Mika Nishikawa, Kazumi Takaishi, Marina Takata, Osamu Sasajima, Shigeki Fujiwara Joseph Luke, Satoru Eguchi and Shinji Kawahito : Pronounced QTc Prolongation During General Anesthesia in a Child with Left Ventricular Non-Compaction Cardiomyopathy, Anesthesia Progress, Vol.70, No.3, 137-139, 2023.
(要約)
We report the case of an 8-year-old boy with left ventricular noncompaction cardiomyopathy (LVNC) and QT prolongation who experienced further prolongation of the QTc during general anesthesia for extraction of a maxillary mesiodens. Pronounced prolongation of the QTc was observed after induction of general anesthesia with thiamylal and during emergence. No notable fluctuations in blood pressure, heart rate, and estimated continuous cardiac output were observed. We considered it likely that the QT prolongation was triggered by thiamylal and increased sympathetic nervous system activity. During general anesthesia for children with LVNC and QT prolongation, it is necessary to monitor intraoperative hemodynamic fluctuations and prepare for the possible occurrence of arrhythmias.
(キーワード)
Male / Humans / Child / Long QT Syndrome / Thiamylal / Anesthesia, General / Arrhythmias, Cardiac / Cardiomyopathies / Electrocardiography
Kazumi Takaishi, Marina Takata, Risa Aoki, Shigeki Fujiwara Joseph Luke, Shinji Kawahito and Hiroshi Kitahata : Total Intravenous Anesthesia Using Remimazolam and Continuous Cardiac Output Monitoring for Dental Anesthesia in a Patient With Takayasus Arteritis: A Case Report, A&A Practice, Vol.16, No.8, e01599, 2022.
(要約)
Takayasu's arteritis is a persistent chronic progressive inflammation of the large- and medium-caliber arteries. Controlling cardiovascular variability during anesthesia and overcoming difficulties of cardiovascular monitoring due to the impaired vessels are important in patients with Takayasu's arteritis. Remimazolam is a novel short-acting benzodiazepine with mild effects on hemodynamics. We report the case of a patient with Takayasu's arteritis who underwent oral surgery under general anesthesia. This report highlights the use of remimazolam and remifentanil to reduce hemodynamic perturbations using estimated continuous cardiac output monitoring.
Shusuke Yagi, Daiju Fukuda, Takayuki Ise, Koji Yamaguchi, Kenya Kusunose, Muneyuki Kadota, Yutaka Kawabata, Tomomi Matsuura, Tomohiro Soga, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Shinji Kawahito and Masataka Sata : Clinical clerkship students' preferences and satisfaction regarding online lectures during the COVID-19 pandemic, BMC Medical Education, Vol.22, No.1, 43, 2022.
(要約)
The COVID-19 pandemic has caused an unprecedented disruption in medical education. Students and lecturers had to adapt to online education. The current study aimed to investigate the level of satisfaction and future preference for online lectures among clinical clerkship students and elucidated the factors that affect these outcomes. We selected a sample of 114 medical students undergoing clinical clerkship during the COVID-19 pandemic. We conducted onsite lectures before the pandemic and online lectures after the outbreak. A survey was conducted, and the sample included students and 17 lecturers. The average scores of total satisfaction and future preference related to online lectures were computed. Students' scores on total satisfaction with online lectures and their future preference were higher than those for onsite lectures. Scores on the ease of debating dimension were low and those on accessibility of lectures in online lectures were higher than those in onsite lectures. There was no difference between the two groups in the scores on the comprehensibility and ease of asking questions dimensions. Results of the multiple regression analysis revealed that accessibility determined total satisfaction, and future preference was determined by comprehensibility as well as accessibility. Contrary to students' future preferences, lecturers favored onsite lectures to online ones. Online lectures are an acceptable mode of teaching during the COVID-19 pandemic for students undergoing clinical clerkship. Online lectures are expected to become more pervasive to avoid the spread of COVID-19.
(キーワード)
COVID-19 / Clinical Clerkship / Humans / Pandemics / Personal Satisfaction / SARS-CoV-2 / Students, Medical
Kazumi Takaishi, Shinji Kawahito and Hiroshi Kitahata : Management of a patient with tracheal stenosis after previous tracheotomy, Anesthesia Progress, Vol.68, No.4, 224-229, 2021.
(要約)
Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.
Kazumi Takaishi, Ryo Otsuka, Shigeki Fujiwara Joseph Luke, Satoru Eguchi, Shinji Kawahito and Hiroshi Kitahata : A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts, Anesthesia Progress, Vol.68, No.3, 168-177, 2021.
(要約)
Previously undiagnosed or asymptomatic epiglottic cysts may be coincidentally detected during intubation. This retrospective case series identified undiagnosed epiglottic cysts that were discovered during intubation in 4 patients who underwent oral surgery under general anesthesia at our hospital during a 6-year period. Including 2 additional cases, 1 previously diagnosed and 1 detected during preoperative imaging, epiglottic cysts were observed in 6 of 1112 cases (0.54%) total. Among the undiagnosed epiglottic cyst cases, mild dyspnea on effort or snoring was reported in 2 patients, but all others were asymptomatic. Upon discovering previously undiagnosed epiglottic cysts during intubation, it is essential to proceed cautiously, remain alert for potential airway management difficulties, and avoid injuring or rupturing the cysts. In addition, any available preoperative imaging should be reviewed as information pertinent to the airway and any abnormalities may be useful. This report discusses the anesthetic care of 6 patients with epiglottic cysts that were previously known or initially discovered during intubation.
Kazumi Takaishi, Yasusei Kudo, Shinji Kawahito and Hiroshi Kitahata : Clinically relevant concentration of propofol and benzodiazepines did not affect in vitro angiogenesis., Journal of Anesthesia, Vol.35, No.6, 870-878, 2021.
(要約)
Angiogenesis, one of regenerative medicine, is essential in the process of wound healing. The detailed effects of intravenous anesthetics and sedatives used during perioperative period have not yet been clarified. We investigated the effects of benzodiazepines and propofol on in vitro capillary tube formation. The effects of midazolam, diazepam and propofol (1, 10, 50 M each) on proliferation of human umbilical vein endothelial cells (HUVEC) and normal human diploid fibroblasts (NHDF) were determined. Quantitation of migration was achieved by measuring the fluorescence of migrating HUVEC using angiogenesis system. The effects of midazolam, diazepam and propofol on in vitro angiogenesis were investigated in co-cultured HUVEC and NHDF incubated. The effects of midazolam on activation of p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinases were examined by Western blot analysis using phospho-specific antibodies. Parametric data were analyzed with one-way repeated measures analysis of variance followed by the Scheff test. A value of P < 0.05 was considered statistically significant. Fifty M of midazolam significantly impaired endothelial cell proliferation, migration, and in vitro capillary tube formation. Propofol, diazepam or lower dose midazolam did not show any enhancing or suppressive effects on in vitro angiogenesis. Fifty M of midazolam remarkably activated ERK, but not p38 MAPK in HUVEC. Propofol and benzodiazepines except high-dose midazolam did not affect in vitro angiogenesis. High-dose midazolam may impair in vitro capillary tube formation due to by suppressing proliferation and migration of endothelial cells via activation of ERK.
Kazumi Takaishi, Hiroyuki Kinoshita, Shingo Kawashima and Shinji Kawahito : Human Vascular Smooth Muscle Function and Oxidative Stress Induced by NADPH Oxidase with the Clinical Implications, Cells, Vol.10, No.8, 1947, 2021.
(要約)
<jats:p>Among reactive oxygen species, superoxide mediates the critical vascular redox signaling, resulting in the regulation of the human cardiovascular system. The reduced form of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase, NOX) is the source of superoxide and relates to the crucial intracellular pathology and physiology of vascular smooth muscle cells, including contraction, proliferation, apoptosis, and inflammatory response. Human vascular smooth muscle cells express NOX1, 2, 4, and 5 in physiological and pathological conditions, and those enzymes play roles in most cardiovascular disorders caused by hypertension, diabetes, inflammation, and arteriosclerosis. Various physiologically active substances, including angiotensin II, stimulate NOX via the cytosolic subunits' translocation toward the vascular smooth muscle cell membrane. As we have shown, some pathological stimuli such as high glucose augment the enzymatic activity mediated by the phosphatidylinositol 3-kinase-Akt pathway, resulting in the membrane translocation of cytosolic subunits of NOXs. This review highlights and details the roles of human vascular smooth muscle NOXs in the pathophysiology and clinical aspects. The regulation of the enzyme expressed in the vascular smooth muscle cells may lead to the prevention and treatment of human cardiovascular diseases.</jats:p>
Kazumi Takaishi, Hiroyuki Kinoshita, Guo-Gang Feng, Toshiharu Azma, Shinji Kawahito and Hiroshi Kitahata : Cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle, Journal of Pharmacological Sciences, Vol.144, No.4, 197-203, 2020.
(要約)
The role of cytoskeleton dynamics in the oxidative stress toward human vasculature has been unclear. The current study examined whether the cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle. All experiments in the human omental arteries without endothelium or the cultured human coronary artery smooth muscle cells were performed in d-glucose (5.5 mmol/L). The exposure toward d-glucose (20 mmol/L) for 60 min reduced the relaxation or hyperpolarization to an ATP sensitive K channel (KATP) opener levcromakalim (10 to 3 × 10 mol/L and 3 × 10 mol/L, respectively). Cytochalasin B and a superoxide inhibitor Tiron, restored them similarly. Cytochalasin B reduced the NADPH oxidase activity, leading to a decrease in superoxide levels of the arteries treated with high d-glucose. Also, cytochalasin B impaired the F-actin constitution and the membrane translocation of an NADPH oxidase subunit p47phox in artery smooth muscle cells treated with high d-glucose. A clinical concentration of cytochalasin B prevented human vascular smooth muscle malfunction via the oxidative stress caused by high glucose. Regulation of the cytoskeleton may be essential to keep the normal vascular function in patients with hyperglycemia.
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.
Shusuke Yagi, Robert Zheng, Seiichi Nishiyama, Yutaka Kawabata, Takayuki Ise, Kosuke Sugiura, Haruhiko Yoshinari, Toshihiko Nishisho, Yoshimi Bando, Kumiko Kagawa, Daiju Fukuda, Tomohiro Soga, Yoshihito Saijoh, Kenya Kusunose, Koji Yamaguchi, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Shinji Kawahito, Masashi Akaike and Masataka Sata : Osteolytic primary bone lymphoma in the multiple bones, The Journal of Medical Investigation : JMI, Vol.66, No.3,4, 347-350, 2019.
(要約)
Primary non-Hodgkin bone lymphoma (PBL) can involve solitary or multiple destructive bone lesions such as those of the femur or pelvis humerus, and some cases have osteolytic lesions. PBL is a rare disease in adults. Thus, PBL is rarely considered a differential diagnosis of the osteolytic tumor. In addition, PBL can be underdiagnosed because patients do not experience symptoms or show objective abnormalities in the early stage. Here, we reported an elderly patient with PBL in multiple bones, including the cranial and femoral bones that were fractured due to falling. J. Med. Invest. 66 : 347-350, August, 2019.
Shusuke Yagi, Itsuro Endo, Taichi Murakami, Tetsuya Hida, Yousuke Yamamoto, Tomohiro Soga, Takayuki Ise, Kenya Kusunose, Koji Yamaguchi, Daiju Fukuda, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Shinji Kawahito and Masataka Sata : Adult onset of Immunoglobulin A vasculitis - A case report,, The Journal of Medical Investigation : JMI, Vol.66, No.3,4, 344-346, 2019.
(要約)
Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, primarily occurs during childhood between the ages of 3 and 15 years and is the most common form of systemic vasculitis in children ; its occurrence in adults has been rarely reported. Such low incidence could be attributable to either under-diagnosis or misdiagnosis. Thus, not only pediatricians but also physicians should be able to diagnose IgAV accurately to manage the patients appropriately and avoid its associated complications. In addition, treatment of adult onset IgAV with renal involvement has not been fully established yet. We describe here a case of adult onset IgAV complicated by proteinuria and pharyngitis, which was cured by no specific treatment. J. Med. Invest. 66 : 344-346, August, 2019.
(キーワード)
Acetaminophen / Adult / Factor XIII / Humans / Immunoglobulin A / Male / Pharyngitis / Proteinuria / Purpura, Schoenlein-Henoch
Hiroyuki Kinoshita, Shinji Kawahito and Kazumi Takaishi : The unique action of nicorandil on cerebral circulation., Journal of Anesthesia, Vol.32, No.3, 462, 2018.
Kazumi Takaishi, Shinji Kawahito, Shigeki Fujiwara Joseph Luke and Hiroshi Kitahata : Nasotracheal intubation through pharyngeal flap after pharyngeal flap construction., Journal of Clinical Anesthesia, Vol.44, 121-122, 2018.
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.
Toshiharu Azma, Saori Ogawa, Akira Nishioka, Hiroyuki Kinoshita, Shinji Kawahito, Hiroshi Nagasaka and Nobuyuki Matsumoto : Involvement of superoxide generated by NADPH oxidase in the shedding of procoagulant vesicles from human monocytic cells exposed to bupivacaine, Journal of Thrombosis and Thrombolysis, Vol.44, No.1, 341-354, 2017.
(要約)
It is known that a variety of sized procoagulant vesicles that express tissue factor are released from several types of cells including monocytes by mechanisms related to the induction of apoptosis, while it has not yet been evaluated whether superoxide is involved in the production of such vesicles. Here, we report that a local anesthetic bupivacaine induces apoptosis in human monocytic cells THP-1 within a short observation period, where the shedding of procoagulant vesicles is associated. The property as procoagulant vesicles was evaluated using flow cytometry by the binding of FITC-conjugated fibrinogen to vesicles in the presence of fresh frozen plasma and the suppression of this binding by heparin. Bupivacaine (1 mg/ml) increased the apoptotic cells and procoagulant vesicles. LY294002 (100 µM), that inhibits the recruiting of intracellular component of NADPH oxidase to construct the activated form of this enzyme complex, or superoxide dismutase (1500 unit/ml) suppressed bupivacaine-provoked induction of apoptosis and the increase of procoagulant vesicles. We suggest that this simple experimental system is useful to explore the molecular mechanisms of action of superoxide in the shedding of procoagulant vesicles from human monocytic cells.
Shinji Kawahito, Tomohiro Soga, Naoji Mita, Shiho Satomi, Hiroyuk Kinoshita, Tomoko Arase, Akira Kondo, Hitoshi Miki, Kazumi Takaishi and Hiroshi Kitahata : Successful treatment of mixed (mainly cancer) pain by tramadol preparations, The Journal of Medical Investigation : JMI, Vol.64, No.3,4, 311-312, 2017.
(要約)
The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache. Because this pain could not be controlled by an increase to eight combination tablets per day, we switched her medication to a tramadol capsule. At 11 months post-surgery, we then switched her medication to an orally disintegrating tramadol tablet to improve medication adherence of the drug. From 14 months post-surgery, the patient also used a sustained-release tramadol preparation, and she was then able to sleep well. Her current regimen is an orally disintegrating sustained-release tablet combination (total 300 mg tramadol) per day, and she achieved sufficient pain relief. Because tramadol is not classified as a medical narcotic drug, it widely available and was shown here to be extremely useful for the treatment of our patient's mixed (mainly cancer) pain. J. Med. Invest. 64: 311-312, August, 2017.
Naoji Mita, Shinji Kawahito, Tomohiro Soga, Kazumi Takaishi, Hiroshi Kitahata, Munehide Matsuhisa, Mitsuo Shimada, Kinoshita Hiroyuki, Yasuo Tsutsumi and Katsuya Tanaka : Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative acute kidney injury, Journal of Artificial Organs, Vol.20, No.1, 76-83, 2017.
(要約)
The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19). After the induction of anesthesia, a 20-G intravenous catheter was inserted into the peripheral forearm vein of patients in the programmed insulin group and connected to an artificial endocrine pancreas (STG-55). The target range for glucose concentrations was set to 100-150 mg/dL. The mean serum creatinine concentrations of preoperative, postoperative 24 and 48 h were 0.72, 0.78, and 0.79 mg/dL in the programmed insulin group, and 0.81, 0.95, and 1.03 mg/dL in the manual insulin group, respectively. Elevations in serum creatinine concentrations postoperative 48 h were significantly suppressed in the programmed insulin group. The STG-55 closed-loop system was effective for maintaining strict blood glucose control during hepatectomy with minimal variability in blood glucose concentrations and for suppressing elevations in serum creatinine concentrations. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative AKI.
(キーワード)
Acute Kidney Injury / Aged / Aged, 80 and over / Blood Glucose / Creatinine / Female / Hepatectomy / Humans / Insulin / Insulin Infusion Systems / Japan / Male / Middle Aged / Pancreas, Artificial / Postoperative Complications / Treatment Outcome
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.
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.
36.
Noriko Kambe, Shinji Kawahito, Naoji Mita, Kazumi Takaishi, Tosiko Katayama, Yoko Sakai, Tomohiro Soga, Hiroaki Kawano, Munehide Matsuhisa, Mitsuo Shimada, Tetsuya Kitagawa and Hiroshi Kitahata : Impact of newly developed, next-generation artificial endocrine pancreas, The Journal of Medical Investigation : JMI, Vol.62, No.1-2, 41-44, 2015.
(要約)
Recent studies have shown that strict perioperative blood glucose management may reduce mortality and morbidity in critically ill adult patients. The purpose of this study was to assess the accuracy and efficacy of the intraoperative application of a newly developed, next-generation artificial endocrine pancreas (STG-55, Nikkiso Co., Ltd., Tokyo, Japan). Twenty patients scheduled to undergo surgery were enrolled in this study. The STG-55 is designed to be more user-friendly than its conventional counterpart (STG-22) while maintaining the latter's fundamental functions, such as a closed-loop system using algorithms for insulin and glucose infusion. After anesthetic induction, a 20G intravenous catheter was inserted into a peripheral forearm vein and connected to a continuous blood glucose monitor. The resultant 105 scores for paired blood glucose values were compared by Bland-Altman analysis. Stable blood glucose values were maintained automatically, and there were no complications related to use of the STG-55. A close correlation (r=0.96) was observed between continuous glucose measurements using the STG-55 and conventional intermittent glucose measurements. The difficulty of manipulation using this system was decreased by improved preparation procedures. The glycemic control system using the STG-55 could provide an alternative way to achieve effective and safe perioperative glycemic control.
Abstract Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.
Yoko Sakai, Shinji Kawahito, Kazumi Takaishi, Naoji Mita, Hiroyuki Kinoshita, Noboru Hatakeyama, Toshiharu Azma, Yutaka Nakaya and Hiroshi Kitahata : Propofol-induced relaxation of rat aorta is altered by aging., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 278-284, 2014.
(要約)
Propofol causes vasodilation via endothelium-dependent and -independent mechanisms. Because endothelial function is impaired with aging, the effects of propofol on endothelium-dependent vasodilation might be altered by aging. The aim of this study was thus to determine the effects of aging on vascular responses to propofol. Young (4-6 weeks old) or adult (16-25 weeks old) rats were anesthetized with sevoflurane. The thoracic aorta was dissected and cut into pieces 3-4 mm in length. In some rings, the endothelium was deliberately removed. The ring segment of the aorta was mounted for isometric force recording at a resting tension of 0.5-1.0 g in a 2 ml organ bath, containing Krebs-Ringer bicarbonate buffer. Arteries were precontracted with phenylephrine, and the function of endothelium was confirmed with acetylcholine. Then, we studied the concentration-dependent effects of propofol in endothelium-intact (control group) and -denuded aortic rings (denuded group), as well as those treated with N()-nitro-L-arginine methylester (L-NAME group). Relaxation due to propofol was observed in the control groups of both young and adult rats in a concentration-dependent manner, but the magnitude of relaxation was significantly greater in young rats. In addition, in young rats, relaxation due to propofol was significantly and equally reduced in both L-NAME and denuded groups at all propofol concentrations that we studied (10(-6)-10(-3) M). In adult rats, relaxation due to propofol was quite similar between control and L-NAME groups at all propofol concentrations, whereas it was significantly reduced in the denuded group. These results suggest that endothelium-derived nitric oxide plays an important role in propofol-induced vasodilation in young rats, but not in adult rats. J. Med. Invest. 61: 278-284, August, 2014.
Kayo Hirose, Shinji Kawahito, Naoji Mita, Kazumi Takaishi, Tomiya Kawahara, Tomohiro Soga, Toshiko Katayama, Satoru Imura, Yuji Morine, Tetsuya Ikemoto, Mitsuo Shimada, Munehide Matsuhisa and Hiroshi Kitahata : Usefulness of artificial endocrine pancreas during resection of insulinoma., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 421-425, 2014.
(要約)
A 71-year-old woman had an episode of syncope due to hypoglycemia of 27 mg/dl. She was diagnosed with insulinoma and scheduled for laparoscopic enucleation along with the use of an artificial endocrine pancreas (STG-22, Nikkiso Co., Ltd., Tokyo, Japan). Anesthesia was maintained with sevoflurane and remifentanil. Her blood glucose level was controlled using the artificial endocrine pancreas, which enabled continuous blood glucose monitoring and computer-operated glucose and insulin infusion to maintain the blood glucose level at a steady state. The target concentration of blood glucose was set at 80-120 mg/dl during surgery. Until removal of the tumor, the blood glucose level was kept at around 80-100 mg/dl. After removal of the tumor, the blood glucose level gradually increased, but it was kept in the normal range by the artificial endocrine pancreas. The artificial endocrine pancreas was useful to monitor and maintain blood glucose levels during and after the removal of insulinoma, without any hyper- or hypoglycemia. J. Med. Invest. 61: 421-425, August, 2014.
Ito Taishin, Azma Toshiharu, Ogawa Saori, Kinoshita Hiroyuki, Shinji Kawahito and Matsumoto Nobuyuki : Flow cytometric analysis for shedding of procoagulant particles provoked by calcium influx through the cell membrane in human monocytic cells, Experimental & Clinical Cardiology, Vol.20, No.7, 1862-1885, 2014.
Toshiharu Azma, Florin Tuluc, Taishin Ito, Chikako Aoyama-Mani, Shinji Kawahito and Hiroyuki Kinoshita : Mechanisms of action of anesthetics for the modulation of perioperative thrombosis: evidence for immune machanisms from basic and clinocal studies, Current Pharmaceutical Design, Vol.20, No.36, 5779-5793, 2014.
(要約)
Thrombotic events occurring in either arteries or veins are the primary causes of fatal perioperative cardiovascular events. Risk factors for deep vein thrombosis, several of which are evidently associated with specific surgical procedures, are quite different from those for arterial thrombosis (e.g., aging or atherosclerotic diseases). Thrombus formed in arteries consists mainly of platelets coated with fibrin (i.e., white thrombus), while venous thrombus formed at relatively lower shear stress consists of all blood components including erythrocytes as well as leukocytes infiltrated with fibrin (red thrombus). Clinical evidence indicates beneficial roles of neuraxial anesthesia/analgesia in the prevention of VTE for patients undergoing high risk surgical procedures. To date, mechanisms of action of drugs used for neuraxial anesthesia/analgesia to prevent venous thrombosis are uncertain. However, accumulation of clinical as well as experimental findings points to the involvement of immune cells (especially monocytes) in red thrombus generation and to the interaction of anesthetics with these cells. We also suggest that adhesion molecules associated with the formation of monocyte platelet aggregates as well as substance P: neurokinin-1 receptor (SP/NK1R) pathway that involves neurogenic inflammation are crucial. Local anesthetics and NK1R antagonists are candidate drugs that may possess the capability to prevent venous thrombotic disorders in perioperative settings.
Shinji Kawahito, Nakahata Katsutoshi, Azma Toshiharu, Yasuhiro Kuroda, Cook J David and Kinoshita Hiroyuki : Protective effects of anesthetics on vascular function related to K+ channels, Current Pharmaceutical Design, Vol.20, No.36, 5727-5737, 2014.
(要約)
K(+) channels play an essential role in the membrane potential of arterial smooth muscle, and also in regulating contractile tone. Especially, in vascular smooth muscle, the opening of adenosine triphosphate (ATP)-sensitive K(+) (KATP) channels leads to membrane hyperpolarization, resulting in muscle relaxation and vasodilation. This activation also plays a role in tissues during pathophysiologic events such as ischemia, hypoxia, and vasodilatory shock. In this review, we will describe the physiological and pathophysiological roles of vascular smooth muscle KATP channels in relation to the effects of anesthetics. Although accumulated evidence suggests that many anesthetics modify the above function of K(+) channels as a metabolic sensor, further studies are certainly needed to resolve certain issues, especially in clinical settings of anesthesia use.
Kazumi Takaishi, Shinji Kawahito, Hirotsugu Yamada, Takeshi Soeki, Masataka Sata and Hiroshi Kitahata : Increase in prominence of electrocardiographic J waves after a single dose of propofol in a patient with early ventricular repolarisation., Anaesthesia, Vol.69, No.2, 170-175, 2014.
(要約)
J waves appear on an electrocardiogram as an elevation of the J point in the terminal portion of the QRS complex. J waves are often benign, but may be associated with malignant ventricular arrhythmias. In some cases, such problems appear to have been precipitated by propofol infusions. We observed a sudden increase in J waves and profound hypotension following a single intravenous dose of propofol in an 84-year-old woman with early repolarisation in the inferior ventricular wall. When early repolarisation (as shown by electrocardiographic J waves) is observed in the inferior ventricular wall pre-operatively, patients should be carefully monitored. Myocardial ischaemia and the use of drugs that might worsen J waves should be avoided.
Hirose Kayo, Hirose Masao, Katsuya Tanaka, Shinji Kawahito, Toshiaki Tamaki and Shuzo Oshita : Perioperative management of severe anorexia nervosa., British Journal of Anaesthesia, Vol.112, No.2, 246-254, 2013.
(要約)
As the prevalence of anorexia nervosa (AN) increased, surgery in severe AN patients also increased in the 2000s. We experienced a surgical case of a patient with severe AN, showing an extremely low BMI of 8.6 kg m(-2). We investigated the problems associated with this case and propose criteria to manage severe AN. We endeavour to report on the perioperative management of rare and severe symptoms and surgical indications of severely malnourished patients. All published reports were identified through comprehensive searches using PubMed, BioMedLib, and the Japan Medical Abstracts Society with the following terms and keywords: 'anorexia nervosa', 'eating disorder', 'hypoglycaemia', 'leucocytopaenia', 'gelatinous bone marrow', 'surgery', and 'operation'. In cases of AN with a BMI under 13 kg m(-2), marked hypoglycaemia, leucocytopaenia <3.0×10(9) litre(-1), or both, potentially fatal complications frequently occur. Accordingly, patients need strict nutritional support to avoid re-feeding syndrome until surgery. During the course of anaesthesia, careless loading of glucose or catecholamine may lead to disturbance of electrolytes or fatal arrhythmia. Intensive care and early feeding as soon as possible after surgery are important to prevent surgical site infection. Although not many perioperative cases of AN have been reported, clinicians must be aware of the danger and the causes of mortality in critical cases. Thus, the decision to undertake surgery must be taken carefully and close perioperative coordination among physicians, surgeons, psychiatrists, anaesthesiologists, and intensivists is essential.
Shinji Kawahito, Seiichi Higuchi, Naoji Mita, Tetsuya Kitagawa and Hiroshi Kitahata : Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit., Journal of Artificial Organs, Vol.16, No.4, 508-509, 2013.
(要約)
We tried to perform continuous blood glucose monitoring during cardiovascular surgery involving cardiopulmonary bypass using an artificial endocrine pancreas (STG-22 or -55; Nikkiso, Tokyo, Japan); however, we often encountered problems during these procedures because insufficient blood was obtained for monitoring. Thus, we started performing the blood sampling via the venous side of the cardiopulmonary bypass circuit. As a result, continuous blood glucose monitoring using an artificial endocrine pancreas was proven to be stable and reliable during cardiovascular surgery involving cardiopulmonary bypass.
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
Kazumi Takaishi, Hiroshi Kitahata and Shinji Kawahito : Local anesthetics inhibit nitric oxide production and l-arginine uptake in cultured bovine aortic endothelial cells., European Journal of Pharmacology, Vol.704, No.1-3, 58-63, 2013.
(要約)
Previous studies have shown that local anesthetics have various effects on nitric oxide (NO) production, but the mechanisms remain unclear. The purpose of this study was to evaluate the effects of local anesthetics on NO production and 2-amino-5-guanidinopentanoic acid (l-arginine) uptake in one cell line. Cultured bovine aortic endothelial cells (BAEC) were stimulated with bradykinin and/or acetylcholine to activate endothelial NO synthase (NOS). BAEC were also incubated with interleukin-1β and lipopolysaccharide to stimulate inducible NOS. NO production was measured with the rapid spectrophotometric method, and l-arginine uptake was measured with high performance liquid chromatography. To assess the effects of local anesthetics, NO production and l-arginine uptake were measured in the presence or absence of procaine or lidocaine. NO was produced in BAEC stimulated with bradykinin and acetylcholine or interleukin-1β and lipopolysaccharide, but NO production was not affected by the addition of superoxide dismutase. In the cells stimulated with bradykinin and acetylcholine, 10 μM each of procaine and lidocaine significantly inhibited NO production by 35% and 20%, respectively. In the cells incubated with interleukin-1ß and lipopolysaccharide, the same quantities of procaine and lidocaine significantly inhibited NO production by 15% and 10%, respectively. Both procaine and lidocaine significantly suppressed l-arginine uptake in BAEC stimulated with either bradykinin/acetylcholine or interleukin-1β/lipopolysaccharide. It is suggested that inhibitory effects of procaine and lidocaine on NO production are partially due to suppression of l-arginine uptake.
(キーワード)
Anesthetics, Local / Animals / Aorta / Arginine / Cattle / Cells, Cultured / Endothelial Cells / Lidocaine / Nitric Oxide / Nitric Oxide Synthase Type II / Nitric Oxide Synthase Type III / Procaine
T Minonishi, H Kinoshita, M Hirayama, Shinji Kawahito and T Azma : The supine to prone position change induces modification of endotracheal tube cuff pressue accompanied by the tube displacement, Journal of Clinical Anesthesia, Vol.25, No.1, 28-31, 2013.
(要約)
To determine whether the supine-to-prone position change displaced the endotracheal tube (ETT) and, if so, whether the displacement related to this change modified ETT cuff pressure. Prospective study. Operating room of a university hospital. 132 intubated, adult, ASA physical status 1, 2, and 3 patients undergoing lumbar spine surgery. After induction of anesthesia, each patient's trachea was intubated. The insertion depth of each ETT was 23 cm for men and 21 cm for women at the upper incisors. In the supine position and after the supine-to-prone position change with the head rotated to the right, the length from the carina to ETT tip and ETT cuff pressure were measured. After the supine-to-prone position change, 91.7% patients had ETT tube displacement. Of these, 48% of patients' ETT moved ≥ 10 mm, whereas 86.3% of patients had changes in tube cuff pressure. There was a slight but significant correlation between ETT movement and change in cuff pressure. Depending on the position change, ETT cuff pressure decreased and the ETT tended to withdraw. After the supine-to-prone position change, patients had ETT tube displacement. Such ETT movement may be accompanied by a decrease in cuff pressure.
(キーワード)
Aged / Anesthesia, General / Female / Head Movements / Hoarseness / Humans / Intubation, Intratracheal / Lumbar Vertebrae / Male / Middle Aged / Motion / Patient Positioning / Pharyngitis / Postoperative Complications / Pressure / Prone Position / Prospective Studies / Supine Position
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.
Tsuyoshi Okada, Shinji Kawahito, Naoji Mita, Munehide Matsuhisa, Hiroshi Kitahata, Mitsuo Shimada and Shuzo Oshita : Usefulness of continuous blood glucose monitoring and control for patients undergoing liver transplantation., The Journal of Medical Investigation : JMI, Vol.60, No.3-4, 205-212, 2013.
(要約)
The STG-22 closed-loop system is effective for maintaining strict blood glucose control during liver transplantation with minimal variability in blood glucose concentration.
Dexmedetomidine is reported to have an effect on peripheral vasoconstriction; however, the exact mechanisms underlying this process are unclear. In this study, we hypothesized that dexmedetomidine-induced inhibition of vascular ATP-sensitive K(+) (K(ATP)) channels may be associated with this vasoconstriction. To test this hypothesis, we investigated the effects of dexmedetomidine on vascular K(ATP)-channel activity at the single-channel level. We used cell-attached and inside-out patch-clamp configurations to examine the effects of dexmedetomidine on the activities of native rat vascular K(ATP) channels, recombinant K(ATP) channels with different combinations of various inwardly rectifying potassium channels (Kir6.0 family: Kir6.1, 6.2) and sulfonylurea receptor subunits (SUR1, 2A, 2B), and SUR-deficient channels derived from a truncated isoform of Kir6.2 subunit, namely, Kir6.2ΔC36 channels. Dexmedetomidine was observed to inhibit the native rat vascular K(ATP) channels in both cell-attached and inside-out configurations. This drug also inhibited the activity of all types of recombinant SUR/Kir6.0 K(ATP) channels as well as Kir6.2ΔC36 channels with equivalent potency. These results indicate that dexmedetomidine directly inhibits K(ATP) channels through the Kir6.0 subunit.
Shinji Kawahito, Takashi Kawano, Hiroshi Kitahata, Jun Oto, Akira Takahashi, Kazumi Takaishi, Nagakatsu Harada, Tadahiko Nakagawa, Hiroyuki Kinoshita, Toshiharu Azma, Yutaka Nakaya and Shuzo Oshita : Molecular mechanisms of the inhibitory effects of clonidine on vascular adenosine triphosphate-sensitive potassium channels., Anesthesia & Analgesia, Vol.113, No.6, 1374-1380, 2011.
(要約)
We investigated the effects of the imidazoline-derived α2-adrenoceptor agonist clonidine on vascular adenosine triphosphate-sensitive potassium (K(ATP)) channel activity in rat vascular smooth muscle cells and recombinant vascular K(ATP) channels transiently expressed in COS-7 cells. Using the patch-clamp method, we investigated the effects of clonidine on the following: (1) native vascular K(ATP) channels; (2) recombinant K(ATP) channels with different combinations of various types of inwardly rectifying potassium channel (Kir6.0 family: Kir6.1, 6.2) and sulfonylurea receptor (SUR1, 2A, 2B) subunits; (3) SUR-deficient channels derived from a truncated isoform of the Kir6.2 subunit (Kir6.2ΔC36 channels); and (4) mutant Kir6.2ΔC36 channels with diminished sensitivity to ATP (Kir6.2ΔC36-K185Q channels). Clonidine (≥3 × 10(-8) M) inhibited native K(ATP) channel activity in cell-attached configurations with a half-maximal inhibitory concentration value of 1.21 × 10(-6) M and in inside-out configurations with a half-maximal inhibitory concentration value of 0.89 × 10(-6) M. With similar potency, clonidine (10(-6) or 10(-3) M) also inhibited the activities of various recombinant SUR/Kir6.0 K(ATP) channels, the Kir6.2ΔC36 channel, and the Kir6.2ΔC36-K185Q channel. Clinically relevant concentrations of clonidine inhibit K(ATP) channel activity in vascular smooth muscle cells. This inhibition seems to be the result of its effect on the Kir6.0 subunit and not on the SUR subunit.
Hiroaki Kawano, E Hamaguchi, Shinji Kawahito, Yasuo Tsutsumi, Katsuya Tanaka, Hiroshi Kitahata and Shuzo Oshita : Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-D-aspartate receptor antibodies., Anaesthesia, Vol.66, No.6, 515-518, 2011.
(要約)
Paraneoplastic limbic encephalitis associated with ovarian teratoma has recently been related to the development of antibodies to specific heteromers of the N-methyl-d-aspartate receptor and exhibits various manifestations including psychiatric symptoms, hypoventilation, seizures and derangement of autonomic nervous system function. Although recovery can sometimes occur spontaneously, early tumour resection with immunotherapy facilitates earlier recovery. Herein, we describe anaesthetic management of a 20-year-old woman who developed general convulsions and decreased level of consciousness, whom we suspected of having paraneoplastic limbic encephalitis and was scheduled for left ovarian tumour resection. Anaesthetic management was successful with no complications but the case acts as focus of discussion for the potential interaction of N-methyl-D-aspartate receptors and anaesthetic sensitivity.
Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with Wolff-Parkinson-White (WPW) syndrome. We report the perioperative management of 3 patients (a 34-year-old man, a 5-month-old boy and a 5-year-old girl) with Ebstein's anomaly associated with WPW syndrome. Anesthetic managements for valvuloplasty of the tricuspid valve and ablation of accessory pathway in 3 patients were successfully accomplished with a combination of fentanyl, sevoflurane, and midazolam. The management of Ebstein's anomaly is based on its severity. The major concerns with anesthesia for children with Ebstein's anomaly include decreased cardiac output, right-to-left atrial level shunting with cyanosis, and the propensity for atrial tachyarrhythmias. We conclude that perioperative management of arrhythmia and evaluation of residual tricuspid regurgitation using transesophageal echocardiography are essential.
Hiroshi Kitahata, Junpei Nozaki, Shinji Kawahito, Takehito Tomino and Shuzo Oshita : Low-dose sevoflurane inhalation enhances late cardioprotection from the anti-ulcer drug geranylgeranylacetone., Anesthesia & Analgesia, Vol.107, No.3, 755-761, 2008.
(要約)
We investigated in rabbits whether sevoflurane enhances late cardioprotection induced by geranylgeranylacetone (GGA), a gastric antiulcer drug. S(+)-ketamine and xylazine-anesthetized rabbits were assigned to one of seven experimental groups: a control (vehicle only) group, a GGA group, a sevoflurane group, a GGA+sevoflurane group, a sodium 5-hydroxydecanoate (5HD) group, a GGA + 5HD group, and a heat stress group. All rabbits were subjected to 30 min of coronary artery occlusion followed by 3 h of reperfusion. Rabbits were pretreated with IV vehicle, GGA (10 mg/kg), or heat stress (42 degrees C for 15 min) 24 h before coronary occlusion. Sevoflurane (0.5 minimum alveolar concentration) or 5HD (5 mg/kg) were administered before myocardial ischemia. Myocardial infarct size and the area at risk for ischemia were measured, and heat shock protein (Hsp) 70 levels in each experimental group were determined. Compared with vehicle only, GGA significantly reduced the size of myocardial infarction in relation to the area at risk (39 +/- 10% vs 59 +/- 9%, P < 0.02). Sevoflurane enhanced the GGA-induced cardioprotection (23 +/- 17%, P < 0.05 vs GGA). The cardioprotective effect of GGA was abolished by administration of 5HD (56 +/- 15%, P < 0.01). GGA enhanced Hsp 70 expression compared with that in the control group (0.69 +/- 0.15 vs 0.36 +/- 0.05, P < 0.02). Administration of GGA with sevoflurane resulted in the same level of Hsp 70 expression as GGA (0.69 +/- 0.16, P > 0.98). GGA appears to reduce myocardial infarct size in association with increased Hsp 70 expression. Sevoflurane enhances the GGA-induced cardioprotective effect.
(キーワード)
Administration, Inhalation / Animals / Anti-Ulcer Agents / Cardiotonic Agents / Coronary Vessels / Diterpenes / Drug Synergism / HSP70 Heat-Shock Proteins / Hemodynamics / Male / Methyl Ethers / Myocardial Infarction / Protein Kinase C / Rabbits / Time Factors
Nitta Kazuhito, Shinji Kawahito, Hiroshi Kitahata, Junpei Nozaki, Tosiko Katayama and Shuzo Oshita : Two unusual complications associated with cardiopulmonary bypass for pediatric cardiac surgery detected by transesophageal echocardiography after decannulation., Paediatric Anaesthesia, Vol.18, No.4, 325-329, 2008.
(要約)
We describe two rare cases of complications associated with cannulation for cardiopulmonary bypass during pediatric cardiac surgery detected by transesophageal echocardiography (TEE). The first patient (a 20-month-old boy, 11 kg) was scheduled for complete repair of an atrial septal defect and partial anomalous pulmonary venous connection. After decannulation of the superior vena cava, a mosaic jet was observed by means of TEE. The second patient (an 11-month-old boy, 6.4 kg), with a double outlet right ventricle, was scheduled for a hemi-Fontan procedure. After decannulation of the ascending aorta, high blood flow velocity of 4 m x s(-1) was detected by TEE. Intraoperative TEE was useful for early detection of complications associated with cardiopulmonary bypass cannulation during pediatric cardiac surgery.
Shinji Kawahito, Hiroshi Kitahata, Tetsuya Kitagawa, Shuzo Oshita and Nose Yukihiko : Non-cardiac surgery applications of extracorporeal circulation, The Journal of Medical Investigation : JMI, Vol.54, No.3,4, 200-210, 2007.
(要約)
Although the efficacy of extracorporeal circulation (ECC) is well established for open-heart surgery, application of ECC in other surgical areas has not been given much attention. Advances in the related surgical technique and anesthetic management combined with refinements in the ECC procedure itself have encouraged several institutions to use ECC for complex non-cardiac surgeries. ECC is beginning to be used for circulatory support or tissue oxygenation during surgery on the lung, brain, liver, and kidney as well as in emergency situations. With ECC, difficult and complex surgeries can be performed more safely, and the success rate of certain surgeries has been positively affected. It is important that the surgeon, anesthesiologist, and perfusionist are trained in non-cardiac surgery applications of ECC. Thus, we review here non-cardiac uses that have emerged and summarize the related procedures.
Nakamura Akiyo, Shinji Kawahito, Takashi Kawano, Nazari Hossein, Akira Takahashi, Hiroshi Kitahata, Yutaka Nakaya and Shuzo Oshita : Differential Effects of Etomidate and Midazolam on Vascular Adenosine Triphosphate-sensitive Potassium Channels: Isometric Tension and Patch Clamp Studies., Anesthesiology, Vol.106, No.3, 515-522, 2007.
(要約)
The aim of this study was to investigate the effects of two imidazoline-derived intravenous anesthetics, etomidate and midazolam, on vascular adenosine triphosphate-sensitive potassium (KATP) channel activity. In isolated rat aorta, isometric tension was recorded to examine the anesthetic effects on vasodilator response to levcromakalim, a selective KATP channel opener. Using the patch clamp method, the anesthetic effects were also examined on the currents through (1) native vascular KATP channels, (2) recombinant KATP channels with different combinations of various types of inwardly rectifying potassium channel (Kir6.0 family: Kir6.1, 6.2) and sulfonylurea receptor (SUR1, 2A, 2B) subunits, (3) SUR-deficient channels derived from a truncated isoform of Kir6.2 subunit (Kir6.2DeltaC36 channels), and (4) mutant Kir6.2DeltaC36 channels with reduced sensitivity to adenosine triphosphate (Kir6.2DeltaC36-K185Q channels). Etomidate (> or = 10 m), but not midazolam (up to 10 m), inhibited the levcromakalim-induced vasodilation, which was sensitive to glibenclamide (IC50: 7.21 x 10 m; maximum inhibitory concentration: 1.22 x 10 m). Etomidate (> or = 3 x 10 m), but not midazolam (up to 10 m), inhibited the native KATP channel activity in both cell-attached and inside-out configurations with IC50 values of 1.68 x 10 m and 1.52 x 10 m, respectively. Etomidate (10 m) also inhibited the activity of various types of recombinant SUR/Kir6.0KATP channels, Kir6.2DeltaC36 channels, and Kir6.2DeltaC36-K185Q channels with equivalent potency. Clinical concentrations of etomidate, but not midazolam, inhibit the KATP channel activity in vascular smooth muscle cells. The inhibition is presumably through its effects on the Kir6.0 subunit, but not on the SUR subunit, with the binding site different from adenosine triphosphate at the amino acid level.
Katsuya Tanaka, Takashi Kawano, Akiyo Nakamura, Hossein Nazari, Shinji Kawahito, Shuzo Oshita, Akira Takahashi and Yutaka Nakaya : Isoflurane activates sarcolemmal adenosine Triphosphate-sensitive potassium channels in vascular smooth muscle cells: A role of protein kinase A, Anesthesiology, Vol.106, No.5, 984-991, 2007.
(要約)
Recent evidence indicates that vascular adenosine triphosphate-sensitive potassium (K(ATP)) channels in vascular smooth muscle cells are critical in the regulation of vascular tonus under both physiologic and pathophysiologic conditions. Studies of the interaction of volatile anesthetics with vascular K(ATP) channels have been limited. In the current study, the authors investigated the molecular mechanism of isoflurane's action on vascular K(ATP) channels. Electrophysiologic experiments were performed using cell-attached and inside-out patch clamp techniques to monitor native vascular K(ATP) channels, and recombinant K(ATP) channels comprised of inwardly rectifying potassium channel subunits (Kir6.1) and the sulfonylurea receptor (SUR2B). Isometric tension experiments were performed in rat thoracic aortic rings without endothelium. Application of isoflurane (0.5 mM) to the bath solution during cell-attached recordings induced a significant increase in K(ATP) channel activity, which was greatly reduced by pretreatment with a selective inhibitor of protein kinase A (PKA), Rp-cAMPS (100 microM). In inside-out patches, isoflurane did not activate K(ATP) channels. Isoflurane significantly activated wild-type recombinant SUR2B/Kir6.1 in cell-attached patches. Isoflurane-induced activation of wild-type channels was diminished in the PKA-insensitive mutant SUR2B-T633A/Kir6.1, SUR2B-S1465A/Kir6.1, and SUR2B/Kir6.1-S385A. In addition, the authors demonstrated that isoflurane-induced PKA activation was associated with isoflurane-induced decreases in isometric tension in the rat aorta. These results indicate that isoflurane activates K(ATP) channels via PKA activation. PKA-dependent vasodilation induced by isoflurane also was observed in isometric tension experiments. Analysis of expressed vascular-type K(ATP) channels suggested that PKA-mediated phosphorylation of both Kir6.1 and SUR2B subunits plays a pivotal role in isoflurane-induced vascular K(ATP) channel activation.
Stent graft implantation for thoracic descending aorta is a promising alternative to open repair. Transesophageal echocardiography (TEE) is a sensitive imaging modality for aortic disease. We reviewed our experience with TEE in stent graft implantation for thoracic descending aorta. Five patients underwent stent graft implantation for thoracic descending aorta under general anesthesia. Intraoperative angiography and TEE were used to identify the extent of the aneurysm and the placement of the stent. TEE showed stent graft configuration and presence of leakage in all cases. In three cases, additional stent graft placement or bypass was performed. Useful information was obtained by TEE in enhancing the accuracy of stent graft positioning potentially improving outcomes. TEE may facilitate repair by confirming aortic pathology, identifying endograft placement, and assessing the adequacy of aneurysm sack isolation, presence of leakage, as well as dynamic intraoperative cardiac performance.
A 3-month-old boy with Pena-Shokeir syndrome underwent tracheotomy under general anesthesia. Patients with this syndrome may present anesthetic problems involving difficulties in tracheal intubation, possibilities of malignant hyperthermia, as well as perioperative respiratory complications related to hypoplasia of the lung. General anesthesia was induced and maintained with sevoflurane (2-3%) and nitrous oxide (0-50%) in oxygen (50-100%). The patient developed bronchospasm during tracheotomy. Atropine and epinephrine were administered intravenously and 5% sevoflurane was inhaled. The bronchospasm was improved gradually and surgery was successfully finished. Pena-Shokeir syndrome is an uncommon disease first reported by Pena & Shokeir in 1974 and characterized by congenital multiple arthrogryposis, characteristic facies, camptodactyly and pulmonary hypoplasia. In the perioperative management for a patient with Pena-Shokeir syndrome, special attention should be paid to abnormalities in the upper and lower respiratory systems, especially bronchospasm.
Mikiko Inatsugi, Katsuya Tanaka, Hiroshi Kitahata, Junpei Nozaki, Shinji Kawahito and Shuzo Oshita : Minute distance obtained from pulmonary venous flow velocity using transesophageal pulsed Doppler echocardiography is related to cardiac output during cardiovascular surgery, The Journal of Medical Investigation : JMI, Vol.52, No.3,4, 178-185, 2005.
(要約)
We studied the relationship between minute distance calculated from pulmonary venous flow (PVF) velocity tracing and cardiac output (CO) measured with thermodilution method in patients undergoing cardiovascular surgery. In 32 patients undergoing cardiovascular surgery, simultaneous measurements of hemodynamics including CO and transesophageal pulsed Doppler signals of PVF velocity were performed before and after surgical repair. Minute distance was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF. The minute distance after surgical intervention increased from 1121 +/- 347 cm x sec(-1) to 1764 +/- 538 cm x sec(-1) (p < 0.001; mean +/- SD), while CO increased after surgical intervention from 3.5 +/- 0.9 L x min(-1) to 5.3 +/- 1.1 L x min(-1). Simple linear regression analysis showed that minute distance was related with CO before and after surgical intervention (r = 0.81 and r = 0.76, respectively). The changes in minute distance were also related with those in CO (r = 0.80). The present study demonstrated that minute distance obtained from the pulsed Doppler tracings of PVF velocity was related with CO during cardiovascular surgery in adults. These results suggest that the changes in CO could be estimated from minute distance in pulmonary vein.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Risk factors for perioperative myocardial ischemia in carotid artery endarterectomy., Journal of Cardiothoracic and Vascular Anesthesia, Vol.18, No.3, 288-292, 2004.
(要約)
To identify variables associated with perioperative myocardial ischemia in patients undergoing carotid artery endarterectomy (CEA). Prospective, observational study. University-affiliated hospital operating room and intensive care unit. One hundred twenty-eight consecutive patients who underwent CEA during a 7-year period. Patients had general anesthesia with sevoflurane or isoflurane. CEA was performed by standard methods with shunting if clinically indicated. Holter electrocardiogram (ECG) monitoring was performed during surgery and 24 hours after surgery. The incidence of perioperative myocardial ischemia was examined, and perioperative risk factors were analyzed. Nineteen patients (15%) showed significant perioperative ECG abnormalities indicative of myocardial ischemia (10 patients during surgery, 12 patients after surgery, and 3 patients both during and after surgery). Multivariate analysis showed perioperative myocardial ischemia to be significantly associated with a history of angina (odds ratio, 11.68; 95% confidence interval, 2.64-51.70) and a history of hypertension (odds ratio, 14.08; 95% confidence interval, 1.51-131.04). The data indicate that perioperative myocardial ischemia defined as an ECG abnormality does not often occur in patients undergoing CEA. However, angina and hypertension may be important risk factors warranting further investigation.
Katsuya Tanaka, Hiroshi Kitahata, Shinji Kawahito, Junpei Nozaki, Yoshinobu Tomiyama and Shuzo Oshita : Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot., Canadian Journal of Anaesthesia, Vol.50, No.9, 926-929, 2003.
(要約)
Although it has been reported that the increase in blood pressure improves arterial oxygen saturation (SaO(2)) in children with tetralogy of Fallot, no prospective study has demonstrated that an increase in blood pressure induces an increase in pulmonary blood flow in these patients. The purpose of this study was to see whether a phenylephrine-induced increase in systemic blood pressure increased pulmonary blood flow, resulting in improved arterial oxygenation in tetralogy of Fallot. In 14 consecutive children with tetralogy of Fallot (2-32 months old), transesophageal pulsed Doppler signals of left upper pulmonary venous flow (PVF) velocity were recorded before and four minutes after 10 micro g x kg(-1) of phenylephrine i.v. Simultaneously, arterial blood gas analysis and hemodynamic measurements were performed. The minute distance (MD) was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF. Phenylephrine iv increased mean arterial blood pressure from 54 +/- 8 mmHg to 73 +/- 10 mmHg. This phenylephrine-induced hypertension significantly increased SaO(2) and MD (92.0 +/- 7.5 vs 95.0 +/- 5.0% and 1318 +/- 344 vs 1533 +/- 425 cm x min(-1), respectively). There was a significant correlation (r = 0.72) between the change in MD and the change in SaO(2). Our results suggest that the phenylephrine-induced increase in systemic blood pressure produces an increase in pulmonary blood flow in tetralogy of Fallot. Our results further suggest that this increase in pulmonary blood flow is involved in the mechanism of phenylephrine-induced improvement of arterial oxygenation in tetralogy of Fallot.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Intraoperative transoesophageal echocardiography in a low birth weight neonate with atrioventricular septal defect., Paediatric Anaesthesia, Vol.13, No.8, 735-738, 2003.
(要約)
An 18-day-old male neonate (45 cm, 1.8 kg) with a history of cyanosis and congestive heart failure from an atrioventricular septal defect (AVSD) with a large left-to-right shunt was scheduled for surgical repair of the AVSD. After routine induction of anaesthesia with fentanyl and vecuronium, a 4.5-mm diameter transoesophageal echocardiography (TOE) probe was inserted into the oesophagus, and systematic echocardiographic evaluation was performed during surgery. After cardiopulmonary bypass was stopped, intraoperative TOE revealed mild residual mitral valve regurgitation. Because good left ventricular wall motion was confirmed and haemodynamic parameters were stable, cardiopulmonary bypass was not reinitiated. The patient's cardiac output was low in the postoperative intensive care unit. TOE was performed the next day to detect the source of this problem, revealed severe regurgitation compared with that observed intraoperatively. TOE was useful for evaluation of the residual mitral valve regurgitation, and we reconfirmed the importance of continuous monitoring even in a low birthweight neonate undergoing repair of a complete AVSD.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Dynamic QRS-complex and ST-segment monitoring by continuous vectorcardiography during carotid endarterectomy., British Journal of Anaesthesia, Vol.90, No.2, 142-147, 2003.
(要約)
Many authors report a high incidence of cardiac events during carotid endarterectomy. The aim of the present study was to evaluate the usefulness of dynamic continuous on-line vectorcardiography for monitoring the occurrence of myocardial ischaemia during carotid endarterectomy. We studied 21 patients undergoing carotid endarterectomy. Patients underwent general anaesthesia with isoflurane or sevoflurane. The vectorcardiogram was monitored continuously during carotid endarterectomy. Electrodes were placed according to the previously described lead system and connected to a computerized system for on-line vectorcardiography. Two trend variables were recorded: the QRS vector difference, which reflects changes in the shape of the QRS complex; and the ST vector magnitude, which represents deflection of the ST segment from the isoelectric level. The ST segment deflection was measured 60 ms after termination of the QRS complex. Vectorcardiography was successfully recorded in all 21 patients. Three patients showed intraoperative vectorcardiogram abnormalities. In one of these three patients, both ST vector magnitude and QRS vector difference increased after induction of anaesthesia and ST vector magnitude returned to baseline after administration of nitroglycerin. In the other two patients, both ST vector magnitude and QRS vector difference gradually increased after cross-clamping of the internal carotid artery and ST vector magnitude returned to baseline after unclamping. QRS vector difference remained elevated for several hours in all three patients. Monitoring ST vector magnitude and QRS vector difference by vectorcardiography may be useful for identifying myocardial ischaemia during carotid endarterectomy.
Junpei Nozaki, Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito and Shuzo Oshita : Effects of acute normovolemic hemodilution on ventriculoarterial coupling in dogs., Acta Anaesthesiologica Scandinavica, Vol.47, No.1, 46-52, 2003.
(要約)
Acute normovolemic hemodilution (ANH) causes a decrease in systemic vascular resistance. Similar to vasodilating drugs, ANH might modify ventriculoarterial coupling. Left ventricular elastance (Ees), effective arterial elastance (Ea), stroke work (SW), and pressure volume area (PVA) were used as indicators to examine the effects of ANH on this coupling. After institutional approval eight dogs were anesthetized with isoflurane and subjected to measurements including aortic pressure, left ventricular (LV) pressure, and LV volume. Left ventricular volume was measured with a conductance catheter. Ees was determined as the slope of the end-systolic pressure-volume relationship. Ea was determined as the ratio of LV end-systolic pressure to stroke volume. Ventriculoarterial coupling was evaluated as the ratio of Ees to Ea. Mechanical efficiency, another criterion for ventriculoarterial coupling, was calculated as the ratio of SW to PVA. Data are expressed as mean+/-SD, and P<0.05 was considered significant. Normovolemic exchange of 50 ml kg-1 of blood for 6% hydroxyethyl starch (ANH50) reduced hemoglobin concentration from 12.8+/-3.0 g dl-1 to 6.4+/-1.3 g dl-1. Acute normovolemic hemodilution 50 did not change Ees significantly although it significantly decreased Ea. Left ventricular elastance/Ea did not change after ANH (1.0+/-0.4 at baseline and 1.2+/-0.5 at ANH50). Acute normovolemic hemodilution 50 significantly increased SW and PVA, preventing SW/PVA from changing significantly after ANH (0.57+/-0.10 at baseline and 0.62+/-0.14 at ANH50). Before ANH, ventriculoarterial coupling was so matched as to maximize SW at the expense of the work efficiency. This relation was preserved at ANH50.
(キーワード)
Algorithms / Anesthesia / Animals / Arteries / Blood Gas Analysis / Blood Pressure / Blood Volume / Dogs / Elasticity / Female / Heart / Hemodilution / Male / Stroke Volume / Ventricular Function / Ventricular Function, Left
Junpei Nozaki, Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito and Shuzo Oshita : The effects of acute normovolemic hemodilution on left ventricular systolic and diastolic function in the absence or presence of beta-adrenergic blockade in dogs., Anesthesia & Analgesia, Vol.94, No.5, 1120-1126, 2002.
(要約)
Acute normovolemic hemodilution (ANH) increases cardiac output because of a reduction in blood viscosity and enhancement of left ventricular (LV) contractility. The status of LV function, especially LV diastolic function during ANH, remains controversial. We therefore examined LV systolic and diastolic function during ANH. Sixteen dogs were anesthetized with isoflurane in the absence (Group 1) and presence (Group 2) of beta-adrenergic blockade (propranolol 1 mg/kg). LV contractility was quantified by the slope (M(w)) of the stroke work and end-diastolic volume relation. Diastolic function was evaluated with the time constant of LV relaxation (T), chamber stiffness constant (K(c)), peak LV diastolic filling rate during early filling (peak E) and atrial contraction (peak A), and ratio of peak E to peak A (E/A). Normovolemic exchange of blood (50 mL/kg) for 6% hydroxyethyl starch (ANH50) significantly increased M(w) in Group 1 but not in Group 2. In both groups, ANH50 significantly decreased T. ANH50 significantly increased peak E in both groups and peak A in Group 1, and it did not change the E/A ratio or K(c) in either group. ANH causes positive inotropic effects and enhances diastolic function without beta-blockade. Even after beta-adrenergic blockade, ANH improves diastolic function through the reduction of LV ejection impedance. IMPLICATIONS: Acute normovolemic hemodilution enhances LV (left ventricular) diastolic function by alterations in the LV loading condition produced by hemodilution, which mainly contributes to a compensatory increase in cardiac output.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Pulmonary arterial pressure can be estimated by transesophageal pulsed Doppler echocardiography., Anesthesia & Analgesia, Vol.92, No.6, 1364-1369, 2001.
(要約)
We examined whether pulmonary arterial pressure can be estimated on the basis of pulmonary arterial flow velocity determined via intraoperative pulsed Doppler transesophageal echocardiography (TEE) in 20 patients undergoing cardiac surgery. Standard pulmonary artery measurements were taken as well. Measurements were taken before sternotomy, after pericardiotomy, after cardiopulmonary bypass, and after sternum closure. The variables obtained by TEE included preejection period (PEP), acceleration time (AT), right ventricular ejection time (RVET), and R-R interval (RR). Five ratios were calculated as indices of pulmonary arterial pressure--PEP/AT, PEP/RVET, AT/RVET, PEP/ square root of RR, and AT/ square root of RR--and were compared with pulmonary artery catheterization findings, i.e., systolic pulmonary arterial pressure (sPAP), log sPAP, mean PAP (mPAP), and log mPAP. Before sternotomy, PEP/AT, PEP/ square root of RR, and AT/ square root of RR showed significant correlation with all pulmonary artery catheterization values. AT/RVET showed correlation with all pulmonary artery values except log mPAP. PEP/AT showed the closest correlation with sPAP (r = 0.771) and log sPAP (r = 0.789). PEP/AT also showed close correlation with mPAP (r = 0.764) and log mPAP (r = 0.777). Significant agreement between sPAP and mPAP values calculated from a regression equation and values measured via pulmonary artery catheter was observed by plotting the differences against the mean values of the two measurements. We therefore conclude that noninvasive estimation of pulmonary arterial pressure is feasible via intraoperative TEE when sternotomy is not involved.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Intraoperative evaluation of pulmonary artery flow during the Fontan procedure by transesophageal Doppler echocardiography., Anesthesia & Analgesia, Vol.91, No.6, 1375-1380, 2000.
(要約)
After the Fontan procedure, pulmonary artery (PA) flow is maintained without right ventricular pump function. We evaluated intraoperative PA flow velocity patterns using transesophageal Doppler echocardiography (TEE) immediately after cardiopulmonary bypass (CPB) in patients during Fontan or hemi-Fontan procedures. We studied 10 patients with single-ventricle physiology (age range, 5 mo to 3 yr 1 mo). Anesthesia was induced and maintained with fentanyl. After induction of anesthesia, a pediatric TEE probe was inserted into the esophagus. All patients had surgical repair involving direct anastomosis of the right atrium to the PA. Immediately after completion of CPB, adequacy of the atriopulmonary anastomosis was assessed and PA flow velocity was recorded. In all patients, the atriopulmonary anastomosis was clearly defined using a single-plane TEE probe, and PA flow recording was completed successfully. Intraoperative PA flow velocities showed two distinct patterns. Biphasic forward flows with peak velocities during systole and diastole were observed in six patients. The remaining four patients showed forward flows with flow reversals. The four patients demonstrating flow reversals showed significantly reduced fractional shortening (26.5+/-2.1% vs. 35.5+/-6.3%) and larger pressure gradient between the right atrium and left atrium (10.8+/-1.3 mm Hg vs 8.0+/-0.9 mm Hg) when compared to those without reverse flow. Two patients with reverse flow required reoperation because of hypotension. Because PA flow is influenced by pulmonary vascular resistance and left ventricular function, TEE assessed intraoperative PA flow should be further evaluated as a useful predictor of surgical outcome after a Fontan procedure.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Transesophageal echocardiographic assessment of pulmonary arterial and venous flow during high-frequency jet ventilation., Journal of Clinical Anesthesia, Vol.12, No.4, 308-314, 2000.
(要約)
To evaluate high-frequency jet ventilation (HFJV) effects on pulmonary arterial and venous flow compared to those of intermittent positive-pressure ventilation (IPPV) by using pulsed Doppler transesophageal echocardiography. Prospective clinical study. University-affiliated hospital operating room.Patients: 13 ASA physical status I and II patients undergoing lower abdominal or lower extremity surgery. Patients had total IV anesthesia with propofol and fentanyl. After anesthesia induction, a transesophageal echocardiography probe was inserted into the esophagus. IPPV (TV, 8-10 mL/kg; respiratory rate, 10-12 cycles/min; I/E ratio, 1:2; FIO(2), 1.0) and HFJV (driving pressure, 0.5-0.6 kgf/cm(2); frequency,3 Hz; I/E ratio, 1:1; FIO(2), 1.0) were performed under hemodynamically stable conditions. Pulmonary-arterial-flow velocity, pulmonary-venous-flow velocity, left ventricular short-axis view, and airway-pressure curve were recorded simultaneously. Parameters measured were: hemodynamic variables, arterial blood gases, inspiratory airway pressure; [from pulmonary-arterial-flow velocity] pre-ejection period (PEP), acceleration time (AT), right ventricular ejection time (RVET), and their ratios (PEP/AT, AT/RVET); [from pulmonary-venous-flow velocity] time-velocity integral of the first systolic wave (S1), second systolic wave (S2), and diastolic wave (D), and systolic fraction (integral S1 + S2/S1+ S2 + D); [from M-mode] left-ventricular-end systolic volume, left-ventricular-end diastolic volume (LVEDV), stroke volume, cardiac output, and ejection fraction, using Teichholz's method. Peak inspiratory airway pressure during HFJV was significantly lower than that during IPPV. HFJV significantly decreased PEP/AT, correlating positively with pulmonary arterial pressure, and significantly increased AT and AT/RVET, correlating negatively with pulmonary arterial pressure. Systolic fraction, correlating negatively with left atrial pressure, increased significantly during HFJV, as did LVEDV, stroke volume, cardiac output, and ejection fraction. Our results suggest that, in comparison to IPPV, HFJV significantly decreases pulmonary arterial pressure and left atrial pressure, resulting in significant increases in cardiac output and ejection fraction in healthy anesthetized adults.
Yoshiaki Hirose, Hideyuki Kimura, Hiroshi Kitahata, Shinji Kawahito and Shuzo Oshita : Nitric oxide does not play a major role in the regulation of systemic hemodynamic responses to acute normovolemic hemodilution., Acta Anaesthesiologica Scandinavica, Vol.44, No.1, 96-100, 2000.
(要約)
The mechanisms of cardiovascular changes following acute normovolemic hemodilution (ANH) have not been fully elucidated. We tested the hypothesis that inhibition of nitric oxide synthesis attenuates ANH-induced cardiovascular responses. We observed the effects of N(omega)-nitro-L-arginine methyl ester (L-NAME) pretreatment on ANH-induced cardiovascular responses and compared these effects with those elicited by phenylephrine (PHE). Twenty dogs anesthetized with isoflurane were divided into two groups: one group was pretreated with L-NAME and the other with PHE. Both groups were normovolemically hemodiluted using 6% hydroxyethyl starch to reduce the hemoglobin concentration to approximately 50% of the pretreatment value. Pretreatment with either L-NAME or PHE caused a significant increase in mean aortic blood pressure (MAP) and systemic vascular resistance (SVR) with a significant decrease in cardiac output (CO) and stroke volume (SV). However, no remarkable differences in these variables were seen between groups. In both groups ANH produced increases in heart rate, CO, SV, and maximal left ventricular dP/dt with a significant decrease in SVR. No significant differences in these variables were apparent after ANH except that MAP was decreased in the PHE group but not in the L-NAME group. Our results suggest that nitric oxide does not play a major role in mediation or modulation of the systemic vascular responses to ANH.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura, Katsuya Tanaka and Shuzo Oshita : Recurrent laryngeal nerve palsy after cardiovascular surgery, --- Relationship to the placement of a transesophageal echocardiographic probe ---, Journal of Cardiothoracic and Vascular Anesthesia, Vol.13, No.5, 528-531, 1999.
(要約)
To examine the relationship between the incidence of recurrent laryngeal nerve palsy after cardiovascular surgery and the placement of a transesophageal echocardiographic probe. A prospective clinical study. A single-institutional study in a university hospital. One hundred sixteen patients undergoing cardiovascular surgery. All patients were assigned into one of two groups: 64 patients in whom transesophageal echocardiography (TEE) was performed and 52 patients in whom TEE was not performed during surgery. The incidence of recurrent laryngeal nerve palsy was examined and compared between the two groups. Five of 64 patients (7.8%) in whom TEE was monitored and 3 of 52 patients (5.8%) in whom TEE was not monitored were diagnosed with recurrent laryngeal nerve palsy postoperatively. There was no statistically significant difference between the incidence of recurrent laryngeal nerve palsy in patients with intraoperative TEE monitoring, and patients without it. The durations of surgery, anesthesia, and cardiopulmonary bypass were significantly longer in patients with nerve palsy than those without it. These results suggest that placement of the transesophageal echocardiographic probe is not responsible for postoperative recurrent laryngeal nerve palsy. It seems likely that surgical manipulation itself and the durations of surgery, cardiopulmonary bypass, and tracheal intubation are related to the incidence of laryngeal nerve palsy.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura, Katsuya Tanaka and Shuzo Oshita : Autotransfusion performed on a patient with cis AB blood group., British Journal of Anaesthesia, Vol.83, No.3, 491-492, 1999.
(要約)
Cis AB blood group is a rare variant of the AB blood group resulting from inheritance of both A and B genes on one chromosome. It may lead to misclassification in ABO grouping and clinical misdiagnosis as a result of its divergence from the laws of Landsteiner and Mendel. We encountered a case of cis AB blood group, and we found that autotransfusion was useful during surgery in this patient with a rare blood group.
(キーワード)
ABO Blood-Group System / Blood Transfusion, Autologous / Female / Humans / Hysterectomy / Intraoperative Care / Middle Aged
(文献検索サイトへのリンク)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 10655930
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Pulmonary hemodynamics, --- Intraoperative assessment with transesophageal Doppler echocardiography ---, Critical Care International, Vol.9, No.4, 10-12, 1999.
87.
Hiroshi Kitahata, Katsuya Tanaka, Hideyuki Kimura, Shinji Kawahito and Shuzo Oshita : The feasibility of gastrothoracic ventricular pacing during transesophageal echocardiography., Anesthesia & Analgesia, Vol.89, No.1, 21-25, 1999.
(要約)
We evaluated whether ventricular pacing is possible using pacing electrodes attached to a transesophageal echocardiography (TEE) probe in 20 patients undergoing elective cardiovascular surgery. A bipolar pacing lead was fixed with silicone adhesive anteriorly to the TEE probe with the distal electrode 25 mm from the TEE probe tip. The TEE probe was positioned to obtain a transgastric short-axis view of the left ventricle. The distal or proximal electrode on the TEE probe was the cathode; the chest electrode placed at the V5 lead position was the anode. Gastrothoracic ventricular pacing (GVP) was performed at 100 bpm at 30- or 50-ms pulse duration. Transgastric ventricular pacing (TVP) was also attempted using both TEE probe electrodes alternately as cathode/anode. Maximal generator output was 32 mA. GVP with the distal electrode as cathode was successful in 75% and 80% of patients at 30- and 50-ms pulse durations and 23.3+/-5.8 mA and 22.6+/-5.8 mA threshold currents, respectively. However, success rates (20% and 25%, respectively) were significantly lower with the proximal electrode as cathode using the same pulse durations and 14.4+/-5.3 mA and 16.7+/-6.8 mA threshold currents. The TVP success rate was significantly lower than that for GVP. With optimization, this system could become an available technique for intraoperative emergency ventricular pacing. Using an endocardial pacing lead attached to a transesophageal echocardiography probe, gastrothoracic ventricular pacing can be performed successfully without complications in 75%-80% of patients undergoing cardiovascular surgery.
Hiroshi Kitahata, Shinji Kawahito, Junpei Nozaki, Hideyuki Kimura, Katsuya Tanaka, Tetsuya Kitagawa and Shuzo Oshita : effects of sevoflurane on regional myocardial blood flow distribution, --- Quantification with myocardial contrast echocardiography ---, Anesthesiology, Vol.90, No.5, 1436-1445, 1999.
(要約)
Using myocardial contrast echocardiography, the authors tried to determine whether sevoflurane causes myocardial blood maldistribution in humans and dogs. In animal experiments, 15 mongrel dogs were organized into dipyridamole (n = 6) and sevoflurane (n = 9) groups. Sonicated albumin was infused into the left main coronary artery. The peak gray level corrected for background was analyzed at the following intervals: (1) at baseline, (2) after stenosis of the left circumflex coronary artery (blood flow reduced by 40%), (3) after administration of dipyridamole (1 mg/kg given intravenously) or sevoflurane (1 minimum alveolar concentration) during stenosis, and (4) after phenylephrine during stenosis and administration of dipyridamole or sevoflurane. In human studies, nine patients undergoing coronary artery bypass grafting were studied. During partial extracorporeal circulation, the peak gray level was analyzed before and 20 min after sevoflurane (1 minimum alveolar concentration). In animal experiments, dipyridamole decreased significantly the inner:outer ratio of the peak gray level in the ischemic area and the ischemic:normal ratio of the peak gray level. After arterial pressure was restored with phenylephrine, neither the inner:outer ratio nor the ischemic:normal ratio improved. In contrast, after sevoflurane administration, the inner:outer ratio and the ischemic:normal ratio remained unchanged, but these increased with phenylephrine. In human studies, sevoflurane did not change the inner:outer ratio in the area supplied by the most stenotic coronary artery. These results suggest that dipyridamole, a potent coronary vasodilator, produces maldistribution of coronary blood flow in our dog models, whereas sevoflurane does not do this in animal or human studies.
Katsuya Tanaka, Hiroshi Kitahata, Shinji Kawahito, Hideyuki Kimura and Shuzo Oshita : Simultaneous transesophageal echocardiography and atrial pacing for intraoperative management of mitral regurgitation., Anesthesiology, Vol.90, No.1, 305-308, 1999.
91.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura, Katsuya Tanaka, Yoko Sakai, Yoshiaki Hirose and Shuzo Oshita : Anaesthetic management of a patient with Williams syndrome undergoing aortoplasty for supravalvular aortic stenosis., Canadian Journal of Anaesthesia, Vol.45, No.12, 1203-1206, 1998.
(要約)
A case of a patient associated with Williams syndrome undergoing aortoplasty for supravalvular aortic stenosis is presented. Williams syndrome is a rare disease associated with a characteristic facies, supravalvular aortic stenosis, and mental retardation. A 15-yr-old girl with Williams syndrome underwent aortoplasty for supravalvular aortic stenosis. Anaesthesia was induced with fentanyl and thiamylal, and maintained with nitrous oxide, oxygen, sevoflurane, and continuous intravenous infusion of fentanyl. Supravalvular aortic stenosis was evaluated using a multiplane transesophageal echocardiography (TEE) probe before and after repair. Multiplane TEE was found to be very useful for anaesthetic management in a patient with Williams syndrome undergoing aortoplasty for supravalvular aortic stenosis.
Katsuya Tanaka, Shuzo Oshita, Hiroshi Kitahata, Hideyuki Kimura, Shinji Kawahito, Y-C Park and Takeshi Sakabe : Effects of nicardipine on ventriculo-arterial coupling in humans., British Journal of Anaesthesia, Vol.81, No.2, 180-185, 1998.
(要約)
The ratio of effective arterial elastance (Ea) to left ventricular elastance (Ees) is an indicator of the coupling between ventricular properties and arterial load properties. Another criterion for the coupling between an energy source and its load is the principle of economical fuel consumption, or mechanical efficiency, which is defined as the ratio of stroke work (SW) to myocardial oxygen consumption per beat (MVO2). It has been revealed that SW of ventricular contraction is maximized when Ea/Ees = 1, while mechanical efficiency is maximized when Ea/Ees = 0.5. The purpose of the present study was to investigate the ventriculo-arterial coupling during hypertension, and the effects of nicardipine on this relationship in surgical patients using Ea/Ees and SW/MVO2 as indicators. Anaesthesia was maintained with isoflurane, nitrous oxide, and fentanyl. Radial artery pressure was displayed on a polygraph, and left ventricular end-systolic and end-diastolic volumes were determined by use of transoesophageal echocardiography. Ees was calculated as MAP/(ESVI-4), where MAP is mean arterial pressure and ESVI is end-systolic volume index. Ea was calculated as the ratio of MAP to stroke volume index (SVI). Stroke work index (SWI) was calculated as the product of MAP and SVI. MVO2 was assessed by estimating the ventricular pressure-volume area index (PVAI), which is expressed as the sum of SWI and the end-systolic potential energy index. Before (baseline), and 3, 10, 20, and 30 min after i.v. nicardipine (30 micrograms kg-1), Ea/Ees and SWI/PVAI were determined in 14 surgical patients with intraoperative hypertension. Before nicardipine (during hypertension), Ea was almost equal to Ees, whereas Ea/Ees was significantly reduced to about 0.5-0.6 at 3, 10, and 20 min after nicardipine. SWI/PVAI was maximized and significantly greater than the baseline value at 3 min after nicardipine. These results suggest that, during hypertension, ventricular and arterial properties were so matched as to maximize SW at the expense of the work efficiency, whereas mechanical efficiency of ventricular contraction was maximized after nicardipine.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura, Arifumi Kohyama and Takao Saito : A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction., Journal of Anesthesia, Vol.9, No.4, 370-373, 1995.
Potassium channels play an essential role in the membrane potential of arterial smooth muscle, and also in regulating contractile tone. Especially, in vascular smooth muscle, the opening of adenosine triphosphate(ATP)-sensitive potassium(KATP)channels leads to membrane hyperpolarization, resulting in muscle relaxation and vasodilation. This activation also plays a role in tissues during pathophysiologic events such as ischemia, hypoxia, and vasodilatory shock. In this review, we will describe the physiological and pathophysiological roles of vascular smooth muscle KATP channels in relation to the effects of anesthetics and perioperative managements. Although accumulated evidence suggests that many anesthetics and perioperative managements(especially, diabetes and hyperglycemia)modify the above function of K+ channels as a metabolic sensor. Use of effective volatile anesthetics and the strict glycemic control may contribute to protect perioperative vascular function.
Shinji Kawahito, Hiroshi Kitahata, Tetsuya Kitagawa and Shuzo Oshita : Intensive insulin therapy during cardiovascular surgery., The Journal of Medical Investigation : JMI, Vol.57, No.3-4, 191-204, Aug. 2010.
(要約)
Recent evidence in the fields of surgery, emergency and critical care medicine indicates that strict glycemic control results in lower mortality. Hyperglycemia occurs frequently in patients with and without diabetes during cardiovascular surgery, especially during cardiopulmonary bypass. However, strict glucose control is difficult to achieve during cardiovascular procedures. To establish effective intensive insulin therapy during cardiovascular surgery, we conduct continuous blood glucose monitoring and employ automatic control by using an artificial endocrine pancreas (the STG-22, Nikkiso, Tokyo, Japan). In this review, we will outline the present status and problems of conventional glycemic control for perioperative cardiovascular surgery and introduce the new perioperative blood glucose management method that we are testing now. We will also discuss the importance of perioperative glycemic control for cardiovascular surgery as well as future prospects.
Shinji Kawahito, Hiroshi Kitahata and Shuzo Oshita : Problems associated with glucose toxicity: Role of hyperglycemia-induced oxidative stress., World Journal of Gastroenterology : WJG, Vol.15, No.33, 4137-4142, Nov. 2009.
(要約)
Glucose homeostasis deficiency leads to a chronic increase in blood glucose concentration. In contrast to physiological glucose concentration, chronic superphysiological glucose concentration negatively affects a large number of organs and tissues. Glucose toxicity means a decrease in insulin secretion and an increase in insulin resistance due to chronic hyperglycemia. It is now generally accepted that glucose toxicity is involved in the worsening of diabetes by affecting the secretion of beta-cells. Several mechanisms have been proposed to explain the adverse effects of hyperglycemia. It was found that persistent hyperglycemia caused the functional decline of neutrophils. Infection is thus the main problem resulting from glucose toxicity in the acute phase. In other words, continued hyperglycemia is a life-threatening risk factor, not only in the chronic but also the acute phase, and it becomes a risk factor for infection, particularly in the perioperative period.
Naoji Mita, Shinji Kawahito, Tomohiro Soga, Shusuke Yagi, Kazumi Takaishi and Hiroshi Kitahata : Can strict blood glucose control by an artificial pancreas during hepatectomy improve patient outcomes?, The 8th Meeting of the International Federation for Artificial Organs, Osaka, Nov. 2019.
2.
Kazumi Takaishi, Tomohiro Aoyama, Shigeki Fujiwara Joseph Luke, Ryo Otsuka, Satoru Eguchi, Yasuo Tsutsumi, Shinji Kawahito, Hiroyuki Kinoshita and Hiroshi Kitahata : Pleth Variability Index Predicts Hemodynamic Derangements In Patients Undergoing Oral Surgery, The Anesthesiology 2019 Annual Meeting, Orando USA, Oct. 2019.
3.
Shiho Satomi, Kazumi Takaishi, Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka and Kinoshita Hiroyuki : The role of F-actin constitution in oxidative stress caused by high glucose in the human artery, American Society of Anesthesiologists Annual meeting 2018, San Francisco, Oct. 2018.
4.
山本 剛士, Kazumi Takaishi, 大塚 良, Shigeki Fujiwara Joseph Luke, Satoru Eguchi, Tomohiro Soga, Shinji Kawahito and Hiroshi Kitahata : Three‒dimensional computed tomography and nasopharyngoscopy for nasotracheal intubation after pharyngeal flap construction, Joint Conference of IFDAS2018-FADAS2018-JDSA46, Nara, Oct. 2018.
5.
Kazumi Takaishi, s Satomi, Naoji Mita, T Yamamoto, 大塚 良, Satoru Eguchi, Shigeki Fujiwara Joseph Luke, Shinji Kawahito, H Kinoshita and Hiroshi Kitahata : Rapamycin becomes the sevoflurane vasodilator effect apparent in the rat artery, Joint Conference of IFDAS2018-FADAS2018-JDSA46, Nara, Oct. 2018.
6.
Satomi Shiho, Kazumi Takaishi, Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka and Kinoshita Hiroyuki : Roles of clinical sevoflurane doses as both the protein kinase C activator and NADPH oxidase inhibitor upon thromboxane A2 application in the rat arteries., American Society of Anesthesiologists 2017 Annual Meeting, Oct. 2017.
7.
Shiho Satomi, Shinji Kawahito, Tomohiro Soga, Naoji Mita, Eisuke Hamaguchi, Kazumi Takaishi, Hiroshi Kitahata, Yasuo Tsutsumi and Katsuya Tanaka : Accuracy and Reliability of Continuous Blood Glucose Monitoring During Pediatric Cardiopulmonary Bypass, The Annual Meeting of the American Society of Anesthesiologists, Chicago, Oct. 2016.
8.
Naoji Mita, Shinji Kawahito, Tomohiro Soga, Katsuya Tanaka, Kazumi Takaishi and Hiroshi Kitahata : Blood glucose control by artificial endocrine pancreas during hepatectomy prevents postoperative acute kidney injury., The Annual Meeting of the American Society of Anesthesiologists, San Diego, Oct. 2015.
9.
Hiroshi Kitahata, Yasuo M. Tsutsumi, Tomohiro Aoyama, Kazumi Takaishi, Shinji Kawahito and Katsuya Tanaka : Role of sirtuins in cardioprotection by ischemic and anesthetic preconditioning., Euroanaesthesia 2015, The European Anaesthesiology Congress, Berlin, Jun. 2015.
10.
Kazumi Takaishi, Tomohiro Soga, Shinji Kawahito, Ryo Otsuka, Yasuo M. Tsutsumi and Hiroshi Kitahata : Effects of beta-3 adrenergic stimulation on nitric oxide production in myocardial cells of neonatal rats., Euroanaesthesia 2015, The European Anaesthesiology Congress, Berlin, May 2015.
11.
Kazumi Takaishi, Shinji Kawahito, Naoji Mita, Tomohiro Aoyama, R Otsuka and Hiroshi Kitahata : The effects of intravenous anesthetics on cell migration using cultured human umbilical vein endothelial cells, IARS 2015 Annual Meeting and International Science Symposium, Honolulu, Mar. 2015.
12.
Naoji Mita, Shinji Kawahito, T Kawahara, K Kume, Sachiyo Higashijima, Yoko Sakai, Tosiko Katayama, Kazumi Takaishi and Hiroshi Kitahata : Usefulness of continuous blood glucose monitoring and control for patients undergoing total pancreatectomy., The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 2014.
13.
Naoji Mita, Shinji Kawahito, T Kawahara, Katsuyoshi Kume, Sachiyo Higashijima, Yoko Sakai, Tosiko Katayama, Kazumi Takaishi and Hiroshi Kitahata : Is the continuous interstitial subcutaneous fluid glucose monitoring system useful for intraoperative glucose management?, The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 2014.
14.
Kazumi Takaishi, Shinji Kawahito, Aoyama Tomohiro, Otsuka Ryo, Naoji Mita, Satoru Eguchi, Shigemasa Tomioka and Hiroshi Kitahata : The effects of ketamine on the release of vascular endothelial growth factor and in vitro capillary tube formation., The 7th Annual Meeting of the Federation of Asian Dental Anesthesiology Societies, Niigata, Oct. 2014.
15.
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.
16.
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.
17.
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.
18.
Kazumi Takaishi, Shinji Kawahito, Naoji Mita, Satoru Eguchi, Shigemasa Tomioka and Hiroshi Kitahata : The effects of intravenous anesthetics on in vitro angiogenesis and cell proliferation., Euroanaesthesia 2013, Barcelona, Jun. 2013.
19.
Naoji Mita, Shinji Kawahito, Kazumi Takaishi, Hiroshi Kitahata and Shuzo Oshita : Impact of the newly developed, next-generation artificial dndocrine pancreas., The Annual Meeting of the American Society of Anesthesiologists, Washington, D.C., Oct. 2012.
20.
Kazumi Takaishi, Shinji Kawahito, Nakamura Dai, Tatsuishi Tomoko, Satoru Eguchi, Shigemasa Tomioka and Hiroshi Kitahata : The effects of intravenous anesthetics on the release of vascular endothelial growth factor and angiogenesis., Euroanaesthesia 2012, Paris, Jun. 2012.
21.
Shinji Kawahito, Hiroshi Kitahata, Tsuyoshi Okada, Hirose Kayo and Shuzo Oshita : Continuous blood glucose monitoring and control for patients undergoing hepatic resection., The Annual Meeting of the American Society of Anesthesiologists, Chicago, Oct. 2011.
22.
Shinji Kawahito, Hiroshi Kitahata, Tsuyoshi Okada, Hirose Kayo and Shuzo Oshita : Continuous blood glucose monitoring and control for patients undergoing liver transplantation., The Annual Meeting of the American Society of Anesthesiologists, San Diego, Oct. 2010.
23.
Shinji Kawahito, Hiroshi Kitahata, Nakamura Tomoka, Tsuyoshi Okada and Shuzo Oshita : Usefulness of continuous blood glucose monitoring during cardiovascular surgery., The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 2009.
24.
Hiroshi Kitahata, Junpei Nozaki, Shinji Kawahito, Yoshinobu Tomiyama and Shuzo Oshita : Interaction of the β1-blocker landiolol with early and late sevoflurane-induced preconditioning., The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 2009.
25.
Wakamatsu Narutomo, Shinji Kawahito, Hiroshi Kitahata, Goh Ritsuko and Kohyama Arifumi : Landiolol produces cardioprotection in patients undergoing off-pump coronary artery bypass surgery., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 2008.
26.
Shinji Kawahito, Hiroshi Kitahata, Nakamura Tomoka, Akio Iseki and Shuzo Oshita : Continuous intraoperative blood glucose monitoring and control using the STG-22 closed-loop system., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 2008.
27.
Nakamura Tomoka, Shinji Kawahito, Hiroshi Kitahata, Yoshinobu Tomiyama and Shuzo Oshita : Intensive insulin therapy in patients undergoing living-related liver transplantation., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 2008.
28.
Shinji Kawahito, Akio Iseki, Yoshinobu Tomiyama, Hiroshi Kitahata and Shuzo Oshita : High-frequency jet ventilation during thoracoscopic sympathectomy for palmar hyperhidrosis., The Annual Meeting of the American Society of Anesthesiologists, San Francisco, Oct. 2007.
29.
Nitta Kazuhito, Shinji Kawahito, Hiroshi Kitahata, Junpei Nozaki and Shuzo Oshita : Accuracy of pulse oximetry and capnography in children with cyanotic congenital heart disease., The Annual Meeting of the American Society of Anesthesiologists, Chicago, Oct. 2006.
30.
Shinji Kawahito, Nakamura Akiyo, Junpei Nozaki, Hiroshi Kitahata and Shuzo Oshita : The role of K+ channels in vasorelaxation induced by hypoxia and the modulator effects of etomidate., The Annual Meeting of the American Society of Anesthesiologists, Chicago, Oct. 2006.
31.
Hiroshi Kitahata, Junpei Nozaki, Shinji Kawahito, Yoshinobu Tomiyama and Shuzo Oshita : The involvement of the mitochondrial KATP channel on heat-shock protein-induced cardioprotection., The Annual Meeting of the American Society of Anesthesiologists, Chicago, Oct. 2006.
32.
Shinji Kawahito, Junpei Nozaki, Nakamura Akiyo, Hiroshi Kitahata and Shuzo Oshita : Effects of dexmedetomidine and clonidine on vasorelaxation mediated by adenosine triphosphate-sensitive potassium channels in the rat aorta., The Annual Meeting of the American Society of Anesthesiologists, Atlanta, Oct. 2005.
33.
Hiroshi Kitahata, Junpei Nozaki, Shinji Kawahito, Yoshinobu Tomiyama and Shuzo Oshita : Influences of sevoflurane in myocardial protection of an ultra-short-acting β1-blocker, landiolol., The Annual Meeting of the American Society of Anesthesiologists, Atlanta, Oct. 2005.
34.
Junpei Nozaki, Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito and Shuzo Oshita : Sevoflurane enhances geranylgeranylacetone-induced cardioprotection via increased Hsp 70 expression against myocardial ischemia and reperfusion injury in vivo rabbits., The Annual Meeting of the American Society of Anesthesiologists, Las Vegas, Oct. 2004.
35.
Shinji Kawahito, Takashi Kawano, Junpei Nozaki, Hiroshi Kitahata and Shuzo Oshita : Molecular mechanisms underlying etomidate modulating effects of ATP-sensitive potassium channels., The Annual Meeting of the American Society of Anesthesiologists, Las Vegas, Oct. 2004.
36.
Shinji Kawahito, Takashi Kawano, Katsuya Tanaka, Hiroshi Kitahata and Shuzo Oshita : Effect of midazolam on ATP-sensitive potassium channel activities in vascular smooth muscle cells., The Annual Meeting of the American Society of Anesthesiologists, Las Vegas, Oct. 2004.
37.
Nitta Kazuhito, Hiroshi Kitahata, Shinji Kawahito, Katsuya Tanaka and Shuzo Oshita : The factors influencing contrast effect during intraoperative contrast echocardiography., 9th International Congress of Cardiothoracic and Vascular Anesthesia, Tokyo, Sep. 2004.
38.
Yamanaka Akemi, Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito and Shuzo Oshita : Implication of intraoperative transesophageal ventricular pacing in pediatric patients., 9th International Congress of Cardiothoracic and Vascular Anesthesia, Tokyo, Sep. 2004.
39.
Shinji Kawahito, Hiroshi Kitahata, Junpei Nozaki, Takashi Kawano and Shuzo Oshita : Etomidate has an inhibitory effect on vasorelaxation mediated by adenosine triphosphate-sensitive potassium channels in the rat aorta., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-657, San Francisco, Oct. 2003.
40.
Hiroshi Kitahata, Shinji Kawahito, Junpei Nozaki and Shuzo Oshita : Effects of ischemic preconditioning on the left ventricular work efficiency and the regional wall motion during fentanyl and sevoflurane anesthesia., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-684, San Francisco, Oct. 2003.
41.
Shinji Kawahito, Hiroshi Kitahata, Akio Iseki, Fumihiko Tada, Junpei Nozaki, Akemi Tsuda and Shuzo Oshita : High-frequency jet ventilation during thoracoscopic sympathectomy for palmar hyperhidrosis., 7th America-Japan Anesthesia Congress, Kofu, Oct. 2002.
42.
Hiroshi Kitahata, Shinji Kawahito, Junpei Nozaki, Katsuya Tanaka and Shuzo Oshita : Influences of inhaled gases and administration route on intraoperative contrast echocardiography., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-141, Orlando, Oct. 2002.
43.
Shinji Kawahito, Hiroshi Kitahata, Junpei Nozaki, Katsuya Tanaka and Shuzo Oshita : Hypoxemia during cesarean section: Comparison between obese and normal parturients., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-1067, Orlando, Oct. 2002.
44.
Junpei Nozaki, Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito and Shuzo Oshita : Effects of acute normovolemic hemodilution on left ventricular systolic and diastolic function in the absence or presence of -adrenergic blockade in dogs., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-657, Orlando, Oct. 2001.
45.
Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki, Shinji Kawahito and Shuzo Oshita : Effects of ischemic preconditioning on the ultrasonic myocardial tissue characterization and the left ventricular work efficiency during sevoflurane anesthesia in canine stunned myocardium., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-674, New Orleans, Oct. 2001.
46.
Shinji Kawahito, Tadashi Motomura, Hiroshi Kitahata, Shuzo Oshita and Yukihiko Nose : Feasibility of a new hollow fiber silicone membrane oxygenator for ECMO application., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-401, New Orleans, Oct. 2001.
47.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Risk factors for perioperative myocardial ischemia in carotid endarterectomy., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-390, San Francisco, Oct. 2000.
48.
Junpei Nozaki, Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito and Shuzo Oshita : Effects of acute normovolemic hemodilution on ventriculoarterial coupling in dogs., The Annual Meeting of the American Society of Anesthesiologists, Dallas, Oct. 1999.
49.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Junpei Nozaki and Shuzo Oshita : Intraoperative evaluation of pulmonary artery flow during Fontan procedure., The Annual Meeting of the American Society of Anesthesiologists, Dallas, Oct. 1999.
50.
Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito, Junpei Nozaki and Shuzo Oshita : Feasibility of gastrothoracic ventricular pacing during transesophageal echocardiography - Factors influencing successful ventricular pacing., The Annual Meeting of the American Society of Anesthesiologists, Dallas, Oct. 1999.
51.
Katsuya Tanaka, Hiroshi Kitahata, Shinji Kawahito, Junpei Nozaki and Shuzo Oshita : Intraoperative estimation of cardiac output from pulsed Doppler recording of pulmonary venous flow using transesophageal echocardiography., The Annual Meeting of the American Society of Anesthesiologists, Dallas, Oct. 1999.
52.
Katsuya Tanaka, Hiroshi Kitahata, Shinji Kawahito, Hideyuki Kimura and Shuzo Oshita : Effects of sevoflurane on regional myocardial blood flow distribution., --- Quantification with myocardial contrast echocardiography ---, 5th America-Japan Anesthesia Congress, Matsuyama, Oct. 1998.
53.
Shinji Kawahito, Hiroshi Kitahata, Katsuya Tanaka, Hideyuki Kimura and Shuzo Oshita : Intraoperative evaluation of pulmonary artery flow during Fontan procedures., 5th America-Japan Anesthesia Congress, Matsuyama, Oct. 1998.
54.
Katsuya Tanaka, Hiroshi Kitahata, Shinji Kawahito, Hideyuki Kimura and Shuzo Oshita : Effects of phenylephrine on pulmonary venous flow and arterial oxygenation in patients with tetralogy of Fallot., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 1998.
55.
Hiroshi Kitahata, Shinji Kawahito, Katsuya Tanaka, Hideyuki Kimura and Shuzo Oshita : Influence of sevoflurane on regional myocardial blood distribution - Clinical study using myocardial contrast echocardiography., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 1998.
56.
Katsuya Tanaka, Hiroshi Kitahata, Shinji Kawahito, Hideyuki Kimura and Shuzo Oshita : Simultaneous transesophageal echocardiography and atrial pacing in patients with valvular heart disease., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 1998.
57.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura, Katsuya Tanaka and Shuzo Oshita : Pulmonary arterial pressure can be estimated by transesophageal pulsed Doppler echocardiography., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 1998.
58.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura, Katsuya Tanaka and Shuzo Oshita : Transesophageal echocardiographic assessment of pulmonary arterial and venous flow during high-frequency jet ventilation., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 1998.
59.
Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito, Hideyuki Kimura and Shuzo Oshita : Transgastric ventricular pacing using transesophageal echocardiographic probe., The Annual Meeting of the American Society of Anesthesiologists, Orlando, Oct. 1998.
60.
Hideyuki Kimura, Yoshiaki Hirose, Katsuya Tanaka, Shinji Kawahito, Yoshinobu Tomiyama, Hiroshi Kitahata and Shuzo Oshita : Nitric oxide dose not play a major role in regulation of systemic hemodynamic response to acute normovolemic hemodilution., The Annual Meeting of the American Society of Anesthesiologists, San Diego, Oct. 1997.
61.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura and Shuzo Oshita : Recurrent laryngeal nerve palsy after cardiovascular surgery., --- Relationship to the placement of transesophageal echocardiography probe ---, The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 1996.
62.
Hiroshi Kitahata, Shinji Kawahito, Katsuya Tanaka, Hideyuki Kimura and Shuzo Oshita : Effects of sevoflurane on regional myocardial blood distribution., --- The study using myocardial contrast echocardiography ---, The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 1996.
63.
Shuzo Oshita, Y-C Park, Hiroshi Kitahata, Shinji Kawahito and Hideyuki Kimura : Increasing extracellular potassium attenuates ischemia-induced increases in cytosolic calcium concentrations in single rat ventricular myocytes., The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 1996.
64.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura and Arifumi Kohyama : Intraoperative contrast echocardiography using Albunex., 9th Asean Congress of Anaesthesiologists, Singapore, Nov. 1995.
65.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura and Arifumi Kohyama : The effects of sevoflurane in regional myocardial blood flow distribution., --- The study using myocardial contrast echocardiography ---, Inaugural Meeting of Asian Society of Cardiothoracic Anaesthesia, Singapore, Nov. 1995.
66.
Shinji Kawahito, Hiroshi Kitahata, Hideyuki Kimura, Arifumi Kohyama and Takao Saito : A case of pulmonary arteriovenous fistula in whom venous air embolism during cesarean section may have caused postoperative subendocardial infarction., 8th Congress of the International Cardiac Doppler Society, Sapporo, Jul. 1995.