Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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OBJECTIVES: The authors investigated the management of neuromuscular blocking agents (NMBAs) for pediatric patients after cardiac surgery, and compared the outcomes of patients who received prophylactic NMBA (pNMBA) infusions and patients without pNMBA infusions. DESIGN: A retrospective cohort study. SETTING: At a tertiary teaching hospital. PARTICIPANTS: Patients younger than 18, with congenital heart disease, who underwent cardiac surgery. INTERVENTIONS: Commencement of NMBA infusion in the first 2 hours after surgery MEASUREMENTS AND MAIN RESULTS: The primary endpoint was a composite of one or more of the following major adverse events (MAEs) that occurred within 7 days after surgery: death from any cause, a circulatory collapse that needed cardiopulmonary resuscitation, and requirement for extracorporeal membrane oxygenation. The secondary endpoints included the total duration of mechanical ventilation for the first 30 days after surgery. A total of 566 patients were included in this study. The MAEs occurred in 13 patients (2.3%). An NMBA was commenced within 2 hours after surgery in 207 patients (36.6%). There were significant differences in the incidence of postoperative MAEs between the pNMBA group and the non-pNMBA group (5.3% v 0.6%; p < 0.001). In multivariate regression models, pNMBA infusion was not significantly associated with the incidence of MAEs (odds ratio: 1.79, 95% CI: 0.23-13.93, p = 0.58), but was significantly associated with prolonged mechanical ventilation by 3.85 days (p < 0.001). CONCLUSIONS: Postoperative prophylactic neuromuscular blockade after cardiac surgery can be associated with prolonged mechanical ventilation, but has no association with MAEs among pediatric patients with congenital heart disease.

DOI： 10.1053/j.jvca.2023.02.030

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PURPOSE: This study investigated the incidence of postoperative pulmonary complications (PPC) when high-flow nasal cannula therapy (HFNC) is used prophylactically after pediatric cardiac surgery, and evaluated its efficacy. METHODS: This was a single-arm prospective interventional study that was conducted in a tertiary teaching hospital with eight beds in the pediatric cardiac ICU after approval by the Ethics Committee. One-hundred children under the age of 48 months who were scheduled for cardiac surgery for congenital heart disease were recruited. HFNC was used for 24 h after extubation at a 2 L/kg/min flow rate. The primary outcome was the incidence of PPC within 48 h after extubation. PPC was defined as atelectasis and acute respiratory failure meeting certain criteria. We considered prophylactic HFNC as effective if the prevalence of PPC was < 10%, based on previous reports of reintubation rates of 6%-9% after pediatric cardiac surgery. RESULTS: A total of 91 patients were finally included in the analysis. The incidence of PPC within 48 h after extubation was 18.7%, whereas atelectasis was observed in 13.2%, and acute respiratory failure in 8.8%. Reintubation rate within 48 h after extubation was 0%. CONCLUSIONS: We found the incidence of PPC with prophylactic HFNC after planned extubation after pediatric cardiac surgery. However, the incidence was > 10%; therefore, we could not demonstrate its efficacy in this single-arm study. Further studies are needed to investigate whether the HFNC could be adapted as first-line oxygen therapy after pediatric cardiac surgery.

DOI： 10.1007/s00540-023-03187-3

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Regional cerebral oxygen saturation (ScO2) determined by near-infrared spectroscopy, monitoring both arterial and venous blood oxygenation of the brain, could reflect the balance between oxygen delivery and consumption. The aim of this study was to determine the predictabilities of ScO2 and estimated oxygen extraction ratio (eO2ER) with outcomes in infants with congenital heart disease (CHD). This study was a two-center, retrospective study of patients at 12 months of age or younger with CHD who underwent cardiac surgery. The primary outcome was a composite of one or more major adverse events (MAEs) after surgery: death from any cause, circulatory collapse that needed cardiopulmonary resuscitation, and requirement for extracorporeal membrane oxygenation. Based on the assumptions of arterial to venous blood ratio, eO2ER was calculated. A total of 647 cases were included in this study. MAEs occurred in 16 patients (2.5%). There were significant differences in post-bypass ScO2 [46.61 (40.90, 52.05) vs. 58.52 (51.52, 66.08), p < 0.001] and post-bypass eO2ER [0.66 (0.60, 0.78) vs. 0.52 (0.43, 0.61), p < 0.001] between patients with MAEs and patients without MAEs. Area under the receiver operating curve (AUROC) of post-bypass ScO2 was 0.818 (95% confidence interval: 0.747-0.889), AUROC of post-bypass eO2ER was 0.783 (0.697-0.870) and AUROC of post-bypass maximum serum lactate level was 0.635 (0.525-0.746). Both ScO2 and eO2ER, especially after weaning off bypass, are acceptable predictive markers for predicting MAEs after cardiac surgery in infants.(227 words).

DOI： 10.1007/s00246-023-03158-1

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BACKGROUND: The present retrospective study was carried out to determine the incidence of unrecognized cardiac surgery-associated acute kidney injury (CSA-AKI) due to infrequency of serum creatinine (SCr) measurements in pediatric cardiac patients and to assess the association between unrecognized CSA-AKI and clinical outcomes. METHODS: This study was a single-center, retrospective study of pediatric patients who underwent cardiac surgery. Patients were diagnosed with CSA-AKI based on SCr measurements, and unrecognized CSA-AKI was defined under the assumptions that there had been only one or two SCr measurements within 48 h after surgery: CSA-AKI unrecognized by one SCr measurement (AKI-URone), CSA-AKI unrecognized by two SCr measurements (AKI-URtwo), and CSA-AKI recognized by one and two SCr measurements (AKI-R). The change of SCr from baseline to postoperative day 30 (delta SCr30d) was assessed as a surrogate of kidney recovery. RESULTS: In a total of 557 cases, 313 patients (56.2%) were diagnosed with CSA-AKI, 188 (33.8%) of whom had unrecognized CSA-AKI. Delta SCr30d in the AKI-URtwo group and delta SCr30d in the AKI-URone group was not significantly different from delta SCr30d in the non-AKI group (p = 0.67 and p = 0.79, respectively). There were significant differences in the durations of mechanical ventilation, serum B-type natriuretic peptide levels, and lengths of stay in hospital between the non-AKI group and the AKI-URtwo group and between the non-AKI group and the AKI-URtwo group. CONCLUSIONS: Unrecognized CSA-AKI due to infrequent SCr measurements is not rare and is associated with prolonged mechanical ventilation, high postoperative BNP level, and prolonged length of stay in hospital. A higher resolution version of the Graphical abstract is available as Supplementary information.

DOI： 10.1007/s00467-023-05925-x

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BACKGROUND: Postpartum hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is more difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to plasma exchange (PE) therapy. CASE PRESENTATION: A 30-year-old primipara woman was hospitalized for gestational hypertension at 33 weeks of gestation and underwent an emergent cesarean section at 36 weeks and 6 days of gestation due to rapidly progressing pulmonary edema. After delivery, liver dysfunction and a rapid decrease in platelet count were observed, and the patient was diagnosed with severe HELLP syndrome. She experienced multiple organ failure despite intensive care, and PE therapy was initiated. Her general condition dramatically stabilized within a few hours of PE therapy. CONCLUSION: It is controversial whether PE therapy should be used primarily in the management of HELLP syndrome, but early initiation of PE therapy could be effective for severe HELLP syndrome.

DOI： 10.1186/s40981-023-00602-2

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Language：Japanese   Publisher：克誠堂出版(株)  

82歳の女性に対して,硬膜外麻酔併用全身麻酔下に尿管皮膚瘻造設術が行われた。術後2日目より下肢に筋力低下・感覚障害を生じ,硬膜外カテーテルを抜去したが,症状は消失しなかった。術後3日目の磁気共鳴画像(MRI)で硬膜外に液体貯留を認めており,硬膜外コンパートメント症候群により持続的な神経障害を生じたと考えられた。(著者抄録)

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Some pediatric cardiac patients might experience low regional cerebral oxygen saturation (rSO2) during surgery. We investigated whether a pediatric patient's mean arterial pressure (MAP) can affect the rSO2 value during cardiopulmonary bypass (CPB). We retrospectively analyzed the cases of the pediatric patients who underwentcardiac surgery at our hospital (Jan. -Dec. 2019; n=141). At each MAP stage, we constructed line charts through the mean of the rSO2 values corresponding to each MAP and then calculated the correlation coefficients. We next divided the patients into age subgroups (neonates, infants, children) and into cyanotic congenital heart disease (CHD) and acyanotic CHD groups and analyzed these groups in the same way. The analyses of all 141 patients revealed that during CPB the rSO2 value increased with an increase in MAP (r=0.1626). There was a correlation between rSO2 and MAP in the children (r=0.2720) but not in the neonates (r=0.06626) or infants (r=0.05260). Cyanotic CHD or acyanotic CHD did not have a significant effect on the rSO2/MAP correlation. Our analysis demonstrated different patterns of a correlation between MAP and rSO2 in pediatric cardiac surgery patients, depending on age. MAP was positively correlated with rSO2 typically in children but not in neonate or infant patients.

DOI： 10.18926/AMO/64037

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Language：Japanese   Publisher：(一社)日本小児麻酔学会  

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Language：Japanese   Publisher：(一社)日本小児麻酔学会  

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Language：Japanese   Publisher：(一社)日本小児麻酔学会  

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Language：Japanese   Publisher：真興交易(株)医書出版部  

無痛分娩に関連した母児の死亡、後遺障害の個別案件が続いたことを受けて、無痛分娩の安全な提供体制の構築が求められている。本邦における無痛分娩普及率は、欧米と比較すると低いが、その割合は着実に増してきている。今後、麻酔科医による無痛分娩の需要は高まっていく可能性があり、産科麻酔を専門としない麻酔科医にとっても無痛分娩に関する最低限の知識は持っておく必要があると思われる。(著者抄録)

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BACKGROUND: We present our experience with transcatheter vascular occlusion using 0.035-inch hydrogel expandable coils, which has been reported only in a few cases in the pediatric cardiology fields. METHODS: This study is a retrospective analysis of all patients who underwent transcatheter embolization with 0.035-inch hydrogel coils at the Department of Pediatrics, Okayama University Hospital, between October 2018 and September 2020. RESULTS: Twenty patients with a median age of 5.1 years (0.05-26.0 years) and a median weight of 13.8 kg (3.0-56.8 kg) were included. A total of fifty-four 0.035-inch hydrogel coils, including 35 Azur 35 and nineteen Azur CX 35 coils (Terumo, Tokyo, Japan), were successfully deployed in 22 target vessels. The target vessels consisted of 10 aortopulmonary collaterals, 8 veno-venous collaterals, and 4 pulmonary arteriovenous malformations. We achieved technical success in all the target vessels. In total, the mean target vessel diameter was 4.4 mm, the mean number of 0.035-inch hydrogel coils was 2.5 per vessel. The mean device to vessel ratio was 1.6 for the anchor coil and 1.2 for the additional coil. Post-implantation angiograms revealed that the primary occlusion rate was 18/22 (82%). There were no periprocedural complications. CONCLUSIONS: The 0.035-inch hydrogel expandable coils are effective and safe in patients with congenital heart disease and vascular anomalies. These occlusion devices could be valuable options for interventional pediatric cardiologists.

DOI： 10.1016/j.jjcc.2022.04.005

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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BACKGROUND: Endoscopic procedures are rarely performed in children with congenital heart disease (CHD); therefore, the associated complications are unknown. We report an abrupt change in circulatory and respiratory condition during endoscopic injection sclerotherapy for esophageal varices. CASE PRESENTATION: A 9-year-old boy with a history of total anomalous pulmonary venous connection (TAPVC) repair and Fontan procedure for asplenia and a single ventricle with TAPVC underwent endoscopic injection sclerotherapy under general anesthesia for esophageal varices. Systolic blood pressure decreased from 70 to 50 mmHg following a sclerosant injection; a second injection reduced his peripheral oxygen saturation from 93 to 79% secondary to ventilation difficulty. Although we suspected anaphylaxis intraoperatively, postoperative imaging suggested that balloon dilation performed to prevent sclerosing agent leakage caused compression of the pulmonary venous chamber and trachea owing to the anomalous intrathoracic organ anatomy. CONCLUSION: Thorough understanding of the complex anatomy is important before performing endoscopic procedures in children with CHD to preoperatively anticipate possible intraoperative complications and select the optimal therapeutic approach and anesthesia management.

DOI： 10.1186/s40981-022-00538-z

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PURPOSE: The purpose of this study is to investigate the current status of postoperative BNP measurement in the pediatric cardiac intensive care unit (PCICU). METHODS: This was a prospective multicenter observational study. Children under 15 years old who underwent pediatric cardiac surgery were included. Postoperatively, all BNP measurement was collected in PCICU. We checked whether each BNP measurement was used for the decision-making of intervention or not. We divided the BNP measurements into 4 groups: group A 0-299 pg/ml (reference), group B 300-999 pg/ml, group C 1000-1999 pg/ml, group D ≧ 2000 pg/ml. We performed logistic regression analysis to compare the intervention ratio between group A and B, C, D. We also did multiple comparison analyses to compare the intervention ratio in each group. RESULTS: Thirty-nine (15.8%) measurements were used as a criterion to intervene in all BNP measurements. There was no protocol for the measurement of BNP in all institutions. The number of BNP measurements in each group is as follows: group A 113 (45.9%), group B 81 (32.9%), group C 45 (18.3%), group D 7 (2.8%). The intervention ratio in each group was 6.2% (group A), 8.6% (group B), 44.4% (group C), and 71.4% (group D). The intervention ratio of group C and D were significantly higher than group A: (Odds ratio (95%CI): 12.1(4.8-33.9), p < 0.0001, 25.2(5.2-146.2), p < 0.0001). The result of multiple comparisons is similar to logistic regression analysis. CONCLUSION: High BNP concentration, especially more than 1000 pg/ml, was more often intervened upon compared to that of less than 1000 pg/ml.

DOI： 10.1007/s00540-022-03052-9

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BACKGROUND: We present our experience with transcatheter vascular occlusion using 0.035-inch hydrogel expandable coils, which has been reported only in a few cases in the pediatric cardiology fields. METHODS: This study is a retrospective analysis of all patients who underwent transcatheter embolization with 0.035-inch hydrogel coils at the Department of Pediatrics, Okayama University Hospital, between October 2018 and September 2020. RESULTS: Twenty patients with a median age of 5.1 years (0.05-26.0 years) and a median weight of 13.8 kg (3.0-56.8 kg) were included. A total of fifty-four 0.035-inch hydrogel coils, including 35 Azur 35 and nineteen Azur CX 35 coils (Terumo, Tokyo, Japan), were successfully deployed in 22 target vessels. The target vessels consisted of 10 aortopulmonary collaterals, 8 veno-venous collaterals, and 4 pulmonary arteriovenous malformations. We achieved technical success in all the target vessels. In total, the mean target vessel diameter was 4.4 mm, the mean number of 0.035-inch hydrogel coils was 2.5 per vessel. The mean device to vessel ratio was 1.6 for the anchor coil and 1.2 for the additional coil. Post-implantation angiograms revealed that the primary occlusion rate was 18/22 (82%). There were no periprocedural complications. CONCLUSIONS: The 0.035-inch hydrogel expandable coils are effective and safe in patients with congenital heart disease and vascular anomalies. These occlusion devices could be valuable options for interventional pediatric cardiologists.

DOI： 10.1016/j.jjcc.2022.04.005

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Even today, when the surgical outcome of congenital heart disease in the neonatal period has improved, the prognosis for heterotaxy syndrome and functional single ventricle complicated with total anomalous pulmonary venous connection (TAPVC), especially the infra-cardiac type, is catastrophic. We describe a strategy that combines percutaneous ductus venosus (DV) stent placement and occlusion after TAPVC repair to ensure survival from initial surgery to bidirectional cavopulmonary shunt (BCPS) procedure and facilitate subsequent treatment. Three consecutive patients with heterotaxy syndrome and functional single ventricle complicated by infra-cardiac TAPVC treated with our own strategy were retrospectively studied. In two infants, DV stent placement was performed on the day of birth. In one case at 11 days of age. The risk of pulmonary vein obstruction was reduced, and on-pump surgery, including TAPVC repair, was performed on a standby basis. Since the rapid increase in hepatic enzymes occurred on postoperative day 0 to 1 in all cases, percutaneous stent occlusion was performed until postoperative day 3. The procedure improved liver function. One patient died due to severe atrioventricular valve regurgitation, one case underwent BCPS, and one patient was waiting to undergo. DV stent placement can avoid TAPVC repair in the early neonatal period. After TAPVC repair, the portosystemic shunt remained, resulting in hepatic dysfunction, but this could be improved by stent and vertical vein occlusion. A series of stepwise treatments can be useful to help such critically ill infants survive the high-risk neonatal period and achieve good BCPS circulation.

DOI： 10.1007/s00246-021-02782-z

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Other Link： https://link.springer.com/article/10.1007/s00246-021-02782-z/fulltext.html

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

Even today, when the surgical outcome of congenital heart disease in the neonatal period has improved, the prognosis for heterotaxy syndrome and functional single ventricle complicated with total anomalous pulmonary venous connection (TAPVC), especially the infra-cardiac type, is catastrophic. We describe a strategy that combines percutaneous ductus venosus (DV) stent placement and occlusion after TAPVC repair to ensure survival from initial surgery to bidirectional cavopulmonary shunt (BCPS) procedure and facilitate subsequent treatment. Three consecutive patients with heterotaxy syndrome and functional single ventricle complicated by infra-cardiac TAPVC treated with our own strategy were retrospectively studied. In two infants, DV stent placement was performed on the day of birth. In one case at 11 days of age. The risk of pulmonary vein obstruction was reduced, and on-pump surgery, including TAPVC repair, was performed on a standby basis. Since the rapid increase in hepatic enzymes occurred on postoperative day 0 to 1 in all cases, percutaneous stent occlusion was performed until postoperative day 3. The procedure improved liver function. One patient died due to severe atrioventricular valve regurgitation, one case underwent BCPS, and one patient was waiting to undergo. DV stent placement can avoid TAPVC repair in the early neonatal period. After TAPVC repair, the portosystemic shunt remained, resulting in hepatic dysfunction, but this could be improved by stent and vertical vein occlusion. A series of stepwise treatments can be useful to help such critically ill infants survive the high-risk neonatal period and achieve good BCPS circulation.

DOI： 10.1007/s00246-021-02782-z

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Language：Japanese   Publisher：克誠堂出版(株)  

小児心臓手術において人工心肺離脱直後のトロンボエラストメトリー(ROTEM Delta、アムコ、東京)の10分での各測定値(amplitude at 10 minutes:A10)が術後ドレーン出血量と関連するかを単施設で後方視的に検討した。対象は18歳未満の、2010年10月1日から2011年7月31日までの小児心臓手術症例で人工心肺離脱時にROTEMを施行した18症例である。INTEM、EXTEM、FIBTEMのA10、maximum clot firmness(MCF)が術後6および24時間出血量と有意に相関関係を認めた。INTEMおよびEXTEMのA10とMCFはそれぞれ強い相関関係を認めた。術後出血量はINTEM、EXTEM、FIBTEM-A10の結果と相関し、検査完了を待たずともA10が確認できれば術後出血量が予測できる可能性がある。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01397&link_issn=&doc_id=20211203130007&doc_link_id=%2Fad3msuie%2F2021%2F007012%2F008%2F1315b1321%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2021%2F007012%2F008%2F1315b1321%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

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BACKGROUND: Atrial tachycardia (AT) is rare in children and can usually be reversed to sinus rhythm with pharmacotherapy and cardioversion. We report a rare case of severe left-sided heart failure due to refractory AT. CASE PRESENTATION: A 12-year-old boy had AT with a heart rate of 180 beats/minute, which was refractory to any medication and defibrillation despite the first attack. Due to rapid cardiorespiratory collapse shortly after arriving at our hospital, central extracorporeal membrane oxygenation (ECMO) with left arterial venting was started immediately. Although AT persisted after that, it stopped on the 3rd day after admission following surgical resection of the left atrial appendage thought to be the source of AT. He was weaned off ECMO on the 7th day and ventilator on the 14th day. CONCLUSIONS: The appropriate timing of central ECMO and surgical ablation were effective in saving this child from a life-threatening situation caused by refractory AT.

DOI： 10.1186/s40981-021-00481-5

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OBJECTIVES: The aim of this study was to investigate whether milrinone infusion improved one-year survival in patients who underwent the Norwood-Sano procedure. DESIGN: A retrospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: Children who underwent the Norwood-Sano procedure from January 2008 to December 2014. INTERVENTIONS: Patients were categorized into two groups: group E+D, who received routine epinephrine and dopamine infusion, and group M, who received routine milrinone infusion for intra- and postoperative inotropic support. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study was one-year survival after the Norwood-Sano procedure. A total of 45 patients were included (group E+D, 22; group M, 23). One-year survival in group M was significantly higher than that in group E+D (95.7% [22/23] v 72.7% [16/22], p = 0.03). A Kaplan-Meier curve also showed that one-year survival in group M was significantly higher than that in group E+D (p = 0.04), from the result of the log-rank test. The number of patients who had any arrhythmias in the intensive care unit (ICU) was significantly lower in group M than in group E+D (21.7% [5/23] v 50% [11/22], p = 0.03). The duration of ICU stay did not have statistical difference between groups (group M 19; interquartile range [IQR], 15-28) v group E+D 19.5 (IQR, 16.3-35.5) days, p = 0.57). CONCLUSIONS: Perioperative milrinone infusion improved the mortality after the Norwood-Sano procedure. Potential advantages of milrinone compared with epinephrine are fewer arrhythmias and better systemic perfusion, which could decrease lethal cardiac events in the ICU.

DOI： 10.1053/j.jvca.2021.02.017

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PURPOSE: The relationship between regional cerebral oxygen saturation (rSO2) and the amount of left-to-right shunt in ventricular septal defect (VSD) patients has not yet been investigated. The purpose of this study was to identify the association of preoperative pulmonary to systemic blood flow (Qp/Qs) ratio and preoperative rSO2 in patients with VSD. METHODS: We retrospectively evaluated 49 VSD surgical closure candidates at a single institution. Preoperative Qp/Qs ratio was compared with rSO2 measurements at the time of VSD closure surgery. RESULTS: Forty-nine were eligible for the final analysis. The median age at surgery was 6 (interquartile range [IQR]: 3, 12) months, and 36.7% were male. Atrial septal defects coexisted in 51.0%. There were no genetic abnormalities except trisomy 21 in 32.6% of the patients. Pulmonary hypertension was found in 42.8%. The median Qp/Qs ratio, calculated based on catheter testing results before the surgery, was 2.7 (IQR: 2.1, 3.7). Postoperative rSO2 was significantly higher than preoperative values (52.2 ± 12.9, 63.5 ± 13.1%, p < 0.001). There was an inverse relationship of Qp/Qs and preoperative cerebral rSO2 (r = - 0.11, p = 0.02). CONCLUSION: A higher Qp/Qs ratio was associated with a lower preoperative cerebral rSO2 in pediatric patients with VSD.

DOI： 10.1007/s00540-021-02931-x

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BACKGROUND: Respiratory compromise (RC) including hypoxia and hypoventilation is likely to be missed in the postoperative period. Integrated pulmonary index (IPI) is a comprehensive respiratory parameter evaluating ventilation and oxygenation. It is calculated from four parameters: end-tidal carbon dioxide, respiratory rate, oxygen saturation measured by pulse oximetry (SpO2), and pulse rate. We hypothesized that IPI monitoring can help predict the occurrence of RC in patients at high-risk of hypoventilation in post-anesthesia care units (PACUs). METHODS: This prospective observational study was conducted in two centers and included older adults (≥ 75-year-old) or obese (body mass index ≥ 28) patients who were at high-risk of hypoventilation. Monitoring was started on admission to the PACU after elective surgery under general anesthesia. We investigated the onset of RC defined as respiratory events with prolonged stay in the PACU or transfer to the intensive care units; airway narrowing, hypoxemia, hypercapnia, wheezing, apnea, and any other events that were judged to require interventions. We evaluated the relationship between several initial parameters in the PACU and the occurrence of RC. Additionally, we analyzed the relationship between IPI fluctuation during PACU stay and the occurrences of RC using individual standard deviations of the IPI every five minutes (IPI-SDs). RESULTS: In total, 288 patients were included (199 elderly, 66 obese, and 23 elderly and obese). Among them, 18 patients (6.3 %) developed RC. The initial IPI and SpO2 values in the PACU in the RC group were significantly lower than those in the non-RC group (6.7 ± 2.5 vs. 9.0 ± 1.3, p < 0.001 and 95.9 ± 4.2 % vs. 98.3 ± 1.9 %, p = 0.040, respectively). We used the area under the receiver operating characteristic curves (AUC) to evaluate their ability to predict RC. The AUCs of the IPI and SpO2 were 0.80 (0.69-0.91) and 0.64 (0.48-0.80), respectively. The IPI-SD, evaluating fluctuation, was significantly greater in the RC group than in the non-RC group (1.47 ± 0.74 vs. 0.93 ± 0.74, p = 0.002). CONCLUSIONS: Our study showed that low value of the initial IPI and the fluctuating IPI after admission to the PACU predict the occurrence of RC. The IPI might be useful for respiratory monitoring in PACUs and ICUs after general anesthesia.

DOI： 10.1186/s12871-021-01338-1

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BACKGROUND: Intraoperative complications during combined thoracoscopic-laparoscopic surgery for esophagogastric junction (EGJ) carcinoma have not been reported as compared to those during surgery for esophageal carcinoma. We present two cases which had surgery-related hemodynamic instability during laparoscopic proximal gastrectomy and intra-mediastinal valvuloplastic esophagogastrostomy (vEG) with thoracoscopic mediastinal lymphadenectomy for EGJ carcinoma. CASE PRESENTATION: In case 1, the patient fell into hypotension with hypoxemia during laparoscopic vEG due to pneumothorax caused by entry of intraabdominal carbon dioxide. In case 2, ventricular arrythmia and ST elevation occurred during laparoscopic vEG. Pericardium retraction to secure surgical field during reconstruction compressed the coronary artery, which caused coronary malperfusion. These two events were induced by the surgical procedure, characterized by the following: (1) connection of the thoracic and abdominal cavities and (2) cardiac displacement during vEG. CONCLUSION: These cases indicated tension pneumothorax and coronary ischemia are possible intraoperative complications specific to combined thoracoscopic-laparoscopic surgery for EGJ carcinoma.

DOI： 10.1186/s40981-021-00419-x

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BACKGROUND: Pneumopericardium in neonates is often associated with respiratory diseases, of which positive pressure ventilation (PPV) is an exacerbating factor. Here, we present a neonate case of pneumopericardium after cardiac surgery which was resolved after applying PPV. CASE PRESENTATION: A 28-day-old neonate with left recurrent nerve palsy after aortic reconstruction for interrupted aortic arch developed pericardial effusion. Pericardiocentesis was performed under general anesthesia, and a drainage tube was left in the pericardium. After extubation, stridor gradually exacerbated, following hemodynamic deterioration. A chest X-ray demonstrated pneumopericardium. Upper airway stenosis due to recurrent nerve palsy developed excessive negative pleural pressure, and air was drawn into pericardium via the insertion site of the drainage tube. After tracheal intubation and applying PPV, the pneumopericardium improved. CONCLUSION: PPV does not always exacerbate pneumopericardium. In a patient with pericardial-atmosphere communication, increased inspiration effort can cause pneumopericardium, and PPV is a therapeutic option to alleviate the pneumopericardium.

DOI： 10.1186/s40981-020-00384-x

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Background and aims: Agreement between measurements of creatinine concentrations using point-of-care (POC) devices and measurements conducted in a standard central laboratory is unclear for pediatric patients. Our objectives were (a) to assess the agreement for pediatric patients and (b) to compare the incidence of postoperative acute kidney injury (AKI) according to the two methods. Methods: This retrospective, single-center study included patients under 18 years of age who underwent cardiac surgery and who were admitted into the pediatric intensive care unit of a tertiary teaching hospital (Okayama University Hospital, Japan) from 2013 to 2017. The primary objective was to assess the correlation and the agreement between measurements of creatinine concentrations by a Radiometer blood gas analyzer (Cregas) and those conducted in a central laboratory (Crelab). The secondary objective was to compare the incidence of postoperative AKI between the two methods based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results: We analyzed the results of 1404 paired creatinine measurements from 498 patients, whose median age was 14 months old (interquartile range [IQR] 3, 49). The Pearson correlation coefficient of Cregas vs Crelab was 0.968 (95% confidence interval [CI], 0.965-0.972, P < 0.001). The median bias between Cregas and Crelab was 0.02 (IQR -0.02, 0.05) mg/dL. While 199 patients (40.0%) were diagnosed as having postoperative AKI based on Crelab, 357 patients (71.7%) were diagnosed as having postoperative AKI based on Cregas (Kappa = 0.39, 95% CI, 0.33-0.46). In a subgroup analysis of patients whose Cregas and Crelab were measured within 1 hour, similar percentage of patients were diagnosed as having postoperative AKI based on Cregas and Crelab (42.8% vs 46.0%; Kappa = 0.76, 95% CI, 0.68-0.84). Conclusion: There was an excellent correlation between Cregas and Crelab in pediatric patients. Although more patients were diagnosed as having postoperative AKI based on Cregas than based on Crelab, paired measurements with a short time gap showed good agreement on AKI diagnosis.

DOI： 10.1002/hsr2.143

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A 9-year-old girl with Glenn circulation suffered from massive atelectasis of the left lung caused by bleeding during cardiac catheterization. The atelectasis resulted in frequent hypoxia leading to oxygen saturation (SpO2) of 40%-50%. In the intensive care unit, we performed a unilateral lung recruitment maneuver (ULRM) for 2 days. The ULRM involved placement of a bronchial blocker in the right main bronchus and application of continuous positive airway pressure to the left lung without hemodynamic deterioration. Eventually, SpO2 improved to 80%-85%. ULRM can be a treatment option for unilateral atelectasis in a child with Glenn circulation.

DOI： 10.1213/XAA.0000000000001101

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We here report that a 71-year-old Japanese woman with a history of anaphylaxis induced by muscle relaxants had local anesthetic systemic toxicity (LAST) following an abdominal surgery under general anesthesia with combined spinal-epidural anesthesia without muscle relaxants. The total dosages of local anesthetics reached 0.67 mg/kg of ropivacaine and 11.5 mg/kg of lidocaine over 12.5 h to obtain sufficient muscle relaxation for surgery. Regional anesthesia is useful in cases in which muscle relaxants are to be avoided during a surgery. However, especially for a patient with risk factors and prolonged surgery, precautions should be taken to prevent LAST.

DOI： 10.18926/AMO/57721

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BACKGROUND: Minimally invasive cardiac surgery (MICS) for simple congenital heart defects has become popular, and monitoring of regional cerebral oxygen saturation (rSO2) is crucial for preventing cerebral ischemia during pediatric MICS. We describe a pediatric case with a sudden decrease in rSO2 during MICS. CASE PRESENTATION: An 8-month-old male underwent minimally invasive ventricular septal defect closure. He developed a sudden decrease in rSO2 and right radial artery blood pressure (RRBP) without changes in other parameters following pericardium traction. The rSO2 and RRBP immediately recovered after removal of pericardium fixation. Obstruction of the right innominate artery secondary to the pericardium traction would have been responsible for it. CONCLUSIONS: Pericardium traction, one of the common procedures during MICS, triggered rSO2 depression alerting us to the risk of cerebral ischemia. We should be aware that pericardium traction during MICS can lead to cerebral ischemia, which is preventable by cautious observation of the patient.

DOI： 10.1186/s40981-019-0273-7

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OBJECTIVE: Hyperchloremia recently has been shown to have an association with the development of acute kidney injury (AKI) in critically ill patients. However, there is little information about the prevalence of an abnormal chloride concentration after pediatric cardiac surgery and its association with postoperative AKI. The aim of this study was to determine the prevalence of hyperchloremia and its association with AKI in pediatric patients after cardiac surgery. DESIGN: A retrospective single-center study. SETTING: Referral high-volume pediatric cardiac center in a tertiary teaching hospital. PARTICIPANTS: Patients under 72 months of age with congenital heart disease who underwent cardiac surgery with the use of cardiopulmonary bypass. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was development of AKI diagnosed by Kidney Disease Improving Global Outcomes consensus criteria. The associations of outcomes with the highest serum chloride concentration ([Cl-]max) and time-weighted average chloride concentration ([Cl-]ave) within the first 48 hours after surgery were investigated. Of 521 patients included in the study, 463 patients (88.9%) had hyperchloremia at least 1 time within the first 48 hours after surgery. Postoperative AKI occurred in 205 patients (39.3%). [Cl-]ave and [Cl-]max in the AKI group were significantly higher than those in the non-AKI group (112 [110-114] mEq/L v 111 [109-113] mEq/L, p = 0.001 and 116 [113, 119] mEq/L v 114 [112-118] mEq/L, p = 0.002, respectively). After adjustment for other predictors of AKI by multivariable analyses, neither [Cl-]ave nor [Cl-]max was associated independently with the development of AKI (odds ratio [OR] = 1.040, 95% confidence interval [CI]: 0.885-1.220, p = 0.63; OR = 0.992, 95% CI: 0.874-1.130. p = 0.90). CONCLUSION: Postoperative hyperchloremia was common and was associated with the development of AKI in pediatric patients after congenital cardiac surgery in univariate analysis. After adjustment for predictors of AKI by multivariate analyses, there was no significant relationship between postoperative chloride concentration and AKI.

DOI： 10.1053/j.jvca.2018.12.009

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We compared the reintubation rate in children who received high-flow nasal cannula (HFNC) therapy to the rate in children who received noninvasive ventilation (NIV) therapy for acute respiratory failure (ARF) after cardiac surgery. This was a retrospective analysis of 35 children who received HFNC therapy for ARF after cardiac surgery in 2014-2015 (the HFNC group). We selected 35 children who had received NIV therapy for ARF after cardiac surgery in 2009-2012 as a control group. The matching parameters were body weight and risk adjustment for congenital heart surgery category 1. The reintubation rate within 48 h in the HFNC group tended to be lower than that in the NIV group (3% vs. 17%, p=0.06). The reintubation rate within 28 days was significantly lower in the HFNC group compared to the NIV group (3% vs. 26%, p=0.04). The HFNC group's ICU stays were significantly shorter than those of the NIV group: 10 (IQR: 7-17) days vs. 17 (11-32) days, p=0.009. HFNC therapy might be associated with a reduced reintubation rate in children with ARF after cardiac surgery.

DOI： 10.18926/AMO/56454

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We investigated the incidence of desaturation during general anesthesia in preoperatively hypoxic (< 92%), and nonhypoxic (≥ 92%) pediatric (n=1,090) and adult (n=5,138) patients. We plotted the patients' SpO2 value time-courses and assessed desaturation in 6,228 patients. The crude overall incidence (95%CI) for desaturation was 11.1% (9.4-13.1) in the pediatric patients and 0.9% (0.6-1.2) in the adults. The crude incidence of desaturation in the hypoxic pediatric patients was 2.5 times the risk in the nonhypoxic patients: risk ratio (RR) 2.5 (1.8-3.5), p<0.001. The risk of desaturation in the hypoxic adult patients was 20.1 times the risk in the nonhypoxic adult patients: RR 20.1 (10.3-39.2), p<0.001. When the patients were separately stratified by American Society of Anesthesiologists Physical Status (ASA-PS) and by age, the directly adjusted risk-ratio (RRS) showed that the hypoxic pediatric patients had 1.8 and 1.6 times the risk in the nonhypoxic pediatric patients: ASA-PS adjusted RRS 1.6 (1.8-2.2), p<0.001; age-adjusted RRS 1.8 (1.3-2.5), p<0.001, and the hypoxic adult patients had 13.8 times the risk in the nonhypoxic adult patients: RRS 13.8 (6.9-27.6), p<0.001. A pulse-oximeter check before the start of general anesthesia could ensure timely preparation to avoid intraoperative desaturation.

DOI： 10.18926/AMO/56244

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OBJECTIVE: There has been controversy regarding the beneficial effects of calcium on myocardial contractility and the harmful effects on myocardial cells, especially in children. The aim of this study was to investigate an association between ionized calcium concentration (iCa) and outcomes for pediatric patients after cardiac surgery. DESIGN: A retrospective, single-center study from May 2013 to December 2014. SETTING: Referral high-volume pediatric cardiac center in a tertiary teaching hospital. PATIENTS: Patients <72 months old with congenital heart disease who underwent palliative or definitive surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The association between pH-corrected iCa within 24 hours after surgery and intensive care unit (ICU) length of stay (ILOS) was defined as the primary outcome. The highest iCa (iCamax), lowest iCa (iCamin), and time-weighted average iCa (iCaave) were stratified and compared with the outcomes. The authors reviewed 5,468 ionized calcium measurements from 357 consecutive pediatric patients during the study period. One patient died at postoperative day 34 in the ICU. Significant differences in ILOS were observed among patients after cardiopulmonary bypass (CPB) according to iCaave, iCamax, and iCamin but not among patients without CPB. Patients with CPB and an iCaave value of 1.31-to-1.40 mmol/L, 1.41-to-1.50 mmol/L, 1.51-to-1.60 mmol/L, and >1.60 mmol/L stayed in the ICU for 7 (interquartile range [IQR] 4-10) days, 8 (IQR 6-16) days, 10 (IQR 8-14) days, and 19 (IQR 12-38) days, respectively, which was significantly longer than the ILOS of 5 (4-8) days for patients with an iCaave of 1.21-to-1.30 mmol/L. Even after adjustment for other predictors of ILOS using multivariable analyses, there were significant relationships of ILOS with iCaave and iCamin values of >1.50 mmol/L among patients with CPB. CONCLUSIONS: Higher iCa within 24 hours after congenital cardiac surgery using CPB was independently associated with longer LOS in the ICU.

DOI： 10.1053/j.jvca.2017.11.006

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We will investigate the incidence of postoperative pulmonary complications (PPCs) with the prophylactic use of a high-flow nasal cannula (HFNC) after pediatric cardiac surgery. Children < 48 months old with congenital heart disease for whom cardiac surgery is planned will be included. The HFNC procedure will be commenced just after extubation, at a flow rate of 2 L/kg/min with adequate oxygen concentration to achieve target oxygen saturation ≥ 94%. This study will reveal the prevalence of PPCs after pediatric cardiac surgery with the prophylactic use of HFNC.

DOI： 10.18926/AMO/55862

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Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Clinical Anesthesia  

DOI： 10.2199/jjsca.38.142

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OBJECTIVES: The aim of this study was to investigate the relationship between perioperative brain natriuretic peptide levels and the incidence of postoperative serious adverse events (SAEs) in pediatric cardiac patients. DESIGN: A prospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: Children under 15 years old who underwent cardiac surgery that required cardiopulmonary bypass from December 21, 2012 to February 26, 2014. The Risk Adjustment for Congenital Heart Surgery 1 category less than 1 was excluded. INTERVENTIONS: Brain natriuretic peptide (BNP) levels were measured preoperatively (BNPpre) and on postoperative day 1 (BNPPOD1) and postoperative day 3 (BNPPOD3). METHODS AND RESULTS: Primary outcome was the incidence of postoperative SAEs; (1) death in the intensive care unit, (2) requirement of extracorporeal membrane oxygenation, (3) cardiac arrest, and (4) requirement of reoperation for hemodynamic instability. The authors included 71 patients in this study. There were 8 patients (11%) who had at least 1 SAE. Median preoperative BNP level in patients with SAEs was significantly higher than in those without SAEs (1,541 pg/mL [IQR: 121-5,962] v 122 pg/mL [QR: 34-342], p = 0.01). From the receiver operating characteristic curve of BNPpre for the incidence of SAEs, an area under the curve was 0.77 (95%CI 0.55-0.91). The best cutoff BNPpre number was 1,000 pg/mL. From the multivariate logistic regression model, BNPpre>1,000 pg/mL was associated independently with risk of SAEs (adjusted odds ratio = 8.5, 95% CI [1.3, 59.3], p = 0.02). CONCLUSIONS: In conclusion, the authors' study showed that increased preoperative brain natriuretic peptide concentration, especially a concentration of more than 1,000 pg/mL, was associated with risk of SAEs in pediatric cardiac surgery patients.

DOI： 10.1053/j.jvca.2016.09.008

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BACKGROUND: Reintubation after pediatric cardiac surgery is associated with a high rate of mortality. Therefore, adequate respiratory support for postextubation acute respiratory failure (ARF) is important. However, little is known about the physiological impact of high-flow nasal cannula (HFNC) therapy on ARF after pediatric cardiac surgery. Our working hypothesis was that HFNC therapy for postextubation ARF after pediatric cardiac surgery improves hemodynamic and respiratory parameters. METHODS: This was a prospective observational study conducted at a single university hospital. Children less than 48 months of age who had postextubation ARF after cardiac surgery were included in this study. HFNC therapy was started immediately after diagnosis of postextubation ARF. Data obtained just before starting HFNC therapy were used for pre-HFNC analysis, and data obtained 1 h after starting HFNC therapy were used for post-HFNC analysis. We compared hemodynamic and respiratory parameters between pre-HFNC and post-HFNC periods. The Wilcoxon signed-rank test was used to analyze these indices. RESULTS: Twenty children were included in this study. The median age and body weight were 4.5 (2.3-14.0) months and 4.3 (3.1-7.1) kg, respectively. Respiratory rate (RR) significantly decreased from 43.5 (32.0-54.8) to 28.5 (21.0-40.5) breaths per minute (p = 0.0008) 1 h after the start of HFNC therapy. Systolic blood pressure also decreased from 87.5 (77.8-103.5) to 76.0 (70.3-85.0) mmHg (p = 0.003). Oxygen saturation, partial pressure of arterial carbon dioxide, heart rate, and lactate showed no remarkable changes. There was no adverse event caused by HFNC therapy. CONCLUSIONS: HFNC therapy improves the RR of patients who have postextubation ARF after pediatric cardiac surgery without any adverse events.

DOI： 10.1186/s40560-017-0226-z

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

A 75-year-old woman was scheduled for spinal cord tumor resection. General anesthesia was induced and maintained using propofol, remifentanil and fentanyl. Aside from fluctuations in intraoperative blood pres- sure, the surgery was uneventful, but emergence from anesthesia was delayed and the patient showed partial paralysis. Emergent brain CT revealed multiple intracranial hemorrhages and pneumocephalus. Since a large amount of fluid was observed from the drainage tube at the surgical site, loss of cerebrospinal fluid and subsequent low intracranial pressure were considered to be the cause of the hemorrhage and pneumocepha- lus. Intracranial hemorrhage and pneumocephalus are rare complications after spinal surgery, but they can lead to serious neurological dysfunction. Dural tear and/or excessive drainage are considered to be the causes of these complications, and careful observation of the property, amount and rate of drainage is there- fore warranted.

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PURPOSE: To study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit (ICU) patients and subsequent hospital mortality in critically ill patients. METHODS: We performed a multicenter, multinational, retrospective observational study of patients with available HbA1c levels within the 3-month period preceding ICU admission. We separated patients into three cohorts according to pre-admission HbA1c levels (<6.5, 6.5-7.9, ≥8.0%, respectively). Based on published data, we defined a glucose concentration of 40-69 mg/dL (2.2-3.8 mmol/L) as moderate hypoglycemia and <40 mg/dL (<2.2 mmol/L) as severe hypoglycemia. We applied logistic regression analysis to study the impact of pre-morbid glycemic control on the relationship between acute hypoglycemia and mortality. RESULTS: A total of 3084 critically ill patients were enrolled in the study. Among these patients, with increasing HbA1c levels from <6.5, to 6.5-7.9, and to ≥8.0%, the incidence of both moderate (3.8, 11.1, and 16.4%, respectively; p < 0.001) and severe (0.9, 2.5, and 4.3%, respectively; p < 0.001) hypoglycemia progressively and significantly increased. The relationship between the occurrence of hypoglycemic episodes in the ICU and in-hospital mortality was independently and significantly affected by pre-morbid glucose control, as assessed by adjusted odds ratio (OR) and 95 % confidence interval (CI) for hospital mortality: (1) moderate hypoglycemia: in patients with <6.5, 6.5-7.9, and ≥8.0 % of HbA1c level-OR 0.54, 95% CI 0.25-1.16; OR 0.82, 95 % CI 0.33-2.05; OR 3.42, 95 % CI 1.29-9.06, respectively; (2) severe hypoglycemia: OR 1.50, 95% CI 0.42-5.33; OR 1.59, 95% CI 0.36-7.10; OR 23.46, 95% CI 5.13-107.28, respectively (interaction with pre-morbid glucose control, p = 0.009). We found that the higher the glucose level before admission to the ICU, the higher the mortality risk when patients experienced hypoglycemia. CONCLUSIONS: In critically ill patients, chronic pre-morbid hyperglycemia increases the risk of hypoglycemia and modifies the association between acute hypoglycemia and mortality.

DOI： 10.1007/s00134-016-4216-8

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The aim of this study was to evaluate the association of storage duration of transfused red blood cells with the risk of postoperative serious adverse events in pediatric cardiac surgery patients. We studied 517 patients and found that 22 patients (4.3%) had at least one serious adverse event. The maximum and mean storage duration of transfused red blood cells did not differ significantly between patients with and without serious adverse events (maximum, p = 0.89; mean, p = 0.81). In our study of pediatric cardiac surgery patients, the storage duration of transfused red blood cells was not significantly associated with the risk of serious adverse events.

DOI： 10.1016/j.transci.2016.01.027

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OBJECTIVE: Mortality and morbidity of acute kidney injury (AKI) after cardiac surgery still remain high. The authors undertook the present study to evaluate the utility of early postoperative urinary albumin (uAlb) as a diagnostic marker for predicting occurrence of AKI and its severity in pediatric patients undergoing cardiac surgery. DESIGN: A prospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: All patients<18 years of age who underwent repair of congenital heart disease with cardiopulmonary bypass between July 2010 and July 2012 were included in the study. Neonates age<1 month were excluded from the study population. INTERVENTIONS: The association between uAlb and occurrence of AKI within 3 days after admission to the intensive care unit was investigated. Criteria from pediatric-modified Risk Injury Failure Loss and End-stage kidney disease (pRIFLE) were used to determine the occurrence of AKI. The value of uAlb was measured at intensive care unit admission immediately after cardiac surgery in all participants from whom a 5-mL urine sample was obtained. MEASUREMENTS AND MAIN RESULTS: Of 376 patients, AKI assessed by pRIFLE was identified in 243 (64.6%): 172 for risk (R; 45.7%), 44 for injury (I; 11.7%), and 27 for failure (F; 7.2%). One hundred thirty-three patients (35.4%) were classified as being without AKI (normal [N]) by pRIFLE. The concentration of uAlb was significantly higher in AKI patients than in non-AKI patients (median [interquartile range]): uAlb (µg/mL): 13.5 (6.4-39.6) v 6.0 (3.4-16), p<0.001; uAlb/Cr (mg/gCr): 325 (138-760) v 121 (53-269), p< 0.001. CONCLUSIONS: The utility of uAlb for prompt diagnosis of AKI was shown. Obtaining uAlb measurements early after pediatric cardiac surgery may be useful for predicting the occurrence and severity of AKI.

DOI： 10.1053/j.jvca.2015.05.194

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Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/01.ccm.0000508918.45752.7a

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BACKGROUND: A change of serum lactate concentrations appeared to be useful for predicting outcomes in various acute ill settings. However, there is little information on intraoperative change of lactate level in pediatric cardiac surgery patients. METHODS: We conducted a retrospective observational study of 459 children who received pediatric cardiac surgery to determine the association between change of lactate level after cardiopulmonary bypass (CPB) and patient prognosis (length of ICU stay and incidence of postoperative serious adverse events (SAEs)). We defined change of lactate level after CPB (LAC⊿) as (final lactate level measurement in the operating room) - (lactate level measured at the end of CPB). To study the independent association of LAC⊿ with length of ICU stay, we used linear regression model. RESULTS: There were 1145 lactate measurements after CPB in this study cohort. After weaning from CPB, the serum lactate levels significantly increased from 2.1 mmol/L to 2.5 mmol/L (p < 0.001). Patients with higher LAC⊿ had significantly longer stay in ICU (p = 0.017) and higher incidence of SAEs (p = 0.002). In multivariate linear regression analysis, higher LAC⊿ showed a significant independent association with longer length of ICU stay. CONCLUSIONS: Increased lactate level after CPB was associated with the longer duration of ICU stay and increased risk of postoperative SAEs in pediatric cardiac surgery patients. Future studies should be conducted to determine the clinical utility of intraoperative trend of lactate levels.

DOI： 10.1186/s12871-015-0007-y

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OBJECTIVE: Delirium is a common complication in postoperative, critically ill patients. The mechanism of postoperative delirium is not well understood but many studies have shown significant associations between benzodiazepine use, alcohol withdrawal and cirrhosis, and an increased risk of delirium. We aimed to investigate a possible link with alterations of gamma-aminobutyric acid (GABA) activity. DESIGN, SETTING AND PARTICIPANTS: A prospective observational investigation of 40 patients > 20 years old who had undergone elective surgery with general anaesthesia and were expected to need postoperative intensive care for more than 48 hours. We assessed postoperative delirium using the confusion assessment method in the intensive care unit at 1 hour after the operation and on postoperative Day (POD) 1 and POD 2. We collected blood samples for measurement of plasma GABA concentrations before the operation and on POD 1 and 2. MAIN OUTCOME MEASURES: Postoperative delirium and perioperative plasma GABA concentrations in patients with and without delirium. RESULTS: Postoperative delirium occurred in 13 of the patients. Patients with delirium had significantly higher Acute Physiology and Chronic Health Evaluation II scores than patients without delirium. The mean plasma GABA concentration on POD 2 was significantly lower in patients with delirium than in those without delirium. After adjustment of relevant variables, plasma GABA concentration on POD 2 was independently associated with postoperative delirium. CONCLUSIONS: Plasma GABA level on POD 2 has a significant independent association with postoperative delirium.

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It is known that blood concentration of rocuronium increases after administration of sugammadex, but this is not clear in the case of vecuronium. We report a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. A 19-month-old girl weighing 7.8 kg had a history of aortic valvuloplasty at 4 months of age due to truncus arteriosus. She presented again to our hospital due to aortic regurgitation. She underwent aortic valvuloplasty and then aortic valve replacement. The postoperative course was complicated with severe heart failure and acute kidney injury requiring peritoneal dialysis. For that reason she required long-term sedation including administration of a large amount of muscle relaxant due to severe low cardiac output syndrome after aortic valvuloplasty. A total of 615 mg (79 mg x kg(-1)) of vecuronium was administered over a period of 24 days. On weaning from mechanical ventilation, 125 mg (16 mg x kg(-1)) of sugammadex was given. Vecuronium concentration measured by high-performance liquid chromatography (HPLC) was 5.03 ng x ml(-1) before sugammadex administration and increase to 13.98 ng x ml(-1) after that. However, blood concentration of metabolic products of vecuronium did not exceed the lower limits of measurement in each sample. She was successfully weaned from mechanical ventilation without recurarizarion. Serum concentration of vecuronium increased after administration of sugammadex because extravascular vecuronium was redistributed to intravascular space according to the concentration gradient induced by binding and clathration of vecuronium. The measured values of vecuronium after sugammadex administration on HPLC represented the total amount of free vecuronium and vecuronium combined with sugammadex. Recurarization might occur after sugammadex reversal in patients after long-term administration of vecuronium, especially if relatively smaller doses of sugammadex were given. We experienced a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. There is a risk of recurarization after sugammadex reversal in patients after long-term administration of vecuronium.

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PURPOSE: Delirium is a common complication in postoperative critically ill patients. Although abnormal melatonin metabolism is thought to be one of the mechanisms of delirium, there have been few studies in which the association between alteration of perioperative plasma melatonin concentration and postoperative delirium was assessed. MATERIALS: We conducted a prospective observational study to assess the association of perioperative alteration of plasma melatonin concentration with delirium in 40 postoperative patients who required intensive care for more than 48 hours. We diagnosed postoperative delirium using Confusion Assessment Method for the intensive care unit and measured melatonin concentration 4 times (before the operation as the preoperative value, 1 hour after the operation, postoperative day 1, and postoperative day 2). RESULTS: Postoperative delirium occurred in 13 (33%) of the patients. Although there was no significant difference in preoperative melatonin concentration, Δ melatonin concentration at 1 hour after the operation was significantly lower in patients with delirium than in those without delirium (-1.1 vs 0 pg/mL, P = .036). After adjustment of relevant confounders, Δ melatonin concentration was independently associated with risk of delirium (odds ratio, 0.50; P = .047). CONCLUSIONS: Delta melatonin concentration at 1 hour after the operation has a significant independent association with risk of postoperative delirium.

DOI： 10.1016/j.jcrc.2012.11.004

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Amiodarone is widely used in Europe and the United States for refractory ventricular fibrillation (VF) in various situations, such as VF after myocardial infarction or out-of-hospital cardiac arrest. We report a case of successful treatment with amiodarone of refractory VF immediately after releasing aortic cross-clamp in cardiac surgery. A 66-year-old man suffering from severe aortic stenosis underwent aortic valve replacement (AVR). General anesthesia was induced with propofol and remifentanil, and subsequently AVR was performed under cardiopulmonary bypass. Just after releasing aortic cross-clamp, VF occurred, and it continued despite multiple trials of cardioversion with direct current (DC) shocks of 20 J or 30 J. Furthermore, some DC shocks of 30 J or 50 J after administering lidocaine 60 mg and 0.5 mol x l(-1) magnesium sulfate 20 ml were also ineffective. Then, nifekalant 20 mg was administered and DC shocks of 50 J were repeated intermittently, but VF still persisted. Eventually, VF disappeared after a final DC shock of 50 J with intravenous amiodarone 125 mg. Overall duration of VF was 60 minutes. The patient's trachea was extubated three days after the surgery without any complications. Intravenous amiodarone may be one of the most useful remedies for some types of arrhythmias including persistent VE.

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Hypoplastic left heart syndrome (HLHS) with intact atrial septum (IAS) is an extreme type of single ventricle physiology among congenital heart diseases, in which a baby cannot supply oxygenated blood into systemic circulation without alternative pathway. We report the case of the neonate undergoing open balloon atrial septostomy (BAS) and bilateral pulmonary artery banding (PAB) soon after scheduled caesarean sections (C/S). A 35-year-old female was pregnant and fetal echocardiography at 32 weeks revealed one of the twins as HLHS/IAS. Severe hypoxia soon after birth was suspected. Thus, scheduled C/S followed by open BAS was planned. At 36 weeks of gestation, the mother was anesthetized with spinal bupivacaine and the female baby with HLHS/IAS was delivered. After diagnosed definitely by pediatric cardiologists, her trachea was intubated by anesthegiologists and umbilical catheters were placed by neonatologists. Then the baby was transferred to neighboring operating theater for BAS 68 minutes after the birth, while her Sp(O2) was maintained around 75-85% through serial procedures. Open BAS and PAB were performed under general anesthesia without any hemodynamic instability or severe hypoxia. Cooperation among anesthegiologists, neonatologists, pediatric cardiologists, and cardiac surgeons is mandatory in order to successfully complete such a rushed procedure.

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

Validation of a scoring algorithm for non-overt disseminated intravascular coagulation (DIC) proposed by the International Society on Thrombosis and Haemostasis (ISTH) is still incomplete. It was the objective of this study to assess the impact of including AT to non-overt DIC scoring on the predictability for intensive care unit (ICU) death and the later development of overt-DIC defined by the Japanese Ministry of Health and Welfare (JMHW) or the ISTH. We performed a retrospective observational study conducted in 364 patients in critical care. Coagulation parameters obtained daily for DIC screening were utilised for scoring. There were 194 and 196 patients scored as positive non-overt DIC with and without AT, respectively; diagnostic agreement between the two was 78%. As compared with patients without non-overt DIC, these non-overt DIC patients had significantly higher mortality. In 37 ICU non-survivors, positive non-overt DIC scoring with AT preceded ICU death by a median of 6.8 days, which was significantly earlier as compared with a median of 5.4 days for non-overt DIC without AT (p = 0.022). In patients who developed overt-DIC after admission, the time period from positive non-overt DIC to positive overt-DIC was significantly longer when AT was utilised (overt-DIC ISTH; 1.3 days vs. 0.1 days, p = 0.004, overt-DIC JMHW; 2.5 days vs. 2.0 days, p = 0.04, with AT vs. without AT, respectively). Non-overt DIC scoring predicted a high risk of death in critically ill patients. When information on AT levels was included, non-overt DIC scoring was found to predict development of overt-DIC significantly earlier than non-overt DIC scoring without AT.

PubMed

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Publisher：株式会社医学書院  

DOI： 10.11477/mf.3101202368

CiNii Books

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Language：Japanese   Publisher：克誠堂出版  

CiNii Books

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：克誠堂出版  

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2022069464

Language：Japanese   Publisher：中国四国産科婦人科学会  

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Language：Japanese   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.28_227

CiNii Article

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

6歳男児。1年前に頭蓋咽頭腫に対して開頭腫瘍摘出術を施行された。今回、頭蓋咽頭腫の再発に対して再度摘出術を施行され、術後2日目に意識障害が出現し、血清Na値が182mmol/Lまで上昇した。中枢性尿崩症と考え、生理食塩水とバソプレシンの持続静注を開始した。術後3日目以降は意識レベルが回復していたが、7日目に意識障害が再度出現し、血清Na値が142mmol/Lまで低下していたため、浸透圧性脱髄症候群を鑑別に挙げて頭部MRIを施行し、橋外性髄鞘崩壊症と診断した。本例は頭蓋咽頭腫が視床下部に強く癒着しており、腫瘍摘出に伴い視床下部機能障害が生じたことで高Na血症が急速に進行したものと考えられた。

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Language：Japanese   Publisher：日本循環制御医学会  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：真興交易(株)医書出版部  

先天性心疾患の予後向上に伴い、成人先天性心疾患患者が増加している。成人先天性心疾患患者は、高血圧・高脂血症などの代謝疾患に罹患するリスクが高く、また癌罹患のリスクが上がるという報告もあり心臓手術以外の手術を受ける患者が増えている。非心臓手術の場合、一般的な病院でも手術手技自体は可能であるが、特殊な病態であるため周術期管理に難渋することが多い。ヨーロッパのガイドラインでは、専門機関での術前評価を推奨しており、手術も専門機関で行うことが望ましいとしている。特に気をつける病態は、単心室患者、肺高血圧症患者、妊婦の麻酔であり、麻酔科医はそれぞれの病態の基礎的な知識を有し、専門家との連携を取る必要がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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J-GLOBAL

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

症例は1歳11ヵ月の男児、声門下狭窄に対して輪状軟骨前方切開術が予定された。術中管理の問題点として、Tチューブ挿入後の陽圧換気中のTチューブ口側断端からのエアリークが挙げられたため、Tチューブ内にTチューブ径より小径の挿管チューブを経鼻的に留置し、挿管チューブをクランプすることで口側断端を塞ぐ方法を計画した。しかしスペースが小さく留置困難だったため、経鼻的にFogartyカテーテルをTチューブ内に留置し、バルーン拡張にて口側断端からのエアリークを軽減し、確実に換気することができた。Tチューブ挿入下での呼吸管理において、位置調整など慎重な管理は必要となるが、小児症例ではFogartyカテーテルを用いた換気方法は有用性が高いと考える。(著者抄録)

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Language：Japanese   Publisher：克誠堂出版  

CiNii Article

CiNii Books

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：一般社団法人 日本心臓血管麻酔学会  

機関誌『Cardiovascular Anesthesia Vol. 22 No. 1 2018』におきまして，一部誤りがございましたので，下記の通り訂正いたします。

P45 著者名

正：塩路 直弘，岩崎 達雄，清水 一好，金澤 伴幸，川瀬 宏和，木村 聡

黒江 泰利，佐藤 明，森松 博史，大月 審一，笠原 真悟

誤：塩路 直弘，岩崎 達雄，清水 一好，金澤 伴幸，川瀬 宏和，木村 聡

黒江 泰利，佐藤 明，森松 博史，大月 審一，笠原 慎吾

DOI： 10.11478/jscva.2018-9-001

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Language：Japanese   Publisher：真興交易(株)医書出版部  

小児心臓手術の麻酔は、その複雑な病態を理解し、適切な麻酔薬の選択や人工呼吸器設定を行うことが必要である。大量麻薬麻酔から、フェンタニルに加え少量の吸入麻酔薬などを使用したバランス麻酔へと移行し、早期覚醒を目指した全静脈麻酔も行われている。特徴的な単心室の並列循環では、以前から提唱されている肺血管抵抗の調節に加え、血管拡張薬を使用した体血管抵抗の積極的な調節がより重要視されている。また、SvO2や脳組織rSO2などの新たなモニタリングにより心拍出量の推定や、中枢神経障害などの重度合併症を予防する積極的な取り組みなど、小児心臓麻酔は、より良い生存率と成績の質の向上を目指した管理へと移行している。(著者抄録)

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

The issue of extracorporeal membrane oxygenation in patients with complex congenital heart disease is indispensable for discussing ECMO in the pediatric population. Although a clear consensus is lacking on the proper indication of ECMO in this population, induction of ECMO should be considered earlier when hemodynamics are unstable to avoid circulatory collapse. Hemorrhagic complication is not rare and should be treated with supplemental treatment according to its etiology. Aggressive systemic ventricle decompression should be considered for better and earlier systemic ventricle functional recovery. Better ECMO management in patients with characteristic single ventricle of complex congenital heart disease requires a better understanding of the unique physiology of patients with single ventricle, and ECMO management specific to the physiology of each patient is required.

DOI： 10.2199/jjsca.39.148

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Language：Japanese   Publisher：日本臨床麻酔学会  

小児におけるECMO(Extracorporeal Membrane Oxygenation)治療は、先天性心疾患に対しても重要な適応がある。小児複雑心奇形周術期におけるECMO導入のコンセンサスの得られた明確な基準はないが、循環破綻による多臓器障害を合併した状態での導入より、計画的早期の導入の方が離脱率の向上につながると考えられる。出血性合併症が問題となりやすいが、病態を把握し補充療法に努める。心機能の回復には心室の十分な減圧が必要である。小児複雑心奇形の特徴的な疾患である単心室症例のECMO管理では循環生理および解剖学的特徴をよく理解し、各々の状態に応じた管理が肝要である。(著者抄録)

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Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2019114743

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

A 55-year-old man was diagnosed with right lung cancer concomitant with invasion of the left atrium. The patient was scheduled for resection of the right upper lobe and S6 and partial resection of the left atrium using cardiopulmonary bypass（CPB）. We intraoperatively monitored the patient’s bilateral regional cerebral oxygen saturation（rSO₂）because of the use of CPB. When the surgeons peeled the lung off from the thoracic wall by the hemi-clamshell approach, only right rSO₂ decreased with no remarkable change in other vital signs and parameters including blood pressure and CVP. We suspected that lifting up the thoracic wall resulted in stenosis of the right common carotid artery, which induced right-sided cerebral ischemia. After we released it, the right rSO₂ value soon recovered. After the operation, the patient had no neurologic complications. rSO₂ should be monitored when using the hemi-clamshell approach for detecting cerebral desaturation due to brain malperfusion.

DOI： 10.2199/jjsca.39.21

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Language：Japanese   Publisher：日本臨床麻酔学会  

55歳、男性。左房浸潤を伴う肺癌に対し、右上葉切除、S6切除および人工心肺を用いた左房部分切除術が予定された。人工心肺使用症例であることから、両側の脳局所組織酸素飽和度(rSO2)をモニターした。胸壁への癒着剥離の際、hemi-clamshell開胸開始後から右rSO2値のみ低下を認めた。胸壁のつり上げに伴い腕頭動脈が狭窄し右脳血流が著明に低下したことが原因と考えた。つり上げ程度の調整により右rSO2値は速やかに改善した。術後は神経学的後遺症なく経過した。本症例ではrSO2測定により術操作に伴う脳血流異常を検知・対応でき、神経学的後遺症を回避できた。(著者抄録)

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Language：Japanese   Publisher：日本小児麻酔学会  

CiNii Books

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：一般社団法人 日本心臓血管麻酔学会  

Nasal high flow therapy (NHFT)は，死腔の二酸化炭素洗い流し効果，規定された吸入酸素濃度の供給，持続陽圧効果などの特徴を有する呼吸補助デバイスである。成人では，NHFTは従来の酸素療法に比べて再挿管率の改善で有利な結果が得られており，小児心臓術後でもその役割が期待される。小児心臓手術後症例には並列循環やフォンタン循環といった特殊な循環動態の症例が含まれる。このような症例では投与酸素濃度や持続陽圧が循環動態に影響を与えるため，小児心臓手術後症例にNHFTを使用する際は病態やデバイスの特徴をよく理解して使用することが望ましい。また，NHFTの応用的な使用方法に，一酸化窒素（NO）とNHFTを併用したNO療法，窒素とNHFTを併用した低酸素療法がある。このようにNHFTは可能性がある呼吸補助デバイスであるが，現時点で小児心臓手術後のNHFTに関するエビデンスは限定されている。今後，小児心臓手術後の呼吸管理に関する新たな臨床研究が行われることが嘱望される。

DOI： 10.11478/jscva.2018-1-004

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

Nasal high flow therapy(NHFT)は、死腔の二酸化炭素洗い流し効果、規定された吸入酸素濃度の供給、持続陽圧効果などの特徴を有する呼吸補助デバイスである。成人では、NHFTは従来の酸素療法に比べて再挿管率の改善で有利な結果が得られており、小児心臓術後でもその役割が期待される。小児心臓手術後症例には並列循環やフォンタン循環といった特殊な循環動態の症例が含まれる。このような症例では投与酸素濃度や持続陽圧が循環動態に影響を与えるため、小児心臓手術後症例にNHFTを使用する際は病態やデバイスの特徴をよく理解して使用することが望ましい。また、NHFTの応用的な使用方法に、一酸化窒素(NO)とNHFTを併用したNO療法、窒素とNHFTを併用した低酸素療法がある。このようにNHFTは可能性がある呼吸補助デバイスであるが、現時点で小児心臓手術後のNHFTに関するエビデンスは限定されている。今後、小児心臓手術後の呼吸管理に関する新たな臨床研究が行われることが嘱望される。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

小児患者は、年齢・体重・身長がさまざまであり、麻酔中の人工呼吸器設定は一定の条件下ですべての患者を管理することはできない。成長発達に伴い体格が変化するため、それぞれに合わせた設定が必要である。また、小児患者は成人に比べ呼吸数が多い、気道が狭いなどの特徴を持ち、それら呼吸生理学・解剖学に基づいた呼吸器設定や気管チューブ選択が必要である。すなわち小児の人工呼吸器設定を適切に行うには、まず小児の呼吸生理学を理解する必要がある。全身麻酔下の呼吸生理学は自発呼吸下のそれとは異なるため、本稿では、まず小児の自発呼吸下での呼吸生理学を正しく理解しそれを全身麻酔下人工呼吸に応用する方法を解説する。(著者抄録)

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Language：Japanese   Publisher：日本臨床麻酔学会  

胸腺腫摘出術術後の抜管時に冠動脈攣縮から心停止に至ったと考えられる1例を経験した。症例は60歳、男性。術前評価で冠動脈器質的異常を認めなかったが、喫煙など複数の冠攣縮危険因子を有していた。腫瘍の浸潤性や術中循環動態の不安定性から、胸骨正中切開、静脈バイパス併用下胸腺腫摘出手術を行った。手術終了後にST上昇先行の心停止を発症したが、蘇生後の心機能回復は良好で、後遺症なく独歩退院した。術後の冠動脈攣縮誘発試験陽性から、心停止の原因は冠攣縮が強く疑われた。高侵襲手術などの手術因子、麻酔覚醒や薬剤投与などの術中因子が合わさり、冠攣縮に伴う心停止に至ったと考えられた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

It is very difficult to manage the respiratory status of pediatric patients during anesthesia because children’s respiratory physiology changes dramatically from neonate to teenager. Anesthesiologists have to take particular care with each patient（age, body weight, height）to determine adequate ventilator setting according to idiosyncrasy. In addition, anesthesiologists have to understand the respiratory physiology of pediatric patients according to age：changes in respiratory rate, relatively narrow airway compared to adult patients, alveolar size and amount, stiffness of rib cage, etc. We select adequate tracheal tubes and set ventilator settings. It is also crucial to understand the difference in respiratory physiology between anesthetized mechanical ventilation and spontaneous breathing to manage pediatric patients.

DOI： 10.2199/jjsca.38.250

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Other Link： https://search.jamas.or.jp/link/ui/2018172811

Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

We experienced a case of cardiac arrest due to coronary artery spasm on extubation after thymectomy. The patient was a 60-year-old male. He had several risk factors of coronary vasospasm including being a male, a smoker and a drinker in addition to abnormal of lipid metabolism, but he did not have any significant coronary abnormalities preoperatively. He underwent thymectomy under veno-venous bypass for hemodynamic instability, which required frequent administration of phenylephrine. Cardiac arrest occurred following hypotension and ST elevation on an electrocardiogram（ECG）after surgery. His spontaneous circulation recovered 2 minutes after cardiopulmonary resuscitation. There was cardiac dysfunction indicating anteroseptal abnormal wall motion on the ECG. The ECG change was transient and was resolved without any invasive intervention within several days after surgery. He was finally discharged from the hospital without any disabilities. Coronary artery spasm was strongly suspected as a cause of the cardiac arrest because of the positive result of a provocation test for coronary spasm after surgery. In addition to preoperative risk factors for coronary spasm, several intraoperative factors, including surgical invasiveness, situation of awakening and administration of an anesthesia-related agent, possibly led to coronary spasm.

DOI： 10.2199/jjsca.38.142

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2018172796

Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

総肺静脈還流異常症と大血管転位症はともに新生児期に根治的手術が必要となりうる先天性心疾患である.新生児の心臓は構造的,機能的に未熟であるため術後心不全に陥りやすい.加えて総肺静脈還流異常症,大血管転位症の患者は疾患特有の血行動態により左心不全や肺高血圧のリスクが高く注意が必要である.両疾患の新生児期の根治的手術を成功に導くためには,前負荷,後負荷,心筋収縮力,心拍数を適切に調節し限られた心機能を無理なく発揮できる環境を作ることが重要である.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01620&link_issn=&doc_id=20170727200014&doc_link_id=%2Fci4jjsca%2F2017%2F003704%2F016%2F0491-0497%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2017%2F003704%2F016%2F0491-0497%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Language：Japanese   Publisher：医学図書出版(株)  

先天性心疾患患者は全出生のうち約1%であるが、近年手術成績は向上し、約90%の先天性心疾患患者が成人できるようになっている。これに伴い成人先天性心疾患患者が手術を受ける機会が増加しており、肺動脈弁置換、Atrial Septal Defect修復、導管を用いた手術などが多いとされている。とくにファロー四徴症術後の肺動脈弁逆流や右室流出路狭窄に対する手術、フォンタン手術は今後も増加してくることが予想され、その問題点と管理方法については良く理解しておく必要がある。これらの成人先天性心疾患患者ではバランスをとる管理が要求され、その管理は容易ではないが、今後誰でも遭遇しえる疾患として捉えておく必要があると考える。成人先天性心疾患患者は特殊な管理を要求される病態ではあるが、理解をすれば決して難しいものではない。今後はいつでも遭遇する疾患としての認識が大切である。(著者抄録)

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Language：Japanese   Publisher：医学図書出版  

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2017189388

Language：Japanese   Publisher：真興交易(株)医書出版部  

カテコラミン誘発多形性心室頻拍(Catecholaminergic polymorphic ventricular tachycardia:CPVT)は遺伝性不整脈疾患で突然死の原因となる。器質的心疾患がないこと、安静時心電図に異常がないこと、運動や情動による交感神経刺激で誘発される2方向性あるいは多形性の心室頻拍を特徴とする。β遮断薬が治療の中心になるが、治療中でも発作を起こす症例がある。本疾患は特異的な病態から急性期治療、周術期管理に特別の注意が必要で、病態生理を理解することが治療法の理解につながる。本稿ではCPVTの疾患の病態生理、分類、診断、慢性期治療について記述し、急性期治療、周術期管理について考察する。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

NAVAは自発呼吸を温存した新しい呼吸器モードで、使用の際には専用カテーテルで計測された横隔膜活動電位(Edi)が必要である。Ediは一般的に健常者における安静時呼吸では数μVを示すとされている。呼吸負荷がかかった場合にはEdi値は上昇するため、患者から得られた呼吸努力をEdiとして捉え、加えてNAVA levelを設定することで、NAVAの供給圧が決定する。NAVAの利点は、患者-人工呼吸器の同調性に優れ、人工呼吸の過剰サポートが回避できる点で、Ediの利点は、波形から患者-人工呼吸器の非同調を評価でき、値により呼吸努力の程度を把握できる点である。これらは成人、小児においていくつかの論文で報告されている。しかし、NAVA levelの設定方法、ウィーニングの方法、Edi値の解釈など定まっていない点も多く、今後の課題となる。また、患者予後に与える影響を示した報告はないため、今後の研究が待たれる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00001&link_issn=&doc_id=20170131390003&doc_link_id=%2Faa6icutc%2F2017%2F004101%2F004%2F0021-0027%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2017%2F004101%2F004%2F0021-0027%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：医学図書出版  

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2017087182

Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

Total anomalous pulmonary venous connection（TAPVC）and transposition of the great arteries（TGA）are congenital heart diseases for which radical surgery can be performed during the neonatal period. Cardiac surgery during the neonatal period is considered high-risk because of the immaturity of cardiac function. In addition, there is a risk of left heart failure and pulmonary hypertension in patients with TAPVC and TGA. It is important to optimize cardiac condition by controlling preload, afterload, contractility, and heart rate during the perioperative period.

DOI： 10.2199/jjsca.37.491

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2017336568

Language：Japanese   Publisher：克誠堂出版  

CiNii Article

CiNii Books

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Publisher：株式会社医学書院  

DOI： 10.11477/mf.1407211347

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Language：Japanese   Publisher：(株)医学書院  

＜POINT＞集中治療室で用いる心血管作動薬はカテコールアミンと非カテコールアミンに分かれる.心血管作動薬にはそれぞれの特性があり,それを理解して使用する必要がある.集中治療室で用いる抗不整脈薬はβブロッカーとアミオダロンが多くなってきている.抗不整脈薬の作用機序・副作用を理解して使用する必要がある.(著者抄録)

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

症例は29歳、男性。5年前に肺動脈性肺高血圧症(pulmonary arterial hypertension、PAH)を指摘されたが、内科的治療は行われていなかった。今回、胸痛を主訴に近医を受診し、造影CTにて肺動脈解離(pulmonary artery dissection、PAD)を指摘されたため、当院へ転院となった。当院入院後、緊急で主肺動脈人工血管置換術および左右肺動脈縫縮術が施行された。術後、PAHに対して早期に治療を開始した。未治療であったためPAHのコントロールに難渋したが、PAH治療薬の多剤併用および厳重な鎮静・挿管・人工呼吸管理を行うことで、POD21に抜管、POD29にICUを退室、POD101に退院となった。PADは非常に致死率の高い疾患であるが、早期の手術および厳重な術後管理により救命できた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02874&link_issn=&doc_id=20160610390006&doc_link_id=10.3918%2Fjsicm.23.318&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.23.318&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：真興交易(株)医書出版部  

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Language：Japanese   Publisher：日本臨床麻酔学会  

スガマデクスは安全・迅速にロクロニウムを拮抗できる薬剤として広く使用されている.今回われわれは筋弛緩モニターを使用し,投与基準どおりにスガマデクスを使用したにもかかわらず,術後に再クラーレ化が疑われた症例を経験した.症例は78歳の男性で,胃癌に対し腹腔鏡下幽門側胃切除術が施行された.術中およびスガマデクス投与前にTOFウォッチを使用し,TOFカウント2を確認後,スガマデクスを3.6mg/kg投与し抜管した.その約70分後に著明な酸素化の悪化と四肢の体動低下を認め,ネオスチグミン投与により酸素化・体動の改善を得た.投与基準どおりのスガマデクス使用でも再クラーレ化の可能性は否定できないため,抜管後の厳重な呼吸の観察が重要である.(著者抄録)

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：The Japanese Society of Intensive Care Medicine  

A 29-year-old man was diagnosed with pulmonary arterial hypertension (PAH) 5 years ago. He had not been treated for PAH. He was transferred to our hospital after visiting a nearby hospital for chest pain and being diagnosed with pulmonary artery dissection. After admission, he emergently underwent a prosthetic graft replacement of the main pulmonary artery and bilateral pulmonary artery plication. Subsequently, he was transferred to the ICU and we immediately started aggressive treatment for the refractory PAH including multiple medications therapy, strict sedation and mechanical ventilation. Good control of PAH was achieved, and he was finally extubated on POD 21, discharged from the ICU on POD 29, and discharged from the hospital on POD 101. Because the mortality rate of PAD is very high, early surgery and strict postoperative management are required.

DOI： 10.3918/jsicm.23.318

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Other Link： https://search.jamas.or.jp/link/ui/2016258189

Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

There are a few reports regarding recurarization, which is mainly caused by insufficient dosage of sugammadex. However, there is no report of recurarization after adequate usage of sugammadex according to recommendation. We experienced a patient in whom recurarization occurred despite using sugammadex under proper monitoring with aceleromyography during the operation. A 78-year-old man with a slight renal impairment was scheduled for laparoscopic distal gastrectomy under general anesthesia with sevoflurane, fentanyl and remifentanil. Muscle relaxation was induced and maintained with rocuronium with continuous monitoring using TOF Watch SX^®. At the end of the procedure, two twitches were visualized after supramaximal train-of-four stimulation at the adductor pollicis muscle. His tracheal tube was removed after administration of sugammadex 200 mg (3.6 mg/kg). Seventy minutes later, he complained of difficulty breathing and an immobilization of his limbs with desaturation. After the additional dose of sugammadex 200 mg (3.6 mg/kg), oxygenation and mobilization were dramatically improved. There is a risk of recurarization even when the recommended dose of sugammadex is administered, so it is necessary to observe a patient closely for a while even after extubation.

DOI： 10.2199/jjsca.36.1

DOI： 10.2199/jjsca.41.475_references_DOI_1m9b8cEJ6khgm6P8ZfoH860Tvvs

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Other Link： https://search.jamas.or.jp/link/ui/2016124833

J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本臨床麻酔学会  

筋萎縮性側索硬化症は,麻酔や手術侵襲により術後呼吸器機能が低下した場合には,人工呼吸器管理を余儀なくされる可能性がある.そのため,肺葉切除術のような呼吸機能を低下させる手術の麻酔管理はほとんど報告がない.今回われわれは,76歳女性の筋萎縮性側索硬化症患者の肺葉切除術に対して,プロポフォール,レミフェンタニルを用いた全静脈麻酔と胸部硬膜外麻酔を併用し安全に管理しえた.短時間作用型の麻酔薬や術後鎮痛の進歩,低侵襲手術の普及により筋萎縮性側索硬化症患者でも以前より安全に手術が行えるようになった.しかし将来的な人工呼吸までの期間を短縮する可能性はあるため,手術適応には慎重な評価が必要である.(著者抄録)

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Language：Japanese   Publisher：日本臨床麻酔学会  

小児の重症筋無力症(myasthenia gravis:MG)に対する胸腺摘出術の適応は限られており,その麻酔管理の報告は少なく,安全性は確立されていない.症例は9歳の男児.症状の増悪を認める全身型小児MGに対して胸腔鏡下胸腺摘出術が施行された.術後の呼吸不全を避けるため,筋弛緩薬を用いずに全身麻酔で管理した.麻酔導入時はセボフルランとレミフェンタニルにて麻酔深度を深め,スムーズに気管挿管を行えた.術中も体動を認めることなく安定して経過し,手術室にて抜管した.術後経過は良好であった.全身型小児MG患者の胸腺摘出術の周術期管理において筋弛緩薬を用いることなく麻酔を行い,安全に管理することができた.(著者抄録)

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：医学図書出版(株)  

症例は71歳、男性。上顎癌に対して放射線、化学療法を先行した後、根治術を施行した。術後ICUに予定入室したが、入室約6時間後から血圧低下、代謝性アシドーシスが出現した。輸液負荷とノルアドレナリン持続投与にも抵抗性で敗血症性ショックを疑い、抗菌薬を変更、バソプレシン、アドレナリン、ハイドロコルチゾンを追加、CHDFを開始した。入室2日目に血液培養でグラム陰性桿菌が陽性となった。循環・呼吸不全と肝不全が進行したため、血漿交換、VA ECMOを導入した。その後も左心不全が急速に進行しIABPも挿入した。経過中2度、開創し皮弁を確認したが皮弁の血流は保たれていた。あらゆる治療に反応なく入室4日目に永眠した。後日、血液培養の結果がAeromonas属であることが判明した。免疫抑制の背景をもつ患者の場合、Aeromonas属による敗血症性ショックは重篤化し、急激に進行する可能性がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本小児救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

We experienced anesthetic management of lung lobectomy in a patient with amyotrophic lateral sclerosis (ALS).<BR>A 76 year old woman suffering from ALS was scheduled for video-assisted right lower lung lobectomy. General anesthesia combined with thoracic epidural anesthesia was successfully performed with total intravenous anesthesia (TIVA) using propofol and remifentanil, without any muscle relaxants. The intraoperative course was uneventful, without coughing or moving. The epidural analgesia provided good postoperative pain management and the patient was discharged from the intensive care unit without complications the next day. <BR>Our experience shows that the combination of TIVA, without neuromuscular blockade, and thoracic epidural anesthesia may be an effective technique for lung lobectomy in a patient with ALS. However, careful assessment is needed to determine when this surgery is indicated in patients with ALS.

DOI： 10.2199/jjsca.35.711

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Other Link： https://search.jamas.or.jp/link/ui/2016057745

Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

Thymectomy is rare treatment option for juvenile myasthenia gravis (JMG), but there is very limited information about anesthetic management of JMG.<BR>A 9 year-old boy was diagnosed with severe type JMG and underwent thoracoscope-assisted thymectomy. To avoid myasthenia crisis, he was anesthetized without muscular relaxant. Sevoflurane and remifentanil fully suppressed coughing and body movement even with tracheal intubation and the surgery was performed safely. After surgery, he was extubated in the operating room and had an uneventful postoperative course.<BR>We report anesthetic management without neuromuscular relaxant for a severe JMG patient.

DOI： 10.2199/jjsca.35.715

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Other Link： https://search.jamas.or.jp/link/ui/2016057746

Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

1歳6ヵ月男児。生下時にFallot四徴症と診断され、Blalock-Taussigシャント術、狭窄に対する頻回のバルーン拡張術、狭窄解除術が施行されていた。今回、左肺動脈(PA)狭窄に対しカテーテルによるバルーン拡張術が施行された。術中にPA損傷による肺出血を来たし、術前からの低酸素血症もあるため、術後ICUで筋弛緩薬を用いた完全鎮静・抜管管理を行うこととした。ICU入室後に肺出血は消失したが、低酸素血症は遷延した。PAの著明狭窄に伴う肺高血圧症と肺出血による肺のコンプライアンス低下が問題であったため、人工呼吸器のモードは鎮静下に自発呼吸を温存することが有利と考え、ICU入室2日目に筋弛緩薬の投与を中止したところ、呼吸循環不全を生じた。ICU入室5日目に筋弛緩薬投与を再開したところ、呼吸循環動態は著明に改善し、11日目に抜管に至り、18日目には一般病棟に転棟することができた。

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Language：Japanese   Publisher：(株)南山堂  

＜Key Points＞呼吸性アルカローシスは、呼吸障害だけでなく中枢神経障害、中毒、肝不全、敗血症などさまざまな病態で起こる。呼吸性アルカローシスは、通常治療を要することは少ないが最も頻繁に目にする。過換気症候群は速やかな処置が必要である。集中治療患者に起こる呼吸性アルカローシスは、基礎に重症疾患があることが多く、病態の見極めが重要である。(著者抄録)

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Language：Japanese   Publisher：日本臨床麻酔学会  

先天性心疾患で最もその生理が成人と異なり管理が困難な症例は,並列循環を伴う単心室症である.これらの患児は,まず第一期姑息術を受けるが,術後にも並列循環が残存するため周術期管理ではこの並列循環の管理が大切になる.理想的な並列循環を達成するために動脈血酸素飽和度のみならず体静脈血酸素飽和度をモニタリングして循環動態を正確に把握する.また体静脈血酸素飽和度は患児の予後予測,目標指向型治療の指標としても有用である.体・肺血流のバランスをとるために心拍出量,体・肺血管抵抗を調節するが,第一期姑息術後では体血管抵抗を調節する方がより効果的で,積極的な後負荷軽減療法は並列循環を安定させ,術後合併症を低減する.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01620&link_issn=&doc_id=20140319200001&doc_link_id=%2Fci4jjsca%2F2014%2F003402%2F001%2F0169-0176%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2014%2F003402%2F001%2F0169-0176%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

DOI： 10.11477/mf.3101102050

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Language：Japanese   Publisher：メディカル・サイエンス・インターナショナル  

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2014110920

Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

小児に発生する敗血症性ショックを含む急性臓器不全を伴う重症敗血症は、集中治療管理を必要とする重篤な病態である。本論文は、小児重症敗血症診療に関して日本集中治療医学会小児集中治療委員会が作成した専門家の合意意見書である。本意見書は、2012年に発表されたエビデンスに基づくSurviving Sepsis Campaign guidelines(SSCG2012)を参考にし、日本の現状を勘案した事項を取り入れて作成された。同委員会が日本の小児集中治療室を対象に行った小児敗血症レジストリの結果も参考にした。また、関連各学会やパブリックコメントの意見を取り入れ、一部関連学会より推薦を頂いた。本論文は、日本初の小児重症敗血症に関する意見書であり、臨床現場で適切に活用されることで、小児重症敗血症患者の転帰改善に寄与することが期待される。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02874&link_issn=&doc_id=20140218390020&doc_link_id=10.3918%2Fjsicm.21.67&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.21.67&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

The most difficult congenital heart disease (CHD) with the shunt lesion to manage is the single ventricle with parallel circulation (PC). Children undergo some kind of initial palliative surgery to establish unobstructed pulmonary and systemic venous return and unobstructed systemic outflow and limited pulmonary blood flow (PBF) and pulmonary artery pressure. Even after the initial palliative surgery, children still have PC that is difficult to manage, and control of PC is the key issue in the perioperative management of children with complex CHD. To attain the ideal physiology, better evaluation of circulatory status with monitoring not only SaO₂ but also SvO₂ is crucial. SvO₂ is also an excellent indicator of outcome, and Goal-directed therapy with SvO₂ as an indicator of systemic oxygen delivery is associated with excellent, early survival and a low incidence of organ failure in infants after Norwood. <br>  Cardiac output, systemic vascular resistance, and pulmonary vascular resistance must be manipulated in order to control Qp/Qs. Manipulation of Qp/Qs by manipulation of SVR may be more effective, especially after initial palliative surgery, and aggressive after load reduction therapy contributes to stable hemodynamic status and improves early outcome.

DOI： 10.2199/jjsca.34.169

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Language：Japanese   Publisher：克誠堂出版(株)  

ベクロニウム(Vec)を長期投与されていた小児(1歳7ヵ月の女児)にスガマデクス(Sug)を投与したところVec血中濃度が上昇した。Sugは血中の遊離ロクロニウム(Roc)を包接することで筋弛緩作用を拮抗する薬物であり、Vecは構造上Rocに類似していることから、SugはVecに対しても同様の作用を持つといわれている。StaalsらはSug投与後にRoc血中濃度が再上昇したと報告しており、Vecでも類似の現象が生じたものと思われた。本例では再クラーレ化は認めなかったが、Vec長期投与後のSug投与時にはその危険性があるため、投与量には注意が必要と考えられた。

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

66歳男。労作時呼吸困難が持続し、高度大動脈弁狭窄症の診断で大動脈弁置換術が予定された。手術開始から大きな問題なく人工心肺開始、大動脈遮断となり、術操作も問題なく終了し、大動脈遮断時間は95分であった。遮断解除後に心室細動(VF)を認め、計3回の直流除細動器による電気ショックを行ったが改善せず、更に塩酸リドカインと硫酸マグネシウム液の静脈内投与後に計7回、次いで塩酸ニフェカラント投与後に計5回の電気ショックを行ったがVFは継続した。そこで、塩酸アミオダロンを静脈投与した後に電気ショックを行ったところ、1回で除細動に成功した。VFの持続時間は60分で、この間血液ガス分析では電解質や酸塩基平衡の異常はなかった。その後は心室ペーシング下で人工心肺を離脱し、手術終了となった。術後は塩酸アミオダロン、塩酸ランジオロールの静脈内持続投与を行い、VFの再発はなく、4日目に中止した。術後13日目にICUを退室し、63日目に退院した。

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Language：Japanese   Publisher：克誠堂出版(株)  

双胎妊娠の1児。妊娠32週の胎児エコーで左心低形成症候群/心房中隔閉鎖と診断され、妊娠36週での帝王切開と、患児への緊急開胸下バルーン心房中隔裂開(BAS)、両側肺動脈絞扼術(PAB)が計画された。帝王切開は脊髄くも膜下麻酔で行い、児娩出後ただちにインファントウォーマへ移動させた。児のSpO2は80%前後で、チアノーゼは認めず、小児循環器医による心エコーで最終診断した後、麻酔科医による気管挿管と、新生児科医による臍カテーテル留置を行った。手術室で臍カテーテルよりプロスタグランジンを持続投与し、出生後68分で手術を開始した。SpO2の低下はなく、塩化カルシウム使用により血圧は安定し、手術開始直前にパンクロニウム、フェンタニルを投与して人工呼吸管理とした。出生199分後に心臓血管外科医と小児循環器科医によるBASが完了し、その後PABを行った。術後13日目に人工呼吸から離脱し、18日目に集中治療室から一般病棟へ転出した。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01397&link_issn=&doc_id=20101005180023&doc_link_id=%2Fad3msuie%2F2010%2F005910%2F024%2F1308-1310%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2010%2F005910%2F024%2F1308-1310%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：真興交易(株)医書出版部  

小児用イントロックを装散したAirway Scope(AWS)を用いて、Cormack-Lehane分類IV度の挿管困難歴を有するCornelia de Lange症候群の患者に気管挿管を行った。セボフルランによる緩徐導入で自発呼吸を残しながら、専従1年目の麻酔科研修医が1回の操作で30秒以内に挿管を完了した。小児用イントロックにより、AWSは小児の気道管理困難においても重要な役割を担う可能性がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

2006年12月〜2007年6月に、ICU入室後に筋弛緩薬を持続投与された先天性心疾患40例(6.3〜15.8ヵ月・平均11ヵ月)を対象に、挿管時間への影響因子について検討した。40例のうち37例(92.5%)は心臓手術後患者で、施行術式はRACHS-1カテゴリーで2.8〜3.6(平均3.2)、人工心肺時間92〜140分(平均116分)、大動脈遮断時間49〜82分(平均65分)、人工心肺中の冷却温度は24.8〜28.4℃(平均26.6℃)であった。ICU入室中に投与したベクロニウムの総投与量は3.3〜11.7mg・kg-1(平均7.5mg・kg-1)、持続投与中止から抜管までの時間は48.4〜153.9時間(平均101.1時間)と4日間を要していた。そのうち約80%の症例は100時間以内に抜管可能であった。5例は抜管まで200時間以上と長時間を要した。挿管時間と各因子の比例ハザードモデルによる単変量解析の結果、ベクロニウム総投与量と人工心肺冷却温度が有意に独立した危険因子であった。

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Language：Japanese   Publisher：(株)診断と治療社  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J00642&link_issn=&doc_id=20100423200003&doc_link_id=%2Fae4shond%2F2010%2F007305%2F005%2F0703-0708%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4shond%2F2010%2F007305%2F005%2F0703-0708%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：診断と治療社  

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2010174619

Language：Japanese   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.17.353

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

先天性心疾患患者への腸回転異常修復術における麻酔を経験した。症例は2歳9ヵ月男児で、生後すぐに心雑音を指摘された。生後10日目に心エコー検査で無脾症、単心房、共通房室弁孔、両大血管右室起始、総肺静脈還流異常(TAPVC)、superior-inferior ventricleと診断され、TAPVC修復術、肺動脈絞扼術が施行された。生後7ヵ月で両方向性グレン手術とvertical vein ligationが施行された。今回、両大静脈肺動脈吻合法予定で入院したが、腸回転異常が認められ、入院後17日目に待機的に腸回転異常修復術を施行した。本症例の麻酔経過を述べ、このような患児の麻酔を安全に行うためには原疾患の血行動態を把握する必要があることを指摘した。非心臓手術の対象となる疾患の理解も必要である。

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：日本小児麻酔学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本小児救急医学会  

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Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：姫路赤十字病院図書学術委員会  

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Language：Japanese   Publisher：(一社)日本小児救急医学会  

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Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：姫路赤十字病院図書学術委員会  

4歳男児.発熱し上気道炎として投薬加療を行ない解熱したが,3日後に突然眼球偏位及び全身強直発作が出現した.入院時の検査で異常は認めなかったが,その後もけいれん発作が出現し,二次性に全般化する痙攣発作の群発と重積化を認めた.第3病日の脳波所見と臨床経過から急性脳炎・脳症と診断し,グリセロール,アシクロビル,デキサメタゾン投与とチオペンタール持続静注療法を開始した.第17病日の脳波検査で両頭頂部優勢の多棘徐波が見られ,二次性の全般化を認めた.チオペンタール減量に伴うけいれんの群発と重積化を認め,バルブロ酸ナトリウム,クロバザム内服ではチオペンタール持続静注療法から離脱できず,フェノバルビタール大量療法を行なった.その後,けいれんの再燃及び重積化はなく,チオペンタール静注療法も中止できた.第60病日の頭部CTと第81病日のMRIでは全般性脳萎縮が見られた.退院時は3語文が可能で,現在は軽度認知障害を認めるが,順調に回復している

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Language：Japanese   Publisher：姫路赤十字病院図書学術委員会  

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Language：Japanese   Publisher：姫路赤十字病院図書学術委員会  

ペインクリニック外来開設から約5年間の推移について統計的に検討した.受診者及び新患患者共に年々増加し,午前中のみの診察が午後も続くようになり,待ち時間が長いことが患者の不満を増加させていた.麻酔科の入院病床も設置されたが,症例数は多くはなかった.患者の増加に伴い顔面神経痛以外の患者も増加し,腰下肢痛や帯状疱疹及び帯状疱疹後神経痛の症例の増加が有意であった.又,通常の内服薬治療のほかに行う各種透視下神経ブロック治療も有意に増加した.癌性疼痛のコントロール患者には有意な増加は見られなかった

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本赤十字社医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本赤十字社医学会  

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