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)  

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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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)  

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)  

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   Publishing type：Research paper (scientific journal)  

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：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   Publisher：(公社)日本麻酔科学会  

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

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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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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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.  

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

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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)  

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  

DOI： 10.1007/s00540-023-03236-x

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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：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：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)

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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

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Publisher：克誠堂出版  

DOI： 10.18916/masui.2023050006

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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)

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DOI： 10.1007/s00540-023-03162-y

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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。

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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

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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

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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：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

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

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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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)  

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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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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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。

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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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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。

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)

Publisher：克誠堂出版(株)  

DOI： 10.18916/j01397.2022279366

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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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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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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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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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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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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。

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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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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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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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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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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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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)  

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)  

DOI： 10.1186/s40981-021-00483-3

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

DOI： 10.1007/s00540-021-03005-8

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

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)  

DOI： 10.1532/hsf.4061

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

DOI： 10.1016/j.transproceed.2021.08.007

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DOI： 10.1186/s40981-021-00465-5

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DOI： 10.1186/s40981-021-00459-3

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

DOI： 10.1186/s40981-021-00457-5

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

DOI： 10.1186/s40981-021-00451-x

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

DOI： 10.1097/HJH.0000000000002728

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

DOI： 10.1186/s40981-021-00437-9

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

DOI： 10.1007/s00540-021-02914-y

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

DOI： 10.1007/s00540-020-02862-z

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

DOI： 10.1016/j.ajic.2020.06.202

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

DOI： 10.1186/s40792-020-01068-5

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

DOI： 10.12659/AJCR.928743

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

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)  

DOI： 10.1016/j.transproceed.2020.04.1820

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

DOI： 10.1016/j.pcorm.2020.100119

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

DOI： 10.1213/XAA.0000000000001350

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

DOI： 10.1186/s13287-020-02015-9

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

DOI： 10.1186/s40981-020-00386-9

Language：Japanese  

Background: Peripheral nerve injury is a significant perioperative complication. We report a case of a patient with intraoperative position-related brachial plexus injury, whose symptoms were improved by brachial plexus block. Case: A 23-year-old man underwent thoracoscopic resection for an anterior mediastinal tumor. The surgery lasted 8 hours under the right prone position with his left arm fixed at the shoulder height, and his neck-slightly extended. Immediately after the surgery, the patient complained of severe pain, with paralysis and numbness of the left upper extremity. Magnetic resonance neurography revealed a swollen brachial plexus. He was referred to our pain clinic because his symptoms did not improve with conservative treatment. We decided to perform ultrasound-guided branchial plexus block (1％ mepivacaine＋dexamethasone [3.3 mg]) to control pain and inflammation. After five blocks, although numbness remained, his pain improved considerably. Conclusion: The brachial plexus block could ameliorate acute neuropathic pain with inflammation.

DOI： 10.11321/jjspc.20-0022

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

DOI： 10.1186/s13041-020-00666-6

Language：English  

DOI： 10.1371/journal.pone.0239094

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

DOI： 10.1016/j.lfs.2020.118074

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

DOI： 10.1177/0267659120948435

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

DOI： 10.2199/jjsca.40.353

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

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)  

DOI： 10.1007/s00540-020-02763-1

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

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)  

DOI： 10.1186/s40981-019-0301-7

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

DOI： 10.1161/JAHA.119.013628

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

DOI： 10.1007/s00540-019-02672-y

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

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)  

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  

DOI： 10.1371/journal.pone.0218281

Language：Japanese  

75歳女。絞扼性イレウスに対し腸閉塞解除術、回腸部分切除術を行い、術後は全身管理目的で人工呼吸管理のままICUに入室した。術後1日目にショック状態となり、晶質液静脈内投与とノルアドレナリン・アドレナリンを開始したが循環動態は改善しなかった。心エコーでは右室の拡大と左室内腔の狭小化を認め、Wellsスコアは2.5点とmoderate riskであり、Dダイマーとフィブリン分解産物が高値であったため、肺血栓塞栓症(PTE)を疑った。体外式膜型人工肺を導入して循環動態が安定した後の胸部CTでPTEは否定され、心エコーで重度の大動脈弁狭窄症(AS)が判明した。術後7日目に人工呼吸から離脱、22日目に退院となった。退院時の心エコーでASは残存していたが右室拡大はなく、左室駆出率は68&#37;であった。

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

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)  

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  

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

DOI： 10.1186/s40981-018-0197-7

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

DOI： 10.14814/phy2.13796

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

DOI： 10.1186/s40981-018-0191-0

Language：English  

Language：English  

Language：Japanese  

Language：Japanese  

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

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

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

DOI： 10.1016/j.transproceed.2017.09.025

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

DOI： 10.1097/AAP.0000000000000644

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

DOI： 10.1532/hsf.1808

Language：Japanese  

DOI： 10.2199/jjsca.37.368

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

DOI： 10.1213/XAA.0000000000000440

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

DOI： 10.1016/j.mimet.2016.11.003

Language：Japanese  

The WHO's Surgical Safety Checklist was introduced in 2009, and around 60％ of hospitals in Japan have adopted the original or modified CHECKLISTS. The CHECKLIST can help identify most of problems that are often missed by surgical teams, clarify the process of complex procedures, and/or enhance overall performance by improving teamwork in the operating theater. No doubt the CHECKLIST can be meaningless if ignored by the operating room staff. While we cannot totally eliminate incidents happening during anesthesia and surgery even when using the CHECKLISTS, we should make efforts to implement and promote Safety Culture.

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

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

DOI： 10.4253/wjge.v8.i13.466

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

DOI： 10.1007/s10877-015-9705-8

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

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)  

Language：Japanese  

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

DOI： 10.1371/journal.pone.0147339

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

DOI： 10.12659/AJCR.893416

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

DOI： 10.1007/s10877-014-9605-3

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

DOI： 10.1016/j.jclinane.2014.04.012

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

DOI： 10.1016/j.aat.2014.02.005

Language：Japanese  

手術が安全に行われるようになった現在でも周術期における重大な合併症の主な原因は出血に伴うものが多くを占めている1)．日本麻酔科学会の麻酔関連偶発症例調査によると周術期の30 日以内の死亡の原因の第1 位は「術前合併症としての出血性ショック」，第2 位が「手術が原因の大出血」であり，これらを合わせると約半数が出血に関連した死亡である2)．このように周術期は出血を如何にコントロールするかが重要であるが，一方塞栓症の危険性も高い時期でもあり，止血凝固管理は大きな課題の一つである．

DOI： 10.15017/1448721

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

DOI： 10.1007/s10877-013-9479-9

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

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  

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

症例は29歳女性で、出生直後に臍帯の止血困難を認め、先天性無フィブリノゲン血症と診断された。24歳時より卵巣出血予防、妊娠目的にフィブリノゲン(Fbg)製剤投与下に妊娠が成立し、右卵管楔状切除術既往があるため、妊娠38週2日に選択的帝王切開が予定された。プロトロンビン時間(PT)、活性化部分トロンボプラスチン時間(APTT)は正常で、臨床的出血傾向もなかった。麻酔は全身麻酔で行い、チアミラール、スキサメトニウムで導入し、気管挿管後、亜酸化窒素、酸素で維持し、児娩出後、ペンタゾシン、ベクロニウムを投与した。手術直後の改良型トロンボエラストメトリ(ROTEM)は正常であった。術後はFbg製剤を投与し血漿Fbg値80mg/dl前後とやや低めに推移したが術後出血所見はなかった。術後4日目のROTEMのMLが35&#37;と全身性の線溶系亢進を示唆する所見であったが、臨床的には血栓症や出血傾向などの所見はなく、術後6日目の検査ではこの所見も改善し退院した。

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

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

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

DOI： 10.1007/s00540-011-1290-5

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

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

DOI： 10.1007/s00540-010-1087-y

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

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

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

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

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

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

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

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

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

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

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

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.

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

DOI： 10.1152/ajpheart.01416.2006

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

DOI： 10.1007/s10877-007-9081-0

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

DOI： 10.1016/j.neuroscience.2006.08.021

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

DOI： 10.1161/01.STR.0000189997.84161.95

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

DOI： 10.1007/s00540-004-0296-7

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

DOI： 10.1007/s00540-003-0225-1

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

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

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

DOI： 10.1053/j.jvca.2003.09.005

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

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.

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

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)  

Language：English  

Language：Japanese  

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)  

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

DOI： 10.1034/j.1399-6576.2001.045004427.x

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

DOI： 10.1053/jcan.2001.21954

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

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)  

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

DOI： 10.1097/00000542-199812000-00028

Language：English  

DOI： 10.1016/S0952-8180(97)00100-1

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

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)  

DOI： 10.1007/BF02471391

Responsible for pages：44．抗血栓療法ガイドライン　pp247-252   Language：Japanese   Book type：Scholarly book

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Responsible for pages：総ページ数：110, 担当ページ数：58-63, 76-77, 86-87   Language：Japanese  

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

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Brain function monitoring during cardiovascular surgery

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Event date： 2012.10

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Country：United States  

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

Event date： 2012.10

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Country：United States  

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

Event date： 2012.10

Language：English   Presentation type：Oral presentation (general)  

Country：United States  

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

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Venue：神戸市   Country：Japan  

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

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Venue：徳島市   Country：Japan  

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Coagulopathy Following Cardiopulmonary Bypass Assessed by Modified Rotational Thromboelastometry

Event date： 2011.10

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Venue：旭川市   Country：Japan  

Event date： 2011.10

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Venue：徳島市   Country：Japan  

Event date： 2010.10

Language：English   Presentation type：Oral presentation (general)  

Country：United States  

Incidence of myocardial ischemia during endvascular versus open repair of abdominal aortic aneurysm.

Event date： 2010.6

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Venue：福岡市   Country：Japan  

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Venue：福岡市   Country：Japan  

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Venue：大阪府豊中市   Country：Japan  

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Venue：浜松市   Country：Japan  

Event date： 2009.10

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Venue：浜松市   Country：Japan  

Event date： 2009.10

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Venue：浜松市   Country：Japan  

Event date： 2009.8

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

Venue：神戸   Country：Japan  

Event date： 2009.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：鹿児島市   Country：Japan  

Event date： 2008.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都市   Country：Japan  

Language：Japanese  

Country：Japan  

＜文献概要＞成人先天性心疾患(ACHD)患者は増加の一途をたどっており,日本のACHD患者数はすでに50万人を超えていると予想されている。いずれ,心臓手術患者の半数はACHDを合併した患者になるとの予測もあり,ACHDを合併した患者の非心臓手術の麻酔を担当する機会も増加していくであろう。今回は両大血管右室起始症(DORV)に対して小児期に姑息術のみが行われ,心機能低下が進行中のACHD患者に対する心臓再同期ペースメーカ(CRT-P)用ジェネレータの交換術について,経験豊富な3施設にPLANを立ててもらった。誌上カンファレンスを通して読者がACHDに対する理解を深め,将来担当するかもしれないACHD合併患者の麻酔計画を立案する際の一助となれば幸いである。