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DOI： 10.1016/j.jclinane.2020.109946

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Platelet Mapping can measure both the degree of platelet inhibition and fibrinogen activation, was not originally designed to measure fibrinogen concentration. Traditional laboratory fibrinogen concentration testing requires around 60 minutes; however, fibrinogen activation only takes 10 minutes, and is indicated as maximum amplitude of activator f. If Platelet Mapping can predict fibrinogen concentration during cardiopulmonary bypass, this could facilitate rapid hemostasis management. The aim of this study was to verify whether fibrinogen concentration could be predicted using Platelet Mapping results. Thus, a pilot study was conducted to evaluate this concept during cardiopulmonary bypass. This prospective, observational pilot study investigated 15- to 90-year-old patients who underwent cardiac or aortic surgery from August 2019 to September 2019. Twenty-one patients enrolled in this study, and 43 blood samples were obtained for both fibrinogen activation measurements using Platelet Mapping and traditional laboratory-based tests, respectively. Correlations between results were analyzed using linear regression and the receiver operating characteristic curve. Correlation by Pearson's correlation analysis indicates a significant relationship (correlation coefficient of r = 0.91), and a receiver operating characteristic curve indicated that sensitivity, specificity, and receiver operating characteristic area were 100% (95% confidence interval, 75.3-100%), 93.8% (79.2-99.2%), and 0.995 (0.984-1.00), respectively. Our results indicate a strong correlation between fibrinogen activation and serum fibrinogen concentration. The maximum amplitude of activator f can estimate low fibrinogen concentration faster than traditional methods; this method quickly provides important information for anesthesia and hemostatic management in cardiac surgery.

DOI： 10.18999/nagjms.82.4.623

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Authorship：Last author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/EJA.0000000000001223

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Cell salvage is frequently used to avoid unnecessary allogeneic blood transfusions, which results in a reduction in blood transfusion volume and cost. The aspirated blood is washed with normal saline and centrifuged to recover only blood cells, salvaged blood is then made. In cardiovascular surgery, heparin is used to maintain activated clotting time over 400 seconds. Some practitioners believe that heparin remains in the salvaged blood. Therefore, we hypothesized that salvaged blood during cardiovascular surgery includes heparin. A pilot study was conducted to evaluate our hypothesis using three different salvage systems. This study was a prospective, observational, pilot study, with patients aged 20-85 years old who were scheduled for cardiovascular surgery from May 2018 to October 2018. The intent of this study was to evaluate whether salvaged blood with three different devices includes large enough quantities of heparin to influence activated clotting time in cardiovascular surgery. Between May and October 2018, 12 samples during heparinization were collected, and 12 samples of salvaged blood from 3 devices were collected after administrating protamine. The heparin concentration of the 24 samples was measured. All heparin concentrations in salvage blood sample from two devices was below the limit of measurement (0.10 IU/mL). Slightly measurable heparin was detected in salvaged blood sample from one device (mean 0.15 IU/mL). Salvaged blood during cardiovascular surgery intervention does not contain enough heparin to influence activated clotting time.

DOI： 10.18999/nagjms.82.3.449

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DOI： 10.1007/s11748-019-01201-8

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DOI： 10.1111/anae.14982

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Authorship：Last author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.18999/nagjms.82.1.93

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Authorship：Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Cardiovascular Anesthesiologists  

<p> In this report, we describe the case of a patient with a massive primary cardiac malignant lymphoma who underwent anesthetic management for transvenous pacemaker implantation, which was safely performed using combined transesophageal echocardiography (TEE) and fluoroscopy intraoperatively with pacing lead placement guided by echocardiography.</p><p> A 71 year-old male was diagnosed with a massive cardiac malignant lymphoma. The tumor occupied the right atrium and ventricle, as well as the vena cava. Electrocardiography revealed a complete atrioventricular block. Elective pacemaker implantation under general anesthesia was planned. General anesthesia was carefully introduced with extracorporeal circulation on stand-by in case of collapsed circulation.</p><p> Intraoperatively, guiding the pacing lead to the proper position was difficult for the cardiovascular surgeon. The anesthesiologist then suggested the use of TEE for guiding the pacing lead. Subsequently, the pacing lead was successfully placed in the appropriate position by a combination of TEE guidance and fluoroscopy without any cardiovascular complications.</p><p> TEE guidance may be considered feasible and efficient for transvenous pacemaker implantation under general anesthesia.</p>

DOI： 10.11478/jscva.2020-2-006

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DOI： 10.1111/anae.14856

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Minimally invasive cardiac surgery requires fewer blood transfusions and mediastinitis is less frequently observed compared to conventional median sternotomy surgical intervention, and it leads to earlier recovery and discharge. However, once reexpansion pulmonary edema occurs, the patient requires long-term management in the intensive care unit. This retrospective study was performed to investigate the incidence of reexpansion pulmonary edema in minimally invasive cardiac surgery. Patients who underwent minimally invasive cardiac valve surgery using cardiopulmonary bypass and port-access by a minimal right lateral thoracic incision between January 2010 and January 2018 were enrolled in this single-center retrospective study, which was approved by the institutional review board of Japanese Red Cross Nagoya Daiichi Hospital (Nagoya, Japan), and the requirement for written informed consent was waived. All data were collected from electronic charts. The primary outcome was the incidence rate of reexpansion pulmonary edema in patients undergoing minimally invasive cardiac surgery. A total of 662 patients underwent minimally invasive cardiac surgery, and we analyzed 651 of these cases. No case of reexpansion pulmonary edema was observed in this study. The statistically-calculated incidence rate of reexpansion pulmonary edema was less than 0.6% (95% confidence interval: 0.0-0.6). The incidence of cerebral infarction was 0.92% (n = 6). Intensive care unit stay days, hospital stay days after surgery, and the death rate after 30 days were 1.5 ± 2.0 days, 9.6 ± 3.9 days, and 0.15%, respectively. Although there was no incidence of clinical reexpansion pulmonary edema in this study, the predicted incidence of reexpansion pulmonary edema by statistical analysis was less than 0.6%.

DOI： 10.18999/nagjms.81.4.647

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DOI： 10.1053/j.jvca.2019.05.022

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We used auditory-evoked magnetic fields to investigate the properties of echoic memory. The sound stimulus was a repeated 1-ms click at 100 Hz for 500 ms, presented every 800 ms. The phase of the sound was shifted by inserting an interaural time delay of 0.49 ms to each side. Therefore, there were two sounds, lateralized to the left and right. According to the preceding sound, each sound was labeled as D (preceded by a different sound) or S (by the same sound). The D sounds were further grouped into 1D, 2D, and 3D, according to the number of preceding different sounds. The S sounds were similarly grouped to 1S and 2S. The results showed that the preceding event significantly affected the amplitude of the cortical response; although there was no difference between 1S and 2S, the amplitudes for D sounds were greater than those for S sounds. Most importantly, there was a significant amplitude difference between 1S and 1D. These results suggested that sensory memory was formed by a single sound, and was immediately replaced by new information. The constantly-updating nature of sensory memory is considered to enable it to act as a real-time monitor for new information.

DOI： 10.1038/s41598-019-48796-9

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This randomized, observer-blinded prospective study aimed to compare the postoperative analgesic effects of ultrasound-guided rectus sheath block with those of local anesthetic infiltration of the surgical field in children undergoing inguinal hernia repair. Children aged 2 to 14 years, scheduled for elective single-incision laparoscopic percutaneous extraperitoneal closure, were randomly allocated to receive ultrasound-guided rectus sheath block (group R) or local anesthetic infiltration of the surgical field (group L). In group R, 0.5 ml/kg of 0.25% ropivacaine (per side) was administered after intubation. In group L, 0.4 ml/kg of 0.5% ropivacaine was administered after peritoneal closure. Postoperative pain was assessed using the Face Scale and Face, Legs, Activity, Cry, Consolability scale at various time points, including the primary endpoint of 2 h after leaving the operation room. Additional analgesic drugs were used according to the Face Scale scores. Patient characteristics, the amount of additional drugs, and complication rate were evaluated in both groups. The patient and surgical characteristics were comparable between groups. The Face Scale and Face, Legs, Activity, Cry, Consolability scale scores were not significantly different between group R (n = 38) and group L (n = 38) at 2 h after leaving the operation room. The amount of additional drugs administered at 2 h after leaving the operation room were also comparable between groups. Our findings suggest that the postoperative analgesic efficacy of ultrasound-guided rectus sheath block is not superior to that of local anesthetic infiltration of the surgical field for pediatric single-incision laparoscopic percutaneous extraperitoneal closure.

DOI： 10.18999/nagjms.81.3.341

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OBJECTIVES: The authors investigated the association between intraoperative motor-evoked potential (MEP) changes and the severity of spinal cord infarction diagnosed with magnetic resonance imaging (MRI) to clarify the discrepancy between them, which was observed in patients with postoperative motor deficits after thoracic and thoracoabdominal aortic surgery. DESIGN: A multicenter retrospective study. SETTING: Motor-evoked potential <25% of control values was deemed positive for spinal cord ischemia. The severity of spinal cord infarction was categorized into grades A to D based on previous studies using the most severe axial MRI slices. The associations between MRI grade, MEP changes, and motor deficits were examined using logistic regression. PARTICIPANTS: Twenty-three of 1,245 patients (from 1999 to 2013, at 12 hospitals in Japan) were extracted from medical records of patients who underwent thoracic and thoracoabdominal aortic repair, with intraoperative MEP examinations and postoperative spinal MRI. INTERVENTIONS: No intervention (observational study). MEASUREMENTS AND MAIN RESULTS: Motor-evoked potential <25% of control value was associated significantly with motor deficits at discharge (adjusted odds ratio [OR], 130.0; p = 0.041), but not with severity of spinal cord infarction (adjusted OR, 0.917; p = 0.931). Motor deficit at discharge was associated with severe spinal cord infarction (adjusted OR, 4.83; p = 0.043), MEP <25% (adjusted OR, 13.95; p = 0.031), and combined deficits (motor and sensory, motor and bowel or bladder, or sensory and bowel or bladder deficits; adjusted OR, 31.03; p = 0.072) in stepwise logistic regression analysis. CONCLUSION: Motor-evoked potential <25% was associated significantly with motor deficits at discharge, but not with the severity of spinal cord infarction.

DOI： 10.1053/j.jvca.2018.12.004

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The activity of fibrinogen has been reported to decrease soon after the onset of major bleeding and to be an important determinant of the final extent of bleeding and postoperative outcome. A device that measures the perioperative fibrinogen level using the dry hematology (DH) method has recently become available. The aim of this study was to compare perioperative fibrinogen levels measured by the DH method with those measured by the conventional Clauss method and to assess the effects of heparin on these measurements. The study included 206 samples from 36 patients undergoing major surgery who received high-dose heparin (HH group, 23 samples), low-dose heparin (LH group, 57 samples), or no heparin (C group, 126 control samples). Each sample was measured using the DH and Clauss methods. After excluding samples outside the effective measurement range, the three study groups (HH group, n=23; LH group, n=49; C group, n=115) were compared. The mean fibrinogen level measured by the DH method in the HH group (87.9 ± 3.1%) was significantly lower than that measured by the Clauss method. There were no significant differences between the fibrinogen measurements obtained by the two methods between the LH and C groups. In patients on high-dose heparin, the mean fibrinogen level measured by the DH method was significantly lower than that measured by the Clauss method. When hemorrhage requires emergency treatment, a method that can measure the fibrinogen level rapidly is important. The DH method may be useful for decision-making with regard to perioperative coagulation factor replacement.

DOI： 10.18999/nagjms.81.2.259

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OBJECTIVES: To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. DESIGN: Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. SETTING: Four hospitals (1 national cardiovascular center and 3 university hospitals). PARTICIPANTS: Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). INTERVENTIONS: Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. MEASUREMENTS AND MAIN RESULTS: Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score-matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95% confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95% confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. CONCLUSIONS: Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients.

DOI： 10.1053/j.jvca.2018.06.001

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Purpose: Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS. Methods: This crossover volunteer study included five healthy men. For comparison, both the ultrasound-guided QLB type 2 (QLB2) and QLBi were employed on opposite sides of each volunteer, and the spread of LA solution (0.7 mL/kg) mixed with contrast media in the PVS was assessed 1 h after the first injection using magnetic resonance imaging. Sensory loss was evaluated by pinprick 90 min post-injection. Each volunteer underwent both QLB types, and the same procedures were administered on opposite sides 7 days after the first experiment. Results: In total, 20 QLB blocks (10 QLB2 and 10 QLBi) were performed. LA did not spread into the PVS after the QLBi. The sensory block area included the lower abdomen after the QLB2, but not after the QLBi. The sensory block area did not extend to the upper abdominal region or the midline of the lower abdomen with either block method. Conclusion: LA administered by the QLB2 spreads into the PVS of T10–T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.

DOI： 10.1007/s00540-018-2578-5

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DOI： 10.1007/s11010-018-3397-6

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japan Society of Transfusion Medicine and Cell Therapy  

DOI： 10.3925/jjtc.65.21

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Authorship：Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：一般社団法人 日本ペインクリニック学会  

DOI： 10.11321/jjspc.18-0031

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Authorship：Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

<p>We experienced a case of ventilation difficulty after intubation due to tracheal diverticulum caused by radical surgery for esophageal atresia/tracheoesophageal fistula repair. The patient was a seven-month-old male infant. Esophageal stricture was found after radical surgery for type C esophageal atresia, so an esophageal balloon dilatation under general anesthesia was scheduled. Tracheal intubation was easily accomplished after general anesthesia was induced, but audible breathing and chest movements were not detected after manual ventilation, so extubation was performed and mask ventilation initiated. Similar ventilation difficulties occurred after re-intubation, but ventilation became possible with a shallow intubation. Upon further investigation using bronchoscopy, it was determined that the ventilation difficulty had been caused by the tip of the tracheal tube straying into a posterior tracheal wall diverticulum. Tracheal diverticulum, which is a complication of radical surgery for esophageal atresia/tracheoesophageal fistula repair, should be considered as a potential cause of ventilation difficulties following intubation.</p>

DOI： 10.2199/jjsca.39.253

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Background and Objectives Several types of quadratus lumborum block (QLB) are used for postoperative analgesia and are believed to be effective against both somatic and visceral pain via a local anesthetic (LA) effect in the paravertebral space (PVS). However, it remains unclear whether all QLB techniques result in LA spread into the PVS. We hypothesized that LA administered via intramuscular QLB would spread into the paravertebral space and investigated the spread and sensory block area of LA in intramuscular QLB. Methods This volunteer study included 5 healthy men and 1 woman, with no previous medical history. Intramuscular QLB and lateral transversus abdominis plane block were performed under real-time ultrasound guidance for comparison of sensory deprivation range. Two days later, the same procedure was performed on the contralateral side of the body. The spread of LA via intramuscular QLB spread to the PVS was assessed 1 hour after the first injections using magnetic resonance imaging. Sensory perception was also evaluated by the pinprick test at 90 minutes after injection. Results In total, we performed 11 intramuscular QLBs and 11 lateral transversus abdominis plane blocks. Magnetic resonance imaging showed that LA did not spread into the PVS after ultrasound-guided intramuscular QLB. The analgesic area corresponded to the side of the body that was ipsilateral to the block. Conclusions Ultrasound-guided intramuscular QLBs are not clinically useful for procedures requiring LA spread into the PVS but do result in an ipsilateral analgesic effect in healthy volunteers.

DOI： 10.1097/AAP.0000000000000735

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Journal of Anesthesiology  

Thoracic paravertebral block (TPVB) is an efficient alternative to epidural anesthesia. The location of a catheter within the thoracic paravertebral space (TPVS) has been examined in the human cadaver studies, but it is unclear how it goes into the TPVS during catheterization. In this report, thoracoscopy was used to observe the thoracic cavity in real-time during a parasagittal in-plane approach of ultrasound-guided TPVB. During thoracoscopy, we observed whether a paravertebral catheter could be advanced caudally beyond the ribs into the neighboring TPVS. Our result demonstrated that the catheter was difficult to be advanced beyond the ribs and confined within the same level of TPVS as where it was inserted. In the previous thoracoscopic observation of the paravertebral spread, we assumed that the local anesthetic acts most strongly at the intercostal level of the injection. Therefore, we recommend to insert the catheter for TPVB at the level corresponding to the incision site of thoracotomy.

DOI： 10.1016/j.aja.2017.05.004

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本臨床麻酔学会  

DOI： 10.2199/jjsca.37.58

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Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

<p>Owing to recent advancements in surgical techniques and developments in perioperative patient care, greater numbers of surgeries are being performed worldwide. In order to reduce surgery-related deaths and complications, the World Health Organization（WHO）published the WHO Guidelines for Safe Surgery 2009. This article outlines global trends in patient safety in the perioperative period；summarized the WHO guidelines；describes Japanese efforts to follow the guidelines；and discusses the Helsinki Declaration on Patient Safety in Anesthesiology, which aims to ensure patient safety, especially in the field of anesthesiology by focusing on the WHO Guidelines for Safe Surgery 2009 and other protocols. The Helsinki Declaration was firstly ratified by the European Society of Anesthesiology, and then by many other bodies all over the world including the Japanese Society of Anesthesiologists.</p>

DOI： 10.2199/jjsca.37.59

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DOI： 10.1016/j.aat.2016.05.004

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DOI： 10.1007/s10157-013-0915-4

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本臨床麻酔学会  

DOI： 10.2199/jjsca.34.538

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DOI： 10.1007/s00540-012-1536-x

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Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本臨床麻酔学会  

DOI： 10.2199/jjsca.33.884

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DOI： 10.5897/AJMR11.387

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japan Society of Transfusion Medicine and Cell Therapy  

<b>Background:</b> Massive hemorrhage during surgery often results from diluted coagulopathy due to loss of coagulation factors (e.g., fibrinogen), especially in cases of thoracic aortic aneurysm, liver transplantation, and hepatoma/perihilar cholangiocarcinoma. The most important issue in preventing massive hemorrhage during surgery is transfusion therapy for hemostasis. This study analyzed the hemostatic efficacy of cryoprecipitate or fibrinogen concentrate during surgery when massive bleeding occurred.<br> <b>Patients and Methods:</b> When massive hemorrhage occurred in cases of thoracic aortic aneurysm, liver transplantation, and hepatoma/perihilar cholangiocarcinoma, we measured the fibrinogen level in plasma, and administered cryoprecipitate or fibrinogen concentrate to the patient when the fibrinogen level was below 150mg/d<i>l</i>(in 2007&sim;2008). The hemostatic efficacy of this treatment was evaluated by counting the volume of blood loss and number of transfusion units in comparison with cases of treatment with fresh frozen plasma (in 2005&sim;2006).<br> <b>Results:</b> We observed a rapid increase in plasma fibrinogen level and subsequent improvement in hemostasis after cryoprecipitate or fibrinogen concentrate was administered. The average blood loss decreased by 30% and the average number of transfusion units was reduced about 30% to 60% when those agents were given to patients with severe hypofibrinogenemia during surgery. The number of cases of early death due to massive hemorrhage during surgery decreased by 75% in 2007&sim;2008 when fibrinogen concentrate was used.<br> <b>Conclusion:</b> In patients showing hypofibrinogenemia (i.e. <150mg/d<i>l</i>) during surgery, administration of fibrinogen concentrate should be effective in establishing hemostatsis, and therefore in reducing blood loss and transfusion volume. This treatment should help to improve the prognosis of patients in surgery, and also to decrease the use of blood products.<br>

DOI： 10.3925/jjtc.56.36

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DOI： 10.1007/s00540-023-03189-1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

Purpose: Cerebrospinal fluid drainage (CSFD) is recommended during open or endovascular thoracic aortic repair. However, the incidence of CSFD complications is still high. Recently, CSF pressure has been kept high to avoid complications, but the efficacy of CSFD at higher pressures has not been confirmed. We hypothesize that CSFD at higher pressures is effective for preventing motor deficits. Methods: This prospective observational study included 14 hospitals that are members of the Japanese Society of Cardiovascular Anesthesiologists. Patients who underwent thoracic and thoracoabdominal aortic repair were divided into four groups: Group 1, CSF pressure around 10 mmHg; Group 2, CSF pressure around 15 mmHg; Group 3, CSFD initiated when motor evoked potential amplitudes decreased; and Group 4, no CSFD. We assessed the association between the CSFD group and motor deficits using mixed-effects logistic regression with a random intercept for the institution. Results: Of 1072 patients in the study, 84 patients (open surgery, 51; thoracic endovascular aortic repair, 33) had motor deficits at discharge. Groups 1 and 2 were not associated with motor deficits (Group 1, odds ratio (OR): 1.53, 95% confidence interval (95% CI): 0.71–3.29, p = 0.276; Group 2, OR: 1.73, 95% CI: 0.62–4.82) when compared with Group 4. Group 3 was significantly more prone to motor deficits than Group 4 (OR: 2.56, 95% CI: 1.27–5.17, p = 0.009). Conclusion: CSFD is not associated with motor deficits in thoracic and thoracoabdominal aortic repair with CSF pressure around 10 or 15 mmHg.

DOI： 10.1007/s00540-023-03179-3

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The potential of extrapulmonary ventilation pathways remains largely unexplored. Here, we assessed the enteral ventilation approach in hypoxic porcine models under controlled mechanical ventilation. 20 mL/kg of oxygenated perfluorodecalin (O2-PFD) was intra-anally delivered by a rectal tube. We simultaneously monitored arterial and pulmonary arterial blood gases every 2 min up to 30 min to determine the gut-mediated systemic and venous oxygenation kinetics. Intrarectal O2-PFD administration significantly increased the partial pressure of oxygen in arterial blood from 54.5 ± 6.4 to 61.1 ± 6.2 mmHg (mean ± SD) and reduced the partial pressure of carbon dioxide from 38.0 ± 5.6 to 34.4 ± 5.9 mmHg. Early oxygen transfer dynamics inversely correlate with baseline oxygenation status. SvO2 dynamic monitoring data indicated that oxygenation likely originated from the venous outflow of the broad segment of large intestine including the inferior mesenteric vein route. Enteral ventilation pathway offers an effective means for systemic oxygenation, thus warranting further clinical development.

DOI： 10.1016/j.isci.2023.106142

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DOI： 10.1093/cercor/bhad071

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

Purpose: The estimated continuous cardiac output (esCCO) system was recently developed as a noninvasive hemodynamic monitoring alternative to the thermodilution cardiac output (TDCO). However, the accuracy of continuous cardiac output measurements by the esCCO system compared to TDCO under different respiratory conditions remains unclear. This prospective study aimed to assess the clinical accuracy of the esCCO system by continuously measuring the esCCO and TDCO. Methods: Forty patients who had undergone cardiac surgery with a pulmonary artery catheter were enrolled. We compared the esCCO with TDCO from mechanical ventilation to spontaneous respiration through extubation. Patients undergoing cardiac pacing during esCCO measurement, those receiving treatment with an intra-aortic balloon pump, and those with measurement errors or missing data were excluded. In total, 23 patients were included. Agreement between the esCCO and TDCO measurements was evaluated using Bland–Altman analysis with a 20 min moving average of the esCCO. Results: The paired esCCO and TDCO measurements (939 points before extubation and 1112 points after extubation) were compared. The respective bias and standard deviation (SD) values were 0.13 L/min and 0.60 L/min before extubation, and − 0.48 L/min and 0.78 L/min after extubation. There was a significant difference in bias before and after extubation (P < 0.001); the SD before and after extubation was not significant (P = 0.315). The percentage errors were 25.1% before extubation and 29.6% after extubation, which is the criterion for acceptance of a new technique. Conclusion: The accuracy of the esCCO system is clinically acceptable to that of TDCO under mechanical ventilation and spontaneous respiration.

DOI： 10.1007/s00540-023-03176-6

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DOI： 10.1007/s00540-022-03117-9

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.30_32

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DOI： 10.11321/jjspc.22-0022

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Analytical Biochemistry  

The Notch pathway represents evolutionarily conserved intercellular signaling essential for cell–to–cell communication during development. Dysregulation of Notch signaling has been implicated in various diseases, and its control represents a potential cancer treatment strategy. Notch signaling is initiated by the interaction of NOTCH receptors with their ligands on neighboring cells. Therefore, the truncated NOTCH ectodomain, composed mainly of tandem repeats of epidermal growth factor-like (EGF) domains, serves as a decoy molecule that competes for ligand binding and thus inhibits ligand-dependent Notch signaling. Although full-length NOTCH EGF repeats exhibited potent Notch inhibitory activity, they were poorly produced in the transfected cells. This study evaluated the effect of EGF domain-modifying glycosyltransferases on the secretion of NOTCH EGF repeats. Our results in HEK293T cells revealed that, unlike the effect on endogenous NOTCH receptors, overexpressed EGF domain-specific O-GlcNAc transferase (EOGT) markedly enhanced the secretion of NOTCH1 EGF repeats in an enzyme activity-dependent manner. The co-expression of protein O-glucosyltransferase 1 further manifested the effect of EOGT. The resultant changes in O-glycosylation of NOTCH3 were evaluated by label-free glycopeptide quantification. This study provides an experimental strategy to efficiently generate NOTCH EGF repeats by manipulating the expression of glycosyltransferases that alter the O-glycosylation of EGF domains.

DOI： 10.1016/j.ab.2022.114881

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.29_601

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nagoya Journal of Medical Science  

Paravertebral block and epidural block are frequently employed for post-thoracotomy pain relief. It is not clear which postoperative analgesia method is effective for the chronic pain after the postoperative long term progress. Our hypothesis was that paravertebral block would be more effective than epidural block for chronic pain 1.5–2 years after thoracotomy. A cohort study investigating postoperative pain was performed in lung cancer patients undergoing thoracotomy between the ages of 20–80 year-old, employed for another randomized controlled trial. In previously study, the patients were randomly allocated into either the epidural block or paravertebral block group (n = 36/group). Patients in each group received the respective block placement with continuous 0.2% ropivacaine infusion at 5 ml/h. The patients completed a telephone observational survey using the EQ-5D-5L at 1.5–2 years. Forty-eight patients, 23 in the epidural block group and 25 in the paravertebral block group, were included in the final analysis. Quality of life scores at 1.5–2 postoperative years was similar in both groups. Mean scores ± standard deviation and 95% confidence interval were 0.899 ± 0.081 (0.705–0.938) in the epidural block group and 0.905 ± 0.079 (0.713–0.938) in the paravertebral block group, respectively, p = 0.81. The incidence rate of chronic postsurgical pain was eight patients; four in the epidural block group (17.4%) and four in the paravertebral block group (16.0%). There was no difference in incidence rate of long-term chronic postsurgical pain at 1.5–2 years after thoracotomy between the both groups. Our result will be used for further study protocols.

DOI： 10.18999/nagjms.84.4.752

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Artificial Organs  

Background: Perioperative hyperglycemia leads to poor postoperative clinical outcomes, including compromised immune function, cardiovascular events, and mortality. The optimal perioperative blood glucose levels during cardiac surgery remain unclear. A closed-loop glycemic control system (artificial pancreas, target blood glucose range:120–150 mg/dl) prevents postoperative inflammatory response more effectively than conventional insulin therapy (<200 mg/dl). However, the clinical effects of intensive insulin therapy with strict glycemic control (80–110 mg/dl) are controversial. This study aimed to determine whether intensive insulin therapy would further suppress postoperative inflammatory reactions. Methods: This study analyzed 262 patients who underwent cardiovascular surgery with cardiopulmonary bypass. The patients were divided into two groups according to their target blood glucose range: 80–110 mg/dl and 120–150 mg/dl. The primary outcome was the difference in the C-reactive protein levels between the two groups. Results: Propensity score matching resulted in 95 patients in each group based on their covariates. There was no difference in the postoperative maximum C-reactive protein levels between the two groups (14.81 ± 5.93 mg/dl vs. 14.34 ± 5.52 mg/dl; p = 0.571) following propensity score matching. Hypoglycemia did not occur during intensive insulin therapy. Conclusions: Intensive insulin therapy following cardiac surgery with cardiopulmonary bypass did not demonstrate significant advantages in the suppression of postoperative inflammatory reactions compared to that with mild glycemic control. However, intensive insulin therapy using an artificial pancreas was found to be safe, with no hypoglycemic events.

DOI： 10.1111/aor.14418

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：一般社団法人 日本ペインクリニック学会  

DOI： 10.11321/jjspc.22-0005

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Reanimatology  

DOI： 10.11414/jjreanimatology.41.1_38

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Artificial Organs  

Recently, the Sherlock 3CG™ Tip Confirmation System, including a magnetic tracking system and an intracavitary electrocardiography guidance system, has been introduced for bedside peripherally inserted central catheter (PICC) insertion. Magnetic field sources interfere with the magnetic tracking system. Electromagnetic interference of the ventricular assist device (VAD) has already been reported with various devices but not on Sherlock 3CG™. We assessed the availability of the magnetic tracking system in patients with and without a VAD during Sherlock 3CG™ insertion and evaluated the rate of optimal PICC tip position. We retrospectively reviewed 99 patients who had undergone PICC insertion using Sherlock 3CG™ on the bedside at our institutional intensive care unit from February 2018 to December 2020. Patients were divided into groups with and without a VAD. The availability of magnetic navigation and the success rate of optimal catheter tip position in each group were assessed. Among 87 cases analyzed, there were 12 and 75 cases with a VAD and without a VAD, respectively. The availability of magnetic navigation during Sherlock 3CG™ insertion was significantly lower in the group with a VAD [4/12 (33%) with VAD vs. 72/75 (96%) without VAD, P < 0.001]. In addition, the rate of optimal PICC tip position was also significantly lower in the group with a VAD [6/12 (50%) vs. 63/75 (84%), P = 0.015] The VAD significantly led to magnetic tracking system failure due to its electromagnetic interference during Sherlock 3CG™ insertion and significantly reduced the success rate of PICC insertions in the optimal position.

DOI： 10.1007/s10047-021-01293-1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

Purpose: Intraoperative anaphylaxis caused by blood products is uncommon, but it is unclear whether the rarity of this reaction is attributable to the difficulty of diagnosis, underreporting, or both. We investigated the incidence of intraoperative transfusion anaphylaxis and its reporting to the hemovigilance system. Methods: We retrospectively reviewed cases wherein general anesthesia was used at a single hospital during a 12-year period. Cases of intraoperative anaphylaxis were extracted using an electronic search strategy and determined using the recently developed grading and clinical scoring system. The causative blood products were determined by the onset duration based on literature regarding intraoperative transfusion anaphylaxis cases. Results: Among the 62,146 general anesthesia cases, 22 cases of intraoperative anaphylaxis were identified, and 11 of the 22 cases received transfusions before the onset of anaphylaxis. Intraoperative transfusion anaphylaxis was defined as occurring within 30 min of transfusion. Finally, nine cases of intraoperative transfusion anaphylaxis were analyzed. The overall incidence of intraoperative transfusion anaphylaxis was 1/3,994, with the highest incidence noted for fresh frozen plasma (1/2146; 95% confidence interval [CI] 1/6610–1/920), platelet concentrate (1/2348; 95% CI 1/92,742–1/422), and red blood cells (1/22,867; 95% CI 1/903,199–1/4,105). No evidence indicated that these cases were reported to the Japanese hemovigilance system, although all intraoperative transfusion anaphylaxis cases were diagnosed by anesthesiologists. Conclusion: The incidence of intraoperative anaphylaxis caused by blood products was higher than that reported and may be underreported to the Japanese hemovigilance system. Further research, particularly multicenter studies, is needed to confirm our results.

DOI： 10.1007/s00540-022-03059-2

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

This is a case report regarding the utility of lung ultrasonography for the postoperative respiratory management of esophagectomy. Herein, we reported a 50-year-old male who developed severe oxygenation disorder following esophagectomy. Lung ultrasonography was helpful in bilateral pneumothorax diagnosis and allowed us to judge the eligibility of thoracic drainage.

DOI： 10.3918/jsicm.29_216

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nagoya Journal of Medical Science  

i-gel™ is a supraglottic airway device widely used for airway management during general anesthesia as an alternative to tracheal intubation. It sometimes results in a sore throat postoperatively; however, the risk factors for a postoperative sore throat caused by i-gel remain unclear. Here, we clarify the risk factors for a postoperative sore throat associated with i-gel insertion. We retrospectively reviewed the data of 426 adult patients who received general anesthesia with i-gel at our institution from January 2018 to December 2019. The incidence of postoperative sore throat and intraoperative data (size of i-gel, number of insertion attempts, total insertion time, and dose of the neuromuscular blocker and opioid) were evaluated. Logistic regression analysis was performed to identify the risk factors. Postoperative sore throat following i-gel insertion occurred in 24/426 patients (5.6%). The insertion time was significantly associated with the incidence of postoperative sore throat in the univariate analysis, but not in the multivariate analysis (P=0.519). Increased doses of neuromuscular blockers before i-gel insertion (odds ratio [OR], 5.46; 95% confidence interval [CI], 1.50–19.80; P=0.001) and reduced doses of intraoperative fentanyl (OR, 0.51; 95% CI, 0.28–0.93; P=0.028) were risk factors in the univariate and multivariate analyses. In the subgroup that used neuromuscular blockers before i-gel insertion, only an increased dose of neuromuscular blocker (OR, 17.2; 95%, CI 1.06–280; P=0.046) was an associated risk factor in the univariate and multivariate analyses. Overall, increased doses of neuromuscular blockers before i-gel insertion could contribute to the development of postoperative sore throat.

DOI： 10.18999/nagjms.84.2.319

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

Several pieces of evidence suggest that volatile anesthetics (VAs), which were originally used as sedatives, have myocardial protective effects against cardiac ischemia–reperfusion injury. In Europe and the United States, the use of VAs during cardiopulmonary bypass (CPB) is widespread, as 2019 European Association for Cardio-Thoracic Surgery (EACTS)/European Association of Cardiothoracic Anaesthesiology/European Board of Cardiovascular Perfusion, 2011 American College of Cardiology/American Heart Association, and 2017 EACTS guidelines recommend their use in cardiovascular surgery, based on their potential myocardial protective effects. In other countries, including Japan, the use of VAs is gradually increasing. Therefore, it is important to be aware of the risks and possible adverse events associated with VA use during CPB to ensure safe sedation management. Herein, we describe in detail issues such as intraoperative awareness, air pollution, and damage to oxygenators due to VA use and propose precautions.

DOI： 10.1007/s00540-022-03054-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiothoracic and Vascular Anesthesia  

Objectives: Perioperative hyperglycemia is associated with poor postoperative recovery, including compromised immune function and increased risk of infection. A closed-loop glycemic control system (artificial pancreas) has demonstrated strict safe perioperative glycemic control without hypoglycemia risk. The authors hypothesized that the artificial pancreas would reduce surgical site infections (SSIs) and postoperative inflammatory reactions. This study aimed to assess the effect of the artificial pancreas on SSIs and C-reactive protein (CRP) levels after cardiac surgery. Design: A single-center retrospective, propensity score–matched analysis. Setting: A university hospital. Participants: In total, 295 patients who underwent cardiovascular surgery with cardiopulmonary bypass were included. Interventions: Patients were divided into two groups: artificial pancreas (target blood glucose: 120-150 mg/dL) and intravenous insulin infusion (conventional insulin therapy, target blood glucose: <200 mg/dL). Measurements and Main Results: The differences in the incidence of SSIs and CRP levels between the two groups were assessed. After 1:1 propensity score matching based on their covariates, 101 matched patients were selected from each group. The incidence of SSIs was reduced by 3%, 5% (conventional insulin therapy), and 2% (artificial pancreas), but the reduction was not statistically significant (p = 0.45). The postoperative maximum CRP level was significantly lower in the artificial pancreas group than in the conventional insulin therapy group, mean (standard deviation)14.53 (5.64) mg/dL v 16.57 (5.58) mg/dL; p = 0.01. Conclusions: The artificial pancreas did not demonstrate a significant reduction in the incidence of SSIs. However, the artificial pancreas was safe and suppressed postoperative inflammation compared with conventional insulin therapy.

DOI： 10.1053/j.jvca.2021.04.047

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

A new ultra-short-acting benzodiazepine intravenous anesthetic agent, remimazolam, was launched in Japan in 2020. Anesthesia during awake craniotomy is reportedly being performed safely using remimazolam; however, studies on its efficacy in awake craniotomy have not been conducted. We aimed to compare the efficacy of remimazolam and propofol in awake craniotomy. In this retrospective study, patients who underwent awake craniotomy (n = 36) at our hospital between December 2019 and January 2021 were divided into two groups: the propofol group (P group: n = 21) and the remimazolam group (R group: n = 15). There was no significant difference in the recovery time between the two groups (p = 0.18). The number of patients experiencing nausea was higher in the R group than in the P group (p = 0.02); however, regression analysis revealed that the use of remimazolam contributed to increased intraoperative nausea (odds ratio = 14.4, p = 0.04). No significant differences were observed in the frequency of vomiting and other intraoperative complications between the two groups. In conclusion, remimazolam has the potential for use as an alternative drug in anesthetic management during awake craniotomy.

DOI： 10.1007/s00540-021-03021-8

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nagoya Journal of Medical Science  

High-dose opioids induce hyperalgesia and tolerance, which negatively affects postoperative recovery.Prolonged surgery inevitably requires higher opioid doses. Ketamine reduces perioperative opioid consumptionand prevents opioid-induced tolerance. However, its effects in cases of prolonged surgery remainunknown. This study aimed to evaluate the dose of intraoperative remifentanil, an ultrashort-acting μ-opioidagonist, administered after an intravenous ketamine bolus during prolonged head and neck surgery. Thissingle-center, retrospective, observational study included 251 patients who underwent head and necksurgery (operation time ≥8 h) between January 2015 and December 2019. The participants were stratifiedinto two groups: those who received an intravenous bolus of ketamine and those who did not (ketaminegroup and non-ketamine group, respectively). Propensity score-matching was used to match patients in a1:1 ratio between the two groups, based on their covariates. The difference in intraoperative remifentanildose administered between the two groups was assessed. After 1:1 propensity score-matching, 89 matchedpatients were selected from each group. The mean ± standard deviation dose of remifentanil administeredwas significantly lower in the ketamine group than in the non-ketamine group before (0.15±0.05 vs0.17±0.05 μg/kg/min; P=0.01) and after matching (0.15±0.06 vs 0.17±0.05 μg/kg/min; P=0.03). In conclusion,intravenous ketamine administration may reduce the intraoperative dose of remifentanil requiredduring prolonged head and neck surgery. However, further studies are required to evaluate the effect ofthis finding on enhanced recovery after surgery

DOI： 10.18999/nagjms.84.1.1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nagoya Journal of Medical Science  

Volatile anesthetics (VAs) protect myocardial cells during cardiovascular surgeries, including cardiopulmonary bypass (CPB). In CPB, blood is gradually transferred from the body to a CPB unit until the target cardiac index is achieved, following which human lung (HL) ventilation is stopped. This pilot study aimed to evaluate changes in the blood sevoflurane concentrations 5 min after the start of CPB when its delivery to the oxygenator began after HL ventilation with sevoflurane was completed. Six patients were recruited and participated in this study. For each patient, the equilibrated blood sample, collected 20 min after starting the delivery of 1.7% sevoflurane (HL group), and another blood sample, collected 5 min after starting the CPB, were analyzed using gas chromatography equipped with a flame ionization detector. The mean (± standard deviation) sevoflurane concentrations in the HL and 5 min after starting CPB groups were 58.6 ± 4.7 and 14.5 ± 5.0 μg/ml, respectively (P < 0.01). In conclusion, the equilibrated blood sevoflurane concentrations showed a rapid decrease when switching from sevoflurane ventilation for the HL to CPB unless it was introduced to the oxygenator until completion of the switch

DOI： 10.18999/nagjms.84.1.163

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Frontiers in Neuroscience  

Wind-up like pain or temporal summation of pain is a phenomenon in which pain sensation is increased in a frequency-dependent manner by applying repeated noxious stimuli of uniform intensity. Temporal summation in humans has been studied by observing the increase in pain or flexion reflex by repetitive electrical or thermal stimulations. Nonetheless, because the measurement is accompanied by severe pain, a minimally invasive method is desirable. Gradual augmentation of flexion reflex and pain induced by repetitive stimulation of the sural nerve was observed using three stimulation methods—namely, bipolar electrical, magnetic, and monopolar electrical stimulation, with 11 healthy male subjects in each group. The effects of frequency, intensity, and number of repetitive stimuli on the increase in the magnitude of flexion reflex and pain rating were compared among the three methods. The reflex was measured using electromyography (EMG) from the short head of the biceps femoris. All three methods produced a frequency- and intensity-dependent progressive increase in reflex and pain; pain scores were significantly lower for magnetic and monopolar stimulations than for bipolar stimulation (P < 0.05). The slope of increase in the reflex was steep during the first 4–6 stimuli but became gentler thereafter. In the initial phase, an increase in the reflex during the time before signals of C-fibers arrived at the spinal cord was observed in experiments using high-frequency stimulation, suggesting that wind-up was caused by inputs of A-fibers without the involvement of C-fibers. Magnetic and monopolar stimulations are minimally invasive and useful methods for observing the wind-up of the flexion reflex in humans. Monopolar stimulation is convenient because it does not require special equipment. There is at least a partial mechanism underlying the wind-up of the flexion reflex that does not require C-fibers.

DOI： 10.3389/fnins.2022.837340

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Frontiers in Medicine  

Introduction: During awake craniotomy, effective use of local anesthetics, such as ropivacaine, is critical. Blood concentrations of ropivacaine after repeated administration over a short period during awake craniotomy have not been studied. Materials and Methods: In this prospective cohort study, we evaluated serum concentrations of ropivacaine 15 min after each administration during awake craniotomy at Nagoya University Hospital between April 5, 2018 and August 31, 2019 to determine the safe dose. A total of 30 patients scheduled to undergo elective awake craniotomy were included. Patients were injected with 0.375% ropivacaine before the awake phase at the following points: scalp block (T1), headpin area (T2), skin incision area (T3), temporal muscle (T4), and dura mater (T5). Arterial blood samples were collected 15 min after ropivacaine administration. In addition to the blood concentrations of ropivacaine, complications during the awake phase were evaluated as secondary endpoints. Results: The mean total dose of ropivacaine was 5.01 ± 0.68 mg/kg (maximum total dose: 6.30 mg/kg). The mean interval from T1 to T5 was 128.0 ± 17.7 min. The maximum serum concentration did not exceed the toxicity threshold of 4.3 μg/mL in any patient (mean serum concentration: T1, 1.23 ± 0.36 μg/mL; T5, 0.82 ± 0.26 μg/mL). No addiction symptoms were observed during awakening in any case. Conclusion: Our results show that, in cases of awake craniotomy with repeated anesthetic administration, a total dose of up to 5.0 mg/kg is safe, without addiction symptoms. Relatively large amounts of ropivacaine can be safely injected during awake craniotomy.

DOI： 10.3389/fmed.2022.834334

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Clinical Monitoring and Computing  

The recovery time of the motor evoked potential (MEP) amplitude following a neuromuscular blockade (NMB) during surgery is useful for interpreting low-amplitude waveforms or selecting the baseline waveform. In this study, the MEP data of 195 orthopedic cases who received a bolus dose of rocuronium at the beginning of surgery, between June 2009 and January 2016 were used. A non-linear regression analysis was applied to MEP amplitude data of multiple patients. The time taken for 90% of the maximum-amplitude recovery was estimated from the identified time series model. The 90% amplitude recovery time was 88.6 min in the pharmacological model and 89.4 min in the logistic model. These results were included in the 95% confidence interval of the previous studies. Although MEP amplitude is relatively unstable because of anesthesia, the averaged time series model of MEP amplitude can be estimated by using a large number of data.

DOI： 10.1007/s10877-020-00600-0

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

Microglia, which migrate into the central nervous system (CNS) during the early embryonic stages, are considered to play various roles in CNS development. However, their embryonic roles are largely unknown, partly due to the lack of an effective microglial ablation system in the embryo. Here, we show a microglial ablation model by injecting diphtheria toxin (DT) into the amniotic fluid of Siglechdtr mice, in which the gene encoding DT receptor is knocked into the microglia-specific gene locus Siglech. We revealed that embryonic microglia were depleted for several days throughout the CNS, including some regions where microglia transiently accumulated, at any embryonic time point from embryonic day 10.5, when microglia colonize the CNS. This ablation system was specific for microglia because CNS-associated macrophages, which are a distinct population from microglia that reside in the CNS interfaces such as meninges, were unaffected. Therefore, this microglial ablation system is highly effective for studying the embryonic functions of microglia.

DOI： 10.1016/j.neures.2021.06.002

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Society of Pain Clinicians  

<p>A 46-year-old woman, 157 cm 58 kg, underwent left total hip arthroplasty after lumbar plexus block and sciatic nerve block via the parasacral approach. Postoperative X-ray revealed 20-mm leg extension. After surgery, both legs had movement disorder and sensory disturbance, which improved within a few hours. Lumbar plexus block was considered to be an epidural block. Thereafter, sensory and motor disorders slightly improved, but recovery of dorsiflexion movement of the left ankle joint was delayed and mild peroneal neuropathy at the level of the peroneal head was diagnosed by electromyography 28 days after surgery. Thirty-two days after surgery, the patient was discharged with stable walking using a cane. The neurological symptoms were suspected to be caused by physical factors, such as hyperextension of the peroneal nerve, because the neuropathy was at the level of the peroneum. We also cannot exclude the possibility that this nerve block affected paralysis.</p>

DOI： 10.11321/jjspc.21-0029

CiNii Research

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

Although conditioned pain modulation (CPM) is considered to represent descending pain inhibitory mechanisms triggered by noxious stimuli applied to a remote area, there have been no previous studies comparing CPM between pain and tactile systems. In this study, we compared CPM between the two systems objectively using blink reflexes. Intra-epidermal electrical stimulation (IES) and transcutaneous electrical stimulation (TS) were applied to the right skin area over the supraorbital foramen to evoke a nociceptive or a non-nociceptive blink reflex, respectively, in 15 healthy males. In the test session, IES or TS were applied six times and subjects reported the intensity of each stimulus on a numerical rating scale (NRS). Blink reflexes were measured using electromyography (R2). The first and second sessions were control sessions, while in the third session, the left hand was immersed in cold water at 10 °C as a conditioning stimulus. The magnitude of the R2 blink and NRS scores were compared among the sessions by 2-way ANOVA. Both the NRS score and nociceptive R2 were significantly decreased in the third session for IES, with a significant correlation between the two variables; whereas, TS-induced non-nociceptive R2 did not change among the sessions. Although the conditioning stimulus decreased the NRS score for TS, the CPM effect was significantly smaller than that for IES (p = 0.002). The present findings suggest the presence of a pain-specific CPM effect to a heterotopic noxious stimulus.

DOI： 10.1016/j.neuroscience.2021.06.019

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

Purpose: We aimed to compare the effects of saline with and without heparin on the catheter-occlusion rate and coagulation-related blood test results for the management of arterial catheters among patients admitted to a short-term intensive care unit postoperatively. Methods: This prospective, triple-blinded, randomized controlled study recruited patients aged 20–90 years scheduled to undergo radial arterial catheter insertion and postoperative intensive care unit admission between February and August 2019. Patients were randomly allocated to two groups (1:1 ratio) depending on the use of heparin: study (normal saline with heparin, 3000 units to 500 ml of normal saline) and control (normal saline without heparin) groups with arterial catheters. The allocated management method was employed immediately after intensive care unit admission. Occlusion assessment (every 12 h), arterial blood gas tests (every 6 h), and blood sample collection (every 24 h) were performed. The occlusion of arterial catheter was assessed using occlusion rate, and blood test results were assessed using a linear mixed model. Results: There were 147 patients in the arterial catheter groups. There were no significant differences in occlusion rates and changes in platelet counts and activated partial thromboplastin time between the groups with arterial (p = 0.98, 0.16, and 0.32, respectively) catheters during the first 6 days after intensive care unit admission. Conclusion: Normal saline with and without heparin showed similar efficiency for both the prevention of occlusion and the results of coagulation.

DOI： 10.1007/s00540-021-02949-1

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

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The dura mater contains abundant macrophages whose functions remain largely elusive. Recent studies have demonstrated the origin, as well as the gene expression pattern, of dural macrophages (dMΦs). However, their histological features have not been explored yet. In this study, we performed immunohistochemistry and electron microscopy to elucidate their precise morphology, localization, and postnatal development in mice. We found that the morphology, as well as the localization, of dMΦs changed during postnatal development. In neonatal mice, dMΦ exhibited an amoeboid morphology. During postnatal development, their cell bodies elongated longitudinally and became aligned along dural blood vessels. In adulthood, nearly half of the dMΦs aligned along blood vessel networks. However, most of these cells were not directly attached to vessels; pericytes and fibroblasts interposed between dMΦs and vessels. This morphological information may provide further indications for the functional significance of dMΦs.

DOI： 10.1007/s00441-020-03346-y

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

Background: Cerebrospinal fluid drainage (CSFD) is recommended as a spinal cord protective strategy in open and endovascular thoracic aortic repair. Although small studies support the use of CSFD, systematic reviews have not suggested definite conclusion and a large-scale study is needed. Therefore, we reviewed medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open and endovascular repair) at multiple institutions to assess the association between CSFD and postoperative motor deficits. Methods: Patients included in this study underwent descending or thoracoabdominal aortic repair between 2000 and 2013 at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery. We conducted a retrospective study to investigate whether motor-evoked potential monitoring is effective in reducing motor deficits in thoracic aortic aneurysm repair. We use the same dataset to examine whether CSFD reduces motor deficits after propensity score matching. Results: We reviewed data from 1214 patients [open surgery, 601 (49.5%); endovascular repair, 613 (50.5%)]. CSFD was performed in 417 patients and not performed in the remaining 797 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. After propensity score matching (n = 700), mixed-effects logistic regression performed revealed that CSFD is associated with postoperative motor deficits at discharge [adjusted odds ratio (OR), 3.87; 95% confidence interval (CI), 2.30–6.51]. Conclusion: CSFD may not be effective for postoperative motor deficits at discharge.

DOI： 10.1007/s00540-020-02857-w

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-020-02892-7

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BACKGROUND: To date, five randomized controlled trials have assessed the clinical benefit of perioperative steroid administration in hepatectomy; however, all of these studies involved a substantial number of 'minor' hepatectomies. The benefit of steroid administration for patients undergoing 'complex' hepatectomy, such as major hepatectomy with extrahepatic bile duct resection, is still unclear. This study aimed to evaluate the clinical benefit of perioperative steroid administration for complex major hepatectomy. METHODS: Patients with suspected hilar malignancy scheduled to undergo major hepatectomy with extrahepatic bile duct resection were randomized into either the control or steroid groups. The steroid group received hydrocortisone 500 mg immediately before hepatic pedicle clamping, followed by hydrocortisone 300 mg on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. The control group received only physiologic saline. The primary endpoint was the incidence of postoperative liver failure. RESULTS: A total of 94 patients were randomized to either the control (n = 46) or steroid (n = 48) groups. The two groups had similar baseline characteristics; however, there were no significant differences between the groups in the incidence of grade B/C postoperative liver failure (control group, n = 8, 17%; steroid group, n = 4, 8%; p = 0.188) and other complications. Serum bilirubin levels on PODs 2 and 3 were significantly lower in the steroid group than those in the control group; however, these median values were within normal limits in both groups. CONCLUSION: Perioperative steroid administration did not reduce the risk of postoperative complications, including liver failure following major hepatectomy with extrahepatic bile duct resection.

DOI： 10.1245/s10434-020-08745-7

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Objective: Several strategies are employed for administering fresh frozen plasma (FFP) during weaning from cardiopulmonary bypass (CPB). This study evaluated by coagulation function aimed to compare two strategies of administering FFP in cardiovascular surgery: administering 4 units of FFP before separating from CPB or administering it after weaning from CPB. Methods: Thirty patients who underwent CPB and were expected to receive 8 units of FFP and 20 units of platelet concentrate were randomly allocated into group A (8 units of FFP and 20 units of platelet concentrate administered after separating from CPB) and group B (4 units of FFP administered before separation, and 4 units of FFP and 20 units of platelet concentrate administered after separating from CPB). Thromboelastography (TEG6s®, HAEMONETICS Japan GK, Tokyo, Japan) was conducted at four time points before and after separation. Blood test results, blood loss, and required amounts of blood transfusion were compared. The primary outcome was the difference in coagulation function evaluated by TEG6s 90 min after protamine administration. Results: Twenty-eight patients were enrolled in the study. Coagulation function after separating from CPB was not significantly different between the groups. Additionally, no significant differences were found in intensive care unit outcomes, such as 24-h transfusion requirements. Conclusions: Coagulation function 90 min after separating from CPB was not significantly different between the groups. Prior FFP administration before separation did not provide significant improvement in coagulation function.

DOI： 10.1007/s11748-020-01372-9

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Purpose: Volatile anesthetics (VAs) protect myocardial cells in cardiovascular surgery. A recent clinical trial of cardiopulmonary bypass (CPB) surgery reported no significant difference in mortality rates between the use of VAs and total intravenous anesthetics at 1 year postoperatively. However, oxygenator function may affect the VA pharmacokinetics. Thus, we measured the VA blood concentrations during CPB in patients managed with four different microporous polypropylene hollow fiber membrane oxygenators. Methods: Twenty-four patients scheduled for elective CPB were randomly allocated to one of the two VA groups (desflurane and sevoflurane groups) and, then, randomly divided into one of four oxygenator groups: Terumo, LivaNova, Medtronic, and Senko (n = 3). Additionally, in each VA group, three patients were randomly selected and redundantly allocated to the human lung group (for control blood VA concentration without oxygenator). Blood samples collected 20 min after starting 6.0 vol% desflurane or 1.7 vol% sevoflurane were analyzed using gas chromatography. Oxygenator-related complications and structural changes in the membrane surface of each oxygenator after surgery were evaluated. Results: The mean (standard deviation) concentrations of desflurane and sevoflurane in the human lung were 182.4 (23.2) and 54.0 (9.6) μg/ml, respectively; not significantly different from those in the four oxygenator groups. No oxygenator-related complications occurred. Structural changes in membrane fibers did not occur after clinical use, except for difficulty in image acquisition with Senko products. Conclusion: Our results demonstrated that the blood concentrations of desflurane and sevoflurane passing through oxygenators used during CPB were similar to those in the human lung control.

DOI： 10.1007/s00540-020-02844-1

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BACKGROUND: Previous studies showed that the mitral inter-commissural (IC) distance differed by a few millimeters between the systolic and diastolic cardiac cycles. However, sizing of the mitral annuloplasty ring with a ring sizer, which should be performed in the systole, is performed in diastole during hyperkalemic cardioplegic arrest. The aim of this study was to investigate whether three-dimensional transesophageal echocardiography (3D-TEE) measurements of the mitral valve in end-systole are effective to determine the size of the annuloplasty ring. METHODS: This study retrospectively reviewed 92 patients who underwent mitral annuloplasty for degenerative. The IC distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systole. The annuloplasty ring size was measured by the surgeons using specific ring sizers. We compared the IC distance measured by 3D-TEE with the implanted annuloplasty size. We also investigated differences in IC distance, A2 height, and ratio of A2 height to IC distance in patients with and without recurrent mild to moderate MR for 36 months. RESULTS: There was a significant correlation between the IC distance by 3D-TEE and the implanted ring size (R2 = 0.7023, p < 0.001). Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059). CONCLUSIONS: Our results demonstrated a larger ratio of A2 height to IC distance in patients with recurrent MR. 3D-TEE could be useful for the ring sizing.

DOI： 10.1007/s12574-020-00465-x

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DOI： 10.2344/anpr-67-04-05

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DOI： 10.1111/anae.14960

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DOI： 10.1007/s00540-019-02713-6

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DOI： 10.1007/s00540-019-02701-w

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DOI： 10.1007/s00540-019-02719-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Journal of Obstetric Anesthesia  

The authors regret that there was an error in Fig. 1 of their article. The correct Fig. 1 is as follows: [Figure presented] The incorrect Fig. 1 was as follows: [Figure presented] The authors would like to apologise for any inconvenience caused.

DOI： 10.1016/j.ijoa.2019.12.002

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.27_113

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Background: This study aimed to compare the postoperative analgesic effects of ultrasound-guided posterior quadratus lumborum block with spinal morphine, after cesarean section, using the visual analogue scale pain score. Methods: One-hundred-and-seventy-six pregnant women scheduled for elective cesarean section with spinal anesthesia were randomly allocated into four groups to receive spinal morphine 0.1 mg (group M+); spinal saline (M−); posterior quadratus lumborum block using either 0.3% ropivacaine (0.45 mL/kg each side, maximum 150 mg) group pQ+); or saline (pQ−). All patients received 11–13 mg hyperbaric bupivacaine 0.5% and 10 μg fentanyl. Intravenous droperidol, fentanyl and acetaminophen were administered during surgery. Bilateral posterior quadratus lumborum block was performed immediately after surgery. Postoperative pain was assessed at 0.5, 1, 2, 4, 6, 18 and 24 h after surgery, and the pain score 6 h after surgery was the primary endpoint. Results: One-hundred-and-forty-six patients were included in the final analysis. Pain scores 6 h after surgery, both at rest and when moving, were significantly different when comparing the M+pQ+ group with the M−pQ+ or M−pQ− groups, and when comparing the M+pQ− group with the M− pQ+ or M− pQ− groups (all P <0.05). There was no significant difference between the M+pQ+ and M+pQ– groups, or between the M−pQ+ and M−pQ− groups. Conclusion: Spinal morphine improved postoperative analgesia but the combination of posterior quadratus lumborum block with spinal morphine did not lead to further improvement.

DOI： 10.1016/j.ijoa.2019.06.008

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DOI： 10.1186/s40981-019-0228-z

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DOI： 10.1245/s10434-018-6943-2

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Dental Society of Anesthesiology  

<p>  Nicolaides-Baraitser syndrome (NCBRS) is a rare congenital genetic disorder characterized by specific facial features, distal limb malformations, and mental retardation. At present, there are no reports of anesthetic management in patients with NCBRS. We report the first case of a successful nasal fiberscopic intubation in a patient with NCBRS in whom intubation was difficult because of a prominent small jaw, restricted mouth opening, and sleep apnea. A 9-year-old girl who had been diagnosed as having NCBRS was scheduled to undergo the extraction of decayed teeth under general anesthesia. She had a medical history of a cleft palate revision at the age of 3 years. Because she had a small jaw and restricted mouth opening, intubation was performed using an Airwayscope^® (AWS) during the previous anesthesia. First, we attempted oral intubation using an AWS after induction. After the administration of muscle relaxants, however, mouth opening was not possible. Therefore, we could not intubate using AWS or an oral fiberscope. Next, we tried nasal intubation using a bronchofiberscope. Despite an unclear visualization because of the presence of the adenoids and oral secretions, we were able to intubate the patient. There were no complications during the intubation, such as nose bleeding, and there were no problems in providing positive ventilation. The operation was completed without any adverse events. The postoperative course was not problematic, and she was discharged on the third day after surgery. Intubation might be difficult in patients with NCBRS ; therefore, the risk of a difficult airway should be evaluated during the anesthetic management of these patients.</p>

DOI： 10.24569/jjdsa.47.3_107

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DOI： 10.1097/AAP.0000000000000815

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Anesthesiology  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Anesthesiology  

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DOI： 10.1213/ANE.0000000000002749

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DOI： 10.1007/s00540-017-2397-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：株式会社医学書院  

DOI： 10.11477/mf.3101200998

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DOI： 10.1007/s10157-016-1318-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Allergology  

DOI： 10.1016/j.alit.2017.02.002

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DOI： 10.1097/ALN.0000000000001577

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DOI： 10.1007/s00540-017-2307-5

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DOI： 10.1007/s00540-017-2307-5

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DOI： 10.1186/s40981-016-0074-1

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

A 69-year-old man suffered from sudden, severe back pain and was transported to our emergency room. An emergency Y-graft replacement was performed due to the rupture of an abdominal aortic aneurysm. We found a major thrombus in his right internal jugular vein by a CT scan performed on day 9, so we started the continuous intravenous infusion of heparin as thrombolytic therapy. On the same day, a hemodiafiltration circuit was frequently occluded by blood clots. The next day, the platelet count decreased to 40% compared with that the day before. We considered the possibility of heparin-induced thrombocytopenia (HIT) and immediately stopped administering heparin. On day 11, HIT antibodies with a high titer were detected. Then, we continuously administered argatroban. However, we had no choice but to decrease its dosage and finally stopped its administration after five days because of a prolonged APTT. The patient developed multiple organ dysfunction syndrome and died on day 59. We think that this case could have involved HIT accompanied by consumptive coagulopathy. The administration of argatroban is the only approved treatment for HIT in Japan. The dosage of argatroban has to be set according to the APTT. When a patient suffers a tendency for bleeding or a prolonged APTT, there is no choice but to reduce its dosage or stop its administration. There is no established therapy for HIT-associated consumptive coagulopathy.

DOI： 10.3918/jsicm.24_22

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Authorship：Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Cardiovascular Anesthesiologists  

<p> In this case, hemodynamic collapse occurred due to the systolic anterior motion (SAM) of the mitral valve after a mitral valvuloplasty (MVP). Intravenous administration of cibenzoline, a sodium (Na⁺)-channel blocker, reduced left ventricular outflow tract (LVOT) obstruction and the mitral regurgitation (MR) resulting from the SAM, and the hemodynamic condition was improved.</p><p> SAM is a well-known complication after MVP. The Venturi effect created by increasing the blood flow velocity at the narrowed LVOT causes the anterior leaflet of the mitral valve to be drawn into the LVOT. Effective perioperative management suppresses the left ventricular contraction, and increases the pre-load and after-load. This requires discontinuation of inotropic drugs, administration of vasoconstrictors, and expansion of intravascular volume. Considering the pathogenesis of SAM, therapies for hypertrophic obstructive cardiomyopathy, such as a beta (β)-blocker, a calcium antagonist, or a Na⁺-channel blocker, can be effective for treatment of SAM after MVP. A short-acting β-blocker is convenient, and commonly used for the perioperative management of SAM. The essential cause of SAM after MVP is myocardial hypercontraction rather than tachycardia. A Na⁺-channel blocker is effective for attenuation of the left ventricular pressure gradient (LVPG) because it has more of a negative inotropic effect than a negative chronotropic effect. Therefore, we suggest that if a β-blocker is unavailable, or is insufficient for decreasing the LVPG, cibenzoline is effective for SAM after MVP.</p>

DOI： 10.11478/jscva.2016-3-022

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DOI： 10.11477/mf.3101200524

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION  

Anesthesia is sometimes used for the reduction of maternal pain in normal human term labor, but whether the drugs affect oxidative stress remains unclear. The placenta serves as an interface between the maternal and fetal vasculature. In this study, we immunohistochemically analyzed two markers for oxidative stress, namely 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 4-hydroxy-2-nonenal-modified proteins (HNE), using placentas from 21 cases of normal tansvaginal delivery (V group), 20 Caesarean sections (C group), and 17 normal transvaginal deliveries with epidural anesthesia (E group). 8-OHdG staining in the nuclei of trophoblasts lining the chorionic villi was significantly stronger in the V group either compared with the C or E group (p<0.001), without significant differences in the C and E groups (p = 0.792). Moderate to intense staining by HNE of the intravascular serum of chorionic villi vasculature was frequently observed in the placentas from the V group, but less frequently of those in either C or E groups (p<0.001), nor the p value comparing the C and E groups was significant (p = 0.128) for HNE staining. Our results suggest that although the role of oxidative stress and its influences on fetal state in the placenta in labor remains unclear, it seems to be lessened by epidural anesthesia.

DOI： 10.3164/jcbn.15-138

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DOI： 10.1055/s-0035-1549030

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Medical Association of Nippon Medical School  

<p>Epidural analgesia is used to promote rehabilitation in patients with refractory complex regional pain syndrome (CRPS) who cannot bear physical programs due to intense pain. However, the actual rehabilitation process has not been focused in previous reports. Here, we outline our experience of treating a young woman with CRPS type 1 who underwent rehabilitation facilitated by a continuous lumbar epidural block. A 15-year-old girl developed throbbing pain from her left toe to her ankle, with no obvious cause. She was admitted to the hospital 2 months after symptom onset for an assessment of pain intensity, range of motion, weight-bearing, neglect-like symptoms, pain catastrophizing, and a CRPS severe score with impaired activities of daily living. The rehabilitation program was initiated under facilitation of continuous epidural block. Her rehabilitation program included physical therapy, motor imagery, mirror therapy, and cognitive behavioral therapy. The intensity of the exercise was gradually increased without exacerbating her symptoms. Ultimately, she recovered completely after a continuous epidural block for 21 days and rehabilitation for 80 days. A combination of continuous epidural block and intensive rehabilitation improved the symptoms of this patient. The treatment course would be helpful for planning rehabilitation programs in other patients with CRPS.</p>

DOI： 10.1272/jnms.83.262

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Authorship：Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

Propofol infusion syndrome (PRIS) is a fatal syndrome associated with continuous propofol infusion, which causes several serious clinical conditions such as rhabdomyolysis, acute kidney injury (AKI), lactic acidosis, and hyperlipidemia. We report the case of a 44-year-old adult male patient suspected of having PRIS who was successfully treated by promptly discontinuing propofol infusion. The patient underwent total arch replacement for Stanford type A aortic dissection. Propofol was used for postoperative sedation, but his serum CK level was elevated up to 15,247 IU/<I>l</I>. He also developed AKI and lactic acidosis. Therefore, we strongly suspected PRIS, so propofol was discontinued. His serum CK level subsequently decreased, and AKI and lactic acidosis improved rapidly. CT scan showed some high-density areas in the hip and femoral muscles, which can be considered post-rhabdomyolysis changes. Serum CK, pH, and lactate levels should be measured routinely during prolonged propofol infusion, and alternative sedatives should be administered promptly if PRIS is suspected.

DOI： 10.3918/jsicm.23.647

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DOI： 10.11477/mf.1407211022

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DOI： 10.1007/s10877-014-9648-5

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本蘇生学会  

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DOI： 10.11414/jjreanimatology.34.3_282a

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Anesthesiology  

The World Health Organization WHO launched the Safe Surgery Saves Lives campaign in 2007 to improve safety of surgical care in the world. As a part of the campaign, the first edition of the Surgical Safety Checklist was created through an international consultative process in 2008 and the second edition was published in the WHO Guidelines for Safe Surgery 2009. The guidelines consist of ten essential objectives for safe surgery, and nine of the ten objectives are facilitated by introducing the surgical checklist in the operating room, which is designed to improve teamwork of the operating room member and to give them chances to use the safety processes consistently. It consists of nineteen check points scheduled to be used in three phases : before anesthesia induction, before any skin incisioa and at the end of surgery. In this article we gave an outline of WHO Surgical Safety Checklist and WHO Guidelines for Safe Surgery 2009, and reviewed the evidence of the guidelines and checklist Finally we presented the evidence indicating the efficacy of the WHO Surgical Safety Checklist, which included the pilot study attached in the guidelines showing that its use markedly decreased complications in patients undergoing noncardiac surgery in eight diverse international hospitals.

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DOI： 10.1007/s00540-013-1676-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：株式会社医学書院  

DOI： 10.11477/mf.3101102022

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本蘇生学会  

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DOI： 10.11414/jjreanimatology.33.177b

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本蘇生学会  

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DOI： 10.11414/jjreanimatology.32.186b

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

&nbsp;&nbsp;We introduces two postoperative cases in which the diagnosis and treatment were difficult in the ICU. Case 1 is a case who had frequent bleeding in thoracic cavity after lung surgery, and was diagnosed as having acquired hemophilia. PT was normal and APTT was prolonged preoperatively. Recombinant activated factor VII, activated prothrombin concentrates and steroid were administered. The inhibitor disappeared and the patient was discharged. Case 2 is a postoperative case of the LVOT stricture release and AVR. The patient had pulmonary hypertension and acute renal failure. PCPS and CHDF were performed. Sildenafil, bosentan and NO were administered, We performed APRV as respiratory management. The patient died of bowel ischemia. The anesthesiologist can influence the patient's outcome by taking part in the diagnosis and treatment in the ICU after the surgery.

DOI： 10.2199/jjsca.32.507

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：一般社団法人日本外科学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.19.699

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS LTD  

Although spinal cord stimulation has been reported to be effective for controlling neuropathic pain in diabetic neuropathy, it has rarely been investigated in other peripheral neuropathies. We describe, for the first time, the efficacy of spinal cord stimulation for refractory neuropathic pain in a patient with transthyretin Val30Met associated familial amyloid polyneuropathy (FAP ATTR Val30Met). A 72-year-old man was diagnosed as having FAP ATTR Val30Met when he was 70 years old. He had been complained of burning pain in the distal portion of his bilateral lower limbs since he was 69 years old. Because conventional symptomatic therapies, including nonsteroidal anti-inflammatory drugs, antiepileptic drugs, and tricyclic antidepressants did not ameliorate pain, he underwent bilateral lumbar spinal cord electrical stimulation at high frequency and low voltage at the level of Th12 vertebral body and this was markedly effective. Our case expands the application of spinal cord stimulation, which should be considered as an alternative therapeutic approach for relief of neuropathic pain, which can be extremely distressful for patients and may lead to an impaired quality of life.&lt;/.

DOI： 10.3109/13506129.2011.569782

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Egyptian Journal of Anaesthesia  

Objectives: Thoracic epidural block is considered by many as the method of choice for control of post-thoracotomy pain. Ultrasound guided thoracic paravertebral block is a recent technique which may offer several advantages. We therefore evaluated the analgesic effects of both bocks. Methods: We randomized 30 patients undergoing elective thoracotomy to two groups: thoracic epidural group (TED) and ultrasound guided thoracic paravertebral group (TPV). During early postoperative 72 h, we measured pain intensity, intravenous fentanyl consumption by patient controlled analgesia pump, spirometric tests, arterial blood gas analysis and complications. Results: Analgesic quality was comparable in both groups with a higher consumption of fentanyl in ultrasound guided TPV group. Spirometric tests were comparable between both groups except forced vital capacity and forced expiratory volume in one second at 24h which was more favorable in TED group. Values of vital parameters (SpO2%, respiratory rate, heart rate and mean arterial blood pressure) were comparable in both groups. Perforation of the pleura was reported in one patient who belongs to the TPV group. Conclusion: TPVB is a suitable alternative to epidural analgesia for pain management following thoracotomy and it can provide proper anesthesia and analgesia in patients with severe comorbidities and contraindications to neuroaxial blocks... Despite the use of ultrasound guided, puncture of the pleura is still a possible complication.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Egyptian Journal of Anaesthesia  

Background and Objectives: Continuous lumbar plexus block (CLPB) 1, 2 has recently been shown to give effective postoperative analgesia following total hip arthroplasty. The aim of this retrospective study was to evaluate the effectiveness of continuous infusion of lumbar plexus block (LPB) with only a local anesthetic compared with continuous infusion of the LPB with fentanyl added to the local anesthetic for postoperative analgesia after total hip arthroplasty. We also compared the patient satisfaction, PCA fentanyl consumption, complications and side effects. Methods: Thirty patients who underwent total hip arthroplasty surgery were included in the study. The subjects were randomly assigned to Group R (n=15; posterior lumbar plexus block with only a local anesthetic where 25 ml of 0.375% ropivacaine then continuous infusion of 0.2% of ropivacaine at a rate of 6-8 ml/h or Group F (n=15; posterior lumbar plexus block with 25 ml of 0.375% ropivacaine plus100 μg fentanyl then continuous infusion of 0.2% ropivacaine plus fentanyl 0.5 μg/kg/h at the same rate. Patient controlled analgesia (PCA) pump containing fentanyl was given to all patients that was calibrated to deliver a dose of 20ug, the lock out time is 5 minutes and maximum dose was 200 ug /h. Scores on a visual analog pain scale (VAS) at rest and on movement were used as the primary outcome measured. Secondary outcomes included PCA fentanyl consumption, opioid-related side effects, complications and patient satisfaction. Results: CLPB with fentanyl added to the continuous infusion significantly reduced pain scores at 2, 4, 16, 24 and 66 h at rest and at 16, 24 h on movement compared with CLPB with only ropivacaine. The use of a continuous lumbar plexus block also favorably affected secondary outcomes such as PCA fentanyl consumption which was statistically significant at 2, 4, 16, 24, 48 and 66h and the overall patient satisfaction that was statistically higher in the group F compared with group R. Nausea was significantly higher in group R, while other opioid-related side effects or complications were similar in the two groups. Conclusion: Adding fentanyl to the continuous infusion of Lumbar plexus block provides more effective analgesia with less side effects and better patient satisfaction than continuous infusion with only local anesthetic after hip arthroplasty surgery.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Egyptian Journal of Anaesthesia  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Anesthesia  

Atlantoaxial rotatory subluxation (AARS) is an infrequent condition that occurs most commonly in children for unknown reasons. Pediatric surgery, otopharyngeal inflammation, general anesthesia, and extreme rotation of the head are risk factors for development of postsurgical AARS, but AARS can often occur unnoticed, and the syndrome is not well known. We encountered three cases of postoperative AARS that occurred within 7 months; therefore, we have developed guidelines for prevention and early treatment of postoperative AARS. Postoperative AARS cannot be eliminated completely, but informed consent, a preoperative check, an appropriate surgical position, and a postoperative check may reduce the risk and damage related to this condition. © Japanese Society of Anesthesiologists 2010.

DOI： 10.1007/s00540-010-0932-3

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Authorship：Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Anesthesiology  

Catheter-related bloodstream infections (CRBSIs) are recognized as an important and serious problem, especially in an intensive care unit (ICU), since they have far higher infection rates compared to those for other type of intravascular devices. However, in the operation room, there seems to be little concern among anesthesiologists regarding this problem. It is important for anesthesiologists to understand that CRBSIs can be prevented or reduced by evidence-based interventions such as hand hygiene, education in hand washing and alcohol-based hand rubbing, sterile catheter care techniques, proper skin disinfection, maximal barrier precautions during catheter insertion, choice of subclavian vein placement, avoidance of femoral vein placement, and removal of an unnecessary catheter. This evidence is based mainly on findings in ICU patients, but introduction of these interventions into operation rooms may be very useful for reducing perioperative CRBSIs.

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DOI： 10.1213/ane.0b013e3181af7e7b

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DOI： 10.1152/ajpheart.00886.2006

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DOI： 10.1213/01.ane.0000258756.41649.2d

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

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

DOI： 10.1111/j.1460-9592.2005.01817.x

PubMed

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

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

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

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

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

PubMed

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

PubMed

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

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

DOI： 10.1152/ajpheart.00630.2003

PubMed

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

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

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

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

PubMed

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

PubMed

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

DOI： 10.1007/BF02514715

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

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

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

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

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

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

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

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

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

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

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

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

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

Language：Japanese

特殊なALI/ARDSの1病態である神経原性肺水腫について、臨床像、肺水腫発生のメカニズム、肺水腫治療・予防について、現在の最先端の情報を概説した。特に神経原性肺水腫発生のメカニズムについて、肺毛細管内圧の上昇によるという従来の説と、我々の報告しているニュウロペプタイドＹによる神経性透過性亢進の関与について、日本語でわかり易く説明した。

Language：English  

DOI： 10.1055/s-0035-1549030

Scopus

PubMed

researchmap

Event date： 2007.5

Language：Japanese   Presentation type：Poster presentation  

Country：Japan  

Event date： 2002.3

Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan