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Ken Yamaura Last modified date：2024.04.03

Professor / Surgery / Department of Clinical Medicine / Faculty of Medical Sciences


Papers
1. Kazuhiro Shirozu, Kaoru Umehara, Shinnosuke Takamori, Sayuri Takase, Ken Yamaura, Associations between ondansetron and the incidence of postoperative nausea and vomiting and food intake in Japanese female undergoing laparoscopic gynecological surgery: a retrospective study., Journal of anesthesia, 10.1007/s00540-023-03295-0, 2023.12, PURPOSE: Prevention of postoperative nausea and vomiting (PONV) is important to achieve DREAM (drinking, eating, mobilization). Ondansetron inhibits PONV, but its effects on postoperative food intake have not been investigated. This study aimed to examine associations between ondansetron and PONV incidence, and postoperative food intake. METHODS: This retrospective study included adult patients (n = 632) who underwent laparoscopic gynecological surgery at Kyushu University Hospital between January 2017 and June 2023. Outcomes were PONV on the day of surgery, PONV up to the day after surgery, and food intake, which was assessed for breakfast and lunch on the day after surgery. Odds ratios (ORs) for PONV incidence and postoperative no-food intake were calculated between those with and without ondansetron during surgery. Multivariable-adjusted analysis was performed using possible confounding factors for PONV. Synergistic effects of combining ondansetron with dexamethasone or total intravenous anesthesia (TIVA) were assessed. RESULTS: Multivariable-adjusted ORs for PONV on the day of surgery and up to the day after surgery were 0.56 (95% confidence interval, 0.32-0.99, p = 0.04) and 0.52 (0.30-0.93, p = 0.03), respectively, in the ondansetron group (n = 84) compared with the non-ondansetron group (n = 548). In contrast, multivariable-adjusted ORs for no-food intake of breakfast and lunch the day after surgery in the ondansetron group compared with the non-ondansetron group were not significant. Analysis of synergistic effects on PONV showed no significant interaction between ondansetron and dexamethasone or ondansetron and TIVA combinations. CONCLUSION: Ondansetron administration during surgery was significantly associated with decreased PONV risk but was not associated with food intake the day after surgery..
2. Shiho Shibata, Hideaki Tagashira, Takayuki Nemoto, Satomi Kita, Tomo Kita, Yasuharu Shinoda, Kouzaburo Akiyoshi, Ken Yamaura, Takahiro Iwamoto, Perineural treatment with anti-TNF-α antibody ameliorates persistent allodynia and edema in novel mouse models with complex regional pain syndrome., Journal of pharmacological sciences, 10.1016/j.jphs.2023.06.003, 153, 1, 1-11, 2023.09, Complex regional pain syndrome (CRPS) is an intractable chronic pain syndrome with various signs and symptoms including allodynia/hyperalgesia, edema, swelling, and skin abnormalities. However, a definitive therapeutic treatment for CRPS has not been established. In CRPS patients, inflammatory cytokines such as TNF-α and IL-1β have been shown to increase in affected areas, suggesting that these molecules may be potential therapeutic targets for CRPS. Here, we first created a novel CRPS mouse model (CRPS-II-like) via sciatic nerve injury and cast immobilization, which was characterized by mechanical allodynia, local edema, and skin abnormalities, to evaluate the pathophysiology and pharmacotherapy of CRPS. When an anti-TNF-α antibody was consecutively administered near the injured sciatic nerve of CRPS model mice, persistent allodynia and CRPS-related signs in the ipsilateral hindpaw were markedly attenuated to control levels. Perineural administration of anti-TNF-α antibody also suppressed the upregulation of inflammatory cytokines as well as the activation of macrophages and Schwann cells in the injured sciatic nerve. These findings indicate that persistent allodynia and CRPS-related signs in CRPS models are primarily associated with TNF-α-mediated immune responses in injured peripheral nerves, suggesting that perineural treatment with anti-TNF-α antibody might be therapeutically useful..
3. Makoto Sumie, Alan Yang, Jason Hayes, Ken Yamaura, Kazuyoshi Aoyama, How to mitigate confounding factors in observational studies., Journal of anesthesia, 10.1007/s00540-023-03236-x, 2023.08.
4. Keiko Nobukuni, Kazuhiro Shirozu, Aiko Maeda, Kouta Funakoshi, Midoriko Higashi, Ken Yamaura, Recovery of memory retention after anesthesia with remimazolam: an exploratory, randomized, open, propofol-controlled, single-center clinical trial., JA clinical reports, 10.1186/s40981-023-00635-7, 9, 1, 41-41, 2023.07, 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 
5. Kazuhiro Shirozu, Keiko Nobukuni, Jun Maki, Kanako Nagamatsu, Ryudo Tanaka, Kaiki Oya, Kouta Funakoshi, Midoriko Higashi, Ken Yamaura, Redistributional Hypothermia Prevention by Prewarming with Forced-Air: Exploratory, Open, Randomized, Clinical Trial of Efficacy., Therapeutic hypothermia and temperature management, 10.1089/ther.2022.0009, 13, 2, 55-61, 2023.06, 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 
6. Makoto Sumie, Ken Yamaura, Kazuyoshi Aoyama, Association of labor neuraxial analgesia with autism spectrum disorders in offspring., Journal of anesthesia, 10.1007/s00540-023-03162-y, 37, 2, 327-329, 2023.04.
7. Aiko Maeda, Yoji Chikama, Ryudo Tanaka, Masachika Tominaga, Kazuhiro Shirozu, Ken Yamaura, Safety and utility of ultrasound-guided superior cervical ganglion block for headaches and orofacial pain: a retrospective, single-center study of 10 patients., JA clinical reports, 10.1186/s40981-023-00613-z, 9, 1, 21-21, 2023.04, BACKGROUND: Several new ultrasound-guided superior cervical ganglia blocks (U-SCGBs) have been proposed to overcome the shortcomings of conventional superior cervical ganglia blocks; however, their clinical utility and practicality have not yet been demonstrated. The aim of this study was to evaluate the safety and utility of a new method of U-SCGB. METHODS: We retrospectively collected data on patients who underwent U-SCGB for the treatment of headaches and orofacial pain at a single center. U-SCGB was performed by injecting 2-3 mL of 1% mepivacaine posterior to the internal carotid artery, just above the bifurcation. The Wilcoxon signed-rank test was used to compare pain scores. Numerical data are expressed as the mean ± standard error. RESULTS: The total number of U-SCGB procedures was 43. All procedures were accompanied by Horner's sign. The numerical rating scale score for pain (possible scores, 0-10) was reduced predominantly from 7.0 ± 0.7 before treatment to 4.5 ± 0.7 at the follow-up (p = 0.014). CONCLUSION: U-SCGB was considered a clinically useful and accurate treatment for headaches and orofacial pain in this study..
8. Yuto Tanaka, Makoto Sumie, Takuma Hashimoto, Sayaka Osawa, Yuji Karashima, Tadashi Kandabashi, Ken Yamaura, Anesthetic management of pheochromocytoma and paraganglioma for patients with Fontan circulation: a case series., JA clinical reports, 10.1186/s40981-023-00605-z, 9, 1, 13-13, 2023.03, BACKGROUND: Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology. CASE PRESENTATION: We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3. CONCLUSIONS: Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation..
9. Makoto Sumie, Nozomi Kameyama, Taiki Akasaka, Yuto Tanaka, Taichi Ando, Tadashi Kandabashi, Yuji Karashima, Ken Yamaura, Anesthetic management of hepatectomy for the patient with Fontan circulation: a case series., JA clinical reports, 10.1186/s40981-022-00582-9, 8, 1, 94-94, 2022.12, BACKGROUND: Hepatectomy for patients with Fontan circulation consists of high central venous pressure and low pulmonary vascular resistance, and is challenging for physicians. CASE PRESENTATION: We performed anesthetic management for hepatectomy in three patients with Fontan circulation. Massive bleeding and transfusion as well as careful management were needed. Open abdominal surgery had to be conducted instead of laparoscopic surgery for controlling bleeding in one case. We successfully performed general anesthesia using nitric oxide and inotropes while monitoring arterial pressure and central venous pressure in all the cases. CONCLUSIONS: To maintain Fontan circulation during hepatectomy, it is important to manage central venous pressure and ensure appropriate circulatory volume..
10. Tadayuki Ishibashi, Daichi Sueto, Yu Yoshikawa, Keisuke Koga, Ken Yamaura, Makoto Tsuda, Identification of Spinal Inhibitory Interneurons Required for Attenuating Effect of Duloxetine on Neuropathic Allodynia-like Signs in Rats., Cells, 10.3390/cells11244051, 11, 24, 2022.12, Neuropathic pain is a chronic pain condition that occurs after nerve damage; allodynia, which refers to pain caused by generally innocuous stimuli, is a hallmark symptom. Although allodynia is often resistant to analgesics, the antidepressant duloxetine has been used as an effective therapeutic option. Duloxetine increases spinal noradrenaline (NA) levels by inhibiting its transporter at NAergic terminals in the spinal dorsal horn (SDH), which has been proposed to contribute to its pain-relieving effect. However, the mechanism through which duloxetine suppresses neuropathic allodynia remains unclear. Here, we identified an SDH inhibitory interneuron subset (captured by adeno-associated viral (AAV) vectors incorporating a rat neuropeptide Y promoter; AAV-NpyP+ neurons) that is mostly depolarized by NA. Furthermore, this excitatory effect was suppressed by pharmacological blockade or genetic knockdown of α1B-adrenoceptors (ARs) in AAV-NpyP+ SDH neurons. We found that duloxetine suppressed Aβ fiber-mediated allodynia-like behavioral responses after nerve injury and that this effect was not observed in AAV-NpyP+ SDH neuron-selective α1B-AR-knockdown. These results indicate that α1B-AR and AAV-NpyP+ neurons are critical targets for spinal NA and are necessary for the therapeutic effect of duloxetine on neuropathic pain, which can support the development of novel analgesics..
11. Tomohiko Akahoshi, Noriyuki Kaku, Yuji Shono, Yuzo Yamamoto, Keita Takahashi, Takeshi Iyonaga, Kenta Momii, Masaaki Nishihara, Jun Maki, Kentaro Tokuda, Ken Yamaura, Impact of Antithrombin Activity Levels Following Recombinant Antithrombin Gamma Therapy in Patients with Sepsis-Induced Disseminated Intravascular Coagulation., Clin Appl Thromb Hemost, 10.1177/10760296221135790, 10760296221135790., 2022.11.
12. Yoji Chikama, Aiko Maeda, Ryudo Tanaka, Masachika Tominaga, Kazuhiro Shirozu, Ken Yamaura, Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report., JA clinical reports, 10.1186/s40981-022-00574-9, 8, 1, 84-84, 2022.10, BACKGROUND: Intractable chronic pain, as well as motor, sensory, and autonomic neuropathy, significantly reduces the quality of life of brachial plexus avulsion (BPA) patients. We report the successful application of cervical selective nerve root injection (CSNRI) in a patient with BPA. CASE PRESENTATION: A 40-year-old man had been diagnosed with complete left BPA due to a motorcycle accident and underwent intercostal nerve transplantation at the age of 18 years and had been experiencing pain ever since. His pain increased after fracture of the left humerus, and he was referred to our pain management clinic. As his exacerbated pain was suspected to be due to peripheral nerve hypersensitivity, we performed repetitive ultrasound-guided CSNRI (3 mL of 1% mepivacaine of each) targeted C5 and 6 intervertebral foramina, and his symptoms gradually improved. CONCLUSIONS: Repetitive CSNRI may help diagnose and treat BPA-associated peripheral neuropathic pain, even in patients diagnosed with BPA..
13. Hiroki Matsushita, Tetsushiro Fujiyoshi, Koichiro Yoshimaru, Toshiharu Matsuura, Yuichi Mushimoto, Yuji Karashima, Ken Yamaura, Anesthesia management in living-donor liver transplantation in a patient with carbamoyl phosphate synthetase deficiency: a case report., JA clinical reports, 10.1186/s40981-022-00558-9, 8, 1, 71-71, 2022.09, BACKGROUND: Carbamoyl phosphate synthetase deficiency (CPS1D) is a urea-cycle disorder (UCD). We report successful perioperative management of pediatric living donor liver transplantation (LDLT) in a CPS1D patient. CASE PRESENTATION: A 10-year-old female patient with CPS1D underwent LDLT. Proper administration of dextrose 50% and 60 kcal/kg/day with L-arginine and L-carnitine resulted in the avoidance of intraoperative hyperammonemia induced by hypercatabolism. Serum ammonia level transiently increased to 61 mmol/L in the anhepatic phase and decreased to 44 mmol/L after reperfusion. CONCLUSIONS: We suggest anesthesia management with administration of dextrose to avoid hyperammonemia during LDLT in patients with CPS1D..
14. Jun Maki, Makoto Sumie, Tomoko Ide, Masako Nagamatsu, Katsuyuki Matsushita, Kazuhiro Shirozu, Midoriko Higashi, Ken Yamaura, A pressure-resistant peripherally inserted central catheter is as useful as a central venous catheter for rapid fluid infusion: an in vitro study., BMC anesthesiology, 10.1186/s12871-022-01738-x, 22, 1, 205-205, 2022.07, 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..
15. Yuka Inoue, Kazuhiro Shirozu, Ryotaro Shiraki, Tetsuhiro Fujiyoshi, Kana Fukutoku, Yukie Mizuta, Midoriko Higashi, Ken Yamaura, Lower-Leg Amputation Performed Under Regional Anesthesia in a Patient with Epidermolysis Bullosa: A Case Report., The American journal of case reports, 10.12659/AJCR.936722, 23, e936722, 2022.07, 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..
16. Yukie Mizuta, Tomohiko Akahoshi, Hinako Eto, Fuminori Hyodo, Masaharu Murata, Kentaro Tokuda, Masatoshi Eto, Ken Yamaura, Noninvasive Diagnosis of the Mitochondrial Function of Doxorubicin-Induced Cardiomyopathy Using In Vivo Dynamic Nuclear Polarization-Magnetic Resonance Imaging., Antioxidants (Basel, Switzerland), 10.3390/antiox11081454, 11, 8, 2022.07, 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..
17. Kazuhiro Shirozu, Ken Yamaura, The relationship between EMG and processed EEG., Journal of anesthesia, 10.1007/s00540-022-03074-3, 36, 3, 445-446, 2022.05.
18. Masako Asada, Mao Shibata, Naoki Hirabayashi, Tomoyuki Ohara, Yoshihiko Furuta, Taro Nakazawa, Takanori Honda, Jun Hata, Masako Hosoi, Nobuyuki Sudo, Ken Yamaura, Toshiharu Ninomiya, Association between chronic low back pain and regional brain atrophy in a Japanese older population: the Hisayama Study., Pain, 10.1097/j.pain.0000000000002612, 163, 11, 2185-2193, 2022.03, ABSTRACT: Chronic low back pain (CLBP) is the leading cause of years lived with disability. Recently, it has been reported that CLBP is associated with alterations in the central nervous system. The present study aimed to investigate the association between CLBP and regional brain atrophy in an older Japanese population. A total of 1106 community-dwelling participants aged ≥65 years underwent brain magnetic resonance imaging scans and a health examination in 2017 to 2018. We used the FreeSurfer software for the analysis of brain magnetic resonance imaging. Chronic pain was defined as subjective pain for ≥3 months. Participants were divided into 3 groups according to the presence or absence of chronic pain and the body part that mainly suffered from pain: a "no chronic pain (NCP)" group (n = 541), "CLBP" group (n = 189), and "chronic pain in body parts other than the lower back (OCP)" group (n = 376). The brain volumes of the ventrolateral and dorsolateral prefrontal cortex, the posterior cingulate gyrus, and the amygdala were significantly lower in the CLBP group than in the NCP group after adjustment for sociodemographic, physical, and lifestyle factors and depressive symptoms. In addition, the left superior frontal gyrus was identified as a significant cluster by the Query, Design, Estimate, Contrast interface. There were no significant differences in the brain volumes of pain-related regions between the NCP and the OCP groups. The present study suggests that CLBP is associated with lower brain volumes of pain-related regions in a general older population of Japanese..
19. Kaoru Umehara, Yuji Karashima, Tomoharu Yoshizumi, Ken Yamaura, Factors Associated With Postreperfusion Syndrome in Living Donor Liver Transplantation: A Retrospective Study., Anesthesia and analgesia, 10.1213/ANE.0000000000006002, 135, 2, 354-361, 2022.03, BACKGROUND: Postreperfusion syndrome (PRS) after portal vein reperfusion during liver transplantation (LT) has been reported to cause rapid hemodynamic changes and is associated with a prolonged postoperative hospital stay, renal failure, and increased mortality. Although there are some reports on risk factors for PRS in brain-dead donor LT, there are a few reports on those in living donor LT. Therefore, we retrospectively reviewed the factors associated with PRS to contribute to the anesthetic management so as to reduce PRS during living donor LT. METHODS: After approval by the ethics committee of our institution, 250 patients aged ≥20 years who underwent living donor LT at our institution between January 2013 and September 2018 were included in the study. A decrease in mean arterial pressure of ≥30% within 5 minutes after portal vein reperfusion was defined as PRS, and estimates and odds ratio (OR) for PRS were calculated using logistic regression. The backward method was used for variable selection in the multivariable analysis. RESULTS: Serum calcium ion concentration before reperfusion (per 0.1 mmol/L increase; OR, 0.74; 95% confidence interval (CI), 0.60-0.95; P
20. Taichi Ando, Makoto Sumie, Shoichi Sasaki, Miho Yoshimura, Keiko Nobukuni, Jun Maki, Katsuyuki Matsushita, Kazuhiro Shirozu, Midoriko Higashi, Ken Yamaura, Anesthetic management of cesarean section in a patient with Takayasu's arteritis: a case report., JA clinical reports, 10.1186/s40981-021-00494-0, 8, 1, 1-1, 2022.01, 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..
21. Kazuhiro Shirozu, Keiko Nobukuni, Kaoru Umehara, Masako Nagamatsu, Midoriko Higashi, Ken Yamaura, Comparison of the Occurrence of Postoperative Shivering Between Sevoflurane and Desflurane Anesthesia., Therapeutic hypothermia and temperature management, 10.1089/ther.2021.0029, 12, 3, 177-181, 2022.01, 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..
22. Kazuhiro Shirozu, Keiko Nobukuni, Shota Tsumura, Kazuya Imura, Kosuke Nakashima, Shinnosuke Takamori, Midoriko Higashi, Ken Yamaura, Neurological sedative indicators during general anesthesia with remimazolam., Journal of anesthesia, 10.1007/s00540-021-03030-7, 36, 2, 194-200, 2022.01, 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 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..
23. Erisa Nakamori, Kenji Shigematsu, Midoriko Higashi, Ken Yamaura, Postoperative Noninvasive Hemoglobin Monitoring Is Useful to Prevent Unnoticed Postoperative Anemia and Inappropriate Blood Transfusion in Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Controlled Trial, Geriatric Orthopaedic Surgery & Rehabilitation, 10.1177/21514593211060575, 12, 1-8, 2021.11, 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 12 g/dL or delayed transfusion in a case of SpHb
24. Tomonori Takazawa, Ken Yamaura, Tetsuya Hara, Tomoko Yorozu, Hiromasa Mitsuhata, Hiroshi Morimatsu, Practical guidelines for the response to perioperative anaphylaxis., Journal of anesthesia, 10.1007/s00540-021-03005-8, 35, 6, 778-793, 2021.10, Perioperative anaphylaxis is a severe adverse event during anesthesia that requires prompt diagnosis and treatment by physicians, including anesthesiologists. Muscle relaxants and antibiotics are the most common drugs that cause perioperative anaphylaxis in Japan, as in many countries. In addition, sugammadex appears to be a primary causative agent. Obtaining previous anesthesia records is necessary in a patient with a history of allergic reactions during anesthesia, whenever possible, to avoid recurrence of anaphylaxis. Although medical staff are likely to notice abnormal vital signs because of complete monitoring during anesthesia, surgical drapes make it difficult to notice the appearance of skin symptoms. Even if there are no skin symptoms, anaphylaxis should be suspected, especially when hypotension resistant to inotropes and vasopressors persists. For improving the diagnostic accuracy of anaphylaxis, it is helpful to collect blood samples to measure histamine/tryptase concentrations immediately after the events and at baseline. The first-line treatment for anaphylaxis is adrenaline. In the perioperative setting, adrenaline should be administered through the intravenous route, which has a faster effect onset and is secured in most cases. Adrenaline can cause serious complications including severe arrhythmias if the appropriate dose is not selected according to the severity of symptoms. The anesthesiologist should identify the causative agent after adverse events. The gold standard for identifying the causative agent is the skin test, but in vitro tests including specific IgE antibody measurements and basophil activation tests are also beneficial. The Working Group of the Japanese Society of Anesthesiologists has developed this practical guide to help appropriate prevention, early diagnosis and treatment, and postoperative diagnosis of anaphylaxis during anesthesia.Grade of recommendations and levels of evidence Anaphylaxis is a relatively rare condition with few controlled trials, and thus a so-called evidence-based scrutiny is difficult. Therefore, rather than showing evidence levels and indicating the level of recommendation, this practical guideline only describes the results of research available to date. The JSA will continue to investigate anaphylaxis during anesthesia, and the results may lead to an amendment of this practical guideline..
25. Keisuke Mihara, Haruna Nakahara, Kouhei Iwashita, Kenji Shigematsu, Ken Yamaura, Kozaburo Akiyoshi, Cerebral hemorrhagic infarction was diagnosed subsequently after high-amplitude slow waves detected on processed electroencephalogram during sedation: a case report., JA clinical reports, 10.1186/s40981-021-00483-3, 7, 1, 79-79, 2021.10, BACKGROUND: Continuous electroencephalogram (EEG) monitoring is useful for assessing the level of sedation and detecting non-convulsive epileptic seizures and cerebral ischemia in the intensive care unit. This report describes a case of cerebral hemorrhagic infarction diagnosed after the detection of high-amplitude slow waves on processed EEG during sedation. CASE PRESENTATION: A 68-year-old man who underwent cardiac surgery was sedated in the intensive care unit following an invasive procedure. High-amplitude slow waves appeared on processed EEG monitoring before the detection of anisocoria. Computed tomography revealed a cerebral hemorrhagic infarction. CONCLUSIONS: In the management of critically ill patients, continuous EEG monitoring with forehead electrodes may be useful in the early detection of brain lesions..
26. Hiroyoshi Doi, Taito Matsuda, Atsuhiko Sakai, Shuzo Matsubara, Sumio Hoka, Ken Yamaura, Kinichi Nakashima, Early-life midazolam exposure persistently changes chromatin accessibility to impair adult hippocampal neurogenesis and cognition., Proceedings of the National Academy of Sciences of the United States of America, 10.1073/pnas.2107596118, 118, 38, 2021.09, Linkage between early-life exposure to anesthesia and subsequent learning disabilities is of great concern to children and their families. Here we show that early-life exposure to midazolam (MDZ), a widely used drug in pediatric anesthesia, persistently alters chromatin accessibility and the expression of quiescence-associated genes in neural stem cells (NSCs) in the mouse hippocampus. The alterations led to a sustained restriction of NSC proliferation toward adulthood, resulting in a reduction of neurogenesis that was associated with the impairment of hippocampal-dependent memory functions. Moreover, we found that voluntary exercise restored hippocampal neurogenesis, normalized the MDZ-perturbed transcriptome, and ameliorated cognitive ability in MDZ-exposed mice. Our findings thus explain how pediatric anesthesia provokes long-term adverse effects on brain function and provide a possible therapeutic strategy for countering them..
27. GO Kusumoto, Midoriko Higashi, Kenji Shigematsu, Ken Yamaura, Third-Generation Hydroxyethyl Starch Causes Dose-Dependent Coagulopathy in Patients Undergoing Off-Pump Coronary Artery Bypass with Continuation of Preoperative Aspirin., The heart surgery forum, 10.1532/hsf.4061, 24, 5, E949-E854, 2021.09, 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
28. Keita Takahashi, Kazuya Imura, Keiko Nobukuni, Shoichi Sasaki, Taichi Nagano, Noboru Harada, Tomoharu Yoshizumi, Midoriko Higashi, Ken Yamaura, Anesthetic Management Using Low Fraction of Inspiratory Oxygen for Living Donor Liver Transplantation in a Patient With Hepatopulmonary Syndrome Complicated by Interstitial Pneumonia: A Case Report., Transplantation proceedings, 10.1016/j.transproceed.2021.08.007, 53, 8, 2556-2558, 2021.08, BACKGROUND: Hepatopulmonary syndrome frequently complicates end-stage liver disease. It causes hypoxemia and requires oxygen administration. Additionally, interstitial pneumonia causes hypoxemia; however, it is known to be aggravated by high-concentration oxygen administration. CASE PRESENTATION: A 71-year-old woman with hepatopulmonary syndrome and interstitial pneumonia underwent living donor liver transplantation, requiring conflicting management in terms of the inspiratory oxygen concentration. We achieved a low intraoperative fraction of inspiratory oxygen by increasing the cardiac output with intravenous catecholamines. As a result, the transplanted liver functioned well postoperatively, and the patient was discharged without exacerbation of the interstitial pneumonia. CONCLUSION: We suggest that patients with hepatopulmonary syndrome complicated with interstitial pneumonia can undergo successful living donor liver transplantation without the use of high inspiratory oxygen concentration by using catecholamines to maintain a high mixed venous oxygen saturation..
29. Aiko Maeda, Kenzo Araki, Chiaki Yamada, Shoko Nakayama, Kazuhiro Shirozu, Ken Yamaura, Treatment of trigeminal and glossopharyngeal neuralgia in an adolescent: a case report., JA clinical reports, 10.1186/s40981-021-00465-5, 7, 1, 61-61, 2021.08, BACKGROUND: Hyperactive dysfunction syndrome (HDS) refers to a constellation of symptoms developing from cranial nerve overactivity caused by neurovascular compression at the root entry or exit zone near the brainstem. Although the combined features of HDS are seen in the elderly, there are no reports of such cases in adolescents, to date. CASE PRESENTATION: A 17-year-old male was diagnosed with right glossopharyngeal neuralgia and treated with microvascular decompression. He experienced new-onset right facial pain later and was diagnosed with right trigeminal neuralgia, which required prompt radiofrequency thermocoagulation of the right mandibular nerve. Follow-up in the third post-treatment year revealed the absence of symptom recurrence. DISCUSSION: We report the treatment of a rare case of adolescent-onset combined HDS presenting as trigeminal and glossopharyngeal neuralgia. This report highlights the possibility of combined hyperactive dysfunction syndrome in younger age groups. It is crucial to establish a diagnosis early on for prompt management..
30. Ryoko Owaki-Nakano, Midoriko Higashi, Kohei Iwashita, Kenji Shigematsu, Emiko Toyama, Ken Yamaura, Anesthetic management of multiple acyl-coenzyme A dehydrogenase deficiency in a series of surgeries under general anesthesia: a case report., JA clinical reports, 10.1186/s40981-021-00459-3, 7, 1, 54-54, 2021.07, BACKGROUND: Glutaric acidemia is a type of multiple acyl-coenzyme A dehydrogenase deficiency, an inborn error in fatty acid metabolism. In patients with glutaric acidemia, during the perioperative period, prolonged fasting, stress, and pain have been identified as risk factors for the induction of metabolic derangement. This report describes the surgical and anesthetic management of a patient with glutaric acidemia. CASE PRESENTATION: A 56-year-old male patient with glutaric acidemia type 2 underwent a series of surgeries. During the initial off-pump coronary artery bypass surgery, the patient developed renal failure due to rhabdomyolysis upon receiving glucose at 2 mg/kg/min. However, in the second laparoscopic cholecystectomy, rhabdomyolysis was avoided by administering glucose at 4 mg/kg/min. CONCLUSIONS: To avoid catabolism in patients with glutaric acidemia, appropriate glucose administration is important, depending on the surgical risk..
31. Mizuko Ikeda, Miwako Tanabe, Ayumi Fujimoto, Tomoka Matsuoka, Makoto Sumie, Ken Yamaura, Predictors of failure of intersegmental line creation using bronchoscopic jet ventilation for thoracoscopic pulmonary segmentectomy., JA clinical reports, 10.1186/s40981-021-00457-5, 7, 1, 53-53, 2021.07, BACKGROUND: During pulmonary segmentectomy, identification of the target segment is essential. We used bronchoscopic jet ventilation (BJV) to delineate the intersegmental plane by selectively sending air into the target segment. The purpose of this study was to investigate the factors associated with BJV failure. METHODS: Data were retrospectively collected from 48 patients who underwent pulmonary segmentectomy with BJV between March 2014 and May 2019 at a single center. Data were compared between BJV succeeded cases and failed cases. RESULTS: In 13 cases (27%), BJV were unsuccessful. The Brinkman index was significantly higher in failed cases (962 ± 965 failed vs. 395 ± 415 successful, P = 0.0067). The success rate was significantly lower when BJV was applied to the posterior basal segmental bronchus (B10) (B10: 1/5 (20%) vs others: 34/43 (79%), P = 0.015). CONCLUSION: Long-term smoking and the bronchus corresponding to the posterior basal segment might make successful performance of BJV difficult..
32. Chiaki Yamada, Aiko Maeda, Katsuyuki Matsushita, Shoko Nakayama, Kazuhiro Shirozu, Ken Yamaura, 1-kHz high-frequency spinal cord stimulation alleviates chronic refractory pain after spinal cord injury: a case report., JA clinical reports, 10.1186/s40981-021-00451-x, 7, 1, 46-46, 2021.06, BACKGROUND: Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. CASE PRESENTATION: A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. CONCLUSIONS: SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects..
33. Misaki Yamamoto, Fumi Takahashi-Yanaga, Masaki Arioka, Kazunobu Igawa, Katsuhiko Tomooka, Ken Yamaura, Toshiyuki Sasaguri, Cardiac and renal protective effects of 2,5-dimethylcelecoxib in angiotensin II and high-salt-induced hypertension model mice., Journal of hypertension, 10.1097/HJH.0000000000002728, 39, 5, 892-903, 2021.05, BACKGROUND: We reported that 2,5-dimethylcelecoxib (DM-celecoxib), a celecoxib derivative that is unable to inhibit cyclooxygenase-2, prevented cardiac remodeling induced by sarcomeric gene mutation, left ventricular pressure overload, or β-adrenergic receptor stimulation. This effect seemed to be mediated by the inhibition of the canonical Wnt/β-catenin signaling pathway, which has been suggested to play a key role in the development of chronic kidney disease and chronic heart failure. METHOD: We investigated the effect of DM-celecoxib on cardiac remodeling and kidney injury in hypertension model mice induced by angiotensin II infusion in the absence or presence of high-salt load. RESULTS: DM-celecoxib prevented cardiac remodeling and markedly reduced urinary albumin excretion without altering blood pressure in those mice. Moreover, DM-celecoxib prevented podocyte injury, glomerulosclerosis, and interstitial fibrosis in the kidney of mice loaded with angiotensin II and high-salt load. DM-celecoxib reduced the phosphorylation level of Akt and activated glycogen synthase kinase-3, which led to the suppression of the Wnt/β-catenin signal in the heart and kidney. DM-celecoxib also reduced the expression level of snail, a key transcription factor for the epithelial-mesenchymal transition and of which gene is a target of the Wnt/β-catenin signal. CONCLUSION: Results of the current study suggested that DM-celecoxib could be beneficial for patients with hypertensive heart and kidney diseases..
34. Katsuyuki Matsushita, Risa Arai, Tetsuzo Nakayama, Toshiaki Nakagaki, Tadashi Kandabashi, Ken Yamaura, Complete atrio-ventricular block with coronary artery spasm due to direct laryngoscopy in a pediatric patient with laryngeal papillomatosis: a case report., JA clinical reports, 10.1186/s40981-021-00437-9, 7, 1, 36-36, 2021.04, BACKGROUND: Coronary artery spasm has rarely been reported in pediatric patients. Previous studies have reported comorbidities and risk factors for coronary artery spasms. We present the case of a complete atrio-ventricular (AV) block that occurred in the absence of other risk factors immediately after direct laryngoscopy. CASE PRESENTATION: A 2-year-old girl developed severe coronary artery spasm after direct laryngoscopy for elective laryngeal papillomatosis resection. Immediately after the initiation of laryngoscopy, complete AV block and ST elevation on lead II of the electrocardiogram were observed. These findings indicated that the complete AV block was caused by a right coronary artery spasm. CONCLUSION: Coronary artery spasm resulting in lethal arrhythmia rarely occurs in healthy pediatric patients. To the best of our knowledge, this is the first pediatric case of a severe coronary artery spasm resulting in a complete AV block due to direct laryngoscopy in a healthy patient..
35. Tetsuzo Nakayama, Kaoru Umehara, Kazuhiro Shirozu, Makoto Sumie, Yuji Karashima, Midoriko Higashi, Ken Yamaura, Association between ionized magnesium and postoperative shivering., Journal of anesthesia, 10.1007/s00540-021-02914-y, 35, 3, 412-419, 2021.03, PURPOSE: Ionized magnesium (iMg) is considered to be the biologically active fraction of circulating total serum Mg (tMg). However, only the relationship between tMg and postoperative shivering has been studied. To our knowledge, hitherto no clinical studies have investigated the association between serum ionized magnesium concentration ([iMg]) and postoperative shivering. Therefore, we aimed to retrospectively examine this association, focusing on hypomagnesemia and depletion of [iMg]. METHODS: This retrospective study involved 421 patients who underwent pancreaticoduodenectomy under general anesthesia at our center from December 2012 to September 2019. Logistic regression analysis was performed to estimate the odds ratio (OR) for the incidence of postoperative shivering. RESULTS: Postoperative shivering developed in 111 out of 421 patients. The post-surgical concentration of [iMg] was significantly associated with postoperative shivering in the non-adjusted model, but not in the multivariable-adjusted model. In multivariable-adjusted analysis, progressive decrease of [iMg] by 0.1 mmol/L significantly increased the risk of postoperative shivering (OR: 1.64, 95% CI 1.02-2.64, p = 0.04). The multivariable-adjusted OR for postoperative shivering was 3.65 (95% CI 1.25-13.55, p = 0.02) in subjects with post-surgical [iMg] less than 0.6 mmol/L and decrease in [iMg] during surgery compared with those with post-surgical [iMg] more than 0.6 mmol/L and constant or increased of [iMg] during surgery. CONCLUSION: A decrease in the [iMg] during surgery was significantly associated with postoperative shivering. Subjects who had an [iMg] lower than 0.6 mmol/L post-surgery and decreased [iMg] during surgery had a significantly higher risk of postoperative shivering. Intraoperative depletion of [iMg] was significantly associated with shivering..
36. Kazuhiro Shirozu, Kaoru Umehara, Masatsugu Watanabe, Akihiro Tsuchimoto, Yasuhiro Okabe, Ken Yamaura, Evaluation of postoperative kidney function after administration of 6% hydroxyethyl starch during living-donor nephrectomy for transplantation., Journal of anesthesia, 10.1007/s00540-020-02862-z, 35, 1, 59-67, 2021.02, PURPOSE: We aimed to investigate whether 6% HES 130/0.4 was associated with postoperative reduction of estimated glomerular filtration rate (eGFR) in donor patients who underwent nephrectomy for living kidney transplantation. METHODS: This retrospective study included 213 living kidney transplant donors treated at Kyushu University Hospital in Japan from April 2014 to March 2018. Patients who were administered 6% HES 130/0.4 were allocated in the HES group (n = 108), and those who were not were allocated in the control group (n = 105). The postoperative decrements in estimated glomerular filtration rates (eGFRs) from preoperative values were calculated on postoperative days (PODs) 1, 3, and 14. Decline in kidney function (DKF) according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification were analyzed by multivariable-adjusted ordinal logistic regression to estimate odds ratios (ORs) for postoperative DKF. RESULTS: In HES group, administration amount of HES was median 9.4 [interquartile range: 8.2-14.3] ml/kg. Postoperative decrements in eGFR were similar in the control and HES groups on POD 1 (control group: mean 32.0 vs. HES group: 33.0 mL/min/1.73 m2), same as POD 3 (21.1 vs. 22.4 mL/min/1.73 m2) and POD 14 (26.0 vs. 25.9 mL/min/1.73 m2), even after adjusting for confounding factors. The multivariable-adjusted ORs for postoperative DKF did not significantly increase in the HES group on POD 1 (OR: 0.88), POD 3 (OR: 0.96), and POD 14 (OR: 0.52) compared with the control group. CONCLUSION: Six percent HES 130/0.4 is not associated with postoperative renal dysfunction in donor patients undergoing nephrectomy for kidney transplantation..
37. Kazuhiro Shirozu, Hidekazu Setoguchi, Kenzo Araki, Taichi Ando, Ken Yamaura, Impact of air-conditioner outlet layout on the upward airflow induced by forced air warming in operating rooms., American journal of infection control, 10.1016/j.ajic.2020.06.202, 49, 1, 44-49, 2021.01, BACKGROUND: Previously, we found that an upward air current in the head area, induced by forced air warming (FAW), was completely counteracted by downward laminar airflow. However, this study did not include any consideration of the air-conditioner outlet layout (ACOL); hence, its impact remains unclear. METHODS: This study was performed in 2 operating rooms (ORs)-ISO classes 5 and 6, which are denoted as OR-5 and OR-6, respectively. Both ORs have distinct ACOLs. The cleanliness, or the number or ratio of shifting artificial particles was evaluated. RESULTS: During the first 5 minutes after particles generation, significantly more particles shifted into the surgical field in OR-5 when compared to OR-6 (13,587 [4,341-15,913] and 106 [41-338] particles/cubic foot, P
38. Takamori R, Shirozu K, Hamachi R, Abe K, Nakayama S, Yamaura K, Intubation technique in a patient with tracheobronchopathia osteochondroplastica, Am J Case Rep, 10.12659/AJCR.928743., 22, e928743., 2021.01.
39. Yuri Fujimoto, Ryosuke Hamachi, Yoshimasa Motoyama, Etsuko Kanna, Masako Murakami, Takako Matsukado, Genkichi Saito, Ken Yamaura, Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report., JA clinical reports, 10.1186/s40981-020-00407-7, 7, 1, 4-4, 2021.01, BACKGROUND: Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy. CASE PRESENTATION: A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications. CONCLUSIONS: Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications..
40. Ryoko Takamori, Kazuhiro Shirozu, Ryosuke Hamachi, Kiyokazu Abe, Shoko Nakayama, Ken Yamaura, Intubation Technique in a Patient with Tracheobronchopathia Osteochondroplastica., The American journal of case reports, 10.12659/AJCR.928743, 22, e928743, 2021.01, BACKGROUND Tracheobronchopathia osteochondroplastica (TO) is a rare disorder characterized by cartilaginous or ossified submucosal nodules of unknown etiology that project into the tracheobronchial lumen. TO is often accompanied by endotracheal stenosis from cartilage proliferation and is often detected by difficult endotracheal intubation incidence. CASE REPORT Here we report the case of a patient (67-year-old man) with TO scheduled to undergo robot-assisted total prostatectomy for prostate cancer. The tracheal lumen was especially narrow at an area 1 cm below the glottis, with the smallest lumen diameter being 9 mm. After rapid induction, the bronchoscope passed through the stenosed region, and a 6.5-mm spiral endotracheal tube (ETT) was inserted with bronchoscopic assistance. However, because of resistance, the spiral ETT could not pass through the stenosed area. After changing to a 6.5-mm normal ETT, intubation was successfully performed with gentle rotation. Owing to the rotation, the tip entered and gained access to the gap between nodules. With use of a bronchoscope, we confirmed that the tip of the ETT was advanced 10 cm from the glottis, where the site of maximum stenosis was not covered by the tube cuff, and where the tip did not cross the bifurcation. After surgery, no bleeding or edema was found on bronchoscopy. CONCLUSIONS In patients with TO, it is important to assess the airway condition and prepare for difficult intubation. In this case, tracheal intubation was performed with rotation using a bronchoscope and normal ETT..
41. Akiko Shimazaki, Takuma Hashimoto, Masaya Kai, Tetsuzo Nakayama, Mai Yamada, Karen Zaguirre, Kentaro Tokuda, Makoto Kubo, Ken Yamaura, Masafumi Nakamura, Surgical treatment for breast cancer in a patient with erythropoietic protoporphyria and photosensitivity: a case report., Surgical case reports, 10.1186/s40792-020-01068-5, 7, 1, 1-1, 2021.01, BACKGROUND: Erythropoietic protoporphyria (EPP) is a rare disorder of heme synthesis. Patients with EPP mainly show symptoms of photosensitivity, but approximately 20% of EPPs are associated with the liver-related complications. We report a case of breast cancer in a 48-year-old female patient with EPP in whom meticulous perioperative management was required in order to avoid complications resulting from this disease. CASE PRESENTATION: The patient was diagnosed with EPP at the age of 33 and had a rich family history of the disease. For right breast cancer initially considered as TisN0M0 (Stage 0), the right mastectomy and sentinel lymph node biopsy were performed, while the final stage was pT1bN0M0, pStage I. In the perioperative period, we limited the drug use and monitored light wavelength measurements. Besides, we covered surgical lights, headlights, and laryngoscope's light with a special polyimide film that filtered the wavelength of light causing dermal photosensitivity. After the surgery, any emerging complications were closely monitored. CONCLUSIONS: The surgery, internal medicine, anesthesiology, and operation departments undertook all possible measures through close cooperation to ensure a safe surgery for the patient with a rare condition..
42. Sho Kawasaki, Chikako Kiyohara, Yuji Karashima, Ken Yamaura, Blood Pressure Management After Reperfusion in Living-Donor Kidney Transplantation., Transplantation proceedings, 10.1016/j.transproceed.2020.04.1820, 52, 10, 3009-3016, 2020.12, BACKGROUND: The central focus of anesthesia management in kidney transplantation is to avoid hypotensive episodes and maintain adequate perfusion pressure to the graft. However, it is not clear whether there is an optimal systolic blood pressure (SBP) level after reperfusion for living-donor transplant outcomes. The aim of this study is to investigate the effect of SBP after reperfusion on early graft function in living-donor kidney transplantation. METHODS: We retrospectively analyzed 315 patients who underwent living-donor kidney transplantation from January 2013 to December 2017. We divided the patients into 4 groups according to SBP after reperfusion and compared the postoperative estimated glomerular filtration rate and creatinine. RESULTS: There were no differences in the postoperative recovery of kidney graft function in the first 7 postoperative days among the 4 SBP groups after reperfusion. However, the urine output after reperfusion was significantly less in the group with SBP 
43. Kazuhiro Shirozu, Shinnosuke Takamori, Hidekazu Setoguchi, Ken Yamaura, Effects of forced air warming systems on the airflow and sanitation quality of operating rooms with non-laminar airflow systems., Perioperative care and operating room management, 10.1016/j.pcorm.2020.100119, 21, 100119-100119, 2020.12, Background: : Previous studies have demonstrated that forced air warming (FAW) can be used safely in operating rooms with laminar airflow (LAF) ventilation systems. However, the effects of FAW on the airflow at surgical sites under non-LAF (nLAF) ventilation systems remain unclear, as nLAF systems generate outlet-to-inlet multidirectional airflows of the air conditioning system. Here, we evaluate the effects of FAW on the airflow and sanitation quality in surgical fields with nLAF ventilation systems. Methods: : The airflow speed and direction were measured using a three-dimensional ultrasonic anemometer. Sanitation quality was evaluated by measuring the amount of dust particles after the activation of air conditioning. Results: : FAW caused no meaningful airflow (> 10 cm/sec) and did not diminish the sanitation quality in the surgical field separated by the anesthesia screen. Above the head area, the upward FAW airflow was not counteracted by nLAF, which caused an upward airflow at the edges of the operating table, originating from outside of the operating table and the floor. Conclusions: : Sanitation quality was kept under FAW working even in an nLAF-equipped OR. According to the inlet/outlet layouts of nLAF, the upward FAW-induced airflow in the head area was not counteracted, and the upward airflow from the floor induced by the air conditioner outlet could be detected..
44. Midoriko Higashi, Keizo Kaku, Yasuhiro Okabe, Ken Yamaura, Anesthetic Management of Living-Donor Renal Transplantation in a Patient With Epstein Syndrome Using Rotational Thromboelastometry: A Case Report., A&A practice, 10.1213/XAA.0000000000001350, 14, 13, e01350, 2020.11, Epstein syndrome is a myosin heavy chain 9 (MYH9)-related disorder characterized by hearing loss and macrothrombocytopenia with renal failure, which usually requires platelet transfusion during surgery. We report the case of a 22-year-old man who underwent living-donor renal transplantation without platelet transfusion using rotational thromboelastometry (ROTEM) monitoring. His intraoperative laboratory coagulation findings were a platelet count of 28-31 × 10/L based on microscopy and fibrinogen of 256 mg/dL. However, his extrinsic pathway evaluations by ROTEM were normal. The estimated blood loss during the operation was 150 mL, and the patient showed no bleeding complications without platelet transfusion..
45. Yukie Mizuta, Tomohiko Akahoshi, Jie Guo, Shuo Zhang, Sayoko Narahara, Takahito Kawano, Masaharu Murata, Kentaro Tokuda, Masatoshi Eto, Makoto Hashizume, Ken Yamaura, Exosomes from adipose tissue-derived mesenchymal stem cells ameliorate histone-induced acute lung injury by activating the PI3K/Akt pathway in endothelial cells., Stem cell research & therapy, 10.1186/s13287-020-02015-9, 11, 1, 508-508, 2020.11, BACKGROUND: Mesenchymal stem cells (MSCs), including adipose-derived mesenchymal stem cells (ADSCs), have been shown to attenuate organ damage in acute respiratory distress syndrome (ARDS) and sepsis; however, the underlying mechanisms are not fully understood. In this study, we aimed to explore the potential roles and molecular mechanisms of action of ADSCs in histone-induced endothelial damage. METHODS: Male C57BL/6 N mice were intravenously injected with ADSCs, followed by histones or a vehicle. The mice in each group were assessed for survival, pulmonary vascular permeability, and histological changes. A co-culture model with primary human umbilical vein endothelial cells (HUVECs) exposed to histones was used to clarify the paracrine effect of ADSCs. Overexpression and inhibition of miR-126 ADSCs were also examined as causative factors for endothelial protection. RESULTS: The administration of ADSCs markedly improved survival, inhibited histone-mediated lung hemorrhage and edema, and attenuated vascular hyper-permeability in mice. ADSCs were engrafted in the injured lung and attenuated histone-induced endothelial cell apoptosis. ADSCs showed endothelial protection (via a paracrine effect) and Akt phosphorylation in the histone-exposed HUVECs. Notably, increased Akt phosphorylation by ADSCs was mostly mediated by exosomes in histone-induced cytotoxicity and lung damage. Moreover, the expression of miR-126 was increased in exosomes from histone-exposed ADSCs. Remarkably, the inhibition of miR-126 in ADSCs failed to increase Akt phosphorylation in histone-exposed HUVECs. CONCLUSION: ADSC-derived exosomes may exert protective effects on endothelial cells via activation of the PI3K/Akt pathway..
46. Aiko Maeda, Masatsugu Watanabe, Chiaki Saigano, Shoko Nakayama, Ken Yamaura, Spinal cord stimulation alleviates intractable pain due to malignant pleural mesothelioma: a case report., JA clinical reports, 10.1186/s40981-020-00386-9, 6, 1, 78-78, 2020.10, BACKGROUND: Patients with malignant pleural mesothelioma (MPM) frequently complain of intractable pain that is resistant to conservative treatments. Although spinal cord stimulation (SCS) may be promising in the alleviation of such devastating pain, the effects of SCS on MPM-associated pain and the appropriate timing of its application remain unknown. CASE PRESENTATION: A 66-year-old man diagnosed with MPM presented with severe neuropathic pain due to rapid progression of the tumor to the intercostal nerves. The patient immediately decided to receive SCS implantation and burst stimulus, which relieved the conservative therapy-resistant pain and improved his sleep and daily activities. CONCLUSION: This report suggests that the execution of SCS as soon as possible may help to alleviate MPM symptoms. Since MPM extends aggressively to the thorax and nerves that cause mixed nociceptive and/or neuropathic pain, appropriate pain management requires the proper assessment of the etiology by an expert in pain management..
47. Brachial plexus block improved refractory pain due to intraoperative position-related nerve injury: a case report.
48. Taku Nakagawa, Toshiharu Yasaka, Noriyuki Nakashima, Mitsue Takeya, Kensuke Oshita, Makoto Tsuda, Ken Yamaura, Makoto Takano, Expression of the pacemaker channel HCN4 in excitatory interneurons in the dorsal horn of the murine spinal cord., Molecular brain, 10.1186/s13041-020-00666-6, 13, 1, 127-127, 2020.09, In the central nervous system, hyperpolarization-activated, cyclic nucleotide-gated (HCN1-4) channels have been implicated in neuronal excitability and synaptic transmission. It has been reported that HCN channels are expressed in the spinal cord, but knowledge about their physiological roles, as well as their distribution profiles, appear to be limited. We generated a transgenic mouse in which the expression of HCN4 can be reversibly knocked down using a genetic tetracycline-dependent switch and conducted genetically validated immunohistochemistry for HCN4. We found that the somata of HCN4-immunoreactive (IR) cells were largely restricted to the ventral part of the inner lamina II and lamina III. Many of these cells were either parvalbumin- or protein kinase Cγ (PKCγ)-IR. By using two different mouse strains in which reporters are expressed only in inhibitory neurons, we determined that the vast majority of HCN4-IR cells were excitatory neurons. Mechanical and thermal noxious stimulation did not induce c-Fos expression in HCN4-IR cells. PKCγ-neurons in this area are known to play a pivotal role in the polysynaptic pathway between tactile afferents and nociceptive projection cells that contributes to tactile allodynia. Therefore, pharmacological and/or genetic manipulations of HCN4-expressing neurons may provide a novel therapeutic strategy for the pain relief of tactile allodynia..
49. Yukie Mizuta, Kentaro Tokuda, Jie Guo, Shuo Zhang, Sayoko Narahara, Takahito Kawano, Masaharu Murata, Ken Yamaura, Sumio Hoka, Makoto Hashizume, Tomohiko Akahoshi, Sodium thiosulfate prevents doxorubicin-induced DNA damage and apoptosis in cardiomyocytes in mice., Life sciences, 10.1016/j.lfs.2020.118074, 257, 118074-118074, 2020.09, AIM: Doxorubicin (DOX) induces dose-dependent cardiotoxicity due to reactive oxygen species (ROS)-mediated oxidative stress and subsequent apoptosis of cardiomyocytes. We aimed to assess whether sodium thiosulfate (STS), which has antioxidant and antiapoptotic properties, exerts cardioprotective effects on DOX-induced cardiomyopathy. MAIN METHODS: Male C57BL/6N mice were divided into four groups, control, DOX, STS, and DOX + STS, and administered DOX (20 or 30 mg/kg) or normal saline intraperitoneally, followed by an injection of STS (2 g/kg) or normal saline 4 h later. KEY FINDINGS: The DOX group showed a poorer 6-day survival and decreased cardiac function than the DOX + STS group. The DOX group showed a marked increase in the plasma creatine kinase isoenzyme myocardial band (CK-MB) and lactate dehydrogenase (LDH) levels 10 h after DOX injection, while the DOX + STS group showed suppression of DOX-induced elevation of CK-MB and LDH levels. The DOX group showed increased 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in the heart, whereas the DOX + STS group showed increased catalase and superoxide dismutase (SOD) activities and decreased 8-OHdG levels in the heart compared with DOX group, suggesting that STS reduces DOX-induced DNA damage by improving antioxidant enzymes activities in cardiomyocytes. Additionally, the DOX + STS group showed attenuation of cleaved caspase-3 and DNA fragmentation in cardiomyocytes compared with the DOX group, suggesting that STS suppresses DOX-induced apoptosis in cardiomyocytes. SIGNIFICANCE: STS exerts cardioprotective effects against DOX-induced cardiac dysfunction partly by improving antioxidant defense and suppressing apoptosis, indicating the therapeutic potential of STS against DOX-induced cardiomyopathy..
50. Masami Kimura, Hiroaki Shiokawa, Yuji Karashima, Makoto Sumie, Sumio Hoka, Ken Yamaura, Antinociceptive effect of selective G protein-gated inwardly rectifying K+ channel agonist ML297 in the rat spinal cord, PloS one, 10.1371/journal.pone.0239094, 15, 9, e0239094, 2020.09, The G protein-gated inwardly rectifying K+ (GIRK) channels play important signaling roles in the central and peripheral nervous systems. However, the role of GIRK channel activation in pain signaling remains unknown mainly due to the lack of potent and selective GIRK channel activators until recently. The present study was designed to determine the effects and mechanisms of ML297, a selective GIRK1/2 activator, on nociception in the spinal cord by using behavioral studies and whole-cell patch-clamp recordings from substantia gelatinosa (SG) neurons. Rats were prepared for chronic lumber catheterization and intrathecal administration of ML297. The nociceptive flexion reflex was tested using an analgesy-meter, and the influence on motor performance was assessed using an accelerating rotarod. We also investigated pre- and post-synaptic actions of ML297 in spinal cord preparations by whole-cell patch-clamp recordings. Intrathecal administration of ML297 increased the mechanical nociceptive threshold without impairing motor function. In voltage-clamp mode of patch-clamp recordings, bath application of ML297 induced outward currents in a dose-dependent manner. The ML297-induced currents demonstrated specific equilibrium potential like other families of potassium channels. At high concentration, ML297 depressed miniature excitatory postsynaptic currents (mEPSCs) but not their amplitude. The ML297-induced outward currents and suppression of mEPSCs were not inhibited by naloxone, a μ-opioid receptor antagonist. These results demonstrated that intrathecal ML297 showed the antinociceptive effect, which was mediated through direct activation of pre- and post-synaptic GIRK channels. Selective GIRK channel activation is a promising strategy for the development of new agents against chronic pain and opioid tolerance..
51. Kazuhiro Shirozu, Yuji Karashima, Ken Yamaura, Effect of antithrombin in fresh frozen plasma on hemostasis after cardiopulmonary bypass surgery., Perfusion, 10.1177/0267659120948435, 36, 4, 267659120948435-267659120948435, 2020.08, INTRODUCTION: Supplementation of fresh frozen plasma immediately after cardiopulmonary bypass is an effective method to enhance clotting ability as coagulation factors are consumed in the extracorporeal circuit during cardiopulmonary bypass. On the other hand, the anticoagulation factors in fresh frozen plasma can also deter the clotting ability. This study investigated the effect of fresh frozen plasma administration on the comprehensive clotting ability following cardiopulmonary bypass. METHODS: This prospective observational study included 22 patients scheduled for cardiac surgery. Clotting times and maximum clot firmness were evaluated using the types of rotational thromboelastometry, intrinsic rotational thromboelastometry, and heparinase thromboelastography preoperatively, immediately after cardiopulmonary bypass, and 1 hour after cardiopulmonary bypass. Activated clotting time, antithrombin activity, and heparin concentration were also measured at these time-points. RESULTS: Antithrombin activity (62.9 ± 7.2% vs. 51.1 ± 7.4%, p 
52. Ventricular Tachycardia During Total Hip Arthroplasty：A Case Report.
53. Jie Guo, Kazuhiro Shirozu, Tomohiko Akahoshi, Yukie Mizuta, Masaharu Murata, Ken Yamaura, The farnesyltransferase inhibitor tipifarnib protects against autoimmune hepatitis induced by Concanavalin A., International immunopharmacology, 10.1016/j.intimp.2020.106462, 83, 106462-106462, 2020.06, No effective treatment has been established for autoimmune hepatitis (AIH), except for liver transplantation in the fatal stage. Little is known about the roles and mechanisms of farnesyltransferase inhibitors (FTIs) in treating AIH. Thus, we investigated the specific role of the FTI, tipifarnib, in a Concanavalin A (Con A)-induced model of hepatitis. The effects of tipifarnib (10 mg/kg, intraperitoneal injection) were studied in Con A (20 mg/kg, intravenous injection)-challenged mice by histological, biochemical, and immunological analyses. Tipifarnib-treated mice were compared to phosphate-buffered saline (PBS)-treated mice. Con A caused liver injury characterized by increased plasma alanine aminotransferase (ALT) levels and marked histological changes. The increased serum ALT, interleukin-6, or interferon-γ (IFN-γ) levels were observed at 2 or 8 h; tumor necrosis factor-α levels at 2 h post-Con A administration decreased significantly in the tipifarnib group. Tipifarnib also suppressed Con A-induced activation of CD4+ cells (but not CD8+ T cells) in the liver and spleen, and also reversed the Con A-induced decrease of natural killer T (NKT) cells in the liver. Tipifarnib significantly inhibited IFN-γ production and STAT1 phosphorylation from CD4+ T cells (but not CD8+ T and NKT cells) in the liver at 2 h post-Con A administration. Tipifarnib significantly inhibited IFN-γ production by splenic CD4+ T cells at 48 h post-Con A injection in vitro. Tipifarnib also inhibited the expression of farnesylated proteins induced by Con A administration. In conclusion, tipifarnib inhibited IFN-γ derived from Con A-induced CD4+ T cell activation due to downregulated STAT1 phosphorylation, suggesting that Tipifarnib can protect against AIH..
54. Yutaro Kammura, Ai Fujita, Yuji Karashima, Shoko Nakayama, Kazuhiro Shirozu, Tadashi Kandabashi, Ken Yamaura, Anesthetic management of laparoscopy-assisted total proctocolectomy in a cardiac sarcoidosis patient with a cardiac resynchronization therapy-defibrillator: a case report., JA clinical reports, 10.1186/s40981-020-00350-7, 6, 1, 43-43, 2020.06, BACKGROUND: Cardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). For the first time, we report the anesthetic management of a CS patient with a CRT-D. CASE PRESENTATION: A 65-year-old male with an implanted CRT-D due to CS was scheduled for a laparoscopy-assisted total proctocolectomy for his transverse colon cancer. His left ventricular ejection fraction was 32.0%, and his physical status was a New York Heart Association class III. General and epidural anesthesia were performed while using standard monitors and a FloTracTM system. The dual-chamber pacing (DDD) modality of the CRT-D was unchanged, and its defibrillation function was deactivated before surgery. The surgery was successfully performed, and the patient was discharged without worsening of his cardiac condition. CONCLUSIONS: A detailed understanding of this patient's condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient..
55. Kazuhiro Shirozu, Kaoru Umehara, Mizuko Ikeda, Yutaro Kammura, Ken Yamaura, Incidence of postoperative shivering decreased with the use of acetaminophen: a propensity score matching analysis., Journal of anesthesia, 10.1007/s00540-020-02763-1, 34, 3, 383-389, 2020.06, OBJECTIVES: The incidence of postoperative shivering is known to be inversely associated with core body temperature. However, previous studies have pointed out that the threshold of shivering could be affected by peripheral temperature or anesthetic agents. These reports pointed specific drugs, though, anesthesia techniques have since advanced considerably. This study aimed to investigate factors associated with postoperative shivering in the context of the current body warming practice. METHODS: The institutional clinical research ethics committee of Kyushu University approved the study protocol (IRB Clinical Research number 2019-233). This retrospective study involved 340 patients who had undergone radical surgery for gynecological cancer treatment under general anesthesia at our center from December 2012 to June 2019. Logistic regression analysis was performed to estimate the odds ratio (OR) for the incidence of postoperative shivering. RESULTS: Postoperative shivering developed in 109 out of 340 patients. After multivariate-adjusted logistic regression, the incidences of postoperative shivering decreased significantly with increasing patient age (OR = 0.96; 95%CI: 0.93-0.98; p = 0.0004). Volatile anesthesia technique was less inclined to shiver after surgery than TIVA (OR = 0.55; 95%CI: 0.30-0.99; p = 0.04). Acetaminophen was much less used in the shivering group than in the non-shivering group (OR = 0.49; 95%CI: 0.25-0.94; p = 0.03). CONCLUSIONS: This study indicated that the development of shivering in patients receiving the anesthetic technique currently used in our hospital was associated with use of acetaminophen or volatile agents, and patient age..
56. Midoriko Higashi, Kenji Shigematsu, Kenji Tominaga, Kazuya Murayama, Daisuke Seo, Toshikazu Tsuda, Gen Maruta, Kohei Iwashita, Ken Yamaura, Preoperative elevated E/e' (≥ 15) with preserved ejection fraction is associated with the development of postoperative heart failure in intermediate-risk non-cardiac surgical patients., Journal of anesthesia, 10.1007/s00540-019-02728-z, 34, 2, 250-256, 2020.04, 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' 
57. Atsushi Kobayashi, Kazuhiro Shirozu, Yuji Karashima, Katsuyuki Matsushita, Ken Yamaura, Cerebral infarction detected after laparoscopic partial hepatectomy: case report., JA clinical reports, 10.1186/s40981-019-0301-7, 5, 1, 82-82, 2019.12, BACKGROUND: Bleeding and carbon dioxide (CO2) gas embolism have been reported as serious complications associated with laparoscopic surgery. We present a case of cerebral infarction presumably caused by CO2 gas embolism during laparoscopic hepatectomy. CASE PRESENTATION: During liver resection, the end-tidal CO2 suddenly dropped from 40 to 21 mmHg. Simultaneously, ST elevation in lead II and ST depression in lead V5 of the electrocardiogram were observed. After improvement of these electrocardiographic changes, surgery was continued. Postoperatively, incomplete paralysis was present in the right arm and leg. Magnetic resonance imaging revealed cerebral infarction in the broad area of the left cerebral cortex. These complications might have been caused by paradoxical embolism. CONCLUSION: We should always keep in mind the risk of cerebral infarction with neurological deficits in the case of laparoscopic surgery. Careful monitoring and appropriate treatment for gas embolism are necessary during laparoscopic surgery..
58. Masako Asada, Emi Oishi, Satoko Sakata, Jun Hata, Daigo Yoshida, Takanori Honda, Yoshihiko Furuta, Mao Shibata, Kosuke Suzuki, Hiroshi Watanabe, Norihito Murayama, Takanari Kitazono, Ken Yamaura, Toshiharu Ninomiya, Serum Lipopolysaccharide-Binding Protein Levels and the Incidence of Cardiovascular Disease in a General Japanese Population: The Hisayama Study., Journal of the American Heart Association, 10.1161/JAHA.119.013628, 8, 21, e013628, 2019.11, Background Epidemiological studies have reported a link between serum LBP (lipopolysaccharide-binding protein) levels and lifestyle-related diseases. However, there have been no longitudinal studies investigating the association of serum LBP levels and the incidence of cardiovascular disease (CVD) in general populations. Methods and Results A total of 2568 community-dwelling Japanese individuals 40 years and older without prior CVD were followed for 10 years (2002-2012). Serum LBP levels were divided into quartiles (quartile 1: 2.20-9.68 μg/mL; quartile 2: 9.69-10.93 μg/mL; quartile 3: 10.94-12.40 μg/mL; quartile 4: 12.41-24.34 μg/mL). The hazard ratios (HRs) and their 95% CIs for the incidence of CVD were computed using a Cox proportional hazards model. During the follow-up period, 180 individuals developed CVD. The age- and sex-adjusted cumulative incidence of CVD increased significantly with higher serum LBP levels (P for trend=0.005). Individuals with higher serum LBP levels had a significantly greater risk of the development of CVD after adjusting for conventional cardiovascular risk factors (quartile 1: HR, 1.00 [reference]; quartile 2: HR, 1.04 [95% CI, 0.60-1.78]; quartile 3: HR, 1.52 [95% CI, 0.92-2.51]; and quartile 4: HR, 1.90 [95% CI, 1.17-3.09]; P for trend=0.01). This association remained significant after additional adjustment for homeostasis model assessment of insulin resistance (P for trend=0.01). However, when additional adjustment was made for high-sensitivity C-reactive protein, the association was attenuated to the nonsignificant level (P for trend=0.08). Conclusions The present findings suggest that higher serum LBP levels are associated with increased risk of the development of CVD in the general Japanese population. Low-grade endotoxemia may contribute to the pathogenesis of CVD through chronic systemic inflammation..
59. Ryohei Miyazaki, Makoto Sumie, Tadashi Kandabashi, Ken Yamaura, Resting pupil size is a predictor of hypotension after induction of general anesthesia., Journal of anesthesia, 10.1007/s00540-019-02672-y, 33, 5, 594-599, 2019.10, PURPOSE: Arterial hypotension is a major adverse effect of general anesthesia. Patients with pre-existing autonomic dysfunction are at greater risk of hypotension. This study was performed to examine whether objective measurement of the pupillary light reflex is predictive of intraoperative hypotension. METHODS: We studied 79 patients who underwent scheduled surgery under general anesthesia. Patients with severe cardiovascular disease or receiving antihypertensive agents were excluded. The light reflex was measured preoperatively using a portable infrared pupillometer, and the hemodynamic parameters were obtained from the anesthesia records. The patients were divided into two groups according to the development of hypotension: the hypotension and normotension groups. Multivariate logistic regression analysis was performed to determine the pupil parameters predictive of hypotension. RESULTS: Patients in the hypotension group were older and had a greater pupil size or constriction velocity than those in the normotension group. Logistic regression analysis showed that post-induction hypotension was significantly associated with maximum pupil size or constriction velocity after adjustment for age and other clinical variables. Latency of the light reflex and the percent reduction of pupil size were not associated with hypotension. Age was a relatively strong predictor of hypotension; other confounding factors were not associated with hypotension. CONCLUSION: Measurement of maximum pupil size is useful to identify patients at risk for intraoperative hypotension. The influence of age must be considered during measurement of the pupil response. CLINICAL TRIAL NUMBER: UMIN000023729 REGISTRY URL: https://www.umin.ac.jp..
60. Ryosuke Mimata, Midoriko Higashi, Madoka Yasui, Takanao Hirai, Ken Yamaura, Spinal Epidural Hematoma Following Epidural Catheter Removal in a Patient with Postoperative Urgent Coronary Intervention and Intra-Aortic Balloon Pumping (IABP): A Case Report., The American journal of case reports, 10.12659/AJCR.917716, 20, 1356-1359, 2019.09, BACKGROUND It is still challenging to remove an epidural catheter in a postoperative patient receiving urgent antiplatelet and anticoagulation therapy for acute coronary syndrome. CASE REPORT While under general anesthesia combined with thoracic epidural anesthesia, a 72-year-old male patient underwent right radical nephrectomy for renal cell carcinoma. On postoperative day 1 (POD1), the patient experienced bradycardia and a decrease in blood pressure, and he was diagnosed acute myocardial infarction. Intra-aortic balloon pumping (IABP) was induced for cardiogenic shock, and urgent thrombus aspiration and coronary balloon angioplasty were performed. On POD3, the surgeon removed the epidural catheter under both antiplatelet and anticoagulation therapy. At that time, the platelet count was 45×10⁹/L and the activated partial thromboplastin time (APTT) was 72.2 seconds. Four hours after the epidural catheter was removed, the patient complained of bilateral fatigue in legs and developed a loss of sensation. Six hours after the epidural catheter was removed, he developed motor paralysis and became completely paralyzed in both limbs after 9 hours. At 19 hours after the epidural catheter was removed, emergency magnetic resonance imaging detected a spinal epidural hematoma at the level of Th9-11 with compression of the spinal cord. Emergency laminectomy was performed to decompress and remove the spinal epidural hematoma at 18 hours after the onset of sensorimotor symptoms. After surgery and rehabilitation, these symptoms had only slightly improved. CONCLUSIONS In patients with urgent antithrombotic therapy for urgent percutaneous coronary intervention (PCI) with an IABP for acute coronary syndrome, the epidural catheter should not be removed until the IABP and heparin are discontinued, and platelet counts have recovered..
61. Kenji Shigematsu, Kouhei Iwashita, Ryosuke Mimata, Ryoko Owaki, Takaaki Totoki, Akira Gohara, Jingo Okawa, Midoriko Higashi, Ken Yamaura, Preoperative Left Ventricular Diastolic Dysfunction Is Associated with Pulmonary Edema after Carotid Endarterectomy., Neurologia medico-chirurgica, 10.2176/nmc.oa.2019-0028, 59, 8, 299-304, 2019.08, This retrospective study was aimed to investigate the association between preoperative left ventricular (LV) cardiac function and the incidence of postoperative pulmonary edema (PE) in patients undergoing carotid endarterectomy (CEA). Most patients undergoing CEA for carotid artery stenosis have concomitant heart diseases, leading to hemodynamic instability that can cause postoperative cardiac complications such as cardiac heart failure. LV diastolic function has recently been recognized as an independent predictor of adverse cardiac events in patients undergoing cardiovascular surgery. We analyzed clinical data from the anesthetic and medical records of 149 consecutive patients who underwent CEA at our university hospital between March 2012 and March 2018. LV systolic and diastolic function were evaluated by ejection fraction and the ratio of LV early diastolic filling velocity to the peak velocity of mitral medial annulus (E/e'). Postoperative PE was diagnosed based on chest X-ray and arterial gas analysis by two independent physicians. Postoperative PE was developed in four patients (2.8%). Patients with postoperative PE were not related to preoperative low ventricular ejection fraction, but had a significantly higher E/e' ratio than those without PE (P = 0.01). Furthermore, there was an increasing trend of PE according to the E/e' category. Preoperative LV diastolic function evaluated by E/e' was associated with the development of postoperative PE in patients who underwent CEA. The results suggest that the evaluation of LV diastolic dysfunction could be possibly useful to predict PE in patients undergoing CEA..
62. M. Higashi, K. Shigematsu, E. Nakamori, S. Sakurai, K. Yamaura, Efficacy of programmed intermittent bolus epidural analgesia in thoracic surgery: a randomized controlled trial, BMC Anesthesiology, 10.1186/s12871-019-0780-0, 2019.06.
63. Ryohei Miyazaki, Sumio Hoka, Ken Yamaura, Visceral fat, but not subcutaneous fat, is associated with lower core temperature during laparoscopic surgery, PloS one, 10.1371/journal.pone.0218281, 14, 6, 2019.06, Background Previous studies suggest that lower BMI is a risk factor for intraoperative core hypothermia. Adipose tissue has a high insulation effect and is one of the major explanatory factors of core hypothermia. Accordingly, determining the respective influence of visceral and subcutaneous fat on changes in core temperature during laparoscopic surgery is of considerable interest. Methods We performed a prospective study of 104 consecutive donors who underwent laparoscopic nephrectomy. Temperature data were collected from anesthesia records. Visceral and subcutaneous fat were calculated by computed tomography (CT) or ultrasound. For ultrasound measurements, preperitoneal fat thickness was used as an index of visceral fat. Multiple linear regression analysis was performed at 30, 60, and 120 minutes after the surgical incision to identify the predictive factors of body temperature change. The potential explanatory valuables were age, sex, BMI, visceral fat, and subcutaneous fat. Results BMI (β = 0.010, 95%CI: 0.001–0.019, p = 0.033) and waist-to-hip ratio (β = 0.424, 95%CI: 0.065–0.782, p = 0.021) were associated with increased core temperature at 30 minutes after the surgical incision. Ultrasound measured-preperitoneal fat was significantly associated with increased core temperature at 30 and 60 minutes after the surgical incision (β = 0.012, 95%CI: 0.003–0.021, p = 0.009 and β = 0.013, 95%CI: 0.002–0.024, p = 0.026). CT-measured visceral fat was also associated with increased core temperature at 30 minutes after the surgical incision (β = 0.005, 95%CI: 0.000–0.010, p = 0.046). Conversely, subcutaneous fat was not associated with intraoperative core temperature. Male sex and younger age were associated with lower intraoperative core temperature. Conclusions Visceral fat protects against core temperature decrease during laparoscopic donor nephrectomy..
64. Kouhei Iwashita, Kenji Shigematsu, Ken Yamaura, Predicting optimal peripherally inserted central venous catheter insertion depth, 日本手術医学会誌, 40, 2, 61-67, 2019.06.
65. A case of postoperative shock due to aortic stenosis mimicking pulmonary thromboembolism.
66. Kazuhiro Shirozu, Keitaro Murayama, Ken Yamaura, Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy., Journal of visualized experiments : JoVE, 10.3791/59488, 2019, 146, 2019.04, Electroconvulsive therapy (ECT) is reported to be effective for severe neuropsychiatric disorders. In ECT, electrical stimulation is applied to the brain, inducing seizure activity. Adequate seizure induction with ECT is associated with seizure duration, symmetrical high amplitude waveforms during slow-wave activity, postictal suppression, and activation of the sympathetic nervous system. Sympathetic nervous system activation is influenced by anesthetic agents or cardiovascular drugs during ECT. Pupillary responses can reflect sympathetic nervous activity or the degree of brain damage. Pupillary response measurement can be conducted in a simple, precise, and objective way using an automated infrared pupillometer, enabling the measurement of pupil diameter (mm) to two decimal places. The white light used for measuring light reflexes is not overly bright, and patients do not typically report discomfort. Pupillary light reflexes were measured before anesthesia induction and immediately after electrical stimulation using this equipment. Pupil diameter is typically enlarged after brain damage or sympathetic nervous activation. Adequate seizure induction using ECT could induce pupillary enlargement immediately after electrical stimulation. In the current method, the constriction ratio of pupil size was calculated automatically and compared with seizure quality. Pupillary responses immediately after electrical stimulation may provide a useful assessment of the efficacy of seizure induction with ECT..
67. Toshitaka Yamanokuchi, Tomoko Nakagawa, Ken Yamaura, Chikara Yoshimura, Toshiki Maeda, Masayoshi Tsuji, Miki Kawazoe, Atsushi Sato, Hisatomi Arima, Predictors of a prolonged operation during when using general anesthesia in a teaching hospital, Medical Bulletin of Fukuoka university, 46, 1, 55-61, 2019.03.
68. Mari Yamashita-Ichimura, Emiko Toyama, Makoto Sasoh, Hironari Shiwaku, Kanefumi Yamashita, Yuichi Yamashita, Ken Yamaura, Bladder pressure monitoring and CO2 gas-related adverse events during per-oral endoscopic myotomy., Journal of clinical monitoring and computing, 10.1007/s10877-018-0122-7, 32, 6, 1111-1116, 2018.12, Per-oral endoscopic myotomy (POEM) is a minimally invasive treatment for esophageal achalasia. However, POEM has the potential risk of inducing carbon dioxide (CO2) gas-related adverse events, such as pneumoperitoneum, pneumomediastinum, and pneumothorax. The aim of this study was to evaluate the usability of bladder pressure monitoring as an index of CO2 gas-related pneumoperitoneum. The monitoring of bladder pressure and lung compliance and the incidence of iatrogenic pneumoperitoneum were retrospectively studied in 20 patients who underwent POEM between June 2013 and March 2015. The bladder pressure was measured using a Foley catheter. Abdominal distention was found in nine patients. The bladder pressure was significantly higher in the nine patients with the distention findings compared with patients without distention [7 (6-9) mmHg vs. 1 (0-2) mmHg; P 
69. Sasoh M, Shigematsu K, Toyama E, Okawa J, Yamaura K, Cesarean delivery for maternal mirror syndrome managed with general anesthesia: A case report., 麻酔と蘇生, 54, 3, 17-19, 2018.09.
70. Ken Yamaura, Transition to an ere where we constantly aim for improvement of quality and efficiency in medicine, Japanese Journal of Anesthesiology, 67, 8, 2018.08.
71. Shintaro Abe, Isao Haraga, Fumiaki Kiyomi, Hitomi Kumano, Akira Gohara, Shigehiro Matsumoto, Ken Yamaura, Bacterial contamination upon the opening of injection needles., JA clinical reports, 10.1186/s40981-018-0197-7, 4, 1, 61-61, 2018.08, INTRODUCTION: Two opening methods are used for injection needle products: the "peel-apart method" where the adhesive surface of the packaging mount is peeled off, and the "push-off top method," where the needle hub is pressed against the mount to break it. However, the risks of bacterial contamination as a result of opening method remain unknown. The aim of our study was to evaluate the bacterial contamination of needle hubs upon the opening of injection needles by the peel-apart or push-off top method under various conditions. METHODS: Bacterial contamination upon the opening of injection needles was examined in two materials, paper and plastic. Various concentrations of Staphylococcus aureus were applied to the mount and were maintained under wet or dry conditions. Injection needles were opened using the peel-apart or push-off top method. Needle hub contamination was examined using agar medium colony counting. Clinically assumed conditions (the hands and saliva of anesthesiologists) were also evaluated. Data were statistically examined using the Cochran-Mantel-Haenszel, Jonckheere, and Fisher's exact tests. RESULTS: The lateral surfaces of needle hubs were contaminated using the push-off top method, but not by the peel-apart method, in a manner that was dependent on S. aureus concentrations. No significant differences were observed between mount materials. Needle hub contamination was significantly more severe for the wet than for the dry opening portion. The clinically assumed condition study revealed that the lateral and bottom surfaces of the needle hub were contaminated significantly more in the saliva contamination group than in the dry and wet hand groups. CONCLUSIONS: The bacterial contamination of needle hubs may occur upon the opening of injection needles when the push-off top method is used and may be affected by hands contaminated with saliva under clinical conditions..
72. 質と効率の向上を絶え間なく目指す時代への転換.
73. Kiriko Takahashi, Chisato Umebayashi, Tomohiro Numata, Akira Honda, Jun Ichikawa, Yaopeng Hu, Ken Yamaura, Ryuji Inoue, TRPM7-mediated spontaneous Ca2+ entry regulates the proliferation and differentiation of human leukemia cell line K562., Physiological reports, 10.14814/phy2.13796, 6, 14, e13796, 2018.07, Continuous Ca2+ influx is essential to maintain intracellular Ca2+ homeostasis and its dysregulation leads to a variety of cellular dysfunctions. In this study, we explored the functional roles of spontaneous Ca2+ influx for the proliferation and differentiation of a human erythromyeloid leukemia cell line K562. mRNA/protein expressions were assessed by the real-time RT-PCR, western blotting, and immunocytochemical staining. Intracellular Ca2+ concentration ([Ca2+ ]i ) and ionic currents were measured by fluorescent imaging and patch clamping techniques, respectively. Cell counting/viability and colorimetric assays were applied to assess proliferation rate and hemoglobin synthesis, respectively. Elimination of extracellular Ca2+ decreased basal [Ca2+ ]i in proliferating K562 cells. Cation channel blockers such as SK&F96365, 2-APB, Gd3+ , and FTY720 dose dependently decreased basal [Ca2+ ]i . A spontaneously active inward current (Ispont ) contributive to basal [Ca2+ ]i was identified by the nystatin-perforated whole-cell recording. Ispont permeated Ca2+ comparably to Na+ , and was greatly eliminated by siRNA targeting TRPM7, a melastatin member of the transient receptor potential (TRP) superfamily. Consistent with these findings, TRPM7 immune reactivity was detected by western blotting, and immunofluorescence representing TRPM7 was found localized to the K562 cell membrane. Strikingly, all these procedures, that is, Ca2+ removal, TRPM7 blockers and siRNA-mediated TRPM7 knockdown significantly retarded the growth and suppressed hemin-induced γ-globin and hemoglobin syntheses in K562 cells, respectively, both of which appeared associated with the inhibition of ERK activation. These results collectively suggest that spontaneous Ca2+ influx through constitutively active TRPM7 channels may critically regulate both proliferative and erythroid differentiation potentials of K562 cells..
74. Akira Gohara, Sumi Okamatsu-Kifuji, Shinjiro Shono, Midoriko Higashi, Ken Yamaura, Ventricular tachycardia without preceding electrocardiogram change after hypertonic mannitol administration: a case report., JA clinical reports, 10.1186/s40981-018-0191-0, 4, 1, 54-54, 2018.07, 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% 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..
75. Yutaka Kenmizaki, Takahisa Shiratake, Shigeto Kadekawa, Shiori Toda, Ken Yamaura, Bilateral pneumothorax during laparoscopic distal gastrectomy A case report, Japanese Journal of Anesthesiology, 67, 5, 522-524, 2018.05, A 69-year-old man was scheduled for laparoscopic distal gastrectomy. He had pulmonary emphysema and a smoking history. Ninety eight minutes after the beginning of CO2 insufflation (10 mmHg), SpO2 decreased from 99 to 95%, EtCO2 increased from 35 to 39 mmHg While I investigated its cause, SPO2 decreased to 94% (FIO21.0), EtCO2 increased to 59 mmHg. Intraoperative chest X-ray showed bilateral pneumothorax without pneumomediastinum and subcutaneous emphysema Discussing with surgeons, we judged that the continuation of the pneumoperitonium was high-risk and performed open distal gastrectomy. Because it was both side pneumothorax and he was complicated with pulmonary emphysema After the end of the surgery, chest X-ray revealed complete resolution of pneumothoraces. The patient was moved to a general ward after tracheal extubation. As a cause of pneumothorax, the carbon dioxide inflow from the diaphragmatic weak part was suspected. Because it is hard to notice a decrease in pulmonary compliance during pressure controlled ventilatioa the appropriate alarm setting of a tidal volume is necessary..
76. Seiko Sato, Mariko Kaku, Ken Yamaura, Comparison of patient-controlled epidural analgesia and intravenous patient-controlled analgesia for postoperative pain in pediatric patients undergoing nuss procedure, Japanese Journal of Anesthesiology, 67, 4, 365-369, 2018.04, Background: Nuss procedure is a severely painful procedure for correcting pectus excavatum, and we conducted a retrospective comparison of patient-controlled epidural anesthesia (PCEA) and intravenous patient-controlled analgesia (IVPCA). Methods: The subjects were 26 pediatric patients aged between 5 to 15 years undergoing the Nuss procedure for pectus excavatum. Pain management was compared in patients with two groups: PCEA and IVPCA. Data collection included patient age and sex, body length, body weight, pain score, surgery/anesthesia times, the length of hospital stays after surgery, the use time of PCA, the rescue dose of analgesic drug, and complications. Results: Age, body length, body weight duration of anesthesia, length of hospital stays after surgery and time of PCA were significantly lower in IVPCA groups than in PCEA. There was no significant difference regarding the rescue dose of analgesic drug. Conclusions: The analgesic effect was not different between PCEA and IVPCA, and IVPCA may be better choice for anesthesiologist who do not have much experience of thoracic epidural anesthesia in children. The management of PONV and multimodal analgesia are needed..
77. Yuri Imakiire, Tomoaki Yanaru, Hitomi Kumano, Erisa Nakamori, Ken Yamaura, Malposition of Peripherally Inserted Central Catheter Into the Right Inferior Thyroid Vein: A Case Report., The American journal of case reports, 10.12659/AJCR.908636, 19, 491-493, 2018.04, BACKGROUND A peripherally inserted central catheter (PICC) causes few serious complications but can be malpositioned. To avoid malpositioning, ultrasound guidance is widely used. Here, we report the case of a patient who received a PICC that was inserted under ultrasound guidance, but the catheter tip accidentally entered the right inferior thyroid vein. CASE REPORT A 58-year-old woman was scheduled for reconstructive mammoplasty. After general anesthesia, a PICC was inserted via the right basilic vein. The PICC was inserted under guidance using a portable ultrasound machine with a high-frequency linear transducer. The tip of the guide wire and catheter were confirmed by ultrasound to be in the right subclavian vein, not in the right internal jugular vein, during insertion. However, the chest X-ray performed after the PICC insertion showed that the catheter had moved into the right inferior thyroid vein. CONCLUSIONS Malpositioning of a PICC can occur into any small vein. Ultrasound should be used not only to avoid malpositioning into the IJV, but also to confirm the proper position of the catheter tip during PICC insertion..
78. 小児漏斗胸患者の硬膜外鎮痛法と静脈内鎮痛法の検討-後ろ向き研究-.
79. Eriko Chijiiwa, Kenji Shigematsu, Kouhei Iwashita, Ken Yamaura, Ventricular fibrillation due to cardiac herniation upon emergence from general anesthesia in a patient with right completion pneumonectomy: A case report, 循環制御, 10.11312/ccm.38.218, 38, 3, 218-221, 2017.12.
80. T. Shimauchi, K. Yamaura, M. Higashi, K. Abe, T. Yoshizumi, S. Hoka, Fibrinolysis in Living Donor Liver Transplantation Recipients Evaluated Using Thromboelastometry: Impact on Mortality, TRANSPLANTATION PROCEEDINGS, 10.1016/j.transproceed.2017.09.025, 49, 9, 2117-2121, 2017.11, 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..
81. Kazunori Hirota, Kazuhiko Hirata, Shiho Shibata, Kenji Shigematsu, Kazuo Higa, Ken Yamaura, Risk Vessels of Retropharyngeal Hematoma during Stellate Ganglion Block, Regional Anesthesia and Pain Medicine, 10.1097/AAP.0000000000000644, 42, 6, 778-781, 2017.11, Background and Objective Bleeding into the retropharyngeal space is a potential complication in stellate ganglion block (SGB). Retropharyngeal hematoma formation is considered to be due to damage of small arteries in the region, although only scanty details of the region are available. The aim of this study was to map the risk blood vessels in the retropharyngeal space to avoid accidental damage during SGB. Methods Contrast-enhanced 3-dimensional computed tomography images performed on 80 patients were reanalyzed retrospectively to construct detailed map of cervical blood vessels that are prone to damage and bleeding during SGB. Results Of the 160 bilateral necks, 6 (3.8%) and 82 (51.3%) small arteries were identified in the medial portions of the ventral surface of the transverse processes of the sixth and seventh cervical vertebrae, respectively. In particular, 5 of the 6 small arteries detected in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra were the inferior thyroid artery (ITA). Of the 160 vertebral arteries, 2 arteries were missing, 4 (2.5%) entered the transverse foramen of the fifth cervical vertebra, whereas 1 artery (0.6%) entered the transverse foramen of the fourth cervical vertebra. Conclusions Three-dimensional computed tomography identified the ITA in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra. The risk vessels of retropharyngeal hematoma during SGB could include the ITA..
82. Go Kusumoto, Kenji Shigematsu, Kouhei Iwashita, Kenji Tominaga, Takaaki Totoki, Ken Yamaura, Association between Preoperative Cardiac Left Ventricular Dysfunction and Perioperative Intraaortic Balloon Pump in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery., The heart surgery forum, 10.1532/hsf.1808, 20, 4, E147-E152-E152, 2017.08, BACKGROUND: Prophylactic use of intraaortic balloon pump (IABP) reduces hospital mortality in patients with left ventricular (LV) systolic dysfunction undergoing coronary artery bypass surgery (CABG); however, its association in patients with LV diastolic dysfunction is unclear. This retrospective study investigated the association between preoperative LV function and perioperative use of IABP in patients undergoing off-pump CABG (OPCAB) at a university hospital. METHODS: 100 consecutive patients who underwent OPCAB between January 1, 2011 and August 31, 2014 were studied. Preoperative LV function was categorized into four groups based on LV systolic and diastolic function determined with preoperative transthoracic echocardiography. The use of IABP was reviewed from medical records. The Mann-Whitney test, Pearson chi-square test, or Fisher exact test were used. RESULTS: Patients were categorized into the following groups: normal LV function (n = 43), isolated LV systolic dysfunction (n = 13), isolated LV diastolic dysfunction (n = 21), and combined LV systolic and diastolic dysfunction (n = 14). Intraoperative IABP use was significantly more frequent in patients with isolated LV systolic dysfunction, isolated LV diastolic dysfunction, and combined LV systolic and diastolic dysfunction than in those with normal LV function (P
83. 「麻酔科医ができるSSI予防」によせて.
84. Seiko Sato, Erisa Nakamori, Go Kusumoto, Kenji Shigematsu, Ken Yamaura, Neurally Mediated Syncope During Cesarean Delivery: A Case Report., A & A case reports, 10.1213/XAA.0000000000000440, 8, 5, 96-99, 2017.03, A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia..
85. Isao Haraga, Shintaro Abe, Shiro Jimi, Fumiaki Kiyomi, Ken Yamaura, Increased biofilm formation ability and accelerated transport of Staphylococcus aureus along a catheter during reciprocal movements., Journal of microbiological methods, 10.1016/j.mimet.2016.11.003, 132, 63-68, 2017.01, Staphylococcus spp. is a major cause of device-related infections. However, the mechanisms of deep-tissue infection by staphylococci from the skin surface remain unclear. We performed in vitro experiments to determine how staphylococci are transferred from the surface to the deeper layers of agar along the catheter for different strains of Staphylococcus aureus with respect to bacterial concentrations, catheter movements, and biofilm formation. We found that when 5-mm reciprocal movements of the catheter were repeated every 8h, all catheter samples of S. aureus penetrated the typical distance of 50mm from the skin to the epidural space. The number of reciprocal catheter movements and the depth of bacterial growth were correlated. A greater regression coefficient for different strains implied faster bacterial growth. Enhanced biofilm formation by different strains implied larger regression coefficients. Increased biofilm formation ability may accelerate S. aureus transport along a catheter due to physical movements by patients..
86. 手術室における医療安全 手術室におけるインシデント -チェックリスト導入後の事例から学ぶ-.
87. Kanefumi Yamashita, Hironari Shiwaku, Toshihiro Ohmiya, Hideki Shimaoka, Hiroki Okada, Ryo Nakashima, Richiko Beppu, Daisuke Kato, Takamitsu Sasaki, Seiichiro Hoshino, Satoshi Nimura, Ken Yamaura, Yuichi Yamashita, Efficacy and safety of endoscopic submucosal dissection under general anesthesia., World journal of gastrointestinal endoscopy, 10.4253/wjge.v8.i13.466, 8, 13, 466-71, 2016.07, AIM: To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) under general anesthesia. METHODS: From January 2011 to July 2014, 206 consecutive patients had undergone ESD under general anesthesia for neoplasms of the stomach, esophagus, and colorectum were enrolled in this retrospective study. The efficacy and safety of ESD under general anesthesia were assessed. RESULTS: The en bloc resection rate of esophageal, gastric, and colorectal lesions was 100.0%, 98.3%, and 96.1%, respectively. The complication rate of perforation and bleeding were 0.0% and 0.0% in esophageal ESD, 1.7% and 1.7% in gastric ESD, and 3.9% and 2.0% in colorectal ESD, respectively. No cases of aspiration pneumonia were observed. All complications were managed by conservative treatment, with no surgical intervention required. CONCLUSION: With the cooperation of an anesthesiologist, ESD under general anesthesia appears to be a useful method, decreasing the risk of complications..
88. Katsuyuki Matsushita, Ken Yamaura, Yuji Karashima, Kozaburo Akiyoshi, Sumio Hoka, Differences in anatomical relationship between vertebral artery and internal jugular vein in children and adults measured by ultrasonography., Journal of clinical monitoring and computing, 10.1007/s10877-015-9705-8, 30, 2, 221-5, J Clin Monit Comput 30:221-225, 2016, 2016.04, Cannulation of the internal jugular vein (IJV) under ultrasound guidance can reduce complications, such as common carotid artery (CCA) puncture, accidental vertebral artery (VA) puncture. However, these complications still occur, especially in pediatric patients probably due to anatomical predisposition of VA. This study compared differences in anatomical location of VA and IJV between pediatric and adult patients. Children with body weight
89. 原賀 勇壮, 比嘉 和夫, 安部 伸太郎, 山浦 健, A novel model of epidural catheter-related infection: the importance of repeated catheter movements, 日本ペインクリニック学会誌, 10.11321/jjspc.15-0001, 23, 1, 1-7, 2016.03, Staphylococcus spp., which are nonmotile, are the most frequently isolated pathogens from the catheter of epidural abscesses. The movement mechanisms of Staphylococci remain unclear. We hypothesized that increased bacterial concentration and catheter reciprocal movements correlated with deeper penetration of Staphylococci into the catheterized site. We investigated the correlations among bacterial concentrations on the needle puncture surface and epidural catheter insertion sites, catheter movement, and Staphylococcus aureus growth in deeper layers of the agar. Staphylococci grew in the deeper layers of the agar when bacterial concentrations on the needle puncture surface and catheter insertion sites were increased. When 5-mm reciprocal movements of the catheter were repeated every 12 h over a 72-h period, Staphylococci penetrated the 5-cm-thick agar, the average distance from the skin to epidural space in adults. This resulted in increased Staphylococci concentrations and minor repeated catheter-movements because of physical movements of patients, which may result in the migration of Staphylococci into deeper tissues from the skin surface..
90. 福岡大学肺移植プログラム初期10年の成績.
91. 全身麻酔の可否に関する他科からのコンサルタントに対して.
92. Sumie M, Shiokawa H, Yamaura K, Karashima Y, Hoka S, Yoshimura M, Direct Effect of Remifentanil and Glycine Contained in Ultiva® on Nociceptive Transmission in the Spinal Cord: In Vivo and Slice Patch Clamp Analyses., PLoS One., 10.1371/journal.pone.0147339, 11, 1, e0147339, 2016.01.
93. Shiho Shibata, Eisuke Shono, Emi Nishimagi, Ken Yamaura, A patient with urinary tract tuberculosis during treatment with etanercept., The American journal of case reports, 10.12659/AJCR.893416, 16, 341-6, 2015.06, BACKGROUND: Tumor necrosis factor (TNF)-α inhibitors are widely used for rheumatoid arthritis (RA). However, there are several risks to use TNFα inhibitors. Given the properties of TNF-α inhibitors, prevention and early detection of tuberculosis (TB) are especially important. Even among TNF-α inhibitors, the risk of TB infection differs according to each drug. The incidence of TB is lowest with etanercept (ETN). We present a case of urinary tract TB during treatment with ETN. CASE REPORT: A 58-year-old woman was receiving ETN for RA. Before starting ETN, isoniazid (INH) prophylaxis was started. RA was well controlled by ETN. However, 32 months after starting ETN, she noticed urinary frequency and a sensation of residual urine. The diagnosis was elusive, and it took 3 months until urinary tract TB was finally diagnosed. The TB resolved with antituberculosis medication, but RA disease activity flared up after ETN was discontinued. ETN was resumed with careful monitoring for TB recurrence. After resuming ETN, the RA was again well controlled, with no recurrence of TB. CONCLUSIONS: Patients should be monitored for development of TB during ETN treatment, but ETN can be used safely with careful management..
94. Midoriko Higashi, Ken Yamaura, Yukie Matsubara, Takuya Fukudome, Sumio Hoka, In-line pressure within a HOTLINEA (R) Fluid Warmer, under various flow conditions, JOURNAL OF CLINICAL MONITORING AND COMPUTING, 10.1007/s10877-014-9605-3, 29, 2, 301-305, 2015.04, 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
95. Ken Yamaura, Noriko Nanishi, Midoriko Higashi, Sumio Hoka, Effects of thermoregulatory vasoconstriction on pulse hemoglobin measurements using a co-oximeter in patients undergoing surgery, JOURNAL OF CLINICAL ANESTHESIA, 10.1016/j.jclinane.2014.04.012, 26, 8, 643-647, 2014.12, 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 3 degrees C group (P 3 degrees C group.
Conclusion: SpHb measured at fingertip was significantly affected by the perfusion state, with lower perfusion associated with lower SpHb. Thermoregulatory vasoconstriction affects measurement of SpHb. (C) 2014 Elsevier Inc. All rights reserved..
96. Tsukasa Shimauchi, Ken Yamaura, Sayaka Sugibe, Sumio Hoka, Usefulness of sugammadex in a patient with Becker muscular dystrophy and dilated cardiomyopathy, Acta Anaesthesiologica Taiwanica, 10.1016/j.aat.2014.02.005, 52, 3, 146-148, 2014.09, A 54-year-old patient with Becker muscular dystrophy and dilated cardiomyopathy underwent laparoscopic cholecystectomy under total intravenous anesthesia. Muscle relaxation was induced by rocuronium (0.4 mg/kg body weight) under train-of-four (TOF) ratio monitoring. The TOF ratio was 0 at intubation, and 0.2 at the end of surgery. Residual muscle relaxant activity was successfully reversed by sugammadex (2 mg/kg body weight) without any hemodynamic adverse effects (TOF ratio 1.0 at extubation). The clinical and hemodynamic findings suggest that sugammadex can be safely used in patients with Becker muscular dystrophy and dilated cardiomyopathy..
97. Perioperative Management of Blood Coagulation - Monitoring of Coagulation Disorder and Fibrinolysis -.
98. Maiko Tanaka, Ken Yamaura, Midoriko Higashi, Sumio Hoka, Leakage of sevoflurane from vaporizer detected by air monitoring system: a case report, JOURNAL OF CLINICAL MONITORING AND COMPUTING, 10.1007/s10877-013-9479-9, 27, 6, 629-631, 2013.12, 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..
99. M. Higashi, K. Yamaura, M. Ikeda, T. Shimauchi, H. Saiki, S. Hoka, Diastolic dysfunction of the left ventricle is associated with pulmonary edema after renal transplantation, ACTA ANAESTHESIOLOGICA SCANDINAVICA, 10.1111/aas.12168, 57, 9, 1154-1160, 2013.10, Background
Post-operative pulmonary complications are associated with high mortality and graft loss in renal transplantation recipients. Left ventricular diastolic dysfunction is not uncommon in patients with chronic renal failure, including those with preserved left ventricular systolic function. The purpose of this study was to determine the relationship between left ventricular diastolic dysfunction and incidence of post-operative pulmonary edema in renal transplantation recipients with preserved left ventricular systolic function.
Methods
Pre-operative left ventricular function and incidence of pulmonary edema were retrospectively studied in 209 patients who underwent living-donor renal transplantation between January 2010 and October 2012. Left ventricular systolic and diastolic functions were evaluated by ejection fraction and E/E' ratio, retrospectively, using transthoracic echocardiography. Pulmonary edema was defined by evidence of pulmonary congestion on the chest X-ray together with PaO2/FiO(2) ratio 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..
100. Noriko Nanishi, Ken Yamaura, Matsushita Katsuyuki, Akiyoshi Kozaburo, Yuji Karashima, Midoriko Higashi, Sumio Hoka, Endovascular abdominal aortic aneurysm repair under general anesthesia does not decrease perioperative myocardial ischemic event compared with open repair., OJAnes, 10.4236/ojanes.2013.32021, 3, 2, 84-89, 2013.03.
101. Shotaro Sakimura, Midoriko Higashi, Noriko Nanishi, Norimitsu Sugioka, Kazuhiro Sirouzu, Ken Yamaura, Sumio Hoka, Anesthetic management of a parturient with congenital afibrinogenemia undergoing cesarean section, Japanese Journal of Anesthesiology, 61, 12, 1369-1372, 2012.12, A 29-year-old parturient with congenital afibrinogenemia was scheduled to receive cesarean section at 38 weeks 2 days of gestation. Due to the bleeding tendency by her abnormality of fibrinogen and afibrinogenemia, general anesthesia was chosen. In addition to routine administration of fibrinogen, perioperative supplementation of fibrinogen with the meticulous evaluation of the coagulation and fibrinolysis status using rotation thromboelastometry (ROTEM&reg) enabled the patient to deliver a healthy baby without any hematological complications. The ROTEM® was a useful device to check coagulopathy and fibrinolysis in this patient..
102. 先天性無フィブリノゲン血症妊婦の帝王切開の麻酔経験.
103. Kengo Hayamizu, Ken Yamaura, Mariko Hayamizu, Tadashi Kandabashi, Sumio Hoka, Anesthetic management of a patient with Klippel-Trenaunay syndrome for caesarean section, Japanese Journal of Anesthesiology, 61, 8, 893-895, 2012.08, Klippel-Trenaunay syndrome (KTS) is characterized by capillary and venous malformation and hypertrophy of bone and soft tissues. A 29-year-old Primigravida, who had been diagnosed of KTS by her hemangiomas and varicosities in the right leg, pubic area, rectum, vagina and lower abdominal area, was scheduled to receive caesarean section at 37 weeks gestation because vaginal delivery might cause hemorrhagic complications and extension of the venous lesions. Regional anesthesia was avoided because of the possible injuries of unknown venous malformations or varicose veins in the epidural or spinal space. The cesarean section was performed under general anesthesia uneventfully and an infant was delivered normally. There were no complications such as massive hemorrhage, disseminated intravascular coagulation and deep venous thrombosis in the perioperative period. Careful anesthetic considerations for the prevention of hemorrhagic and thrombotic complications are necessary for cesarean section in a patient with KTS..
104. クリッペル・トレノネー症候群合併患者における帝王切開の麻酔経験.
105. Makoto Sumie, Kouhei Toyama, Keiko Morikawa, Tomoka Yokoo-Matsuoka, Chihiro Takamatsu, Ken Yamaura, Sumio Hoka, Inadvertent bleeding in an infant after inguinal hernioplasty leads to diagnosis of hemophilia B, JOURNAL OF ANESTHESIA, 10.1007/s00540-011-1290-5, 26, 2, 299-300, 2012.04.
106. 重症慢性閉塞性肺疾患患者の大腿ー膝窩動脈バイパス術を超音波ガイド下神経ブロックで行った一例.
107. Kozaburo Akiyoshi, Tadashi Kandabashi, Junko Kaji, Ken Yamaura, Hayashi Yoshimura, Kazuo Irita, Sumio Hoka, Accuracy of arterial pressure waveform analysis for cardiac output measurement in comparison with thermodilution methods in patients undergoing living donor liver transplantation, JOURNAL OF ANESTHESIA, 10.1007/s00540-010-1087-y, 25, 2, 178-183, 2011.04, The aim of this study was to assess the accuracy of the first and third versions of arterial pressure waveform cardiac output (APCO(v.1.0) and APCO(v.3.0)) measurements in comparison with thermodilution methods in patients undergoing living donor liver transplantation.
Twenty patients were anesthetized and mechanically ventilated. A radial arterial line was connected to a dedicated transducer for the APCO evaluation (FloTrac (TM)). A pulmonary artery catheter was placed and connected to a computer system (Vigilance (TM)) to measure intermittent thermodilution cardiac output (COTD) and continuous cardiac output (CCO).
A total of 138 measurements were analyzed. Bland-Altman analysis showed that the mean biases for COTD-APCO(v.3.0), COTD-APCO(v.1.0), and COTD-CCO were 0.89, 1.73, and -0.79 L/min, and the adjusted percentage errors were 37.5, 30.3, and 43%, respectively. While the variance for COTD-APCO(v3.0) was greater, the accuracy (bias) improved by 0.8 L/min as compared with COTD-APCO(v1.0). The difference COTD-APCO(v.3.0) became apparent when systemic vascular resistance was lower than 1000 dyne x s/cm(5), especially below 700 dyne x s/cm(5).
These data suggest that the accuracy of APCO(v.3.0) has improved compared to APCO(v.1.0) due to the updated algorithm, but additional improvements should be evaluated, especially in patients undergoing living donor liver transplantation with low systemic vascular resistance..
108. Yoshiro Sakaguchi, Sayaka Osawa, Kentaro Tokuda, Kohei Toyama, Chihiro Takamatsu, Y Matsuoka, Ken Yamaura, Sumio Hoka, Anaphylactic shock during anesthesia in a child undergoing emergent cadaver donor renal transplantation., 日本小児麻酔学会誌, 16, 1, 157-159, case report, 2010.12.
109. Junko Kaji, Midoriko Higashi, Yoshiro Sakaguchi, Jun Maki, Tetsuya Kai, Ken Yamaura, Sumio Hoka, Fiberoptic intubation using two tracheal tubes for a child with goldenhar syndrome, Japanese Journal of Anesthesiology, 59, 12, 1526-1528, 2010.12, 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..
110. Sayaka Osawa, Ken Yamaura, Akiyoshi Kozaburo, sakaguchi yoshiro, EIICHIRO NODA, Sumio Hoka, A gastric perforation after transesophageal echocardiography in an elderly patient undergoing cardiac surgery., 循環制御, 10.11312/ccm.31.193, 31, 3, 193-195, 2010.12.
111. Nakahara E, Nara Y, Ozawa A, Toda M, Okamoto H, Yamaura K, Hoka S, The Effect of Synthetic Agonists and Antagonists of Cannabinoid Receptors on Migration of Neutrophils Elicited by Leukotrience B4 in the Microvasculature of Hamster Cheek Pouch, 循環制御, 10.11312/ccm.31.202, 31, 3, 202-207, 2010.12.
112. Goldenhar症候群患児に対する経鼻ファイバー挿管の工夫.
113. Yamaura K, Kai T, Kandabashi T, Akiyoshi K, Sakaguchi Y, Hoka S, The Accuracy of Continuous Thermodilution Method in Comparison with Bolus Cardiac Output Measurement Using Room Temperature Versus Cold Injectates in Cardiac Surgical Patients, 循環制御, 10.11312/ccm.31.39, 31, 1, 39-43, 2010.07.
114. Nakayama S, Yamaura K, Nanishi N, Kandabashi T, Hoka S, Sedated Awake Intubation Using Pentax-AES® in a Patient with Treacher-Collins Syndrome., 麻酔と蘇生, 46, 2, 31-33, 2010.06.
115. Debebe Gebremedhin, Ken Yamaura, David R. Harder, Role of 20-HETE in the hypoxia-induced activation of Ca2+-activated K+ channel currents in rat cerebral arterial muscle cells, AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 10.1152/ajpheart.01416.2006, 294, 1, H107-H120, 2008.01, The mechanism of sensing hypoxia and hypoxia-induced activation of cerebral arterial Ca2+-activated K+ (K-Ca) channel currents and vasodilation is not known. We investigated the roles of the cytochrome P-450 4A (CYP 4A) omega-hydroxylase metabolite of arachidonic acid, 20-hydroxyeicosatetraenoic acid (20-HETE), and generation of superoxide in the hypoxia-evoked activation of the K-Ca channel current in rat cerebral arterial muscle cells (CAMCs) and cerebral vasodilation. Patch-clamp analysis of K+ channel current identified a voltage- and Ca2+-dependent 238 +/- 21-pS unitary K+ currents that are inhibitable by tetraethylammonium ( TEA, 1 mM) or iberiotoxin (100 nM). Hypoxia (
116. Ken Yamaura, Kazuo Irita, Tadashi Kandabashi, Kohei Tohyama, Shosuke Takahashi, Evaluation of finger and forehead pulse oximeters during mild hypothermic cardiopulmonary bypass, Journal of Clinical Monitoring and Computing, 10.1007/s10877-007-9081-0, 21, 4, 249-252, 2007.08, Objective: The purpose of this study was to examine and compare the four combination of pulse oximeters (POs) and monitoring sites, the Nihon Kohden BSS-9800 (N), the Masimo SET Radical (M), the Nellcor N550 D-25 (N-D) and the Nellcor N550 Max-Fast (N-MF) in patients with peripheral hypoperfusion. Methods: About 20 adult patients undergoing cardiac surgery using mild hypothermic cardiopulmonary bypass (CPB) were studied prospectively. PO sensors were applied on fingers in N, M and N-D, while on the forehead in N-MF. Results: PO failure was defined as failure to show no SpO2 value or incorrect SpO2 values. PO failure occurred in 12 patients with N, ten patients with M, four patients with N-D and ten patients with N-MF, respectively (p &lt
0.05 N-D vs. N, M, N-MF). The duration of PO failure was 19+/-30% of aortic cross-clamping with N, 29 +/-33% with M, 10 +/-26% with N-D and 43 +/- 57% with N-MF, respectively (p &lt
-0.05 N-D vs. M and N-MF). Conclusions: The results suggested that N-D is most useful among four combinations of POs and monitoring sites tested in this study for monitoring SpO2 during hypoperfusion. The superiority of N-MF during hypoperfusion was not evident in the present study. © Springer Science+Business Media B.V. 2007..
117. K. Yamaura, D. Gebremedhin, C. Zhang, J. Narayanan, K. Hoefert, E. R. Jacobs, R. C. Koehler, D. R. Harder, Contribution of epoxyeicosatrienoic acids to the hypoxia-induced activation of Ca2+-activated K+ channel current in cultured rat hippocampal astrocytes, NEUROSCIENCE, 10.1016/j.neuroscience.2006.08.021, 143, 3, 703-716, 2006.12, Brief hypoxia differentially regulates the activities of Ca2+-activated K+ channels (K-Ca) in a variety of cell types. We investigated the effects of hypoxia (
118. D Zagorac, K Yamaura, C Zhang, RJ Roman, DR Harder, The effect of superoxide anion on autoregulation of cerebral blood flow, STROKE, 10.1161/01.STR.0000189997.84161.95, 36, 12, 2589-2594, 2005.12, Background and Purpose - Recent studies have suggested that autoregulation of cerebral blood flow (CBF) is impaired after traumatic and ischemic brain injury. Given that the levels of superoxide anion (O-2(.-)) are increased in these conditions, we postulate that O-2(.-) contributes to the impairment of CBF autoregulation.
Methods - CBF was monitored with laser Doppler flowmetry during increases in blood pressure.
Results - During the control period, CBF was well autoregulated after the increase in mean arterial pressure (MAP) from 98 +/- 3 to 140 +/- 6 mm Hg. The autoregulation index (AI;Delta CBF/Delta MAP) averaged 0.25 +/- 0.02 (n = 6). O-2(.-) in the brain was then increased by subdural perfusion of xanthine/xanthine oxidase (different concentrations) and catalase. Low concentrations of O-2(.-) decreased basal CBF by 10 +/- 1.6% but had no effect on autoregulation (AI, 0.19 +/- 0.02; n = 6). Higher concentrations of O-2(.-) (0.2 mmol/L xanthine and either 3 or 20 mU xanthine oxidase) increased basal CBF by 30 +/- 2% and 42 +/- 4%, respectively, and impaired autoregulation of CBF (AI, 0.55 +/- 0.03 and 0.76 +/- 0.02; n = 6). Inclusion of superoxide dismutase in the O-2(.-)-generating system restored autoregulation (AI, 0.28 +/- 0.05; n = 6). Neither inhibition of NO synthase nor the addition of deferioxamine had any effect on the ability of higher concentrations of O-2(.-) to impair autoregulation of CBF (AI, 0.65 +/- 0.07 and 0.72 +/- 0.05 respectively; n = 6). O-2(.-) also increased the activity of K-Ca channels in cerebral vascular smooth muscle cells (VSMCs; n = 8).
Conclusion - These results suggest that O-2(.-) increases basal CBF and impairs autoregulation of CBF, likely through the activation of KCa channels in cerebral VSMCs..
119. Ken Yamaura, Sumio Hoka, Hirotsugu Okamoto, Shosuke Takahashi, Noninvasive assessment of left ventricular pressure-area relationship using transesophageal echocardiography and tonometry during cardiac and abdominal aortic surgery, Journal of Anesthesia, 10.1007/s00540-004-0296-7, 19, 2, 106-111, 2005.05, Purpose: The purpose of this study was to noninvasively evaluate intraoperative left ventricular (LV) performance by an online pressure-area relationship using transesophageal echocardiography (TEE) and tonometry. Methods: In study 1, LV pressure with a micromanometer catheter, LV cross-sectional area with TEE, direct radial pressure, and tonometric arterial pressure were simultaneously recorded in 5 patients (10 measurements) undergoing cardiac surgery. End-systolic elastance (E′es) was determined from pressure-area loops during inferior vena caval (IVC) occlusion. In study 2, in 16 patients undergoing repair of abdominal aortic aneurysm, LV performance (E′es
effective arterial load, E′a, and LV end-diastolic area, LV-EDA) was examined by noninvasive assessment of pressure-area loops using TEE and tonometry at aortic cross-clamping and unclamping. Results: E′es by tonometric arterial pressure closely correlated with E′es by LV pressure (r = 0.92) in study 1. E′es at aortic clamping were not significantly different from those at unclamping. The clamping increased LV-EDA and E′a by approximately 13% and 44%, and the unclamping significantly decreased by 9% and 22%, respectively. Conclusion: Our results demonstrated that online tonometric arterial pressure and LV area measured by automated border detection (ABD) of TEE might be used to calculate E′es to estimate LV contractility and allow the estimation of LV performance during aortic clamping and unclamping. © JSA 2005..
120. Takashi Akata, Ken Yamaura, Tadashi Kandabashi, Shinya Sadamatsu, Shosuke Takahashi, Changes in body temperature during profound hypothermic cardiopulmonary bypass in adult patients undergoing aortic arch reconstruction, Journal of Anesthesia, 10.1007/s00540-003-0225-1, 18, 2, 73-81, 2004.08, Purpose. Our aim was to characterize changes in body temperatures during profound hypothermic cardiopulmonary bypass (CPB) conducted with the sternum opened. Methods. In ten adult patients who underwent profound hypothermic (
121. Yamaura K, Hoka S, Yoshimura J, Takahashi S, Preoperative non-invasive assessment of stress response to breath-holding test, 循環制御, 10.11312/ccm.25.272, 25, 3, 272-275, 2004.03, The purpose of this study was to evaluate circulatory and respiratory responses to a breath-holding stress test in surgical patients at the bed-side using continuous and non-invasive monitoring with arterial tonometry and pulse oxymetry. Sixty-one patients were assigned into four groups: normal healthy patients(Cont), elderly patients(Elder), hypertensive patients(HT) and diabetic patients(DM). The breath-holding stress test was conducted in the supine position at the functional residual capacity level and in room air. Breath-holding time, changes in heart rate(HR), mean arterial pressure(MAP), arterial oxyhemoglobin saturation using a pulse oxymeter(SpO2) and the recovery time of SpO2 were measured. Breath-holding time was significantly shorter in the HT group(30±2.0sec, p2, and ΔSpO2 were not significantly different among the four groups. Our results suggest that non-invasive continuous monitoring facilitates evaluation of stress responses to breath-holding in preoperative patients, and that the breath-holding stress test causes sympathetic augmentation, resulting in increases in MAP and HR by approximately 15%, concomitant with a decrease in SpO2 to 90-94%. The magnitude of the response is similar regardless of age and existence of HT and DM..
122. K Yamaura, S Hoka, H Okamoto, S Takahashi, Quantitative analysis of left ventricular regional wall motion with color kinesis during abdominal aortic cross-clamping, JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 10.1053/j.jvca.2003.09.005, 17, 6, 703-708, 2003.12, Objectives: The authors aimed to establish a technique for quantitative analysis of regional wall motion abnormality (RWMA) using color kinesis (CK) of transesophageal echocardiography (TEE) in surgical patients. This technique was used to determine whether RWMAs develop de novo after infrarenal aortic cross-clamping in patients undergoing vascular surgery with a preoperative dipyridamole thallium stress test (DTST).
Design: An observational study.
Setting: University hospital.
Participants: Thirty-eight patients undergoing infrarenal abdominal aortic aneurysm resection or aortofemoral bypass.
Measurements and Main Results: CK images of the left ventricle (LV) were obtained from the midventricular transgastric short-axis view before and after infrarenal aortic cross-clamping using TEE and analyzed off-line using custom software. The predictive value of the category "reversible perfusion defect" (RD) was also estimated from DTST for predicting new RWMAs with CK. CK analysis is suitable for clinical use based on the comparison with conventional two-dimensional echocardiogram measurements and inter-observer variability. CK analysis showed all 7 patients with persistent perfusion defects on DTST had RWMAs. New RWMAs occurred in 2 of 9 patients with RD and in 2 of 15 patients with normal DTST, indicating that there was no significant difference between RD and normal DTST in the incidence of new RWMAs.
Conclusions: A new method is available for clinical use, which is capable of visualizing RWMAs. These results suggest that new RWMAs introduced by aortic cross-clamping occur irrespective of the risk as assessed by preoperative DTST. CK with the new analysis method might be a useful tool to quantitatively evaluate RWMAs during surgery. (C) 2003 Elsevier Inc. All rights reserved..
123. D Gebremedhin, Ken Yamaura, C Zhang, RC Koehler, DR Harder, Metabotropic glutamate receptor activation enhances the activities of two types of Ca2+-activated k+ channels in rat hippocampal astrocytes., J Neurosci, 23, 5, 1678-1687, 2003.05.
124. Matsuo K. Akata T. Yamaura K. Morikawa K. Kandabashi T. Ueda N. Tohyama K. Takahashi S., Intraoperative monitoring of pressure within saline-filled, endotracheal tube cuff in adult patients undergoing CO2 laser laryngomicrosurgery., Masui - Japanese Journal of Anesthesiology, 51, 5, 482-488, 2002.06.
125. Junko Murakami, Ken Yamaura, Takashi Akata, Shosuke Takahashi, Acute renal failure in an infant attributable to arterial cannula malposition during cardiopulmonary bypass via ministernotomy, Japanese Journal of Anesthesiology, 51, 3, 264-269, 2002.04, A 6-month-old female (4.9 kg) with multiple congenital heart lesions underwent intracardiac repair with the aid of cardiopulmonary bypass (CPB) through a lower half sternotomy. Aortic cannulation, venous cannulation, and cardioplegia cannula insertion were all accomplished through the ministernotomy. During the CPB, in spite of a high perfusion flow rate (182 ml · kg
-1
· min
-1
), the systemic arterial pressure was persistently low (mean values = 25-35 mmHg) and the urine output was greatly reduced ( -1
). In addition, inappropriate increases in the arterial inflow line pressure were recognized. Since abutment of the cannula tip against the aortic intima was suspected, several attempts were made to correct its malpositioning. During the CPB, hemolysis was also found in the mixed venous blood. Since the oliguria and resultant hyperkalemia persisted after weaning from the CPB, peritoneal dialysis was introduced immediately after the surgery. Her renal function gradually recovered postoperatively, and she was finally weaned from the peritoneal dialysis on the 13
th
postoperative day. Although the ministernotomy has been proposed to be a safe approach for most of cardiac surgeries, it appears to increase the risk for arterial cannula malposition as compared to the standard full-length sternotomy in small pediatric patients..
126. 至適気管チューブカフ内圧を得るのに必要な生理食塩液注入量の予測..
127. 胸骨小切開開心術における人工心肺送血カニューレ位置異常により急性腎不全に至った乳児の1症例.
128. Intraoperative Monitoring of Pressure within Saline-filled, Endotracheal Tube Cuff in Adult Patients Undergoing CO2 Laser Laryngomicrosurgery..
129. K Yamaura, K Akiyoshi, K Irita, S Takahashi, Effect of coronary artery bypass grafting with gastroepiploic artery on gastric intramucosal pH and systemic inflammation, JOURNAL OF CARDIOVASCULAR SURGERY, 42, 6, 723-729, 2001.12, Background. The purpose of this study was to investigate the effect of coronary arterial bypass grafting (CABG) with gastroepiploic artery (GEA) on gastric intramucosal pH and systemic inflammation.
Methods. Design: retrospective study. Setting: University hospital. Participants: 22 patients under-went CABG. Investigations: the GEA group (n=13) received CABG with the GEA graft. The non-GEA group (n=9) received conventional CABG without the GEA graft. Measurements: gastric intramucosal pH (pHi) and carbon dioxide tension (PrCO2) were assessed by capnometric air tonometry. The difference between PrCO2 and PaCO2, PCO2-gap, was also determined. Systemic inflammatory responses were evaluated by serum interleukin-6 (IL-6) and leucocyte counts. Hemodynamics, oxygen delivery index ((D) over dot O2I) and uptake index ((V) over dot O2I) were monitored with catheters in the radial and pulmonary arteries (thermodilution).
Results. The duration of aortic cross-clamping and cardiopulmonary bypass was similar in both groups. Both groups did not show any significant difference in gastric pHi, PCO2-gap, systemic inflammation and hemodynamics.
Conclusions. Our findings suggest that CABG using the GEA graft does not disturb gastric mucosal perfusion, and that laparotomy for the GEA graft does not aggravate systemic oxygen demand-supply imbalance or systemic inflammatory responses induced by hypothermic CPB. CABG with the GEA graft does not seem to pose an additional risk and is a safe technique compared with conventional CABG with regard to pHi and systemic inflammation..
130. K Yamaura, K Akiyoshi, K Irita, T Taniyama, S Takahashi, Effects of olprinone, a new phosphodiesterase inhibitor, on gastric intramucosal acidosis and systemic inflammatory responses following hypothermic cardiopulmonary bypass, ACTA ANAESTHESIOLOGICA SCANDINAVICA, 10.1034/j.1399-6576.2001.045004427.x, 45, 4, 427-434, 2001.04, lBackground: Phosphodiesterase (PDE) III inhibitors have both an inotropic and a peripheral vasodilatory effect, and also inhibit the activation of macrophages. Thus a newly developed PDE ill inhibitor, olprinone, could modify gastric intramucosal pH (pHi), systemic oxygen consumption, and systemic inflammatory responses in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods: We studied 23 patients. In 15 patients, olprinone (0.1 or 0.2 mug . kg(-1) min(-1)) was administered from the commencement of CPB until their admission to the ICU. The other 8 patients received placebo. The pHi and regional CO2 tension (PrCO2) were assessed by a capnometric air tonometry. Systemic inflammatory responses were evaluated by serum interleukin-6 (IL-6), IL-10, and leucocyte counts.
Results: The pHi and PCO2-gap, the difference between PrCO2 and arterial CO2 tension (PaCO2), showed a transient decrease and an increase after CPB, respectively. Although olprinone did not affect pHi, olprinone at 0.2 mug . kg(-1) min(-1) significantly lessened post-CPB increase in PCO2-gap. Olprinone at 0.2 mug . kg(-1) min(-1) significantly increased IL-10 and reduced the extent of leucocytosis, while it did not affect IL-6 levels. At the same dosage, olprinone also lessened the surge in systemic oxygen uptake index ((V (over dot) O-2) and augmented the increase in mixed oxygen saturation (S (v) over barO(2)) both of which occurred after CPB. At 0.1 mug . kg(-1) min(-1), however, olprinone did not show any significant effect.
Conclusion: Our results suggest that olprinone at 0.2 mug . kg(-1) min(-1) suppresses gastric intramucosal acidosis and systemic inflammation following CPB..
131. K Yamaura, H Okamoto, K Akiyoshi, K Irita, T Taniyama, S Takahashi, Effect of low-dose milrinone on gastric intramucosal pH and systemic inflammation after hypothermic cardiopulmonary bypass, JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 10.1053/jcan.2001.21954, 15, 2, 197-203, 2001.04, Objective: To investigate the usefulness of low-dose milrinone on gastric intramucosal pH (pHi) and systemic inflammation in patients undergoing hypothermic cardiopulmonary bypass (CPB).
Design: Prospective randomized study.
Setting: University hospital.
Participants: Twenty patients scheduled for cardiac surgery.
Interventions: Ten patients were administered a low dose of milrinone, 0.25 mug/kg/min, from the initiation of CPB to 1 hour after admission to the intensive care unit. The other patients were administered saline. Supplemental inotropes and intravenous fluid were given to obtain adequate mean arterial blood pressure and pulmonary artery occlusion pressure.
Measurements and Main Results: Gastric pHi and carbon dioxide pressure (PCO2) were assessed by capnometric air tonometry. The difference between PCO2 and arterial carbon dioxide pressure (PaCO2), PCO2-gap, was also examined. Systemic inflammatory responses were evaluated by serum interleukin-6 and leukocyte counts. Hemodynamics, oxygen delivery index, and oxygen uptake index were monitored with catheters in the radial and pulmonary arteries (thermodilution). The hepatic venous blood flow and left ventricular flow were measured using transesophageal echocardiography. Milrinone prevented gastric intramucosal acidosis, detected as a decrease in pi-ii or an increase in PCO2-gap, without affecting hepatic venous blood flow. Increases in interleukin-6, leukocyte count, and oxygen uptake index, all of which developed after CPB, were significantly less in the milrinone group than in the control group.
Conclusion: These results suggest that in patients undergoing hypothermic CPB, supplemental low-dose milrinone prevents gastric intramucosal acidosis and increases in some markers of systemic inflammation. Copyright (C) 2001 by W.B. Saunders Company..
132. K Yamaura, M Higashi, K Akiyoshi, Y Itonaga, H Inoue, S Takahashi, Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia, EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 10.1046/j.1365-2346.2000.00759.x, 17, 11, 704-708, 2000.11, 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..
133. Ken Yamaura, Sumio Hoka, Hirotsugu Okamoto, Tadashi Kandabashi, Kozaburo Akiyoshi, Changes in left ventricular end-diastolic area, end-systolic wall stress, and fractiona area change during anesthetic induction with propofol or thiamylal, Journal of Anesthesia, 14, 3, 138-142, 2000.08.
134. K Yamaura, H Okamoto, T Maekawa, T Kanna, K Irita, S Takahashi, Detection of retroperitoneal hemorrhage by transesophageal echocardiography during cardiac surgery, CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 46, 2, 169-172, 1999.02, Purpose: To present a case of massive retroperitoneal hemorrhage during cardiopulmonary bypass (CPB) which was detected using transesophageal echocardiography (TEE).
Clinical feature: A 50-yr-old man suffering from severe mitral regurgitation (MR) was admitted for mitral valvuloplasty, After the beginning of CPB,the volume in the reservoir was noticed to be gradually decreasing. Although venous cannulation had been properly performed, TEE showed an echo free space around the liver, the spleen and in front of the abdominal aorta showed intraabdominal hemorrhage. After cardiac surgery, emergency laparotomy revealed about 5,000 mi of blood in the retroperitoneal space probably as a result of femoral artery cannulation prior to CPB, Hemostasis was achieved, and the patient made complete cardiac and neurological recovery. Retrospective review of the TEE imaging revealed that the kidneys were surrounded by blood bilaterally confirming the diagnosis of retroperitoneal hemorrhage.
Conclusion: Retroperitoneal hemorrhage during CPB is rare, but may be lethal. Transesophageal echocardiography is a useful monitor not only to evaluate cardiac performance, but also to detect unexpected intraabdominal bleeding during cardiac surgery..
135. S Hoka, K Yamaura, T Takenaka, S Takahashi, Propofol-induced increase in vascular capacitance is due to inhibition of sympathetic vasoconstrictive activity, ANESTHESIOLOGY, 10.1097/00000542-199812000-00028, 89, 6, 1495-1500, 1998.12, Background Venodilation is thought to be one of the mechanisms underlying propofol-induced hypotension. The purpose of this study is to test two hypotheses: (1) propofol increases systemic vascular capacitance, and (2) the capacitance change produced by propofol is a result of an inhibition of sympathetic vasoconstrictor activity,
Methods: In 33 Wistar rats previously anesthetized with urethane and ketamine, vascular capacitance was examined before and after propofol infusion by measuring mean circulatory filling pressure (P-mcf). The P-mcf was measured during a brief period of circulatory arrest produced by inflating an indwelling balloon In the right atrium. Rats were assigned into four groups: an intact group, a sympathetic nervous system (SNS)-block group produced by hexamethonium infusion, a SNS-block + noradrenaline (NA) group, and a hypovolemic group. The P-mcf was measured at a control state and 2 min after a bolus administration of 2, 10, and 20 mg/kg of propofol,
Results: The mean arterial pressure (MAP) was decreased by propofol dose-dependently in intact, hypovolemic, and SNS-block groups, but the decrease in MAP was less in the SNS-block group (-25%) than in the intact (-50%) and hypovolemic (-61%) groups. In the SNS-block + NA group, MAP decreased only at 20 mg/kg of propofol (-18%), The P-mcf decreased in intact and hypovolemic groups In a dose-dependent fashion but was unchanged in the SNS-block and SNS-block + NA groups.
Conclusions: The results have provided two principal findings: (1) propofol decreases P-mcf dose-dependently, and (2) the decrease In P-mcf by propofol is elicited only when the sympathetic nervous system is intact, suggesting that propofol increases systemic vascular capacitance as a result of an inhibition of sympathetic nervous system..
136. Sumio Hoka, Hirotsugu Okamoto, Ken Yamaura, Shosuke Takahashi, Ryuji Tominaga, Hisataka Yasui, Removal of retained air during cardiac surgery with transesophageal echocardiography and capnography, Journal of Clinical Anesthesia, 10.1016/S0952-8180(97)00100-1, 9, 6, 457-461, 1997.09, Study Objective: To evaluate a new method for removal of retained air at the end of cardiopulmonary bypass (CPB) by end-tidal CO2 pressure (P(ET)CO2) and pulmonary arterial pressure (PAP) monitoring, and transesophageal two-dimensional echocardiogra phy (TEE). Design: Prospective study. Setting: Cardiac surgery unit at a university hospital. Patients: 36 ASA physical status I, II, and III patients for open heart surgery. Interventions: The CPB reservoir was gradually raised to decrease venous drainage. Accordingly, the right heart began to receive the venous blood and eject it to the pulmonary artery. The vent existing in the left ventricle or the left atrium then collected any whole blood containing aft bubbles that came from the pulmonary circulation. The air bubbles were confirmed by TEE to be removed and not to eject from the left ventricle to the systemic circulation. Measurements and Main Results: Levels of P(ET)CO2, PaCO2, PAP, and the duration of the removal procedure were measured when a sufficient pulmonary circulation was established and the removal of retained air was considered to be satisfactorily accomplished by the absence of air bubbles, confirmed by TEE for more than 30 seconds. P(ET)CO2 reached 28 ± 4 mmHg during the removal of air, while PaCO2 reached 35 ± 6 mmHg (p 2 and PAP are useful indicators of pulmonary circulation during this procedure for removal of air, P(ET)CO2 of 25 to 30 mmHg and PAP of 90% of the prebypass level have been found to be necessary for the removal of air. Our technique for removal of air using P(ET)CO2, PAP, and TEE enables us to satisfactorily eliminate residual air..
137. Ju-Tae Sohn, Sumio Hoka, Ken Yamaura, Shosuke Takahashi, Effect of nicardipine on vascular capacitance: Comparison with sodium nitroprusside during induced hypotension, Journal of Anesthesia, 10.1007/BF02471391, 10, 3, 199-203, 1996.09, The purpose of this study was to examine the effects of nicardipine and sodium nitroprusside (SNP) on vascular capacitance in the rat. In ten rats anesthetized with pentobarbital, mean arterial pressure was lowered to about 70 mmHg and subsequently 50 mmHg by intravenous infusion of nicardipine or SNP. Vascular capacitance was assessed before and during nicardipine- or SNP-induced hypotension by measuring the mean circulatory filling pressure (MCFP). MCFP was measured during a brief period of circulatory arrest produced by inflating a balloon inserted in the right atrium. MCFP was significantly decreased by SNP from 7.1 ±0.3 mmHg at control to 5.6 ± 0.4 mmHg and 4.4 ± 0.3 mmHg at mean arterial pressures of 70 mmHg and 50 mmHg, respectively. However, MCFP stayed at a similar level to that of the control during nicardipine-induced hypotension. These results suggest that nicardipine has a negligible influence on vascular capacitance during induced hypotension, whereas SNP has a potent vasodilating effect on the venous system as well as the arterial system. © 1996 JSA..
138. Ken Yamaura, Bunsho Kao, Emiko Iimori, Hidekazu Urakami, Shosuke Takahashi, Recurrent ventricular tachyarrhythmias associated with QT prolongation following hydrofluoric acid burns, Journal of Toxicology - Clinical Toxicology, 35, 3, 311-313, 1997.04, Background: Some hydrofluoric acid burns appear initially as only a slight wound, but patients may show dramatic changes within several hours. The extent of such burns are directly related to the concentration, amount, and duration of exposure. Case Report: A 64-year-old man sustained 44% total body surface burns after exposure to 30% hydrofluoric acid. Approximately 5 h after injury, he developed recurrent ventricular tachycardia and ventricular fibrillation which occurred in conjunction with long QT syndrome. In this case, the occurrence of hypocalcemia and especially hypomagnesemia played an important role in the development of long QT syndrome..
139. T. Okuyama, S. Hoka, H. Okamoto, T. Kawasaki, K. Yamaura, S. Takahashi, α1-adrenoceptor stimulation is able to reverse halothane-induced cardiac depression in isolated rat hearts, Acta Anaesthesiologica Scandinavica, 10.1111/j.1399-6576.1997.tb04812.x, 41, 7, 939-944, 1997.01, Background. Stimulation of myocardial α1-adrenoceptors has been shown to exert positive inotropic effects through a cyclic AMP-independent mechanism. The purpose of this study was to examine if α1-adrenoceptor stimulation is able to attenuate myocardial depression produced by exposure to halothane, and to test if α1-adrenoceptor stimulation alters myocardial oxygen supply-demand balance in hearts exposed to halothane. Methods. The effects of phenylephrine were examined in 7 isolated perfused rat hearts. Variables measured were: heart rate, isovolumetric peak left ventricular pressure (LVP), LV dP/dt, coronary arterial flow, myocardial O2 delivery (DO2), myocardial O2 consumption (MVO2) and the ratio of DO2/MVO2. Each heart was exposed to phenylephrine cumulatively 0.1 μM, 0.3 μM, 1 μM and 3 μM under the administration of 1% halothane in the presence of propranolol 1 μM. Results. Halothane 1% decreased the heart rate by 9±3%, LVP by 37±3%, and LV dP/dt by 35±2%. Phenylephrine restored these decreases to the baseline levels. Phenylephrine maintained or further enhanced the reductions in coronary flow and DO2 produced by halothane, resulting in a decrease in the DO2/MVO2 ratio. Conclusion. α1-adrenoceptor stimulation is capable of restoring direct cardiac depressant effects of halothane with a possible impairment of the oxygen supply-demand balance..


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