity. After the surgery, any emerging complications were closely monitored. CONCLUSIONS: The surgery, internal medicine, anesthesiology, and operation departments undertook all possible measures through close cooperation to ensure a safe surgery for the patient with a rare condition.

DOI： 10.1186/s40792-020-01068-5

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND Tracheobronchopathia osteochondroplastica (TO) is a rare disorder characterized by cartilaginous or ossified submucosal nodules of unknown etiology that project into the tracheobronchial lumen. TO is often accompanied by endotracheal stenosis from cartilage proliferation and is often detected by difficult endotracheal intubation incidence. CASE REPORT Here we report the case of a patient (67-year-old man) with TO scheduled to undergo robot-assisted total prostatectomy for prostate cancer. The tracheal lumen was especially narrow at an area 1 cm below the glottis, with the smallest lumen diameter being 9 mm. After rapid induction, the bronchoscope passed through the stenosed region, and a 6.5-mm spiral endotracheal tube (ETT) was inserted with bronchoscopic assistance. However, because of resistance, the spiral ETT could not pass through the stenosed area. After changing to a 6.5-mm normal ETT, intubation was successfully performed with gentle rotation. Owing to the rotation, the tip entered and gained access to the gap between nodules. With use of a bronchoscope, we confirmed that the tip of the ETT was advanced 10 cm from the glottis, where the site of maximum stenosis was not covered by the tube cuff, and where the tip did not cross the bifurcation. After surgery, no bleeding or edema was found on bronchoscopy. CONCLUSIONS In patients with TO, it is important to assess the airway condition and prepare for difficult intubation. In this case, tracheal intubation was performed with rotation using a bronchoscope and normal ETT.

DOI： 10.12659/AJCR.928743

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy. CASE PRESENTATION: A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications. CONCLUSIONS: Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications.

DOI： 10.1186/s40981-020-00407-7

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.12659/AJCR.928743.

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The central focus of anesthesia management in kidney transplantation is to avoid hypotensive episodes and maintain adequate perfusion pressure to the graft. However, it is not clear whether there is an optimal systolic blood pressure (SBP) level after reperfusion for living-donor transplant outcomes. The aim of this study is to investigate the effect of SBP after reperfusion on early graft function in living-donor kidney transplantation. METHODS: We retrospectively analyzed 315 patients who underwent living-donor kidney transplantation from January 2013 to December 2017. We divided the patients into 4 groups according to SBP after reperfusion and compared the postoperative estimated glomerular filtration rate and creatinine. RESULTS: There were no differences in the postoperative recovery of kidney graft function in the first 7 postoperative days among the 4 SBP groups after reperfusion. However, the urine output after reperfusion was significantly less in the group with SBP < 140 mm Hg after reperfusion compared with the remaining 3 groups in a multivariate analysis (P = .04). CONCLUSIONS: No significant differences in early graft function were observed among the 4 SBP groups. SBP ≥ 140 mm Hg after reperfusion, which is linked to greater urine output, can be beneficial in terms of long-term graft survival and mortality.

DOI： 10.1016/j.transproceed.2020.04.1820

Language：English   Publishing type：Research paper (scientific journal)  

Background: : Previous studies have demonstrated that forced air warming (FAW) can be used safely in operating rooms with laminar airflow (LAF) ventilation systems. However, the effects of FAW on the airflow at surgical sites under non-LAF (nLAF) ventilation systems remain unclear, as nLAF systems generate outlet-to-inlet multidirectional airflows of the air conditioning system. Here, we evaluate the effects of FAW on the airflow and sanitation quality in surgical fields with nLAF ventilation systems. Methods: : The airflow speed and direction were measured using a three-dimensional ultrasonic anemometer. Sanitation quality was evaluated by measuring the amount of dust particles after the activation of air conditioning. Results: : FAW caused no meaningful airflow (> 10 cm/sec) and did not diminish the sanitation quality in the surgical field separated by the anesthesia screen. Above the head area, the upward FAW airflow was not counteracted by nLAF, which caused an upward airflow at the edges of the operating table, originating from outside of the operating table and the floor. Conclusions: : Sanitation quality was kept under FAW working even in an nLAF-equipped OR. According to the inlet/outlet layouts of nLAF, the upward FAW-induced airflow in the head area was not counteracted, and the upward airflow from the floor induced by the air conditioner outlet could be detected.

DOI： 10.1016/j.pcorm.2020.100119

Language：English   Publishing type：Research paper (scientific journal)  

Epstein syndrome is a myosin heavy chain 9 (MYH9)-related disorder characterized by hearing loss and macrothrombocytopenia with renal failure, which usually requires platelet transfusion during surgery. We report the case of a 22-year-old man who underwent living-donor renal transplantation without platelet transfusion using rotational thromboelastometry (ROTEM) monitoring. His intraoperative laboratory coagulation findings were a platelet count of 28-31 × 10/L based on microscopy and fibrinogen of 256 mg/dL. However, his extrinsic pathway evaluations by ROTEM were normal. The estimated blood loss during the operation was 150 mL, and the patient showed no bleeding complications without platelet transfusion.

DOI： 10.1213/XAA.0000000000001350

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Mesenchymal stem cells (MSCs), including adipose-derived mesenchymal stem cells (ADSCs), have been shown to attenuate organ damage in acute respiratory distress syndrome (ARDS) and sepsis; however, the underlying mechanisms are not fully understood. In this study, we aimed to explore the potential roles and molecular mechanisms of action of ADSCs in histone-induced endothelial damage. METHODS: Male C57BL/6 N mice were intravenously injected with ADSCs, followed by histones or a vehicle. The mice in each group were assessed for survival, pulmonary vascular permeability, and histological changes. A co-culture model with primary human umbilical vein endothelial cells (HUVECs) exposed to histones was used to clarify the paracrine effect of ADSCs. Overexpression and inhibition of miR-126 ADSCs were also examined as causative factors for endothelial protection. RESULTS: The administration of ADSCs markedly improved survival, inhibited histone-mediated lung hemorrhage and edema, and attenuated vascular hyper-permeability in mice. ADSCs were engrafted in the injured lung and attenuated histone-induced endothelial cell apoptosis. ADSCs showed endothelial protection (via a paracrine effect) and Akt phosphorylation in the histone-exposed HUVECs. Notably, increased Akt phosphorylation by ADSCs was mostly mediated by exosomes in histone-induced cytotoxicity and lung damage. Moreover, the expression of miR-126 was increased in exosomes from histone-exposed ADSCs. Remarkably, the inhibition of miR-126 in ADSCs failed to increase Akt phosphorylation in histone-exposed HUVECs. CONCLUSION: ADSC-derived exosomes may exert protective effects on endothelial cells via activation of the PI3K/Akt pathway.

DOI： 10.1186/s13287-020-02015-9

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Patients with malignant pleural mesothelioma (MPM) frequently complain of intractable pain that is resistant to conservative treatments. Although spinal cord stimulation (SCS) may be promising in the alleviation of such devastating pain, the effects of SCS on MPM-associated pain and the appropriate timing of its application remain unknown. CASE PRESENTATION: A 66-year-old man diagnosed with MPM presented with severe neuropathic pain due to rapid progression of the tumor to the intercostal nerves. The patient immediately decided to receive SCS implantation and burst stimulus, which relieved the conservative therapy-resistant pain and improved his sleep and daily activities. CONCLUSION: This report suggests that the execution of SCS as soon as possible may help to alleviate MPM symptoms. Since MPM extends aggressively to the thorax and nerves that cause mixed nociceptive and/or neuropathic pain, appropriate pain management requires the proper assessment of the etiology by an expert in pain management.

DOI： 10.1186/s40981-020-00386-9

Language：Japanese  

Brachial plexus block improved refractory pain due to intraoperative position-related nerve injury: a case report

DOI： 10.11321/jjspc.20-0022

Language：English   Publishing type：Research paper (scientific journal)  

In the central nervous system, hyperpolarization-activated, cyclic nucleotide-gated (HCN1-4) channels have been implicated in neuronal excitability and synaptic transmission. It has been reported that HCN channels are expressed in the spinal cord, but knowledge about their physiological roles, as well as their distribution profiles, appear to be limited. We generated a transgenic mouse in which the expression of HCN4 can be reversibly knocked down using a genetic tetracycline-dependent switch and conducted genetically validated immunohistochemistry for HCN4. We found that the somata of HCN4-immunoreactive (IR) cells were largely restricted to the ventral part of the inner lamina II and lamina III. Many of these cells were either parvalbumin- or protein kinase Cγ (PKCγ)-IR. By using two different mouse strains in which reporters are expressed only in inhibitory neurons, we determined that the vast majority of HCN4-IR cells were excitatory neurons. Mechanical and thermal noxious stimulation did not induce c-Fos expression in HCN4-IR cells. PKCγ-neurons in this area are known to play a pivotal role in the polysynaptic pathway between tactile afferents and nociceptive projection cells that contributes to tactile allodynia. Therefore, pharmacological and/or genetic manipulations of HCN4-expressing neurons may provide a novel therapeutic strategy for the pain relief of tactile allodynia.

DOI： 10.1186/s13041-020-00666-6

Language：English  

The G protein-gated inwardly rectifying K+ (GIRK) channels play important signaling roles in the central and peripheral nervous systems. However, the role of GIRK channel activation in pain signaling remains unknown mainly due to the lack of potent and selective GIRK channel activators until recently. The present study was designed to determine the effects and mechanisms of ML297, a selective GIRK1/2 activator, on nociception in the spinal cord by using behavioral studies and whole-cell patch-clamp recordings from substantia gelatinosa (SG) neurons. Rats were prepared for chronic lumber catheterization and intrathecal administration of ML297. The nociceptive flexion reflex was tested using an analgesy-meter, and the influence on motor performance was assessed using an accelerating rotarod. We also investigated pre- and post-synaptic actions of ML297 in spinal cord preparations by whole-cell patch-clamp recordings. Intrathecal administration of ML297 increased the mechanical nociceptive threshold without impairing motor function. In voltage-clamp mode of patch-clamp recordings, bath application of ML297 induced outward currents in a dose-dependent manner. The ML297-induced currents demonstrated specific equilibrium potential like other families of potassium channels. At high concentration, ML297 depressed miniature excitatory postsynaptic currents (mEPSCs) but not their amplitude. The ML297-induced outward currents and suppression of mEPSCs were not inhibited by naloxone, a μ-opioid receptor antagonist. These results demonstrated that intrathecal ML297 showed the antinociceptive effect, which was mediated through direct activation of pre- and post-synaptic GIRK channels. Selective GIRK channel activation is a promising strategy for the development of new agents against chronic pain and opioid tolerance.

DOI： 10.1371/journal.pone.0239094

Language：English   Publishing type：Research paper (scientific journal)  

AIM: Doxorubicin (DOX) induces dose-dependent cardiotoxicity due to reactive oxygen species (ROS)-mediated oxidative stress and subsequent apoptosis of cardiomyocytes. We aimed to assess whether sodium thiosulfate (STS), which has antioxidant and antiapoptotic properties, exerts cardioprotective effects on DOX-induced cardiomyopathy. MAIN METHODS: Male C57BL/6N mice were divided into four groups, control, DOX, STS, and DOX + STS, and administered DOX (20 or 30 mg/kg) or normal saline intraperitoneally, followed by an injection of STS (2 g/kg) or normal saline 4 h later. KEY FINDINGS: The DOX group showed a poorer 6-day survival and decreased cardiac function than the DOX + STS group. The DOX group showed a marked increase in the plasma creatine kinase isoenzyme myocardial band (CK-MB) and lactate dehydrogenase (LDH) levels 10 h after DOX injection, while the DOX + STS group showed suppression of DOX-induced elevation of CK-MB and LDH levels. The DOX group showed increased 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in the heart, whereas the DOX + STS group showed increased catalase and superoxide dismutase (SOD) activities and decreased 8-OHdG levels in the heart compared with DOX group, suggesting that STS reduces DOX-induced DNA damage by improving antioxidant enzymes activities in cardiomyocytes. Additionally, the DOX + STS group showed attenuation of cleaved caspase-3 and DNA fragmentation in cardiomyocytes compared with the DOX group, suggesting that STS suppresses DOX-induced apoptosis in cardiomyocytes. SIGNIFICANCE: STS exerts cardioprotective effects against DOX-induced cardiac dysfunction partly by improving antioxidant defense and suppressing apoptosis, indicating the therapeutic potential of STS against DOX-induced cardiomyopathy.

DOI： 10.1016/j.lfs.2020.118074

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Supplementation of fresh frozen plasma immediately after cardiopulmonary bypass is an effective method to enhance clotting ability as coagulation factors are consumed in the extracorporeal circuit during cardiopulmonary bypass. On the other hand, the anticoagulation factors in fresh frozen plasma can also deter the clotting ability. This study investigated the effect of fresh frozen plasma administration on the comprehensive clotting ability following cardiopulmonary bypass. METHODS: This prospective observational study included 22 patients scheduled for cardiac surgery. Clotting times and maximum clot firmness were evaluated using the types of rotational thromboelastometry, intrinsic rotational thromboelastometry, and heparinase thromboelastography preoperatively, immediately after cardiopulmonary bypass, and 1 hour after cardiopulmonary bypass. Activated clotting time, antithrombin activity, and heparin concentration were also measured at these time-points. RESULTS: Antithrombin activity (62.9 ± 7.2&#37; vs. 51.1 ± 7.4&#37;, p < 0.0001) and activated clotting time (132.6 ± 9.6&#37; vs. 120.0 ± 9.0&#37;, p < 0.001) were significantly higher 1 hour after cardiopulmonary bypass compared to measurements taken immediately after cardiopulmonary bypass. Heparin concentration 1 hour after cardiopulmonary bypass was significantly decreased compared to that immediately after cardiopulmonary bypass. On the other hand, maximum clot firmness determined via intrinsic rotational thromboelastometry was significantly greater 1 hour after cardiopulmonary bypass (53.8 ± 4.8 mm) than that immediately after cardiopulmonary bypass (49.5 ± 4.8 mm). Clotting time determined via intrinsic rotational thromboelastometry and heparinase thromboelastography was also significantly shorter 1 hour after cardiopulmonary bypass than that immediately after cardiopulmonary bypass. CONCLUSION: Fresh frozen plasma administration increased antithrombin activity and caused activated clotting time prolongation, but then increased clotting ability. Thus, testing by rotational thromboelastometry after cardiopulmonary bypass could be valuable in the detection of comprehensive clotting ability.

DOI： 10.1177/0267659120948435

Language：Others   Publishing type：Research paper (scientific journal)  

Ventricular Tachycardia During Total Hip Arthroplasty：A Case Report

DOI： 10.2199/jjsca.40.353

Language：English   Publishing type：Research paper (scientific journal)  

No effective treatment has been established for autoimmune hepatitis (AIH), except for liver transplantation in the fatal stage. Little is known about the roles and mechanisms of farnesyltransferase inhibitors (FTIs) in treating AIH. Thus, we investigated the specific role of the FTI, tipifarnib, in a Concanavalin A (Con A)-induced model of hepatitis. The effects of tipifarnib (10 mg/kg, intraperitoneal injection) were studied in Con A (20 mg/kg, intravenous injection)-challenged mice by histological, biochemical, and immunological analyses. Tipifarnib-treated mice were compared to phosphate-buffered saline (PBS)-treated mice. Con A caused liver injury characterized by increased plasma alanine aminotransferase (ALT) levels and marked histological changes. The increased serum ALT, interleukin-6, or interferon-γ (IFN-γ) levels were observed at 2 or 8 h; tumor necrosis factor-α levels at 2 h post-Con A administration decreased significantly in the tipifarnib group. Tipifarnib also suppressed Con A-induced activation of CD4+ cells (but not CD8+ T cells) in the liver and spleen, and also reversed the Con A-induced decrease of natural killer T (NKT) cells in the liver. Tipifarnib significantly inhibited IFN-γ production and STAT1 phosphorylation from CD4+ T cells (but not CD8+ T and NKT cells) in the liver at 2 h post-Con A administration. Tipifarnib significantly inhibited IFN-γ production by splenic CD4+ T cells at 48 h post-Con A injection in vitro. Tipifarnib also inhibited the expression of farnesylated proteins induced by Con A administration. In conclusion, tipifarnib inhibited IFN-γ derived from Con A-induced CD4+ T cell activation due to downregulated STAT1 phosphorylation, suggesting that Tipifarnib can protect against AIH.

DOI： 10.1016/j.intimp.2020.106462

Language：Japanese  

In January 2016 and 2017, the Committee on Safety of the Japan Society of Pain Clinicians distributed questionnaires on pain management-related adverse events (AEs) in 2015 and 2016 to all board-certified training facilities in Japan. Responses were received from 162 facilities (response rate, 46％) in 2016 and 197 facilities (response rate, 57％) in 2017. Most AEs were reported to result from analgesics, analgesic adjuvants, and nerve blocks. The most frequent drugs to cause AEs were pregabalin, tricyclic antidepressants, and tramadol/acetaminophen. Complications of nerve blocks included infections induced by epidural nerve blocks, loss of consciousness or central nervous system excitation induced by intravascular injections of local anesthetics for stellate ganglion blocks, and development of pneumothorax after intercostal nerve blocks or trigger point injections. Information on these AEs should be shared to ensure safety during pain treatment.

DOI： 10.11321/jjspc.19-0043

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The incidence of postoperative shivering is known to be inversely associated with core body temperature. However, previous studies have pointed out that the threshold of shivering could be affected by peripheral temperature or anesthetic agents. These reports pointed specific drugs, though, anesthesia techniques have since advanced considerably. This study aimed to investigate factors associated with postoperative shivering in the context of the current body warming practice. METHODS: The institutional clinical research ethics committee of Kyushu University approved the study protocol (IRB Clinical Research number 2019-233). This retrospective study involved 340 patients who had undergone radical surgery for gynecological cancer treatment under general anesthesia at our center from December 2012 to June 2019. Logistic regression analysis was performed to estimate the odds ratio (OR) for the incidence of postoperative shivering. RESULTS: Postoperative shivering developed in 109 out of 340 patients. After multivariate-adjusted logistic regression, the incidences of postoperative shivering decreased significantly with increasing patient age (OR = 0.96; 95&#37;CI: 0.93-0.98; p = 0.0004). Volatile anesthesia technique was less inclined to shiver after surgery than TIVA (OR = 0.55; 95&#37;CI: 0.30-0.99; p = 0.04). Acetaminophen was much less used in the shivering group than in the non-shivering group (OR = 0.49; 95&#37;CI: 0.25-0.94; p = 0.03). CONCLUSIONS: This study indicated that the development of shivering in patients receiving the anesthetic technique currently used in our hospital was associated with use of acetaminophen or volatile agents, and patient age.

DOI： 10.1007/s00540-020-02763-1

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Cardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). For the first time, we report the anesthetic management of a CS patient with a CRT-D. CASE PRESENTATION: A 65-year-old male with an implanted CRT-D due to CS was scheduled for a laparoscopy-assisted total proctocolectomy for his transverse colon cancer. His left ventricular ejection fraction was 32.0&#37;, and his physical status was a New York Heart Association class III. General and epidural anesthesia were performed while using standard monitors and a FloTracTM system. The dual-chamber pacing (DDD) modality of the CRT-D was unchanged, and its defibrillation function was deactivated before surgery. The surgery was successfully performed, and the patient was discharged without worsening of his cardiac condition. CONCLUSIONS: A detailed understanding of this patient's condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient.

DOI： 10.1186/s40981-020-00350-7

Language：Japanese  

57歳女。47歳時にEisenmenger症候群と診断されていた。今回、肉眼的血尿に対し、膀胱生検および尿管鏡が予定された。胸部X線写真では、心拡大と肺血管陰影増強を認め、経胸壁心エコーでは、心房中隔に両方向性シャントを伴う21×42mmの欠損孔や三尖弁圧較差の上昇を認めた。心臓カテーテル検査では、酸素および一酸化窒素への反応が不良であった。病状の進行に対し、PDE5阻害薬とエンドセリン受容体拮抗薬の内服に加え、2年前からプロスタグランジンI2誘導体の持続皮下注を受けており、心房細動に対するワルファリン内服は、ヘパリンの持続静注に変更していた。これらの症状および、抗凝固の継続と小手術である点から、声門上器具を用いて全身麻酔を選択した。麻酔導入時は、体血圧とSpO2の変化を見ながら、フェニレフリンの単回投与および少量のノルアドレナリンの持続投与を行った。シャント血流の変化は、SpO2の変化で判断し、導入前のSpO2を持続することに努めた。術後は経過良好で、術後22日目に退院となった。

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Bleeding and carbon dioxide (CO2) gas embolism have been reported as serious complications associated with laparoscopic surgery. We present a case of cerebral infarction presumably caused by CO2 gas embolism during laparoscopic hepatectomy. CASE PRESENTATION: During liver resection, the end-tidal CO2 suddenly dropped from 40 to 21 mmHg. Simultaneously, ST elevation in lead II and ST depression in lead V5 of the electrocardiogram were observed. After improvement of these electrocardiographic changes, surgery was continued. Postoperatively, incomplete paralysis was present in the right arm and leg. Magnetic resonance imaging revealed cerebral infarction in the broad area of the left cerebral cortex. These complications might have been caused by paradoxical embolism. CONCLUSION: We should always keep in mind the risk of cerebral infarction with neurological deficits in the case of laparoscopic surgery. Careful monitoring and appropriate treatment for gas embolism are necessary during laparoscopic surgery.

DOI： 10.1186/s40981-019-0301-7

Language：English   Publishing type：Research paper (scientific journal)  

Background Epidemiological studies have reported a link between serum LBP (lipopolysaccharide-binding protein) levels and lifestyle-related diseases. However, there have been no longitudinal studies investigating the association of serum LBP levels and the incidence of cardiovascular disease (CVD) in general populations. Methods and Results A total of 2568 community-dwelling Japanese individuals 40 years and older without prior CVD were followed for 10 years (2002-2012). Serum LBP levels were divided into quartiles (quartile 1: 2.20-9.68 μg/mL; quartile 2: 9.69-10.93 μg/mL; quartile 3: 10.94-12.40 μg/mL; quartile 4: 12.41-24.34 μg/mL). The hazard ratios (HRs) and their 95&#37; CIs for the incidence of CVD were computed using a Cox proportional hazards model. During the follow-up period, 180 individuals developed CVD. The age- and sex-adjusted cumulative incidence of CVD increased significantly with higher serum LBP levels (P for trend=0.005). Individuals with higher serum LBP levels had a significantly greater risk of the development of CVD after adjusting for conventional cardiovascular risk factors (quartile 1: HR, 1.00 [reference]; quartile 2: HR, 1.04 [95&#37; CI, 0.60-1.78]; quartile 3: HR, 1.52 [95&#37; CI, 0.92-2.51]; and quartile 4: HR, 1.90 [95&#37; CI, 1.17-3.09]; P for trend=0.01). This association remained significant after additional adjustment for homeostasis model assessment of insulin resistance (P for trend=0.01). However, when additional adjustment was made for high-sensitivity C-reactive protein, the association was attenuated to the nonsignificant level (P for trend=0.08). Conclusions The present findings suggest that higher serum LBP levels are associated with increased risk of the development of CVD in the general Japanese population. Low-grade endotoxemia may contribute to the pathogenesis of CVD through chronic systemic inflammation.

DOI： 10.1161/JAHA.119.013628

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Arterial hypotension is a major adverse effect of general anesthesia. Patients with pre-existing autonomic dysfunction are at greater risk of hypotension. This study was performed to examine whether objective measurement of the pupillary light reflex is predictive of intraoperative hypotension. METHODS: We studied 79 patients who underwent scheduled surgery under general anesthesia. Patients with severe cardiovascular disease or receiving antihypertensive agents were excluded. The light reflex was measured preoperatively using a portable infrared pupillometer, and the hemodynamic parameters were obtained from the anesthesia records. The patients were divided into two groups according to the development of hypotension: the hypotension and normotension groups. Multivariate logistic regression analysis was performed to determine the pupil parameters predictive of hypotension. RESULTS: Patients in the hypotension group were older and had a greater pupil size or constriction velocity than those in the normotension group. Logistic regression analysis showed that post-induction hypotension was significantly associated with maximum pupil size or constriction velocity after adjustment for age and other clinical variables. Latency of the light reflex and the percent reduction of pupil size were not associated with hypotension. Age was a relatively strong predictor of hypotension; other confounding factors were not associated with hypotension. CONCLUSION: Measurement of maximum pupil size is useful to identify patients at risk for intraoperative hypotension. The influence of age must be considered during measurement of the pupil response. CLINICAL TRIAL NUMBER: UMIN000023729 REGISTRY URL: https://www.umin.ac.jp.

DOI： 10.1007/s00540-019-02672-y

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND It is still challenging to remove an epidural catheter in a postoperative patient receiving urgent antiplatelet and anticoagulation therapy for acute coronary syndrome. CASE REPORT While under general anesthesia combined with thoracic epidural anesthesia, a 72-year-old male patient underwent right radical nephrectomy for renal cell carcinoma. On postoperative day 1 (POD1), the patient experienced bradycardia and a decrease in blood pressure, and he was diagnosed acute myocardial infarction. Intra-aortic balloon pumping (IABP) was induced for cardiogenic shock, and urgent thrombus aspiration and coronary balloon angioplasty were performed. On POD3, the surgeon removed the epidural catheter under both antiplatelet and anticoagulation therapy. At that time, the platelet count was 45×10⁹/L and the activated partial thromboplastin time (APTT) was 72.2 seconds. Four hours after the epidural catheter was removed, the patient complained of bilateral fatigue in legs and developed a loss of sensation. Six hours after the epidural catheter was removed, he developed motor paralysis and became completely paralyzed in both limbs after 9 hours. At 19 hours after the epidural catheter was removed, emergency magnetic resonance imaging detected a spinal epidural hematoma at the level of Th9-11 with compression of the spinal cord. Emergency laminectomy was performed to decompress and remove the spinal epidural hematoma at 18 hours after the onset of sensorimotor symptoms. After surgery and rehabilitation, these symptoms had only slightly improved. CONCLUSIONS In patients with urgent antithrombotic therapy for urgent percutaneous coronary intervention (PCI) with an IABP for acute coronary syndrome, the epidural catheter should not be removed until the IABP and heparin are discontinued, and platelet counts have recovered.

DOI： 10.12659/AJCR.917716

Language：Japanese  

Blood transfusion has gradually become safer, though it is still associated with complications such as immune reactions and transfusion-associated circulatory overload and prognosis. The patient blood management（PBM）program allows avoidance of allogeneic blood transfusion as much as possible. In PBM, preoperative assessment of anemia, iron deficiency, and antithrombotic therapy are performed, followed by correction of anemia and coagulopathy. To minimize intraoperative blood loss, surgical strategy and anesthetic management should be considered beforehand. To reduce postoperative bleeding, it is important to maintain and monitor body temperature as well as oxygen levels and proper drug interventions, if necessary. Even if blood transfusion is inevitable, appropriate and minimum transfusion should be considered in such cases.

DOI： 10.2199/jjsca.39.551

Language：English   Publishing type：Research paper (scientific journal)  

This retrospective study was aimed to investigate the association between preoperative left ventricular (LV) cardiac function and the incidence of postoperative pulmonary edema (PE) in patients undergoing carotid endarterectomy (CEA). Most patients undergoing CEA for carotid artery stenosis have concomitant heart diseases, leading to hemodynamic instability that can cause postoperative cardiac complications such as cardiac heart failure. LV diastolic function has recently been recognized as an independent predictor of adverse cardiac events in patients undergoing cardiovascular surgery. We analyzed clinical data from the anesthetic and medical records of 149 consecutive patients who underwent CEA at our university hospital between March 2012 and March 2018. LV systolic and diastolic function were evaluated by ejection fraction and the ratio of LV early diastolic filling velocity to the peak velocity of mitral medial annulus (E/e'). Postoperative PE was diagnosed based on chest X-ray and arterial gas analysis by two independent physicians. Postoperative PE was developed in four patients (2.8&#37;). Patients with postoperative PE were not related to preoperative low ventricular ejection fraction, but had a significantly higher E/e' ratio than those without PE (P = 0.01). Furthermore, there was an increasing trend of PE according to the E/e' category. Preoperative LV diastolic function evaluated by E/e' was associated with the development of postoperative PE in patients who underwent CEA. The results suggest that the evaluation of LV diastolic dysfunction could be possibly useful to predict PE in patients undergoing CEA.

DOI： 10.2176/nmc.oa.2019-0028

Language：English   Publishing type：Research paper (scientific journal)  

Efficacy of programmed intermittent bolus epidural analgesia in thoracic surgery: a randomized controlled trial

DOI： 10.1186/s12871-019-0780-0

Language：English  

Language：English  

Background Previous studies suggest that lower BMI is a risk factor for intraoperative core hypothermia. Adipose tissue has a high insulation effect and is one of the major explanatory factors of core hypothermia. Accordingly, determining the respective influence of visceral and subcutaneous fat on changes in core temperature during laparoscopic surgery is of considerable interest. Methods We performed a prospective study of 104 consecutive donors who underwent laparoscopic nephrectomy. Temperature data were collected from anesthesia records. Visceral and subcutaneous fat were calculated by computed tomography (CT) or ultrasound. For ultrasound measurements, preperitoneal fat thickness was used as an index of visceral fat. Multiple linear regression analysis was performed at 30, 60, and 120 minutes after the surgical incision to identify the predictive factors of body temperature change. The potential explanatory valuables were age, sex, BMI, visceral fat, and subcutaneous fat. Results BMI (β = 0.010, 95&#37;CI: 0.001–0.019, p = 0.033) and waist-to-hip ratio (β = 0.424, 95&#37;CI: 0.065–0.782, p = 0.021) were associated with increased core temperature at 30 minutes after the surgical incision. Ultrasound measured-preperitoneal fat was significantly associated with increased core temperature at 30 and 60 minutes after the surgical incision (β = 0.012, 95&#37;CI: 0.003–0.021, p = 0.009 and β = 0.013, 95&#37;CI: 0.002–0.024, p = 0.026). CT-measured visceral fat was also associated with increased core temperature at 30 minutes after the surgical incision (β = 0.005, 95&#37;CI: 0.000–0.010, p = 0.046). Conversely, subcutaneous fat was not associated with intraoperative core temperature. Male sex and younger age were associated with lower intraoperative core temperature. Conclusions Visceral fat protects against core temperature decrease during laparoscopic donor nephrectomy.

DOI： 10.1371/journal.pone.0218281

Language：Japanese  

A case of postoperative shock due to aortic stenosis mimicking pulmonary thromboembolism

Language：English   Publishing type：Research paper (scientific journal)  

Electroconvulsive therapy (ECT) is reported to be effective for severe neuropsychiatric disorders. In ECT, electrical stimulation is applied to the brain, inducing seizure activity. Adequate seizure induction with ECT is associated with seizure duration, symmetrical high amplitude waveforms during slow-wave activity, postictal suppression, and activation of the sympathetic nervous system. Sympathetic nervous system activation is influenced by anesthetic agents or cardiovascular drugs during ECT. Pupillary responses can reflect sympathetic nervous activity or the degree of brain damage. Pupillary response measurement can be conducted in a simple, precise, and objective way using an automated infrared pupillometer, enabling the measurement of pupil diameter (mm) to two decimal places. The white light used for measuring light reflexes is not overly bright, and patients do not typically report discomfort. Pupillary light reflexes were measured before anesthesia induction and immediately after electrical stimulation using this equipment. Pupil diameter is typically enlarged after brain damage or sympathetic nervous activation. Adequate seizure induction using ECT could induce pupillary enlargement immediately after electrical stimulation. In the current method, the constriction ratio of pupil size was calculated automatically and compared with seizure quality. Pupillary responses immediately after electrical stimulation may provide a useful assessment of the efficacy of seizure induction with ECT.

DOI： 10.3791/59488

Language：English   Publishing type：Research paper (bulletin of university, research institution)  

Predictors of a prolonged operation during when using general anesthesia in a teaching hospital

Language：English   Publishing type：Research paper (scientific journal)  

Per-oral endoscopic myotomy (POEM) is a minimally invasive treatment for esophageal achalasia. However, POEM has the potential risk of inducing carbon dioxide (CO2) gas-related adverse events, such as pneumoperitoneum, pneumomediastinum, and pneumothorax. The aim of this study was to evaluate the usability of bladder pressure monitoring as an index of CO2 gas-related pneumoperitoneum. The monitoring of bladder pressure and lung compliance and the incidence of iatrogenic pneumoperitoneum were retrospectively studied in 20 patients who underwent POEM between June 2013 and March 2015. The bladder pressure was measured using a Foley catheter. Abdominal distention was found in nine patients. The bladder pressure was significantly higher in the nine patients with the distention findings compared with patients without distention [7 (6-9) mmHg vs. 1 (0-2) mmHg; P < 0.05]; however, the decrease in dynamic lung compliance was not significantly different compared with patients without distention [- 7 (- 9.3 to - 5.1) vs. - 5 (- 10.2 to - 1.3) ml/cmH2O; P = 0.62]. Based on postoperative changes on CT scans; the following were the observations: pneumomediastinum (55&#37;), minor pneumothorax (5&#37;), pleural effusion (45&#37;), atelectasis (15&#37;), pneumoperitoneum (85&#37;), and subcutaneous emphysema (15&#37;). No significant clinical status was found among the patients postoperatively. Bladder pressure monitoring might be useful for detecting pneumoperitoneum during POEM.

DOI： 10.1007/s10877-018-0122-7

Language：English   Publishing type：Research paper (scientific journal)  

Cesarean delivery for maternal mirror syndrome managed with general anesthesia: A case report.

Language：English  

Language：Japanese  

質と効率の向上を絶え間なく目指す時代への転換

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Two opening methods are used for injection needle products: the "peel-apart method" where the adhesive surface of the packaging mount is peeled off, and the "push-off top method," where the needle hub is pressed against the mount to break it. However, the risks of bacterial contamination as a result of opening method remain unknown. The aim of our study was to evaluate the bacterial contamination of needle hubs upon the opening of injection needles by the peel-apart or push-off top method under various conditions. METHODS: Bacterial contamination upon the opening of injection needles was examined in two materials, paper and plastic. Various concentrations of Staphylococcus aureus were applied to the mount and were maintained under wet or dry conditions. Injection needles were opened using the peel-apart or push-off top method. Needle hub contamination was examined using agar medium colony counting. Clinically assumed conditions (the hands and saliva of anesthesiologists) were also evaluated. Data were statistically examined using the Cochran-Mantel-Haenszel, Jonckheere, and Fisher's exact tests. RESULTS: The lateral surfaces of needle hubs were contaminated using the push-off top method, but not by the peel-apart method, in a manner that was dependent on S. aureus concentrations. No significant differences were observed between mount materials. Needle hub contamination was significantly more severe for the wet than for the dry opening portion. The clinically assumed condition study revealed that the lateral and bottom surfaces of the needle hub were contaminated significantly more in the saliva contamination group than in the dry and wet hand groups. CONCLUSIONS: The bacterial contamination of needle hubs may occur upon the opening of injection needles when the push-off top method is used and may be affected by hands contaminated with saliva under clinical conditions.

DOI： 10.1186/s40981-018-0197-7

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Continuous Ca2+ influx is essential to maintain intracellular Ca2+ homeostasis and its dysregulation leads to a variety of cellular dysfunctions. In this study, we explored the functional roles of spontaneous Ca2+ influx for the proliferation and differentiation of a human erythromyeloid leukemia cell line K562. mRNA/protein expressions were assessed by the real-time RT-PCR, western blotting, and immunocytochemical staining. Intracellular Ca2+ concentration ([Ca2+ ]i ) and ionic currents were measured by fluorescent imaging and patch clamping techniques, respectively. Cell counting/viability and colorimetric assays were applied to assess proliferation rate and hemoglobin synthesis, respectively. Elimination of extracellular Ca2+ decreased basal [Ca2+ ]i in proliferating K562 cells. Cation channel blockers such as SK&F96365, 2-APB, Gd3+ , and FTY720 dose dependently decreased basal [Ca2+ ]i . A spontaneously active inward current (Ispont ) contributive to basal [Ca2+ ]i was identified by the nystatin-perforated whole-cell recording. Ispont permeated Ca2+ comparably to Na+ , and was greatly eliminated by siRNA targeting TRPM7, a melastatin member of the transient receptor potential (TRP) superfamily. Consistent with these findings, TRPM7 immune reactivity was detected by western blotting, and immunofluorescence representing TRPM7 was found localized to the K562 cell membrane. Strikingly, all these procedures, that is, Ca2+ removal, TRPM7 blockers and siRNA-mediated TRPM7 knockdown significantly retarded the growth and suppressed hemin-induced γ-globin and hemoglobin syntheses in K562 cells, respectively, both of which appeared associated with the inhibition of ERK activation. These results collectively suggest that spontaneous Ca2+ influx through constitutively active TRPM7 channels may critically regulate both proliferative and erythroid differentiation potentials of K562 cells.

DOI： 10.14814/phy2.13796

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BACKGROUND: Mannitol is widely used during neurosurgery, but it has a serious complication including lethal arrhythmia due to mannitol-induced hyperkalemia. CASE PRESENTATION: We report on a 62-year-old man scheduled for the clipping of an unruptured cerebral artery aneurysm. During surgery, approximately 20 min after the end of 200-mL 20&#37; hypertonic mannitol administration, ventricular tachycardia (VT) occurred without preceding electrocardiogram (ECG) change, such as peaked T waves, and VT was recovered to sinus rhythm after chest compression. A potassium concentration after recovery from VT was 6.4 mEq/L, which was normalized by the administration of calcium gluconate, furosemide, and insulin with glucose. CONCLUSIONS: Physicians must be aware that VT without preceding ECG change can occur after hypertonic mannitol administration.

DOI： 10.1186/s40981-018-0191-0

Language：English  

A 69-year-old man was scheduled for laparoscopic distal gastrectomy. He had pulmonary emphysema and a smoking history. Ninety eight minutes after the beginning of CO₂ insufflation (10 mmHg), Sp_O2 decreased from 99 to 95&#37;, Et_CO2 increased from 35 to 39 mmHg While I investigated its cause, SP_O2 decreased to 94&#37; (FI_O21.0), Et_CO2 increased to 59 mmHg. Intraoperative chest X-ray showed bilateral pneumothorax without pneumomediastinum and subcutaneous emphysema Discussing with surgeons, we judged that the continuation of the pneumoperitonium was high-risk and performed open distal gastrectomy. Because it was both side pneumothorax and he was complicated with pulmonary emphysema After the end of the surgery, chest X-ray revealed complete resolution of pneumothoraces. The patient was moved to a general ward after tracheal extubation. As a cause of pneumothorax, the carbon dioxide inflow from the diaphragmatic weak part was suspected. Because it is hard to notice a decrease in pulmonary compliance during pressure controlled ventilatioa the appropriate alarm setting of a tidal volume is necessary.

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Background: Nuss procedure is a severely painful procedure for correcting pectus excavatum, and we conducted a retrospective comparison of patient-controlled epidural anesthesia (PCEA) and intravenous patient-controlled analgesia (IVPCA). Methods: The subjects were 26 pediatric patients aged between 5 to 15 years undergoing the Nuss procedure for pectus excavatum. Pain management was compared in patients with two groups: PCEA and IVPCA. Data collection included patient age and sex, body length, body weight, pain score, surgery/anesthesia times, the length of hospital stays after surgery, the use time of PCA, the rescue dose of analgesic drug, and complications. Results: Age, body length, body weight duration of anesthesia, length of hospital stays after surgery and time of PCA were significantly lower in IVPCA groups than in PCEA. There was no significant difference regarding the rescue dose of analgesic drug. Conclusions: The analgesic effect was not different between PCEA and IVPCA, and IVPCA may be better choice for anesthesiologist who do not have much experience of thoracic epidural anesthesia in children. The management of PONV and multimodal analgesia are needed.

Language：Japanese  

Language：Japanese  

小児漏斗胸患者の硬膜外鎮痛法と静脈内鎮痛法の検討-後ろ向き研究-

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BACKGROUND A peripherally inserted central catheter (PICC) causes few serious complications but can be malpositioned. To avoid malpositioning, ultrasound guidance is widely used. Here, we report the case of a patient who received a PICC that was inserted under ultrasound guidance, but the catheter tip accidentally entered the right inferior thyroid vein. CASE REPORT A 58-year-old woman was scheduled for reconstructive mammoplasty. After general anesthesia, a PICC was inserted via the right basilic vein. The PICC was inserted under guidance using a portable ultrasound machine with a high-frequency linear transducer. The tip of the guide wire and catheter were confirmed by ultrasound to be in the right subclavian vein, not in the right internal jugular vein, during insertion. However, the chest X-ray performed after the PICC insertion showed that the catheter had moved into the right inferior thyroid vein. CONCLUSIONS Malpositioning of a PICC can occur into any small vein. Ultrasound should be used not only to avoid malpositioning into the IJV, but also to confirm the proper position of the catheter tip during PICC insertion.

DOI： 10.12659/AJCR.908636

Language：English  

Ventricular fibrillation due to cardiac herniation upon emergence from general anesthesia in a patient with right completion pneumonectomy: A case report

DOI： 10.11312/ccm.38.218

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Background. Inadequate hemostasis during living donor liver transplantation (LDLT) is mainly due to coagulopathy but may also include fibrinolysis. The purpose of this study was to determine the incidence of fibrinolysis and assess its relevance to mortality in LDLT.
Methods. The incidence and prognosis of fibrinolysis were retrospectively studied in 76 patients who underwent LDLT between April 2010 and February 2013. Fibrinolysis was evaluated and defined by maximum lysis (ML) >15&#37; within a 60-minute run time using thromboelastometry (ROTEM).
Results. Fibrinolysis was observed in 19 of the 76 (25&#37;) patients before the anhepatic (pre-anhepatic) phase and was developed in 24 (32&#37;) patients during and after the anhepatic (post-anhepatic) phase. In these 43 patients who had fibrinolysis, spontaneous recovery occurred in 29 patients (73&#37;) within 3 hours after reperfusion of the liver graft. Recovery with tranexamic acid was noted in 2 patients with fibrinolysis in the post-anhepatic phase. Thrombosis in the portal vein and liver artery was noted in 14 patients, and the incidence was significantly greater in patients with post-anhepatic fibrinolysis than in those with pre-anhepatic fibrinolysis (P = .0017). Fibrinolysis that developed in the pre-anhepatic phase was associated with increased 30-day and 6-month mortalities (P = .0003 and .0026, respectively).
Conclusions. Fibrinolysis existed and developed in a large percentage of patients during LDLT. Thrombosis in the portal vein and hepatic artery was more common in patients with fibrinolysis in the post-anhepatic phase. Fibrinolysis that developed in the pre-anhepatic phase was associated with increased 30-day and 6-month mortalities.

DOI： 10.1016/j.transproceed.2017.09.025

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Background and Objective Bleeding into the retropharyngeal space is a potential complication in stellate ganglion block (SGB). Retropharyngeal hematoma formation is considered to be due to damage of small arteries in the region, although only scanty details of the region are available. The aim of this study was to map the risk blood vessels in the retropharyngeal space to avoid accidental damage during SGB. Methods Contrast-enhanced 3-dimensional computed tomography images performed on 80 patients were reanalyzed retrospectively to construct detailed map of cervical blood vessels that are prone to damage and bleeding during SGB. Results Of the 160 bilateral necks, 6 (3.8&#37;) and 82 (51.3&#37;) small arteries were identified in the medial portions of the ventral surface of the transverse processes of the sixth and seventh cervical vertebrae, respectively. In particular, 5 of the 6 small arteries detected in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra were the inferior thyroid artery (ITA). Of the 160 vertebral arteries, 2 arteries were missing, 4 (2.5&#37;) entered the transverse foramen of the fifth cervical vertebra, whereas 1 artery (0.6&#37;) entered the transverse foramen of the fourth cervical vertebra. Conclusions Three-dimensional computed tomography identified the ITA in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra. The risk vessels of retropharyngeal hematoma during SGB could include the ITA.

DOI： 10.1097/AAP.0000000000000644

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BACKGROUND: Prophylactic use of intraaortic balloon pump (IABP) reduces hospital mortality in patients with left ventricular (LV) systolic dysfunction undergoing coronary artery bypass surgery (CABG); however, its association in patients with LV diastolic dysfunction is unclear. This retrospective study investigated the association between preoperative LV function and perioperative use of IABP in patients undergoing off-pump CABG (OPCAB) at a university hospital. METHODS: 100 consecutive patients who underwent OPCAB between January 1, 2011 and August 31, 2014 were studied. Preoperative LV function was categorized into four groups based on LV systolic and diastolic function determined with preoperative transthoracic echocardiography. The use of IABP was reviewed from medical records. The Mann-Whitney test, Pearson chi-square test, or Fisher exact test were used. RESULTS: Patients were categorized into the following groups: normal LV function (n = 43), isolated LV systolic dysfunction (n = 13), isolated LV diastolic dysfunction (n = 21), and combined LV systolic and diastolic dysfunction (n = 14). Intraoperative IABP use was significantly more frequent in patients with isolated LV systolic dysfunction, isolated LV diastolic dysfunction, and combined LV systolic and diastolic dysfunction than in those with normal LV function (P < .05). Furthermore, IABP was used more frequently in patients who developed combined LV systolic and diastolic dysfunction postoperatively (P < .05). Conclusion: Not only the presence of preoperative systolic dysfunction but also LV diastolic dysfunction in the presence of normal LV systolic function were associated with increased use of IABP during and after OPCAB.

DOI： 10.1532/hsf.1808

Language：Japanese  

「麻酔科医ができるSSI予防」によせて

DOI： 10.2199/jjsca.37.368

Language：English   Publishing type：Research paper (scientific journal)  

A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia.

DOI： 10.1213/XAA.0000000000000440

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Staphylococcus spp. is a major cause of device-related infections. However, the mechanisms of deep-tissue infection by staphylococci from the skin surface remain unclear. We performed in vitro experiments to determine how staphylococci are transferred from the surface to the deeper layers of agar along the catheter for different strains of Staphylococcus aureus with respect to bacterial concentrations, catheter movements, and biofilm formation. We found that when 5-mm reciprocal movements of the catheter were repeated every 8h, all catheter samples of S. aureus penetrated the typical distance of 50mm from the skin to the epidural space. The number of reciprocal catheter movements and the depth of bacterial growth were correlated. A greater regression coefficient for different strains implied faster bacterial growth. Enhanced biofilm formation by different strains implied larger regression coefficients. Increased biofilm formation ability may accelerate S. aureus transport along a catheter due to physical movements by patients.

DOI： 10.1016/j.mimet.2016.11.003

Language：Japanese  

手術室における医療安全 手術室におけるインシデント -チェックリスト導入後の事例から学ぶ-

DOI： 10.2199/jjsca.37.76

Language：Japanese   Publishing type：Research paper (scientific journal)  

ペインクリニック領域の感染症についてまとめた．対象疾患は硬膜外カテーテル留置後あるいは硬膜外ブロック後の硬膜外膿瘍，脊髄くも膜下腔カテーテルポート留置後髄膜炎，神経ブロック後の感染症とした．各疾患の頻度と発生要因，起因菌と感染メカニズム，症状・診断・治療ごとに記載した．機能的予後のみならず，生命予後に直結する場合もあるので迅速な初期対応が必要である．具体的には神経学的診察，画像検査，培養検体採取，感染症内科医および外科医との連携までの一連の初期対応が必要である．ペインクリニック領域の臨床に携わる医師は，これらの病態の知識は必須であると思われる．

DOI： 10.2199/jjsca.37.541

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AIM: To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) under general anesthesia. METHODS: From January 2011 to July 2014, 206 consecutive patients had undergone ESD under general anesthesia for neoplasms of the stomach, esophagus, and colorectum were enrolled in this retrospective study. The efficacy and safety of ESD under general anesthesia were assessed. RESULTS: The en bloc resection rate of esophageal, gastric, and colorectal lesions was 100.0&#37;, 98.3&#37;, and 96.1&#37;, respectively. The complication rate of perforation and bleeding were 0.0&#37; and 0.0&#37; in esophageal ESD, 1.7&#37; and 1.7&#37; in gastric ESD, and 3.9&#37; and 2.0&#37; in colorectal ESD, respectively. No cases of aspiration pneumonia were observed. All complications were managed by conservative treatment, with no surgical intervention required. CONCLUSION: With the cooperation of an anesthesiologist, ESD under general anesthesia appears to be a useful method, decreasing the risk of complications.

DOI： 10.4253/wjge.v8.i13.466

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Cannulation of the internal jugular vein (IJV) under ultrasound guidance can reduce complications, such as common carotid artery (CCA) puncture, accidental vertebral artery (VA) puncture. However, these complications still occur, especially in pediatric patients probably due to anatomical predisposition of VA. This study compared differences in anatomical location of VA and IJV between pediatric and adult patients. Children with body weight <20 kg (n = 16) and adults who required central venous or pulmonary arterial pressure monitoring (n = 21) were enrolled. After induction of general anesthesia and tracheal intubation, patients were positioned for IJV cannulation. Images of the right CCA, IJV and VA were recorded by ultrasonography. The size of each vessel, anatomical relationship of other vessels, distance between vessels and between each vessel and skin were measured. The size of VA relative to IJV was significantly larger in children than in adults (14 vs 7 &#37;, P < 0.001). The absolute and relative distance between IJV and VA were significantly shorter in children than those in adults (P < 0.01). The anatomical relationships between IJV and CCA and that between IJV and VA were not different between children and adults. In children, VA was relatively larger and located closer to IJV than adults. The results call for careful attention to the position of VA during ultrasound-guided IJV cannulation especially in children.

DOI： 10.1007/s10877-015-9705-8

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A novel model of epidural catheter-related infection: the importance of repeated catheter movements
Staphylococcus spp., which are nonmotile, are the most frequently isolated pathogens from the catheter of epidural abscesses. The movement mechanisms of Staphylococci remain unclear. We hypothesized that increased bacterial concentration and catheter reciprocal movements correlated with deeper penetration of Staphylococci into the catheterized site. We investigated the correlations among bacterial concentrations on the needle puncture surface and epidural catheter insertion sites, catheter movement, and Staphylococcus aureus growth in deeper layers of the agar. Staphylococci grew in the deeper layers of the agar when bacterial concentrations on the needle puncture surface and catheter insertion sites were increased. When 5-mm reciprocal movements of the catheter were repeated every 12 h over a 72-h period, Staphylococci penetrated the 5-cm-thick agar, the average distance from the skin to epidural space in adults. This resulted in increased Staphylococci concentrations and minor repeated catheter-movements because of physical movements of patients, which may result in the migration of Staphylococci into deeper tissues from the skin surface.

DOI： 10.11321/jjspc.15-0001

Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)  

福岡大学肺移植プログラム初期10年の成績

Language：Japanese  

全身麻酔の可否に関する他科からのコンサルタントに対して

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Direct Effect of Remifentanil and Glycine Contained in Ultiva (R) on Nociceptive Transmission in the Spinal Cord: In Vivo and Slice Patch Clamp Analyses
Background
Ultiva (R) is commonly administered intravenously for analgesia during general anaesthesia and its main constituent remifentanil is an ultra-short-acting mu-opioid receptor agonist. Ultiva (R) is not approved for epidural or intrathecal use in clinical practice. Previous studies have reported that Ultiva (R) provokes opioid-induced hyperalgesia by interacting with spinal dorsal horn neurons. Ultiva (R) contains glycine, an inhibitory neurotransmitter but also an N-methyl-D-aspartate receptor co-activator. The presence of glycine in the formulation of Ultiva (R) potentially complicates its effects. We examined how Ultiva (R) directly affects nociceptive transmission in the spinal cord.
Methods
We made patch-clamp recordings from substantia gelatinosa (SG) neurons in the adult rat spinal dorsal horn in vivo and in spinal cord slices. We perfused Ultiva (R) onto the SG neurons and analysed its effects on the membrane potentials and synaptic responses activated by noxious mechanical stimuli.
Results
Bath application of Ultiva (R) hyperpolarized membrane potentials under current-clamp conditions and produced an outward current under voltage-clamp conditions. A barrage of excitatory postsynaptic currents (EPSCs) evoked by the stimuli was suppressed by Ultiva (R). Miniature EPSCs (mEPSCs) were depressed in frequency but not amplitude. Ultiva (R)-induced outward currents and suppression of mEPSCs were not inhibited by the mu-opioid receptor antagonist naloxone, but were inhibited by the glycine receptor antagonist strychnine. The Ultiva (R)-induced currents demonstrated a specific equilibrium potential similar to glycine.
Conclusions
We found that intrathecal administration of Ultiva (R) to SG neurons hyperpolarized membrane potentials and depressed presynaptic glutamate release predominantly through the activation of glycine receptors. No Ultiva (R)-induced excitatory effects were observed in SG neurons. Our results suggest different analgesic mechanisms of Ultiva (R) between intrathecal and intravenous administrations.

DOI： 10.1371/journal.pone.0147339

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BACKGROUND: Tumor necrosis factor (TNF)-α inhibitors are widely used for rheumatoid arthritis (RA). However, there are several risks to use TNFα inhibitors. Given the properties of TNF-α inhibitors, prevention and early detection of tuberculosis (TB) are especially important. Even among TNF-α inhibitors, the risk of TB infection differs according to each drug. The incidence of TB is lowest with etanercept (ETN). We present a case of urinary tract TB during treatment with ETN. CASE REPORT: A 58-year-old woman was receiving ETN for RA. Before starting ETN, isoniazid (INH) prophylaxis was started. RA was well controlled by ETN. However, 32 months after starting ETN, she noticed urinary frequency and a sensation of residual urine. The diagnosis was elusive, and it took 3 months until urinary tract TB was finally diagnosed. The TB resolved with antituberculosis medication, but RA disease activity flared up after ETN was discontinued. ETN was resumed with careful monitoring for TB recurrence. After resuming ETN, the RA was again well controlled, with no recurrence of TB. CONCLUSIONS: Patients should be monitored for development of TB during ETN treatment, but ETN can be used safely with careful management.

DOI： 10.12659/AJCR.893416

Language：English   Publishing type：Research paper (scientific journal)  

Roller pump infusion devices are widely used for rapid infusion, and may be combined with separate warming devices. There may be instances however, where the pressures generated by the roller pump may not be compatible with the warming device. We assessed a commonly used roller pump in combination with a HOTLINEA (R) Fluid Warmer, and found that it could generate pressures exceeding the HOTLINEA (R) manufacturers specifications. This was of concern because the HOTLINEA (R) manufacturer guideline states that not for use with pressure devices generating over 300 mmHg. Pressure greater than 300 mmHg may compromise the integrity of the HOTLINEA (R) Fluid Warming Set. The aim of this study was to compare in-line pressure within a HOTLINEA (R) Fluid Warmer at different infusion rates of a roller pump using various sizes of intravenous cannulae. The rapid infusion system comprised a 500 mL-normal saline bag, roller pump type infusion device, HOTLINEA (R) Fluid Warmer (blood and fluid warmer system), and six different sizes of intravenous cannulae. In-line pressure was measured proximal to the HOTLINEA (R) (pre-warmer) and proximal to the cannula (post-warmer), at flow rate of 50-160 mL/min. The in-line pressures increased significantly with increasing flow rate. The pre-warmer pressures exceeded 300 mmHg when the flow rate was a parts per thousand yen120 mL/min with 20-gauge, 48 mm length cannula, 130 with 20-gauge, 25 mm cannula, and 160 mL/min with 18-gauge, 48 mm cannula. However, they were < 300 mmHg at any flow rates with 18-gauge, 30 mm cannula and 16-gauge cannulae. The post-warmer pressures exceeded 300 mmHg at the flow rate of 140 mL/min with 20-gauge, 48 mm cannula, and 160 mL/min with 20-gauge, 25 mm cannula, while they were < 300 mmHg at any flow rates with 18 and 16-gauge cannulae. The in-line pressure within a HOTLINEA (R) could exceed 300 mmHg, depending on the flow rate and size and length of cannula. It is important to pay attention to the size and length of cannulae and flow rate to keep the maximum in-line pressure < 300 mmHg when a roller pump type infusion device is used.

DOI： 10.1007/s10877-014-9605-3

Language：English   Publishing type：Research paper (scientific journal)  

Study Objective: To validate intraoperative pulse hemoglobin (SpHb) measurements in anesthetized patients with large forearm temperature fingertip temperature gradients.
Design: prospective and observational study.
Setting: Operating room of a university hospital.
Patients: 28 patients undergoing surgery during general anesthesia, requiring arterial blood withdrawal.
Interventions: Radial arterial blood pressure, forearm and fingertip skin surface temperatures, and SpHb were monitored.
Measurements: Paired SpHb and arterial hemoglobin (Hb) measurements at different skin-surface temperature gradients.
Main Results: A total of 175 paired SpHb and arterial Hb measurements were analyzed. The mean SpHb to arterial Hb differences in each group were 0.33 +/- 1.41 g/dL in the < 1 degrees C group of the forearm temperature fingertip temperature gradient, -0.31 +/- 1.24 g/dL in the 1 - 2 degrees C group, - 0.59 +/- 1.11 g/dL in the 2 - 3 degrees C group, and - 0.53 +/- 0.87 g/dL in the > 3 degrees C group (P < 0.05). The percentage of nonmeasurable SpHb due to low perfusion state was 0&#37; (0 of 115 paired measurements) in the < 1 degrees C group, 6.7&#37; (2 of 30 pairs) in the 1 - 2 degrees C group, 16.7&#37; (3 of 18 pairs) in the 2 - 3 degrees C group, and 66.7&#37; (8 of 12 pairs) in the > 3 degrees C group.
Conclusion: SpHb measured at fingertip was significantly affected by the perfusion state, with lower perfusion associated with lower SpHb. Thermoregulatory vasoconstriction affects measurement of SpHb. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jclinane.2014.04.012

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A 54-year-old patient with Becker muscular dystrophy and dilated cardiomyopathy underwent laparoscopic cholecystectomy under total intravenous anesthesia. Muscle relaxation was induced by rocuronium (0.4 mg/kg body weight) under train-of-four (TOF) ratio monitoring. The TOF ratio was 0 at intubation, and 0.2 at the end of surgery. Residual muscle relaxant activity was successfully reversed by sugammadex (2 mg/kg body weight) without any hemodynamic adverse effects (TOF ratio 1.0 at extubation). The clinical and hemodynamic findings suggest that sugammadex can be safely used in patients with Becker muscular dystrophy and dilated cardiomyopathy.

DOI： 10.1016/j.aat.2014.02.005

Language：Japanese  

Perioperative Management of Blood Coagulation - Monitoring of Coagulation Disorder and Fibrinolysis -

DOI： 10.15017/1448721

Language：English   Publishing type：Research paper (scientific journal)  

Leakage of inhalational anesthetic gases is an important issue not only to staff health but awareness during general anesthesia. After inhalation of sevoflurane commenced, the audible and visible alarm of our custom-made air monitoring system was activated. The system measured 2-4 ppm of sevoflurane. A thorough search failed to identify the source of the leak. After changing inhalational anesthesia to intravenous anesthesia, the concentration of sevoflurane decreased immediately to zero. The filling level on the vaporizer decreased faster than usual. A thorough check of the vaporizer after surgery identified a worn down seal in the filling device of the vaporizer.

DOI： 10.1007/s10877-013-9479-9

Language：English   Publishing type：Research paper (scientific journal)  

Background
Post-operative pulmonary complications are associated with high mortality and graft loss in renal transplantation recipients. Left ventricular diastolic dysfunction is not uncommon in patients with chronic renal failure, including those with preserved left ventricular systolic function. The purpose of this study was to determine the relationship between left ventricular diastolic dysfunction and incidence of post-operative pulmonary edema in renal transplantation recipients with preserved left ventricular systolic function.
Methods
Pre-operative left ventricular function and incidence of pulmonary edema were retrospectively studied in 209 patients who underwent living-donor renal transplantation between January 2010 and October 2012. Left ventricular systolic and diastolic functions were evaluated by ejection fraction and E/E' ratio, retrospectively, using transthoracic echocardiography. Pulmonary edema was defined by evidence of pulmonary congestion on the chest X-ray together with PaO2/FiO(2) ratio < 300 mmHg.
Results
Eleven out of 190 (5.8&#37;) renal transplantation patients with preserved left ventricular systolic function developed post-operative pulmonary edema. Patients with pulmonary edema had a significantly higher geometric mean (95&#37; confidence interval) of E/E' ratio than those without pulmonary edema [17.8 (14.1-22.5) vs. 11.1 (10.6-11.7), P = 0.001].
Conclusion
Pre-operative left ventricular diastolic dysfunction correlated with the development of post-operative pulmonary edema in renal transplantation recipients. Meticulous intraoperative volume therapy is important to avoid post-operative pulmonary edema in such patients.

DOI： 10.1111/aas.12168

Language：English   Publishing type：Research paper (scientific journal)  

Endovascular abdominal aortic aneurysm repair under general anesthesia does not decrease perioperative myocardial ischemic event compared with open repair.

DOI： 10.4236/ojanes.2013.32021

Language：English  

A 29-year-old parturient with congenital afibrinogenemia was scheduled to receive cesarean section at 38 weeks 2 days of gestation. Due to the bleeding tendency by her abnormality of fibrinogen and afibrinogenemia, general anesthesia was chosen. In addition to routine administration of fibrinogen, perioperative supplementation of fibrinogen with the meticulous evaluation of the coagulation and fibrinolysis status using rotation thromboelastometry (ROTEM&reg) enabled the patient to deliver a healthy baby without any hematological complications. The ROTEM® was a useful device to check coagulopathy and fibrinolysis in this patient.

Language：Japanese   Publishing type：Research paper (scientific journal)  

先天性無フィブリノゲン血症妊婦の帝王切開の麻酔経験

Language：English   Publishing type：Research paper (scientific journal)  

Klippel-Trenaunay syndrome (KTS) is characterized by capillary and venous malformation and hypertrophy of bone and soft tissues. A 29-year-old Primigravida, who had been diagnosed of KTS by her hemangiomas and varicosities in the right leg, pubic area, rectum, vagina and lower abdominal area, was scheduled to receive caesarean section at 37 weeks gestation because vaginal delivery might cause hemorrhagic complications and extension of the venous lesions. Regional anesthesia was avoided because of the possible injuries of unknown venous malformations or varicose veins in the epidural or spinal space. The cesarean section was performed under general anesthesia uneventfully and an infant was delivered normally. There were no complications such as massive hemorrhage, disseminated intravascular coagulation and deep venous thrombosis in the perioperative period. Careful anesthetic considerations for the prevention of hemorrhagic and thrombotic complications are necessary for cesarean section in a patient with KTS.

Language：Japanese   Publishing type：Research paper (scientific journal)  

クリッペル・トレノネー症候群合併患者における帝王切開の麻酔経験

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00540-011-1290-5

Language：Japanese   Publishing type：Research paper (scientific journal)  

重症慢性閉塞性肺疾患患者の大腿ー膝窩動脈バイパス術を超音波ガイド下神経ブロックで行った一例

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The aim of this study was to assess the accuracy of the first and third versions of arterial pressure waveform cardiac output (APCO(v.1.0) and APCO(v.3.0)) measurements in comparison with thermodilution methods in patients undergoing living donor liver transplantation.
Twenty patients were anesthetized and mechanically ventilated. A radial arterial line was connected to a dedicated transducer for the APCO evaluation (FloTrac (TM)). A pulmonary artery catheter was placed and connected to a computer system (Vigilance (TM)) to measure intermittent thermodilution cardiac output (COTD) and continuous cardiac output (CCO).
A total of 138 measurements were analyzed. Bland-Altman analysis showed that the mean biases for COTD-APCO(v.3.0), COTD-APCO(v.1.0), and COTD-CCO were 0.89, 1.73, and -0.79 L/min, and the adjusted percentage errors were 37.5, 30.3, and 43&#37;, respectively. While the variance for COTD-APCO(v3.0) was greater, the accuracy (bias) improved by 0.8 L/min as compared with COTD-APCO(v1.0). The difference COTD-APCO(v.3.0) became apparent when systemic vascular resistance was lower than 1000 dyne x s/cm(5), especially below 700 dyne x s/cm(5).
These data suggest that the accuracy of APCO(v.3.0) has improved compared to APCO(v.1.0) due to the updated algorithm, but additional improvements should be evaluated, especially in patients undergoing living donor liver transplantation with low systemic vascular resistance.

DOI： 10.1007/s00540-010-1087-y

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Anaphylactic shock during anesthesia in a child undergoing emergent cadaver donor renal transplantation.

Language：Japanese   Publishing type：Research paper (scientific journal)  

Goldenhar症候群患児に対する経鼻ファイバー挿管の工夫

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The Effect of Synthetic Agonists and Antagonists of Cannabinoid Receptors on Migration of Neutrophils Elicited by Leukotrience B4 in the Microvasculature of Hamster Cheek Pouch
This study was designed to investigate the effects of cannabinoid agonists and antagonists on neutrophil behaviors in response to inflammatory stimulation. The neutrophil behavior was observed in the microvasculature of hamster cheek pouch using a trans-illumination microscope. Superfusion of leukotriene B₄ caused an increase in the number of neutrophils migrating through the endothelium outside the venules. The migration induced by leukotriene B₄ was significantly attenuated in hamsters receiving WIN55212-2, a synthetic non-selective cannabinoid agonist, prior to the leukotriene B₄ superfusion. The inhibitory effect of WIN55212-2 was abolished by AM251, a selective CB₁ antagonist, and also by AM630, a selective CB₂ antagonist. These results suggest that augmentation of the CB₁ and CB₂ cannabinoid system could produce the inhibition of neutrophil migration and contribute to suppression of inflammatory derangement.

DOI： 10.11312/ccm.31.202

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A gastric perforation after transesophageal echocardiography in an elderly patient undergoing cardiac surgery.
An 80-year-old male patient(160 cm, 52 kg) underwent a combined coronary artery bypass graft and aortic valve replacement. He had no history of gastric or esophageal disease. Transesophageal echocardiography(TEE) was used for an intraoperative monitor. At the end of surgery, massive fresh blood was aspirated through a gastric tube after removal of the TEE probe. An urgent esophago-gastroduodenoscopy and computed tomography diagnosed a gastric perforation, for which the patient had to undergo an urgent laparoscopic repair. The surgical repair was successful and the patient was discharged on the postoperative day 21.

DOI： 10.11312/ccm.31.193

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Goldenhar syndrome is associated with difficult airway due to the characteristic craniofacial anomalies such as hypoplasia of the mandible and molar bones. We present our method of fiberoptic intubation using two tracheal tubes for a girl with Goldenhar syndrome undergoing cochlear implant surgery. She had received general anesthesia for dental treatment one year before, but the treatment had been cancelled because of the failure of tracheal intubation. We induced anesthesia for her with inhalation of sevoflurane and nitrous oxide. After obtaining a stable anesthetic level, we inserted two tracheal tubes from the right and left nostrils, one for a tracheal tube and the other for a nasopharyngeal airway. During the procedure, the fiberscope was advanced through the tracheal tube with a slit connector, and her ventilation was assisted through the nasopharyngeal airway with her mouth closed by a tape to avoid a leak of ventilating gas. Using this two-tube method, we successfully intubated the trachea of a patient Goldenhar syndrome.

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The Accuracy of Continuous Thermodilution Method in Comparison with Bolus Cardiac Output Measurement Using Room Temperature Versus Cold Injectates in Cardiac Surgical Patients
We studied 21 adult cardiac surgical patients to assess the accuracy of continuous thermodilution method in comparison with bolus cardiac output measurement using room temperature versus cold injectates. An 8-French gauge thermal filament-wrapped, flow directed, pulmonary artery catheter was placed and connected to a computer system to measure continuous cardiac output(CCO) automatically. Both CCO and bolus cardiac output(BCO) measurements were performed at stable conditions after induction of anesthesia and also after weaning from cardiopulmonary bypass in each patient. As BCO measurement, 10 ml of ice-cold solution (BCO-IC) or room-temperature solution (BCO-RT) were injected using a closed delivery system with in-line temperature measurement. A total of 41 measurements were carried out. BCO-IC ranged from 2.2 to 9.7 L/min, BCO-RT from 2.1 to 9.9 L/min, and CCO from 2.3 to 12.4 L/min. Regression analysis demonstrated a close relationship between either two of three methods; correlation coefficients of [BCO-IC−BCO-RT], [BCO-IC−CCO], and [BCO-RT−CCO] were 0.986, 0.962 and 0.962, respectively. By the Bland and Altman analysis, biases (mean differences) were negligible among the three measurements(0.10-0.38 L/min), although precisions (standard deviation of differences) between [BCO-IC−CCO](0.59 L/min) and [BCO-RT−CCO](0.59 L/min) were slightly larger than that between [BCO-IC−BCO-RT](0.31 L/min). In conclusion, CCO methods are practically acceptable during cardiac surgery, and BCO-RT is equivalent in accuracy with BCO-IC, suggesting that BCO-RT can be used instead of BCO-IC because it is more convenient and less expensive.

DOI： 10.11312/ccm.31.39

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Sedated Awake Intubation Using Pentax-AES&reg; in a Patient with Treacher-Collins Syndrome.
A 23 year-old man with a typical difficult airway due to Treacher-Collins syndrome was scheduled for elective tympanoplasty. His past anesthesia record revealed a history of difficult mask ventilation and several unsuccessful attempts at orotracheal intubation, with laryngeal evaluation of Cormack and Lehane grade 4. We successfully performed sedated awake intubation of the orotrachea using the Pentax AWS®. Sedated awake intubation using Pentax-AWS® is useful in patients with a difficult airway.

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The mechanism of sensing hypoxia and hypoxia-induced activation of cerebral arterial Ca2+-activated K+ (K-Ca) channel currents and vasodilation is not known. We investigated the roles of the cytochrome P-450 4A (CYP 4A) omega-hydroxylase metabolite of arachidonic acid, 20-hydroxyeicosatetraenoic acid (20-HETE), and generation of superoxide in the hypoxia-evoked activation of the K-Ca channel current in rat cerebral arterial muscle cells (CAMCs) and cerebral vasodilation. Patch-clamp analysis of K+ channel current identified a voltage- and Ca2+-dependent 238 +/- 21-pS unitary K+ currents that are inhibitable by tetraethylammonium ( TEA, 1 mM) or iberiotoxin (100 nM). Hypoxia (< 2&#37; O-2) reversibly enhanced the open-state probability (NPo) of the 238-pS unitary K-Ca current in cell-attached patches. This effect of hypoxia was not observed on unitary K-Ca currents recorded from either excised inside-out or outside-out membrane patches. Inhibition of CYP 4A omega-hydroxylase activity increased the NPo of K-Ca single-channel current. Hypoxia reduced the basal endogenous level of 20-HETE by 47 +/- 3&#37; as well as catalytic formation of 20-HETE in cerebral arterial muscle homogenates as determined by liquid chromatography-mass spectrometry analysis. The concentration of authentic 20-HETE was reduced when incubated with the superoxide donor KO2. Exogenous 20-HETE (100 nM) attenuated the hypoxia-induced activation of the K-Ca current in CAMCs. Hypoxia did not augment the increase in NPo of K-Ca channel current induced by suicide inhibition of endogenous CYP 4A omega-hydroxylase activity with 17-octadecynoic acid. In pressure ( 80 mmHg)-constricted cerebral arterial segments, hypoxia induced dilation that was partly attenuated by 20-HETE or by the K-Ca channel blocker TEA. Exposure to hypoxia caused the generation of intracellular superoxide as evidenced by intense staining of arterial muscle with the fluorescent probe hydroethidine, by quantitation using fluorescent HPLC analysis, and by attenuation of the hypoxia-induced activation of the K-Ca channel current by superoxide dismutation. These results suggest that the exposure of CAMCs to hypoxia results in the generation of superoxide and reduction in endogenous level of 20-HETE that may account for the hypoxia-induced activation of arterial K-Ca channel currents and cerebral vasodilation.

DOI： 10.1152/ajpheart.01416.2006

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Objective: The purpose of this study was to examine and compare the four combination of pulse oximeters (POs) and monitoring sites, the Nihon Kohden BSS-9800 (N), the Masimo SET Radical (M), the Nellcor N550 D-25 (N-D) and the Nellcor N550 Max-Fast (N-MF) in patients with peripheral hypoperfusion. Methods: About 20 adult patients undergoing cardiac surgery using mild hypothermic cardiopulmonary bypass (CPB) were studied prospectively. PO sensors were applied on fingers in N, M and N-D, while on the forehead in N-MF. Results: PO failure was defined as failure to show no SpO2 value or incorrect SpO2 values. PO failure occurred in 12 patients with N, ten patients with M, four patients with N-D and ten patients with N-MF, respectively (p &lt
0.05 N-D vs. N, M, N-MF). The duration of PO failure was 19+/-30&#37; of aortic cross-clamping with N, 29 +/-33&#37; with M, 10 +/-26&#37; with N-D and 43 +/- 57&#37; with N-MF, respectively (p &lt
-0.05 N-D vs. M and N-MF). Conclusions: The results suggested that N-D is most useful among four combinations of POs and monitoring sites tested in this study for monitoring SpO2 during hypoperfusion. The superiority of N-MF during hypoperfusion was not evident in the present study. © Springer Science+Business Media B.V. 2007.

DOI： 10.1007/s10877-007-9081-0

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Brief hypoxia differentially regulates the activities of Ca2+-activated K+ channels (K-Ca) in a variety of cell types. We investigated the effects of hypoxia (< 2&#37; O-2) on KCa channel currents and on the activities of cytochrome P450 2C11 epoxygenase (CYP epoxygenase) in cultured rat hippocampal astrocytes. Exposure of astrocytes to hypoxia enhanced macroscopic outward KCa current, increased the open state probability (NPo) of 71 pS and 161 pS single-channel K-Ca currents in cell-attached patches, but failed to increase the NPo of both the 71 pS and 161 pS K-Ca channel currents recorded from excised inside-out patches. The hypoxia-induced enhancement of macroscopic K-Ca current was attenuated by pretreatment with tetraethylammonium (TEA, 1 mM) or during recording using low-Ca2+ external bath solution. Exposure of astrocytes to hypoxia was associated with generation of superoxide as detected by staining of cells with the intracellular superoxide detection probe hydroethidine (HE), attenuation of the hypoxia-induced activation of unitary K-Ca channel currents by superoxide dismutation with tempol, and as quantitated by high-pressure liquid chromatography/fluorescence assay using HE as a probe. In cultured astrocytes in which endogenous CYP epoxygenase activity has been inhibited with either miconazole or N-methylsulfonyl-6-(2-propargyloxyphenyl) hexanamide (MSPPOH) hypoxia failed to increase the NPo of both the 71 pS and 161 pS K-Ca currents and generation of superoxide. Hypoxia increased the level of P450 epoxygenase protein and production of epoxyeicosatrienoic acids (EETs) from cultured astrocytes, as determined by immunohistochemical staining and LC/MS analysis, respectively. Exogenous 11,12-EET increased the NPo of both the 71 pS and 161 pS K-Ca single-channel currents only in cell-attached but not in excised inside-out patches of cultured astrocytes. These findings indicate that hypoxia enhances the activities of two types of unitary K-Ca currents in astrocytes by a mechanism that appears to involve CYP epoxygenase-dependent generation of superoxide and increased production or release of EETs. (c) 2006 IBRO. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.neuroscience.2006.08.021

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Background and Purpose - Recent studies have suggested that autoregulation of cerebral blood flow (CBF) is impaired after traumatic and ischemic brain injury. Given that the levels of superoxide anion (O-2(.-)) are increased in these conditions, we postulate that O-2(.-) contributes to the impairment of CBF autoregulation.
Methods - CBF was monitored with laser Doppler flowmetry during increases in blood pressure.
Results - During the control period, CBF was well autoregulated after the increase in mean arterial pressure (MAP) from 98 +/- 3 to 140 +/- 6 mm Hg. The autoregulation index (AI;Delta CBF/Delta MAP) averaged 0.25 +/- 0.02 (n = 6). O-2(.-) in the brain was then increased by subdural perfusion of xanthine/xanthine oxidase (different concentrations) and catalase. Low concentrations of O-2(.-) decreased basal CBF by 10 +/- 1.6&#37; but had no effect on autoregulation (AI, 0.19 +/- 0.02; n = 6). Higher concentrations of O-2(.-) (0.2 mmol/L xanthine and either 3 or 20 mU xanthine oxidase) increased basal CBF by 30 +/- 2&#37; and 42 +/- 4&#37;, respectively, and impaired autoregulation of CBF (AI, 0.55 +/- 0.03 and 0.76 +/- 0.02; n = 6). Inclusion of superoxide dismutase in the O-2(.-)-generating system restored autoregulation (AI, 0.28 +/- 0.05; n = 6). Neither inhibition of NO synthase nor the addition of deferioxamine had any effect on the ability of higher concentrations of O-2(.-) to impair autoregulation of CBF (AI, 0.65 +/- 0.07 and 0.72 +/- 0.05 respectively; n = 6). O-2(.-) also increased the activity of K-Ca channels in cerebral vascular smooth muscle cells (VSMCs; n = 8).
Conclusion - These results suggest that O-2(.-) increases basal CBF and impairs autoregulation of CBF, likely through the activation of KCa channels in cerebral VSMCs.

DOI： 10.1161/01.STR.0000189997.84161.95

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Purpose: The purpose of this study was to noninvasively evaluate intraoperative left ventricular (LV) performance by an online pressure-area relationship using transesophageal echocardiography (TEE) and tonometry. Methods: In study 1, LV pressure with a micromanometer catheter, LV cross-sectional area with TEE, direct radial pressure, and tonometric arterial pressure were simultaneously recorded in 5 patients (10 measurements) undergoing cardiac surgery. End-systolic elastance (E′es) was determined from pressure-area loops during inferior vena caval (IVC) occlusion. In study 2, in 16 patients undergoing repair of abdominal aortic aneurysm, LV performance (E′es
effective arterial load, E′a, and LV end-diastolic area, LV-EDA) was examined by noninvasive assessment of pressure-area loops using TEE and tonometry at aortic cross-clamping and unclamping. Results: E′es by tonometric arterial pressure closely correlated with E′es by LV pressure (r = 0.92) in study 1. E′es at aortic clamping were not significantly different from those at unclamping. The clamping increased LV-EDA and E′a by approximately 13&#37; and 44&#37;, and the unclamping significantly decreased by 9&#37; and 22&#37;, respectively. Conclusion: Our results demonstrated that online tonometric arterial pressure and LV area measured by automated border detection (ABD) of TEE might be used to calculate E′es to estimate LV contractility and allow the estimation of LV performance during aortic clamping and unclamping. © JSA 2005.

DOI： 10.1007/s00540-004-0296-7

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Purpose. Our aim was to characterize changes in body temperatures during profound hypothermic cardiopulmonary bypass (CPB) conducted with the sternum opened. Methods. In ten adult patients who underwent profound hypothermic (<20°C) CPB for aortic arch reconstruction, pulmonary arterial temperature (PAT), nasopharyngeal temperature (NPT), forehead deep-tissue temperature (FHT), and urinary bladder temperature (UBT) were recorded every 1 min throughout the surgery. In addition, the CPB venous line temperature (CPBT), a reasonable indicator of mixed venous blood temperature during CPB and believed to best reflect core temperature during stabilized hypothermia on CPB, was recorded during the period of total CPB. Results. PAT began to change immediately after the start of cooling or rewarming, closely matching the CPBT (r = 0.98). During either situation, the other four temperatures lagged behind PAT (P < 0.05); however, NPT followed PAT more closely than the other three temperatures (P < 0.05). During stabilized hypothermia, PAT, NPT, and FHT, but not UBT, closely matched the CPBT, with gradients of less than 0.5°C. Conclusion. During induction of profound hypothermia and its reversal on total CPB with the heart in situ, a PA catheter thermistor, presumably because of its placement immediately behind the superior vena cava, would provide a reliable measure of the mixed venous blood temperature. During stabilized profound hypothermia, PAT, NPT, and FHT, but not UBT, serve as a reliable index of core temperature.

DOI： 10.1007/s00540-003-0225-1

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Preoperative non-invasive assessment of stress response to breath-holding test
The purpose of this study was to evaluate circulatory and respiratory responses to a breath-holding stress test in surgical patients at the bed-side using continuous and non-invasive monitoring with arterial tonometry and pulse oxymetry. Sixty-one patients were assigned into four groups: normal healthy patients(Cont), elderly patients(Elder), hypertensive patients(HT) and diabetic patients(DM). The breath-holding stress test was conducted in the supine position at the functional residual capacity level and in room air. Breath-holding time, changes in heart rate(HR), mean arterial pressure(MAP), arterial oxyhemoglobin saturation using a pulse oxymeter(SpO₂) and the recovery time of SpO₂ were measured. Breath-holding time was significantly shorter in the HT group(30±2.0sec, p<0.05) and tended to be shorter in the Elder group(31±3.0sec, p=0.08) compared with the Cont group(41±2.9sec). The maximum mean arterial blood pressure(Max-MAP) was higher in the Elder(105±4.0mmHg)(p<0.05) and HT(128±5.6mmHg)(p<0.05) groups compared with the Cont group(93±4.0mmHg). However, ΔMAP, ΔHR, Min-SpO₂, and ΔSpO₂ were not significantly different among the four groups. Our results suggest that non-invasive continuous monitoring facilitates evaluation of stress responses to breath-holding in preoperative patients, and that the breath-holding stress test causes sympathetic augmentation, resulting in increases in MAP and HR by approximately 15&#37;, concomitant with a decrease in SpO₂ to 90-94&#37;. The magnitude of the response is similar regardless of age and existence of HT and DM.

DOI： 10.11312/ccm.25.272

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Objectives: The authors aimed to establish a technique for quantitative analysis of regional wall motion abnormality (RWMA) using color kinesis (CK) of transesophageal echocardiography (TEE) in surgical patients. This technique was used to determine whether RWMAs develop de novo after infrarenal aortic cross-clamping in patients undergoing vascular surgery with a preoperative dipyridamole thallium stress test (DTST).
Design: An observational study.
Setting: University hospital.
Participants: Thirty-eight patients undergoing infrarenal abdominal aortic aneurysm resection or aortofemoral bypass.
Measurements and Main Results: CK images of the left ventricle (LV) were obtained from the midventricular transgastric short-axis view before and after infrarenal aortic cross-clamping using TEE and analyzed off-line using custom software. The predictive value of the category "reversible perfusion defect" (RD) was also estimated from DTST for predicting new RWMAs with CK. CK analysis is suitable for clinical use based on the comparison with conventional two-dimensional echocardiogram measurements and inter-observer variability. CK analysis showed all 7 patients with persistent perfusion defects on DTST had RWMAs. New RWMAs occurred in 2 of 9 patients with RD and in 2 of 15 patients with normal DTST, indicating that there was no significant difference between RD and normal DTST in the incidence of new RWMAs.
Conclusions: A new method is available for clinical use, which is capable of visualizing RWMAs. These results suggest that new RWMAs introduced by aortic cross-clamping occur irrespective of the risk as assessed by preoperative DTST. CK with the new analysis method might be a useful tool to quantitatively evaluate RWMAs during surgery. (C) 2003 Elsevier Inc. All rights reserved.

DOI： 10.1053/j.jvca.2003.09.005

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Metabotropic glutamate receptor activation enhances the activities of two types of Ca2+-activated k+ channels in rat hippocampal astrocytes.
The influence of activation of glutamate receptor (GluR) on outward K⁺ current in cultured neonate rat hippocampal astrocytes was investigated. Patch-clamp analysis of K⁺ channel currents in cultured astrocytes identified the existence of 71 ± 6 and 161 ± 11 pS single-channel K⁺ currents that were sensitive to changes in voltage and [Ca²⁺]_i and blocked by external TEA but not by charybdotoxin, iberiotoxin, apamin, or 4-aminopyridine. Reverse transcriptase (RT)-PCR and Northern blot analysis revealed transcripts of the Ca²⁺-activated K⁺ channel (K_Ca) β₄-subunit (β4) (KCNMB4) in cultured astrocytes. Expression of the metabotropic glutamate receptor (mGluR) subtypes mGluR1 and mGluR5 and the ionotropic glutamate receptor (iGluR) subtypes iGluR1 and iGluR4 were detected by RT-PCR and immunofluorescence analysis in cultured astrocytes. The mGluR agonists L-glutamate and quisqualate increased the open state probability (NP_o) of the 71 and 161 pSK⁺ channel currents that were prevented by the mGluR receptor antagonists 1-aminoindan-1,5-dicarboxylic acid or L-(+)-2-amino-3-phosphonopropionic acid and not by the iGluR antagonists (+)-5-methyl-10,11-dihydro-5H-dibenzo [a,d] cyclohepten-5,10-imine maleate or CNQX. Activation of the two types of K⁺ channel currents by mGluR agonists was attenuated by pertussis toxin and by inhibition of phospholipase C (PLC) or cytochrome P450 arachidonate epoxygenase. These results indicate that brain astrocytes contain the KCNMB4 transcript and express two novel types of K_Ca channels that are gated by activation of a G-protein coupled metabotropic glutamate receptor functionally linked to PLC and cytochrome P450 arachidonate epoxygenase activity.

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Intraoperative monitoring of pressure within saline-filled, endotracheal tube cuff in adult patients undergoing CO₂ laser laryngomicrosurgery
In laser laryngomicrosurgery, saline is injected into the endotracheal tube cuff to prevent airway fire. Utilizing regression analyses, we investigated the relation between the saline volume required to obtain optimal intracuff pressure and tracheal diameters in patients undergoing laser laryngomicrosurgery as well as in model tracheas. Although excellent linear correlations were found between the saline volume and the diameter of model tracheas, no significant linear or non-linear correlation was found between the saline volume and the patient's tracheal diameter. In the model tracheas, a rate of rise in the intracuff pressure caused by increments in the injected volume was far steeper when saline was injected into the cuff than when air was injected into the cuff. Addition of only 0.2 ml saline could result in large (>50 mmHg) increases in the intracuff pressure. Also in patients, addition of 1 ml could result in notable (>50 mmHg) increases in the intracuff pressure. These results suggest that the saline volume necessary to obtain optimal intracuff pressure is difficult to be predicted from the patient's tracheal diameter, and that slight increases in the saline volume may cause excessive increases in the intracuff pressure. The intracuff pressure should be tightly monitored in patients undergoing laser laryngomicrosurgery.

Language：Japanese   Publishing type：Research paper (scientific journal)  

至適気管チューブカフ内圧を得るのに必要な生理食塩液注入量の予測.

Language：English  

A 6-month-old female (4.9 kg) with multiple congenital heart lesions underwent intracardiac repair with the aid of cardiopulmonary bypass (CPB) through a lower half sternotomy. Aortic cannulation, venous cannulation, and cardioplegia cannula insertion were all accomplished through the ministernotomy. During the CPB, in spite of a high perfusion flow rate (182 ml · kg
^-1
· min
^-1
), the systemic arterial pressure was persistently low (mean values = 25-35 mmHg) and the urine output was greatly reduced (<ml · hr
^-1
). In addition, inappropriate increases in the arterial inflow line pressure were recognized. Since abutment of the cannula tip against the aortic intima was suspected, several attempts were made to correct its malpositioning. During the CPB, hemolysis was also found in the mixed venous blood. Since the oliguria and resultant hyperkalemia persisted after weaning from the CPB, peritoneal dialysis was introduced immediately after the surgery. Her renal function gradually recovered postoperatively, and she was finally weaned from the peritoneal dialysis on the 13
^th
postoperative day. Although the ministernotomy has been proposed to be a safe approach for most of cardiac surgeries, it appears to increase the risk for arterial cannula malposition as compared to the standard full-length sternotomy in small pediatric patients.

Language：Japanese  

胸骨小切開開心術における人工心肺送血カニューレ位置異常により急性腎不全に至った乳児の1症例

Language：Japanese  

Intraoperative Monitoring of Pressure within Saline-filled, Endotracheal Tube Cuff in Adult Patients Undergoing CO₂ Laser Laryngomicrosurgery.

Language：English   Publishing type：Research paper (scientific journal)  

Background. The purpose of this study was to investigate the effect of coronary arterial bypass grafting (CABG) with gastroepiploic artery (GEA) on gastric intramucosal pH and systemic inflammation.
Methods. Design: retrospective study. Setting: University hospital. Participants: 22 patients under-went CABG. Investigations: the GEA group (n=13) received CABG with the GEA graft. The non-GEA group (n=9) received conventional CABG without the GEA graft. Measurements: gastric intramucosal pH (pHi) and carbon dioxide tension (PrCO2) were assessed by capnometric air tonometry. The difference between PrCO2 and PaCO2, PCO2-gap, was also determined. Systemic inflammatory responses were evaluated by serum interleukin-6 (IL-6) and leucocyte counts. Hemodynamics, oxygen delivery index ((D) over dot O2I) and uptake index ((V) over dot O2I) were monitored with catheters in the radial and pulmonary arteries (thermodilution).
Results. The duration of aortic cross-clamping and cardiopulmonary bypass was similar in both groups. Both groups did not show any significant difference in gastric pHi, PCO2-gap, systemic inflammation and hemodynamics.
Conclusions. Our findings suggest that CABG using the GEA graft does not disturb gastric mucosal perfusion, and that laparotomy for the GEA graft does not aggravate systemic oxygen demand-supply imbalance or systemic inflammatory responses induced by hypothermic CPB. CABG with the GEA graft does not seem to pose an additional risk and is a safe technique compared with conventional CABG with regard to pHi and systemic inflammation.

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lBackground: 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 ill inhibitor, olprinone, could modify gastric intramucosal pH (pHi), systemic oxygen consumption, and systemic inflammatory responses in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods: We studied 23 patients. In 15 patients, olprinone (0.1 or 0.2 mug . kg(-1) min(-1)) was administered from the commencement of CPB until their admission to the ICU. The other 8 patients received placebo. The pHi and regional CO2 tension (PrCO2) were assessed by a capnometric air tonometry. Systemic inflammatory responses were evaluated by serum interleukin-6 (IL-6), IL-10, and leucocyte counts.
Results: The pHi and PCO2-gap, the difference between PrCO2 and arterial CO2 tension (PaCO2), showed a transient decrease and an increase after CPB, respectively. Although olprinone did not affect pHi, olprinone at 0.2 mug . kg(-1) min(-1) significantly lessened post-CPB increase in PCO2-gap. Olprinone at 0.2 mug . kg(-1) min(-1) significantly increased IL-10 and reduced the extent of leucocytosis, while it did not affect IL-6 levels. At the same dosage, olprinone also lessened the surge in systemic oxygen uptake index ((V (over dot) O-2) and augmented the increase in mixed oxygen saturation (S (v) over barO(2)) both of which occurred after CPB. At 0.1 mug . kg(-1) min(-1), however, olprinone did not show any significant effect.
Conclusion: Our results suggest that olprinone at 0.2 mug . kg(-1) min(-1) suppresses gastric intramucosal acidosis and systemic inflammation following CPB.

DOI： 10.1034/j.1399-6576.2001.045004427.x

Language：English   Publishing type：Research paper (scientific journal)  

Objective: To investigate the usefulness of low-dose milrinone on gastric intramucosal pH (pHi) and systemic inflammation in patients undergoing hypothermic cardiopulmonary bypass (CPB).
Design: Prospective randomized study.
Setting: University hospital.
Participants: Twenty patients scheduled for cardiac surgery.
Interventions: Ten patients were administered a low dose of milrinone, 0.25 mug/kg/min, from the initiation of CPB to 1 hour after admission to the intensive care unit. The other patients were administered saline. Supplemental inotropes and intravenous fluid were given to obtain adequate mean arterial blood pressure and pulmonary artery occlusion pressure.
Measurements and Main Results: Gastric pHi and carbon dioxide pressure (PCO2) were assessed by capnometric air tonometry. The difference between PCO2 and arterial carbon dioxide pressure (PaCO2), PCO2-gap, was also examined. Systemic inflammatory responses were evaluated by serum interleukin-6 and leukocyte counts. Hemodynamics, oxygen delivery index, and oxygen uptake index were monitored with catheters in the radial and pulmonary arteries (thermodilution). The hepatic venous blood flow and left ventricular flow were measured using transesophageal echocardiography. Milrinone prevented gastric intramucosal acidosis, detected as a decrease in pi-ii or an increase in PCO2-gap, without affecting hepatic venous blood flow. Increases in interleukin-6, leukocyte count, and oxygen uptake index, all of which developed after CPB, were significantly less in the milrinone group than in the control group.
Conclusion: These results suggest that in patients undergoing hypothermic CPB, supplemental low-dose milrinone prevents gastric intramucosal acidosis and increases in some markers of systemic inflammation. Copyright (C) 2001 by W.B. Saunders Company.

DOI： 10.1053/jcan.2001.21954

Language：English   Publishing type：Research paper (scientific journal)  

We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. Pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90&#37;. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. Pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.

DOI： 10.1046/j.1365-2346.2000.00759.x

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Purpose: To present a case of massive retroperitoneal hemorrhage during cardiopulmonary bypass (CPB) which was detected using transesophageal echocardiography (TEE).
Clinical feature: A 50-yr-old man suffering from severe mitral regurgitation (MR) was admitted for mitral valvuloplasty, After the beginning of CPB,the volume in the reservoir was noticed to be gradually decreasing. Although venous cannulation had been properly performed, TEE showed an echo free space around the liver, the spleen and in front of the abdominal aorta showed intraabdominal hemorrhage. After cardiac surgery, emergency laparotomy revealed about 5,000 mi of blood in the retroperitoneal space probably as a result of femoral artery cannulation prior to CPB, Hemostasis was achieved, and the patient made complete cardiac and neurological recovery. Retrospective review of the TEE imaging revealed that the kidneys were surrounded by blood bilaterally confirming the diagnosis of retroperitoneal hemorrhage.
Conclusion: Retroperitoneal hemorrhage during CPB is rare, but may be lethal. Transesophageal echocardiography is a useful monitor not only to evaluate cardiac performance, but also to detect unexpected intraabdominal bleeding during cardiac surgery.

Language：English   Publishing type：Research paper (scientific journal)  

Background Venodilation is thought to be one of the mechanisms underlying propofol-induced hypotension. The purpose of this study is to test two hypotheses: (1) propofol increases systemic vascular capacitance, and (2) the capacitance change produced by propofol is a result of an inhibition of sympathetic vasoconstrictor activity,
Methods: In 33 Wistar rats previously anesthetized with urethane and ketamine, vascular capacitance was examined before and after propofol infusion by measuring mean circulatory filling pressure (P-mcf). The P-mcf was measured during a brief period of circulatory arrest produced by inflating an indwelling balloon In the right atrium. Rats were assigned into four groups: an intact group, a sympathetic nervous system (SNS)-block group produced by hexamethonium infusion, a SNS-block + noradrenaline (NA) group, and a hypovolemic group. The P-mcf was measured at a control state and 2 min after a bolus administration of 2, 10, and 20 mg/kg of propofol,
Results: The mean arterial pressure (MAP) was decreased by propofol dose-dependently in intact, hypovolemic, and SNS-block groups, but the decrease in MAP was less in the SNS-block group (-25&#37;) than in the intact (-50&#37;) and hypovolemic (-61&#37;) groups. In the SNS-block + NA group, MAP decreased only at 20 mg/kg of propofol (-18&#37;), The P-mcf decreased in intact and hypovolemic groups In a dose-dependent fashion but was unchanged in the SNS-block and SNS-block + NA groups.
Conclusions: The results have provided two principal findings: (1) propofol decreases P-mcf dose-dependently, and (2) the decrease In P-mcf by propofol is elicited only when the sympathetic nervous system is intact, suggesting that propofol increases systemic vascular capacitance as a result of an inhibition of sympathetic nervous system.

DOI： 10.1097/00000542-199812000-00028

Language：English  

Study Objective: To evaluate a new method for removal of retained air at the end of cardiopulmonary bypass (CPB) by end-tidal CO₂ pressure (P(ET)CO₂) and pulmonary arterial pressure (PAP) monitoring, and transesophageal two-dimensional echocardiogra phy (TEE). Design: Prospective study. Setting: Cardiac surgery unit at a university hospital. Patients: 36 ASA physical status I, II, and III patients for open heart surgery. Interventions: The CPB reservoir was gradually raised to decrease venous drainage. Accordingly, the right heart began to receive the venous blood and eject it to the pulmonary artery. The vent existing in the left ventricle or the left atrium then collected any whole blood containing aft bubbles that came from the pulmonary circulation. The air bubbles were confirmed by TEE to be removed and not to eject from the left ventricle to the systemic circulation. Measurements and Main Results: Levels of P(ET)CO₂, PaCO₂, PAP, and the duration of the removal procedure were measured when a sufficient pulmonary circulation was established and the removal of retained air was considered to be satisfactorily accomplished by the absence of air bubbles, confirmed by TEE for more than 30 seconds. P(ET)CO₂ reached 28 ± 4 mmHg during the removal of air, while PaCO₂ reached 35 ± 6 mmHg (p < 0.05). Mean PAP during removal of air reached 18 ± 4 mmHg, which was approximately 90&#37; of that before CPB. The duration time of removal of air was 9 ± 2 min. Conclusions: P(ET)CO₂ and PAP are useful indicators of pulmonary circulation during this procedure for removal of air, P(ET)CO₂ of 25 to 30 mmHg and PAP of 90&#37; of the prebypass level have been found to be necessary for the removal of air. Our technique for removal of air using P(ET)CO₂, PAP, and TEE enables us to satisfactorily eliminate residual air.

DOI： 10.1016/S0952-8180(97)00100-1

Language：English   Publishing type：Research paper (scientific journal)  

Background: Some hydrofluoric acid burns appear initially as only a slight wound, but patients may show dramatic changes within several hours. The extent of such burns are directly related to the concentration, amount, and duration of exposure. Case Report: A 64-year-old man sustained 44% total body surface burns after exposure to 30% hydrofluoric acid. Approximately 5 h after injury, he developed recurrent ventricular tachycardia and ventricular fibrillation which occurred in conjunction with long QT syndrome. In this case, the occurrence of hypocalcemia and especially hypomagnesemia played an important role in the development of long QT syndrome.

Language：English  

Background. Stimulation of myocardial α₁-adrenoceptors has been shown to exert positive inotropic effects through a cyclic AMP-independent mechanism. The purpose of this study was to examine if α₁-adrenoceptor stimulation is able to attenuate myocardial depression produced by exposure to halothane, and to test if α₁-adrenoceptor stimulation alters myocardial oxygen supply-demand balance in hearts exposed to halothane. Methods. The effects of phenylephrine were examined in 7 isolated perfused rat hearts. Variables measured were: heart rate, isovolumetric peak left ventricular pressure (LVP), LV dP/dt, coronary arterial flow, myocardial O₂ delivery (DO₂), myocardial O₂ consumption (MVO₂) and the ratio of DO₂/MVO₂. Each heart was exposed to phenylephrine cumulatively 0.1 μM, 0.3 μM, 1 μM and 3 μM under the administration of 1&#37; halothane in the presence of propranolol 1 μM. Results. Halothane 1&#37; decreased the heart rate by 9±3&#37;, LVP by 37±3&#37;, and LV dP/dt by 35±2&#37;. Phenylephrine restored these decreases to the baseline levels. Phenylephrine maintained or further enhanced the reductions in coronary flow and DO₂ produced by halothane, resulting in a decrease in the DO₂/MVO₂ ratio. Conclusion. α₁-adrenoceptor stimulation is capable of restoring direct cardiac depressant effects of halothane with a possible impairment of the oxygen supply-demand balance.

DOI： 10.1111/j.1399-6576.1997.tb04812.x

Language：English   Publishing type：Research paper (scientific journal)  

The purpose of this study was to examine the effects of nicardipine and sodium nitroprusside (SNP) on vascular capacitance in the rat. In ten rats anesthetized with pentobarbital, mean arterial pressure was lowered to about 70 mmHg and subsequently 50 mmHg by intravenous infusion of nicardipine or SNP. Vascular capacitance was assessed before and during nicardipine- or SNP-induced hypotension by measuring the mean circulatory filling pressure (MCFP). MCFP was measured during a brief period of circulatory arrest produced by inflating a balloon inserted in the right atrium. MCFP was significantly decreased by SNP from 7.1 ±0.3 mmHg at control to 5.6 ± 0.4 mmHg and 4.4 ± 0.3 mmHg at mean arterial pressures of 70 mmHg and 50 mmHg, respectively. However, MCFP stayed at a similar level to that of the control during nicardipine-induced hypotension. These results suggest that nicardipine has a negligible influence on vascular capacitance during induced hypotension, whereas SNP has a potent vasodilating effect on the venous system as well as the arterial system. © 1996 JSA.

DOI： 10.1007/BF02471391

Responsible for pages：7章-6、pp645-654   Language：Japanese   Book type：Scholarly book

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Responsible for pages：第7章　16　神経筋疾患の麻酔　pp269-271   Language：Japanese   Book type：Scholarly book

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リトルICUブック 第２版

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麻酔科医が知っておくべき感染症の知識

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麻酔偶発症A to Z 2 区域麻酔 1)硬膜外麻酔の偶発症

Responsible for pages：総ページ数：2, 担当ページ数：p. 423-424   Language：Japanese  

麻酔偶発症 A to Z 2 区域麻酔 1)硬膜外麻酔の偶発症

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麻酔偶発症 A to Z 2 区域麻酔 1)硬膜外麻酔の偶発症

Responsible for pages：総ページ数：9, 担当ページ数：38-46   Language：Japanese  

検査値から考える周術期血液凝固異常 （編集 香取信之）

Responsible for pages：総ページ数：7, 担当ページ数：90-96   Language：Japanese  

新合併症患者の麻酔スタンダード (武田純三 編）

Responsible for pages：硬膜外麻酔後の硬膜外膿瘍   Language：Japanese   Book type：Scholarly book

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OPE NURSING 50 Complications at intraoperation or postoperation

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麻酔科医のための困った時の3分コンサルト（稲田英一編）

Language：Japanese   Book type：Scholarly book

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Clinical management of coagulation and fibrinolysis in peripoerative setting

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Post Operative Pain Service

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まれな疾患の麻酔 A to Z

Responsible for pages：総ページ数：453, 担当ページ数：445   Language：Japanese  

まれな疾患の麻酔A to Z

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まれな疾患の麻酔 A to Z

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麻酔科研修ノート 改訂第2版（永井良三 監修、稲田英一 編集）、虚血性心疾患（狭心症、心筋梗塞）ー評価、リスク、治療、周術期の対応

Language：Japanese   Book type：General book, introductory book for general audience

整形外科Knack & Pitfalls 整形外科手術の要点と盲点（岩本幸英 監修・編集）総論：検査・周術期管理 Ⅰ術前 5.麻酔法の選択

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麻酔科研修ノート（永井良三 監修、稲田英一 編集）、 虚血性心疾患（狭心症、心筋梗塞）－評価、リスク、治療、周術期の対応

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NEW麻酔科学（劔物 修、花岡一雄偏）改定第３版 吸入麻酔器

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Brain function monitoring during cardiovascular surgery

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超高齢社会における周術期循環管理

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麻酔・周術期における輸液管理

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心機能からみた周術期循環管理

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周術期の脳機能モニタリング

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Venue：弘前市   Country：Japan  

高齢化社会における心機能評価と周術期輸液管理

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周術期の体温管理

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帯状疱疹の病期と痛みの治療法

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Venue：神戸市   Country：Japan  

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周術期管理における輸液戦略と心機能

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mECTと麻酔

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多項目モニタRoot®の有用性 ～SpHO2からSpHb®、そして麻酔深度まで～

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これからの周術期循環管理

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抗血栓療法と術後鎮痛法

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麻酔科医が手に入れたコミュニケーションツール

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Venue：福岡市   Country：Japan  

周術期の止血凝固

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Venue：金沢市   Country：Japan  

左室拡張能障害と周術期管理

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周術期輸液療法と心機能

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Venue：横浜市   Country：Japan  

動脈ラインのフラッシュ用シリンジは感染源になり得るか？

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Venue：金沢市   Country：Japan  

タブレット用アプリケーション開発によるシームレスな周術期麻酔診療：iPadを用いた診療効率化への試み

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ローラーポンプ式輸液装置および輸液加温器を用いた急速輸液時の回路圧に関する検討

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人工心肺手術後に角膜陥没を認めた一例

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Country：Japan  

Event date： 2013.9

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麻酔科医が知るべき抗血栓療法の最前線－最近の抗血栓療法とそのモニタリング 「抗凝固薬と周術期凝固モニタリング」

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人工心肺手術とSpHb ~New Radical 7を用いた検討~

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ROTEMハンズオン

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著名に呼吸機能が低下した症例へのデスフルランの使用経験

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生体肝移植術中の線溶亢進に関する検討

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左室拡張能障害と周術期リスク評価

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硬膜外に投与したドロペリドールにより錐体外路症状を来した一例

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Venue：東京   Country：Japan  

手術器械サプライ業務一元化に向けての取り組み ー洗浄・セット組から滅菌までを通しての連携ー

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九州大学病院における最近5年間の手術件数の推移と手術室運営に関する検討

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Accuracy of Non-invasive Hemoglobin Measurement by Pulse Co-oximetry at Various Peripheral Circulatory States

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LV Diastolic Dysfunction is a Predictor of Postoperative Pulmonary Edema in Renal Transplantation Recipients

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Venue：Wahington DC, United States of America   Country：United States  

Evaluation of Analgesic and Hypnotic Effects of Pentobarbital and Propofol Using in Vivo Patch Clamp Recording From Rat Somatosensory Cortex

Event date： 2012.9

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：仙台市   Country：Japan  

Event date： 2012.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：久留米市   Country：Japan  

気道狭窄を有する縦隔内甲状腺腫の麻酔経験

Event date： 2012.8

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：福岡市   Country：Japan  

Event date： 2012.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡市   Country：Japan  

前置胎盤症例の帝王切開術における大量出血に関係する因子の検討

Event date： 2012.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：神戸市   Country：Japan  

小児のエコーガイド下内頸静脈穿刺時における椎骨動脈の解剖学的関係の検討

Event date： 2012.6

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：神戸市   Country：Japan  

Event date： 2012.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：神戸市   Country：Japan  

腎移植術直後の肺水腫と術前心エコー検査からみた心機能との関係

Event date： 2012.4

Language：Japanese  

Venue：福岡市   Country：Japan  

Becker型筋ジストロフィー患者におけるスガマデクスの使用経験

Event date： 2012.3

Language：English   Presentation type：Oral presentation (general)  

Venue：Japan   Country：Japan  

Risk factors for massive hemorrhage during cesarean section in patients with placenta previa

Event date： 2011.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：徳島市   Country：Japan  

先天性無フィブリノゲン血症妊婦の帝王切開術の麻酔経験

Event date： 2011.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：宜野湾市（沖縄）   Country：Japan  

気化器の異常発見に手術室環境ガスモニタリングシステムが有用であった事例

Event date： 2011.10

Language：English   Presentation type：Oral presentation (general)  

Venue：Chicago, United States of America   Country：United States  

Coagulopathy Following Cardiopulmonary Bypass Assessed by Modified Rotational Thromboelastometry

Event date： 2011.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：旭川市   Country：Japan  

術後2日目に急性重症僧帽弁逆流によりショック状態となった左心室内粘液腫の一例

Event date： 2011.10

Language：Japanese