Sarara Mutoh, Michiko Kinoshita, Yuki Maeda and Katsuya Tanaka : Ketamine as an Alternative Anesthetic for Augmenting Seizure Durations During Electroconvulsive Therapy: A Retrospective Observational Study, The Journal of ECT, 2023.
(要約)
Electroconvulsive therapy (ECT) is highly effective for severe psychiatric disorders; however, short seizure durations may lead to ineffective therapy. This retrospective study aimed to examine the risks and benefits of switching to ketamine anesthesia to augment seizure durations during an acute course of ECT. We included 33 patients who underwent ketamine anesthesia due to suboptimal seizures during an acute course of ECT. We assessed seizure duration, stimulus dose, hemodynamic variability, and postseizure complications before and after switching to ketamine. Age was significantly associated with suboptimal seizures during ECT (P = 0.040). After switching to ketamine, 32 patients (97%) experienced prolonged seizure duration. Ketamine significantly prolonged both electroencephalogram and motor seizure durations with a mean difference of 34.6 seconds (95% confidence interval [CI], 26.4-42.7 seconds; P < 0.001) and 26.6 seconds (95% CI, 19.6-33.6 seconds; P < 0.001), respectively. It also significantly reduced stimulus dose (mean difference, -209.5 mC [95% CI, -244.9 to -174.1 mC]; P < 0.001). In addition, maximum changes in systolic blood pressure and heart rate during ECT sessions significantly increased with ketamine (mean difference, 27.2 mm Hg [95% CI, 12.0-42.4 mm Hg; P = 0.001]; 25.7 beats per minute [95% CI, 14.5-36.8 beats per minute; P < 0.001], respectively). Patients reported more headaches with ketamine (P = 0.041). Our results provide evidence that ketamine as an alternative anesthetic can augment seizure durations in specific patients experiencing suboptimal seizures during an acute course of ECT. However, its use requires greater attention to circulatory management and postseizure complications.
Michiko Kinoshita, Makoto Kinoshita, Rikako Takahashi, Sarara Mutoh, Nami Kakuta and Katsuya Tanaka : The Safety and Strategies for Reinitiating Electroconvulsive Therapy After ECT-Induced Takotsubo Cardiomyopathy: A Case Report and Systematic Review., The Journal of ECT, Vol.39, No.3, 185-192, 2023.
(要約)
Electroconvulsive therapy-induced TCM is more likely to cause cardiogenic shock than nonperioperative cases; nevertheless, it has good prognosis. Cautious reinitiation of ECT after TCM recovery is possible. Further studies are required to determine preventive measures for ECT-induced TCM.
Yuta Uemura, Michiko Kinoshita, Yoko Sakai and Katsuya Tanaka : Hemodynamic impact of ephedrine on hypotension during general anesthesia: a prospective cohort study on middle-aged and older patients, BMC Anesthesiology, Vol.23, No.1, 283, 2023.
(要約)
Ephedrine is a mixed α- and β-agonist vasopressor that is frequently used for the correction of hypotension during general anesthesia. β-responsiveness has been shown to decrease with age; therefore, this study aimed to determine whether aging would reduce the pressor effect of ephedrine on hypotension during general anesthesia. Seventy-five patients aged ≥ 45 years were included in this study, with 25 patients allocated to each of the three age groups: 45-64 years, 65-74 years, and ≥ 75 years. All patients received propofol, remifentanil, and rocuronium for the induction of general anesthesia, followed by desflurane and remifentanil. Cardiac output (CO) was estimated using esCCO technology. Ephedrine (0.1 mg/kg) was administered for the correction of hypotension. The primary and secondary outcome measures were changes in the mean arterial pressure (MAP) and CO, respectively, at 5 min after the administration of ephedrine. RESULTS: The administration of ephedrine significantly increased MAP (p < 0.001, mean difference: 8.34 [95% confidence interval (CI), 5.95-10.75] mmHg) and CO (p < 0.001, mean difference: 7.43 [95% CI, 5.20-9.65] %) across all groups. However, analysis of variance revealed that the degree of elevation of MAP (F [2, 72] = 0.546, p = 0.581, η = 0.015 [95% CI, 0.000-0.089]) and CO (F [2, 72] = 2.023, p = 0.140, η = 0.053 [95% CI, 0.000-0.162]) did not differ significantly among the groups. Similarly, Spearman's rank correlation and multiple regression analysis revealed no significant relation between age and the changes in MAP or CO after the administration of ephedrine. The administration of ephedrine significantly increased MAP and CO; however, no significant correlation with age was observed in patients aged > 45 years. These findings suggest that ephedrine is effective for the correction of hypotension during general anesthesia, even in elderly patients. UMIN-CTR (UMIN000045038; 02/08/2021).
Michiko Kinoshita, Yoko Sakai and Katsuya Tanaka : Relative publication output and international collaboration in anaesthesiology and pain medicine: a bibliometric analysis from 1996 to 2021, British Journal of Anaesthesia, Vol.131, No.2, e53-e55, 2023.
Michiko Kinoshita, Takahashi Mina, Katsuya Tanaka and Yoko Sakai : Authorship by gender in anesthesiology journals: a retrospective cross-sectional study for Japan, Journal of Anesthesia, Vol.37, No.3, 364-370, 2023.
(要約)
Although it is important to recognize gender disparities in publishing to achieve gender diversity, women's authorship in Japan remains unclear. Therefore, this study aimed to investigate the percentage and analyze the trends of articles authored and published in anesthesiology journals by Japanese female authors. The genders of the first and last authors affiliated with Japanese institutions were surveyed in the Journal of Anesthesia (JA) (1990, 1995, and 2000-2022) and 11 international anesthesiology journals (2010-2022). We included 845 and 819 original research articles from JA in the analyses of the first and last authors, respectively. The proportion of female first authors significantly increased from 41 (11.7%) out of 351 before 2009 to 119 (24.1%) out of 494 after 2010 (p < 0.001). The proportion of female last authors was 11 (3.3%) out of 335 before 2009 and 22 (4.5%) out of 484 after 2010, respectively, with no significant difference (p = 0.470). We included 624 and 572 original research articles from international anesthesiology journals in the analyses of first and last authors, respectively. Among these, there were 134 (21.5%) and 23 (4.0%) female first and last authors, respectively. These proportions in international anesthesiology journals did not significantly differ from those in JA (p = 0.334, p = 0.789, respectively). The percentage of female first authors has increased, commensurate with the percentage of female anesthesiologists. However, the percentage of female last authors has not increased and remains low in Japan.
Ryo Sekiguchi, Michiko Kinoshita, Ryosuke Kawanishi, Nami Kakuta, Yoko Sakai and Katsuya Tanaka : Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial., BMC Anesthesiology, 2023.
(要約)
MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (- 41.1 [16.4] mmHg and - 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: - 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP < 65 mmHg over 2.5 min), without significant differences between the groups (p = 0.341).
Michiko Kinoshita, Sarara Mutoh, Asuka Kasai, Ryosuke Kawanishi and Katsuya Tanaka : General Anesthesia in a Patient With Neuronal Intranuclear Inclusion Disease: A Case Report., A&A Practice, Vol.16, No.10, 2022.
(要約)
Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disease with diverse clinical manifestations, including dementia and muscle weakness. We summarize anesthetic considerations in reporting general anesthesia for a 58-year-old man with bladder dysfunction and cerebellar ataxia who was diagnosed with NIID. The patient developed postinduction hypotension relevant to autonomic neuropathy. The potential risks, such as prolonged reaction to neuromuscular blocking agent, postoperative delirium, and worsening of NIID-related symptoms, were also considered. The responsiveness to anesthetics may vary widely from case t case. As the number of NIID cases increases, a better understanding of NIID is needed.
Michiko Kinoshita, Yoko Sakai, Kimiko Katome, Tomomi Matsumoto, Shizuka Sakurai, Yuka Jinnouchi and Katsuya Tanaka : Transition in eye gaze as a predictor of emergence from general anesthesia in children and adults: a prospective observational study., BMC Anesthesiology, Vol.22, No.1, 2022.
(要約)
In children, eye-gaze transition was observed significantly earlier than other physical-behavioral responses during emergence from general anesthesia and seemed to reflect emergence from anesthesia. In contrast, observation of eye gaze was not a useful indicator of emergence from anesthesia in adults.
Michiko Kinoshita, Yuki Ishikawa, Ryo Sekiguchi, Miyuki Matsuda and Katsuya Tanaka : Impact of surgical masks on fraction of inspired oxygen during oxygen therapy depends on the type of oxygen masks and respiratory conditions: volunteer- and simulation-based studies., Journal of Anesthesia, Vol.36, No.5, 633-641, 2022.
(要約)
was measured using a simulator that reproduced spontaneous breathing. RR was 12 or 24 bpm, and the tidal volume (Tv) was 300, 500, or 700 mL. The effect of oxygen mask fitting conditions was also examined. The primary outcome measure was FIO
Chiaki Murakami, Hiroaki Kawano, Michiko Kinoshita, Akio Kondo and Masaya Inoue : Effects of Nicorandil Versus Nitroglycerin on Arterial Oxygenation During Two-Lung Ventilation and One-Lung Ventilation in Patients With Risk Factors for Myocardial Ischemia: A Prospective, Randomized, Double-Blind Study., Journal of Cardiothoracic and Vascular Anesthesia, Vol.33, No.3, 702-709, 2018.
(要約)
at TLV (479.7 ± 57.1 v 408.2 ± 70.9 mmHg, p < 0.001); and at 5 minutes (344.8 ± 85.1 v 282.6 ± 85.8 mmHg, p = 0.012), 20 minutes (215.7 ± 103.0 v 158.2 ± 74.5 mmHg, p = 0.027), and 30 minutes (198.8 ± 103.5 v 147.5 ± 64.1 mmHg, p = 0.039) after OLV was significantly higher in the nicorandil group than in the nitroglycerin group.
Hiroaki Kawano, Michiko Kinoshita, Akio Kondo, Yasuhito Yamada and Masaya Inoue : TORSADES DE POINTES ASSOCIATED WITH TAKOTSUBO CARDIOMYOPATHY IN AN ANOREXIA NERVOSA PATIENT DURING EMERGENCE FROM GENERAL ANESTHESIA., Middle East Journal of Anaesthesiology, Vol.23, No.5, 557-561, 2016.
(要約)
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is a disease in which the patient exhibits transient, reversible left ventricular dysfunction that is triggered by physical or emotional stress. Prolongation of QT interval, a risk factor for arrhythmia and sudden death, has been reported to be prevalent among patients with Takotsubo cardiomyopathy and is also observed in those with severe anorexia nervosa. In this report, we describe the rare case of a 30-year-old female patient with anorexia nervosa who developed Torsades de Pointes associated with Takotsubo cardiomyopathy during emergence from general anesthesia for emergency exploratory laparotomy.
Michiko Kinoshita, Yasuo M. Tsutsumi, Kohei Fukuta, Asuka Kasai and Katsuya Tanaka : Isoflurane-induced postconditioning via mitochondrial calcium-activated potassium channels., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 80-84, 2016.
(要約)
Activation of the mitochondrial calcium-activated potassium (mKCa) channel reportedly confers resistance to myocardial ischemic stress. However, the role of the mKCa channel in postconditioning induced by volatile anesthetic remains unclear. Male Japanese white rabbits underwent coronary artery occlusion for 30 min followed by reperfusion for 3 h. Volatile anesthetic, isoflurane, was administered at 3 min prior to reperfusion for 5 min. Rabbits were injected with the mKCa channel blocker, iberiotoxin, or the mKCa channel opener, NS1619, at 8 min prior to reperfusion. Myocardial infarct size and the area at risk (AAR) were measured at the end of the experiment. Isoflurane significantly reduced infarct size (23.0 ± 9.8% of the AAR, P<0.05) compared with the control (44.0 ± 9.1%). Iberiotoxin abolished the cardioprotective impact of isoflurane (43.0 ± 11.6%), while iberiotoxin alone exerted no effect on infarct size (45.0 ± 9.5%). NS1619 and isoflurane/NS1619 both significantly reduced infarct size (21.0 ± 10.3% and 19.0 ± 8.8%, respectively, P<0.05 vs control group), but isoflurane/NS1619 showed no additional benefits compared with isoflurane alone. These results indicate that activation of the mKCa channel contribute isoflurane-induced postconditioning.
Hiroaki Kawano, Naohiro Ohshita, Kimiko Katome, Takako Kadota, Michiko Kinoshita, Yayoi Matsuoka, Yasuo M. Tsutsumi, Shinji Kawahito, Katsuya Tanaka and Shuzo Oshita : [Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery]., Revista Brasileira de Anestesiologia, Vol.66, No.1, 12-18, 2015.
(要約)
We investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery. Patients were randomly divided into three groups: those maintained with sevoflurane (Group S; n = 42), propofol (Group P; n = 42), or combined propofol and sevoflurane (Group PS; n = 42). We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24h after surgery. The number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0-2h (74%; 76% and 43%; respectively, p = 0.001) and 0-24h (71%; 76%, and 38%; respectively, p < 0.0005). The incidence of nausea at 0-2h (Group S = 57%; Group P = 26% and Group PS = 21%; p = 0.001) and 0-24h (Group S = 62%; Group P = 29% and Group PS = 21%; p < 0.0005) was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0-24h. Combined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea.
Hiroaki Kawano, Sawa Manabe, Tomomi Matsumoto, Eisuke Hamaguchi, Michiko Kinoshita, Fumihiko Tada and Shuzo Oshita : Comparison of intraoperative blood loss during spinal surgery using either remifentanil or fentanyl as an adjuvant to general anesthesia., BMC Anesthesiology, Vol.13, No.1, 2013.
(要約)
The remifentanil group exhibited significantly lower intraoperative arterial BP than the fentanyl group. Intraoperative blood loss was also significantly lower in the remifentanil group (125 ± 67 mL vs. 165 ± 82 mL, P = 0.035).
Kayo Hirose, Yasuo M. Tsutsumi, Rie Tsutsumi, Masayuki Shono, Erika Katayama, Michiko Kinoshita, Katsuya Tanaka and Shuzo Oshita : Role of the O-linked -N-acetylglucosamine in the cardioprotection induced by isoflurane., Anesthesiology, Vol.115, No.5, 955-962, 2011.
(要約)
Cardiac protection by volatile anesthetic-induced preconditioning and ischemic preconditioning have similar signaling pathways. Recently, it was reported that augmentation of protein modified with O-linked -N-acetylglucosamine (O-GlcNAc) contributes to cardiac protection. This study investigated the role of O-GlcNAc in cardiac protection induced by anesthetic-induced preconditioning. O-GlcNAc-modified proteins were visualized by immunoblotting. Tolerance against ischemia or reperfusion was tested in vivo (n = 8) and in vitro (n = 6). The opening of the mitochondrial permeability transition pore (mPTP) upon oxidative stress was examined in myocytes treated with calcein AM (n = 5). Coimmunoprecipitation and enzymatic labeling were performed to detect the mitochondrial protein responsible for the mPTP opening. Isoflurane treatment and the consequent augmentation of O-GlcNAc concentrations reduced the infarct size (26 ± 5% [mean ± SD], P < 0.001) compared with the control. The protective effect of O-GlcNAc was eliminated in the group pretreated with the O-GlcNAc transferase inhibitor alloxan (39 ± 5%, P < 0.001). Myocyte survival also showed the same result in vitro. Formation of the mPTP was abrogated in the isoflurane-treated cells (86 ± 4%, P < 0.001) compared with the control and alloxan-plus-isoflurane-treated cells (57 ± 7%, P < 0.001). Coimmunoprecipitation and enzymatic labeling studies revealed that the O-GlcNAc-modified, voltage-dependent anion channel restained the mPTP opening. Isoflurane induced O-GlcNAc modification of mitochondrial voltage-dependent anion channel. This modification inhibited the opening of the mPTP and conferred resistance to ischemia-reperfusion stress.
Nami Kakuta, Yasuo M. Tsutsumi, Yousuke T. Horikawa, Hiroaki Kawano, Michiko Kinoshita, Katsuya Tanaka and Shuzo Oshita : Neurokinin-1 receptor antagonism, aprepitant, effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures., The Journal of Medical Investigation : JMI, Vol.58, No.3-4, 246-251, 2011.
(要約)
Post-operative nausea and vomiting (PONV) remains the most frequently reported patient complaint after anesthesia. Aprepitant is the first neurokinin-1(NK1) receptor antagonism available for use as an antiemetic. We investigated whether aprepitant can effectively decrease PONV in patients undergoing laparoscopic gynecological surgery. Sixty four patients receiving general anesthesia for laparoscopic gynecological surgery were randomly assigned to either receive a preoperative dose of 80 mg aprepitant or no drug. Efficacy was assessed in 2 and 24 hours after surgery. Primary and secondary endpoints were analyzed for the time intervals 0-2 hours (acute phase) and 2-24 hours (delayed phase). Vomiting, nausea, use of rescue anti-emetic, and visual analog scale (VAS) were assessed. Nausea was assessed on a 4-point scale, from 0 to 3. Sixty patients participated in the study. At acute phase, PONV was present in both control and NK1 group and were 63% and 43% respectively. The severity of nausea was much less in the NK1 group. PONV prevalence at delayed phase was present in control but absent in NK1 group 27% vs. 0%, respectively. The amount of pain medication used by patients in the NK1 group was significantly less for diclofenac and pentazocine suggesting increase pain tolerance. Neurokinin-1 receptor antagonism effectively lowered PONV increased pain tolerance, and expedited recovery in patients undergoing laparoscopic gynecological surgery.
Yasuo M. Tsutsumi, Rie Tsutsumi, Kazuaki Mawatari, Yutaka Nakaya, Michiko Kinoshita, Katsuya Tanaka and Shuzo Oshita : Compound K, a metabolite of ginsenosides, induces cardiac protection mediated nitric oxide via Akt/PI3K pathway., Life Sciences, Vol.88, No.15-16, 725-729, 2011.
(要約)
Compound K (C-K; 20-O-D-glucopyranosyl-20(S)-protopanaxadiol) is a novel ginsenoside metabolite formed by intestinal bacteria and does not occur naturally in ginseng. In this study, we investigated whether administration of C-K has protective effects on myocardial ischemia-reperfusion injury and its potential mechanisms.
Katsuya Tanaka, Takashi Kawano, Yasuo M. Tsutsumi, Michiko Kinoshita, Nami Kakuta, Kayo Hirose, Masakazu Kimura and Shuzo Oshita : Differential effects of propofol and isoflurane on glucose utilization and insulin secretion., Life Sciences, Vol.88, No.1-2, 96-103, 2011.
(要約)
Volatile anesthetics, such as isoflurane, reverse glucose-induced inhibition of pancreatic adenosine triphosphate-sensitive potassium (K(ATP)) channel activity, resulting in reduced insulin secretion and impaired glucose tolerance. No previous studies have investigated the effects of intravenous anesthetics, such as propofol, on pancreatic K(ATP) channels. We investigated the cellular mechanisms underlying the effects of isoflurane and propofol on pancreatic K(ATP) channels and insulin secretion.
Yako Matsumoto, Michiko Kinoshita, Yoshinobu Tomiyama and Katsuya Tanaka : Protecting Intraoperative Patients In Time Of Natural DisastersPast Experiences And Lessons Learned: A Scoping Review, The Anesthesiology Annual Meeting 2023, San Francisco, Oct. 2023.
2.
Ryo Sekiguchi, Michiko Kinoshita, Ryosuke Kawanishi, Nami Kakuta, Yoko Sakai and Katsuya Tanaka : Comparison Between Hemodynamics Of Remimazolam And Propofol During General Anesthesia: A Randomized Study, The Anesthesiology Annual Meeting, Oct. 2022.
3.
Michiko Kinoshita, Yoko Sakai, Kimiko Katome, Tomomi Matsumoto, Yuka Jinnouchi, Noriko Niki, Shizuka Sakurai, Yoshiko Yoshida and Katsuya Tanaka : The transition in the eye gaze is a helpful predictor of emergence from general anesthesia with sevoflurane combined with remifentanil in children, but not adults, --- A prospective observational study ---, The Annual Meeting of the American Society of Anesthesiologists, WEB, Oct. 2020.
4.
Mai Morimoto, Katsuya Tanaka, Michiko Kinoshita, Noriko Kambe, Ryosuke Kawanishi, Katsuyoshi Kume, Naohiro Oshita, Yasuo M. Tsutsumi and Shuzo Oshita : Effects of new developed mask for novel mask holding on the quality of mask ventilation and the pressure between face and mask., The American Society of Anesthesiologist Annual Meeting, San Francisco, Oct. 2013.
5.
Michiko Kinoshita, Katsuya Tanaka, Yasuo Tsutsumi and Shuzo Oshita : Role of calcium-activated potassium channel and cAMP-dependent protein kinase on isflurane-induced postconditoning., American Society of Anesthesiologists 2011 Annual Meeting, Chicago, Oct. 2011.
6.
Katsuya Tanaka, Michiko Kinoshita, Yasuo Tsutsumi, Kaori Takata and Shuzo Oshita : Simvastatin restores anesthetic postconditioning in the presence of hyperglycemia in vivo rabbits., American Society of Anesthesiologists 2011 Annual Meeting, Chicago, Oct. 2011.
7.
Michiko Kinoshita, Katsuya Tanaka, Yasuo Tsutsumi, Hirose Kayo and Shuzo Oshita : The effect of the novel mask ventilation technique on airway management., The Annual Meeting of the American Society of Anesthesiologists, San Diego, California, Oct. 2010.
8.
Michiko Kinoshita, Katsuya Tanaka, Jinnouchi Yuka, Yasuo Tsutsumi and Shuzo Oshita : Dose dependent effects of remifentanil on perioperative immune-inflammtory response in patients., The Annual Meeting of the American Society of Anesthesiologists, San Diego, California, Oct. 2010.
9.
Hirose Kayo, Shuzo Oshita, Michiko Kinoshita, Katsuya Tanaka and Yasuo Tsutsumi : The role of O-linked -N-acetylglucosamine in the cardiac protection induced by isoflurane., The Annual Meeting of the American Society of Anesthesiologists, San Diego, California, Oct. 2010.
国内講演発表:
1.
松本 弥子, 酒井 陽子, 木下 倫子, 田中 克哉 : Impact of Anesthesiologists' Experience on Anesthetic Management in Cesarean Section, 第11回日本区域麻酔学会学術集会, 2024年4月.