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   出版者・発行元：Japan Society of Circulation Control in Medicine  

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

DOI： 10.11312/ccm.44.99

CiNii Research

記述言語：英語   出版者・発行元：Antioxidants  

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

DOI： 10.3390/antiox11081454

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：American Journal of Case Reports  

Objective: Background: Case Report: Conclusions: Rare disease 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. 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 diffi-culty of intubation and concern about postoperative upper-airway obstruction due to changes in the oral cav-ity. 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 dexameth-asone. Good analgesia was achieved, and the patient was stable during the operation. The patient was dis-charged 12 days postoperatively without additional signs of infection or new blister formation, although surgical wound healing was delayed. 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

Web of Science

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

開催年月日： 2023年9月

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開催地：京都市   国名：日本国  

開催年月日： 2022年6月 - 2023年6月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：神戸市   国名：日本国  

開催年月日： 2022年5月 - 2023年5月

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開催年月日： 2021年10月

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開催地：Web   国名：日本国  

開催年月日： 2021年9月 - 2021年10月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：Web   国名：日本国  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

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