Country：Japan

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1097/ALN.0000000000003554

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00540-019-02687-5

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00540-019-02687-5

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00540-019-02657-x

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10877-019-00286-z

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1053/j.jvca.2018.05.043

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1213/ANE.0000000000002884

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1213/ANE.0000000000002707

PubMed

Authorship：Last author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1213/ANE.0000000000002707

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1213/ANE.0000000000002884

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.lfs.2017.08.002

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12871-015-0066-0

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Background: Physician-performed transthoracic echocardiography (TTE) is still seldom used during anesthesia. Despite its various advantages, there are only a few reports of intraoperative TTE. We report 3 cases in which intraoperative TTE was successfully used.
Case presentation: A 75-year-old woman (Case 1) was scheduled for a posterior spinal fusion. When the wound was being closed, systolic blood pressure suddenly dropped to 30 mmHg. TTE revealed hypokinesis in the antero-septal region. Emergent coronary angiography showed 90 % stenosis in left anterior descending artery (Segment 7), and a bare metal stent was implanted. A 71-year-old woman (Case 2) with hypertrophic cardiomyopathy was scheduled for brain tumor operation. During anesthesia induction, the patient developed hemodynamic instability. TTE showed systolic anterior motion of the mitral valve, and appropriate treatment was administered. A 78-year-old woman (Case 3) was scheduled for revision total hip arthroplasty. When the wound was closed, TTE revealed severe hypovolemia despite massive infusion. We insisted on reopening the wound and found additional massive hemorrhage.
Conclusion: Intraoperative TTE is a potent tool for quick hemodynamic evaluation because it is noninvasive and has sufficient diagnostic capabilities. The successful outcomes of our cases suggest the great usefulness of intraoperative TTE, and more frequent use is to be encouraged.

DOI： 10.1186/s12871-015-0066-0

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1053/j.jvca.2014.07.022

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10877-014-9609-z

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

This study was aimed at comparing the cardiac output (CO) measured by the Vigileo (TM)-FloTrac (TM) system with that estimated by the thermodilution pulmonary artery catheter (PAC) during one-lung ventilation (OLV) and determining the reliability of this system in tracking phenylephrine-induced CO changes during OLV. Sixteen patients scheduled for descending aorta replacement were enrolled. The study was performed 30 min after starting OLV under stable hemodynamic conditions. We recorded hemodynamic variables, CO measured by PAC thermodilution (ICO), CO measured by Vigileo (TM)-FloTrac (TM) system (Version 3.02, Edwards Lifesciences, Irvine, CA, USA) (APCO), and systemic vascular resistance index (SVRI) before (T0) and after (T1) phenylephrine (100 mu g) administration. We used Bland-Altman analysis to compare ICO and APCO. Polar plot and four-quadrant plot were used to assess the tracking ability of the Vigileo (TM)-FloTrac (TM) system against ICO after administration of phenylephrine. Ninety hemodynamic interventions were performed. Bland-Altman analysis revealed that the mean bias between APCO and ICO was 0.05 L/min and the percentage error, 46.9 %. Four-quadrant plot analysis showed a concordance rate of 24.7 %, while polar plot analysis showed that the concordance rate was 13.3 %; the angular bias, -45.9A degrees; radial limit of agreement, 85.3A degrees. The bias between APCO and ICO was significantly correlated with the SVRI value (p < 0.001, r(2) = 0.822). The reliability of the Vigileo (TM)-FloTrac (TM) system during OLV to estimate CO and track phenylephrine-induced CO changes was not acceptable.

DOI： 10.1007/s10877-014-9609-z

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/anae.12857

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Measurement of left ventricular stroke volume and cardiac output is very important for managing haemodynamically unstable or critically ill patients. The aims of this study were to compare stroke volume measured by three-dimensional transoesophageal echocardiography with stroke volume measured using a pulmonary artery catheter, and to examine the ability of three-dimensional transoesophageal echocardiography to track stroke volume changes induced by haemodynamic interventions. This study included 40 cardiac surgery patients. Haemodynamic variables were measured before and 2min after haemodynamic interventions, which consisted of phenylephrine 100g or ephedrine 5mg. We used Bland-Altman analysis to assess the agreement between the stroke volume measured by three-dimensional transoesophageal echocardiography and by the pulmonary artery catheter. Polar-plot and 4-quadrant plot analyses were used to assess the trending ability of three-dimensional transoesophageal echocardiography compared with the pulmonary artery catheter. Bias and percentage error were -1.2ml and 20%, respectively. The concordance rate in the 4-quadrant analysis after phenylephrine and ephedrine administration was 75% and 84%, respectively. In the polar-plot analysis, the angular concordance rate was 66% and 73% after phenylephrine and ephedrine administration, respectively. Three-dimensional transoesophageal echocardiography was clinically acceptable for measuring stroke volume; however, it was not sufficiently reliable for tracking stroke volume changes after haemodynamic interventions.

DOI： 10.1111/anae.12857

PubMed

Publishing type：Research paper (scientific journal)  

ビジレオフロートラックシステム(VFS)と肺動脈カテーテル法(PAC)による心拍出量を比較し、末梢血管抵抗との関係を検討した。PACを使用する心臓血管外科症例40例155組を対象とした。低SVRI 44例、正常63例、高SVRI 48例であった。フェニレフリン投与後、APCOは有意に増加したが、ICOは低SVRI、正常SVRIでは有意に変化はみられず、高SVRIで有意に減少した。フェニレフリン投与前・後のPEは、低SVRI 46.3%、41.5%、正常SVRI 26.4%、37.6%、高SVRI 61.4%、75.7%であった。CRは、低SVRI 67.5%、正常SVRI 28.8%、高SVRI 7.7%であった。angular CRが、低SVRI 42.1%、正常SVRI 25.0%、高SVRI 5.3%であった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1053/j.jvca.2014.02.020

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1053/j.jvca.2014.02.020

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1053/j.jvca.2013.03.002

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1053/j.jvca.2013.07.013

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1213/ANE.0000000000000011

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

BACKGROUND: Lipid resuscitation has become a standard treatment for local anesthetic (LA) systemic toxicity, but its mechanisms remain to be fully elucidated. Although the partitioning effect is one of the proposed mechanisms, it is difficult to evaluate its impact independently from several other mechanisms or to examine the intracellular concentration of a LA, which is primarily responsible for LA systemic toxicity. We recently reported that LAs as weak bases reduced voltage-gated proton currents by increasing intracellular pH, which could be estimated from the reversal potentials of the channels (V-rev). Using this characteristic, we examined the partitioning effect in detail and showed its impact on lipid resuscitation.
METHODS: A whole-cell voltage clamp technique was used to record proton channel currents in a rat microglial cell line (GMI-R1). We used Intralipid (R) 20% as lipid emulsion. The effects of lipid emulsion on the intracellular concentrations of LAs were evaluated by measuring the current amplitude and the V-rev. The intracellular concentrations of LAs were calculated by the Henderson-Hasselbalch equation, using estimated intracellular pH. To confirm the importance of partitioning, we separated lipid by centrifugation. Data are means +/- SD unless otherwise stated.
RESULTS: Bupivacaine (1 mM) decreased proton currents to 43% +/- 10% of the control and shifted the V-rev to positive voltages (from -88.0 +/- 4.1 to -76.0 +/- 5.5 mV, n = 5 each, P = 0.02). An addition of the lipid emulsion recovered the currents to 79% +/- 2% of the control and returned the V-rev toward the control value (to -86.0 +/- 7.1 mV, n = 5, P = 0.03). Both recoveries of the current and V-rev in the centrifuged aqueous extract were almost the same as in the 4% lipid solution (-85.6 +/- 4.9 mV, n = 5, P = 0.9, 95% confidence interval for difference = -9.3 to 8.6). When 1 mM bupivacaine was applied extracellularly, the intracellular concentration of the charged form of bupivacaine was estimated to reach about 18.1 +/- 3.9 mM but decreased to 5.4 +/- 1.8 mM by the 4% lipid solution.
CONCLUSIONS: Here we quantitatively evaluated for the first time the partitioning effect of lipid emulsion therapy on the intracellular concentration of bupivacaine in real-time settings by analyzing behaviors of voltage-gated proton channels. Our results suggested that lipid emulsion markedly reduced the intracellular concentration of bupivacaine, which was mostly due to the partitioning effect. This could contribute to our understanding of the mechanisms underlying lipid resuscitation, especially the importance of the partitioning effect.

DOI： 10.1213/ANE.0000000000000011

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1093/bja/aet022

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

BackgroundThe aim of this study was to examine the ability of the Vigileo-FloTrac system to measure cardiac output (CO) and track changes in CO induced by increased vasomotor tone, under different states of systemic vascular resistance (SVR).MethodsForty patients undergoing cardiac surgery were enrolled. Haemodynamic variables including CO measured by the Vigileo-FloTrac system (version 3.02) (APCO), CO measured by a pulmonary artery catheter (ICO), and SVR index (SVRI) were recorded before (T1) and 2 min after (T2) phenylephrine administration (100 μg). Bland and Altman analysis was used to compare ICO and APCO at T1. We used four-quadrant plots and polar plots to compare the trending abilities between ICO and APCO. Patients were divided into three groups according to the SVRI value at T1, with low (&lt
1200 dyn cm -5 m2), normal (1200-2500 dyn cm-5 m 2), and high (&gt
2500 dyn cm-5 m2) SVRI states.ResultsA total of 155 paired data were collected. The adjusted percentage error was 46.3%, 26.4%, and 61.4%, and the concordance rate between ΔICO and ΔAPCO was 67.5%, 28.8%, and 7.7% in the low, normal, and high SVRI state, respectively. The polar plot analysis showed that the mean angular bias was -22.3°, -46.0°, and -3.51°, and the radial limits of agreement were 70°, 85°, and 87°, in the low, normal, and high SVRI state, respectively.ConclusionsThese results indicate that the reliability of the Vigileo-FloTrac system to measure CO and track changes in CO induced by phenylephrine administration was not clinically acceptable. © The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

DOI： 10.1093/bja/aet022

PubMed

Publishing type：Research paper (scientific journal)  

症例は60歳男性で、45歳時に下行大動脈のグラフト置換術を施行されていた。グラフト近傍の嚢状動脈瘤が2年間で徐々に拡大したため、左鎖骨動脈下の遠位大動脈弓動脈瘤に対し全身麻酔下で血管内修復術を行った。手術は5時間46分で終了し、神経学的欠損の兆候は全くみられなかった。しかし、集中治療室入室後3時間目に突然麻痺がみられ、筋力が著明に低下し、右はL1以下、左はL2以下の感覚が低下した。平均動脈圧は術中80mmHg以上、術後90mmHg以上に維持していたが、ドーパミンにより120mmHg以上にしても麻痺は改善しなかった。腰部脳脊髄液ドレナージを速やかに行ったところ、筋力が改善し、触感が正常になったが、右L2以下の温度感覚は消失していた。術後7日目の血管造影では、左鎖骨下動脈と大前根髄質動脈のステントによる閉塞は認められなかった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/WNR.0b013e32835509db

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1113/jphysiol.2011.218149

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1113/jphysiol.2011.218149

PubMed

Publishing type：Research paper (scientific journal)  

A 60-year old man developed paraplegia three hours after thoracic endovascular aortic repair under general anesthesia for distal aortic arch aneurysm. This delayed-onset paraplegia was suspected to be due to a steal effect on the spinal small end arteries. The symptom was successfully alleviated by rapid lumbar cerebrospinal fluid drainage.

DOI： 10.11312/ccm.33.112

CiNii Article

Publishing type：Research paper (scientific journal)  

PubMed

Authorship：Lead author,　Last author,　Corresponding author   Publishing type：Research paper (conference, symposium, etc.)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

DOI： 10.11477/mf.3101100978

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1213/ANE.0b013e3181c04faf

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

BACKGROUND: Facilitation of the spread of neuraxial anesthesia in pregnant women may be attributable in part to compression of the dural sac by the engorged epidural venous plexus. In this study, we used magnetic resonance imaging to examine pregnancy-induced changes in the lumbosacral cerebrospinal fluid (CSF) volume and dural sac surface area.
METHODS: Magnetic resonance images of 18 healthy women (mean age 29 yr, mean height 158 cm, and mean weight 58 kg) were obtained to measure lumbosacral CSF volume and dural sac surface area in the nonpregnant and pregnant states (median 36 wk gestation [31-39]) and the paired images were compared.
RESULTS: The mean lumbosacral CSF volume and dural sac surface area in the nonpregnant state were 39.6 +/- 5.8 mL and 11.0 +/- 0.8 cm(2), respectively. Pregnancy was associated with compression of the dural sac, resulting in a significantly reduced mean CSF volume (33.2 +/- 6.2 mL) and dural sac surface area (9.9 +/- 1.0 cm(2)) in all subjects (P < 0.001). The mean change in CSF volume and dural sac surface area was 16.7% +/- 0.8%) and 10.0% +/- 0.5%, respectively. Gestational week (between 31 and 39 wk) correlated significantly with the reduction in CSF volume (rho = 0.74, P < 0.001) and dural sac surface area (rho = 0.66, P < 0.01).
CONCLUSIONS: These findings indicate an association between gestational week (Weeks 31-39) and a reduction in both CSF volume and dural sac surface area. These reductions may, at least in part, explain the facilitation of the spread of intrathecal anesthesia in pregnant women. (Anesth Analg 2010;110:148-53)

DOI： 10.1213/ANE.0b013e3181c04faf

Publishing type：Research paper (scientific journal)  

DOI： 10.1093/bja/aen382

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1093/bja/aem300

Publishing type：Research paper (scientific journal)  

DOI： 10.1213/01.ane.0000281075.77316.98

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1213/01.ane.0000198509.55543.d6

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

In this randomized, double-blind, controlled study, we tested the hypothesis that nitrous oxide (N2O) affects bispectral index (BIS) and 95% spectral edge frequency (SEF95) in response to tracheal intubation during anesthesia with isoflurane and sevoflurane. In protocol 1, we randomly allocated 90 ASA physical status I patients to 6 groups (n = 15 each). Anesthesia was induced with isoflurane or sevoflurane with 0%, 33%, or 66% N2O. The concentration of isoflurane and sevoflurane was gradually increased and end-tidal concentrations were maintained at 1.1% and 1.7%, respectively. Tracheal intubation was performed 12 min after induction of anesthesia. BIS was significantly increased 1 min after tracheal intubation compared before laryngoscopy in patients receiving only isoflurane or sevoflurane (P = 0.001 and 0.007, respectively). In patients receiving 66% N2O-isoflurane or 66% N2O-sevoflurane, both BIS and SEF95 were significantly decreased after tracheal intubation and significantly lower than in those patients receiving only isoflurane or sevoflurane, respectively (P < 0.01 for both). In protocol 2, 3 mu g/kg of IV fentanyl completely abolished the decrease of BIS and SEF95 after tracheal intubation during anesthesia with 66% N2O-isoflurane and 66% N2O-sevoflurane (n = 10). We conclude that 66% N2O induced a paradoxical decrease of BIS in response to tracheal intubation during anesthesia with isoflurane and sevoflurane.

DOI： 10.1213/01.ane.0000198509.55543.d6

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Presentation type：Oral presentation (general)  

Venue：大阪府立国際会議場  

Presentation type：Poster presentation  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Poster presentation  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)