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PURPOSE: The aims of this study were (1) to determine the associations of cardioplegic solutions with postoperative main strong ion difference (mSID), which is the difference between sodium ion concentration and chloride ion concentration ([Cl-]) and (2) to determine the associations of cardioplegic solutions with markers of organ dysfunction. METHODS: In this retrospective cohort study, patients aged <5 years who underwent cardiac surgery in a tertiary teaching hospital were included. Patients were classified on the basis of the type of cardioplegic solution: modified del Nido cardioplegia (mDNC) and conventional cardioplegia (CC). The effects of mDNC on postoperative mSID and markers of organ functions were examined using propensity-matched analysis. RESULTS: A total of 500 cases were included. mDNC solution was used in 163 patients (32.6%). After propensity score matching, patients in the mDNC group (n = 152) had significantly higher minimum mSID [28 (26, 30) mEq/L vs. 27 (25, 29) mEq/L, p = 0.02] and lower maximum [Cl-] [112 (109, 114) mEq/L vs. 113 (111, 117) mEq/L, p < 0.001] than patients in the CC group (n = 304). The incidences of low mSID and hyperchloremia in the mDNC group were significantly lower than those in the CC group (63.8 vs. 75.7%, p = 0.01 and 63.2 vs. 79.3%, p < 0.001, respectively). There was no significant difference in the incidence of postoperative acute kidney injury and B-type natriuretic peptide level between the two groups. CONCLUSION: The use of modified del Nido cardioplegia may reduce the incidence of abnormal mSID and hyperchloremia compared with the use of a chloride-rich cardioplegic solution.

DOI： 10.1007/s00540-023-03306-0

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Remimazolam is a new ultrashort-acting benzodiazepine sedative, the use of which has not been reported for pediatric cardiac surgery. This case report describes the use of remimazolam in a 6-year-old girl who underwent minimally invasive cardiac surgery with right-sided thoracotomy for an atrial septal defect. Under electroencephalographic monitoring, remimazolam (2-4 mg kg-1 h-1) and remifentanil (0.05 μg kg-1 min-1) were administered with an intercostal nerve block during the procedure. The patient awoke and was extubated promptly after surgery, without any serious adverse events, including intraoperative awareness. Remimazolam may be a viable option for general anesthesia during pediatric cardiac surgery.

DOI： 10.1213/XAA.0000000000001735

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DOI： 10.1186/s12871-023-02323-6

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Hemolysis is a complication of cardiopulmonary bypass (CPB). Carboxyhemoglobin (COHb) and methemoglobin (MetHb) were suggested as potential hemolysis biomarkers. This retrospective study was based on a prospective registry aimed to determine the association of COHb and MetHb levels with hemolysis in pediatric patients <4 years old who underwent cardiac surgery with CPB. Plasma-free hemoglobin (PFH), COHb, and MetHb levels were measured before CPB; every 30 minutes during CPB; and on postoperative days 1, 2, and 3. Patients were classified into hemolysis and nonhemolysis groups based on the maximum PFH levels during CPB. A total of 193 patients were included. No significant difference was observed in the maximum COHb levels during CPB (COHbCPB) between the hemolysis and nonhemolysis groups (1.2% [interquartile range {IQR} 0.9-1.4%] vs. 1.1% [IQR: 0.9-1.4%]; p = 0.17). The maximum MetHb levels during CPB (MetHbCPB) were significantly higher in the hemolysis group than in the nonhemolysis group (1.3% [IQR: 1.1-1.5%] vs. 1.2% [IQR: 1.0-1.4%]; p = 0.007). Areas under the receiver operating curves of COHbCPB and MetHbCPB were 0.557 (95% confidence interval: 0.475-0.640) and 0.615 (95% confidence interval: 0.535-0.695), respectively. Therefore, the predictive ability of both hemolysis biomarkers during CPB is limited.

DOI： 10.1097/MAT.0000000000002044

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BACKGROUND: Body temperature (BT) is thought to have associations with oxygen consumption (VO2). However, there have been few studies in which the association between systemic VO2 and BT in humans was investigated in a wide range of BTs. The aims of this study were 1) to determine the association between VO2 and age and 2) to determine the association between VO2 and BT. METHODS: This study was a retrospective study of patients who underwent surgery under general anesthesia at a tertiary teaching hospital. VO2 was measured by the Dräger Perseus A500 anesthesia workstation (Dräger Medical, Lubeck, Germany). The associations of VO2 with age and BT were examined using spline regression and multivariable regression analysis with a random effect. RESULTS: A total of 7,567 cases were included in this study. A linear spline with one knot shows that VO2 was reduced by 2.1 ml/kg/min with one year of age (p < 0.001) among patients less than 18 years of age and that there was no significant change in VO2 among patients 18 years of age or older (estimate: 0.014 ml/kg/min, p = 0.08). VO2 in all bands of BT < 36.0 °C was not significantly different from VO2 in BT >  = 36 °C and < 36.5 °C. Multivariable linear regression analysis showed that compared with VO2 in BT >  = 36 °C and < 36.5 °C as a reference, VO2 levels were significantly higher by 0.57 ml/kg/min in BT >  = 36.5 °C and < 37 °C (p < 0.001), by 1.8 ml/kg/min in BT >  = 37 °C and < 37.5 °C (p < 0.001), by 3.6 ml/kg/min in BT >  = 37.5 °C and < 38 °C (p < 0.001), by 4.9 ml/kg/min in BT >  = 38 °C and < 38.5 °C (p < 0.001), and by 5.7 ml/kg/min in BT >  = 38.5 °C (p < 0.001). The associations between VO2 and BT were significantly different among categorized age groups (p = 0.03). CONCLUSIONS: VO2 increases in parallel with increase in body temperature in a hyperthermic state but remains constant in a hypothermic state. Neonates and infants, who have high VO2, may have a large systemic organ response in VO2 to change in BT.

DOI： 10.1186/s12871-023-02182-1

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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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BACKGROUND: Osler-Weber-Rendu syndrome is characterized by mucocutaneous telangiectasia and arteriovenous malformations in organs. Anesthesia for patients with Osler-Weber-Rendu syndrome is challenging due to complications and physiological changes. CASE PRESENTATION: The case was a 49-year-old female with Osler-Weber-Rendu syndrome, multiple pulmonary arteriovenous malformations and pheochromocytoma who presented for femoral bone head fracture with metastatic adenocarcinoma. The patient was scheduled to undergo bone tumor resection and artificial bone replacement, being positioned laterally with a planned operation duration of 5 h. Anesthesia was managed with spinal and epidural anesthesia, combined with sedation by sevoflurane using a supraglottic airway (SGA) device under spontaneous breathing. Her intraoperative and postoperative courses were uneventful. CONCLUSION: Neuraxial anesthesia combined with general anesthesia using an SGA device to maintain spontaneous ventilation in order to minimize the risk of rupture of pulmonary arteriovenous malformations could be an option.

DOI： 10.1186/s40981-023-00600-4

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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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全身麻酔下の腰椎前方後方固定術後に奇異性声帯運動(paradoxical vocal cord motion:PVCM)による上気道狭窄を呈し、再挿管に至った症例を経験した。本症例のPVCM発症には麻酔深度、術中体位、術中輸液量、内服薬の中断による影響などの複数因子が関係したと考えられた。術後の上気道狭窄の原因として、浮腫などの器質的原因以外にPVCMも鑑別する必要がある。(著者抄録)

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日本集中治療医学会小児集中治療委員会日本小児集中治療連絡協議会COVID-19ワーキンググループは,新型コロナウイルスの国内流行のいわゆる第5波で,その初期の段階で20歳未満の患者数が増加していることを把握した。小児科学会との協力体制のもと,小児重症・中等症例発生状況をまとめた。登録症例数は46例。COVID-19肺炎は20例であり,その他の入室理由が過半数を占めた。また,重症症例の診療体制について整理した。(著者抄録)

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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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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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BACKGROUND: Perioperative atrial fibrillation (POAF) after non-cardiac surgery is a risk factor for cardiovascular events including stroke and death. The aim of this subanalysis of the MAMACARI study, a multicenter randomized control study on the effectiveness of a bisoprolol transdermal patch for prevention of perioperative myocardial injury in high-risk patients undergoing non-cardiac surgery, was to identify the predictors of POAF after non-cardiac surgery in high-risk patients and to determine changes in blood pressure and heart rate during bisoprolol patch administration in the perioperative period. METHODS AND RESULTS: Patients aged over 60 years with hypertension and a high revised cardiac risk index (≥2) who were scheduled to undergo non-cardiac surgery were randomly assigned to a bisoprolol patch group (n = 120) or a control group (n = 120). We divided the patients into two groups: patients with POAF (POAF group; n = 16) and patients without POAF (non-POAF group; n = 206). Multivariate analysis showed that bisoprolol patch therapy (OR: 0.30, 95% CI: 0.092-0.978) and surgery time of 250 min or more (OR: 4.99, 95% CI: 1.37-18.2) were independently associated with POAF. Although systolic blood pressure did not differ significantly between the two groups throughout the perioperative period, treatment with a bisoprolol patch significantly reduced heart rate throughout the perioperative period compared with that in the control group. CONCLUSIONS: Low dose of a bisoprolol patch in the perioperative period was effective for prevention of POAF after non-cardiac surgery in high-risk patients, while long surgery time was an independent risk factor for POAF. It is expected that low dose of a bisoprolol patch can prevent POAF without causing hypotension.

DOI： 10.1016/j.jjcc.2021.05.001

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The effectiveness of adenosine-induced flow arrest in surgical clipping for the cerebral aneurysms with difficulties in temporary clip placement to the proximal main trunk has been reported. This is the first clinical trial to evaluate the safety and feasibility of adenosine-assisted clipping surgery for unruptured cerebral aneurysms (UCAs) in Japan. The inclusion criteria are as follows: patients over 20 years old, patients who agree to be enrolled in this study after providing informed consent, patients who undergo clipping surgery for UCA in our institute, and patients in whom the surgeons (T.H. or I.D.) judge that decompression of the aneurysm is effective. The primary endpoint is a modified Rankin Scale (mRS) score 30 days after surgery. We plan to enroll 10 patients in this study. The original protocol of adenosine administration was established in this trial. Herein, we present the study protocol.

DOI： 10.2176/nmc.st.2021-0018

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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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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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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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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: The aim of this study was to evaluate the efficacy and safety of transdermal β-blocker patches, which offer stable blood concentration and easy availability during operation, for prevention of perioperative myocardial injury (PMI) in high-risk patients.Methods and Results:In this randomized controlled trial, patients aged >60 years with hypertension and high revised cardiac risk index (≥2) undergoing non-cardiac surgery were randomly assigned to a bisoprolol patch or control group. Primary efficacy outcome was incidence of PMI, defined as postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL and relative hs-cTnT change ≥20%. Secondary efficacy outcomes were number of cardiovascular events and 30-day mortality. From November 2014 to February 2019, 240 patients from 5 hospitals were enrolled in this study. The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in the control group (P=0.18). Incidence of major adverse cardiac events including non-critical myocardial infarction, strokes, decompensated heart failure and tachyarrhythmia was similar between the 2 groups. Tachyarrhythmia tended to be higher in the control group. There were no significant differences in safety outcomes including significant hypotension and bradycardia requiring any treatment between the 2 groups. CONCLUSIONS: Bisoprolol patches do not influence the incidence of PMI and cardiovascular events in high-risk patients undergoing non-cardiac surgery, but perioperative use of these patches is safe.

DOI： 10.1253/circj.CJ-19-0871

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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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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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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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Tachycardia is common in intensive care units (ICUs). It is unknown whether tachycardia or prolonged tachycardia affects patient outcomes. We investigated the association between tachycardia and mortality in critically ill patients. This retrospective cohort study's primary outcome was patient mortality in the ICU and the hospital. We stratified the patients (n=476) by heart rate (HR) as LowHR, MediumHR, and HighHR groups. We also stratified them by their durations of HR >100 (prolonged HR; tachycardia): MildT, ModerateT, and SevereT groups. We determined the six groups' mortality. The ICU mortality rates of the LowHR, MediumHR, and HighHR groups were 1.0%, 1.5%, and 7.9%, respectively; significantly higher in the HighHR vs. LowHR group. The in-hospital mortality rates of these groups were 1%, 4.5%, and 14.6%, respectively; significantly higher in the HighHR vs. LowHR group. The ICU mortality rates of the MildT, ModerateT, and SevereT groups were 0.9%, 5.6%, and 57.1%, respectively. The mortality of the HRT=0 (i.e., all HR ≤ 100) patients was 0%. The in-hospital mortality rates of the MildT, ModerateT, and SevereT groups were 1.8%, 16.7%, and 85.7%, respectively; that of the HRT=0 patients was 0.5%. Both higher HR and prolonged tachycardia were associated with poor outcomes.

DOI： 10.18926/AMO/56650

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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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Using a controlled pre/post study design, we investigated the effects of professional mechanical cleaning of the oral cavity with benzethonium chloride, interdental brushes, and hydrogen peroxide on the number of oral bacteria and postoperative complications among esophageal cancer patients in an intensive care unit. Before surgery, 44 patients with esophageal cancer were recruited at Okayama Hospital from January through August 2015. The control group (n = 23) received routine oral hygiene care in the intensive care unit. The intervention group (n = 21) received intensive interdental cleaning with benzethonium chloride solution and tongue cleaning with hydrogen peroxide. The number of oral bacteria on the tongue surface and plaque index were significantly lower in the intervention group than in the control group on postoperative days 1 and 2 (P < 0.05). Additionally, the number of days with elevated fever during a 1-week period was significantly lower in the intervention group than in the control group (P = 0.037). As compared with routine oral hygiene, a new oral hygiene regimen comprising benzethonium chloride, interdental brushes, and hydrogen peroxide significantly reduced the number of oral bacteria and days with elevated fever in patients with esophageal cancer.

DOI： 10.2334/josnusd.17-0381

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The number of patients who are successfully discharged from the intensive care unit (ICU) after hematopoietic stem cell transplantation (HSCT) remains limited. Most previous studies have evaluated short-term outcomes using ICU mortality; there have been comparatively fewer reports of long-term outcomes. We retrospectively analyzed 39 HSCT patients admitted to the ICU for the first time between April 2008 and July 2014. Performance status was evaluated in four long-term survivors in July 2016. Median age at ICU admission was 54 years (range 30-68). In total, 33 patients (70.2%) required mechanical ventilation and 31 patients (66%) required dialysis. The median OS from first ICU admission was 41 days (95% confidence interval [CI]: 22-64) and the 1-year survival rate was 12.8% (95% CI 4.7-25.2). No statistically significant factors were associated with short-term outcomes. Among long-term outcomes, a second or subsequent HSCT and neutropenia at ICU admission were significant risk factors. Four of 10 ICU survivors have survived with good performance status for a median of 1994 (1203-2633) days. Our results suggest that the number of prior transplants and neutropenia at ICU admission may influence OS.

DOI： 10.1007/s12185-018-2536-x

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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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Glucose transporter type 1 deficiency syndrome (GLUT1DS) causes central nervous system dysfunction including intractable epilepsy caused by impaired glucose transport to the brain. To prevent convulsions and maintain an energy source for the brain in patients with GLUT1DS, the maintenance of adequate ketone body concentrations, compensation of metabolic acidosis, and reduction of surgical stress are essential. We here report the perioperative management of a child with GLUT1DS.

DOI： 10.1213/XAA.0000000000000727

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kokuseido Publishing Co. Ltd  

Mechanical ventilation during surgery was thought to be easy, because it is only of short duration, and it is used for paralyzed, healthy lungs. Recently, however, it is reported that high risk patients are increasing in number and the actual incidence of postoperative pulmonary complications (PPC) is as high as 20-30%. Nowadays, we should pay more attentions to perioperative respiratory care especially in high risk patients. In preoperative periods, several risk calculation systems has been already reported, but their validation and routine use are still limited We really have to pay more attention in predicting high risk patients for PPC. During general anesthesia, lung protective ventilation could be applied especially in high risk patients, and it could reduce PPC. After surgery, high flow nasal cannula can be used to prevent re-intubation, but it is not known whether this approach could reduce PPC. Of course, more evidence is needed, but we suggest that anesthesiologists should pay more attention not only to maintenance of anesthesia during surgery, but also to prevention of PPC by perioperative respiratory care.

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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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J01620&link_issn=&doc_id=20180319160002&doc_link_id=%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery.Methods and Results:In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

DOI： 10.1253/circj.CJ-17-0747

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BACKGROUND: The interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (VT) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (FIO2). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery. METHODS: We performed a prospective observational two-center study in Japan. Patients scheduled for thoracic surgery with OLV from April to October 2014 were eligible. We recorded ventilator settings (FIO2, VT, driving pressure (ΔP), and PEEP) and calculated the time-weighted average (TWA) of ventilator settings for the first 2 h of OLV. PPCs occurring within 7 days of thoracotomy were investigated. Associations between ventilator settings and the incidence of PPCs were examined by multivariate logistic regression. RESULTS: We analyzed perioperative information, including preoperative characteristics, ventilator settings, and details of surgery and anesthesia in 197 patients. Pressure control ventilation was utilized in most cases (92%). As an initial setting for OLV, an FIO2 of 1.0 was selected for more than 60% of all patients. Throughout OLV, the median TWA FIO2 of 0.8 (0.65-0.94), VT of 6.1 (5.3-7.0) ml/kg, ΔP of 17 (15-20) cm H2O, and PEEP of 4 (4-5) cm H2O was applied. Incidence rate of PPCs was 25.9%, and FIO2 was independently associated with the occurrence of PPCs in multivariate logistic regression. The adjusted odds ratio per FIO2 increase of 0.1 was 1.30 (95% confidence interval: 1.04-1.65, P = 0.0195). CONCLUSIONS: High FIO2 was applied to the majority of patients during OLV, whereas low VT and slight degree of PEEP were commonly used in our survey. Our findings suggested that a higher FIO2 during OLV could be associated with increased incidence of PPCs.

DOI： 10.1186/s12871-018-0476-x

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

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 &lt
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.

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The electrical activity of the diaphragm (EAdi) shows global diaphragmatic activation and power output from the central nervous system. We measured the EAdi as an indicator of breathing workload in a 40-year-old man suffering from severe acute respiratory distress syndrome (ARDS) secondary to influenza pneumonia in the process of weaning from extracorporeal membrane oxygenation (ECMO). Turning off the sweep gas flow immediately led to EAdi elevation, followed by hypoxia. The patient was successfully weaned from ECMO by reference to EAdi. This is the first case report to suggest that EAdi monitoring might be useful for ARDS patients during ECMO weaning.

DOI： 10.18926/AMO/55593

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

89歳,女性.口腔癌に対し全身麻酔下に切除術が予定された.気管挿管後,気管切開を施行し,気切孔よりガムエラスティックブジー(GEB)に沿ってスパイラルチューブを挿入した.両者とも抵抗なく挿入できたが,ETCO2は検出されなかった.気管支鏡で確認したところ,気管膜様部裂創を認めた.直ちに右片肺挿管とし,次いで左片肺挿管にした後に,開胸による気管修復術が施行された.この間,SpO2は100%を維持でき,循環動態も安定していた.術後は挿管のまま集中治療室へ入室,術後5日目に人工呼吸器から離脱,7日目にICU退室となった.気管切開手技のチューブ挿入時のGEBのルーチン使用を見直し,症例ごとの必要性などを術者と検討するべきである.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01620&link_issn=&doc_id=20170321180003&doc_link_id=%2Fci4jjsca%2F2017%2F003702%2F003%2F0156-0161%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2017%2F003702%2F003%2F0156-0161%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

妊娠中の急性膵炎は稀な疾患であるが、発症すると母体、胎児ともに予後が悪い。著明な高トリグリセリド(triglyceride、TG)血症による急性膵炎を発症した妊婦に対して、LDL(low density lipoprotein)吸着療法を施行し良好な経過をたどった症例を経験した。症例は35歳、妊娠39週の女性。TG 11,936mg/dlの著明な高TG血症を認め、造影CTにて重症急性膵炎を疑う所見を認めた。帝王切開にて妊娠を中断の後、ICU入室となり急性膵炎、高TG血症に対する治療を開始した。高TG血症に対してLDL吸着療法を3回施行し、TG値は1,764mg/dlまで低下した。その後、膵炎に対する保存加療が継続され、第15病日に退院した。高TG血症起因性急性膵炎において、高TG血症の治療併用は重要である。本疾患を合併した妊婦に対して、血漿交換と比較して合併症頻度の低いLDL吸着療法を選択し、安全に施行できた。(著者抄録)

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

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

PubMed

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

75歳女性。第3・4腰椎レベルの硬膜内髄外腫瘍に対し腫瘍摘出術が予定された。レミフェンタニル、プロポフォールによる麻酔管理を行い、術中の血圧変動にはフェニレフリン、ニカルジピンを使用し、手術は終了した。麻酔終了後の覚醒遅延を契機に頭蓋内出血、気脳症を発症したが、対症療法を主体とした全身管理を行ったところ、術後1日目のCTで気脳症や頭蓋内出血の改善が確認された。その後、徐々に意識レベルは改善し、軽度の認知機能障害が残存したものの、術後22日目に転院となった。

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

慢性甲状腺炎(橋本病)は自己免疫性疾患であり、びまん性の甲状腺腫大を呈する。橋本病に対する治療薬中断により、気管切開部の気道狭窄が顕性化した症例を経験したので報告する。症例は57歳男性で、2年前に気管切開の既往があり、4ヵ月前にレボチロキシンの内服により気道狭窄が改善したエピソードがあった。今回は呼吸困難により受診し、頸部CTにて著明な気管狭窄を認め挿管管理となった。気管切開部の狭窄を浮腫や甲状腺腫大が助長させたと考え、利尿による水分管理に加え、レボチロキシンの内服を再開し気道管理を施行した。第6病日に気管狭窄は入室時より改善し抜管に至った。気管切開の既往がある慢性甲状腺炎を有する症例において、甲状腺ホルモン補充中断は甲状腺腫大増悪により気管狭窄を重症化させる危険性が高い。また、侵襲的気道管理を回避するために、甲状腺ホルモンの内服薬開を含めた内科的な集学的治療をまずは考慮すべきである。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J00001&link_issn=&doc_id=20161012250008&doc_link_id=%2Faa6icutc%2F2016%2F004009%2F009%2F0653-0657%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2016%2F004009%2F009%2F0653-0657%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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/default/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：English   Publishing type：Research paper (scientific journal)  

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

PubMed

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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

PubMed

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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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01620&link_issn=&doc_id=20160128310001&doc_link_id=%2Fci4jjsca%2F2016%2F003601%2F001%2F0001-0006%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2016%2F003601%2F001%2F0001-0006%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(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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J00001&link_issn=&doc_id=20150811310006&doc_link_id=%2Faa6icutc%2F2015%2F003907%2F007%2F0431-0435%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2015%2F003907%2F007%2F0431-0435%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

PubMed

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Language：Japanese   Publisher：(一社)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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J03953&link_issn=&doc_id=20141006150196&doc_link_id=%2Fdq3syoni%2F2014%2Fs02001%2F011%2F0260-0263%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdq3syoni%2F2014%2Fs02001%2F011%2F0260-0263%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

症例は56歳男性で、クモ膜下出血でクリッピング術を行ったが、1週後に別位置の動脈瘤破裂で意識障害となり、コイルによる塞栓術を行ったが意識は改善せず、脳浮腫の進行で外減圧術を行い、開眼はするが従命に応じられない状態で、睡眠時の舌根沈下防止に気管切開を行った。その後水頭症の進行で脳室腹腔シャント術、頭蓋形成術を行ったが、術直後に急性硬膜下血腫をきたし、頭蓋骨を除去して外減圧を行った。意識は改善しなかったが、全身状態が安定したため再度頭蓋形成術が予定され、レミフェンタニル、プロポフォールで入眠させ、ロクロニウム投与後に気管切開チューブをスパイラルチューブに入れ替え、レミフェンタニル、プロポフォールで麻酔を維持した。手術終了後に自発呼吸を認め、気管切開チューブに戻してICUに移動した。Rad87型パルスオキシメーターと呼吸センサーを用いてアコースティック呼吸数を測定し、目測の呼吸数との間に有意差は認めなかった。

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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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J01397&link_issn=&doc_id=20131003060016&doc_link_id=1520290883813124096&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520290883813124096&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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

小児心臓カテーテルの麻酔において麻酔薬の投与量と呼吸・循環指標の変動との関連について検討した。2004年に心臓カテーテルを受けた80名の小児先天性心疾患患児を対象に、使用した麻酔薬の量と、血圧、脈拍、酸素飽和度、呼気終末二酸化炭素分圧の変動率との関連を麻酔記録より後方視的に検討した。患者の年齢は中央値で14ヵ月、体重は8.8kgであった。脈拍の変動率は中央値22.8%、血圧29.3%、酸素飽和度5.9%、呼気終末二酸化炭素分圧10.8%であった。使用した麻酔薬のフェンタニル、ベクロニウム、セボフルランの投与量とこれらの呼吸・循環指標の変動率との相関はなかった。しかしフェンタニルの投与量が多いほうが脈拍は安定する可能性がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J01397&link_issn=&doc_id=20121206150001&doc_link_id=1520009407451776896&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520009407451776896&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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

エキシーマレーザーシースによるリード抜去術を施行した2例を経験した。症例1は73歳男で、71歳時に完全房室ブロックに対しペースメーカ植え込み術が施行された。2ヵ月前より発熱が出現し、ペースメーカが体外に露出した。ペースメーカリード感染に対し、リード除去術を予定した。リードをガイドとしてエキシーマレーザーシースを挿入後、癒着していた鎖骨下静脈部位で焼灼、癒着を剥離し、リードを抜去した。経過中明らかな血管損傷などの合併症はなく、術後経過も問題はなかった。症例2は17歳男で、2歳時に両大血管右室起始症の術後、完全房室ブロックに対しペースメーカを留置した。1年前から発熱を認め、ペースメーカリード感染の診断でリード除去を予定した。無名静脈から上大静脈を露出し血管内の癒着を剥離その部位よりエキシーマレーザーシースを挿入し、レーザーによる剥離を行った。術後経過において、出血などの合併症は見られなかった。

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

術後の発作性心房細動の発生は、ICUや病院滞在日数、医療費の増加につながることが報告されており、その管理は重要である。我々は、食道癌術後に難治性の発作性心房細動を合併し、短時間作用型β1選択的遮断薬である塩酸ランジオロールを使用した7例を経験した。症例は51～87歳で、いずれも男性であった。複数の抗不整脈薬が無効であり、塩酸ランジオロール投与を開始した。初期の急速投与は行わず、4.3～33.5μg/kg/minと低用量の範囲で開始し、投与前と投与1時間後の心拍数は平均153[140、167][95%信頼区間]/minから101[88、116]/min(P<0.0001)と有意な低下を認めた。平均血圧は88[78、94]mmHgから82[74、89]mmHg(P=0.37)と有意な変化を認めず、重症な低血圧に陥る症例もなかった。6例では投与開始24時間以内に洞調律に回復した。複数の抗不整脈薬に抵抗性の食道癌術後発作性心房細動に対する低用量の塩酸ランジオロール投与は、大きな血圧の低下なく心拍数の安定をもたらした。(著者抄録)

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

1歳4ヵ月男児。出生直後の心エコー図検査で、肺動脈閉鎖、心室中隔欠損症、主要大動脈肺動脈側副動脈(MAPCA)、左上大静脈遺残と診断した。根治術として、右室流出路再建、VSD閉鎖および#1のMAPCA結紮を施行した。術後ICU入室後、徐々に左房圧(LAP)、中心静脈圧の上昇を認めた。血圧低下の原因は、左室がやや小さいことや術後に左心負荷が増大したことによる低心拍出量症候群(LCOS)と考え、アドレナリン、ヒト心房性カルペリチドに加え、腹膜透析を開始し集学的な治療を施行したが、LCOSは持続した。術後5日目に緊急心臓カテーテル検査を施行し、#1のMAPCAの結紮が本幹ではなく2本に分岐した1本の分枝のみに行われ、本幹のMAPCAは大きく残存した。心不全の原因はMAPCA#1の残存による容量負荷である可能性が高いと考え、コイル塞栓術を施行した。LAPは低下し、術後15日目に他院へ転院した。

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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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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：(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)シービーアール  

近年、下肢手術に対して術後鎮痛の手段として持続大腿神経ブロック(continuous femoral nerve block:CFNB)が選択されている。人工股関節手術患者7症例にCFNBを施行し、薬物の到達部位を検討するため造影剤の拡がりを前向きに調査した。X線正面像で仙腸関節下端より頭側まで、また、軸位像で腸骨筋の走行に沿って背側に拡がりを認めた5症例(71%)では、CFNBの鎮痛効果がすぐれていた。(著者抄録)

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

集中治療領域における白血球減少において、血球貪食症候群(hemophagocytic syndrome:HPS)の存在を念頭におき診療にあたる必要がある。今回われわれは、重症感染症の治療中に骨髄穿刺によって鑑別診断可能であった薬剤性白血球減少症例を経験したので報告する。症例は55歳、男性。食道癌術後、喀痰から検出された細菌に対して抗菌薬投与されていたが、高熱とCRP上昇(15.58mg/dL)がみられ、敗血症性ショックの状態となりICU入室となった。入室時、白血球数1,270/μLと減少し、末梢血白血球分画では好中球の著明な減少がみられた。経過よりHPSが疑われ、骨髄穿刺を行ったが、HPSの所見とは異なり顆粒球系の成熟停止が認められ、薬剤性の骨髄抑制が強く疑われた。原因と思われる抗菌薬を変更後9日目の骨髄穿刺像で顆粒球系に分化傾向認めた。その後白血球数は徐々に回復し、感染徴候も軽快した。感染症に伴う白血球減少例では、骨髄穿刺による適切な診断が不可欠であると思われた。(著者抄録)

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

We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units.
A retrospective observational study was conducted in a pediatric cardiac care unit in a tertiary care university hospital. The subjects were 40 patients with AKI requiring PD between 2003 and 2005, and controls matched by type of surgery and body weight. Acid-base variables, including blood gas data and electrolytes, were assessed. The Stewart-Figge variables, including strong ion difference apparent (SIDa), strong ion difference effective (SIDe), and strong ion gap (SIG), were calculated.
Blood gas analyses showed that the PD group was more acidemic, with a lower mean bicarbonate and a lower mean base excess, typical features of metabolic acidosis. The strong ion analyses revealed that the PD group had lower mean sodium and albumin concentrations. Based on the Stewart-Figge methodology, SIDa was smaller in the PD group than in the control group, but SIG was similar in the two groups. Receiver-operating characteristic curve analyses showed that serum albumin was the only prognostic factor associated with PCCU mortality, even after adjustment for PD treatment.
Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.

DOI： 10.1007/s00540-009-0747-2

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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：克誠堂出版(株)  

日齢0男児。患者は先天性食道閉鎖症に対して出生10時間後に根治術が予定されていた。術前に著明な低酸素血症が認められ、麻酔は100%酸素投与下で左手背静脈路よりフェンタニル、パンクロニウムが投与された。そして経鼻気管挿管を行ない、手術開始となった。麻酔は60%酸素とセボフルランで維持されたが、術中に低酸素血症や血圧の低下がみられ、そのため5%アルブミン製剤による頻回の容量負荷、ならびにメチルプレドニゾロンの投与が行なわれた。だが、反応は乏しく、両肺換気を行なうことで血圧上昇が得られた。一方、術後も低酸素血症は持続し、超音波検査を行なったところ総肺静脈還流異常が判明し、緊急に根治術を施行された。

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

OBJECTIVE: To describe our institutional experience in the management of infants and children with pertussis admitted during a 20-yr period (January 1985 through December 2004) and also to study the relation between method of presentation and outcome. SETTING: Pediatric intensive care unit in a university-affiliated tertiary pediatric hospital in Melbourne, Australia. DESIGN/METHODS: Retrospective review of medical records and radiology reports of patients with a diagnosis of pertussis identified from the pediatric intensive care unit database. RESULTS: A total of 49 patients (median age, 6 wks; interquartile range, 4-8 wks) required 55 admission episodes to the pediatric intensive care unit. Main reasons for admission were apnea with or without cough paroxysms (63%), pneumonia (18%), and seizures (10%). None of the infants had completed the primary course of immunization, and 94% had not received a single dose of pertussis vaccine. Infants presenting with pneumonia presented earlier (p = .001), had longer intensive care stay (p = .007), higher white cell count (p < or = .001), lower Pao2 at admission (p = .020), and higher mortality. Six infants out of seven needing circulatory support died (including all four treated with extracorporeal membrane oxygenation), and all deaths (n = 7) occurred in infants who had pneumonia at presentation. CONCLUSION: Patients with pertussis, presenting as apnea (with or without cough paroxysms), treated in the pediatric intensive care unit had 100% survival. However, pneumonia as the main reason for admission and the need for circulatory support is associated with a very poor outcome. A deeper understanding of the molecular basis of Bordetella pertussis and its relation to the human host might offer means for future therapies.

PubMed

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Norwood手術施行時に鎖骨下動脈-肺動脈シャント(BTシャント)を用いた6症例(BT群)と右室-肺動脈シャント(RV-PAシャント)を用いた6症例(RV-PA群)について,術後循環動態を比較・検討した.両群間で日齢,体重,体外循環時間,循環停止時間,下半身虚血時間,脳虚血時間に有意差はなかったが,心筋虚血時間はRV-PA群において有意に長かった.心拍数は収縮期血圧に群間差はなかった.拡張期血圧はRV-PA群で有意に高かった.しかし心房圧,catecholamine indexには2群間に有意差を認めなかった.乳酸値はRV-P群が低い値で推移し2群間に有意差が見られたが,塩基過剰(BE)の推移には有意差がなかった.Pao2,Fio2には2群間に有意差はなかった.modified Norwood手術後症例は,従来のBTシャントを用いた症例に比し拡張期血圧が高く,安定した冠循環を維持できた上,術後乳酸値も低く推移し末梢循環が良く保たれていた

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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：(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  

日本集中治療医学会小児集中治療委員会による新型コロナウイルス関連小児重症・中等症例のオンライン登録システムでは,新型コロナウイルス感染症(COVID-19)の第6波において症例数が増加し,2022年1月から6月までの半年間に225例が登録された。第6波においては第5波では見られなかったCOVID-19関連クループが新たに報告され,登録症例の10%にのぼった。また,中枢神経系の異常を呈した症例の報告も14%から30%に増え,うち20%が小学生であることなど,臨床像に変化が見られた。本報告では第5波と第6波を比較してCOVID-19の臨床像について報告する。(著者抄録)

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

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (other)  

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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：(一社)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：日本歯科衛生学会  

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Language：Japanese   Publisher：(NPO)日本口腔科学会  

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

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J-GLOBAL

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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  

CiNii Article

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Other Link： https://search.jamas.or.jp/link/ui/2020057460

Language：Japanese   Publisher：(株)シービーアール  

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：(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：(NPO)日本急性血液浄化学会  

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Language：Japanese   Publisher：(NPO)日本急性血液浄化学会  

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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)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(NPO)日本急性血液浄化学会  

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Language：English  

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery.Methods and Results:In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

DOI： 10.1253/circj.CJ-17-0747

PubMed

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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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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J05198&link_issn=&doc_id=20181005110007&doc_link_id=%2Fca4crbam%2F2018%2F002201%2F007%2F0045-0048%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca4crbam%2F2018%2F002201%2F007%2F0045-0048%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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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

CiNii Article

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

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：(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：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(公社)日本臨床工学技士会  

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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  

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)

DOI： 10.2199/jjsca.37.491

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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=http%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：医学図書出版  

CiNii Article

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

J-GLOBAL

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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  

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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)日本ペインクリニック学会  

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Language：Japanese   Publisher：(NPO)日本急性血液浄化学会  

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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)日本ペインクリニック学会  

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Language：Japanese   Publisher：(一社)日本血液浄化技術学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：ELSEVIER SCIENCE INC  

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Language：English   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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 &lt;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 &lt;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 (mu g/mL): 13.5 (6.4-39.6) v 6.0 (3.4-16), p &lt; 0.001; uAlb/Cr (mg/gCr): 325 (138-760) v 121 (53-269), p &lt; 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. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1053/j.jvca.2015.05.194

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PubMed

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

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本アフェレシス学会  

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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)医療の質・安全学会  

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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)日本小児麻酔学会  

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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：(一社)日本集中治療医学会  

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

DOI： 10.11386/jst.50.6_582

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00083&link_issn=&doc_id=20160202330004&doc_link_id=%2Fcl8isoke%2F2015%2F005006%2F004%2F0582-0588%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2015%2F005006%2F004%2F0582-0588%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J02874&link_issn=&doc_id=20141020410004&doc_link_id=10.3918%2Fjsicm.21.481&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.21.481&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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)日本救急医学会  

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

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Language：Japanese   Publisher：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/default/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：(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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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02874&link_issn=&doc_id=20141020410004&doc_link_id=10.3918%2Fjsicm.21.481&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.21.481&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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)

DOI： 10.2199/jjsca.34.169

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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：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：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：日本臨床麻酔学会  

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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：(一社)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：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：SPRINGER TOKYO  

DOI： 10.1007/s00540-011-1299-9

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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：克誠堂出版(株)  

小児心臓カテーテルの麻酔において麻酔薬の投与量と呼吸・循環指標の変動との関連について検討した。2004年に心臓カテーテルを受けた80名の小児先天性心疾患患児を対象に、使用した麻酔薬の量と、血圧、脈拍、酸素飽和度、呼気終末二酸化炭素分圧の変動率との関連を麻酔記録より後方視的に検討した。患者の年齢は中央値で14ヵ月、体重は8.8kgであった。脈拍の変動率は中央値22.8%、血圧29.3%、酸素飽和度5.9%、呼気終末二酸化炭素分圧10.8%であった。使用した麻酔薬のフェンタニル、ベクロニウム、セボフルランの投与量とこれらの呼吸・循環指標の変動率との相関はなかった。しかしフェンタニルの投与量が多いほうが脈拍は安定する可能性がある。(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：English   Publisher：SPRINGER TOKYO  

Purpose The benefit of tranexamic acid (TXA) in pediatric cardiac surgery on postoperative bleeding has varied among studies. It is also unclear whether the effects of TXA differ between cyanotic patients and acyanotic patients. The aim of this study was to test the benefit of TXA in pediatric cardiac surgery in a well-balanced study population of cyanotic and acyanotic patients.
Methods A total of 160 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (81 cyanotic, 79 acyanotic) were included in this single-blinded, randomized trial at a tertiary care university-affiliated teaching hospital. Eighty-one children (41 cyanotic, 40 acyanotic) were randomly assigned to a TXA group, in which they received 50 mg/kg of TXA as a bolus followed by 15 mg/kg/h infusion and another 50 mg/kg into the bypass circuit. The other 79 patients were randomly assigned to a placebo group. The primary end point was the amount of 24-h blood loss.
Results The amount of 24-h blood loss was significantly less in the TXA group than in the placebo group [mean (95% confidence interval): 18.6 (15.8-21.4) vs. 23.5 (19.4-27.5) ml/kg, respectively; mean difference -4.9 (-9.7 to -0.01) ml/kg; p = 0.049]. This effect of TXA was already significant at 6 h [9.5 (7.5-11.5) vs. 13.2 (10.6-15.9) ml/kg, respectively; mean difference -3.47 (-7.0 to -0.4) ml/kg; p = 0.027]. However, there was no significant difference in the amount of blood transfusion between the groups. There was also no statistical difference in the effect of TXA in each cyanotic and acyanotic subgroup.
Conclusion TXA can reduce blood loss in pediatric cardiac surgery but not the transfusion requirement (http://ClinicalTrials.gov number NCT00994994).

DOI： 10.1007/s00540-011-1235-z

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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)日本小児麻酔学会  

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術後の発作性心房細動の発生は、ICUや病院滞在日数、医療費の増加につながることが報告されており、その管理は重要である。我々は、食道癌術後に難治性の発作性心房細動を合併し、短時間作用型β1選択的遮断薬である塩酸ランジオロールを使用した7例を経験した。症例は51〜87歳で、いずれも男性であった。複数の抗不整脈薬が無効であり、塩酸ランジオロール投与を開始した。初期の急速投与は行わず、4.3〜33.5μg/kg/minと低用量の範囲で開始し、投与前と投与1時間後の心拍数は平均153[140、167][95%信頼区間]/minから101[88、116]/min(P<0.0001)と有意な低下を認めた。平均血圧は88[78、94]mmHgから82[74、89]mmHg(P=0.37)と有意な変化を認めず、重症な低血圧に陥る症例もなかった。6例では投与開始24時間以内に洞調律に回復した。複数の抗不整脈薬に抵抗性の食道癌術後発作性心房細動に対する低用量の塩酸ランジオロール投与は、大きな血圧の低下なく心拍数の安定をもたらした。(著者抄録)

DOI： 10.3918/jsicm.18.215

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

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

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

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

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

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

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

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

腎機能は新生児で成人の約7分の1,肝機能は半分程度しかない.しかし生後約1年を過ぎるとほぼ成人に近い機能を備えることになる.では,精神の発達は何歳で成人と同じになるのだろうか?精神発達の未熟な子どもたちが手術を受けなければならないと知ったとき,その不安や恐怖は安易に想像できるものではないだろう.大きな不安を抱えたまま手術に臨むと,術後に異常行動を起こしたり,果ては術後の回復を遅らせたりもする可能性がある.また,記銘障害や学習障害を受けたりする子どもも少なくない.こうした望ましくない反応を防ぐための介入には,前投薬,両親との同伴麻酔導入などの麻酔導入方法の検討,術後鎮痛,などがあげられる.前投薬が最も効果的なのは2〜5歳くらいの学童期以前の小児ではあるが,年長児に使用した報告もある.親同伴で麻酔を導入することが子どもの不安を軽減する,との報告もあるが,ミダゾラム前投薬の方が効果的である.ただし,同伴することは親の不安を軽減するし,これは子どもの不安軽減にもつながる.マスクか静注導入かは意見が分かれる.PCAやPCEAは小児でも安全かつ有効に使用でき,ぜひとも慣れておきたい鎮痛方法である.子どもたちがストレスなく周術期を過ごし,ひいてはその後の健やかな成長・発達に寄与できるようわれわれも関与すべきであろう.(著者抄録)

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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.

DOI： 10.1160/TH08-07-0448

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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：克誠堂出版(株)  

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

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

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

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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  

岡山大学病院では年間約350例の小児心臓手術が行われており、そのほとんどで動脈カテーテルの留置が行われている。動脈ラインは、不安定な術前・術中・術後管理を行ううえで欠かせないものである。持続的な血圧のモニターとしてだけでなく、頻回の血液ガス測定の際にも力を発揮する。本稿では、当院での方法をベースに、小児における橈骨動脈穿刺のコツと注意点を述べる。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2007&ichushi_jid=J02927&link_issn=&doc_id=20070806370002&doc_link_id=10.11477%2Fmf.3101100362&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.3101100362&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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岡山大学病院では年間約350例の小児心臓手術が行われており、そのほとんどで動脈カテーテルの留置が行われている。動脈ラインは、不安定な術前・術中・術後管理を行ううえで欠かせないものである。持続的な血圧のモニターとしてだけでなく、頻回の血液ガス測定の際にも力を発揮する。本稿では、当院での方法をベースに、小児における橈骨動脈穿刺のコツと注意点を述べる。(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：医学図書出版(株)  

過去18年間の劇症肝炎61症例について劇症肝炎の予後と意識改善に影響を与える因子を解析し,血液浄化療法のそれらに対する効果を検討した.劇症肝炎において,高年齢は予後,意識改善に悪影響を及ぼしており,入院時高D/T ratio,高クレアチニン値であれば意識が回復しやすかった.また,血漿交換,血液透析,High-flow持続的血液濾過透析は予後,意識の改善に関係していなかった

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

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Language：Japanese   Publisher：(株)へるす出版  

31歳男.うつ症状に対し三環系抗鬱薬であるクロミプラミンを内服し,いったん症状の改善を認めたが,発汗や奇異行動が出現し内服を中止した.その後,全身の振戦,空笑,粗暴性が出現し分裂病を疑われた.レボメプロマジンを筋注されたが40℃を超える発熱,CK1000IU/1台への上昇などを認め,悪性症候群が疑われた.抗鬱薬服薬既往,ミオクローヌス主体の臨床症状,治療への良好な反応性などから悪性症候群よりもセロトニン症候群と診断し,対症療法を中心に行った.経過良好でICU第5病日に一般病棟へ転棟となった.今後,選択的セロトニン再取り込み阻害薬の普及とともに救急医療領域で遭遇する機会が増加すると考えられ,本症候群に関する知識の整理の必要性が示唆された

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

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Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Language：Japanese   Presentation type：Poster presentation