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   Publishing type：Research paper (scientific journal)  

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

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

術前にナトリウム・グルコース共輸送体2(SGLT2)阻害薬を中止する新たな推奨事項について、その妥当性を検証した。各種文献データベースを用いて、SGLT2阻害薬投与患者で、術前、術中、術後30日以内にケトアシドーシス(血液pH<7.3および血中または尿ケトン陽性)を発症した患者の症例報告文献や症例集積文献を検索した。抽出された文献76件から症例99件(男性37例、女性55例、不明7例、平均57歳)を解析した結果、59例(59.6%)に術前にSGLT2阻害薬中止時期の記載を認め、中止した患者は術前2日以内に投薬が中止されていた。だが、術前2日以上前に投薬が中止され、SGLT2阻害薬関連ケトアシドーシスを発症した症例は0例で、多くの症例報告で術前のSGLT2阻害薬中止時期やBMI、ベースライン時のヘモグロビンA1c値、周術期輸液管理の詳細、麻酔の種類など重要なケトアシドーシス発症因子の情報が不足していた。以上より、術前に少なくとも3日間SGLT2阻害薬を中止すると、SGLT2阻害薬関連ケトアシドーシスの発症予防に寄与することが示唆された。

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Abstract

Although the recommended preoperative cessation period for sodium-glucose cotransporter 2 inhibitors (SGLT2is) changed in 2020 (from 24 h to 3–4 days preoperatively) to reduce the risk of SGLT2i-associated perioperative ketoacidosis (SAPKA), the validity of the new recommendation has not been verified. Using case reports, we assessed the new recommendation effectiveness and extrapolated precipitating factors for SAPKA. We searched electronic databases up to June 1, 2022 to assess SAPKA (blood pH &lt; 7.3 and blood or urine ketone positivity within 30 days postoperatively in patients taking SGLT2i). We included 76 publications with 99 cases. The preoperative SGLT2i cessation duration was reported for 59 patients (59.6%). In all cases with available cessation periods, the SGLT2is were interrupted &lt; 3 days preoperatively. No SAPKA cases with &gt; 2-day preoperative cessation periods were found. Many case reports lack important information for estimating precipitating factors, including preoperative SGLT2i cessation period, body mass index, baseline hemoglobin A1c level, details of perioperative fluid management, and type of anesthesia. Our study suggested that preoperative SGLT2i cessation for at least 3 days could prevent SAPKA. Large prospective epidemiologic studies are needed to identify risk factors for SAPKA.

DOI： 10.1007/s00540-023-03174-8

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Other Link： https://link.springer.com/article/10.1007/s00540-023-03174-8/fulltext.html

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。

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

DOI： 10.1186/s12871-022-01738-x

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

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

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

DOI： 10.1186/s40981-021-00494-0

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Language：English   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

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DOI： 10.1097/MD.0000000000027808

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DOI： 10.1186/s40981-021-00459-3

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DOI： 10.1177/21514593211060575

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DOI： 10.1532/hsf.4061

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DOI： 10.1016/j.transproceed.2021.08.007

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DOI： 10.1007/s00540-021-02914-y

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DOI： 10.1213/XAA.0000000000001350

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Purpose: Left ventricular diastolic dysfunction is an independent risk factor for adverse cardiovascular morbidities and mortalities in cardiovascular and high-risk surgical patients. However, there were only a few investigations among intermediate-risk surgical patients. This study aimed to investigate postoperative heart failure (HF) in intermediate-risk surgical patients who had preoperative diastolic dysfunction with preserved ejection fraction (EF). Methods: Consecutive patients underwent intermediate-risk surgery between January 2016 and December 2018 were retrospectively evaluated. Patients with preserved EF were divided into three groups using one of the parameters of diastolic function: the ratio of early diastolic filling velocity to the peak diastolic velocity of mitral medial annulus (E/e’) ≥ 15, E/e’ between 8 and 15, and E/e’ < 8. Postoperative HF was defined as clinical symptoms and radiological evidence and low SpO₂ less than 93&#37;. The primary outcome was the incidence of postoperative HF and its relation to preoperative E/e’. Chi-squared test, unpaired t test with Welch’s correction, and multivariate logistic regression were used for analysis. Results: In total, 965 patients were included in the final analysis. Postoperative HF developed in 36/965 (3.7&#37;) patients with preserved EF. The incidence of postoperative HF was stratified according to the E/e’, and the rates of HF occurrence in patients with E/e’ < 8, 8–15, and ≥ 15 were 1.8&#37;, 2.7&#37;, and 15&#37;, respectively (P < 0.01). Conclusion: Preoperative elevated E/e’ (≥ 15) was associated with the development of postoperative HF in intermediate-risk surgical patients with preserved EF.

DOI： 10.1007/s00540-019-02728-z

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

Efficacy of programmed intermittent bolus epidural analgesia in thoracic surgery: a randomized controlled trial
Background: Continuous epidural infusion (CEI) has some disadvantages, such as increased local anesthetic consumption and limited area of anesthetic distribution. Programmed intermittent bolus (PIB) is a technique of epidural anesthesia in which boluses of local anesthetic are automatically injected into the epidural space. The usefulness of PIB in thoracic surgery remains unclear. In this study, we aimed to compare the efficacies of PIB epidural analgesia and CEI in patients undergoing thoracic surgery. Methods: This randomized prospective study was approved by the Institutional Review Board. The study included 42 patients, who were divided into CEI (n = 21) and PIB groups (n = 21). In the CEI group, patients received continuous infusion of the local anesthetic at a rate of 5.1 mL/90 min. In the PIB group, a pump delivered the local anesthetic at a dose of 5.1 mL every 90 min. The primary endpoints were the frequency of patient-controlled analgesia (PCA) and the total dose of local anesthetic until 36 h following surgery. Student's t-test, the chi-square test, and the Mann-Whitney U test were used for statistical analyses. Results: The mean number of PCA administrations and total amount of local anesthetic were not significantly different between the two groups up to 24 h following surgery. However, the mean number of PCA administrations and total amount of local anesthetic at 24-36 h after surgery were significantly lower in the PIB group than in the CEI group (median [lower-upper quartiles]: 0 [0-2.5] vs. 2 [0.5-5], P = 0.018 and 41 [41-48.5] vs. 47 [43-56], P = 0.035, respectively). Hypotension was significantly more frequent in the PIB group than in the CEI group at 0-12 h and 12-24 h (3.3&#37; vs. 0.5&#37;, P = 0.018 and 7.9&#37; vs. 0&#37;, P = 0.017, respectively). Conclusion: PIB can reduce local anesthetic consumption in thoracic surgery. However, it might result in adverse events, such as hypotension. Trial registration: This randomized prospective study was approved by the Institutional Review Board (IRB No. 15-9-06) of the Fukuoka University Hospital, Fukuoka, Japan, and was registered in the clinical trials database UMIN (ID 000019904) on 24 November 2015. Written informed consent was obtained from all patients.

DOI： 10.1186/s12871-019-0780-0

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

DOI： 10.11312/ccm.40.35

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

DOI： 10.2176/nmc.oa.2019-0028

Language：English  

DOI： 10.12659/AJCR.917716

Language：English  

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

DOI： 10.1186/s40981-018-0191-0

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

Meta-analyses on measurement precision of non-invasive hemodynamic monitoring technologuies in adults
An ideal non-invasive monitoring system should provide accurate and reproducible measurements of clinically relevant variables that enables clinicians to guide therapy accordingly. The monitor should be rapid, easy to use, readily available at the bedside, operator-independent, cost-effective and should have a minimal risk and side effect profile for patients. An example is the introduction of pulse oximetry, which has become established for non-invasive monitoring of oxygenation worldwide. A corresponding non-invasive monitoring of hemodynamics and perfusion could optimize the anesthesiological treatment to the needs in individual cases. In recent years several non-invasive technologies to monitor hemodynamics in the perioperative setting have been introduced: suprasternal Doppler ultrasound, modified windkessel function, pulse wave transit time, radial artery tonometry, thoracic bioimpedance, endotracheal bioimpedance, bioreactance, and partial CO₂ rebreathing have been tested for monitoring cardiac output or stroke volume. The photoelectric finger blood volume clamp technique and respiratory variation of the plethysmography curve have been assessed for monitoring fluid responsiveness. In this manuscript meta-analyses of non-invasive monitoring technologies were performed when non-invasive monitoring technology and reference technology were comparable. The primary evaluation criterion for all studies screened was a Bland-Altman analysis. Experimental and pediatric studies were excluded, as were all studies without a non-invasive monitoring technique or studies without evaluation of cardiac output/stroke volume or fluid responsiveness. Most studies found an acceptable bias with wide limits of agreement. Thus, most non-invasive hemodynamic monitoring technologies cannot be considered to be equivalent to the respective reference method. Studies testing the impact of non-invasive hemodynamic monitoring technologies as a trend evaluation on outcome, as well as studies evaluating alternatives to the finger for capturing the raw signals for hemodynamic assessment, and, finally, studies evaluating technologies based on a flow time measurement are current topics of clinical research.

DOI： 10.1007/s00101-018-0452-3

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

DOI： 10.1016/j.transproceed.2017.09.025

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

DOI： 10.2199/jjsca.37.600

Language：Japanese  

BACKGROUND: The proportion of obese people is gradually increasing. In recent years, laparoscopic sleeve gastrectomy has been performed as a weight loss surgery. We reported the extent of respiratory complications and the keys of anesthetic management in this procedure.
METHODS: Forty consecutive morbidly obese patients received laparoscopic sleeve gastrectomy. A sample for arterial blood gas analysis was taken after intubation and at the end of the operation. Moreover, to examine the risk of silent aspiration, 16 patients were subjected to measuring the gastric juice volume and pH of the pharynx.
RESULTS: Oxygenation index (P/F ratio) after intuba- tion was markedly reduced, but there was no correla- tion with the BMI On the other hand, P/F ratio at the end of surgery improved in patients with low BMI Hypercapnia was rare after extubation, but respiratory rate was increased in the patients with high BMI Gas- tric secretion after induction was increased, but there was no overt sign of silent regurgitation of gastric juice.
CONCLUSIONS: Oxygenation was extremely deterio- rated immediately after intubation in the morbidly obese patients. There is a need for aggressive respira- tory management because intraoperative oxygenation was not improved in the patients with high BMI.

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  

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 events compared with open repair

DOI： 10.4236/ojanes.2013.32021

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

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

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

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

DOI： 10.1016/j.yjmcc.2004.05.008

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

DOI： 10.1161/01.CIR.0000127939.16111.58

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

DOI： 10.1161/01.RES.0000107196.21335.2B

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

DOI： 10.1161/01.RES.0000096650.91688.28

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

DOI： 10.1161/01.ATV.0000029121.63691.CE

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

DOI： 10.1046/j.1365-2346.2000.00759.x

Responsible for pages：分子細胞機序・病態生理 Rho・Rhoキナーゼ　86-87   Language：Japanese   Book type：Scholarly book

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Anesthetic management of living-donor renal transplantation without platelet transfusion in a patient with macrothrombocytopenia using thromboelastometry

Event date： 2020.11 - 2020.12

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Event date： 2020.9 - 2020.11

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Event date： 2019.10 - 2020.10

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Event date： 2019.10 - 2020.10

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Diastolic dysfunction with preserved ejection fraction is related with postoperative heart failure in surgical patients.

Event date： 2019.9

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Event date： 2019.9

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Event date： 2019.6 - 2020.6

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Venue：軽井沢   Country：Japan  

Event date： 2019.5 - 2020.6

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Venue：神戸   Country：Japan  

Event date： 2019.5 - 2020.6

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Venue：神戸   Country：Japan  

Event date： 2019.5 - 2019.6

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Venue：神戸   Country：Japan  

Event date： 2018.11

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Venue：北九州   Country：Japan  

Event date： 2018.11

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Venue：北九州   Country：Japan  

Event date： 2018.10 - 2020.10

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Event date： 2018.10 - 2020.10

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Venue：東京   Country：Japan  

Event date： 2018.9

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Venue：那覇   Country：Japan  

Event date： 2018.9

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Venue：沖縄   Country：Japan  

Event date： 2015.5

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

Venue：神戸   Country：Japan  

Event date： 2015.5

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Venue：神戸   Country：Japan  

Event date： 2014.10 - 2020.10

Language：English  

Country：United States  

Early assessment of fibrinolysis with thromboelastometry (ROTEM) in orthotopic liver transplantation

Event date： 2014.9

Language：Japanese  

Venue：北九州   Country：Japan  

Event date： 2014.9

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Venue：北九州   Country：Japan  

Event date： 2014.7

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Venue：福岡   Country：Japan  

Event date： 2014.7

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Venue：福岡   Country：Japan  

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Venue：横浜   Country：Japan  

Event date： 2014.5

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Venue：横浜   Country：Japan  

Event date： 2014.5

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Venue：横浜   Country：Japan  

Event date： 2013.11

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Event date： 2013.11

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Venue：金沢   Country：Japan  

Event date： 2013.9

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Venue：熊本   Country：Japan  

Event date： 2013.9

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Venue：熊本   Country：Japan  

Event date： 2013.5

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Venue：札幌   Country：Japan  

Event date： 2012.10

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Event date： 2012.10

Language：English   Presentation type：Oral presentation (general)  

Country：United States  

LV diastolic dysfunction is a predictor of postoperative pulmonary edema in renal transplantation recipients
Introduction
Postoperative respiratory complication is associated with high morbidity and mortality and therefore with possible graft loss in renal transplantation recipients. Most of patients with chronic renal failure have a risk of left ventricular (LV) diastolic dysfunction even with preserved LV contractility. The purpose of this study is to examine the relationship of the development of postoperative pulmonary edema (PE) and preoperative LV diastolic function in renal transplantation recipients.

Methods
This was a retrospective cohort study of adult patients who underwent living-donor renal transplantation (n=138) at our University hospital from January 2010 to December 2011. After obtaining our Institutional Review Board approval, anesthetic and medical records were reviewed and the relationship of postoperative PE and preoperative LV diastolic function was investigated. The LV diastolic function was evaluated by conventional Doppler and tissue Doppler measurements using transthoracic echocardiography. PE was defined as congestive signs on chest X-rays concomitantly with decreased PaO2/FIO2 less than 300 mmHg after surgery. Furthermore, PE was confirmed by independent two physicians. As parameters of preoperative LV diastolic function, the ratio of peak early and late (atrial) flow of mitral inflow (E/A) and the ratio of LV early diastolic filling velocity to the peak early diastolic velocity of the mitral annulus (E/E’) on echocardiography were used. The significance of differences between groups was assessed using Welch’s t test. The distribution of E/E’ and E/A were skewed to higher values, and logarithmic transformation were done in statistical analysis. Trend of increasing proportions across E/E’ categories were statistically tested by The Cochran–Armitage methods. Two-sided P values of less than 0.05 were regarded as statistically significant.

Results
Of 138 patients who underwent renal transplantation, nine patients were excluded because of their severely impaired LV systolic function (LV ejection fraction <50&#37;) or failure to record E/E’ on the reports of echocardiography. Of remained 129 patients whose LV systolic function was preserved, seven patients (5.6&#37;) developed PE after surgery. Patients with PE showed significantly higher geometric mean [95&#37; confidence interval] of E/E’ (16.4 [11.7, 22.9]) than those without PE (11.0 [10.3, 11.7]) (P = 0.02). The incidence of PE according to E/E’ categories of <8, 8-15, and ≥15 were 0&#37;, 5.4&#37;, and 14.3&#37;, respectively (P for trend = 0.06). However, there were no significant differences in E/A value between patients with and without PE. Intraoperative in-out balance was also identical between the two groups.

Conclusion
Our results demonstrated that postoperative PE was significantly related to preoperative higher E/E’ in renal transplantation recipients who preserved LV systolic function. E/E’ is reported to be a good parameter for elevated LV filling pressure and thus LV diastolic function in end-stage renal failure patients including dialysis patients. Therefore, it is suggested that LV diastolic dysfunction may be a predictor of postoperative PE in renal transplantation recipients. Meticulous preoperative evaluation of LV diastolic function with tissue Doppler velocity is important in renal transplantation recipients who are necessary to receive strenuous volume therapy during and following surgery.

Event date： 2012.6

Language：Japanese  

Venue：神戸   Country：Japan  

背景
腎不全患者の多くは高血圧や虚血性心疾患などの心血管系合併症を有しており、心機能の低下を伴うことが少なくない。一方で、腎移植の麻酔管理では腎血流の再開時に腎血流維持を目的に輸液負荷が必要となるため心機能低下患者では術後の肺水腫が懸念される。そこで今回腎移植術直後の肺水腫の発症について、術前の心エコー検査と術中輸液バランスとの関係について検討を行った

方法
2010年12月から1年間に当院で行われた成人腎臓移植術68症例について後ろ向きに検討した。術直後の胸部X線写真および動脈血血液ガス所見から肺水腫の診断を行い、肺水腫発症群（PE群）と非発症群（non-PE群）に分けて術前の心エコー所見と術中輸液バランスについて検討した。左室収縮能の指標として左室駆出率（EF）、左室拡張能の指標として左室流入血流速パターンからE/A、DcT、組織ドップラーによる弁輪速度からE/E’を比較した。データーは平均±標準偏差で示し、統計解析としてWelchのｔ検定を用いP<0.05を有意とした。

結果
PE群は3例、non-PE群は65例であった。E/AはPE群で有意に小さかった（0.74±0.15 vs. 1.15±0.70, p<0.01）。EF、DcT、E/E’は両群に有意差を認めなかった。
術中輸液総バランスは両群で差は認められなかったが、PE群はnon-PE群に比べ尿量が有意に少なかった(122±103 vs. 542±529 ml、P<0.01)。

考察
今回の結果は左室拡張能低下症例では術中尿量が少ない場合に腎移植術直後に肺水腫を発症するリスクがあることを示しており、このような症例ではより厳密な全身管理を要することが示唆された。腎移植患者では術前の心機能評価において左室収縮能のみならず左室拡張能にも注目して評価する必要がある。

Event date： 2011.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：沖縄   Country：Japan  

Event date： 2011.10

Language：Others   Presentation type：Oral presentation (general)  

Venue：鹿児島   Country：Japan  

現在の医療に於いて、電子カルテの利用は必然と言える。しかし、本当に電子カルテが我々の医療に役立っているのであろうか？当院では2006年から電子カルテを利用し始めた。電子カルテ本体に関する問題の一事例としては、指紋認証がある。この認証デバイスはキーボードに搭載されたものであるため認証制度が非常に悪く、電子カルテにログインするまでにかなりの時間を要する。また、すべての実施入力においてこの指紋認証が求められる。一方、部門システムである手術予約・支援システムは、当院手術部が1997年に開発してから現在まで実運用しているシステムである。このシステムのコンセプトは、セキュリティーはあくまでもある程度確保された上で、現場の作業効率をいかに妨げずに運用を電子化するかということである。今回、手術部門システムとして『手術患者搬入・搬出システム』を構築した。これを部門が独自に構築するシステムの事例の1つとして、医療情報部門が構築するシステムと比較することで、電子システムに求められる本質とは一体何なのか、現在のIT時代において現場で求められるべき電子システムの在り方について私見を交えて考察する。

Event date： 2002.3

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Inhibition of renin-angiotensin system ameliorates endothelial dysfunction with aging in rats

Event date： 2002.3

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Event date： 2001.10

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Event date： 2001.10

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Venue：大阪   Country：Other  

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Long-term inhibition of Rho-kinase suppresses angiotensin II-induced formation of cardiovascular lesions in rats in vivo

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Long-term inhibition of Rho-kinase suppresses angiotensin II-induced formation of coronary vascular lesions and cardiac hypertrophy in rats in vivo

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Long-Term inhibition of rho-kinase suppresses angiotensin II-induced formation of cardiovascular lesions in rats in vivo

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Long-term inhibition of Rho-kinase suppresses angiotensin II-induced formation of cardiovascular lesions in rats in vivo -Effect on endothelial NAD(P)H oxidase system-

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Venue：横浜   Country：Other  

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Long-term inhibition of Rho-kinase suppresses angiotensin II-induced formation of cardiovascular lesions in rats in vivo -Effect on endothelial NAD(P)H oxidase system-

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Long-term inhibition of Rho-kinase suppresses angiotensin II-induced formation of cardiovascular lesions in rats in vivo -Effect on endothelial NAD(P)H oxidase system-

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Venue：名古屋   Country：Other  

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Venue：東京   Country：Other  

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Long-term inhibition of Rho-kinase suppresses angiotensin II-induced cardiovascular hypertrophy and endothelial dysfunction in rats in vivo

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Venue：名古屋   Country：Other  

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Role of Rho-kinase in the pathogenesis of hypertensive cardiovascular disease

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Venue：神戸   Country：Other  

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Venue：大阪   Country：Other  

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Type：Competition, symposium, etc. 

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc.