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.
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).
Mayu Sebe, Rie Tsutsumi, Takuro Oyama, T Yousuke Horikawa, Yuta Uemura, Nami Kakuta, Yoko Sakai, Atsushi Morio, Hirotsugu Miyoshi, Takashi Kondo, Tomoaki Urabe, Yuko Noda, Satoshi Kamiya, Noboru Saeki, Masashi Kuroda, Katsuya Tanaka, Yasuo Tsutsumi and Hiroshi Sakaue : Assessment of postoperative nutritional status and physical function between open surgical aortic valve replacement and transcatheter aortic valve implantation in elderly patients., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 139-144, 2020.
(要約)
Background and aims : Severe aortic stenosis (AS) has been normally treated with surgical aortic valve replacement (AVR) whereas recently, transcatheter aortic valve implantation (TAVI) has been introduced as a minimally invasive operation for patients with high surgical risk and frailty. In this study, we have evaluated postoperative physical function and nutrition intake in the patients following AVR and TAVI. Methods : This prospective observational study involved 9 patients with surgical aortic valve replacement (AVR) and 7 patients with transcatheter aortic valve implantation (TAVI). Body composition was measured one day prior surgery, postoperative day (POD) 1, POD 3, POD 5 and POD 7. Hand grip strength, calf circumference and gait speed were measured one day before surgery and on the day of discharge. Results : Skeletal muscle was significantly decreased in AVR patients at postoperative day 3 and 7, while there was no change in TAVI patients. Patients with TAVI showed higher dietary intake after surgery compared to patients with AVR, and they maintained hand grip strength and calf circumference at discharge. Conclusions : In elderly patients with AS, TAVI can improve post-operative recovery maintaining nutritional status and physical function even. J. Med. Invest. 67 : 139-144, February, 2020.
Shinji Kawahito, Naoji Mita, Tomohiro Soga, Shusuke Yagi, Nami Kakuta, Shiho Satomi, Hiroyuki Kinoshita, Kazumi Takaishi, Tetsuya Kitagawa and Hiroshi Kitahata : Accuracy and reliability of continuous blood glucose monitoring during pediatric cardiopulmonary bypass., Journal of Artificial Organs, Vol.22, No.4, 353-356, 2019.
(要約)
The purpose of this study was to assess the accuracy and reliability of a continuous blood glucose monitoring system (artificial endocrine pancreas; STG-55, Nikkiso, Tokyo, Japan) during pediatric cardiopulmonary bypass surgery. Twenty-five pediatric patients scheduled to undergo cardiovascular surgery with cardiopulmonary bypass (age 4 months to 11 years; body weight 5.6-59.7 kg) were enrolled. The glucose sensor line of the artificial endocrine pancreas was connected to the venous side of the cardiopulmonary bypass circuit and used for continuous blood glucose monitoring. We obtained 192 samples for blood gas assessment from the cardiopulmonary bypass circuit, and i-STAT (Abbott, East Windsor, NJ, USA) was used for conventional blood glucose assessment. The accuracies of continuous glucose measurements (STG-55) and conventional intermittent glucose measurements (i-STAT) during cardiopulmonary bypass were compared by means of Clarke error grid analysis. The results were divided into five zones, A, B, C, D, and E, and 78.6% of paired measurements were in zone A, while 21.4% were in zone B. We confirmed that the results of this continuous blood glucose monitoring system for cardiopulmonary bypass during pediatric cardiovascular surgery were highly reliable. An artificial endocrine pancreas may facilitate the safe use of intensive insulin therapy during pediatric cardiovascular surgery.
Yuta Uemura, Yoko Sakai, Yasuo Tsutsumi, Nami Kakuta, Chiaki Murakami, Shiho Satomi, Takuro Oyama, Naohiro Ohshita, Tomoya Takasago, Daisuke Hamada, Koichi Sairyo and Katsuya Tanaka : Postoperative nausea and vomiting following lower limb surgery :a comparison between single-injection intraarticular anesthesia and continuous epidural anesthesia., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 303-307, 2019.
(要約)
Study Objective : the incidence of postoperative nausea and vomiting (PONV) following single-injection intraarticular anesthesia was compared to that following continuous epidural anesthesia. Design : Prospective, double-blind, randomized study. Setting : University-affiliated teaching hospital. Patients : Forty-eight patients finally participated in this study, and each group contained twenty-four patients. Interventions : Patients scheduled to undergo lower limb surgery under general anesthesia were randomly allocated into two groups, to receive either single-injection intraarticular or continuous epidural anesthesia for postoperative analgesia. Measurements : The incidence and severity of PONV, complete response rates (i.e., no vomiting or rescue antiemetic use), and pain scores were recorded 2, 24, and 48 h postoperatively. Main results : No significant differences between groups were observed in the incidence and severity of PONV, rescue antiemetic use, or complete response rate at any of the time points, but only the use of rescue analgesics was significantly less in continuous epidural anesthesia group during the 2-24h postoperative period (P=0.04). Conclusion : While the use of single-injection intraarticular anesthesia following lower limb surgery did not prevent PONV more than continuous epidural anesthesia in this study, the intraarticular technique still provides greater simplicity, safety, and cost-effectiveness. J. Med. Invest. 66 : 303-307, August, 2019.
Yuta Uemura, Nami Kakuta, Katsuya Tanaka and Yasuo Tsutsumi : Anesthetic management of a patient with methylmalonic acidemia: a case report., JA Clinical Reports, Vol.4, No.1, 71, 2018.
(要約)
Methylmalonic acidemia (MMA) is a metabolic disorder of organic acids and is characterized by the accumulation of methylmalonic acids. The patient was a 19-year-old female diagnosed with severe MMA at 3 days of age, who was scheduled for renal replacement therapy. Preoperatively, there was no evidence of metabolic acidosis or electrolyte abnormalities. Glucose was administered preoperatively following a 6-h fast. Anesthesia was administered using thiamylal, remifentanil, rocuronium, and sevoflurane. After tracheal intubation, the patient underwent an ultrasound-guided bilateral rectus sheath block with ropivacaine. A drop in blood sugar level was treated with 5% glucose. Extubation was performed after intravenous administration of sugammadex. We report the anesthetic management of a patient with MMA using a combination of general anesthesia and rectus sheath block.
Shiho Satomi, Nami Kakuta, Chiaki Murakami, Yoko Sakai, Katsuya Tanaka and Yasuo Tsutsumi : The Efficacy of Programmed Intermittent Epidural Bolus for Postoperative Analgesia after Open Gynecological Surgery: A Randomized Double-Blinded Study., BioMed Research International, Vol.2018, 6297247, 2018.
(要約)
It is well known that the programmed intermittent epidural bolus (PIEB) technique effectively provides epidural anesthesia in labor. This randomized double-blind trial compared the postoperative analgesic efficacy of PIEB with that of continuous epidural infusion (CEI) in patients undergoing gynecological surgery under combined general-epidural anesthesia. Patients undergoing open gynecological surgery under combined general-epidural anesthesia were randomized at a 1 : 1 ratio to receive PIEB or CEI. In the PIEB group, the pump delivered 4L ropivacaine 0.2% plus fentanyl 2 g/mL every hour. In the CEI group, the pump delivered the same solution at a rate of 4L/h. In both groups, additional 4L boluses of ropivacaine 0.2% plus fentanyl 2 g/mL were provided, when necessary, by patient-controlled epidural analgesia after surgery. The primary outcome was the total ropivacaine dose 40 hours after surgery. The secondary outcomes were the number of PCEA boluses and postoperative pain (evaluated on an 11-point numerical rating scale) 3, 24, and 48 hours after surgery. In total, 57 patients were randomized ( = 28 and 29 in the PIEB and CEI groups, resp.). The two groups differ significantly in terms of the total ropivacaine dose 40 hours after surgery (mean (standard deviation): 155.38 (4.55) versus 159.73 (7.87)L, = 0.016). Compared to the CEI group, the PIEB group had significantly lower numerical rating scale scores 3 hours (median [lower-upper quartiles]: 0 [0-0.5] versus 3 [0-5.5], = 0.002), 24 hours (1 [0-2] versus 3 [1-4], = 0.003), and 48 hours (1 [0-2] versus 2 [2-3.5], = 0.002) after surgery. PIEB was better than CEI in terms of providing postoperative analgesia after open gynecological surgery under combined general-epidural anesthesia.
Takuro Oyama, Nami Kakuta, Naoji Mita, Shinji Kawahito, Katsuya Tanaka and Yasuo Tsutsumi : Jelly-type carbohydrate supplement in healthy subjects suppresses the catabolism of adipose tissue and muscle protein and improved their satisfactions., Clinical Nutrition Experimental, Vol.19, 1-11, 2018.
Nami Kakuta, Yasuo Tsutsumi, Chiaki Murakami, Yoko Sakai, Takuro Oyama, Asuka Kasai, Katsuyoshi Kume and Katsuya Tanaka : Effectiveness of using non-invasive continuous arterial pressure monitoring with ClearSight in hemodynamic monitoring during living renal transplantation in a recipient:a case report., The Journal of Medical Investigation : JMI, Vol.65, No.1.2, 139-141, 2018.
(要約)
We investigated the effectiveness of the ClearSight system for hemodynamic management during kidney transplantation for a recipient. The recipient was to receive a kidney transplant from his mother under general anesthesia. We used continuous noninvasive finger-cuff-based monitoring of blood pressure, provided by the ClearSight system, and stroke volume variation to predict fluid responsiveness. We used of a balanced anesthetic technique and stringent monitoring standards to ensure a successful outcome for the patient. This case demonstrated that ClearSight has the potential to improve patient monitoring in hemodynamically stable patients who received kidney transplantation under general anesthesia. J. Med. Invest. 65:139-141, February, 2018.
Yoko Sakai, Yasuo M. Tsutsumi, Takuro Oyama, Chiaki Murakami, Nami Kakuta and Katsuya Tanaka : Noninvasive continuous blood pressure monitoring by the ClearSight system during robot-assisted laparoscopic radical prostatectomy., The Journal of Medical Investigation : JMI, Vol.65, No.1.2, 69-73, 2018.
(要約)
Robot-assisted laparoscopic radical prostatectomy (RALRP) is commonly performed in the surgical treatment of prostate cancer. However, the steep Trendelenburg position (25) and pneumoperitoneum required for this procedure can sometimes cause hemodynamic changes. Although blood pressure is traditionally monitored invasively during RALRP, the ClearSight system (BMEYE, Amsterdam, The Netherlands) enables a totally noninvasive and simple continuous blood pressure and cardiac output monitoring based on finger arterial pressure pulse contour analysis. We therefore investigated whether noninvasive continuous arterial blood pressure measurements using the ClearSight system were comparable to those obtained invasively in patients undergoing RALRP. Ten patients scheduled for RALRP with American Society of Anesthesiologists physical status I-II were included in this study. At each of the seven defined time points, noninvasive and invasive blood pressure measurements were documented and compared in each patient using Bland-Altman analysis. Although the blood pressure measured with the ClearSight system correlated with that measured invasively, a large difference between the values obtained by the two devices was noted. The ClearSight system was unable to detect blood pressure accurately during RALRP, suggesting that blood pressure monitoring using this device alone is not feasible in this small patient population. J. Med. Invest. 65:69-73, February, 2018.
Chiaki Murakami, Nami Kakuta, Katsuyoshi Kume, Yoko Sakai, Asuka Kasai, Takuro Oyama, Katsuya Tanaka and Yasuo Tsutsumi : A comparison of fosaprepitant and ondansetron for preventing postoperative nausea and vomiting in moderate to high risk patients: A retrospective database analysis., BioMed Research International, Vol.2017, 5703528, 2017.
(要約)
Postoperative nausea and vomiting (PONV) occur in 30-50% of patients undergoing general anesthesia and in 70-80% of high PONV risk patients. In this study, we investigated the efficacy of fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, compared to ondansetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, in moderate to high PONV risk patients from our previous randomized controlled trials. Patients (171 patients from 4 pooled studies) with the Apfel simplified score ≥ 2 and undergoing general anesthesia were randomly allocated to receive intravenous fosaprepitant 150 mg (NK1 group, = 82) and intravenous ondansetron 4 mg (ONS group, = 89) before induction of anesthesia. Incidence of vomiting was significantly lower in the NK1 group compared to the ONS group 0-2, 0-24, and 0-48 hours after surgery (2 versus 17%, 2 versus 28%, and 2 versus 29%, resp.). However, no significant differences in PONV, complete response, rescue antiemetic use, and nausea score were observed between groups 0-48 hours after surgery. In moderate to high PONV risk patients, fosaprepitant decreased the incidence of vomiting and was superior to ondansetron in preventing postoperative vomiting 0-48 hours after surgery.
(キーワード)
Adult / Aged / Aged, 80 and over / Databases as Topic / Demography / Humans / Middle Aged / Morpholines / Ondansetron / Postoperative Care / Postoperative Nausea and Vomiting / Retrospective Studies / Risk Factors / Young Adult
Yasuo Tsutsumi, Takuro Oyama, Nami Kakuta, YT Horikawa, Katsuyoshi Kume, Yoko Sakai, Rie Tsutsumi and Katsuya Tanaka : Effect of oral carbohydrate with amino acid solution on serum oxidative/anti-oxidative status in healthy volunteers., Journal of Anesthesia, Vol.31, No.3, 472-475, 2017.
(要約)
The aim of this work was to investigate the effect of oral carbohydrate with amino acid [oral nutritional supplement (ONS)] solution on oxidative stress in healthy persons. Fourteen healthy volunteers were segregated into control and ONS groups. Volunteers in the ONS group ingested 250 ml of Arginaid Water (Nestle Japan, Tokyo, Japan) in the evening before the experiment and at 7:00 am on the day of the experiment. Volunteers in the control group fasted after dinner and drank only water until 7:00 am on the day of the experiment. In both groups, blood was collected at 9:00 am. The serum total oxidant levels and antioxidant capacity were assessed by d-ROMs (derivatives of reactive oxygen metabolites) test and BAP (biological antioxidant potential) test, respectively. In the ONS group, the serum d-ROMs level was significantly lower than in the control group (297 ± 43 and 327 ± 41 U.CARR, respectively, p = 0.018), while the serum BAP level was significantly higher than the control group (2410 ± 432 and 1979 ± 397 µmol/l, respectively, p = 0.005). The OXY level of Arginaid Water was much higher than preOp drink (Nutricia, Ireland). In conclusion, our study showed that an ONS with arginine loading could decrease oxidative stress and increase antioxidant capacity in healthy volunteers.
Eisuke Hamaguchi, Yasuo Tsutsumi, Katsuyoshi Kume, Yoko Sakai, Nami Kakuta, Yuta Uemura, Shinji Kawahito and Katsuya Tanaka : General anesthesia of a Japanese infant with Barber-Say syndrome: a case report, JA Clinical Reports, Vol.2, No.11, 2016.
Takako Kadota, Nami Kakuta, Yousuke T. Horikawa, Rie Tsutsumi, Takuro Oyama, Katsuya Tanaka and Yasuo Tsutsumi : Plasma substance P concentrations in patients undergoing general anesthesia: an objective marker associated with postoperative nausea and vomiting, JA Clinical Reports, Vol.2, No.9, 9, 2016.
(要約)
This study investigated plasma concentrations of substance P (SP) in patients undergoing general anesthesia (GA) and postoperative nausea and vomiting (PONV). This prospective, observational, cohort study included 23 patients who underwent scheduled surgery under general anesthesia. Blood was collected from the radial artery at predetermined time points (15-30 mins prior anesthesia, 15-30 mins after surgery/GA, and 24 h after surgery). PONV, SP concentrations, risk factors, and analgesics used were measured. Nine of 23 patients experienced PONV. In patients without PONV, SP concentrations significantly decreased ( < 0.0001) at the end of surgery/GA, compared to baseline, and recovered at 24 h after surgery/GA (452.9 ± 146.2 vs. 666.9 ± 176.5 vs. 580.7 ± 168.6 pg/mL, respectively), whereas SP levels were unchanged during surgery/GA and increased at 24 hours after surgery ( = 0.020) in patients with PONV (726.1 ± 167.8 vs. 655.8 ± 168.0 vs. 779.7 ± 220.7 pg/mL, respectively). These finding suggest that SP levels may be utilized as an objective marker for PONV.
Nami Kakuta, Shinji Kawahito, Naoji Mita, Tomohiro Soga, Toshiko Katayama, Kohei Fukuta, Hiroaki Kawano, Fumihiko Tada, Yasuo M. Tsutsumi, Katsuya Tanaka, Kazumi Takaishi and Hiroshi Kitahata : Role of transesophageal echocardiography during biventricular pacemaker implantation in children, Clinical Pediatric Anesthesia, Vol.21, 182-185, 2015.
19.
Tomohiro Soga, Katsuyoshi Kume, Nami Kakuta, Eisuke Hamaguchi, Rie Tsutsumi, Ryosuke Kawanishi, Kohei Fukuta, Katsuya Tanaka and Yasuo M. Tsutsumi : Fosaprepitant versus ondansetron for the prevention of postoperative nausea and vomiting in patients who undergo gynecologic abdominal surgery with patient-controlled epidural analgesia: a prospective, randomized, double-blind study., Journal of Anesthesia, Vol.29, No.5, 696-701, 2015.
(要約)
No (0 %) patient in the NKI group experienced vomiting after surgery; however, 4-6 (20-30 %) of 20 patients in the ONS group experienced vomiting. This difference was significant at 0-24, 0-48, and 0-72 h. During the study period, no significant differences existed between the NK1 and ONS groups in the incidence of PONV, complete response rate, rescue antiemetic use, nausea score, and VAS score for pain.
Nami Kakuta, Shinji Kawahito, Naoji Mita, Noriko Kambe, Asuka Kasai, Narutomo Wakamatsu, Tosiko Katayama, Tomohiro Soga, Fumihiko Tada, Takashi Kitaichi, Tetsuya Kitagawa and Hiroshi Kitahata : Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt., The Journal of Medical Investigation : JMI, Vol.60, No.3, 4, 272-275, 2013.
(要約)
A PediaSat™ oximetry catheter (PediaSat: Edwards Lifesciences Co., Ltd., Irvine, CA, U. S. A.), which facilitates continuous measurement of central venous oxygen saturation (ScvO2), may be useful for surgery for pediatric congenital heart disease. We used PediaSat during a bidirectional Glenn shunt. The patient was a 13-month-old boy. Under a diagnosis of left single ventricle (pulmonary atresia, right ventricular hypoplasia, atrial septal defect) and residual left aortic arch/left superior vena cava, a modified right Blalock-Taussig shunt was performed. Cyanosis deteriorated, so a bidirectional Glenn shunt was scheduled. After anesthesia induction, a 4.5 Fr double-lumen (8 cm) PediaSat was inserted through the right internal jugular vein for continuous ScvO2 monitoring. Furthermore, the probe of a near-infrared, mixed blood oxygen saturation-measuring monitor was attached to the forehead for continuous monitoring of the regional brain tissue mixed blood oxygen saturation (rSO2) (INVOS™ 5100C, Covidien; Boulder, CO, U. S. A.). Blockage of the right pulmonary artery and right superior vena cava decreased the oxygen saturation, ScvO2, and rSO2, but increased the central venous pressure. Although changes in ScvO2 were parallel to those in rSO2, the former showed more marked changes. A combination of ScvO2 and rSO2 for monitoring during Glenn shunt may be safer.
(キーワード)
Blood Gas Monitoring, Transcutaneous / Catheterization, Central Venous / Fontan Procedure / Heart Defects, Congenital / Heart Ventricles / Humans / Infant / Male / Monitoring, Intraoperative / Oximetry
Tomohiro Soga, Shinji Kawahito, Nami Kakuta, Tosiko Katayama, Narutomo Wakamatsu, Kazumi Takaishi, Kunihisa Yamaguchi, Hirofumi Izaki, Hiro-omi Kanayama, Hiroshi Kitahata and Shuzo Oshita : Recent less-invasive circulatory monitoring during renal transplantation., The Journal of Medical Investigation : JMI, Vol.60, No.1, 2, 159-163, 2013.
(要約)
For anesthetic management during renal transplantation, it is necessary to maintain the blood flow and function of the transplanted kidney by performing massive fluid management and stabilizing blood pressure. We report anesthetic management for renal transplantation with a less-invasive circulatory monitoring system (Edwards Life Sciences Co., Ltd., Irvine, California, U.S.A.). In November 2010, renal transplantation was started in our hospital, and performed in 6 patients. In the first patient, fluid/circulatory management was conducted by connecting a standard arterial line and a standard central venous (CV) line. In the second patient, a FloTrac(TM) system and a standard CV line were used. In the third patient, a standard arterial line and a PreSep(TM) CV Oximetry Catheter were used. In the fourth and fifth patients, a FloTrac(TM) and a PreSep(TM) were used. In the latest patient, FloTrac(TM) and PreSep(TM) were connected to an EV1000(TM) Clinical Platform for fluid/circulatory management. The establishment of high-visibility monitors was useful for evaluating the condition and confirming the effects. As there are marked changes in hemodynamics, the CV pressure, which has been used as a parameter of fluid management, is not reliable in renal failure patients with a high incidence of cardiovascular complications. Advances in noninvasive circulatory monitoring with dynamic indices may improve the safety of anesthetic management during renal transplantation.
We describe anesthetic management of a patient with airway stenosis due to a tracheal tumor involving the carina. A 68-year-old man developed dyspnea and was scheduled for YAG laser surgery under general anesthesia. Awake fiberoptic intubation was selected for anesthesia induction, and percutaneous cardiopulmonary support (PCPS) was ready to be established prior to induction of anesthesia. Anesthesia was maintained with remifentanil (0.05 microg x kg(-1) x min(-1)) and propofol (2 mg x kg(-1) x hr(-1)), and spontaneous breathing was preserved throughout the surgical procedure. The operation was completed successfully without any adverse events, and PCPS was not used. In this patient, preservation of spontaneous breathing using remifentanil was found to be useful for airway management.
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.
We experienced anesthetic management of a patient with Becker muscular dystrophy. He had advanced dilated cardiomyopathy and high serum CK in the preoperative examinations. Anesthesia was planned to avoid triggering malignant hyperthermia or rhabdomyolysis and hemodynamic changes. Propofol, remifentanil and a minimum dose of rocuronium bromide were used for anesthetic induction and maintainance. Arterial pressure, cardiac output and stroke volume variation were monitored by Flotrac sensor. There were no adverse events observed during the anesthetic management. In conclusion, total intravenous anesthesia with the administration of rocuronium and circulatory monitoring by Flotrac sensor could be safe and efficient for anesthetic management of patients with Becker muscular dystrophy.
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.
We evaluated Disposable Crystal Laryngoscope Blades in terms of preventing infection. Most anesthesiologists were satisfied with the view offered by the Disposable Crystal Laryngoscope Blade; however more force is necessary to lift the epiglottis during intubation. It may be more difficult to use by residents, inexperienced anesthesiologist, or emergency medical technicians, although the Disposable Crystal Laryngoscope blade is useful for preventing infection.
(キーワード)
機器の汚染
(文献検索サイトへのリンク)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 20560395
Angelman syndrome is a hereditary disease described by Angelman. The clinical features of Angelman syndrome are characterized by mental retardation, puppet-like ataxia, easily excitable personality, seizures, paroxysmal laughter, strabismus and macroglossia. A 4-year-old girl with Angelman syndrome underwent strabismus repair under general anesthesia. Anesthesia was slowly induced with sevoflurane in oxygen and maintained with air, oxygen, propofol and remifentanil. Tracheal intubation was performed after administration of rocuronium. During and after anesthesia, no adverse events regarding circulatory and respiratory systems occurred. However, this case demonstrates that it is necessary to pay attention to airway troubles including the difficulty of tracheal intubation, management of body temperature and chronotropic action or respiratory depression by anesthetic agents.
(キーワード)
*Angelman症候群(合併症)
(文献検索サイトへのリンク)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 20420140
Post-operative nausea and vomiting(PONV)remains the most frequently reported patientscomplaint after anesthesia, and for patients, it is of greater concern than postoperative pain. PONVhas four main risk factors including : female gender, history of PONV or motion sickness, nonsmoking,and the use of postoperative opioids. Primary control of nausea and vomiting arises from the centralpattern generator for vomiting located in the medulla oblongara.Traditionally, the most common anti-emetics used to treat PONV include serotonin 5-hydroxytryptamine type3antagonists such as ondansetron, corticosteroids, like dexamethasone,or droperidol, which is a neuroleptic. However, these anti-emetics are not completely reliable andonly reduce the incidence of PONV by∼26%. Adding additional anti-emetics could further lowerthe incidence of PONV.PONV can result in several post-surgical complications. Neurokinin-1(NK-1)receptors are foundin gastrointenstinal vagal afferents and within the central nervous system vomiting reflex pathways.NK-1receptors are activated by Substance P, which is a regulatory peptide and preferred endogenousligand.We investigated whether NK-1antagonism can effectively diminish PONV in patients undergoinglaparoscopic gynecological surgery. Forty two patients were randomized into two groups : NK-1group which received an oral NK-1antagonist, aprepitant at80mg, and a control that did not receiveany anti-emetic. PONV incidence at2hours was present in both control and NK-1groups and was81% and52%, respectively. At24hours PONV was present in the control group, but was absentin the NK1group(27% and0%，respectively).PONV is associated with dissatisfaction after anesthesia and surgery, can result in several postsurgicalcomplications. NK-1receptor antagonism effectively lowered PONV, and expedited recoveryin patients undergoing laparoscopic gynecological surgery.
(キーワード)
post-operative nausea and vomiting / Neurokinin-1 receptor antagonism / aprepitant
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.
2.
Yuta Uemura, Nami Kakuta, Ryosuke Kawanishi and Katsuya Tanaka : Effects of administration based on muscle mass on the onset and duration of action., American Society of Anesthesiologists 2019 Annual Meeting, Orlando FL, Oct. 2019.
3.
Takuro Oyama, Yuta Uemura, Nami Kakuta, Yasuo Tsutsumi and Katsuya Tanaka : Glucose transporter-4 mediates acute isoflurane-induced preconditioning in vivo rabbits., American Society of Anesthesiologists, San Francisco, Oct. 2018.
4.
Asuka Kasai, Kouhei Fukuta, Katsuya Tanaka, Nami Kakuta and Yasuo Tsutsumi : The effect of intraoperative glucose load on metabolism in patients with diabetes mellitus., American Society of Anesthesiologists 2017 Annual Meeting, Oct. 2017.
5.
Takuro Oyama, Nami Kakuta, Asuka Kasai, Naoji Mita, Katsuyoshi Kume and Katsuya Tanaka : Effect of Jelly type carbohydrate on metabolism and evaluation of its excretion in healthy subjects., American Society of Anesthesiologists 2017 Annual Meeting, Oct. 2017.
6.
Noriko Kambe, Katsuya Tanaka, Nami Kakuta, Yasuo M. Tsutsumi and Shuzo Oshita : Short-term simvastatin administration in hyperglycemia rabbits facilitate anesthetic postconditioning., The American Society of Anesthesiologist Annual Meeting, San Francisco, Oct. 2013.
7.
Naoji Mita, Shinji Kawahito, Nami Kakuta, 久米 克佳, Kazumi Takaishi and Hiroshi Kitahata : Continuous blood glucose monitoring during cardiopulmonary bypass for children., The Annual Meeting of the American Society of Anesthesiologists, San Francisco, Oct. 2013.
8.
Naoji Mita, Shinji Kawahito, Nami Kakuta, Katsuyoshi Kume, Kazumi Takaishi and Hiroshi Kitahata : Intraoperative application of the artificial endocrine pancreas., The Annual Meeting of the American Society of Anesthesiologists, San Francisco, Oct. 2013.
9.
Shinji Kawahito, Naoji Mita, Nami Kakuta, Kazumi Takaishi and Hiroshi Kitahata : Intensive insulin therapy using an artificial pancreas during liver transplantation., --- Symposium: Artificial Pancreas: What is more sophisticated glycemic control? ---, 5th Congress of the International Federation for Artificial Organs (IFAO 2013), Yokohama, Sep. 2013.
10.
Yasuo Tsutsumi, Nami Kakuta, Hiroaki Kawano, Katsuya Tanaka and Shuzo Oshita : Neurokinin-1 receptor antagonism effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures., American Society of Anesthesiologists 2011 Annual Meeting, Chicago, Oct. 2011.