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

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

Web of Science

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

Scopus

PubMed

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

Background: Oscillometric noninvasive blood pressure and/or invasive intra-arterial blood pressure are commonly used to measure the systolic, diastolic, and mean components of blood pressure. Agreement between the two methods has been reported in adults, children, and infants, but rarely in neonates, especially under general anesthesia. Aims: This retrospective study compared the agreement of each measured blood pressure value (oscillometric noninvasive or invasive intra-arterial blood pressure monitoring) in term neonates under general anesthesia. Methods: Data were collected from neonates born at ≥36 weeks of gestation whose body weight was ≥2500 g and who underwent abdominal or noncardiac thoracic surgery with both oscillometric noninvasive and invasive intra-arterial blood pressure measurements from January 2015 to March 2020. The primary outcome was the agreement of systolic, diastolic, and mean blood pressure values between the two methods using Bland-Altman analysis. Results: Paired blood pressure measurements (n = 1193) from 67 cases were compared. In Bland-Altman analysis, bias (standard deviation), 95% limits of agreement, and percentage error were −9.3 (8.4), −26.1-7.6, and 26.9% for systolic; 1.6 (6.5), −11.3-14.6, and 38.7% for diastolic; and −1.3 (5.8), −13.0-10.3, and 26.9% for mean blood pressure, respectively. During low blood pressure (intra-arterial mean blood pressure ≤30 mm Hg), the biases (standard deviation) of systolic, diastolic, and mean blood pressure were −11.4 (5.7), −0.7 (3.7), and −5.1 (4.2), whereas during high blood pressure (intra-arterial mean blood pressure ≥60 mm Hg), the values were 0.1 (9.7), 5.6 (9.4), and 6.4 (7.4), respectively. Conclusions: Based on the bias and percentage error, the mean blood pressure exhibited the most acceptable agreement between oscillometric noninvasive and invasive intra-arterial blood pressure monitoring in term neonates under general anesthesia. However, during hypertension or hypotension, there was a large discrepancy between the two methods.

DOI： 10.1111/pan.14020

Web of Science

Scopus

PubMed

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

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

Web of Science

Scopus

PubMed

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Anaesthesiology  

BACKGROUND Several approaches have been proposed for ultrasound-guided thoracic paravertebral block, but the best approach remains unclear. OBJECTIVE We compared two ultrasound-guided in-plane approaches using a microconvex probe, transverse and parasagittal. We assessed whether either approach would facilitate successful catheter placement in the paravertebral space. DESIGN Randomised controlled trial. SETTING University hospital, July 2015 to March 2016. PATIENTS Sixty patients scheduled to undergo thoracotomy were randomly allocated into two groups. INTERVENTIONS A microconvex probe was placed transversely between adjacent ribs (transverse) or sagittally between adjacent transverse processes (parasagittal). When the Tuohy needle reached the paravertebral space, a catheter was inserted to a depth of 4 cm. Then, 0.5-ml radiocontrast was injected through the catheter under fluoroscopy. MAIN OUTCOME MEASURES The primary outcome was successful catheter placement in the paravertebral space; secondary outcomes were 0 to 100 mm visual analogue scale pain score and morphine consumption in the first 24 h. RESULTS All patients received the allocated paravertebral block. Correct catheter placement occurred in 23 (77%) and 24 patients (80%) using the transverse (n=30) and parasagittal approaches (n=30), respectively (P = 1.00). Five patients were excluded due to changes in surgical procedure. Postoperative pain, represented by median [IQR] visual analogue scale score, was 19.5 [12 to 25] at rest and 55 [44 to 77] on movement with the transverse approach (n=28) vs. 22 [12 to 33.5] at rest and 59 [41.5 to 75] on movement with the parasagittal approach (n=27) (P = 0.57 at rest, P = 0.76 on movement). Median morphine consumption was 11.5 [5 to 21] and 11 [5 to 18] mg in the transverse and parasagittal approaches, respectively (P = 0.99). CONCLUSION There were no clinically significant differences between approaches for continuous ultrasound-guided thoracic paravertebral block using a microconvex probe, and both approaches achieved a high rate of correct catheter placement.

DOI： 10.1097/EJA.0000000000001223

Web of Science

Scopus

PubMed

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

DOI： 10.1111/anae.14982

Web of Science

Scopus

PubMed

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

DOI： 10.1111/anae.14960

Web of Science

Scopus

PubMed

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

Purpose: Thoracic paravertebral block (TPVB) provides a unilateral nerve block at multiple intercostal levels allowing injection of a local anesthetic into paravertebral space (PVS) via a needle or catheter. However, the most effective injection method remains unclear. This study compared the real-time spread of ropivacaine between two paravertebral injection methods using thoracoscopy. Methods: Thirty-four patients scheduled for thoracoscopic surgery were randomly allocated into the Needle or Catheter groups, and performed transverse in-plane ultrasound-guided TPVB. The Needle group received 20 ml of 0.5% ropivacaine via a needle placed into the lateral edge of PVS; the Catheter group received the same dose of ropivacaine via a catheter inserted 5 cm into PVS. The primary outcome was the spreading pattern of ropivacaine in each group. The secondary outcome was intraoperative vasopressor requirement after paravertebral injection. Results: In the Needle group, all cases showed ropivacaine spread to multiple intercostal levels, mainly across the ribs. Contrastingly, the Catheter group showed variable spreading patterns; multiple intercostal levels (n = 10) [across the ribs (n = 4), anterolateral aspect of the vertebral bodies (n = 6)] or unobservable spreading (no change; n = 7) (P = 0.007). Vasopressors were required in two and ten cases in the Needle and Catheter groups, respectively (P = 0.010). Conclusion: Paravertebral injection via a needle typically resulted in spreading to multiple intercostal levels, especially across the ribs on the peripheral side of injection site, whereas injection via a catheter resulted in variable spreading patterns. Therefore, injections via needles are more stable.

DOI： 10.1007/s00540-019-02713-6

Web of Science

Scopus

PubMed

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

Thoracic wall nerve blocks reduce postoperative acute pain after breast cancer surgery (BCS); however, their short-term effects and the most effective technique remain unclear. To compare the effects of pectoral nerve block type-2 (Pecs II block) and serratus plane block for postoperative short-term analgesia, we retrospectively reviewed 43 BCS patients who underwent Pecs II block (n=22) or serratus plane block (n=21). The primary outcome was the proportion of patients with no complaints of pain 2 months post-BCS. The odds ratio (OR) was assessed, adjusting for axillary lymph node dissection. The secondary outcomes were pain severity 24 hours and 2 months post-operation using the numerical rating scale score, and morphine consumption within 24 hours. The proportion of patients without pain 2 months post-BCS was significantly less with Pecs II block than in patients with serratus plane block (55% vs. 19%, adjusted OR, 5.04; 95% confidence interval, 1.26-20.07; P=0.02); the median [interquartile range] score for pain 2 months post-operation was also significantly lower with Pecs II block (Pecs II block 0.5 [0-1] vs. serratus plane block 1 [1-2]); P=0.03). Regarding post-BCS acute analgesia, the median [interquartile range] postoperative 24-hour pain score was 2 [1-3] and 3 [1.5-3.5], and the median morphine consumption within 24 hours was 1.5 [0.75-5.5] and 3 [1.5-10] mg in Pecs II block and serratus plane block (P=0.47 and P=0.11), respectively. This study suggests that Pecs II block prevents short-term post-BCS pain better than serratus plane block. However, further studies are needed in order to support this finding.

DOI： 10.18999/nagjms.82.1.93

Web of Science

Scopus

PubMed

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Cardiothoracic and Vascular Anesthesia  

Objectives: Right ventricular (RV) failure with pulmonary hypertension (PH) is frequently encountered in patients with advanced left-sided heart disease (LHD). However, RV energetics in patients with postcapillary PH because of LHD has not been well studied. The authors investigated intraoperative RV energetics in patients with PH due to LHD based on pressure–volume curves with three-dimensional transesophageal echocardiography and pulmonary artery catheterization. Design: Exploratory study. Setting: National center. Participants: Thirty-three patients who underwent cardiac surgery for LHD were enrolled. Ten patients had PH (mean pulmonary artery pressure ≥ 25 mmHg). Interventions: None. Measurements and Main Results: RV stroke work index (RVSWI) was calculated by integrating the area bounded by the pressure–volume curve. RV minute work index (RVMWI) was calculated as RVSWI × heart rate. Right ventriculo-arterial coupling was estimated as stroke volume divided by end-systolic volume (SV/ESV). The authors compared RV energetics between patients with and without PH because of LHD. RVSWI and RVMWI were significantly higher in patients with PH (690.7 mmHg·mL/m2 [601.6-737.1] v 440.9 mmHg·mL/m2 [330.8-585.3], p = 0.015, and 60,068 mmHg·mL/m2/min [35,547-68,741] v 26,351 mmHg·mL/m2/min [17,316-32,517], p = 0.011, respectively), although cardiac index was nearly identical. SV/ESV was significantly lower in patients with PH (0.520 [0.305-0.810] v 0.820 (0.650-1.090), p = 0.007). Conclusions: Although cardiac index was similar, RVSWI and RVMWI were significantly higher and SV/ESV was significantly lower in patients with PH because of LHD, suggesting that patients with postcapillary PH have inefficient RV performance.

DOI： 10.1053/j.jvca.2019.05.025

Web of Science

Scopus

PubMed

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

Thoracic interfascial plane blocks are effective for post-mastectomy acute analgesia. However, their effects on chronic pain are uncertain. We randomly allocated 80 women equally to pectoral nerve-2 (PECS 2) block or serratus plane block. The pectoral nerve-2 block reduced the rate of moderate or severe chronic pain from 13/40 (33%) with the serratus plane block to 4/40 (10%), p = 0.03, adjusted odds ratio (95%CI) 0.23 (0.07–0.80), p = 0.02. The rates of pain-free women at six postoperative months were indeterminate, 10/40 (25%) after serratus plane block vs. 19/40 (48%) after pectoral nerve-2 block, p = 0.06, adjusted odds ratio (95%CI) 2.9 (1.1–7.5), p = 0.03. Health-related quality of life at six postoperative months was similar after serratus plane and pectoral nerve-2 blocks, mean (SD) EQ-5D-3L scores 0.87 (0.15) vs. 0.91 (0.14), respectively, p = 0.21. The pectoral nerve-2 block reduced median (IQR [range]) morphine consumption in the first 24 postoperative hours from 6 (3–9 [1–25]) mg to 4 (2–7 [0–37]) mg, p = 0.04. However, acute pain scores after serratus plane and pectoral nerve-2 blocks were similar, median (IQR [range]) 23 (11–35 [0–70]) mm vs. 18 (11–27 [0–61]) mm, respectively, p = 0.44. Pectoral nerve-2 block reduced chronic pain 6 months after mastectomy compared with serratus plane block.

DOI： 10.1111/anae.14856

Web of Science

Scopus

PubMed

CiNii Research

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/anae.14856

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1053/j.jvca.2019.04.025

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

<p>　僧帽弁形成術（MVP）後の僧帽弁前尖収縮期前方運動（SAM）に対してシベンゾリン静脈内投与が有効であった症例を報告する。</p><p>　SAMは狭い左室流出路（LVOT）を通過する加速血流のVenturi効果により増幅弁前尖がLVOTに引き込まれて生じる。周術期管理は前負荷・後負荷の維持，心収縮力の抑制，心拍数の調節が重要である。SAMの発生機序から閉塞性肥大型心筋症の治療（β遮断薬，Ca²⁺拮抗薬，Na⁺チャネル遮断薬）も有効となる。β遮断薬が一般的に使用されているが，MVP後のLVOT狭窄は頻脈より心収縮力増強が主因とされているため，陰性変時作用より陰性変力作用が優位なNa⁺チャネル遮断薬のシベンゾリンも有用となりえる。</p>

DOI： 10.11478/jscva.2016-3-022

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40981-016-0074-1

Web of Science

PubMed

掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.aat.2016.05.004

PubMed

掲載種別：研究論文（学術雑誌）  

PubMed

掲載種別：研究論文（学術雑誌）  

PubMed