Authorship：Last author,　Corresponding author   Language：Japanese   Publisher：日本手術医学会  

researchmap

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

researchmap

Authorship：Last author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00540-023-03256-7

researchmap

Other Link： https://link.springer.com/article/10.1007/s00540-023-03256-7/fulltext.html

Authorship：Last author   Language：Japanese   Publisher：(NPO)日本緩和医療学会  

researchmap

Authorship：Last author   Language：Japanese   Publisher：克誠堂出版  

DOI： 10.18916/masui.2023080014

CiNii Books

researchmap

Authorship：Last author   Language：Japanese   Publisher：(株)文光堂  

researchmap

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

BACKGROUND: Cardiopulmonary resuscitation (CPR) may not be sufficient to halt the progression of brain damage. Using extracellular glutamate concentration as a marker for neuronal damage, we quantitatively evaluated the degree of brain damage during resuscitation without return of spontaneous circulation. MATERIALS AND METHODS: Extracellular cerebral glutamate concentration was measured with a microdialysis probe every 2 minutes for 40 minutes after electrical stimulation-induced cardiac arrest without return of spontaneous circulation in Sprague-Dawley rats. The rats were divided into 3 groups (7 per group) according to the treatment received during the 40 minutes observation period: mechanical ventilation without chest compression (group V); mechanical ventilation and chest compression (group VC) and; ventilation, chest compression and brain hypothermia (group VCH). Chest compression (20 min) and hypothermia (40 min) were initiated 6 minutes after the onset of cardiac arrest. RESULTS: Glutamate concentration increased in all groups after cardiac arrest. Although after the onset of chest compression, glutamate concentration showed a significant difference at 2 min and reached the maximum at 6 min (VC group; 284±48 μmol/L vs. V group 398±126 μmol/L, P =0.003), there was no difference toward the end of chest compression (513±61 μmol/L vs. 588±103 μmol/L, P =0.051). In the VCH group, the initial increase in glutamate concentration was suddenly suppressed 2 minutes after the onset of brain hypothermia. CONCLUSIONS: CPR alone reduced the progression of brain damage for a limited period but CPR in combination with brain cooling strongly suppressed increases in glutamate levels.

DOI： 10.1097/ANA.0000000000000838

PubMed

researchmap

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

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

PubMed

researchmap

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

BACKGROUND: This study aimed to determine whether nutritional education, from the preoperative to postoperative period, and nutritional management designed to improve nutritional status alone, could improve patients' health-related self-management and nutritional management skills during the postoperative period. METHODS: We evaluated 101 hospitalised patients with oesophageal cancer who underwent surgery between 2015 and 2016 and received perioperative nutritional education (PERIO-N). The control group included 52 patients who underwent surgery between 2014 and 2015 and were supported only by normal interventions according to the Enhanced Recovery After Surgery protocol. The PERIO-N group paid specific attention to nutrition risk screening, nutrition assessment, nutrition monitoring, and lifestyle education. RESULTS: The patients in the PERIO-N group were 1.8 times more likely to be able to consume food orally than the control group (p=0.010). In the PERIO-N group, 50.5% of the patients could orally consume food, 42.6% received a combination of oral and enteral nutrition, and 6.9% only underwent enteral nutrition. In comparison, in the control group, 28.8% of the patients could orally consume food, 53.8% received a combination of oral and enteral nutrition, and 17.3% were only administered enteral nutrition (p=0.004). In addition, patients in the PERIO-N group were discharged at a 1.5 times higher rate than those in the control group (p=0.027). The readmission rate for malnutrition within 3 months was 4% in the PERIO group (5.4% for home discharge only) and 5.8% in the control group (10.5% for home discharge only) (p=0.61). CONCLUSION: This study found that perioperative nutrition education in patients who underwent oesophageal cancer surgery led to increase in the amount of oral intake at discharge. Moreover, the group that received nutrition education did not have an increased probability of hospitalisation due to the risk of malnutrition within 3 months after discharge.

DOI： 10.31557/APJCP.2023.24.6.2037

PubMed

researchmap

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

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

PubMed

researchmap

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

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

PubMed

researchmap

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

Abstract

Background

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas which commonly arise from neurofibromatosis type 1. Lung metastases of the tumors are well-known, but intraoperative cerebral tumor embolisms of MPNSTs have not been reported in literature.

Case presentation

A 52-year-old female patient with neurofibromatosis type 1 underwent a right lung partial resection for lung tumors. She was extubated after adequate recovery of spontaneous breathing; however, she could not respond to verbal commands. In the intensive care unit, her neurological examination revealed conjugate eye deviation, right hemiparalysis, and aphasia. Magnetic resonance imaging revealed acute cerebral ischemia, so she underwent an endovascular thrombectomy. The histopathological diagnosis of emboli was a MPNST, which was identical with that of the resected lung tumor.

Conclusion

We report the first case of delayed emergence caused by a cerebral tumor embolism of MPNST during partial lung resection.

DOI： 10.1186/s40981-023-00614-y

researchmap

Other Link： https://link.springer.com/article/10.1186/s40981-023-00614-y/fulltext.html

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

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

PubMed

researchmap

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

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science (PLoS)  

Background

Few sepsis biomarkers accurately predict severity and mortality. Previously, we had reported that first-day histidine-rich glycoprotein (HRG) levels were significantly lower in patients with sepsis and were associated with mortality. Since the time trends of HRG are unknown, this study focused on the time course of HRG in patients with sepsis and evaluated the differences between survivors and non-survivors.

Methods

A multicenter prospective observational study was conducted involving 200 patients with sepsis in 16 Japanese hospitals. Blood samples were collected on days 1, 3, 5, and 7, and 28-day mortality was used for survival analysis. Plasma HRG levels were determined using a modified quantitative sandwich enzyme-linked immunosorbent assay.

Results

First-day HRG levels in non-survivors were significantly lower than those in survivors (mean, 15.7 [95% confidence interval (CI), 13.4–18.1] vs 20.7 [19.5–21.9] μg/mL; P = 0.006). Although there was no time × survivors/non-survivors interaction in the time courses of HRG (P = 0.34), the main effect of generalized linear mixed models was significant (P &lt; 0.001). In a univariate Cox proportional hazards model with each variable as a time-dependent covariate, higher HRG levels were significantly associated with a lower risk of mortality (hazard ratio, 0.85 [95% CI, 0.78–0.92]; P &lt; 0.001). Furthermore, presepsin levels (P = 0.02) and Sequential Organ Function Assessment scores (P &lt; 0.001) were significantly associated with mortality. Harrell’s C-index values for the 28-day mortality effect of HRG, presepsin, procalcitonin, and C-reactive protein were 0.72, 0.70, 0.63, and 0.59, respectively.

Conclusions

HRG levels in non-survivors were consistently lower than those in survivors during the first seven days of sepsis. Repeatedly measured HRG levels were significantly associated with mortality. Furthermore, the predictive power of HRG for mortality may be superior to that of other singular biomarkers, including presepsin, procalcitonin, and C-reactive protein.

DOI： 10.1371/journal.pone.0283426

researchmap

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

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

PubMed

researchmap

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

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

PubMed

researchmap

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

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

PubMed

researchmap

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1409210879

researchmap

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

Abstract

Early brain injury after aneurysmal subarachnoid hemorrhage (SAH) worsens the neurological outcome. We hypothesize that a longer duration of depolarization and excessive release of glutamate aggravate neurological outcomes after SAH, and that brain hypothermia can accelerate repolarization and inhibit the excessive release of extracellular glutamate and subsequent neuronal damage. So, we investigated the influence of depolarization time and extracellular glutamate levels on the neurological outcome in the ultra-early phase of SAH using a rat injection model as Experiment 1 and then evaluated the efficacy of brain hypothermia targeting ultra-early brain injury as Experiment 2. Dynamic changes in membrane potentials, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and extracellular glutamate levels were observed within 30 min after SAH. A prolonged duration of depolarization correlated with peak extracellular glutamate levels, and these two factors worsened the neuronal injury. Under brain hypothermia using pharyngeal cooling after SAH, cerebral perfusion pressure in the hypothermia group recovered earlier than that in the normothermia group. Extracellular glutamate levels in the hypothermia group were significantly lower than those in the normothermia group. The early induction of brain hypothermia could facilitate faster recovery of cerebral perfusion pressure, repolarization, and the inhibition of excessive glutamate release, which would prevent ultra-early brain injury following SAH.

DOI： 10.1038/s41598-022-14360-1

researchmap

Other Link： https://www.nature.com/articles/s41598-022-14360-1

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

researchmap

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

researchmap

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

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

DOI： 10.18926/AMO/64037

PubMed

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

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

researchmap

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

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

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

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

researchmap

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

researchmap

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

PubMed

researchmap

Publisher：克誠堂出版(株)  

DOI： 10.18916/j01397.2022245832

researchmap

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

researchmap

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

Liberation from mechanical ventilation is of great importance owing to related complications from extended ventilation time. In this prospective multicenter study, we aimed to construct a versatile model for predicting extubation outcomes in critical care settings using obtainable physiological predictors. The study included patients who had been extubated after a successful 30 min spontaneous breathing trial (SBT). A multivariable logistic regression model was constructed to predict extubation outcomes (successful extubation without reintubation and uneventful extubation without reintubation or noninvasive respiratory support) using eight parameters: age, heart failure, respiratory disease, rapid shallow breathing index (RSBI), PaO2/FIO2, Glasgow Coma Scale score, fluid balance, and endotracheal suctioning episodes. Of 499 patients, 453 (90.8%) and 328 (65.7%) achieved successful and uneventful extubation, respectively. The areas under the curve for successful and uneventful extubation in the novel prediction model were 0.69 (95% confidence interval (CI), 0.62-0.77) and 0.70 (95% CI, 0.65-0.74), respectively, which were significantly higher than those in the conventional model solely using RSBI (0.58 (95% CI, 0.50-0.66) and 0.54 (95% CI, 0.49-0.60), p = 0.004 and &lt;0.001, respectively). The model was validated using a bootstrap method, and an online application was developed for automatic calculation. Our model, which is based on a combination of generally obtainable parameters, established an accessible method for predicting extubation outcomes after a successful SBT.

DOI： 10.3390/jcm11092520

PubMed

researchmap

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

OBJECTIVES: An increasing number of patients visiting the dental office have a growing need for perioperative oral management (POM) to prevent postoperative complications. Therefore, it is necessary to determine which patients should receive preferential POM. This study investigated the dental status of patients scheduled to undergo surgery and addressed the priority for POM. METHODS: This retrospective study included a total of 150 patients who were scheduled to undergo surgery at the Department of Respiratory Surgery (DRS), Department of Neurological Surgery (DNS), Department of Gynecological Surgery (DGS), Department of Breast and Endocrine Surgery (DBES), and Department of Esophageal Surgery (DES) managed by the Perioperative Management Center of Okayama University Hospital. We compared the general and dental status of patients among the five groups. RESULTS: The DES group had significantly fewer teeth than the DBES group (p = 0.012), more severe periodontitis than both the DBES (p = 0.005) and DNS groups (p = 0.020), and poorer molar occlusal support status than both the DBES (p = 0.002) and DGS groups (p = 0.041). The DES group exhibited a significantly higher median age (p = 0.002), a higher ratio of males (p < 0.001), a higher prevalence of malignant tumors (p < 0.001), and higher proportions of smokers (p < 0.001) and drinkers (p < 0.001) than the other groups. CONCLUSION: Patients who underwent surgery at the DES had more dental problems than other surgery patients. Accordingly, these patients should be given the highest priority for POM triage.

DOI： 10.1007/s11748-021-01757-4

PubMed

researchmap

Other Link： https://link.springer.com/article/10.1007/s11748-021-01757-4/fulltext.html

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

The issue of tolerance to continuous or repeated administration of opioids should be addressed. The ability of ketamine to improve opioid tolerance has been reported in clinical studies, and its mechanism of tolerance may involve improved desensitization of μ-opioid receptors (MORs). We measured changes in MOR activity and intracellular signaling induced by repeated fentanyl and morphine administration and investigated the effects of ketamine on these changes with human embryonic kidney 293 cells expressing MOR using the CellKey™, cADDis cyclic adenosine monophosphate, and PathHunter® β-arrestin recruitment assays. Repeated administration of fentanyl or morphine suppressed the second MOR responses. Administration of ketamine before a second application of opioids within clinical concentrations improved acute desensitization and enhanced β-arrestin recruitment elicited by fentanyl but not by morphine. The effects of ketamine on fentanyl were suppressed by co-treatment with an inhibitor of G-protein-coupled receptor kinase (GRK). Ketamine may potentially reduce fentanyl tolerance but not that of morphine through modulation of GRK-mediated pathways, possibly changing the conformational changes of β-arrestin to MOR.

DOI： 10.3390/biom12030426

PubMed

researchmap

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

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

PubMed

researchmap

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

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

PubMed

researchmap

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

DOI： 10.1007/s00540-021-02931-x

researchmap

Other Link： https://link.springer.com/article/10.1007/s00540-021-02931-x/fulltext.html

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

BACKGROUND: Transvenous lead extraction (TLE) is necessary because of system infection, lead malfunction, or system upgrade. Patients with severe left ventricular dysfunction (SLVD) undergoing TLE may be at a higher risk because hemodynamic parameters may change unfavorably during or after TLE; however, this has not yet been clarified. OBJECTIVE: The purpose of this study was to examine whether patients with SLVD undergoing TLE have higher mortality. METHODS: All patients who underwent TLE were stratified as follows: patients with ejection fraction ≤ 35% (SLVD group) and those with ejection fraction > 35% (non-SLVD group). RESULTS: We assessed the data of 200 patients (SLVD group, 36; non-SLVD group, 164). Brain natriuretic peptide level and cardiac resynchronization therapy rate were higher in the SLVD group than in the non-SLVD group. There were no significant between-group differences in major complications and clinical success rates. Patients with SLVD were more likely to require additional hemodynamic support, such as catecholamine infusion, temporary atrial-ventricle sequential pacing, and temporary cardiac resynchronization therapy pacing (27.8% vs 1.2%; P < .001). The survival rate was not significantly different between the groups at 30 days and 1 year after TLE (SLVD vs non-SLVD: 30 days: 97.2% vs 99.4%; P = .215; 1 year: 80.6% vs 91.5%; P = .053). Multivariate Cox regression analysis revealed log brain natriuretic peptide and serum hemoglobin levels as predictors for 1-year mortality. CONCLUSION: The prognosis after TLE was comparable between patients with and without SLVD. However, additional hemodynamic support was often necessary for patients with SLVD.

DOI： 10.1016/j.hrthm.2021.01.026

PubMed

researchmap

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

Various biomarkers have been proposed for sepsis; however, only a few become the standard. We previously reported that plasma histidine-rich glycoprotein (HRG) levels decreased in septic mice, and supplemental infusion of HRG improved survival in mice model of sepsis. Moreover, our previous clinical study demonstrated that HRG levels in septic patients were lower than those in noninfective systemic inflammatory response syndrome patients, and it could be a biomarker for sepsis. In this study, we focused on septic patients and assessed the differences in HRG levels between the non-survivors and survivors. We studied ICU patients newly diagnosed with sepsis. Blood samples were collected within 24 h of ICU admission, and HRG levels were determined using an enzyme-linked immunosorbent assay. Ninety-nine septic patients from 11 institutes in Japan were included. HRG levels were significantly lower in non-survivors (n = 16) than in survivors (n = 83) (median, 15.1 [interquartile ranges, 12.7-16.6] vs. 30.6 [22.1-39.6] µg/ml; p < 0.01). Survival analysis revealed that HRG levels were associated with mortality (hazard ratio 0.79, p < 0.01), and the Harrell C-index (predictive power) for HRG was 0.90. These results suggested that HRG could be a novel prognostic biomarker for sepsis.

DOI： 10.1038/s41598-021-89555-z

PubMed

researchmap

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

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

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J02874&link_issn=&doc_id=20210611380012&doc_link_id=10.3918%2Fjsicm.28_227&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.28_227&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

ミクログリアの遊走は温度により調整されることが示唆されている．これまで，いくつかのイオンチャネルおよびトランスポータが遊走に関与することが知られているが，温度依存性による遊走の制御機構はまだ不明である．本研究は，実験を通じて，マウスのミクログリアがTRPPV4チャネルを介して温度依存性の運動を示すことを示したものである．
ミクログリアの動画像の自動トラッキング手法を開発し，ミクログリアの挙動解析を行った．

DOI： 10.1073/pnas.2012894118

PubMed

researchmap

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

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

DOI： 10.1186/s12871-021-01338-1

PubMed

researchmap

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

PURPOSE: The scheduled administration of intravenous acetaminophen (scheduled-IV-AcA) is one of the more effective multimodal analgesic approaches for postoperative pain in abdominal/orthopedic surgeries. However, there is little evidence concerning scheduled-IV-AcA after general thoracic surgery, especially when limited to video-assisted thoracoscopic surgery (VATS). We investigated the efficacy of scheduled-IV-AcA administration in patients after undergoing VATS. METHODS: Ninety-nine patients who underwent VATS lobectomy or segmentectomy via an 8-cm access window and 1 camera port were retrospectively reviewed by categorizing them into groups either with scheduled-IV-AcA (Group AcA: n = 29) or without it (Group non-AcA: n = 70). Group AcA received 1 g of IV-AcA every 6 h from the end of the operation until the end of POD2. Postoperative pain was measured using a numeric rating scale (NRS) three times per day until discharge. RESULTS: NRS scores were significantly lower in Group AcA with motion (on POD1 to the first point of POD2) than in Group non-AcA. Group non-AcA was also more likely to use additional analgesics than Group AcA (39% vs. 17%, p = 0.058). CONCLUSIONS: Scheduled-IV-AcA administration is a safe and effective multimodal analgesic approach in patients undergoing VATS pulmonary resection via an 8-cm access window.

DOI： 10.1007/s00595-020-02127-y

PubMed

researchmap

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

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

DOI： 10.1186/s40981-021-00419-x

PubMed

researchmap

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

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

PubMed

researchmap

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

researchmap

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

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

PubMed

researchmap

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

researchmap

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

＜文献概要＞岡山大学病院(以下,当院)は,2008年に周術期管理センターperioperative management center(PERIO)を開設し,多職種連携による周術期管理を目指してきた。2018年には10周年を迎え,2020年時点で12年目である。本稿では,これまでのPERIOの歴史を振り返りながら,これからの周術期管理について考えてみたい。

researchmap

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

researchmap

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

researchmap

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

researchmap

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

＜POINT＞頭蓋内病変を有している症例での血液浄化療法は、▼不均衡症候群に伴う脳浮腫増悪、血圧低下に伴う脳灌流圧低下、抗凝固薬使用に伴う出血増悪などのリスクが高く、頭蓋内圧(intracranial pressure:ICP)上昇をひき起こす危険性が高い。▼血流量と浄化量をゆっくりと、生体適合性に優れた表面積の小さい浄化膜を用い、重炭酸濃度を抑え、ナトリウム濃度を高くした透析液の使用などを考慮する。▼continuous renal replacement therapy(CRRT)のほうが、intermittent renal replacement therapy(IRRT)より推奨される。▼IRRTを選択する場合は血液濾過(hemofiltraion:HF)やsustained low efficiency dialysis(SLED)を検討する。▼抗凝固薬の選択や浸透圧療法の併用を考慮する。(著者抄録)

researchmap

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

PURPOSE: Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE. METHODS: This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications. RESULTS: In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001). CONCLUSIONS: In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.

DOI： 10.1007/s00540-020-02766-y

PubMed

researchmap

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

症例は49歳,女性.肺リンパ脈管筋腫症に対して脳死両肺移植が予定された.麻酔導入後にセフォチアムを投与したところ,突然換気困難となり,同時に肺動脈圧の上昇を認めた.アナフィラキシーによる気管支痙攣を疑いアドレナリンを投与すると,換気は改善し肺動脈圧も低下した.全身麻酔中のアナフィラキシーは皮膚症状,循環症状,呼吸症状を認めることが多いが,肺動脈圧の変化については知られていない.動物実験ではアナフィラキシー発症時の肺血管抵抗の上昇,肺高血圧が報告されているが,ヒトでの報告はこれまでにほとんどない.本症例では,アナフィラキシーによる気管支痙攣時に,急激に肺高血圧を呈している可能性が示唆された.(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01620&link_issn=&doc_id=20200529370003&doc_link_id=10.2199%2Fjjsca.40.221&url=https%3A%2F%2Fdoi.org%2F10.2199%2Fjjsca.40.221&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

PubMed

researchmap

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

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

PubMed

researchmap

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

Few reports of liver transplantation exist in patients with congenital absence of the portal vein and pulmonary hypertension. Living donor liver transplantation is usually performed before exacerbation of pulmonary hypertension. A 7-year-old girl (height: 131.5 cm; weight: 27.4 kg) with congenital absence of the portal vein was diagnosed with pulmonary hypertension (mean pulmonary artery pressure 35 mm Hg), and liver transplantation was planned before exacerbation of pulmonary hypertension. We successfully managed her hemodynamic parameters using low-dose dopamine and noradrenaline under monitoring of arterial blood pressure, central venous pressure, cardiac output, and stroke volume variation. Anesthesia was maintained using air-oxygen-sevoflurane and remifentanil 0.1 to 0.6 μg∙kg-1∙min-1. It is necessary to understand the potential perioperative complications in such cases and to adopt a multidisciplinary team approach in terms of the timing of transplantation and readiness to deal with exacerbation of pulmonary hypertension.

DOI： 10.1016/j.transproceed.2019.11.032

PubMed

researchmap

Language：Japanese   Publisher：スパズム・シンポジウム事務局  

researchmap

Language：Japanese   Publisher：日本老年麻酔学会  

researchmap

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

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

PubMed

researchmap

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

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

PubMed

researchmap

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

BACKGROUND: Sodium-channel myotonia (SCM) is a nondystrophic myotonia, characterized by pure myotonia without muscle weakness or paramyotonia. The prevalence of skeletal muscle channelopathies is approximately 1 in 100,000, and the prevalence of SCM is much lower. To our knowledge, this is the first report on anesthetic management of a patient with SCM. CASE PRESENTATION: A 23-year-old woman with congenital nasal dysplasia and SCM was scheduled to undergo rhinoplasty with autologous costal cartilage. Total intravenous anesthesia without muscle relaxants was administered followed by continuous intercostal nerve block. Although transient elevation of potassium level in the blood was observed during surgery, the patient did not show exacerbation of myotonic or paralytic symptoms in the postoperative period. CONCLUSION: Total intravenous anesthesia and peripheral nerve block can be administered safely to a patient with SCM. However, careful monitoring of the symptoms and electrolytes is recommended.

DOI： 10.1186/s40981-019-0300-8

PubMed

researchmap

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)

researchmap

Language：Japanese   Publisher：(一社)日本脳循環代謝学会  

researchmap

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

PURPOSE: Epidural analgesia (EDA) is an imperative modality for postoperative pain relief after major open abdominal surgery. However, whether EDA has benefits in laparoscopic surgery has not been clear. In this study, the effects of EDA and patient-controlled intravenous analgesia (PCIA) after laparoscopic distal gastrectomy (LDG) were compared. METHODS: This was a retrospective study that included 82 patients undergoing LDG for gastric cancer. Patients received either EDA (n=67) or PCIA (n=15) for postoperative pain relief. Postoperative outcomes and analgesia-related adverse events were compared between the two modalities. RESULTS: EDA and PCIA patients showed no differences in the incidence of complications [9 (13%) vs. 2 (13%); P=0.99] and the length of postoperative hospital stay (9.6±4.5 d vs. 9.7±4.0 d; P=0.90), although the PCIA included poorer preoperative physical status (PS) patients. The number of additional doses of analgesics was higher in the EDA than in the PCIA (1.8±2.4 vs. 0.9±1.0; P=0.01), although postoperative pain scores were similar in the 2 groups. Though the time to first passage of flatus was shorter in the EDA (P<0.05), more EDA patients developed postoperative hypotension as an adverse event (P<0.01). The full mobilization day and the day of oral intake tolerance were not significantly different between the 2 groups after surgery. CONCLUSIONS: After LDG, EDA may not be indispensable, while PCIA may be the optimal modality for providing safe and effective postoperative analgesia and recovery.

DOI： 10.1097/SLE.0000000000000605

PubMed

researchmap

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

researchmap

Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

電気けいれん療法(ECT)は、統合失調症患者においても緊張病状態や薬物治療抵抗例に対して考慮される重要な治療法である。ECTにおいて本邦で頻用される麻酔薬のpropofolは、強い抗けいれん作用を有するため、高い発作閾値が問題になるケースでは麻酔に工夫を要する。発作閾値上昇効果がないとされるketamineへの切り替え、または併用によるpropofolの減量は有効な方法の1つで、うつ病患者では抗うつ効果の増強も期待したketamineによるECTの報告が多い。一方でketamineは、その作用機序から統合失調症の精神症状を悪化させる懸念もある。今回、高い発作閾値が問題化したが、ketamineの併用によりpropofolを減量したECTで有効な発作が得られ、精神病症状の悪化を認めることなく有効かつ安全に治療し得た統合失調症の2例を経験したため報告する。(著者抄録)

researchmap

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

BACKGROUND AND AIMS: Postoperative hypoalbuminemia, especially following liver transplantation, can lead to adverse multisystem effects and even death. We investigated the relationship between postoperative albumin levels and organ failure (assessed using Sequential Organ Failure Assessment [SOFA] scores). METHODS: Sixty liver transplant recipients admitted to the intensive care unit (ICU) from 2012 to 2015 were retrospectively divided into 2 groups: lower albumin (LA) (n=28) and higher albumin (HA) (n=32), using whether serum albumin level fell below 3.0 g/dL during the first postoperative week as the stratifying factor. The SOFA scores (primary endpoint) and associated complications (ascites amount, rejection, re-intubation, abdominal re-operation, thrombosis), additional treatment (dialysis, pleural effusion drainage), and duration of ICU stay (secondary endpoints) of the 2 groups were compared. RESULTS: Average serum albumin levels were significantly different between HA and LA groups (3.6 [3.4-3.8] vs 3.1 [2.9-3.3], respectively, P<.05), although the amounts of albumin infused in the 2 groups during the first postoperative week were not different (HA vs LA: 42 [30-71] vs 40 [30-58], respectively, P=.37). Mean daily SOFA scores were not significantly different between the HA and LA groups (8.3 [6.6-9.0] vs 7.2 [6.3-8.6], P=.73), although the HA group had lower mean cardiovascular SOFA sub-scores than the LA group (0.1 [0-0.4] vs 0.4 [0-1.3], P=.032). There were no significant differences between the groups with regard to complication rates and duration of ICU and hospital stays. CONCLUSIONS: Serum albumin level might not influence cumulative organ function, but it decreases the amount of hemodynamic support required in liver transplant recipients.

DOI： 10.1016/j.transproceed.2019.01.199

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

電気けいれん療法(ECT)は、統合失調症患者においても緊張病状態や薬物治療抵抗例に対して考慮される重要な治療法である。ECTにおいて本邦で頻用される麻酔薬のpropofolは、強い抗けいれん作用を有するため、高い発作閾値が問題になるケースでは麻酔に工夫を要する。発作閾値上昇効果がないとされるketamineへの切り替え、または併用によるpropofolの減量は有効な方法の1つで、うつ病患者では抗うつ効果の増強も期待したketamineによるECTの報告が多い。一方でketamineは、その作用機序から統合失調症の精神症状を悪化させる懸念もある。今回、高い発作閾値が問題化したが、ketamineの併用によりpropofolを減量したECTで有効な発作が得られ、精神病症状の悪化を認めることなく有効かつ安全に治療し得た統合失調症の2例を経験したため報告する。(著者抄録)

researchmap

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

researchmap

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

researchmap

Language：Japanese   Publisher：日本蘇生学会  

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J01761&link_issn=&doc_id=20191106220062&doc_link_id=%2Fcg9sosei%2F2019%2F003803%2F069%2F0193-0193%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcg9sosei%2F2019%2F003803%2F069%2F0193-0193%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

researchmap

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

researchmap

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

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

PubMed

researchmap

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

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

P45 著者名

正：塩路 直弘，岩崎 達雄，清水 一好，金澤 伴幸，川瀬 宏和，木村 聡

黒江 泰利，佐藤 明，森松 博史，大月 審一，笠原 真悟

誤：塩路 直弘，岩崎 達雄，清水 一好，金澤 伴幸，川瀬 宏和，木村 聡

黒江 泰利，佐藤 明，森松 博史，大月 審一，笠原 慎吾

DOI： 10.11478/jscva.2018-9-001

CiNii Article

researchmap

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

Background: The increase in the use of cardiac implantable electronic devices (CIEDs) has been associated with an increase in CIED-related infections. Transvenous lead extraction is safe and effective for patients with CIED-related infections; however, the mortality rate in these patients is high. The prognosis after transvenous lead extraction in Japanese patients, especially those with lead-related infective endocarditis, has not been evaluated. Then, the purpose of this study is to clarify the prognosis after transvenous lead extraction in Japanese patients with CIED-related infections at a single Japanese center. Methods: A total of 107 patients who underwent transvenous lead extraction were retrospectively reviewed. The patients were divided into a lead-related infective endocarditis group (n = 32) and a pocket infection group (n = 75). Procedure success rate and prognosis after lead extraction were evaluated between the two groups. Results: Procedure success rate was not significantly different between the groups. There were no deaths associated with the procedure or with infection. The survival rate was not significantly different at 1 year or at a median of 816 days (lead-related infective endocarditis vs pocket infection; 93.7% vs 94.7%, P = 1.000; 78.1% vs 81.3%, P = 0.791) Time to reimplantation and duration of hospital stay and antibiotics therapy were significantly longer for patients with lead-related infective endocarditis. Conclusion: In this study, the prognosis for patients with lead-related infective endocarditis after transvenous lead extraction was favorable. Thus, extraction should be strongly recommended, even if the general condition of the patient is poor.

DOI： 10.1002/joa3.12164

PubMed

researchmap

Language：Japanese   Publisher：日本歯科衛生学会  

researchmap

Language：Japanese   Publisher：日本歯科衛生学会  

researchmap

Language：Japanese   Publisher：日本歯科衛生学会  

researchmap

Language：Japanese   Publisher：日本歯科衛生学会  

researchmap

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

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

researchmap

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

Morphine, fentanyl, and oxycodone are widely used as analgesics, and recently hydromorphone has been approved in Japan. Although all of these are selective for μ-opioid receptors (MORs) and have similar structures, their analgesic potencies and adverse effects (AEs) are diverse. Recent molecular analyses of MOR signaling revealed that the G protein-mediated signaling pathway causes analgesic effects and the β-arrestin-mediated signaling pathway is responsible for AEs. We used several cell-based analyses that selectively measure cellular responses activated by either G protein- or β-arrestin-mediated pathways. GloSensor™ cAMP, CellKey™, and receptor internalization assays were performed with four different types of cells stably expressing differentially labelled MOR. EC50 values measured by cAMP and CellKey™ assays had potencies in the order fentanyl ≤ hydromorphone < morphine ≤ oxycodone, all also exhibiting full agonist responses. However, in the internalization assay, only fentanyl elicited a full agonist response. Hydromorphone had the strongest potency next to fentanyl; however, contribution of the β-arrestin-mediated pathway was small, suggesting that its effect could be biased toward the G protein-mediated pathway. Based on these properties, hydromorphone could be chosen as an effective analgesic.

DOI： 10.1016/j.jphs.2019.06.005

PubMed

researchmap

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

Purpose of Review: Recently, multidisciplinary strategies on accelerated recovery postoperatively have been provided, and management of the perioperative period has changed and improved dramatically. We summarize the enhanced recovery after surgery (ERAS®) protocol and its outcomes from a nutritional perspective. We established the perioperative management center (PERiO), much of whose work contents conform to ERAS®, but intensive dental staff involvement is characteristic. We also summarize its outcomes. Recent Findings: ERAS® is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. Nutrition is a key pillar for patient care. Throughout the perioperative period, oral nutrition is suggested as well as possible. Good outcomes have been reported by a meta-analysis of randomized controlled trials. However, the dental staff are not regarded as part of the professional team. PERiO reported good outcomes of care bundles and suggested the importance of dental staff contribution. The Japanese social insurance system began to cover involvements of the dental staff for perioperative oral management since 2012. Analysis of the nationwide administrative claims database in Japan concluded that preoperative oral care by a dentist significantly reduced postoperative complications in patients undergoing cancer surgery. Summary: Currently, the dental staff are not regarded as key professionals of ERAS®, although the dental staff can contribute to good outcomes in the perioperative period and PERiO, and consequently, the Japanese universal health insurance coverage system covering involvements of the dental staff for perioperative oral management showed good outcomes. Therefore, further clinical studies involving dental specialty should be considered important for perioperative management from nutritional perspectives.

DOI： 10.1007/s40496-019-0217-3

Scopus

researchmap

DOI： 10.18926/AMO/56650

PubMed

researchmap

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

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

researchmap

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

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

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

PubMed

researchmap

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

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

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01620&link_issn=&doc_id=20190123360004&doc_link_id=130007592686&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007592686&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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

DOI： 10.2139/ssrn.3437790

researchmap

DOI： 10.1007/s12185-018-2536-x

PubMed

researchmap

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。

researchmap

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

researchmap

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

researchmap

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

researchmap

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

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

DOI： 10.18926/AMO/56244

PubMed

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

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

DOI： 10.11478/jscva.2018-1-004

CiNii Article

CiNii Books

researchmap

Other Link： https://search.jamas.or.jp/link/ui/2019006587

DOI： 10.18926/AMO/56169

PubMed

researchmap

DOI： 10.2334/josnusd.17-0381

PubMed

researchmap

Language：Japanese   Publisher：日本歯科衛生学会  

researchmap

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

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

PubMed

researchmap

DOI： 10.1097/ALN.0000000000002181

PubMed

researchmap

Language：Japanese   Publisher：日本脳低温療法・体温管理学会  

researchmap

Language：Japanese   Publisher：日本神経麻酔集中治療学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). Methods: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG
n=34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2&lt
80 mmHg and an alveolar-arterial oxygen gradient (AaDO2)≥15 mmHg were categorized as potentially having HPS (subclinical HPS
n=29). The clinical course after LDLT was investigated according to subclinical high TRPG. Results: A subclinical high TRPG (p=0.012) and older donor age (p=0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. Conclusion: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

DOI： 10.1186/s12876-018-0793-z

Scopus

PubMed

researchmap

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

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01397&link_issn=&doc_id=20180509180007&doc_link_id=%2Fad3msuie%2F2018%2F006705%2F009%2F0511-0517%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2018%2F006705%2F009%2F0511-0517%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

DOI： 10.1097/CCM.0000000000002947

PubMed

researchmap

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

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

researchmap

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

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

researchmap

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   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)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=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

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

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

researchmap

DOI： 10.18926/AMO/55671

PubMed

researchmap

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

researchmap

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

researchmap

Language：Japanese   Publisher：スパズム・シンポジウム事務局  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Association of Neurological Surgeons  

OBJECTIVE Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH. METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites. RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 ± 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P50) was estimated to be 22.4 minutes (95% confdence intervals 17.0-30.3 minutes). CSD was observed in 3 rats at 6 sites in the Type 1 group 5.1 ± 2.2 minutes after initiation of SAH. On NADH?uorescence images CSD was initially observed in the anterior cortex∗it propagated through the entire hemisphere in the direction of the occipital cortex at a rate of 3 mm/minute, with repolarization in 2.3 ± 1.2 minutes. DC potential recording sites that had undergone CSD were found to have intact tissue 24 hours later. Compared with depolarization that caused 50% neuronal damage, the duration of CSD was too short to cause histological damage. CONCLUSIONS CSD was successfully visualized using NADH?uorescence. It propagated from the anterior to the posterior cortex along with an increase in CBF. The duration of depolarization in CSD (2.3 ± 1.2 minutes) was far shorter than that causing 50% neuronal damage (22.4 minutes) and was not associated with histological damage in the current experimental setting.

DOI： 10.3171/2016.9.JNS161385

Scopus

PubMed

researchmap

DOI： 10.1016/j.clnu.2018.01.002

PubMed

researchmap

Language：English  

Sepsis remains a critical problem with high morbidity and mortality worldwide. One of the problems we have in critical care is the need to find a good biomarker of sepsis to determine the existence of bacterial infection and the severity of patients. This would enable us to start appropriate treatment at an earlier stage of the disease course. We propose that decreases in the plasma protein histidine-rich glycoprotein (HRG) is an excellent biomarker of sepsis compared with the current markers. Based on the novel pathophysiological roles of HRG in the cascade of events during sepsis, we also discuss the potential for supplemental therapy with purified HRG.

DOI： 10.1186/s13054-018-2127-5

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

Scopus

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Open Access Text Pvt, Ltd.  

DOI： 10.15761/pccm.1000148

researchmap

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

DOI： 10.2199/jjsca.38.142

researchmap

Language：Japanese   Publisher：日本蘇生学会  

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01761&link_issn=&doc_id=20171204210031&doc_link_id=%2Fcg9sosei%2F2017%2F003603%2F035%2F0161-0161%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcg9sosei%2F2017%2F003603%2F035%2F0161-0161%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  

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

Language：Japanese   Publisher：日本歯科衛生学会  

researchmap

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

researchmap

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)

researchmap

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

Language：Japanese   Publisher：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)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=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  

researchmap

Language：Japanese   Publisher：スパズム・シンポジウム事務局  

researchmap

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

A 35-year-old pregnant woman was referred to our hospital with suspected acute pancreatitis at 39 weeks of gestation. On admission, serum triglyceride (TG) level was 11,936 mg/dl and abdominal dynamic CT revealed severe acute pancreatitis. In order to avoid further progression of hypertriglyceridemia and acute pancreatitis, a cesarean section was performed. We then performed low density lipoprotein (LDL) apheresis for the hypertriglyceridemia with consideration of safety. After three cycles of LDL apheresis, serum TG level declined to 1,764 mg/dl. On the 15th day of hospitalization, she was discharged from our hospital without any complications. Treatment of hypertriglyceridemia, including plasma apheresis and heparin-insulin therapy, is important in addition to treatment of acute pancreatitis to reduce the risk of exacerbation of acute pancreatitis in hypertriglyceridemia-induced acute pancreatitis (HIAP). LDL apheresis would be safer than plasma exchange in terms of electrolyte disturbance and transfusion-related complication. LDL apheresis might be effective for patients with HIAP.

DOI： 10.3918/jsicm.24_26

CiNii Article

researchmap

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。

researchmap

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

DOI： 10.18926/AMO/54809

CiNii Article

CiNii Books

researchmap

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

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

researchmap

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

researchmap

Language：Japanese   Publisher：(株)医学書院  

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

researchmap

Language：Japanese   Publisher：日本蘇生学会  

researchmap

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

researchmap

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

researchmap

Language：Japanese   Publisher：日本歯科衛生学会  

researchmap

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)

researchmap

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

Language：Japanese   Publisher：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)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=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：(一社)日本集中治療医学会  

researchmap

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

DOI： 10.1097/01.ccm.0000508918.45752.7a

researchmap

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

Background The aim of this study was to investigate the changes in oxygen consumption during liver transplantation and to examine the relationship between intraoperatively elevated systemic oxygen consumption and postoperative liver function. Methods This study was performed in 33 adult patients undergoing liver transplantation between September 2011 and March 2014. We measured intraoperative oxygen consumption through the use of indirect calorimetry, preoperative and intraoperative data, liver function tests, and postoperative complications and outcomes. Results The mean age of patients was 52 ± 9.7 years
14 (42%) of them were women. Average Model for End-Stage Liver Disease scores were 20 ± 8.9. Oxygen consumption significantly increased after reperfusion from 172 ± 30 mL/min during the anhepatic phase to 209 ± 30 mL/min (P &lt
.0001). We divided patients into 2 groups according to the increase in oxygen consumption after reperfusion (oxygen consumption after reperfusion minus anhepatic phase oxygen consumption: 40 mL/min increase as cutoff). The higher consumption group had a longer cold ischemia time and higher postoperative aspartate aminotransferase and alanine aminotransferase levels as compared with the lower oxygen consumption group. There were no statistically significant differences in major postoperative complications, but the higher oxygen consumption group tended to have shorter hospital stays than the lower consumption group (58 versus 95 days). Conclusions We have demonstrated that oxygen consumption significantly increased after reperfusion. Furthermore, this increased oxygen consumption was associated with a longer cold ischemia time and shorter hospital stays.

DOI： 10.1016/j.transproceed.2015.10.057

Scopus

PubMed

researchmap

DOI： 10.1007/s10157-015-1092-4

PubMed

researchmap

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

researchmap

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

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

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

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01620&link_issn=&doc_id=20151126250004&doc_link_id=%2Fci4jjsca%2F2015%2F003507%2F004%2F0715-0718%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2015%2F003507%2F004%2F0715-0718%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  

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

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01620&link_issn=&doc_id=20151126250003&doc_link_id=%2Fci4jjsca%2F2015%2F003507%2F003%2F0711-0714%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2015%2F003507%2F003%2F0711-0714%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

Recent studies showed that the administration of dexmedetomidine relieved hyperalgesia in the presence of neuropathic pain. These findings have led to the hypothesis that the local administration of dexmedetomidine is useful for relieving acute inflammatory nociception, such as postoperative pain. Thus, we evaluated the inhibitory effect of locally injected dexmedetomidine on acute inflammatory nociception. Acute inflammatory nociception was induced by an intraplantar injection of 1% carrageenan into the hindpaws of rats, and dexmedetomidine was also injected combined with carrageenan. The paw withdrawal threshold based on von Frey filament stimulation was measured until 12 h after injection. We compared the area under the Lime-curve (AUC) between carrageenan and carrageenan with dexmedetomidine. To clarify that the action of dexmedetomidine was via alpha(2)-adrenoceptors, we evaluated the effect of yohimbine, a selective antagonist of alpha(2)-adrenoceptors, on the anti-nociception of dexmedetomidine. As the results, the intraplantar injection of carrageenan with over 10 mu M dexmedetomidine significantly increased AUC, compared to that with only carrageenan injection. This effect of dexmedetomidine was reversed by the addition of yohimbine to carrageenan and dexmedetomidine. These results demonstrated that the locally injected dexmedetomidine was effective against carrageenan-induced inflammatory nociception via alpha(2)-adrenoceptors. The findings suggest that the local injection of dexmedetomidine is useful for relieving local acute inflammatory nociception. (C) 2015 Elsevier B.V. All rights reserved,

DOI： 10.1016/j.ejphar.2015.06.054

Web of Science

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=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：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01126&link_issn=&doc_id=20150413210006&doc_link_id=40020429139&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40020429139&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：スパズム・シンポジウム事務局  

researchmap

Language：Japanese   Publisher：スパズム・シンポジウム事務局  

researchmap

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

researchmap

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

researchmap

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

researchmap

DOI： 10.1007/s00540-014-1939-y

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本脳循環代謝学会  

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

Language：Japanese   Publisher：(NPO)日本食道学会  

researchmap

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

researchmap

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

researchmap

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

researchmap

DOI： 10.1186/cc14026

Scopus

researchmap

Other Link： http://orcid.org/0000-0001-9444-9746

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

Acoustic respiratory rate (RRa) monitoring has been validated for patients after general anesthesia and has been shown to be a useful technique. However, its feasibility in patients with a tracheostomy has not been assessed yet. Successful monitoring of RRa in a patient with a tracheostomy is described in this case report. A 56-year-old male patient was scheduled for cranioplasty after severe subarachnoidal hemorrhage under general anesthesia. A tracheostomy tube had been placed in the patient because of airway obstruction and altered spontaneous breathing. The acoustic sensor was placed at the usual position and RRa was successfully monitored by Rad 87® (Masimo Corp., Irvine). Statistical analysis was made for comparison of respiratory rate determined by RRa monitoring with respiratory rate visually counted by intensive care nurses. There was no statistically significant difference between the two respiratory rates (P=0.82). RRa monitoring is useful even in patients with a tracheostomy.

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本脳循環代謝学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

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

Scopus

PubMed

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

Web of Science

researchmap

DOI： 10.3892/mmr_00000075

PubMed

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

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

researchmap

Publisher：3  

PubMed

researchmap

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

researchmap

Publisher：6  

PubMed

researchmap

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

researchmap

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

researchmap

researchmap

researchmap

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院薬剤師会  

患者の周術期quality of life向上のため、適切な術後疼痛管理が必要である。そのため、岡山大学病院(以下、当院)では術後に自己調節鎮痛法(patient controlled analgesia:以下、PCA)を使用する患者に対し、術後疼痛ラウンドを行っている。しかしながら、当院で実務実習を行った全実習生がPCAを使用した術後疼痛管理を経験できていなかった。そこで、今回実務実習の一環として「術後疼痛管理実習プログラム」を立案し、実習内容の均一化を試みた。病棟実習での疼痛ラウンド経験にかかわらず、実習生の理解度の上昇が認められた。また、薬剤師の術後疼痛へのかかわりについて高い理解が得られた。「術後疼痛管理実習プログラム」の導入は、すべての実習生が周術期のチーム医療における薬剤師の役割および術後疼痛管理への理解を深めるために有用であると考えられる。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J04451&link_issn=&doc_id=20211108270012&doc_link_id=%2Fdg4hppha%2F2021%2F005711%2F012%2F1237-1242%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg4hppha%2F2021%2F005711%2F012%2F1237-1242%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  

researchmap

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

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

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

researchmap

Language：Japanese   Publisher：日総研出版  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

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

researchmap

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

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02927&link_issn=&doc_id=20190410180005&doc_link_id=10.11477%2Fmf.3101201348&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.3101201348&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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

researchmap

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

researchmap

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

researchmap

Language：English   Publisher：BioMed Central Ltd.  

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

Scopus

researchmap

Language：Japanese   Publisher：(株)ジェフコーポレーション  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：English   Publisher：OKAYAMA UNIV MED SCHOOL  

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.

Web of Science

researchmap

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

researchmap

Language：Japanese   Publisher：日本プランニングセンター  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2017318909

Language：English   Publisher：PUBLIC LIBRARY SCIENCE  

Free heme, a pro-oxidant released from myoglobin, is thought to contribute to the pathogenesis of rhabdomyolysis-associated acute kidney injury (RM-AKI), because renal overexpression of heme oxygenase-1 (HO-1), the rate-limiting enzyme in heme catabolism, confers protection against RM-AKI. BTB and CNC homology 1 (Bach1) is a heme-responsive transcription factor that represses HO-1. Here, we examined the changes with time in the gene expression of Bach1, HO-1, and d-aminolevulinate synthase (ALAS1, a heme biosynthetic enzyme) in the rat kidney using an RM-AKI model induced by the injection of 50% glycerol (10 mL/kg body weight) into bilateral limbs. We also examined the protein expression of Bach1 in the nucleus and cytosol, and HO-1 in the rat kidney. Glycerol treatment induced significant elevation of serum creatinine kinase and aspartate aminotransferase levels followed by the marked elevation of serum blood urea nitrogen and creatinine levels, which caused serious damage to renal tubules. Following glycerol treatment, HO-1 mRNA and protein levels were significantly up-regulated, while ALAS1 mRNA expression was down-regulated, suggesting an increase in the free renal heme concentration. The Bach1 mRNA level was drastically increased 3 h after glycerol treatment, and the increased level was maintained for 12 h. Nuclear Bach1 protein levels were significantly decreased 3 h after treatment. Conversely, cytosolic Bach1 protein levels abruptly increased after 6 h. In conclusion, we demonstrate the dynamic changes in Bach1 expression in a rat model of RM-AKI. Our findings suggest that the increase in Bach1 mRNA and cytosolic Bach1 protein expression may reflect de novo Bach1 protein synthesis to compensate for the depletion of nuclear Bach1 protein caused by the induction of HO-1 by free heme.

DOI： 10.1371/journal.pone.0180934

Web of Science

researchmap

Language：English   Publisher：BioMed Central Ltd.  

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

Scopus

researchmap

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

Web of Science

researchmap

Language：Japanese   Publisher：医学図書出版  

CiNii Article

CiNii Books

researchmap

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

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

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 (BNPpoDi) 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 &gt; 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. (C) 2017 Elsevier Inc. All rights reserved.

DOI： 10.1053/j.jvca.2016.09.008

Web of Science

researchmap

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

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

researchmap

Language：English   Publisher：JAPANESE CIRCULATION SOC  

Background: Patients with pulmonary arterial hypertension (PAH) are currently treated with combination therapy of PAH-targeted drugs. Reverse right ventricular (RV) remodeling after lung transplantation (LTx) in patients with end-stage PAH despite combination therapy of PAH-targeted drugs has not been fully elucidated.
Methods and Results: A total of 136 patients, including 32 with PAH, underwent LTx from 1998 to 2014. We enrolled 12 consecutive patients with PAH treated with combination therapy of PAH-targeted drugs who underwent LTx and retrospectively analyzed the temporal and serial changes in hemodynamics and echocardiography before LTx and at 3 and 12 months after LTx. Before LTx, the RV was markedly dilated with substantially reduced RV fractional area change (RVFAC). At 3 months after LTx, pulmonary artery pressure, pulmonary vascular resistance and RV stroke work index were significantly decreased, while left ventricular stroke work index was increased. RV size assessed by echocardiography also significantly decreased and RVFAC improved. At 12 months after LTx, RVFAC was further increased and RV wall thickness was decreased significantly.
Conclusions: Although severe RV dysfunction and dilation were observed in patients with end-stage PAH despite combination therapy of PAH-targeted drugs, RV function and morphology were improved after reduction of RV pressure load by LTx.

DOI： 10.1253/circj.CJ-16-0838

Web of Science

researchmap

Language：Japanese   Publisher：医学図書出版  

CiNii Article

CiNii Books

researchmap

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

Language：English  

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

PubMed

researchmap

J-GLOBAL

researchmap

Language：English   Publisher：OKAYAMA UNIV MED SCHOOL  

A 32-year-old woman, pregnant with twins, presented with a chief complaint of general fatigue. Her general condition had rapidly deteriorated since her last visit to the primary obstetrician; the patient was then referred to our hospital because of suspected fetal death. She underwent emergency cesarean section because fetal death had indeed occurred, and she was then admitted to the intensive care unit (ICU). On ICI: admission, she was found to he in shock. Laboratory analysis revealed extreme hemoconcentration and a low albumin level, and initially, septic shock with obstetric complications was suspected. However, because she did not respond to conventional therapy but instead, rapidly developed severe generalized edema, systemic capillary leak syndrome (SCLS) was diagnosed. The patient remained in shock for several days until undergoing plasma exchange (PE), despite some earlier empirical treatments. She eventually recovered from profound shock status and was discharged from the ICU without sequelae. Among potentially effective treatments, PE seemed to be the most reasonable choice for the treatment of her SCLS.

DOI： 10.18926/AMO/54814

Web of Science

researchmap

Language：English   Publisher：OKAYAMA UNIV MED SCHOOL  

Postoperative cognitive dysfunction (POCD) occurs in nearly one-third of patients after non-cardiac surgery. Many animal behavior studies have investigated the effect of general anesthesia on cognitive function. However, there have been no studies examining the effects on working memory specifically, with a focus on the retention of working memory. We demonstrate here that isoflurane anesthesia induces deficits in the retention of spatial working memory in rats, as revealed by an increase in isoflurane-induced across-phase errors in the delayed spatial win-shift (SWSh) task with a 30-min delay in an 8-arm radial arm maze on post-anesthesia days (PADs) 1,2,4, and 10. A post-hoc analysis revealed a significant increase in across-phase errors on PAD 1 and recovery on PAD 10 in the isoflurane group. In contrast, within-phase errors independent of the retention of working memory were unaffected by isoflurane. These results demonstrate that isoflurane anesthesia transiently impairs the retention of spatial working memory in rats.

DOI： 10.18926/AMO/54808

Web of Science

researchmap

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

Web of Science

researchmap

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

Web of Science

researchmap

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

Web of Science

researchmap

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

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016359621

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

Web of Science

researchmap

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

Web of Science

researchmap

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

Web of Science

researchmap

researchmap

Language：English   Publisher：JAPAN NEUROSURGICAL SOC  

Perioperative management is critical for positive neurosurgical outcomes. In order to maintain safe and authentic perioperative management, a perioperative management center (PERIO) was introduced to patients of our Neurosurgery Department beginning in June 2014. PERIO involves a multidisciplinary team consisting of anesthesiologists, dentists/dental hygienists/technicians, nurses, physical therapists, pharmacists, and nutritionists. After neurosurgeons decide on the course of surgery, a preoperative evaluation consisting of blood sampling, electrocardiogram, chest X-ray, and lung function test was performed. The patients then visited the PERIO clinic 7-14 days before surgery. One or two days before surgery, the patients without particular issues enter the hospital and receive a mouth cleaning one day before surgery. After surgery, postoperative support involving eating/swallowing evaluation, rehabilitation, and pain control is provided. The differences in duration from admission to surgery, cancellation of surgery, and postoperative complications between PERIO and non-PERIO groups were examined. Eighty-five patients were enrolled in the PERIO group and 131 patients in the non-PERIO group. The duration from admission to surgery was significantly decreased in the PERIO group (3.6 +/- 0.3 days), compared to that in the non-PERIO group (4.7 +/- 0.2 days). There was one cancelled surgery in the PERIO group and six in the non-PERIO group. Postoperative complications and the overall hospital stay did not differ between the two groups. The PERIO system decreased the duration from admission to surgery, and it is useful in providing high-quality medical service, although the system should be improved so as not to increase the burden on medical staff.

DOI： 10.2176/nmc.oa.2016-0085

Web of Science

researchmap

J-GLOBAL

researchmap

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

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016308707

J-GLOBAL

researchmap

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016243341

DOI： 10.1016/j.ebiom.2016.06.003

researchmap

J-GLOBAL

researchmap

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

Web of Science

researchmap

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

researchmap

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

researchmap

Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Objectives: To evaluate the cerebral blood flow thresholds for membrane depolarization and repolarization and the effect of brain hypothermia on the cerebral blood flow threshold for membrane repolarization.
Design: Prospective animal study.
Setting: Experimental laboratory in a university hospital.
Subjects: Male Sprague-Dawley rats (n = 40).
Interventions: Cerebral blood flow and membrane depolarization and repolarization in the cerebral cortex were simultaneously monitored by laser Doppler and extracellular potential, respectively. Following bilateral occlusion of the common carotid arteries, cerebral blood flow was decreased by draining blood at a rate of 2.5% of the control level/min until membrane depolarization was initiated. At 5 and 10 minutes (Normothermia 5 and Normothermia 10 groups, respectively) after depolarization onset, cerebral blood flow was restored at the same rate until membrane repolarization was observed. In some animals, intraischemic brain hypothermia targeting 31 degrees C was initiated immediately after the onset of depolarization (Hypothermia 5 and Hypothermia 10 groups).
Measurements and Main Results: The cerebral blood flow threshold for repolarization (46.5% +/- 12%) was significantly higher than that for depolarization (18.9% +/- 4.8%; p &lt; 0.01) in the Normothermia 5 group and was further increased to 61.5% +/- 14% (p &lt; 0.01) in the Normothermia 10 group. With initiation of hypothermia, the cerebral blood flow threshold for membrane repolarization was suppressed to 33.8% +/- 10% in the Hypothermia 5 group (p &lt; 0.01 vs Normothermia 5 group) and was unaltered by prolongation of ischemia (Hypothermia 10 group; 36.6% +/- 6%).
Conclusions: Cerebral blood flow thresholds were significantly higher for repolarization than for depolarization and were further increased by prolonged ischemia. Intraischemic brain hypothermia decreased the repolarization threshold and abrogated the increase in the repolarization threshold caused by prolonged ischemia.

DOI： 10.1097/CCM.0000000000001095

Web of Science

researchmap

Language：English   Publisher：BIOMED CENTRAL LTD  

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 &lt; 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

Web of Science

researchmap

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015189368

J-GLOBAL

researchmap

Language：English   Publisher：OKAYAMA UNIV MED SCHOOL  

We encountered a 74-year-old male patient with tongue laceration after convulsive seizures under intensive care. The tongue showed severe swelling, and the right ventral surface had been lacerated by his isolated and pointed right lower canine. Our university hospital has established a perioperative management center, and is promoting interprofessional collaboration, including dentists, in perioperative management. Dentists collaborating in the perioperative management center took dental impressions, with the support of anesthesiologists who opened the patient's jaw under propofol sedation, to produce a mouth protector. By raising the patient's bite, the completed mouth protector prevented the isolated tooth from contacting the tongue and protected the lacerated wound. Use of the mouth protector prevented the lacerated tongue from coming into contact with the pointed tooth, and the tongue healed gradually. These findings underscore that interprofessional collaboration including dentists can improve the quality of medical care.

DOI： 10.18926/AMO/53027

Web of Science

researchmap

Language：English   Publisher：AUSTRALASIAN MED PUBL CO LTD  

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

Web of Science

researchmap

Language：English   Publisher：OKAYAMA UNIV MED SCHOOL  

The main purpose of this study was to determine the relationships between Japanese individuals' interest in living wills and their preferred end-of-life care and death locations. Questionnaires were mailed to 1,000 individuals aged &gt;= 50 to measure these 2 factors. We examined the associations between the respondents' characteristics and their preferred care and death locations by using multinomial logistic regression models. The response rate was 74%. Home was the most frequently preferred place for end-of-life care (64%), and a palliative care unit (PCU) was the most commonly preferred place to die (51%). Living will interest was associated with a preference for care (odds ratio [OR] 4.74, 95% confidence interval [CI] 1.95-12.1) and death (OR 2.75, 95% CI 1.70-4.47) in a PCU rather than a hospital, but it was not associated with the choice between receiving care or dying at home instead of a hospital. We must consider why Japanese people think home death is impracticable. The Japanese palliative care system should be expanded to meet patients' end-of-life needs, and this includes not only facilitating home care but also increasing access to PCU care.

DOI： 10.18926/AMO/53023

Web of Science

researchmap

Language：Japanese   Publisher：大道学館出版部  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015029994

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

researchmap

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

researchmap

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

researchmap

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

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

researchmap

researchmap

researchmap

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015122765

researchmap

researchmap

J-GLOBAL

researchmap

Language：English   Publisher：DOVE MEDICAL PRESS LTD  

Metastatic bone cancer causes severe pain, but current treatments often provide insufficient pain relief. One of the reasons is that mechanisms underlying bone cancer pain are not solved completely. Our previous studies have shown that brain-derived neurotrophic factor (BDNF), known as a member of the neurotrophic family, is an important molecule in the pathological pain state in some pain models. We hypothesized that expression changes of BDNF may be one of the factors related to bone cancer pain; in this study, we investigated changes of BDNF expression in dorsal root ganglia in a rat bone cancer pain model. As we expected, BDNF mRNA (messenger ribonucleic acid) and protein were significantly increased in L3 dorsal root ganglia after intra-tibial inoculation of MRMT-1 rat breast cancer cells. Among the eleven splice-variants of BDNF mRNA, exon 1-9 variant increased predominantly. Interestingly, the up-regulation of BDNF is localized in small neurons (mostly nociceptive neurons) but not in medium or large neurons (non-nociceptive neurons). Further, expression of nerve growth factor (NGF), which is known as a specific promoter of BDNF exon 1-9 variant, was significantly increased in tibial bone marrow. Our findings suggest that BDNF is a key molecule in bone cancer pain, and NGF-BDNF cascade possibly develops bone cancer pain.

DOI： 10.2147/JPR.S63527

Web of Science

researchmap

DOI： 10.11321/jjspc.13-0033

researchmap

Language：English  

Hepatic oxidative stress is a major contributor to the pathogenesis of several acute liver diseases. Diagnostic markers of hepatic oxidative stress may facilitate early detection and intervention. Bach1 is an oxidative stress-responsive transcription factor that represses heme oxygenase 1 (HO-1), the rate-limiting enzyme in the catabolism of heme, a potent pro-oxidant. We previously demonstrated that carbon tetrachloride (CCl4) causes oxidative hepatic injury in rats, exacerbated by free heme, suggesting that CCl4 may affect Bach1 gene expression. In the present study, we used northern blot analysis to measure Bach1, HO-1 and δ-aminolevulinate synthase (ALAS1; a heme biosynthesis enzyme) mRNA expression levels during acute hepatic injury induced by CCl4 (at doses of 0.1, 1.0 and 2.0 ml/kg body weight). Oxidative injury was assessed by measuring serum alanine aminotransferase (ALT), hepatic malondialdehyde (MDA) and glutathione (GSH) content. Treatment with CCl4 induced a significant dose-dependent increase in Bach1 mRNA 1-3 h after administration. Bach1 mRNA peaked at 6 h after CCl4 treatment (1 ml/kg), followed by a rapid decrease and gradual return to baseline by 12 h after treatment. The timecourse of transient Bach1 mRNA induction roughly mirrored that of HO-1 mRNA, while ALAS1 mRNA was inversely downregulated. Serum ALT levels and hepatic MDA concentration were significantly increased at 24 h after CCl4 treatment, while the hepatic GSH content was significantly reduced within 3 h of treatment. Serum ALT levels were positively correlated with Bach1 mRNA levels. These findings indicate that Bach1 mRNA is transiently induced in rat liver by CCl4, possibly as a regulatory mechanism to restore HO-1 to baseline following free heme catabolism. Our findings also suggest that Bach1 mRNA expression may be a novel indicator of the extent of oxidative hepatic injury caused by free heme.

PubMed

researchmap

researchmap

researchmap

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

researchmap

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：(一社)日本集中治療医学会  

researchmap

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

J-GLOBAL

researchmap

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

Web of Science

researchmap

Language：Japanese  

J-GLOBAL

researchmap

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

researchmap

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

Purpose: Delirium is a common complication in postoperative critically ill patients. Although abnormal melatonin metabolism is thought to be one of the mechanisms of delirium, there have been few studies in which the association between alteration of perioperative plasma melatonin concentration and postoperative delirium was assessed.
Materials: We conducted a prospective observational study to assess the association of perioperative alteration of plasma melatonin concentration with delirium in 40 postoperative patients who required intensive care for more than 48 hours. We diagnosed postoperative delirium using Confusion Assessment Method for the intensive care unit and measured melatonin concentration 4 times (before the operation as the preoperative value, 1 hour after the operation, postoperative day 1, and postoperative day 2).
Results: Postoperative delirium occurred in 13 (33%) of the patients. Although there was no significant difference in preoperative melatonin concentration, Delta melatonin concentration at 1 hour after the operation was significantly lower in patients with delirium than in those without delirium (-1.1 vs 0 pg/mL, P = .036). After adjustment of relevant confounders, Delta melatonin concentration was independently associated with risk of delirium (odds ratio, 0.50; P = .047).
Conclusions: Delta melatonin concentration at 1 hour after the operation has a significant independent association with risk of postoperative delirium. (c) 2013 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jcrc.2012.11.004

Web of Science

researchmap

Language：English   Publisher：PUBLIC LIBRARY SCIENCE  

Hemorrhagic shock and resuscitation induces pulmonary inflammation that leads to acute lung injury. Biliverdin, a metabolite of heme catabolism, has been shown to have potent cytoprotective, anti-inflammatory, and anti-oxidant effects. This study aimed to examine the effects of intravenous biliverdin administration on lung injury induced by hemorrhagic shock and resuscitation in rats. Biliverdin or vehicle was administered to the rats 1 h before sham or hemorrhagic shock-inducing surgery. The sham-operated rats underwent all surgical procedures except bleeding. To induce hemorrhagic shock, rats were bled to achieve a mean arterial pressure of 30 mmHg that was maintained for 60 min, followed by resuscitation with shed blood. Histopathological changes in the lungs were evaluated by histopathological scoring analysis. Inflammatory gene expression was determined by Northern blot analysis, and oxidative DNA damage was assessed by measuring 8-hydroxy-2' deoxyguanosine levels in the lungs. Hemorrhagic shock and resuscitation resulted in prominent histopathological damage, including congestion, edema, cellular infiltration, and hemorrhage. Biliverdin administration prior to hemorrhagic shock and resuscitation significantly ameliorated these lung injuries as judged by histopathological improvement. After hemorrhagic shock and resuscitation, inflammatory gene expression of tumor necrosis factor-alpha and inducible nitric oxide synthase were increased by 18- and 8-fold, respectively. Inflammatory gene expression significantly decreased when biliverdin was administered prior to hemorrhagic shock and resuscitation. Moreover, after hemorrhagic shock and resuscitation, lung 8-hydroxy-2' deoxyguanosine levels in mitochondrial DNA expressed in the pulmonary interstitium increased by 1.5-fold. Biliverdin administration prior to hemorrhagic shock and resuscitation decreased mitochondrial 8-hydroxy-2' deoxyguanosine levels to almost the same level as that in the control animals. We also confirmed that biliverdin administration after hemorrhagic shock and resuscitation had protective effects on lung injury. Our findings suggest that biliverdin has a protective role, at least in part, against hemorrhagic shock and resuscitation-induced lung injury through anti-inflammatory and anti-oxidant mechanisms.