Asuka Kasai, Kouhei Fukuta, Noriko Kambe, Ryosuke Kawanishi, Nami Kakuta and Katsuya Tanaka : Effect of glucose load on metabolism in patients with type 2 diabetes during elective surgery using remifentanil-induced anesthesia: a randomized controlled trial, The Journal of Medical Investigation : JMI, 73, 1.2, 222-228, 2026.
(Summary)
This study aimed to explore the effect of intraoperative glucose load on metabolism in patients with type 2 diabetes anesthetized with remifentanil. A total of 30 patients were enrolled and randomly allocated to one of two groups:no glucose or low-dose glucose (0.1 g/kg/h for 1 hour followed by 0.05 g/kg/h for 1 hour). Glucose, adrenocorticotropic hormone, 3-methylhistidine, insulin, cortisol, free fatty acid, ketone bodies, and creatinine were measured at several points before, during, and after general anesthesia. Glucose levels in the low-dose glucose group increased significantly at 1 and 2 hours after glucose infusion compared to their preanesthetic levels and to those in the no glucose group. Two patients in the low-dose glucose group had blood glucose levels exceeding 11.1 mmol/L. Free fatty acids, ketone bodies, and 3-methylhistidine/creatinine did not differ significantly between groups. Ketone body levels were significantly higher at 1 hour than preanesthetic levels in both groups;after 1 hour, however, they did not change in the no glucose group but significantly decreased in the low-dose glucose group. Intraoperative low-dose glucose load may suppress ketogenesis, but clinicians must consider the risk of causing hyperglycemia in patients with type 2 diabetes undergoing remifentanil-induced anesthesia. J. Med. Invest. 73 : 222-228, February, 2026.
Yuki Maeda, Nami Kakuta, Asuka Kasai, Hiroki Yonezawa, Ryosuke Kawanishi and Katsuya Tanaka : Successful intraoperative management of laparoscopic hysterectomy in a patient with Eisenmenger syndrome: a case report, JA Clinical Reports, 10, 1, 2024.
(Keyword)
Eisenmenger syndrome / General anesthesia / Laparoscopic surgery
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, 16, 10, 2022.
(Summary)
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.
Kouhei Fukuta, Asuka Kasai, Noriko Niki, Yuki Ishikawa, Ryosuke Kawanishi, Nami Kakuta, Yoko Sakai, Yasuo M. Tsutsumi and Katsuya Tanaka : The effect of 1% glucose loading on metabolism in the elderly patients during remifentanil-induced anesthesia: A randomized controlled trial, BMC Anesthesiology, 20, 1, 143, 2020.
(Summary)
Previous studies showed that remifentanil-induced anesthesia can inhibit surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate fat catabolism. However, little is known about the influence of glucose loading on metabolism in elderly patients, whose condition may be influenced by decreased basal metabolism and increased insulin resistance. We hypothesized that, in elderly patients, intraoperative low glucose infusion may attenuate the catabolism of fat without causing harmful hyperglycemia during remifentanil-induced anesthesia. Elderly, non-diabetic patients scheduled to undergo elective surgery were enrolled and randomized to receive no glucose (0G group) or low-dose glucose infusion (0.1 g/kg/hr. for 1 h followed by 0.05 g/kg/hr. for 1 h; LG group) during surgery. Glucose, adrenocorticotropic hormone (ACTH), 3-methylhistidine (3-MH), insulin, cortisol, free fatty acid (FFA), creatinine (Cr), and ketone body levels were measured pre-anesthesia, 1 h post-glucose infusion, at the end of surgery, and on the following morning. A total of 31 patients (aged 75-85) were included (0G, n = 16; LG, n = 15). ACTH levels during anesthesia decreased significantly in both groups. In the LG group, glucose levels increased significantly after glucose loading but hyperglycemia was not observed. During surgery, ketone bodies and FFA were significantly lower in the LG group than the 0G group. There were no significant differences in insulin, Cr, 3-MH, and 3-MH/Cr between the two groups. Remifentanil-induced anesthesia inhibited surgical stress response in elderly patients. Intraoperative low-dose glucose infusion attenuated catabolism of fat without inducing hyperglycemia. This study has been registered with the University hospital Medical Information Network Center (http://www.umin.ac.jp/english/). UMIN000016189. The initial registration date: January 12th 2015.
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, 65, 1.2, 139-141, 2018.
(Summary)
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.
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, 2017, 5703528, 2017.
(Summary)
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.
(Keyword)
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
Shiho Satomi, Asuka Kasai, Eisuke Hamaguchi, Yasuo Tsutsumi and Katsuya Tanaka : Normothermic Cardiopulmonary Bypass in Patient with Waldenstroms Macroglobulinemia and Cryoglobulinemia: A Case Report., A & A Case Reports, 9, 6, 162-163, 2017.
(Summary)
Waldenström's macroglobulinemia (WM) manifests as hyperviscosity syndrome. Cryoglobulinemia, which may increase blood viscosity or induce thrombosis in association with decreased body temperature, can occur in combination with WM. We describe the management of an 82-year-old woman with WM, hyperviscosity syndrome, and cryoglobulinemia who required open aortic valve replacement. Decreased body temperature in this patient was prevented during cardiopulmonary bypass by using a forced air warming system and normothermic cardioplegia with continuous warm blood cardioplegia perfusion.
Katsuyoshi Kume, Yasuo Tsutsumi M, Tomohiro Soga, Yoko Sakai, Noriko Kambe, Ryosuke Kawanishi, Eisuke Hamaguchi, Tomiya Kawahara, Asuka Kasai, Yoshimi Nakaji, Yousuke Horikawa T, Souichiro Nakayama, Takashi Kaji, Minoru Irahara and Katsuya Tanaka : A case of placenta percreta with massive hemorrhage during cesarean section., The Journal of Medical Investigation : JMI, 61, 1-2, 208-212, 2014.
(Summary)
We describe a case of a 39-year-old woman diagnosed with placenta percreta complicated by massive hemorrhage during a cesarean section. At 27 weeks of gestation, she underwent an emergency cesarean section under general anesthesia for vaginal bleeding and an intrauterine infection. Soon after delivery, a massive hemorrhage was encountered while attempting to separate the placenta percreta from the bladder wall. Although total abdominal hysterectomy and partial cystectomy were performed, massive hemorrhaging persisted. Bleeding was finally controlled following bilateral internal iliac artery embolization. We used a cell salvage device and a rapid infuser for hemodynamics stabilization. Total blood loss was 47,000 mL, and anesthesia time was 12 h and 47 min. The patient was discharged on the 32(nd) postoperative day without major complications. Placenta accreta can be associated with life-threatening hemorrhage and it is vital to plan accordingly preoperatively.
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.
2.
Kouhei Fukuta, Asuka Kasai, Katsuya Tanaka, Yoko Sakai and Yasuo Tsutsumi : The Influence of Glucose Load on Metabolism in Elderly Patients During Surgery Using Remifentanil-induced Anesthesia, American Society of Anesthesiologists 2017 Annual Meeting, Oct. 2017.
3.
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.
Yoshinobu Tomiyama, Ryosuke Kawanishi, Asuka Kasai, Yuki Ishikawa and 板東 悠太郎 : Factors that influence the time from end of surgery to operating room exi, 麻酔, 67, May 2019.