Yako Matsumoto, Michiko Kinoshita, Yoshinobu Tomiyama and Katsuya Tanaka : Earthquake Preparedness for Operating Room Staff: Lessons Learned From Experiences and the Literature, Anesthesia & Analgesia, 2024.
(要約)
Earthquakes pose hazards to health care workers and patients in operating rooms. Proactive planning based on insights gained from past experiences is crucial for enhancing safety. Through a comprehensive literature review, we summarize challenges and lessons learned from real earthquake events to inform the development of effective safety measures in operating rooms. Additionally, we discuss the anesthesiologist's role in crisis management.
Sekiguchi Ryo, Michiko Kinoshita, Yoko Sakai and Katsuya Tanaka : Anesthetic management of a patient with mandibular hypoplasia, deafness, progeroid features, lipodystrophy syndrome: a case report, JA Clinical Reports, 64, 2024.
Rikako Takahashi, Yoko Sakai, Michiko Kinoshita, Yako Matsumoto, Yoshimi Nakaji and Katsuya Tanaka : Quantitative and calculated estimated blood loss in cesarean deliveries for twin and singleton pregnancies: a retrospective analysis, Journal of Anesthesia, Vol.38, No.5, 666-673, 2024.
(要約)
This study retrospectively assessed blood loss during cesarean deliveries for twin and singleton pregnancies using two distinct methods, quantitative estimation measured during cesarean sections and hematocrit-based calculated estimation. We included scheduled cesarean deliveries for twin or singleton pregnancies at 34 weeks of gestation. Quantitative blood loss was recorded based on the blood volume in the graduated collector bottle and by weighing the blood-soaked textiles during cesarean sections. The blood loss was calculated using the change in hematocrit levels before and after the cesarean delivery. We evaluated 403 cases including 44 twins and 359 singletons. Quantitative blood loss during cesarean section was significantly higher in twin pregnancies than that in singleton pregnancies (1117 [440] vs 698 [378] mL; p < 0.001). However, no significant differences were observed in the calculated blood loss between the two groups on the day after delivery (487 mL [692 mL] vs 507 mL [522 mL]; p = 0.861). On post-delivery days 4-5, twin pregnancies were associated with a significantly higher calculated blood loss than singleton pregnancies (725 [868] mL vs 444 [565] mL, p = 0.041). Although a significant moderate correlation between quantitative and calculated blood loss was observed in singleton pregnancies (r = 0.473, p < 0.001), no significant correlation was observed between twin pregnancies (r = 0.053, p = 0.735). Quantitative blood loss measurements during cesarean section may be clinically insufficient in twin pregnancies. Incorporating blood tests and continuous assessments are warranted for enhanced blood loss evaluation, especially in twin pregnancies, owing to the risk of persistent bleeding.
Sarara Mutoh, Michiko Kinoshita, Yuki Maeda and Katsuya Tanaka : Ketamine as an Alternative Anesthetic for Augmenting Seizure Durations During Electroconvulsive Therapy: A Retrospective Observational Study, The Journal of ECT, Vol.40, No.2, 134-139, 2024.
(要約)
Electroconvulsive therapy (ECT) is highly effective for severe psychiatric disorders; however, short seizure durations may lead to ineffective therapy. This retrospective study aimed to examine the risks and benefits of switching to ketamine anesthesia to augment seizure durations during an acute course of ECT. We included 33 patients who underwent ketamine anesthesia due to suboptimal seizures during an acute course of ECT. We assessed seizure duration, stimulus dose, hemodynamic variability, and postseizure complications before and after switching to ketamine. Age was significantly associated with suboptimal seizures during ECT (P = 0.040). After switching to ketamine, 32 patients (97%) experienced prolonged seizure duration. Ketamine significantly prolonged both electroencephalogram and motor seizure durations with a mean difference of 34.6 seconds (95% confidence interval [CI], 26.4-42.7 seconds; P < 0.001) and 26.6 seconds (95% CI, 19.6-33.6 seconds; P < 0.001), respectively. It also significantly reduced stimulus dose (mean difference, -209.5 mC [95% CI, -244.9 to -174.1 mC]; P < 0.001). In addition, maximum changes in systolic blood pressure and heart rate during ECT sessions significantly increased with ketamine (mean difference, 27.2 mm Hg [95% CI, 12.0-42.4 mm Hg; P = 0.001]; 25.7 beats per minute [95% CI, 14.5-36.8 beats per minute; P < 0.001], respectively). Patients reported more headaches with ketamine (P = 0.041). Our results provide evidence that ketamine as an alternative anesthetic can augment seizure durations in specific patients experiencing suboptimal seizures during an acute course of ECT. However, its use requires greater attention to circulatory management and postseizure complications.
Michiko Kinoshita, Makoto Kinoshita, Rikako Takahashi, Sarara Mutoh, Nami Kakuta and Katsuya Tanaka : The Safety and Strategies for Reinitiating Electroconvulsive Therapy After ECT-Induced Takotsubo Cardiomyopathy: A Case Report and Systematic Review., The Journal of ECT, Vol.39, No.3, 185-192, 2023.
(要約)
Electroconvulsive therapy-induced TCM is more likely to cause cardiogenic shock than nonperioperative cases; nevertheless, it has good prognosis. Cautious reinitiation of ECT after TCM recovery is possible. Further studies are required to determine preventive measures for ECT-induced TCM.
Yuta Uemura, Michiko Kinoshita, Yoko Sakai and Katsuya Tanaka : Hemodynamic impact of ephedrine on hypotension during general anesthesia: a prospective cohort study on middle-aged and older patients, BMC Anesthesiology, Vol.23, No.1, 283, 2023.
(要約)
Ephedrine is a mixed α- and β-agonist vasopressor that is frequently used for the correction of hypotension during general anesthesia. β-responsiveness has been shown to decrease with age; therefore, this study aimed to determine whether aging would reduce the pressor effect of ephedrine on hypotension during general anesthesia. Seventy-five patients aged ≥ 45 years were included in this study, with 25 patients allocated to each of the three age groups: 45-64 years, 65-74 years, and ≥ 75 years. All patients received propofol, remifentanil, and rocuronium for the induction of general anesthesia, followed by desflurane and remifentanil. Cardiac output (CO) was estimated using esCCO technology. Ephedrine (0.1 mg/kg) was administered for the correction of hypotension. The primary and secondary outcome measures were changes in the mean arterial pressure (MAP) and CO, respectively, at 5 min after the administration of ephedrine. RESULTS: The administration of ephedrine significantly increased MAP (p < 0.001, mean difference: 8.34 [95% confidence interval (CI), 5.95-10.75] mmHg) and CO (p < 0.001, mean difference: 7.43 [95% CI, 5.20-9.65] %) across all groups. However, analysis of variance revealed that the degree of elevation of MAP (F [2, 72] = 0.546, p = 0.581, η = 0.015 [95% CI, 0.000-0.089]) and CO (F [2, 72] = 2.023, p = 0.140, η = 0.053 [95% CI, 0.000-0.162]) did not differ significantly among the groups. Similarly, Spearman's rank correlation and multiple regression analysis revealed no significant relation between age and the changes in MAP or CO after the administration of ephedrine. The administration of ephedrine significantly increased MAP and CO; however, no significant correlation with age was observed in patients aged > 45 years. These findings suggest that ephedrine is effective for the correction of hypotension during general anesthesia, even in elderly patients. UMIN-CTR (UMIN000045038; 02/08/2021).
Michiko Kinoshita, Takahashi Mina, Katsuya Tanaka and Yoko Sakai : Authorship by gender in anesthesiology journals: a retrospective cross-sectional study for Japan, Journal of Anesthesia, Vol.37, No.3, 364-370, 2023.
(要約)
Although it is important to recognize gender disparities in publishing to achieve gender diversity, women's authorship in Japan remains unclear. Therefore, this study aimed to investigate the percentage and analyze the trends of articles authored and published in anesthesiology journals by Japanese female authors. The genders of the first and last authors affiliated with Japanese institutions were surveyed in the Journal of Anesthesia (JA) (1990, 1995, and 2000-2022) and 11 international anesthesiology journals (2010-2022). We included 845 and 819 original research articles from JA in the analyses of the first and last authors, respectively. The proportion of female first authors significantly increased from 41 (11.7%) out of 351 before 2009 to 119 (24.1%) out of 494 after 2010 (p < 0.001). The proportion of female last authors was 11 (3.3%) out of 335 before 2009 and 22 (4.5%) out of 484 after 2010, respectively, with no significant difference (p = 0.470). We included 624 and 572 original research articles from international anesthesiology journals in the analyses of first and last authors, respectively. Among these, there were 134 (21.5%) and 23 (4.0%) female first and last authors, respectively. These proportions in international anesthesiology journals did not significantly differ from those in JA (p = 0.334, p = 0.789, respectively). The percentage of female first authors has increased, commensurate with the percentage of female anesthesiologists. However, the percentage of female last authors has not increased and remains low in Japan.
Ryo Sekiguchi, Michiko Kinoshita, Ryosuke Kawanishi, Nami Kakuta, Yoko Sakai and Katsuya Tanaka : Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial., BMC Anesthesiology, 2023.
(要約)
MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (- 41.1 [16.4] mmHg and - 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: - 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP < 65 mmHg over 2.5 min), without significant differences between the groups (p = 0.341).
Michiko Kinoshita, Sarara Mutoh, Asuka Kasai, Ryosuke Kawanishi and Katsuya Tanaka : General Anesthesia in a Patient With Neuronal Intranuclear Inclusion Disease: A Case Report., A&A Practice, Vol.16, No.10, 2022.
(要約)
Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disease with diverse clinical manifestations, including dementia and muscle weakness. We summarize anesthetic considerations in reporting general anesthesia for a 58-year-old man with bladder dysfunction and cerebellar ataxia who was diagnosed with NIID. The patient developed postinduction hypotension relevant to autonomic neuropathy. The potential risks, such as prolonged reaction to neuromuscular blocking agent, postoperative delirium, and worsening of NIID-related symptoms, were also considered. The responsiveness to anesthetics may vary widely from case t case. As the number of NIID cases increases, a better understanding of NIID is needed.
Michiko Kinoshita, Yoko Sakai, Kimiko Katome, Tomomi Matsumoto, Shizuka Sakurai, Yuka Jinnouchi and Katsuya Tanaka : Transition in eye gaze as a predictor of emergence from general anesthesia in children and adults: a prospective observational study., BMC Anesthesiology, Vol.22, No.1, 2022.
(要約)
In children, eye-gaze transition was observed significantly earlier than other physical-behavioral responses during emergence from general anesthesia and seemed to reflect emergence from anesthesia. In contrast, observation of eye gaze was not a useful indicator of emergence from anesthesia in adults.
Michiko Kinoshita, Yuki Ishikawa, Ryo Sekiguchi, Miyuki Matsuda and Katsuya Tanaka : Impact of surgical masks on fraction of inspired oxygen during oxygen therapy depends on the type of oxygen masks and respiratory conditions: volunteer- and simulation-based studies., Journal of Anesthesia, Vol.36, No.5, 633-641, 2022.
(要約)
was measured using a simulator that reproduced spontaneous breathing. RR was 12 or 24 bpm, and the tidal volume (Tv) was 300, 500, or 700 mL. The effect of oxygen mask fitting conditions was also examined. The primary outcome measure was FIO
Recently, there have been some reports of electromagnetic interference during capsule endoscopy(CE)in regards to other medical devices and facility environment. These accidental events have not been analyzed sufficiently although academic societies and related ministries are proposing guidelines with cautious attention. Based on this, detailed analyses and development of solution are required. In this study, we review our experience with cases of accidental events during CE and assessed the causes and preventive solutions. A total of149CE cases(male :89, female :60, mean age :56±18 8)from January 2017 until December 2019 were analyzed retrospectively. Four cases(2%)with defective images were noted. Detailed events were as follows ;1 disorder of the sensor array, 2 recorder freezes, and 1 electromagnetic interference. These mechanical and electromagnetic troubles should be assessed and shared among medical staffs and manufacturers to propose possible solutions and perform CE safely.
Mayu Sebe, Rie Tsutsumi, Takuro Oyama, T Yousuke Horikawa, Yuta Uemura, Nami Kakuta, Yoko Sakai, Atsushi Morio, Hirotsugu Miyoshi, Takashi Kondo, Tomoaki Urabe, Yuko Noda, Satoshi Kamiya, Noboru Saeki, Masashi Kuroda, Katsuya Tanaka, Yasuo Tsutsumi and Hiroshi Sakaue : Assessment of postoperative nutritional status and physical function between open surgical aortic valve replacement and transcatheter aortic valve implantation in elderly patients., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 139-144, 2020.
(要約)
Background and aims : Severe aortic stenosis (AS) has been normally treated with surgical aortic valve replacement (AVR) whereas recently, transcatheter aortic valve implantation (TAVI) has been introduced as a minimally invasive operation for patients with high surgical risk and frailty. In this study, we have evaluated postoperative physical function and nutrition intake in the patients following AVR and TAVI. Methods : This prospective observational study involved 9 patients with surgical aortic valve replacement (AVR) and 7 patients with transcatheter aortic valve implantation (TAVI). Body composition was measured one day prior surgery, postoperative day (POD) 1, POD 3, POD 5 and POD 7. Hand grip strength, calf circumference and gait speed were measured one day before surgery and on the day of discharge. Results : Skeletal muscle was significantly decreased in AVR patients at postoperative day 3 and 7, while there was no change in TAVI patients. Patients with TAVI showed higher dietary intake after surgery compared to patients with AVR, and they maintained hand grip strength and calf circumference at discharge. Conclusions : In elderly patients with AS, TAVI can improve post-operative recovery maintaining nutritional status and physical function even. J. Med. Invest. 67 : 139-144, February, 2020.
Yuta Uemura, Yoko Sakai, Yasuo Tsutsumi, Nami Kakuta, Chiaki Murakami, Shiho Satomi, Takuro Oyama, Naohiro Ohshita, Tomoya Takasago, Daisuke Hamada, Koichi Sairyo and Katsuya Tanaka : Postoperative nausea and vomiting following lower limb surgery :a comparison between single-injection intraarticular anesthesia and continuous epidural anesthesia., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 303-307, 2019.
(要約)
Study Objective : the incidence of postoperative nausea and vomiting (PONV) following single-injection intraarticular anesthesia was compared to that following continuous epidural anesthesia. Design : Prospective, double-blind, randomized study. Setting : University-affiliated teaching hospital. Patients : Forty-eight patients finally participated in this study, and each group contained twenty-four patients. Interventions : Patients scheduled to undergo lower limb surgery under general anesthesia were randomly allocated into two groups, to receive either single-injection intraarticular or continuous epidural anesthesia for postoperative analgesia. Measurements : The incidence and severity of PONV, complete response rates (i.e., no vomiting or rescue antiemetic use), and pain scores were recorded 2, 24, and 48 h postoperatively. Main results : No significant differences between groups were observed in the incidence and severity of PONV, rescue antiemetic use, or complete response rate at any of the time points, but only the use of rescue analgesics was significantly less in continuous epidural anesthesia group during the 2-24h postoperative period (P=0.04). Conclusion : While the use of single-injection intraarticular anesthesia following lower limb surgery did not prevent PONV more than continuous epidural anesthesia in this study, the intraarticular technique still provides greater simplicity, safety, and cost-effectiveness. J. Med. Invest. 66 : 303-307, August, 2019.
Yuta Uemura, Nami Kakuta, Katsuya Tanaka and Yasuo Tsutsumi : Anesthetic management of a patient with methylmalonic acidemia: a case report., JA Clinical Reports, Vol.4, No.1, 71, 2018.
(要約)
Methylmalonic acidemia (MMA) is a metabolic disorder of organic acids and is characterized by the accumulation of methylmalonic acids. The patient was a 19-year-old female diagnosed with severe MMA at 3 days of age, who was scheduled for renal replacement therapy. Preoperatively, there was no evidence of metabolic acidosis or electrolyte abnormalities. Glucose was administered preoperatively following a 6-h fast. Anesthesia was administered using thiamylal, remifentanil, rocuronium, and sevoflurane. After tracheal intubation, the patient underwent an ultrasound-guided bilateral rectus sheath block with ropivacaine. A drop in blood sugar level was treated with 5% glucose. Extubation was performed after intravenous administration of sugammadex. We report the anesthetic management of a patient with MMA using a combination of general anesthesia and rectus sheath block.
Shiho Satomi, Nami Kakuta, Chiaki Murakami, Yoko Sakai, Katsuya Tanaka and Yasuo Tsutsumi : The Efficacy of Programmed Intermittent Epidural Bolus for Postoperative Analgesia after Open Gynecological Surgery: A Randomized Double-Blinded Study., BioMed Research International, Vol.2018, 6297247, 2018.
(要約)
It is well known that the programmed intermittent epidural bolus (PIEB) technique effectively provides epidural anesthesia in labor. This randomized double-blind trial compared the postoperative analgesic efficacy of PIEB with that of continuous epidural infusion (CEI) in patients undergoing gynecological surgery under combined general-epidural anesthesia. Patients undergoing open gynecological surgery under combined general-epidural anesthesia were randomized at a 1 : 1 ratio to receive PIEB or CEI. In the PIEB group, the pump delivered 4L ropivacaine 0.2% plus fentanyl 2 g/mL every hour. In the CEI group, the pump delivered the same solution at a rate of 4L/h. In both groups, additional 4L boluses of ropivacaine 0.2% plus fentanyl 2 g/mL were provided, when necessary, by patient-controlled epidural analgesia after surgery. The primary outcome was the total ropivacaine dose 40 hours after surgery. The secondary outcomes were the number of PCEA boluses and postoperative pain (evaluated on an 11-point numerical rating scale) 3, 24, and 48 hours after surgery. In total, 57 patients were randomized ( = 28 and 29 in the PIEB and CEI groups, resp.). The two groups differ significantly in terms of the total ropivacaine dose 40 hours after surgery (mean (standard deviation): 155.38 (4.55) versus 159.73 (7.87)L, = 0.016). Compared to the CEI group, the PIEB group had significantly lower numerical rating scale scores 3 hours (median [lower-upper quartiles]: 0 [0-0.5] versus 3 [0-5.5], = 0.002), 24 hours (1 [0-2] versus 3 [1-4], = 0.003), and 48 hours (1 [0-2] versus 2 [2-3.5], = 0.002) after surgery. PIEB was better than CEI in terms of providing postoperative analgesia after open gynecological surgery under combined general-epidural anesthesia.
Takuro Oyama, Nami Kakuta, Naoji Mita, Shinji Kawahito, Katsuya Tanaka and Yasuo Tsutsumi : Jelly-type carbohydrate supplement in healthy subjects suppresses the catabolism of adipose tissue and muscle protein and improved their satisfactions., Clinical Nutrition Experimental, Vol.19, 1-11, 2018.
Nami Kakuta, Yasuo Tsutsumi, Chiaki Murakami, Yoko Sakai, Takuro Oyama, Asuka Kasai, Katsuyoshi Kume and Katsuya Tanaka : Effectiveness of using non-invasive continuous arterial pressure monitoring with ClearSight in hemodynamic monitoring during living renal transplantation in a recipient:a case report., The Journal of Medical Investigation : JMI, Vol.65, No.1.2, 139-141, 2018.
(要約)
We investigated the effectiveness of the ClearSight system for hemodynamic management during kidney transplantation for a recipient. The recipient was to receive a kidney transplant from his mother under general anesthesia. We used continuous noninvasive finger-cuff-based monitoring of blood pressure, provided by the ClearSight system, and stroke volume variation to predict fluid responsiveness. We used of a balanced anesthetic technique and stringent monitoring standards to ensure a successful outcome for the patient. This case demonstrated that ClearSight has the potential to improve patient monitoring in hemodynamically stable patients who received kidney transplantation under general anesthesia. J. Med. Invest. 65:139-141, February, 2018.
Yoko Sakai, Yasuo M. Tsutsumi, Takuro Oyama, Chiaki Murakami, Nami Kakuta and Katsuya Tanaka : Noninvasive continuous blood pressure monitoring by the ClearSight system during robot-assisted laparoscopic radical prostatectomy., The Journal of Medical Investigation : JMI, Vol.65, No.1.2, 69-73, 2018.
(要約)
Robot-assisted laparoscopic radical prostatectomy (RALRP) is commonly performed in the surgical treatment of prostate cancer. However, the steep Trendelenburg position (25) and pneumoperitoneum required for this procedure can sometimes cause hemodynamic changes. Although blood pressure is traditionally monitored invasively during RALRP, the ClearSight system (BMEYE, Amsterdam, The Netherlands) enables a totally noninvasive and simple continuous blood pressure and cardiac output monitoring based on finger arterial pressure pulse contour analysis. We therefore investigated whether noninvasive continuous arterial blood pressure measurements using the ClearSight system were comparable to those obtained invasively in patients undergoing RALRP. Ten patients scheduled for RALRP with American Society of Anesthesiologists physical status I-II were included in this study. At each of the seven defined time points, noninvasive and invasive blood pressure measurements were documented and compared in each patient using Bland-Altman analysis. Although the blood pressure measured with the ClearSight system correlated with that measured invasively, a large difference between the values obtained by the two devices was noted. The ClearSight system was unable to detect blood pressure accurately during RALRP, suggesting that blood pressure monitoring using this device alone is not feasible in this small patient population. J. Med. Invest. 65:69-73, February, 2018.
Chiaki Murakami, Nami Kakuta, Katsuyoshi Kume, Yoko Sakai, Asuka Kasai, Takuro Oyama, Katsuya Tanaka and Yasuo Tsutsumi : A comparison of fosaprepitant and ondansetron for preventing postoperative nausea and vomiting in moderate to high risk patients: A retrospective database analysis., BioMed Research International, Vol.2017, 5703528, 2017.
(要約)
Postoperative nausea and vomiting (PONV) occur in 30-50% of patients undergoing general anesthesia and in 70-80% of high PONV risk patients. In this study, we investigated the efficacy of fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, compared to ondansetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, in moderate to high PONV risk patients from our previous randomized controlled trials. Patients (171 patients from 4 pooled studies) with the Apfel simplified score ≥ 2 and undergoing general anesthesia were randomly allocated to receive intravenous fosaprepitant 150 mg (NK1 group, = 82) and intravenous ondansetron 4 mg (ONS group, = 89) before induction of anesthesia. Incidence of vomiting was significantly lower in the NK1 group compared to the ONS group 0-2, 0-24, and 0-48 hours after surgery (2 versus 17%, 2 versus 28%, and 2 versus 29%, resp.). However, no significant differences in PONV, complete response, rescue antiemetic use, and nausea score were observed between groups 0-48 hours after surgery. In moderate to high PONV risk patients, fosaprepitant decreased the incidence of vomiting and was superior to ondansetron in preventing postoperative vomiting 0-48 hours after surgery.
(キーワード)
Adult / Aged / Aged, 80 and over / Databases as Topic / Demography / Humans / Middle Aged / Morpholines / Ondansetron / Postoperative Care / Postoperative Nausea and Vomiting / Retrospective Studies / Risk Factors / Young Adult
Shiho Satomi, Asuka Kasai, Eisuke Hamaguchi, Yasuo Tsutsumi and Katsuya Tanaka : Normothermic Cardiopulmonary Bypass in Patient with Waldenstroms Macroglobulinemia and Cryoglobulinemia: A Case Report., A & A Case Reports, Vol.9, No.6, 162-163, 2017.
(要約)
Waldenström's macroglobulinemia (WM) manifests as hyperviscosity syndrome. Cryoglobulinemia, which may increase blood viscosity or induce thrombosis in association with decreased body temperature, can occur in combination with WM. We describe the management of an 82-year-old woman with WM, hyperviscosity syndrome, and cryoglobulinemia who required open aortic valve replacement. Decreased body temperature in this patient was prevented during cardiopulmonary bypass by using a forced air warming system and normothermic cardioplegia with continuous warm blood cardioplegia perfusion.
Yasuo Tsutsumi, Takuro Oyama, Nami Kakuta, YT Horikawa, Katsuyoshi Kume, Yoko Sakai, Rie Tsutsumi and Katsuya Tanaka : Effect of oral carbohydrate with amino acid solution on serum oxidative/anti-oxidative status in healthy volunteers., Journal of Anesthesia, Vol.31, No.3, 472-475, 2017.
(要約)
The aim of this work was to investigate the effect of oral carbohydrate with amino acid [oral nutritional supplement (ONS)] solution on oxidative stress in healthy persons. Fourteen healthy volunteers were segregated into control and ONS groups. Volunteers in the ONS group ingested 250 ml of Arginaid Water (Nestle Japan, Tokyo, Japan) in the evening before the experiment and at 7:00 am on the day of the experiment. Volunteers in the control group fasted after dinner and drank only water until 7:00 am on the day of the experiment. In both groups, blood was collected at 9:00 am. The serum total oxidant levels and antioxidant capacity were assessed by d-ROMs (derivatives of reactive oxygen metabolites) test and BAP (biological antioxidant potential) test, respectively. In the ONS group, the serum d-ROMs level was significantly lower than in the control group (297 ± 43 and 327 ± 41 U.CARR, respectively, p = 0.018), while the serum BAP level was significantly higher than the control group (2410 ± 432 and 1979 ± 397 µmol/l, respectively, p = 0.005). The OXY level of Arginaid Water was much higher than preOp drink (Nutricia, Ireland). In conclusion, our study showed that an ONS with arginine loading could decrease oxidative stress and increase antioxidant capacity in healthy volunteers.
Yasunori Miyamoto, Guo-Gang Feng, Shiho Satomi, Katsuya Tanaka, Yoshihiro Fujiwara and Hiroyuki Kinoshita : Phosphatidylinositol 3-kinase inhibition induces vasodilator effect of sevoflurane via reduction of Rho kinase activity., Life Sciences, Vol.177, 20-26, 2017.
(要約)
This study was aimed to examine whether a volatile anesthetic sevoflurane in clinical doses reduces vasoconstriction under the inhibition of phosphatidylinositol 3-kinase (PI3K) in the rat and human arteries and whether the intravenous administration of the PI3K inhibitor decreases blood pressure in rats under the sevoflurane inhalation. Rat arteries (n=5-6) and human omental arteries (n=5-6) were subjected to isometric force recordings and western immunoblotting for Rho kinase, mitogen-activated protein kinase, and protein kinase C. Some arteries were incubated with sevoflurane (1.5% or 3%), a selective PI3K inhibitor LY294002 (3×10mol/L) or the combination. Mean arterial pressure (MAP) and heart rate (HR) in rats (n=7) were evaluated with or without intravenous injection of LY294002 (3×10mol/L) under 2% sevoflurane inhalation. Sevoflurane with LY294002, but not sevoflurane or LY294002 solely, inhibited the phenylephrine-induced contraction (32% to 52% decrease at phenylephrine [3×10mol/L] in rat arteries and [3×10mol/L] in human arteries). Sevoflurane (3%) only with LY294002 decreased Rho kinase activity in the rat aorta into 30%. Intravenous LY294002 reduced MAP (8.1-12.4mmHg decrease), but not HR, in rats under 2% sevoflurane inhalation. Clinical sevoflurane doses with PI3K inhibition reduce the contraction of rat and human arteries ex vivo resulting from Rho kinase inhibition, and systemic blood pressure of rats in vivo. These results suggest that sevoflurane potentially causes vasodilation and hypotension in patients receiving anti-cancer therapy that inhibits PI3K.
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.
Takako Kadota, Nami Kakuta, Yousuke T. Horikawa, Rie Tsutsumi, Takuro Oyama, Katsuya Tanaka and Yasuo Tsutsumi : Plasma substance P concentrations in patients undergoing general anesthesia: an objective marker associated with postoperative nausea and vomiting, JA Clinical Reports, Vol.2, No.9, 9, 2016.
(要約)
This study investigated plasma concentrations of substance P (SP) in patients undergoing general anesthesia (GA) and postoperative nausea and vomiting (PONV). This prospective, observational, cohort study included 23 patients who underwent scheduled surgery under general anesthesia. Blood was collected from the radial artery at predetermined time points (15-30 mins prior anesthesia, 15-30 mins after surgery/GA, and 24 h after surgery). PONV, SP concentrations, risk factors, and analgesics used were measured. Nine of 23 patients experienced PONV. In patients without PONV, SP concentrations significantly decreased ( < 0.0001) at the end of surgery/GA, compared to baseline, and recovered at 24 h after surgery/GA (452.9 ± 146.2 vs. 666.9 ± 176.5 vs. 580.7 ± 168.6 pg/mL, respectively), whereas SP levels were unchanged during surgery/GA and increased at 24 hours after surgery ( = 0.020) in patients with PONV (726.1 ± 167.8 vs. 655.8 ± 168.0 vs. 779.7 ± 220.7 pg/mL, respectively). These finding suggest that SP levels may be utilized as an objective marker for PONV.
Michiko Kinoshita, Yasuo M. Tsutsumi, Kohei Fukuta, Asuka Kasai and Katsuya Tanaka : Isoflurane-induced postconditioning via mitochondrial calcium-activated potassium channels., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 80-84, 2016.
(要約)
Activation of the mitochondrial calcium-activated potassium (mKCa) channel reportedly confers resistance to myocardial ischemic stress. However, the role of the mKCa channel in postconditioning induced by volatile anesthetic remains unclear. Male Japanese white rabbits underwent coronary artery occlusion for 30 min followed by reperfusion for 3 h. Volatile anesthetic, isoflurane, was administered at 3 min prior to reperfusion for 5 min. Rabbits were injected with the mKCa channel blocker, iberiotoxin, or the mKCa channel opener, NS1619, at 8 min prior to reperfusion. Myocardial infarct size and the area at risk (AAR) were measured at the end of the experiment. Isoflurane significantly reduced infarct size (23.0 ± 9.8% of the AAR, P<0.05) compared with the control (44.0 ± 9.1%). Iberiotoxin abolished the cardioprotective impact of isoflurane (43.0 ± 11.6%), while iberiotoxin alone exerted no effect on infarct size (45.0 ± 9.5%). NS1619 and isoflurane/NS1619 both significantly reduced infarct size (21.0 ± 10.3% and 19.0 ± 8.8%, respectively, P<0.05 vs control group), but isoflurane/NS1619 showed no additional benefits compared with isoflurane alone. These results indicate that activation of the mKCa channel contribute isoflurane-induced postconditioning.
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.
37.
Hiroaki Kawano, Naohiro Ohshita, Kimiko Katome, Takako Kadota, Michiko Kinoshita, Yayoi Matsuoka, Yasuo M. Tsutsumi, Shinji Kawahito, Katsuya Tanaka and Shuzo Oshita : [Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery]., Revista Brasileira de Anestesiologia, Vol.66, No.1, 12-18, 2015.
(要約)
We investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery. Patients were randomly divided into three groups: those maintained with sevoflurane (Group S; n = 42), propofol (Group P; n = 42), or combined propofol and sevoflurane (Group PS; n = 42). We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24h after surgery. The number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0-2h (74%; 76% and 43%; respectively, p = 0.001) and 0-24h (71%; 76%, and 38%; respectively, p < 0.0005). The incidence of nausea at 0-2h (Group S = 57%; Group P = 26% and Group PS = 21%; p = 0.001) and 0-24h (Group S = 62%; Group P = 29% and Group PS = 21%; p < 0.0005) was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0-24h. Combined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea.
Tomohiro Soga, Katsuyoshi Kume, Nami Kakuta, Eisuke Hamaguchi, Rie Tsutsumi, Ryosuke Kawanishi, Kohei Fukuta, Katsuya Tanaka and Yasuo M. Tsutsumi : Fosaprepitant versus ondansetron for the prevention of postoperative nausea and vomiting in patients who undergo gynecologic abdominal surgery with patient-controlled epidural analgesia: a prospective, randomized, double-blind study., Journal of Anesthesia, Vol.29, No.5, 696-701, 2015.
(要約)
No (0 %) patient in the NKI group experienced vomiting after surgery; however, 4-6 (20-30 %) of 20 patients in the ONS group experienced vomiting. This difference was significant at 0-24, 0-48, and 0-72 h. During the study period, no significant differences existed between the NK1 and ONS groups in the incidence of PONV, complete response rate, rescue antiemetic use, nausea score, and VAS score for pain.
Yasuo Tsutsumi, Rie Tsutsumi, Yousuke T. Horikawa, Yoko Sakai, Eisuke Hamaguchi, Hiroshi Kitahata, Asuka Kasai, Noriko Kambe and Katsuya Tanaka : Geranylgeranylacetone and volatile anesthetic-induced cardiac protection synergism is dependent on caveolae and caveolin-3., Journal of Anesthesia, Vol.28, No.5, 733-739, 2014.
(要約)
Pharmacological preconditioning, including that with geranylgeranylacetone (GGA) and volatile anesthetics, has been shown to confer cardiac protection from ischemia/reperfusion injury although the mechanisms for this protection are poorly understood. Caveolins, integral membrane proteins that act as scaffolding proteins in caveolar membranes, localize molecules involved in cardiac protection. We have tested the hypothesis that caveolin-3 (Cav-3), the predominant isoform in cardiac myocytes, is essential for the synergistic effect observed between GGA and volatile anesthetics. Mice were randomly assigned to receive GGA, isoflurane [0.5 and 1.0 minimum alveolar concentration (MAC)], or GGA + isoflurane (0.5 MAC). An in vivo mouse model of ischemia/reperfusion injury was tested in wild-type and Cav-3 knockout mice, and the infarct size was determined. Biochemical assays were also performed in excised hearts. Geranylgeranylacetone and therapeutic isoflurane (1.0 MAC) independently reduced infarct size (31.6 ± 6.1 and 28.0 ± 5.0 % of the area at risk, respectively; n = 10) as compared to the controls (45.8 ± 9.4 %; n = 10). The combination GGA + sub-therapeutic isoflurane (0.5 MAC) further decreased the infarct size to 19.3 ± 5.1 % (n = 10). Preconditioning [GGA, isoflurane (1.0 MAC), and GGA + isoflurane] increased the amount of Cav-3 protein in the discontinuous sucrose-gradient buoyant fractions. Additionally, cardiac protection was not observed in Cav-3 knockout mice following the administration of GGA, isoflurane, and GGA + isoflurane. Combined administration of GGA + isoflurane had a synergistic effect, enhancing the protection against myocardial infarction to a greater extent than either drug alone. This beneficial effect is mediated by Cav-3 expression.
Ryosuke Kawanishi, Kaori Yamamoto, Yoko Tobetto, Kayo Nomura, Michihisa Kato, Ritsuko Go, Yasuo Tsutsumi, Katsuya Tanaka and Yoshitsugu Takeda : Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial., Local and Regional Anesthesia, Vol.7, 5-9, 2014.
(要約)
To determine the effects of intravenous and perineural dexamethasone on the duration of interscalene brachial plexus block (ISB) with ropivacaine in patients undergoing arthroscopic shoulder surgery. In this prospective, randomized, placebo-controlled trial, patients presenting for arthroscopic shoulder surgery with an ISB were randomized to receive ropivacaine 0.75% (group C), ropivacaine 0.75% plus perineural dexamethasone 4 mg (group Dperi), or ropivacaine 0.75% plus intravenous dexamethasone 4 mg (group Div). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first request for analgesic. Thirty-nine patients were randomized. The median times of sensory block in groups C, Dperi, and Div were 11.2 hours (interquartile range [IQR] 8.0-15.0 hours), 18.0 hours (IQR 14.5-19.0 hours), and 14.0 hours (IQR 12.7-15.1 hours), respectively. Significant differences were observed between groups Dperi and C (P=0.001). Kaplan-Meier analysis for the first analgesic request showed significant differences between groups Dperi and C (P=0.005) and between groups Dperi and Div (P=0.008), but not between groups C and Div. Perineural but not intravenous administration of 4 mg of dexamethasone significantly prolongs the duration of effective postoperative analgesia resulting from a single-shot ISB with ropivacaine 0.75%.
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.
Kaori Takata, Yoshinobu Tomiyama, Katsuya Tanaka and Shuzo Oshita : Cardioprotective effects of hyperkalemia during smulated ischemia/reperfusion in neonatal rat cardiomyocytes - Preservation of Na+/K+-ATPase activity -, The Journal of Medical Investigation : JMI, Vol.60, No.1,2,, 66-76, 2013.
(要約)
Hyperkalemia has multimodal effects on myocardial protection during ischemia/reperfusion. The preservation of Na(+)/K(+)-ATPase activity induced by hyperkalemia may have critical impact on myocardial protection. To elucidate the roles of hyperkalemia (16 mM) and Na(+)/K(+)-ATPase inhibition (100 µM ouabain) in myocardial protection during simulated ischemia (5 mM NaCN and 5.5 mM 2-deoxyglucose)/reperfusion, we measured loss of membrane integrity and bleb formation using a vital dye calcein AM in cultured neonatal rat cardiomyocytes. The control perfusate was switched to treatment solution for 15 min, followed by reperfusion for 30 min. In a second set of experiments, myocardial excitability and diastolic intracellular calcium ion concentration ([Ca(2+)]i) were measured during a 45-min treatment using a calcium-sensitive fluorescent dye fluo-4 AM. Simulated ischemia/reperfusion under ouabain treatment induced loss of membrane integrity, which was suppressed by hyperkalemia. Simulated ischemia/reperfusion induced bleb formation, which was accelerated by ouabain. Hyperkalemia delayed and inhibited the increase in diastolic [Ca(2+)]i induced by simulated ischemia. Furthermore, hyperkalemia almost completely inhibited the effects of ouabain on the diastolic [Ca(2+)]i during ischemia. These results suggest that hyperkalemia during ischemia is cardioprotective against ischemia/reperfusion insults and that hyperkalemia inhibits the effects of ouabain during ischemia.
Naohiro Ohshita, Katsuya Tanaka, Yoko Sakai, Toshiko Katayama, Yoshinobu Tomiyama, Shuzo Ohsita and Yasuo M. Tsutsumi : Anesthesia for deep brain stimulation in a patient with X-linked dystonia-parkinsonism/Lubag disease., The Journal of Medical Investigation : JMI, Vol.60, No.1-2, 146-148, 2013.
(要約)
Lubag disease is a genetic X-linked dystonia-parkinsonism syndrome afflicting Filipino men. This disease is characterized by dystonia dominating the first 10-15 years of the disorder, which is associated with or replaced by parkinsonian features in later years of life. A 49-year-old man with Lubag disease underwent general anesthesia for deep brain stimulation (DBS) surgery. Anesthesia was maintained mainly with propofol, remifentanil, rocuronium bromide, and sevoflurane. During magnetic resonance imaging, the patient was anesthetized with midazolam, fentanyl, and rocuronium bromide. The surgery was completed safely using these anesthetic agents. After DBS, some symptoms including involuntary movement improved within 10 days.
Anaphylaxis during anesthesia is a rare but life-threatening event. Sugammadex is a recently introduced drug that was specifically designed for the reversal of rocuroium and vecuronium-induced neuromuscular block. We describe the cases of a 74-year-old man and a 29-year-old man who developed an anaphylactoid reaction to sugammadex, presenting with cardiovascular collapse. Initial management consisted of fluid administration and intermittent i.v. ephedrine, epinephrine, and hydrocortisone. The patients made uncomplicated recovery and were discharged.
A 31-year-old woman with amyotrophic lateral sclerosis (ALS) with respiratory muscle paralysis was scheduled for tracheotomy. After applying standard neuromuscular monitoring devices, general anesthesia was induced and maintained with propofol, remifentanil, rocuronium, and sevoflurane. Sugammadex is a potent agent for reversal of neuromuscular blockade by rocuronium. The patient emerged from general anesthesia smoothly using sugammadex; however, assisted respiration was continued for possible prolongation of the effect of muscle relaxant. The postoperative course was uneventful, and she was discharged without any discomfort.
Takashi Kawano, Katsuya Tanaka, Haidong Chi, Satoru Eguchi, Fumimoto Yamazaki, Sonoe Kitamura, Naoko Kumagai and Masataka Yokoyama : Biophysical and Pharmacological Properties of Glucagon-Like Peptide-1 in Rats Under Isoflurane Anesthesia., Anesthesia & Analgesia, Vol.115, No.1, 62-69, 2012.
(要約)
Glucagon-like peptide-1 (GLP-1) increases insulin secretion and has an important role in maintaining glucose homeostasis. In this study, we evaluated the biophysical and pharmacological properties of GLP-1 by performing in vivo and in vitro experiments to determine the applicability of GLP-1 in glycemic control in rats under isoflurane anesthesia. Levels of portal GLP-1, insulin, and glucose and dipeptidyl peptidase-4 activity were measured in the basal fasting state and after gastric glucose load before, during, and after exposure to 30% O(2) in air (control) or 1.4% isoflurane in a mixture of 30% O(2) and air. The direct effects of isoflurane on GLP-1 secretion were assessed in human enteroendocrine NCI-H716 cells. Insulin release from isolated pancreatic islets was measured using a radioimmunoassay. Single pancreatic β-cell membrane potentials were recorded using whole-cell current-clamp patches perforated by β-escin. In fasting rats, inhalation of isoflurane led to a decrease in the basal levels of GLP-1 but did not affect insulin and glucose levels. Levels of GLP-1, insulin, and glucose increased after gastric administration of glucose in control rats. However, isoflurane attenuated the glucose-induced increase in GLP-1 and insulin levels and increased plasma glucose levels. In contrast, isoflurane did not affect dipeptidyl peptidase-4 activity before or after gastric glucose loading. Isoflurane (0.35 mM) inhibited GLP-1 release in NCI-H716 cells; this finding was similar to that observed in in vivo studies. In perifusion experiments, isoflurane (0.35 mM) inhibited glucose-induced insulin release, whereas exogenous GLP-1 (10 nM) enhanced insulin release. Importantly, combined administration of isoflurane and GLP-1 enhanced both phases of glucose-induced insulin release to an extent similar to that achieved with GLP-1 alone. Whole-cell patches showed that exposure to GLP-1 (10 nM) led to nearly complete restoration of glucose-stimulated depolarization that had been suppressed by isoflurane (0.35 mM). GLP-1 secretion is impaired during isoflurane anesthesia. However, our study showed that the insulinotropic action of GLP-1 was not affected by isoflurane. Furthermore, exposure to GLP-1 increased the membrane activity of pancreatic β-cells, preventing isoflurane-induced impairment of glucose-induced insulin secretion. These results support the hypothesis that GLP-1-based therapy may be a useful approach for achieving intraoperative glycemic control.
We describe anesthetic management of a patient with airway stenosis due to a tracheal tumor involving the carina. A 68-year-old man developed dyspnea and was scheduled for YAG laser surgery under general anesthesia. Awake fiberoptic intubation was selected for anesthesia induction, and percutaneous cardiopulmonary support (PCPS) was ready to be established prior to induction of anesthesia. Anesthesia was maintained with remifentanil (0.05 microg x kg(-1) x min(-1)) and propofol (2 mg x kg(-1) x hr(-1)), and spontaneous breathing was preserved throughout the surgical procedure. The operation was completed successfully without any adverse events, and PCPS was not used. In this patient, preservation of spontaneous breathing using remifentanil was found to be useful for airway management.
Kayo Hirose, Yasuo M. Tsutsumi, Rie Tsutsumi, Masayuki Shono, Erika Katayama, Michiko Kinoshita, Katsuya Tanaka and Shuzo Oshita : Role of the O-linked -N-acetylglucosamine in the cardioprotection induced by isoflurane., Anesthesiology, Vol.115, No.5, 955-962, 2011.
(要約)
Cardiac protection by volatile anesthetic-induced preconditioning and ischemic preconditioning have similar signaling pathways. Recently, it was reported that augmentation of protein modified with O-linked -N-acetylglucosamine (O-GlcNAc) contributes to cardiac protection. This study investigated the role of O-GlcNAc in cardiac protection induced by anesthetic-induced preconditioning. O-GlcNAc-modified proteins were visualized by immunoblotting. Tolerance against ischemia or reperfusion was tested in vivo (n = 8) and in vitro (n = 6). The opening of the mitochondrial permeability transition pore (mPTP) upon oxidative stress was examined in myocytes treated with calcein AM (n = 5). Coimmunoprecipitation and enzymatic labeling were performed to detect the mitochondrial protein responsible for the mPTP opening. Isoflurane treatment and the consequent augmentation of O-GlcNAc concentrations reduced the infarct size (26 ± 5% [mean ± SD], P < 0.001) compared with the control. The protective effect of O-GlcNAc was eliminated in the group pretreated with the O-GlcNAc transferase inhibitor alloxan (39 ± 5%, P < 0.001). Myocyte survival also showed the same result in vitro. Formation of the mPTP was abrogated in the isoflurane-treated cells (86 ± 4%, P < 0.001) compared with the control and alloxan-plus-isoflurane-treated cells (57 ± 7%, P < 0.001). Coimmunoprecipitation and enzymatic labeling studies revealed that the O-GlcNAc-modified, voltage-dependent anion channel restained the mPTP opening. Isoflurane induced O-GlcNAc modification of mitochondrial voltage-dependent anion channel. This modification inhibited the opening of the mPTP and conferred resistance to ischemia-reperfusion stress.
Yasuo M. Tsutsumi, Yoshinobu Tomiyama, Yousuke T. Horikawa, Yoko Sakai, Naohiro Ohshita, Katsuya Tanaka and Shuzo Oshita : General anesthesia for electroconvulsive therapy with Brugada electrocardiograph pattern., The Journal of Medical Investigation : JMI, Vol.58, No.3-4, 273-276, 2011.
(要約)
Brugada syndrome is characterized by an electrocardiograph pattern of right bundle-branch block and has an increased risk for cardiac arrest due to malignant arrhythmia. We describe the successful anesthetic management for electroconvulsive therapy in a patient with Brugada electrocardiograph pattern. Patients with Brugada ECG pattern are not recommended to use neostigmine which augments ST elevation. Sugammadex was administered as a neuromuscular reversal agent in this case. Sugammadex provides rapid reversal of profound rocuronium-induced neuromuscular blockade under propofol anesthesia.
(キーワード)
Anesthesia, General / Brugada Syndrome / Electrocardiography / Electroconvulsive Therapy / Humans / Male / Middle Aged / gamma-Cyclodextrins
Nami Kakuta, Yasuo M. Tsutsumi, Yousuke T. Horikawa, Hiroaki Kawano, Michiko Kinoshita, Katsuya Tanaka and Shuzo Oshita : Neurokinin-1 receptor antagonism, aprepitant, effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures., The Journal of Medical Investigation : JMI, Vol.58, No.3-4, 246-251, 2011.
(要約)
Post-operative nausea and vomiting (PONV) remains the most frequently reported patient complaint after anesthesia. Aprepitant is the first neurokinin-1(NK1) receptor antagonism available for use as an antiemetic. We investigated whether aprepitant can effectively decrease PONV in patients undergoing laparoscopic gynecological surgery. Sixty four patients receiving general anesthesia for laparoscopic gynecological surgery were randomly assigned to either receive a preoperative dose of 80 mg aprepitant or no drug. Efficacy was assessed in 2 and 24 hours after surgery. Primary and secondary endpoints were analyzed for the time intervals 0-2 hours (acute phase) and 2-24 hours (delayed phase). Vomiting, nausea, use of rescue anti-emetic, and visual analog scale (VAS) were assessed. Nausea was assessed on a 4-point scale, from 0 to 3. Sixty patients participated in the study. At acute phase, PONV was present in both control and NK1 group and were 63% and 43% respectively. The severity of nausea was much less in the NK1 group. PONV prevalence at delayed phase was present in control but absent in NK1 group 27% vs. 0%, respectively. The amount of pain medication used by patients in the NK1 group was significantly less for diclofenac and pentazocine suggesting increase pain tolerance. Neurokinin-1 receptor antagonism effectively lowered PONV increased pain tolerance, and expedited recovery in patients undergoing laparoscopic gynecological surgery.
We experienced anesthetic management of a patient with Becker muscular dystrophy. He had advanced dilated cardiomyopathy and high serum CK in the preoperative examinations. Anesthesia was planned to avoid triggering malignant hyperthermia or rhabdomyolysis and hemodynamic changes. Propofol, remifentanil and a minimum dose of rocuronium bromide were used for anesthetic induction and maintainance. Arterial pressure, cardiac output and stroke volume variation were monitored by Flotrac sensor. There were no adverse events observed during the anesthetic management. In conclusion, total intravenous anesthesia with the administration of rocuronium and circulatory monitoring by Flotrac sensor could be safe and efficient for anesthetic management of patients with Becker muscular dystrophy.
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.
Yasuo M. Tsutsumi, Rie Tsutsumi, Kazuaki Mawatari, Yutaka Nakaya, Michiko Kinoshita, Katsuya Tanaka and Shuzo Oshita : Compound K, a metabolite of ginsenosides, induces cardiac protection mediated nitric oxide via Akt/PI3K pathway., Life Sciences, Vol.88, No.15-16, 725-729, 2011.
(要約)
Compound K (C-K; 20-O-D-glucopyranosyl-20(S)-protopanaxadiol) is a novel ginsenoside metabolite formed by intestinal bacteria and does not occur naturally in ginseng. In this study, we investigated whether administration of C-K has protective effects on myocardial ischemia-reperfusion injury and its potential mechanisms.
Yoko Sakai, Yasuo M. Tsutsumi, Narutomo Wakamatsu, Tomohiro Soga, Katsuya Tanaka and Shuzo Oshita : A case where rocuronium was unable to achieve neuromuscular block immediately after sugammadex administration., The Journal of Medical Investigation : JMI, Vol.58, No.1-2, 163-165, 2011.
(要約)
We present a case where immediate muscle relaxation was needed following sugammadex administration. A 72 year-old female underwent surgery for a cerebral artery aneurysm. Upon conclusion of the operation sugammadex (9.3 mg/kg) was administered and the patient was noted to have left hemiplegia. Rocuronium (1.2 mg/kg × 2 doses) was given in order to gain neuromuscular block approximately 25 minutes after sugammadex had been injected. Although TOF monitoring was not utilized in this case and assessing residual muscular block was difficult, spontaneous respirations continued and breathing had to be controlled with sevoflurane and remifentanil. Sugammadex is a potent reversal agent for rocuronium-induced neuromuscular block, however, certain situations require immediate neuromuscular blockade following sugammadex. In this case, rocuronium was unable to induce neuromuscular blockade immediately after sugammadex and that higher concentrations were necessary in addition to intravenous analgesics and inhaled anesthetics.
Katsuya Tanaka, Takashi Kawano, Yasuo M. Tsutsumi, Michiko Kinoshita, Nami Kakuta, Kayo Hirose, Masakazu Kimura and Shuzo Oshita : Differential effects of propofol and isoflurane on glucose utilization and insulin secretion., Life Sciences, Vol.88, No.1-2, 96-103, 2011.
(要約)
Volatile anesthetics, such as isoflurane, reverse glucose-induced inhibition of pancreatic adenosine triphosphate-sensitive potassium (K(ATP)) channel activity, resulting in reduced insulin secretion and impaired glucose tolerance. No previous studies have investigated the effects of intravenous anesthetics, such as propofol, on pancreatic K(ATP) channels. We investigated the cellular mechanisms underlying the effects of isoflurane and propofol on pancreatic K(ATP) channels and insulin secretion.
Takashi Kawano, Katsuya Tanaka, Haidong Chi, Masakazu Kimura, Hiroaki Kawano, Satoru Eguchi and Shuzo Oshita : Effects of aging on isoflurane-induced and protein kinase A-mediated activation of ATP-sensitive potassium channels in cultured rat aortic vascular smooth muscle cells., Journal of Cardiovascular Pharmacology, Vol.56, No.6, 676-685, 2010.
(要約)
Isoflurane activates protein kinase A (PKA) in vascular smooth muscle cells (VSMCs), which in turn activates ATP-sensitive potassium (K(ATP)) channels and causes vasodilation. The present study was undertaken to examine whether advanced age influences the effect of isoflurane on K(ATP) channel activity in cultured VSMCs. We used VSMCs obtained from 12- to 15-week-old (adult) and 24- to 25-month-old (aged) male Wistar rats. Electrophysiological experiments were performed using cell-attached and inside-out patch-clamp techniques to monitor the K(ATP) channel activity. Application of isoflurane or forskolin to the bath solution in cell-attached recordings induced a significant increase in K(ATP) channel activity in the VSMCs from the adult group. However, K(ATP) channel opening induced by isoflurane, but not forskolin, was significantly suppressed by aging. On the other hand, cell-free recordings showed similar pharmacologic sensitivity to the K(ATP) channel opener pinacidil, inward rectification, and unitary conductance (40 45 pS) between groups. In addition, direct K(ATP) channel activation by c-PKA in the inside-out patches was similar in both groups. Furthermore, increasing PKA activation in cell-attached patches by CPT-cAMP restored isoflurane's effects in the aged group. These results suggest that aging decreases isoflurane-induced PKA activation, resulting in attenuation of K(ATP) channel opening.
Takashi Kawano, Katsuya Tanaka, hua Yin, Satoru Eguchi, Hiroaki Kawano, Akira Takahashi, Yutaka Nakaya and Shuzo Oshita : Effects of ketamine on nicorandil induced ATP-sensitive potassium channel activity in cell line derived from rat aortic smooth muscle., The Journal of Medical Investigation : JMI, Vol.57, No.3-4, 237-244, 2010.
(要約)
Nicorandil opens adenosine triphosphate-sensitive potassium (K(ATP)) channels in the cardiovascular system and is being increasingly used for the treatment of angina pectoris. In the present study, we tested whether intravenous anesthetic agent ketamine affected nicorandil-induced native vascular K(ATP) channel activation.
Isoflurane activates vascular adenosine triphosphate sensitive potassium (K(ATP)) channels, and may induce vasodilation. In the present study, we investigated whether hyperglycemia modifies isoflurane activation of vascular K(ATP) channel. We used a cell-attached patch-clamp configuration to test the effects of isoflurane on K(ATP) channel activity in vascular smooth muscle cells (VSMCs) after incubation for 24 h in medium containing normal glucose (NG, 5.5 mM D-glucose), L-glucose (LG, 5.5 mM D-glucose plus 17.5 mM L-glucose), or high glucose (HG, 23 mM D-glucose). Superoxide levels in aortas were measured by the lucigenin-enhanced chemiluminescence technique. Isoflurane-induced open probabilities were significantly reduced in VSMCs from arteries incubated in HG (0.06 +/- 0.01) compared with NG (0.17 +/- 0.02; P < 0.05) and LG (0.15 +/- 0.02; P < 0.05). Pretreatment of VSMCs with protein kinase C (PKC) inhibitors, calphostin C and PKC inhibitor 20-28, greatly reduced HG inhibition of isoflurane-induced K(ATP) channel activity. In addition, a PKC activator, PMA, mimicked the effects of HG. Superoxide release was significantly increased in arteries incubated in HG (18.3 +/- 11.5 relative light units (RLU) x s(-1) x mg(-1); P < 0.05 versus NG). Coincubated with polyethylene glycol-superoxide dismutase (250 U/mL), a cell-permeable superoxide scavenger, greatly reduced the HG-induced increase of superoxide, but failed to reduce HG inhibition of isoflurane-induced K(ATP) channel activity. Our results suggest that the metabolic stress of hyperglycemia can impair isoflurane-induced vascular K(ATP) channel activity mediated by excessive activation of PKC. This could impede the coronary vasodilation response to isoflurane, causing ischemia or hypoxia in patients with perioperative hyperglycemia.
Takashi Kawano, Tomohito Kawano, Katsuya Tanaka, Satoru Eguchi, Akira Takahashi, Yutaka Nakaya and Shuzo Oshita : Effects of dopamine on ATP-sensitive potassium channels in porcine coronary artery smooth-muscle cells, Journal of Cardiovascular Pharmacology, Vol.51, No.2, 196-201, 2008.
(要約)
Dopamine is reported to be a coronary vasodilator; however, the exact mechanism of dopamine action in the coronary circulation remains unclear. In this study, we hypothesized that dopamine-induced activation of coronary ATP-sensitive potassium (KATP) channels may be associated with coronary vasodilation. We therefore investigated the direct effects of dopamine on coronary KATP-channel activity. We used patch-clamp configurations to investigate the effects of dopamine on coronary KATP-channel activity. Application of dopamine (10 to 10 M) to the bath solution during cell-attached recordings induced a concentration-dependent increase in KATP-channel activity. In contrast, dopamine failed to activate KATP channels in inside-out patches. Dopamine-induced coronary KATP-channel currents in cell-attached patches were inhibited by pretreatment with the selective D1-like antagonist, Sch-23390, but they were not influenced by the selective D2-like antagonist, domperidone, or the beta-adrenergic receptor antagonist, propranolol. The selective D1-like agonist, SKF-38393, and the adenylyl cyclase activator, forskolin, mimicked the dopamine effects on coronary KATP channels. Furthermore, pretreatment with an inhibitor of protein kinase A, Rp-cAMPS, abolished the dopamine-induced KATP-channel activation. This study demonstrates that dopamine activates coronary KATP channels via signal transduction involving the D1-like dopaminergic receptor-protein kinase A-signaling pathway.
Satoru Eguchi, Takashi Kawano, hua Yin, Katsuya Tanaka, Sonoko Yasui, Kazuaki Mawatari, Akira Takahashi, Yutaka Nakaya, Shuzo Oshita and Nobuyoshi Nakajo : Effects of prostaglandin E1 on vascular ATP-sensitive potassium channels., Journal of Cardiovascular Pharmacology, Vol.50, No.6, 686-691, 2007.
(要約)
BACKGROUND: Prostaglandin E1 (PGE1) has been reported to activate ATP-sensitive potassium (KATP) channels, which induces vasorelaxation. However, direct evidence of PGE1 interactions with vascular KATP channels is limited. METHODS: The present study investigated the effects and mechanisms of PGE1 on vascular KATP channels in both isometric tension and patch clamp experiments.Isometric tension experiments were performed in rat thoracic aortic rings without an endothelium. Electrophysiologic experiments were performed using patch-clamp techniques to monitor KATP channels in rat vascular smooth muscle cells. RESULTS: PGE1 significantly decreased the isometric tension in a concentration-dependent manner, which was partially inhibited by pretreating with a KATP channel inhibitor, glibenclamide (1 microM), or an inhibitor of protein kinase A (PKA), Rp-cAMPS (100 microM). Application of PGE1 to the bath solution during cell-attached recordings induced a significant increase in KATP channel activity, whereas PGE1 failed to activate KATP channels in the inside-out patches. The PGE1-induced KATP channel currents in cell-attached patches were abolished by pretreating with Rp-cAMPS (100 microM). CONCLUSIONS: The results indicate that the activation of vascular KATP channels played an important role in the PKA-dependent PGE1-induced vasorelaxation. Furthermore, an electrophysiological experiment demonstrated that PGE1 activated vascular KATP channels via PKA activation.
Takashi Kawano, Katsuya Tanaka, Hossein Nazari, Shuzo Oshita, Akira Takahashi and Yutaka Nakaya : The effects of extracellular pH on vasopressin inhibition of ATP-sensitive K+ channels in vascular smooth muscle cells, Anesthesia & Analgesia, Vol.105, No.6, 1714-1719, 2007.
(要約)
Arginine vasopressin (AVP) inhibits ATP-sensitive potassium (K(ATP)) channels and may help to restore vascular tone in patients with vasodilatory shock. In the present study, we investigated whether extracellular acidification modifies the inhibition of vascular K(ATP) channels by AVP. We used a cell-attached patch-clamp configuration to investigate the effects of extracellular pH (pH(o)) on AVP-K(ATP) channel interaction in rat aortic smooth muscle cells. Bath application of AVP significantly inhibited extracellular acidification (pH(o) = 6.5)-induced K(ATP) channel activity in a concentration-dependent manner, with an half-maximal inhibitory concentration (IC50) value of 16.8 pM. Furthermore, bath application of AVP significantly inhibited pinacidil-induced K(ATP) channel activity at mild (pH(o) = 7.0) and severe (pH(o) = 6.5) extracellular acidification, with IC50 values of 266.7 and 21.4 pM, respectively, but failed to significantly inhibit at normal pH (pH(o) = 7.4) or under alkalosis (pH(o) = 9.0). Augmentation of AVP inhibition of vascular K(ATP) channels during extracellular acidification was eliminated by pretreatment with OPC-21268, a specific blocker of the V1 receptor, but not by a V2 blocker, OPC-31260. AVP-induced inhibition was also suppressed by pretreatment with a protein kinase C inhibitor, calphostin C. Our results suggest that AVP inhibits extracellular acidification-induced vascular K(ATP) channel activity, and that the inhibitory effects of AVP on vascular K(ATP) channels are enhanced by extracellular acidification via the V1 receptor-protein kinase C cell-signaling pathway. The potent inhibition of vascular K(ATP) channels by AVP under acidic conditions may make it suitable for management of vasodilatory shock.
Hirohide Yamada, Takashi Kawano, Katsuya Tanaka, Sonoko Yasui, Kazuaki Mawatari, Akira Takahashi, Yutaka Nakaya and Shuzo Oshita : Effects of intracellular MgADP and acidification on the inhibition of cardiac sarcolemmal ATP-sensitive potassium channels by propofol, Journal of Anesthesia, Vol.21, No.4, 472-479, 2007.
(要約)
Propofol inhibits adenosine triphosphate-sensitive potassium (K(ATP)) channels, which may result in the blocking of ischemic preconditioning in the heart. During cardiac ischemia, sarcolemmal K(ATP) channel activity is regulated by the increased levels of cytosolic metabolites, such as adenosine diphosphate (ADP) and protons. However, it remains unclear whether these cytosolic metabolites modulate the inhibitory action of propofol. The aim of this study was to investigate the effects of intracellular MgADP and acidification on K(ATP) channel inhibition by propofol. We used inside-out patch-clamp configurations to investigate the effects of propofol on the activities of recombinant cardiac sarcolemmal K(ATP) channels, which are reassociated by expressed subunits, sulfonylurea receptor (SUR) 2A, and inwardly rectifying potassium channels (Kir6.2). In the absence of MgADP, propofol inhibited the SUR2A/Kir6.2 channel currents in a concentration-dependent manner, and an IC(50) of 78 microM. Increasing the intracellular MgADP concentrations to 0.1 and 0.3 mM markedly attenuated the inhibitory potency of propofol, and shifted the IC(50) to 183 and 265 microM, respectively. Moreover, decreasing the intracellular pH from 7.4 to 6.5 attenuated the inhibitory potency of propofol, and shifted the IC(50) to 277 microM. In addition, propofol-induced inhibition of truncated Kir6.2DeltaC36 currents, which form a functional channel without SUR2A, was not affected by an increase in intracellular MgADP. However, intracellular acidification (pH 6.5) significantly reduced the propofol sensitivity of Kir6.2DeltaC36 channels. Our results demonstrated that the existence of intracellular MgADP and protons attenuated the direct inhibitory potency of propofol on recombinant cardiac sarcolemmal K(ATP) channels, via SUR2A and Kir6.2 subunits, respectively.
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.
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.
Ketamine inhibits adenosine triphosphate-sensitive potassium (KATP) channels, which results in the blocking of ischemic preconditioning in the heart and inhibition of vasorelaxation induced by KATP channel openers. In the current study, the authors investigated the molecular mechanisms of ketamine's actions on sarcolemmal KATP channels that are reassociated by expressed subunits, inwardly rectifying potassium channels (Kir6.1 or Kir6.2) and sulfonylurea receptors (SUR1, SUR2A, or SUR2B). The authors used inside-out patch clamp configurations to investigate the effects of ketamine on the activities of reassociated Kir6.0/SUR channels containing wild-type, mutant, or chimeric SURs expressed in COS-7 cells. Ketamine racemate inhibited the activities of the reassociated KATP channels in a SUR subtype-dependent manner: SUR2A/Kir6.2 (IC50 = 83 microM), SUR2B/Kir6.1 (IC50 = 77 microM), SUR2B/Kir6.2 (IC50 = 89 microM), and SUR1/Kir6.2 (IC50 = 1487 microM). S-(+)-ketamine was significantly less potent than ketamine racemate in blocking all types of reassociated KATP channels. The ketamine racemate and S-(+)-ketamine both inhibited channel currents of the truncated isoform of Kir6.2 (Kir6.2DeltaC36) with very low affinity. Application of 100 mum magnesium adenosine diphosphate significantly enhanced the inhibitory potency of ketamine racemate. The last transmembrane domain of SUR2 was essential for the full inhibitory effect of ketamine racemate. These results suggest that ketamine-induced inhibition of sarcolemmal KATP channels is mediated by the SUR subunit. These inhibitory effects of ketamine exhibit specificity for cardiovascular KATP channels, at least some degree of stereoselectivity, and interaction with intracellular magnesium adenosine diphosphate.
PC Chiari, PS Pagel, Katsuya Tanaka, JG Krolikowski, LM Ludwig, RA Trillo, N Puri, JR Kersten and DC Warltier : Intravenous emulsified halogenated anesthetics produce acute and delayed preconditioning against myocardial infarction in rabbits., Anesthesiology, Vol.101, No.5, 1160-1166, 2004.
(要約)
Preconditioning against myocardial infarction by volatile anesthetics is well known. The authors tested the hypothesis that new emulsified formulations of halogenated anesthetics administered intravenously reduce myocardial infarct size when administered either 1 or 24 h before prolonged ischemia and reperfusion. Pentobarbital-anesthetized rabbits (n = 39) were instrumented for measurement of hemodynamics and randomly assigned to receive intravenous saline (control), lipid vehicle, or infusions (3.5 ml . kg . h for 30 min) of emulsified isoflurane (6.9%), enflurane (7.1%), or sevoflurane (7.5%). Infusions were discontinued 30 min before a 30-min coronary occlusion and 3 h of reperfusion. In three additional groups, conscious rabbits (n = 21) received saline, lipid vehicle, or emulsified sevoflurane (7.5%) infusions (3.5 ml . kg . h for 30 min) 24 h before ischemia and reperfusion. Infarct size was determined using triphenyltetrazolium staining. Lipid vehicle produced transient increases in heart rate, whereas emulsified volatile anesthetics had no effect on hemodynamics before coronary occlusion. Lipid vehicle did not affect infarct size (38 +/- 2% of the area at risk; mean +/- SEM) as compared with saline control (41 +/- 4%). In contrast, emulsified isoflurane, enflurane, and sevoflurane reduced infarct size (20 +/- 3%, 20 +/- 3%, and 21 +/- 2% of the area at risk, respectively; P < 0.05). Administration of lipid vehicle or emulsified sevoflurane did not produce sedation or respiratory depression in conscious rabbits. Emulsified sevoflurane (18 +/- 2%) but not lipid vehicle (44 +/- 2%) reduced infarct size as compared with control in delayed preconditioning experiments. Intravenous emulsified halogenated anesthetics produce acute and delayed preconditioning against myocardial infarction.
LM Ludwig, Katsuya Tanaka, JT Eelles, D Weihrauch, PS Pagel, JR Kersten and DC Warltier : Preconditioning by isoflurane is mediated by reactive oxygen species generated from mitochondrial electron transport chain complex III., Anesthesia & Analgesia, Vol.99, No.5, 1308-1315, 2004.
(要約)
Reactive oxygen species (ROS) mediate volatile anesthetic preconditioning. We tested the hypothesis that isoflurane (ISO) generates ROS from electron transport chain complexes I and III. Rabbits (n = 55) underwent 30 min coronary artery occlusion followed by 3 h reperfusion and received 0.9% saline, the complex I inhibitor diphenyleneiodonium (DPI; 1.5 mg/kg bolus followed by 1.5 mg/kg over 1 h), or the complex III inhibitor myxothiazol (MYX; 0.1 mg/kg bolus followed by 0.3 mg/kg over 1 h) in the absence and presence of 1.0 minimum alveolar concentration ISO. ISO was administered for 30 min and discontinued 15 min before coronary occlusion. Infarct size and ROS production (n = 32) were determined using triphenyltetrazolium staining and ethidium-DNA fluorescence, respectively. Adenosine triphosphate (ATP) synthesis in mitochondria obtained from rabbit hearts (n = 24) subjected to drug interventions was measured by luciferin-luciferase luminometry. ISO significantly (P < 0.05) reduced infarct size (19% +/- 4%) as compared with control (39% +/- 4%). MYX (35% +/- 4%), but not DPI (24% +/- 2%), abolished this protection. ISO increased ethidium-DNA fluorescence (83 +/- 11 U) as compared with control (40 +/- 12 U). MYX (35 +/- 3 U), but not DPI (78 +/- 9 U), abolished ROS generation. DPI and MYX selectively reduced complex I- and complex III-mediated ATP synthesis, respectively. ROS generated from electron transport chain complex III mediate ISO-induced cardioprotection.
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, LM Ludwig, JG Krolilowski, D Alcindor, PF Pratt, JR Kersten, PS Pagel and DC Warltier : Isoflurane produces delayed preconditioning against myocardial ischemia and reperfusion injury: role of cyclooxygenase-2., Anesthesiology, Vol.100, No.3, 525-531, 2004.
(要約)
Whether volatile anesthetics produce a second window of preconditioning is unclear. The authors tested the hypothesis that isoflurane causes delayed preconditioning against infarction and, further, that cyclooxygenase (COX)-2 mediates this beneficial effect. Rabbits (n = 43) were randomly assigned to receive 0.9% intravenous saline, the selective COX-2 inhibitor celecoxib (3 mg/kg intraperitoneal) five times over 2 days before coronary artery occlusion and reperfusion, or isoflurane (1.0 minimum alveolar concentration) 24 h before acute experimentation in the absence or presence of celecoxib pretreatment. Two additional groups of rabbits received a single dose of celecoxib either 30 min before or 21.5 h after administration of isoflurane. Rabbits were then instrumented for measurement of hemodynamics and underwent 30 min of coronary occlusion followed by 3 h of reperfusion. Myocardial infarct size was measured using triphenyltetrazolium staining. Western immunoblotting to examine COX-1 and COX-2 protein expression was performed in rabbit hearts that had or had not been exposed to isoflurane. Isoflurane significantly (P < 0.05) reduced infarct size (22 +/- 3% of the left ventricular area at risk) as compared with control (39 +/- 2%). Celecoxib alone had no effect on infarct size (36 +/- 4%) but abolished isoflurane-induced cardioprotection (36 +/- 4%). A single dose of celecoxib administered 2.5 h before coronary occlusion and reperfusion also abolished the delayed protective effects of isoflurane (36 +/- 4%), but celecoxib given 30 min before exposure to isoflurane had no effect (22 +/- 4%). Isoflurane did not alter COX-1 and COX-2 protein expression. The results indicate that the volatile anesthetic isoflurane produces a second window of preconditioning against myocardial ischemia and reperfusion injury. Furthermore, COX-2 is an important mediator of isoflurane-induced delayed preconditioning.
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.
Weidong Gu, Dorothee Weihrauch, Katsuya Tanaka, John P. Tessmer, Paul S. Pagel, Judy R. Kersten, William M. Chilian and David C. Warltier : Reactive oxygen species are critical mediators of coronary collateral development in a canine model., American Journal of Physiology, Heart and Circulatory Physiology, Vol.285, No.4, H1582-H1589, 2003.
(要約)
Recent evidence suggests that reactive oxygen species (ROS) promote proliferation and migration of vascular smooth muscle (VSMC) and endothelial cells (EC). We tested the hypothesis that ROS serve as crucial messengers during coronary collateral development. Dogs were subjected to brief (2 min), repetitive coronary artery occlusions (1/h, 8/day, 21 day duration) in the absence (occlusion, n = 8) or presence of N-acetylcysteine (NAC) (occlusion + NAC, n = 8). A sham group (n = 8) was instrumented identically but received no occlusions. In separate experiments, ROS generation after a single 2-min coronary artery occlusion was assessed with dihydroethidium fluorescence. Coronary collateral blood flow (expressed as a percentage of normal zone flow) was significantly increased (71 +/- 7%) in occlusion dogs after 21 days but remained unchanged (13 +/- 3%) in sham dogs. Treatment with NAC attenuated increases in collateral blood flow (28 +/- 8%). Brief coronary artery occlusion and reperfusion caused ROS production (256 +/- 33% of baseline values), which was abolished with NAC (104 +/- 12%). Myocardial interstitial fluid produced tube formation and proliferation of VSMC and EC in occlusion but not in NAC-treated or sham dogs. The results indicate that ROS are critical for the development of the coronary collateral circulation.
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.
Katsuya Tanaka, D Weihrauch, LM Ludwig, JR Kersten, PS Pagel and DC Warltier : Mitochondrial adenosine triphosphate-regulated potassium channel opening acts as a trigger for isoflurane-induced preconditioning by generating reactive oxygen species., Anesthesiology, Vol.98, No.4, 935-43, 2003.
(要約)
Whether the opening of mitochondrial adenosine triphosphate-regulated potassium (K(ATP)) channels is a trigger or an end effector of anesthetic-induced preconditioning is unknown. We tested the hypothesis that the opening of mitochondrial K(ATP) channels triggers isoflurane-induced preconditioning by generating reactive oxygen species (ROS) in vivo. Pentobarbital-anesthetized rabbits were subjected to a 30-min coronary artery occlusion followed by 3 h reperfusion. Rabbits were randomly assigned to receive a vehicle (0.9% saline) or the selective mitochondrial K(ATP) channel blocker 5-hydroxydecanoate (5-HD) alone 10 min before or immediately after a 30-min exposure to 1.0 minimum alveolar concentration (MAC) isoflurane. In another series of experiments, the fluorescent probe dihydroethidium was used to assess superoxide anion production during administration of 5-HD or the ROS scavengers N-acetylcysteine or N-2-mercaptopropionyl glycine (2-MPG) in the presence or absence of 1.0 MAC isoflurane. Myocardial infarct size and superoxide anion production were measured using triphenyltetrazolium staining and confocal fluorescence microscopy, respectively. Isoflurane (P < 0.05) decreased infarct size to 19 +/- 3% (mean +/- SEM) of the left ventricular area at risk as compared to the control (38 +/- 4%). 5-HD administered before but not after isoflurane abolished this beneficial effect (37 +/- 4% as compared to 24 +/- 3%). 5-HD alone had no effect on infarct size (42 +/- 3%). Isoflurane increased fluorescence intensity. Pretreatment with N-acetylcysteine, 2-MPG, or 5-HD before isoflurane abolished increases in fluorescence, but administration of 5-HD after isoflurane only partially attenuated increases in fluorescence produced by the volatile anesthetic agent. The results indicate that mitochondrial K(ATP) channel opening acts as a trigger for isoflurane-induced preconditioning by generating ROS in vivo.
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
Katsuya Tanaka, D Weihrauch, F Kehl, LM Ludwig, JF LaDisa, JR Kersten, PS Pagel and DC Warltier : Mechanism of preconditioning by isoflurane in rabbits, --- A direct role for reactive oxygen species ---, Anesthesiology, Vol.97, No.6, 1485-90, 2002.
(要約)
Reactive oxygen species (ROS) contribute to myocardial protection during ischemic preconditioning, but the role of the ROS in protection against ischemic injury produced by volatile anesthetics has only recently been explored. We tested the hypothesis that ROS mediate isoflurane-induced preconditioning in vivo. Pentobarbital-anesthetized rabbits were instrumented for measurement of hemodynamics and were subjected to a 30 min coronary artery occlusion followed by 3 h reperfusion. Rabbits were randomly assigned to receive vehicle (0.9% saline), or the ROS scavengers N-acetylcysteine (NAC; 150 mg/kg) or N-2-mercaptopropionyl glycine (2-MPG; 1 mg. kg(-1).min(-1)), in the presence or absence of 1.0 minimum alveolar concentration (MAC) isoflurane. Isoflurane was administered for 30 min and then discontinued 15 min before coronary artery occlusion. A fluorescent probe for superoxide anion production (dihydroethidium, 2 mg) was administered in the absence of the volatile anesthetic or 5 min before exposure to isoflurane in 2 additional groups (n = 8). Myocardial infarct size and superoxide anion production were assessed using triphenyltetrazolium staining and confocal fluorescence microscopy, respectively. Isoflurane (P < 0.05) decreased infarct size to 24 +/- 4% (mean +/- SEM; n = 10) of the left ventricular area at risk compared with control experiments (43 +/- 3%; n = 8). NAC (43 +/- 3%; n = 7) and 2-MPG (42 +/- 5%; n = 8) abolished this beneficial effect, but had no effect on myocardial infarct size (47 +/- 3%; n = 8 and 46 +/- 3; n = 7, respectively) when administered alone. Isoflurane increased superoxide anion production as compared with control experiments (28 +/- 12 -6 +/- 9 fluorescence units; P < 0.05). The results indicate that ROS produced following administration of isoflurane contribute to protection against myocardial infarction in vivo.
(キーワード)
Analysis of Variance / Anesthetics, Inhalation / Animals / Hemodynamics / Isoflurane / Male / Myocardial Infarction / Rabbits / Reactive Oxygen Species
Katsuya Tanaka, Franz Kehl, Weidong Gu, John G. Krolilowski, Paul S. Pagel, David C. Warltier and Judy R. Kersten : Isoflurane-induced preconditioning is attenuated by diabetes., American Journal of Physiology, Heart and Circulatory Physiology, Vol.282, No.6, H2018-H2023, 2002.
(要約)
Volatile anesthetics stimulate, but hyperglycemia attenuates, the activity of mitochondrial ATP-regulated K(+) channels. We tested the hypothesis that diabetes mellitus interferes with isoflurane-induced preconditioning. Acutely instrumented, barbiturate-anesthetized dogs were randomly assigned to receive 0, 0.32, or 0.64% end-tidal concentrations of isoflurane in the absence or presence of diabetes (3 wk after administration of alloxan and streptozotocin) in six experimental groups. All dogs were subjected to a 60-min left anterior descending coronary artery occlusion followed by 3 h of reperfusion. Myocardial infarct size (triphenyltetrazolium staining) was 29 +/- 3% (n = 8) of the left ventricular area at risk in control experiments. Isoflurane reduced infarct size (15 +/- 2 and 13 +/- 1% during 0.32 and 0.64% concentrations; n = 8 and 7 dogs, respectively). Diabetes alone did not alter infarct size (30 +/- 3%; n = 8) but blocked the protective effects of 0.32% (27 +/- 2%; n = 7) and not 0.64% isoflurane (18 +/- 3%; n = 7). Infarct size was directly related to blood glucose concentrations in diabetic dogs, but this relationship was abolished by higher concentrations of isoflurane. The results indicate that blood glucose and end-tidal isoflurane concentrations are important determinants of infarct size during anesthetic-induced preconditioning.
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.
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.
98.
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.
102.
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.
Michiko Kinoshita, Yoko Sakai and Katsuya Tanaka : Relative publication output and international collaboration in anaesthesiology and pain medicine: a bibliometric analysis from 1996 to 2021, British Journal of Anaesthesia, Vol.131, No.2, e53-e55, 2023.
Post-operative nausea and vomiting(PONV)remains the most frequently reported patientscomplaint after anesthesia, and for patients, it is of greater concern than postoperative pain. PONVhas four main risk factors including : female gender, history of PONV or motion sickness, nonsmoking,and the use of postoperative opioids. Primary control of nausea and vomiting arises from the centralpattern generator for vomiting located in the medulla oblongara.Traditionally, the most common anti-emetics used to treat PONV include serotonin 5-hydroxytryptamine type3antagonists such as ondansetron, corticosteroids, like dexamethasone,or droperidol, which is a neuroleptic. However, these anti-emetics are not completely reliable andonly reduce the incidence of PONV by∼26%. Adding additional anti-emetics could further lowerthe incidence of PONV.PONV can result in several post-surgical complications. Neurokinin-1(NK-1)receptors are foundin gastrointenstinal vagal afferents and within the central nervous system vomiting reflex pathways.NK-1receptors are activated by Substance P, which is a regulatory peptide and preferred endogenousligand.We investigated whether NK-1antagonism can effectively diminish PONV in patients undergoinglaparoscopic gynecological surgery. Forty two patients were randomized into two groups : NK-1group which received an oral NK-1antagonist, aprepitant at80mg, and a control that did not receiveany anti-emetic. PONV incidence at2hours was present in both control and NK-1groups and was81% and52%, respectively. At24hours PONV was present in the control group, but was absentin the NK1group(27% and0%，respectively).PONV is associated with dissatisfaction after anesthesia and surgery, can result in several postsurgicalcomplications. NK-1receptor antagonism effectively lowered PONV, and expedited recoveryin patients undergoing laparoscopic gynecological surgery.
(キーワード)
post-operative nausea and vomiting / Neurokinin-1 receptor antagonism / aprepitant
Katsuya Tanaka, LM Ludwig, JR Kersten, PS Pagel and DC Warltier : Mechanisms of cardioprotection by volatile anesthetics., Anesthesiology, Vol.100, No.3, 707-721, Mar. 2004.
LM Ludwig, JR Kersten, Katsuya Tanaka, W Gu, JF LaDisa, DC Warltier and PS Pagel : Mechanisms of volatile anesthetic-induced myocardial protection., Current Topics in Pharmacology, Vol.7, No.2, 195-207, 2003.
国際会議:
1.
Takahashi Rikako, Yoko Sakai, Matsumoto Yako, Nakaji Yoshimi, Michiko Kinoshita and Katsuya Tanaka : Quantitative and Calculated Estimated Blood Loss in Caesarean Sections: A Retrospective Comparative Analysis between Twin and Singleton Pregnancies, Euroanesthesia 2024, May 2024.
Yako Matsumoto, Michiko Kinoshita, Yoshinobu Tomiyama and Katsuya Tanaka : Protecting Intraoperative Patients In Time Of Natural DisastersPast Experiences And Lessons Learned: A Scoping Review, The Anesthesiology Annual Meeting 2023, San Francisco, Oct. 2023.
4.
Ryo Sekiguchi, Michiko Kinoshita, Ryosuke Kawanishi, Nami Kakuta, Yoko Sakai and Katsuya Tanaka : Comparison Between Hemodynamics Of Remimazolam And Propofol During General Anesthesia: A Randomized Study, The Anesthesiology Annual Meeting, Oct. 2022.
5.
Nomura Honoka, Ryosuke Kawanishi, Honda Yasuto and Katsuya Tanaka : The effects of ten minutes' pre-warming of body temperature during breast surgery., American Society of Anesthesiology 2021 Annual Meeting, Online, Oct. 2021.
6.
Michiko Kinoshita, Yoko Sakai, Kimiko Katome, Tomomi Matsumoto, Yuka Jinnouchi, Noriko Niki, Shizuka Sakurai, Yoshiko Yoshida and Katsuya Tanaka : The transition in the eye gaze is a helpful predictor of emergence from general anesthesia with sevoflurane combined with remifentanil in children, but not adults, --- A prospective observational study ---, The Annual Meeting of the American Society of Anesthesiologists, WEB, Oct. 2020.
7.
Ryosuke Kawanishi and Katsuya Tanaka : Comparison of facemask pressure-controlled ventilation and facemask pressure-conntrolled ventilation volume-guaranteed during induction of anesthesia. - A randomized-controlled trial -, American Society of Anesthesiologists, WEB, Oct. 2020.
8.
Yuta Uemura, Nami Kakuta, Ryosuke Kawanishi and Katsuya Tanaka : Effects of administration based on muscle mass on the onset and duration of action., American Society of Anesthesiologists 2019 Annual Meeting, Orlando FL, Oct. 2019.
9.
Takuro Oyama, Yuta Uemura, Nami Kakuta, Yasuo Tsutsumi and Katsuya Tanaka : Glucose transporter-4 mediates acute isoflurane-induced preconditioning in vivo rabbits., American Society of Anesthesiologists, San Francisco, Oct. 2018.
10.
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.
11.
Asuka Kasai, Kouhei Fukuta, Katsuya Tanaka, Nami Kakuta and Yasuo Tsutsumi : The effect of intraoperative glucose load on metabolism in patients with diabetes mellitus., American Society of Anesthesiologists 2017 Annual Meeting, Oct. 2017.
12.
Kouhei Fukuta, Asuka Kasai, Katsuya Tanaka, Yoko Sakai and Yasuo Tsutsumi : The Influence of Glucose Load on Metabolism in Elderly Patients During Surgery Using Remifentanil-induced Anesthesia, American Society of Anesthesiologists 2017 Annual Meeting, Oct. 2017.
13.
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.
14.
Takuro Oyama, Nami Kakuta, Asuka Kasai, Naoji Mita, Katsuyoshi Kume and Katsuya Tanaka : Effect of Jelly type carbohydrate on metabolism and evaluation of its excretion in healthy subjects., American Society of Anesthesiologists 2017 Annual Meeting, Oct. 2017.
15.
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.
16.
Kei Muraoka, Myonri Kan, Ryosuke Kawanishi, Shiho Satomi, Yasuo Tsutsumi and Katsuya Tanaka : Risk factors Associated with Hoarseness and Glottis Edema after Tracheal Intubation., American Society of Anesthesiologists 2016 Annual Meeting 2016.10.23, Chicago, Oct. 2016.
17.
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.
18.
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.
19.
Noriko Kambe, Ryosuke Kawanishi, Nakaji Yoshimi, Matsumoto Tomomi, Kume Katsuyoshi and Katsuya Tanaka : Effects of Tracheal Intubation with Airwayscope on the Injury around Glottis in a Manikin with Normal Airway, American Society of Anesthesiologist annual meeting, Oct. 2014.
20.
Noriko Kambe, Katsuya Tanaka, Rie Oi, Asuka Kasai, Yasuo M. Tsutsumi and Shuzo Oshita : The influence of glucose load during the operation on the metabolism., The American society of Anesthesiologist Annual Meeting, San Francisco, Oct. 2013.
21.
Noriko Kambe, Katsuya Tanaka, Nami Kakuta, Yasuo M. Tsutsumi and Shuzo Oshita : Short-term simvastatin administration in hyperglycemia rabbits facilitate anesthetic postconditioning., The American Society of Anesthesiologist Annual Meeting, San Francisco, Oct. 2013.
22.
Mai Morimoto, Katsuya Tanaka, Michiko Kinoshita, Noriko Kambe, Ryosuke Kawanishi, Katsuyoshi Kume, Naohiro Oshita, Yasuo M. Tsutsumi and Shuzo Oshita : Effects of new developed mask for novel mask holding on the quality of mask ventilation and the pressure between face and mask., The American Society of Anesthesiologist Annual Meeting, San Francisco, Oct. 2013.
23.
Eisuke Hamaguchi, Shuzo Oshita, Katsuya Tanaka, Rie Tsutsumi and Yasuo M. Tsutsumi : Glucagon-like peptide-1 induced cardiac protection is dependent on caveolin-3 expression., Experimental Biology Annual Meeting, Boston, Illinois, Apr. 2013.
24.
Yasuo Tsutsumi, Katsuya Tanaka, Kasai Asuka, Kadota Naoko and Shuzo Oshita : Protective effects of amino acids on the ischemic myocardium via m TOR/S6 kinase pathway, Experimental Biology Annual Meeting, San Diego, California, Apr. 2012.
25.
Katsuya Tanaka : Effects of volatile anesthetics on ATP-sensitive K+ channels in various tissues., 日中麻酔科学シンポジウム, 沖縄県, Nov. 2011.
26.
Michiko Kinoshita, Katsuya Tanaka, Yasuo Tsutsumi and Shuzo Oshita : Role of calcium-activated potassium channel and cAMP-dependent protein kinase on isflurane-induced postconditoning., American Society of Anesthesiologists 2011 Annual Meeting, Chicago, Oct. 2011.
27.
Yasuo Tsutsumi, Nami Kakuta, Hiroaki Kawano, Katsuya Tanaka and Shuzo Oshita : Neurokinin-1 receptor antagonism effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures., American Society of Anesthesiologists 2011 Annual Meeting, Chicago, Oct. 2011.
28.
Hirose Kayo, Katsuya Tanaka, Yasuo Tsutsumi and Shuzo Oshita : The relation between isoflurane-induced O-linked β-N-acetylglucosamine and mitochondrial function., American Society of Anesthesiologists 2011 Annual Meeting, Chicago, Oct. 2011.
29.
Katsuya Tanaka, Michiko Kinoshita, Yasuo Tsutsumi, Kaori Takata and Shuzo Oshita : Simvastatin restores anesthetic postconditioning in the presence of hyperglycemia in vivo rabbits., American Society of Anesthesiologists 2011 Annual Meeting, Chicago, Oct. 2011.
30.
Yoshinobu Tomiyama, Kaori Takata, Katsuya Tanaka and Shuzo Oshita : The effects of hyperkalemia and ouabain during Ischemia on the membrane potential during ischemia/reperfusion, The Annual Meeting of the American Society of Anesthesiologists, Oct. 2011.
31.
Michiko Kinoshita, Katsuya Tanaka, Yasuo Tsutsumi, Hirose Kayo and Shuzo Oshita : The effect of the novel mask ventilation technique on airway management., The Annual Meeting of the American Society of Anesthesiologists, San Diego, California, Oct. 2010.
32.
Kawano Takashi, Katsuya Tanaka, Kinoshita Michiko and Shuzo Oshita : Differential Effects of Isoflurane and Propofol on Insulin Release in Rat Pancreatic -Cells., American Society of Anesthesiologists 2010 Annual Meeting, Oct. 2010.
33.
Michiko Kinoshita, Katsuya Tanaka, Jinnouchi Yuka, Yasuo Tsutsumi and Shuzo Oshita : Dose dependent effects of remifentanil on perioperative immune-inflammtory response in patients., The Annual Meeting of the American Society of Anesthesiologists, San Diego, California, Oct. 2010.
34.
Yoshinobu Tomiyama, Kaori Takata, Katsuya Tanaka and Shuzo Oshita : The Effects of Hyperkalemia and Ouabain on Membrane Integrity during Ischemia/Reperfusion., American Society of Anesthesiologists 2010 Annual Meeting, Oct. 2010.
35.
Hirose Kayo, Shuzo Oshita, Michiko Kinoshita, Katsuya Tanaka and Yasuo Tsutsumi : The role of O-linked -N-acetylglucosamine in the cardiac protection induced by isoflurane., The Annual Meeting of the American Society of Anesthesiologists, San Diego, California, Oct. 2010.
36.
Yasuo Tsutsumi, Hirose Kayo, Katayama Erika, Rie Tsutsumi, Kinoshita Michiko, Katsuya Tanaka and Shuzo Oshita : Role of O-linked -N-acetylglucosamine in isoflurane induced cardiac protection., Experimental Biology Annual Meeting, Anaheim, California, Apr. 2010.
37.
Kaori Takata, Yoshinobu Tomiyama, Katsuya Tanaka, Hiroshi Kitahata and Shuzo Oshita : Role of hyperkalemia and Na+/K+ ATPase in myocardial protection during simulated ischemia., The Annual Meeting of the American Society of Anesthesiologists, New Orleans, Oct. 2009.
38.
Katsuya Tanaka, Kawano Takashi, Okada Tsuyoshi, Tomino Takehito and Oshita Shuzo : Mechanisms of impaired glucose tolerance and insulin secretion during isoflurane anesthesia, Anesthesiology, Vol.107, A1661, 2007.
39.
Okada Tsuyoshi, Katsuya Tanaka, Kawano Takashi, Tomino Takehito and Oshita Shuzo : Effects of Propofol on Glucose Tolerance in Rabbits: A Comparison with Isoflurane, Anesthesiology, Vol.107, A520, 2007.
40.
Katsuya Tanaka, Kawano Takashi, Nakamura Akiyo, Nozaki Junpei and Oshita Shuzo : Isoflurane Activates Sarcolemmal ATP-Sensitive Potassium Channels Via Protein Kinase A Activation in Cultured Rat Aortic Smooth, Anesthesiology, Vol.103, A685, 2005.
41.
Yamada Hidehiro, Kawano Takashi, Katsuya Tanaka and Oshita Shuzo : The Interaction of MgADP with Intravenos Anesthetics Inhibition of Cloned ATP-Sensitive Potassium Channels, Anesthesiology, Vol.103, A736, 2005.
42.
Eguchi Satoru, Kawano Takashi, Katsuya Tanaka, Oshita Shuzo and Nakajo Nobuyoshi : Effects of Ketamine on Nicorandil Induced ATP-Sensitive Potassium Channel Activity in Cultured Rat Aortic Smooth Muscle Cells, Anesthesiology, Vol.103, A738, 2005.
43.
Nakamura Akiyo, Kawano Takashi, Kawahito Shinji, Katsuya Tanaka and Oshita Shuzo : Molecular Mechanisms of the Inhibitory Effects of Lidocaine on Cloned Cardiac Sarcolemmal ATP-Sensitive Potassium Channels, Anesthesiology, Vol.103, A731, 2005.
44.
Kakuta Nami, Kawano Takashi, Katsuya Tanaka and Oshita Shuzo : A Comparison of Landiolol and Esmolol for Attenuation of Cardiovascular Response and Plasma Renin Activity Against Tracheal Intubation with Laryngoscopy, Anesthesiology, Vol.103, A433, 2005.
45.
Nitta Kazuhito, Kawano Takashi, Katsuya Tanaka and Oshita Shuzo : Blockade of ATP-Sensitive Potassium Channels by Dexmedetomidine in Rat Vascular Smooth Muscle Cells, Anesthesiology, Vol.103, A479, 2005.
46.
Kawano Takashi, Nakamura Akiyo, Yamada Hirohide, Katsuya Tanaka and Oshita Shuzo : Insulin Activates ATP-Sensitive Potassium Channels in Rat Vascular Smooth Muscle Cells, Anesthesiology, Vol.103, A495, 2005.
47.
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.
48.
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.
49.
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.
50.
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.
51.
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.
52.
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.
53.
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.
54.
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.
55.
Katsuya Tanaka, Hiroshi Kitahata, Junpei Nozaki, Tosiko Katayama and Shuzo Oshita : Effects of left ventricular function on arterial pressure following gastrothoracic ventricular pacing., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-170, San Francisco, Oct. 2000.
56.
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.
57.
Junpei Nozaki, Hiroshi Kitahata, Katsuya Tanaka, Akio Iseki and Shuzo Oshita : Influences of acute normovolemic hemodilution on left ventricular systolic and diastolic function in dogs., The Annual Meeting of the American Society of Anesthesiologists, Vol.A-645, San Francisco, Oct. 2000.
58.
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.
59.
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.
60.
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.
61.
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.
62.
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.
63.
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.
64.
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.
65.
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.
66.
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.
67.
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.
68.
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.
69.
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.
70.
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.
71.
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.