記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本循環制御医学会  

 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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Journal of Case Reports  

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

DOI： 10.12659/ajcr.941563

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記述言語：英語   出版者・発行元：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。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JA Clinical Reports  

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

DOI： 10.1186/s40981-023-00635-7

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記述言語：英語   出版者・発行元：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。

記述言語：英語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Anesthesia  

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 < 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&#37;). In all cases with available cessation periods, the SGLT2is were interrupted < 3 days preoperatively. No SAPKA cases with > 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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その他リンク： https://link.springer.com/article/10.1007/s00540-023-03174-8/fulltext.html

記述言語：英語   出版者・発行元：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。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Therapeutic Hypothermia and Temperature Management  

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

DOI： 10.1089/ther.2022.0009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Journal of Case Reports  

BACKGROUND Epidermolysis bullosa (EB) is a group of rare genetic conditions that can cause eruption of blisters on the skin and mucous membranes by the slightest mechanical stimulus. In these patients particular attention should be paid to potential complications, from monitoring of vital signs to anesthesia procedures in the perioperative period. CASE REPORT A 31-year-old man with EB underwent lower-leg amputation for squamous cell carcinoma. Multiple blisters and scars had appeared all over his face and body, and his extremities were contracted. The patient's mouth could open only up to approximately 5 mm, and laboratory examination showed a high inflammatory response. In addition, he had anemia and hypoalbuminemia with a serum albumin concentration of 1.4 g/dL. We planned sciatic and femoral nerve blocks with sedation for anesthesia management because of the anticipated difficulty of intubation and concern about postoperative upper-airway obstruction due to changes in the oral cavity. While protecting the skin from external force application, we performed sciatic and femoral nerve blocks (1.7 mg/kg) using 0.25&#37; levobupivacaine, 10 mL (3.5 mg/kg) of 1&#37; 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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Anesthesiology  

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

DOI： 10.1186/s12871-022-01738-x

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記述言語：英語   出版者・発行元：(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。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JA Clinical Reports  

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

DOI： 10.1186/s40981-021-00494-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Anesthesia  

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

DOI： 10.1007/s00540-021-03030-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Therapeutic Hypothermia and Temperature Management  

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

DOI： 10.1089/ther.2021.0029

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記述言語：英語   出版者・発行元：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。

記述言語：英語   出版者・発行元：日本循環制御医学会  

<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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

<title>Abstract</title><sec>
<title>Background</title>
Glutaric acidemia is a type of multiple acyl-coenzyme A dehydrogenase deficiency, an inborn error in fatty acid metabolism. In patients with glutaric acidemia, during the perioperative period, prolonged fasting, stress, and pain have been identified as risk factors for the induction of metabolic derangement. This report describes the surgical and anesthetic management of a patient with glutaric acidemia.


</sec><sec>
<title>Case presentation</title>
A 56-year-old male patient with glutaric acidemia type 2 underwent a series of surgeries. During the initial off-pump coronary artery bypass surgery, the patient developed renal failure due to rhabdomyolysis upon receiving glucose at 2 mg/kg/min. However, in the second laparoscopic cholecystectomy, rhabdomyolysis was avoided by administering glucose at 4 mg/kg/min.


</sec><sec>
<title>Conclusions</title>
To avoid catabolism in patients with glutaric acidemia, appropriate glucose administration is important, depending on the surgical risk.


</sec>

DOI： 10.1186/s40981-021-00459-3

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Remimazolam, a benzodiazepine ultra-short-acting sedative, has been used in general anesthesia since August 2020. It is used in awake surgeries that require awakening the patient in the middle of the surgery because of its rapid awakening effect as well as antagonistic interactions. If remimazolam has associated anterograde amnesia similar to benzodiazepines, it will have a positive effect on preventing psychological trauma. However, to our knowledge, the effect of remimazolam on anterograde amnesia has not been previously examined. METHODS/DESIGN: The aim of this exploratory, open, propofol-controlled, single-center, randomized clinical trial is to examine the effect of remimazolam on postoperative memory retention and delayed regeneration. Seventy patients undergoing breast surgery will be included in the study. The patients will be randomly assigned to receive propofol or remimazolam as sedatives during surgery. The primary endpoint is the number of posters patients remember 24 hours after surgery (among 4 posters shown after awakening from anesthesia) as an assessment of anterograde amnesia. Secondary endpoints are retrograde amnesia, dose of analgesic given from the time the patient returns to the ward until 24 hours after surgery, immediate postoperative pain numerical rating scale scores, and pain numerical rating scale scores 24 hours after leaving the operating room. Recruitment will take place between October 2021 and March 2022 to achieve the target sample size. DISCUSSION: To our knowledge, this is the first trial designed to examine the effects of remimazolam on postoperative memory retention and delayed regeneration in patients undergoing breast surgery. TRIAL REGISTRATION: This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center on September 28, 2021 (UMIN-CTR: UMIN000045593).

DOI： 10.1097/MD.0000000000027808

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1177/21514593211060575

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1532/hsf.4061

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.transproceed.2021.08.007

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00540-021-02914-y

記述言語：日本語  

Epstein syndrome is a myosin heavy chain 9 (MYH9)-related disorder characterized by hearing loss and macrothrombocytopenia with renal failure, which usually requires platelet transfusion during surgery. We report the case of a 22-year-old man who underwent living-donor renal trans- plantation without platelet transfusion using rotational thromboelastometry (ROTEM) monitoring. His intraoperative laboratory coagulation findings were a platelet count of 28–31 × 109/L based on microscopy and fibrinogen of 256 mg/dL. However, his extrinsic pathway evaluations by ROTEM were normal. The estimated blood loss during the operation was 150 mL, and the patient showed no bleeding complications without platelet transfusion.

DOI： 10.1213/XAA.0000000000001350

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.11312/ccm.40.35

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.2176/nmc.oa.2019-0028

記述言語：英語  

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

DOI： 10.12659/AJCR.917716

記述言語：英語  

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

記述言語：その他   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1016/j.transproceed.2017.09.025

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Hyponatremia as a Cause of Postoperative Headache after Epidural Anesthesia

DOI： 10.2199/jjsca.37.600

記述言語：日本語  

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.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1007/s10877-014-9605-3

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1016/j.jclinane.2014.04.012

記述言語：英語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1007/s10877-013-9479-9

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Post-operative pulmonary complications are associated with high mortality and graft loss in renal transplantation recipients. Left ventricular diastolic dysfunction is not uncommon in patients with chronic renal failure, including those with preserved left ventricular systolic function. The purpose of this study was to determine the relationship between left ventricular diastolic dysfunction and incidence of post-operative pulmonary edema in renal transplantation recipients with preserved left ventricular systolic function. Methods Pre-operative left ventricular function and incidence of pulmonary edema were retrospectively studied in 209 patients who underwent living-donor renal transplantation between January 2010 and October 2012. Left ventricular systolic and diastolic functions were evaluated by ejection fraction and E/E' ratio, retrospectively, using transthoracic echocardiography. Pulmonary edema was defined by evidence of pulmonary congestion on the chest X-ray together with PaO₂/FiO₂ ratio < 300 mmHg. Results Eleven out of 190 (5.8%) renal transplantation patients with preserved left ventricular systolic function developed post-operative pulmonary edema. Patients with pulmonary edema had a significantly higher geometric mean (95% confidence interval) of E/E' ratio than those without pulmonary edema [17.8 (14.1-22.5) vs. 11.1 (10.6-11.7), P = 0.001]. Conclusion Pre-operative left ventricular diastolic dysfunction correlated with the development of post-operative pulmonary edema in renal transplantation recipients. Meticulous intraoperative volume therapy is important to avoid post-operative pulmonary edema in such patients.

DOI： 10.1111/aas.12168

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

During the perioperative period, evaluation of digital blood flow would be useful in early detection of decreased circulating volume, thermoregulatory responses or anaphylactoid reactions, and assessment of the effects of vasoactive agents. This study was designed to assess the reliability of fingertip temperature, core-fingertip temperature gradients and fingertip-forean-n temperature gradients as indices of fingertip blood flow in the clinical setting of the operating theatre.
In 22 adult patients undergoing abdominal surgery with general anaesthesia, fingertip skin-surface temperature, forearm skin-surface temperature, and nasopharyngeal temperature were measured every five minutes during the surgery.
Fingertip skin-surface blood flow was simultaneously estimated using laser Doppler flowmetry. These measurements were made in the same upper limb with an IVcatheter (+IVgroup, n =11) or without an IVcatheter (-IV group, n=11). Fingertip blood flow, transformed to a logarithmic scale, significantly correlated with any of the three thermal measures in both the groups. Their rank order as an index of fingertip blood flow in the -IV group was forearm-fingertip temperature gradient (r=-0.86) > fingertip temperature (r=0.83) > nasopharyngeal-fingertip temperature gradient (r=-0.82), while that in the +IV group was nasopharyngeal-fingertip temperature gradient (r=-0.77) > fingertip temperature (r=0.71) > forearm-fingertip temperature gradient (r=-0.66). The relation of fingertip blood flow to each thermal measure in the -IV group was stronger (P<0.05) than that in the +IVgroup. In the clinical setting of the operating theatre, using the upper limb without IV catheters, fingertip skin-surface temperature, nasopharyngeal-fingertip temperature gradients, and forearm-fingertip temperature gradients are almost equally reliable measures of fingertip skin-surface bloodflow.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recent studies have demonstrated that upregulated Rho-kinase plays an important role in the pathogenesis of arteriosclerosis and vasospasm in both animals and humans. However, little is known about the molecular mechanism(s) involved in the Rho-kinase upregulation. Since inflammatory mechanisms have been implicated in the pathogenesis of arteriosclerosis and vasospasm, we examined whether inflammatory stimuli upregulate Rho-kinase in vitro and in vivo. In cultured human coronary vascular smooth muscle cells (hcVSMC), inflammatory stimuli, such as angiotensin II and interleukin-1beta, increased Rho-kinase expression (at both mRNA and protein levels) and function (as evaluated by the extent of the phosphorylation of the ERM (the ezrin/radixin/moesin) family, substrates of Rho-kinase) in a time-and concentration-dependent manner. The expression of Rho-kinase was inhibited by blockades of protein kinase C (PKC) (by either GF109253 or prolonged treatment with phorbol myristate acetate for 24 h) and an adenovirus-mediated gene transfer of dominant-active Ikappa-B, suggesting an involvement of PKC and NF-kappaB in the intracellular signal transduction pathway for the Rho-kinase expression. Furthermore, coronary vascular lesion formation (characterized by medial thickening and perivascular fibrosis) induced by a long-term administration of angiotensin II was markedly suppressed in NF-kappaB(-/-) mice with reduced expression and activity of Rho-kinase in vivo. These results indicate that the expression and function of Rho-kinase are upregulated by inflammatory stimuli (e.g. angiotensin II and IL-1beta) in hcVSMC with an involvement of PKC and NF-kappaB both in vitro and in vivo. (C) 2004 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.yjmcc.2004.05.008

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background-Rho-kinase has been implicated as an important regulator of inflammatory responses mediated by cytokines and chemokines. Because proinflammatory cytokines play a critical role in left ventricular (LV) remodeling after myocardial infarction (MI), we examined whether long-term blockade of Rho-kinase suppresses LV remodeling in a mouse model of MI in vivo.
Methods and Results-Mice underwent ligation of the left coronary artery and were treated with a Rho-kinase inhibitor, fasudil (100 mg . kg(-1) . d(-1) in tap water), for 4 weeks, starting 1 day after the surgery. At 4 weeks, LV infarct size was histologically comparable between the 2 groups. LV cavity dilatation and dysfunction evaluated by echocardiography were significantly suppressed in the fasudil group (P<0.05, n=15 to 28). The beneficial effects of fasudil were accompanied by suppression of cardiomyocyte hypertrophy and interstitial fibrosis (both P<0.01, n=6). The expression of inflammatory cytokines, including transforming growth factor (TGF)-beta(2), TGF-beta(3), and macrophage migration inhibitory factor, was upregulated in the noninfarcted LV in the control group and was significantly suppressed in the fasudil group (both P<0.05, n=10 to 11). Rho-kinase activity as evaluated by the extent of phosphorylation of the ERM family, a substrate of Rho-kinase, was significantly increased in the noninfarcted LV in the control group and was significantly suppressed in the fasudil group (P<0.05, n=5).
Conclusions-These results indicate that Rho-kinase is substantially involved in the pathogenesis of LV remodeling after MI associated with upregulation of proinflammatory cytokines, suggesting a therapeutic importance of the molecule for the prevention of post-MI heart failure.

DOI： 10.1161/01.CIR.0000127939.16111.58

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cardiac allograft vasculopathy (CAV) continues to be a major cause of late graft failure after cardiac transplantation. We have demonstrated that Rho-kinase, an effector of the small GTPase Rho, plays an important role in the pathogenesis of arteriosclerosis. In this study, we examined whether the Rho-kinase-mediated pathway is also involved in the pathogenesis of CAV using a specific Rho-kinase inhibitor and a dominant-negative Rho-kinase. Hearts from AKR mice were heterotopically transplanted to C3H/He (allograft) or AKR mice (isograft), and the effects of long-term oral treatment with fasudil, which is metabolized to a specific Rho-kinase inhibitor hydroxyfasudil, on CAV were examined at 2 and 4 weeks after the transplantation. Coronary remodeling in the allografts characterized by intimal thickening and perivascular fibrosis was dose-dependently suppressed in the fasudil group compared with the control group (P < 0.01, n = 9 to 10). The inhibitory effects of hydroxyfasudil were mimicked by in vivo gene transfer of dominant-negative Rho-kinase (P < 0.05, n = 4). Among the proinflammatory cytokines examined, those of macrophage migration inhibitory factor, interferon-gamma, and transforming growth factor-beta1 were upregulated in the control group and were dose-dependently inhibited in the fasudil group (P < 0.01, n = 5). Vascular inflammation in the allografts, as evidenced by accumulation of inflammatory cells (macrophages and T cells), was also significantly inhibited in the fasudil group (P < 0.05, n = 5 to 10). These results indicate that long-term treatment with fasudil suppresses CAV in mice, suggesting that Rho-kinase is an important therapeutic target for the prevention of CAV.

DOI： 10.1161/01.RES.0000107196.21335.2B

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intracellular signaling pathway mediated by small GTPase Rho and its effector Rho-kinase plays an important role in regulation of vascular smooth muscle contraction and other cellular functions. We have recently demonstrated that Rho-kinase is substantially involved in angiotensin II-induced gene expressions and various cellular responses in vitro. However, it remains to be examined whether Rho-kinase is involved in the angiotensin II-induced cardiovascular hypertrophy in vivo and, if so, what mechanisms are involved. Long-term infusion of angiotensin II for 4 weeks caused hypertrophic changes of vascular smooth muscle and cardiomyocytes in rats. Both changes were significantly suppressed by concomitant oral treatment with fasudil, which is metabolized to a specific Rho-kinase inhibitor, hydroxyfasudil, after oral administration. Angiotensin II caused a perivascular accumulation of macrophages and Rho-kinase activation, both of which were also significantly suppressed by fasudil. Vascular NAD(P)H oxidase expression (nox1, nox4, gp91phox, and p22phox) and endothelial production of superoxide anions were markedly increased by angiotensin II, both of which were also significantly suppressed by fasudil. Thus, fasudil ameliorated the impaired endothelium-dependent relaxations caused by angiotensin II without affecting vasodilator function of vascular smooth muscle. These results provide evidence that Rho-kinase is substantially involved in the angiotensin II-induced cardiovascular hypertrophy in rats in vivo. The suppression of endothelial NAD( P) H oxidase upregulation and resultant superoxide production and the amelioration of endothelial vasodilator function may be involved in this process.

DOI： 10.1161/01.RES.0000096650.91688.28

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective - Endothelial vasodilator functions are progressively impaired with aging, which may account in part for the increased incidence of cardiovascular events in elderly people. We examined what treatment could ameliorate the endothelial dysfunction associated with aging in rats. Methods and Results - Aged (12-month-old) Wistar-Kyoto rats were treated with vehicle, temocapril, CS-866 (an angiotensin II type 1 receptor antagonist), cerivastatin, or hydralazine for 2 weeks. Endothelium-dependent relaxations (EDRs) of aortas from aged rats were markedly impaired compared with EDRs of aortas from young (3-month-old) rats. Indomethacin, NS-398 (a cyclooxygenase [COX]-2 inhibitor), and SQ-29548 (a thromboxane A₂/prostaglandin H₂ receptor antagonist) acutely restored EDRs in aged rats, suggesting an involvement of COX-2-derived vasoconstricting eicosanoids. Tiron, a superoxide scavenger, also partially improved EDRs, suggesting an involvement of superoxide. EDRs were significantly ameliorated in aged rats after long-term treatment with temocapril or CS-866 but not after treatment with cerivastatin or hydralazine. Indomethacin induced no further improvement of EDRs after treatment with temocapril or CS-866. COX-2 protein expression and superoxide production were increased in the aortas of aged rats and were also attenuated by treatment with temocapril or CS-866. Conclusions - These results demonstrate that long-term inhibition of the renin-angiotensin system ameliorates endothelial dysfunction associated with aging through the inhibition of the synthesis of COX-2-derived vasoconstricting factors and superoxide anions.

DOI： 10.1161/01.ATV.0000029121.63691.CE

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1046/j.1365-2346.2000.00759.x

担当ページ：分子細胞機序・病態生理 Rho・Rhoキナーゼ　86-87   記述言語：日本語   著書種別：学術書

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Anesthetic management of Left ventricular assist device (LVAD) implantation in a patient with multiminicore disease

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

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開催地：Orlando, FL, USA   国名：アメリカ合衆国  

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

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左室収縮能が保たれた左室拡張能障害と一般外科手術後の心不全発症との関係

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輸液反応性の指標としてのPulse Wave Transit Time (PWTT) 測定における末梢脈波測定部位の意義

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関節鏡下肩関節腱板修復術の腕神経叢ブロックにおける持続神経ブロックとステロイド添加単回神経ブロックの比較

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周術期管理センターの患者滞在時間短縮に向けた取り組み

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高位脛骨骨切り術の術後鎮痛における持続大腿神経ブロックの有用性についての検討

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Diastolic dysfunction of the left ventricle is associated with pulmonary edema after renal transplantation

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Fibrinolysis in orthotopic liver transplantation recipients evaluated by ROTEM

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

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極度の病的肥満患者に対する腹腔鏡下胃縮小術の周術期管理

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測定機器によるヘモグロビン値の差に関する検討 –生体肝移植術レシピントにおいて−

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ラリンジアルマスクを用いて自発呼吸下に管理した気管ステント留置術の一例

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記述言語：日本語   会議種別：口頭発表（一般）  

開催地：札幌   国名：日本国  

生体肝移植術中の線溶亢進に関する検討

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開催年月日： 2012年10月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Washington, DC   国名：アメリカ合衆国  

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.

開催年月日： 2012年6月

記述言語：日本語  

開催地：神戸   国名：日本国  

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。

開催年月日： 2011年11月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：沖縄   国名：日本国  

気化器の異常発見に手術室環境ガスモニタリングシステムが有用であった事例 【はじめに】吸入麻酔薬による全身麻酔中の手術室環境汚染の原因には複数あることが報告されている。今回当院で採用している手術室環境ガスモニタリングシステムによる麻酔ガス漏れ警報により気化器の異常が判明した事例を報告する。 【事例】セボフルランを用いた全身麻酔中に手術室環境ガスモニタリングシステムで吸入麻酔ガスの環境濃度上昇（最大で4ppm）の警報が作動した。このため、余剰麻酔ガス排気装置、二酸化炭素吸収装置を含めた呼吸回路のリーク、気管チューブからのガス漏れ、呼気麻酔ガスモニタリングシステムの余剰ガス排泄装置などを点検したが明らかな異常は見つからなかった。気化器の吸入麻酔薬消費量が通常よりも大幅に増加していること、気化器のダイアルをOFFにすることで改善することから気化器の異常を疑い、気化器の薬液注入口のパッキン破損による漏出が判明した。 【考察】気化器の薬液注入口のパッキン破損は始業点検や定期点検での発見が難しい。特にセボフルランのような比較的刺激臭が少ない麻酔薬では麻酔ガス漏出の発見は困難である。手術室環境ガスモニタリングシステムは気化器の異常による室内汚染の発見に有用であった。

開催年月日： 2011年10月

記述言語：その他   会議種別：口頭発表（一般）  

開催地：鹿児島   国名：日本国  

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。

開催年月日： 2002年3月

記述言語：英語  

国名：その他  

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

開催年月日： 2002年3月

記述言語：英語  

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開催年月日： 2001年10月

記述言語：英語  

国名：その他  

開催年月日： 2001年10月

記述言語：英語  

researchmap

記述言語：日本語  

国名：その他  

Angiotensin II 慢性投与によるラット冠動脈病変形成におけるRho-kinaseの関与

記述言語：日本語  

国名：その他  

Angiotensin II慢性投与によるラット心血管病変形成に置けるRho-kinaseの関与

記述言語：日本語  

開催地：大阪   国名：その他  

Angiotensin II 慢性投与によるラット心血管病変形成におRho-kinaseの関与

記述言語：英語  

開催地：札幌   国名：その他  

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

記述言語：日本語  

国名：その他  

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

記述言語：英語  

国名：その他  

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

記述言語：英語  

開催地：Chicago, USA   国名：その他  

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

記述言語：英語  

開催地：福岡   国名：その他  

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-

記述言語：日本語  

開催地：横浜   国名：その他  

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-

記述言語：英語  

国名：その他  

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-

記述言語：日本語  

国名：その他  

Angiotensin II誘発性心血管病変形成におけるRho-kinaseの関与

記述言語：英語  

開催地：San Francisco, USA   国名：その他  

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-

記述言語：日本語  

開催地：名古屋   国名：その他  

Angiotensin II慢性投与による心血管病変の分子機構におけるRho-kinaseの役割

記述言語：英語  

開催地：東京   国名：その他  

Heterogenous expression of Rho-kinase isoforms, Rho-kinase α and Rho-kinase β, in angiotensin II-infused mice.

記述言語：英語  

開催地：奈良   国名：その他  

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

記述言語：日本語  

開催地：名古屋   国名：その他  

Heterogenous expression of Rho-kinase isoforms, Rho-kinase α and Rho-kinase β, in angiotensin II-infused mice

記述言語：日本語  

国名：その他  

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

記述言語：英語  

開催地：横浜   国名：その他  

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

記述言語：日本語  

開催地：神戸   国名：その他  

アミノ酸輸液の低体温防止効果 −長時間開腹手術を受けた成人患者における検討−

記述言語：日本語  

開催地：大阪   国名：その他  

SMON患者の開腹横行結腸切除の麻酔経験

記述言語：日本語  

国名：その他  

ハンチントン舞踏病患者の麻酔経験

記述言語：日本語  

国名：その他  

不整脈源性右室異形成患者の麻酔経験

記述言語：日本語  

開催地：福岡   国名：その他  

術中の多量の造影剤使用により麻酔覚醒時に肺水腫をきたしたステントグラフト挿入術の麻酔経験

記述言語：日本語  

開催地：徳島   国名：その他  

先天性無フィブリノゲン血症妊婦の帝王切開術の麻酔経験

記述言語：日本語  

開催地：宮崎   国名：その他  

経食道心エコープローブの屈曲に気付かずに挿入した症例

記述言語：日本語  

開催地：宮崎   国名：その他  

完全房室ブロック患者への肺動脈カテーテル挿入時に心停止となり体表ペーシングを要した一症例

記述言語：日本語  

開催地：久留米   国名：その他  

Lennox-Gastaut症候群患者に対する生体腎移植術の麻酔経験

記述言語：日本語  

開催地：久留米   国名：その他  

Cronkhite-Canada症候群合併患者に対する膵頭十二指腸切除術の麻酔経験

記述言語：日本語  

開催地：金沢   国名：その他  

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

記述言語：日本語  

開催地：金沢   国名：その他  

オプソクローヌス・ミオクローヌス症候群患児の腹腔鏡下副腎神経芽細胞腫摘出術の麻酔経験

記述言語：日本語  

開催地：神戸   国名：その他  

心臓手術後の認知機能障害と脳局所酸素飽和度の低下との関係

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

種別：大会・シンポジウム等 

種別：大会・シンポジウム等 

種別：大会・シンポジウム等 

医学部4年生の侵襲医学講義

医局員の学会発表、症例報告、論文執筆指導