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

DOI： 10.1016/j.bjao.2024.100348

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

OBJECTIVE: This study was designed to investigate the distribution of nadir oxygen delivery (DO2), mean DO2, and area under ideal DO2 (AUiDO2) among categorized age groups of pediatric patients and their associations with postoperative cardiac surgery-associated (CSA) acute kidney injury (AKI) and clinical outcomes. DESIGN: Retrospective cohort study. SETTING: A tertiary teaching hospital. PARTICIPANTS: Patients aged <15 years with congenital heart disease who underwent cardiac surgery between May 2018 and May 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nadir DO2, mean DO2, and AUiDO2 were defined as the lowest DO2, average DO2, and dose of decrement combining the intensity and duration of DO2 less than the calculated ideal DO2, respectively. The primary outcome was CSA-AKI occurrence within 48 hours postoperatively. Secondary outcomes included maximum serum lactate levels (Lacmax) for the first 24 hours after pediatric cardiac intensive care unit admission. Of 479 patients, 147 (30.7%) developed AKI. Nadir DO2 and AUiDO2 were not significantly different between patients with CSA-AKI and those without CSA-AKI (p = 0.115 and p = 0.12, respectively). However, the mean DO2 was significantly higher in patients with CSA-AKI (p = 0.025). After adjusting for potential confounders, no significant differences were observed in the odds for CSA-AKI based on increments in nadir DO2, mean DO2, or AUiDO2. In contrast, nadir DO2 and mean DO2 were significantly associated with Lacmax in both univariate and multivariable regression analyses. CONCLUSION: DO2-related values during cardiopulmonary bypass were not associated with CSA-AKI in pediatric patients with congenital heart disease. However, nadir DO2 and mean DO2 were significantly associated with postoperative serum lactate levels.

DOI： 10.1053/j.jvca.2024.11.017

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OBJECTIVE: To compare the incidence of hypotension between remimazolam and sevoflurane under general anesthesia for cardiac catheterization in patients with congenital heart disease. DESIGN: Retrospective observational study. SETTING: A single university hospital with 300 pediatric cardiac catheterizations by general anesthesia performed annually. PARTICIPANTS: Patients younger than 15 years who underwent cardiac catheterization under general anesthesia between March 1, 2021, and December 31, 2022. Exclusion criteria were general anesthesia maintained with other than remimazolam or sevoflurane, receipt of remifentanil, American Society of Anesthesiologists score 4 or 5, emergency procedures, and no direct arterial pressure measurement. INTERVENTIONS: General anesthesia was maintained with remimazolam or sevoflurane. MEASUREMENTS AND MAIN RESULTS: A total of 309 patients were analyzed, including 28 in the remimazolam group and 281 in the sevoflurane group. Propensity score matching adjusted for confounding factors resulted in 28 patients in each arm, with no apparent differences in background factors. Hypotension was defined as a time-averaged area > 1, in which systolic arterial pressure fell below 80% of the baseline from the start of anesthesia to the end of procedure. The significance level was set at P < .05. The incidence of hypotension was 39.3% in the remimazolam arm and 46.4% in the sevoflurane arm, with no significant difference (P = .79), although the ratio of the median systolic arterial pressure to the baseline value was significantly higher in the remimazolam arm (91.4 ± 15.2% vs 83.2 ± 11.4% in the sevoflurane arm; P = .03). CONCLUSIONS: Remimazolam was not associated with a lower incidence of hypotension compared to sevoflurane during pediatric cardiac catheterization for congenital heart disease while maintaining significantly higher blood pressure overall.

DOI： 10.1053/j.jvca.2024.08.038

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

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Controlling pulmonary blood flow in patients who have undergone Norwood palliation, especially early postoperatively, is challenging due to a change in the balance of systemic and pulmonary vascular resistance. We applied a combination therapy of clipping and balloon angioplasty for right ventricle-pulmonary artery (RV-PA) shunt to control pulmonary blood flow, but the influence of the combination therapy on the PA condition is uncertain. Retrospectively analysis was conducted of all infants with hypoplastic left heart syndrome who had undergone Norwood palliation with RV-PA shunt at Okayama University Hospital from January 2008 to September 2022. A total of 50 consecutive patients underwent Norwood palliation with RV-PA shunt in this study period. Of them, 29 patients underwent RV-PA shunt flow clipping, and the remaining 21 had unclipped RV-PA shunt. Twenty-three patients underwent balloon angioplasty for RV-PA shunt with clips. After balloon angioplasty, oxygen saturation significantly increased from 69 (59-76)% to 80 (72-86)% (p < 0.001), and the narrowest portion of the clipped conduit significantly improved from 2.8 (1.8-3.4) to 3.8 (2.9-4.6) mm (p < 0.001). In cardiac catheterizations prior to Bidirectional cavo-pulmonary shunt (BCPS), there were no significant differences in pulmonary-to-systemic flow ratio (Qp/Qs), ventricular end-diastolic pressure, Nakata index, arterial saturation, mean pulmonary artery pressure and pulmonary vascular resistance index. On the other hand, in Cardiac catheterizations prior to Fontan, Nakata index was larger in the clipped group (p = 0.02). There was no statistically significant difference in the 5-year survival between the two groups (clipped group 96%, unclipped group 74%, log-rank test: p = 0.13). At least, our combination therapy of clipping and balloon angioplasty for RV-PA shunt did not negatively impact PA growth. Although there is a trend toward better but not statistically significant difference in outcomes in the clipped group compared to the non-clipped group, this treatment strategy may play an important role in improving outcomes in hypoplastic left heart syndrome.

DOI： 10.1007/s00246-024-03579-6

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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=2024&ichushi_jid=J02874&link_issn=&doc_id=20240719470006&doc_link_id=20240719470001&url=http%3A%2F%2Fsearch.jamas.or.jp%2Flink%2Fbc%2F20240719470001&type=jamaslink&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F99999_1.gif

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

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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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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Publisher：克誠堂出版  

DOI： 10.18916/masui.2023080014

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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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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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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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Language：Japanese  

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

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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Authorship：Last author   Language：Japanese  

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Authorship：Last author  

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

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

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

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

DOI： 10.1016/j.jjcc.2022.04.005

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

DOI： 10.1007/s00246-021-02782-z

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<title>Abstract</title><sec>
<title>Background</title>
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.


</sec><sec>
<title>Case presentation</title>
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.


</sec><sec>
<title>Conclusions</title>
The appropriate timing of central ECMO and surgical ablation were effective in saving this child from a life-threatening situation caused by refractory AT.


</sec>

DOI： 10.1186/s40981-021-00481-5

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：克誠堂出版  

CiNii Article

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

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

<sec><title>Background</title> Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD.

</sec><sec><title>Methods</title> We retrospectively reviewed the medical records of 37 patients (&lt;16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38–53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge.

</sec><sec><title>Results</title> The median ECMO duration was 160 (91–286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration &gt;1 week and urine output &lt;1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min.

</sec><sec><title>Conclusions</title> Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.

</sec>

DOI： 10.1177/0218492321997379

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

J-GLOBAL

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

DOI： 10.1053/j.jvca.2021.02.017

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

DOI： 10.1007/s00540-021-02931-x

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

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

Abstract

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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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：真興交易(株)医書出版部  

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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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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本小児麻酔学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：克誠堂出版(株)  

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

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CiNii Article

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Cambridge University Press (CUP)  

Abstract

Background:

Pulmonary vein stenosis (PVS) is a condition with challenging treatment and leads to severe cardiac failure and pulmonary hypertension. Despite aggressive surgical or catheter-based intervention, the prognosis of PVS is unsatisfactory. This study aimed to assess the prognosis and to establish appropriate treatment strategies.

Methods:

We retrospectively reviewed endovascular treatments for PVS (2001–2017) from the clinical database at the Okayama University Hospital.

Results:

A total of 24 patients underwent PVS associated with total anomalous pulmonary venous connection and 7 patients underwent isolated congenital PVS. In total, 53 stenotic pulmonary veins were subjected to endovascular treatments; 40 of them were stented by hybrid (29) and percutaneous procedures (11) (bare-metal stent, n = 34; drug-eluting stent, n = 9). Stent size of hybrid stenting was larger than percutaneous stenting. Median follow-up duration from the onset of PVS was 24 months (4–134 months). Survival rate was 71 and 49% at 1 and 5 years, respectively. There was no statistically significant difference between stent placement and survival; however, patients who underwent bare-metal stent implantation had statistically better survival than those who underwent drug-eluting stent implantation or balloon angioplasty. Early onset of stenosis, timing of stenting, and small vessel diameter of pulmonary vein before stenting were considered as risk factors for in-stent restenosis. Freedom from re-intervention was 50 and 26% at 1 and 2 years.

Conclusions:

To improve survival and stent patency, implantation of large stent is important. However, re-intervention after stenting is also significant to obtain good outcome.

DOI： 10.1017/s1047951119001495

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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

PubMed

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：真興交易(株)医書出版部  

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

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

DOI： 10.1111/ped.13716

Web of Science

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

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01620&link_issn=&doc_id=20190319280006&doc_link_id=%2Fci4jjsca%2F2019%2F003902%2F007%2F0148-0154%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2019%2F003902%2F007%2F0148-0154%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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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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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

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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：バイオメカニズム学会  

適切な神経刺激と誘発筋収縮の正確なモニタリングを行うことができる筋弛緩モニターを開発するために、機器の試作および刺激実験を行って性能を確認した。被験者は健常な50～60代男性2名とした。筋弛緩モニターシステムは、母指の筋振動を検出する軸加速度センサ、尺骨神経の選択的神経刺激が可能なアレイ電極、電極の自動探索を行う電極選択インタフェース、および電気刺激や四連刺激比を表示する筋弛緩モニターから構成された。まず、臨床でよく用いられ尺骨神経の支配を受ける母指内転筋を対象とし、筋弛緩モニタリングを行った。次に、試作したアレイ電極の神経刺激選択性を確認するために、正中神経を刺激して実験を行った。また、正中神経よりも細い尺骨神経を選択的に電気刺激して、正確に母指内転筋の筋振動を誘発できるかを確認した。本実験で得られた結果から、製作したアレイ電極は筋弛緩モニタリングに適した尺骨神経刺激部位を探索することが可能であり、また本実験で用いた加速度センサによって精度良く対象筋の動きを測定でき、当初の問題点を解決できたと考える。

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

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

DOI： 10.18926/AMO/55862

PubMed

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

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

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01620&link_issn=&doc_id=20180319160017&doc_link_id=%2Fci4jjsca%2F2018%2F003802%2F020%2F0250-0255%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2018%2F003802%2F020%2F0250-0255%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(NPO)日本小児循環器学会  

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Authorship：Lead author   Language：Japanese   Publisher：日本臨床麻酔学会  

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

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

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

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

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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：(NPO)日本小児循環器学会  

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

DOI： 10.1186/s40560-017-0226-z

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Pediatric Cardiology and Cardiac Surgery  

<p>Background: Protein-losing enteropathy (PLE) following the Fontan operation has been an extremely difficult complication to treat successfully. This study aimed to assess the prognosis and to establish appropriate treatment strategies for PLE.</p><p>Methods: From 1991 to 2014, 23 patients with PLE following the Fontan operation were identified from clinical database at Okayama University Hospital. Data were collected retrospectively.</p><p>Results: A total of 401 patients underwent Fontan operation at our institution during the study period. In this cohort, the 5.7％ incidence of PLE was relative to the total number of Fontan operations. Following PLE diagnosis, patients had a 68％ and 54％ survival rate at 5 and 10 years, respectively. The causes of death included sepsis, multiple organ failure, heart failure, and intracranial bleeding. In the treatment of PLE, 23 (100％) patients were treated with medication, 10 (43％) patients underwent catheter intervention and 15 (65％) patients underwent surgery. Patients who died were older at the time of PLE diagnosis and were associated with a longer interval between the Fontan operation and PLE diagnosis. Decreased survival was observed in patients with the following conditions post-PLE treatment: a cardiac index (CI)＜2.8 L/min/mm, decreased ventricular ejection fraction (vEF)＜50％, and high central venous pressure (meanCVP)≧15 mmHg.</p><p>Conclusion: Our current treatment for PLE was only partially successful. Strategies for reducing CVP and improving both CI and vEF may be effective. Further studies are necessary to determine better treatment strategies for the future.</p>

DOI： 10.9794/jspccs.33.202

CiNii Article

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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   Publishing type：Research paper (scientific journal)  

CiNii Article

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

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

DOI： 10.1161/CIRCRESAHA.116.310253

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Language：Japanese   Publisher：日本成人先天性心疾患学会  

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

DOI： 10.18926/AMO/54809

CiNii Article

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Other Link： http://search.jamas.or.jp/link/ui/2017326186

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

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

DOI： 10.3918/jsicm.23.318

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

DOI： 10.1016/j.transci.2016.01.027

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DOI： 10.1111/aor.12588

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

DOI： 10.1053/j.jvca.2015.05.194

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

DOI： 10.1097/01.ccm.0000508918.45752.7a

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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

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

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本小児麻酔学会  

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

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

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

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Language：Japanese   Publisher：(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  

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Other Link： https://search-tp.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   Publishing type：Research paper (scientific journal)  

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

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

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

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

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Language：Japanese   Publisher：(株)学研メディカル秀潤社  

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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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40歳以上成人例において、心房中隔欠損症(ASD)のカテーテル閉鎖術と外科的閉鎖術で臨床上の有効性・安全性の比較を行い、成人期ASDに対するカテーテル閉鎖術の治療戦略上の有用性を明らかにした。中心窩型ASDを閉鎖した40歳以上の100例を対象とした。27例が手術閉鎖(外科的閉鎖群)、73例がカテーテル閉鎖(カテーテル閉鎖群)であった。外科的閉鎖群はカテーテル閉鎖群に比べ、有意に低年齢で、大きいASD径を有した。両群間で治療に関連する死亡、重篤な合併症は認めなかった。外科的閉鎖群は術後在院日数が有意に長かった。単変量解析で外科的閉鎖群は、有意に術後の上室性不整脈発生率が高かった。成人期ASDに対するカテーテル治療の導入によって、術後遠隔期の上室性不整脈発生頻度が低下する可能性があり、本疾患患者の長期予後を改善させる可能性が示唆された。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J02003&link_issn=&doc_id=20110128260006&doc_link_id=%2Fee7shoni%2F2011%2F002701%2F007%2F0023-0030%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fee7shoni%2F2011%2F002701%2F007%2F0023-0030%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English  

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

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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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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01397&link_issn=&doc_id=20101005180011&doc_link_id=1520853833824188416&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520853833824188416&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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)  

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

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01397&link_issn=&doc_id=20101005180023&doc_link_id=1520572357291616512&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520572357291616512&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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

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

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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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J02874&link_issn=&doc_id=20100730590017&doc_link_id=10.3918%2Fjsicm.17.353&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.17.353&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

The high-flow management of cardiopulmonary bypass (CPB; >or=2.4 L/min/m(2)) is a standard strategy used at this institute for children with pulmonary atresia (PA) due to a fear that the blood flow may be diverted by the major/minor aortopulmonary-collateral-arteries and hypervascularization due to long-term hypoxia. The purpose of this study was to describe the validity of high-flow management in children with PA. The CPB records of 23 children with PA who underwent a definitive biventricular repair between Feb 2006 and Nov 2008 were retrospectively reviewed. The mean age at the operation was 33 +/- 22 months. The blood-pressure during bypass was controlled with the same protocol. The mean cooling-temperature was 28.4 +/- 3.7 degrees C. The mean minimum hematocrit was 25.0 +/- 3.4%. The mean maximum bypass flow index at the initiation, the mean maximum flow index during aortic cross-clamping, the mean minimum flow index during aortic cross-clamping, and the mean maximum flow index after rewarming were 3.1 +/- 0.5, 3.1 +/- 0.5, 2.6 +/- 0.4, and 3.2 +/- 0.4 L/min/m(2), respectively. The higher bypass flow indexes significantly correlated with the lower serum lactate levels. The lowest oxygen delivery during CPB had significant influences on the urine output during bypass (R = 0.547, P = 0.007), the serum lactate levels at the end of CPB (R = -0.442, P = 0.035), and the postoperative thoracic effusion (R = -0.459, P = 0.028). A bypass flow index of 2.4 L/min/m(2) may not be sufficient and the maximum requirement of bypass flow index may be 3.2 L/min/m(2) or more in this patient population.

DOI： 10.1111/j.1525-1594.2009.00895.x

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

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/j.1442-200x.2008.02731.x

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

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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.

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

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DOI： 10.2174/157340608786241972

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

A male newborn infant born at 38 weeks of gestation and weighing 2,660 g, was diagnosed as esophageal atresia. Although there was mild cyanosis at birth, his initial ultrasonographic examination performed by neonatologist showed normal anatomy of the heart. He underwent a surgical repair of esophageal atresia under general anesthesia. Anesthesia was induced with fentanyl and pancuronium, and maintained with sevoflurane and 60% oxygen. Frequent desaturation occurred during the procedure, requiring manual hyperventilation with 100% oxygen. Since blood pressure during the operation was unstable, volume loading with albumin was attempted. Further echocardiography was performed by pediatric cardiologist after going back to NICU. This revealed total anomalous pulmonary venous connection (TAPVC). He underwent cardiac surgery for repair of TAPVC on the next day. Although TAPVC was not preoperatively diagnosed regardless of results of echocardiogram, cyanosis and unstable blood pressure should be considered as signs of potential cardiac disease. Fluid restriction, higher hemoglobin, lower inspired oxygen and slightly higher carbon dioxide rather than albumin administration and hyperventilation should have been attempted during the esophageal repair.

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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：シュプリンガー・ジャパン(株)  

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

DOI： 10.1007/s00540-004-0283-z

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

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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2004&ichushi_jid=J01397&link_issn=&doc_id=20040910300006&doc_link_id=1520009409162371584&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520009409162371584&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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

BACKGROUND: A recent modification of the Norwood procedure involves the use of a right ventricle-to-pulmonary artery (RV-PA) shunt to provide pulmonary blood flow for patients with hypoplastic left heart syndrome (HLHS). We investigated the hemodynamics after first-stage palliation of HLHS with RV-PA shunt compared with classic Norwood procedure with subclavian-to-pulmonary artery (BT) shunt. METHODS: The postoperative course of 12 infants who had undergone first-stage palliation for HLHS using BT shunt (group BT: n=6) and RV-PA shunt (group RV-PA: n=6) were retrospectively reviewed and we obtained the following data: blood pressure, heart rate, inotropic support, atrial pressure, lactate, base excess, PaO2, FIO2. RESULTS: The RV-PA shunt using a non-valved conduit provided higher diastolic blood pressure than the BT shunt, but no significant difference in heart rate, systemic blood pressure, inotropic support and atrial pressure was observed between the two groups. Although the infants in the group RV-PA required significantly more myocardial ischemic time for operative procedure than those in the group BT, the serum lactate level in the group RV-PA was significantly lower than those in the group BT. CONCLUSIONS: These results show that the RV-PA shunt provides a stable systemic circulation and abundant tissue oxygen supply. Excellent hemodynamics provided by RV-PA shunt is beneficial for infants undergoing stage I palliation for HLHS.

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

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DOI： 10.1007/s005400200015

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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：日総研出版  

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J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)  

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Language：English   Publishing type：Research paper, summary (international conference)  

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

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J-GLOBAL

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J-GLOBAL

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

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

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

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

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

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

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

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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=20140218390020&doc_link_id=10.3918%2Fjsicm.21.67&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.21.67&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Language：English  

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

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

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

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

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

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

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

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

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

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

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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：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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

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

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

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

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

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

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

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

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

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

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

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

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Language：Japanese   Publisher：(公社)日本小児科学会  

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Language：Japanese   Publisher：(公社)日本小児科学会  

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

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

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

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J01620&link_issn=&doc_id=20091120160007&doc_link_id=%2Fci4jjsca%2F2009%2F002907%2F008%2F0797-0802%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2009%2F002907%2F008%2F0797-0802%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Language：English  

CiNii Article

CiNii Books

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Language：Japanese   Publisher：岡山歯学会  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Language：English  

Web of Science

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

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

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

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

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

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J-GLOBAL

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

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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

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

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Language：Japanese   Publisher：(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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J-GLOBAL

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J-GLOBAL

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

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

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

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

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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：日本医療ガス学会  

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

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Language：English  

DOI： 10.1159/000067933

Web of Science

PubMed

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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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Event date： 2021.7.9 - 2021.7.11

Presentation type：Oral presentation (general)  

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Event date： 2021.7.9 - 2021.7.11

Presentation type：Oral presentation (general)  

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Event date： 2021.7.9 - 2021.7.11

Presentation type：Symposium, workshop panel (public)  

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Event date： 2021.6.3 - 2021.7.9

Language：English  

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Event date： 2021.6.3 - 2021.7.9

Language：English  

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Event date： 2013.9.27 - 2013.9.29

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2013.7.11 - 2013.7.13

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2013.7.11 - 2013.7.13

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2013.7.11 - 2013.7.13

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2013.5.23 - 2013.5.25

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

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Event date： 2013.5.23 - 2013.5.25

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2013.5.23 - 2013.5.25

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2013.5.23 - 2013.5.25

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2013.5.23 - 2013.5.25

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2013.2.28 - 2013.3.2

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.10.13 - 2012.10.17

Language：English   Presentation type：Poster presentation  

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Event date： 2012.10.13 - 2012.10.17

Language：English   Presentation type：Poster presentation  

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Event date： 2012.10.13 - 2012.10.17

Language：English   Presentation type：Poster presentation  

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Event date： 2012.10.13 - 2012.10.17

Language：English   Presentation type：Poster presentation  

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Event date： 2012.10.13 - 2012.10.17

Language：English   Presentation type：Poster presentation  

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Event date： 2012.9.28 - 2012.9.29

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2012.9.28 - 2012.9.29

Language：Japanese   Presentation type：Oral presentation (invited, special)  

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Event date： 2012.9.28 - 2012.9.29

Language：Japanese   Presentation type：Oral presentation (invited, special)  

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Event date： 2012.9.28 - 2012.9.29

Language：Japanese   Presentation type：Oral presentation (invited, special)  

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Event date： 2012.9.15 - 2012.9.16

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2012.9.15 - 2012.9.16

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.9.15 - 2012.9.16

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2012.7.5 - 2012.7.7

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2012.7.5 - 2012.7.7

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2012.7.5 - 2012.7.7

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2012.7.5 - 2012.7.7

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.7.5 - 2012.7.7

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.7.5 - 2012.7.7

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.6.7 - 2012.6.9

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.6.7 - 2012.6.9

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.6.7 - 2012.6.9

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.6.7 - 2012.6.9

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.6.7 - 2012.6.9

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2012.6.7 - 2012.6.9

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.2.28 - 2012.3.1

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2012.2.4 - 2012.2.8

Language：English   Presentation type：Oral presentation (keynote)  

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Event date： 2008.11.2 - 2008.11.3

Presentation type：Poster presentation  

Venue：沖縄  

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