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Dan K, Takahashi K, Lefor AK. Measuring and maintaining organ perfusion in a patient with Takayasu's arteritis undergoing cardiac surgery. Anaesth Rep 2023; 11:e12236. [PMID: 37408768 PMCID: PMC10318576 DOI: 10.1002/anr3.12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/07/2023] Open
Abstract
Takayasu's arteritis is a rare vasculitis affecting the aorta and its branches. Disease progression can result in arterial stenosis and subsequent organ dysfunction. Estimating organ perfusion by measuring the peripheral blood pressure can be challenging because it may be altered by arterial stenosis. We report the case of a 61-year-old woman with Takayasu's arteritis with aortic and mitral regurgitation who presented for aortic valve replacement and mitral valvuloplasty. Peripheral arterial pressure was considered a less reliable surrogate for organ perfusion because the patient had diminished blood flow in both the lower and upper extremities. In addition to the bilateral radial arterial pressure, the blood pressure in the ascending aorta was monitored to estimate the patient's organ perfusion pressure during cardiopulmonary bypass. The initial target blood pressure was determined based on the pre-operative baseline and modified by measurement of the aortic pressure. Cerebral oximetry using near-infrared spectroscopy and mixed venous saturation was monitored to estimate oxygen supply-demand balance, which helped evaluate cerebral perfusion and determine the transfusion threshold. The entire procedure was uneventful, and no organ dysfunction was observed postoperatively.
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Affiliation(s)
- K. Dan
- Department of AnaesthesiaTokyo Bay Urayasu Ichikawa Medical CenterChibaJapan
| | - K. Takahashi
- Department of AnaesthesiaJichi Medical University Saitama Medical CenterSaitamaJapan
| | - A. K. Lefor
- Department of SurgeryJichi Medical UniversityTochigiJapan
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Masuyama T, Yasuda H, Sanui M, Lefor AK. Effect of skin antiseptic solutions on the incidence of catheter-related bloodstream infection: a systematic review and network meta-analysis. J Hosp Infect 2021; 110:156-164. [PMID: 33529623 DOI: 10.1016/j.jhin.2021.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/17/2021] [Accepted: 01/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The most effective skin antiseptic solution to reduce the incidence of catheter-related bloodstream infections (CRBSI) remains unknown. AIM To compare solutions with different chlorhexidine (CHG)-based concentrations and povidone-iodine (PVI) in adults with a central venous catheter (CVC) or arterial catheter, and identify an association with the incidence of CRBSI. METHODS This study evaluated randomized controlled trials comparing CHG and PVI antiseptic agents in patients aged ≥18 years with an underlying illness and a CVC or arterial catheter. The primary outcome was CRBSI rate. Network meta-analysis was performed by a frequentist-based approach with multi-variate random effects meta-analysis, and the effect size was expressed as relative risk (RR) with 95% confidence interval (CI). FINDINGS The search yielded 1511 records, of which five studies (2815 catheters) were included in the network meta-analysis. The risk of CRBSI was significantly lower with 1% CHG-alcohol than with 0.5% CHG-alcohol (RR 0.40, 95% CI 0.16-0.98; high certainty) or 10% PVI-aqueous (RR 0.31, 95% CI 0.15-0.63; high certainty). There was no significant difference in the risk of CRBSI between 1% CHG-alcohol and 2% CHG-aqueous (RR 0.35, 95% CI 0.12-1.04; moderate certainty) or other antiseptic solutions. The hierarchy of efficacy in reducing CRBSI was 1% CHG-alcohol, 0.5% CHG-alcohol, 2% CHG-aqueous and 10% PVI-aqueous. CONCLUSION Antiseptic agents containing 1% CHG-alcohol were more strongly associated with reduced risk for CRBSI compared with agents containing 0.5% CHG-alcohol or 10% PVI-aqueous.
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Affiliation(s)
- T Masuyama
- Department of Anaesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan
| | - H Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan; Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Centre, Tokyo, Japan.
| | - M Sanui
- Department of Anaesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, Japan
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Sakamoto T, Fujiogi M, Lefor AK, Matsui H, Fushimi K, Yasunaga H. Stent as a bridge to surgery or immediate colectomy for malignant right colonic obstruction: propensity-scored, national database study. Br J Surg 2020; 107:1354-1362. [DOI: 10.1002/bjs.11561] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 01/02/2023]
Abstract
Abstract
Background
The aim of this study was to compare perioperative outcomes of urgent colectomy and placement of a self-expanding metallic stent followed by colectomy for patients with malignant right colonic obstruction. Right-sided malignant obstruction is less common than left-sided. Stenting for malignant left colonic obstruction has been reported to reduce postoperative complications. However, the impact of stenting for malignant right colonic obstruction remains undefined.
Methods
The study included patients with right-sided malignant obstruction or stenosis undergoing colectomy between April 2012 and March 2017 identified from a nationwide database. Propensity score matching analysis was used to compare mortality and morbidity rates, proportion receiving a stoma and postoperative stay between urgent colectomy and stent groups.
Results
From 9572 patients, 1500 pairs were generated by propensity score matching. There was no significant difference in in-hospital mortality between the urgent colostomy and stent groups (1·6 versus 0·9 per cent respectively; P = 0·069). Complications were more common after urgent colectomy than stenting (22·1 versus 19·1 per cent; P = 0·042). Surgical-site infection was more likely with urgent colectomy (7·1 versus 4·4 per cent; P = 0·001). There was no significant difference between the two groups in anastomotic leakage (3·8 versus 2·6 per cent; P = 0·062). The proportion of patients needing a stoma was higher with urgent colectomy than primary treatment with stents (5·1 versus 1·7 per cent; P < 0·001). Postoperative stay was longer after urgent colectomy (15 versus 13 days; P < 0·001).
Conclusion
Stenting followed by colectomy in patients with malignant right colonic obstruction may provide more favourable perioperative outcomes than urgent colectomy.
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Affiliation(s)
- T Sakamoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Centre, Urayasu, Japan
| | - M Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
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Sasabuchi Y, Yasunaga H, Matsui H, Lefor AK, Fushimi K, Sanui M. Epidural analgesia is infrequently used in patients with acute pancreatitis : a retrospective cohort study. Acta Gastroenterol Belg 2017; 80:381-384. [PMID: 29560667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUNDS AND AIMS Epidural analgesia is an option for pain control in patients with acute pancreatitis. The aim of this study is to describe characteristics, morbidity and mortality of patients with acute pancreatitis treated with epidural analgesia. PATIENTS AND METHODS Data was extracted from a national inpatient database in Japan on patients hospitalized with acute pancreatitis between July 2010 and March 2013. A total of 44,146 patients discharged from acute care hospitals were included in this retrospective cohort study. The patient background, timing and duration of epidural analgesia, complications (epidural hematoma or abscess), surgery (for cholelithiasis / cholecystitis or complications) and mortality were verified. RESULTS Epidural analgesia was used in 307 patients (0.70 %). The mean age was 64.0 years (standard deviation, 15.4 years) and 116 (37.8%) of the patients were female. The median duration of epidural analgesia was four days (interquartile range, 3-5 days). No patient underwent surgery for epidural hematoma or abscess. Six (2.0%) patients died during hospitalization. Most likely causes of death were pulmonary embolism, multiple organ failure, sepsis, and methicillin-resistant staphylococcus aureus enterocolitis. The responsible physician for 250 of the patients (81.4%) was a gastroenterological surgeon. Epidural analgesia was started on the day of surgery in 278 (90.6%) patients. CONCLUSION Epidural analgesia is rarely used in patients with acute pancreatitis. None of the patients included in the study required surgery for epidural hematoma or abscess. Further research to evaluate the efficacy and safety of epidural analgesia in patients with acute pancreatitis is warranted.
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Affiliation(s)
- Y Sasabuchi
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, 113-0033, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, 113-0033, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, 329-0498, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - M Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Saitama Medical Center, Saitama, 330-0834, Japan
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Sasabuchi Y, Yasunaga H, Lefor AK. Propofol infusion in children - a reply. Anaesthesia 2016; 71:987. [DOI: 10.1111/anae.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Matsubara S, Takahashi H, Horie K, Lefor AK, Fujiwara H. Caesarean hysterectomy for placenta accreta: paracervix should be divided sequentially, not en masse. Eur J Obstet Gynecol Reprod Biol 2016; 201:227-8. [PMID: 27129744 DOI: 10.1016/j.ejogrb.2016.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/30/2016] [Indexed: 12/01/2022]
Affiliation(s)
- S Matsubara
- Department of Obstetrics and Gynaecology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - H Takahashi
- Department of Obstetrics and Gynaecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - K Horie
- Department of Obstetrics and Gynaecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - H Fujiwara
- Department of Obstetrics and Gynaecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Matsubara S, Takahashi H, Takei Y, Lefor AK. Re: Abnormally invasive placenta - prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2016; 123:1031-2. [DOI: 10.1111/1471-0528.13759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- S Matsubara
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi Japan
| | - H Takahashi
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi Japan
| | - Y Takei
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi Japan
| | - AK Lefor
- Department of Surgery; Jichi Medical University; Tochigi Japan
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Sasabuchi Y, Yasunaga H, Matsui H, Lefor AK, Fushimi K. Prolonged propofol infusion for mechanically ventilated children. Anaesthesia 2016; 71:424-8. [PMID: 26874247 DOI: 10.1111/anae.13401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
We retrospectively analysed 30-day mortality and duration of intubation for 8016 children ventilated for three or more days, sedated with midazolam (n = 7716) or propofol (n = 300). We matched the propensity scores of 263 pairs of children. The propensity-matched 30-day mortality (95% CI) was similar: 17/263 (6.5%) with midazolam vs. 24/263 (9.1%) with propofol, p = 0.26. Weaning from mechanical ventilation of children sedated with midazolam was slower than weaning of children sedated with propofol, subhazard ratio (95% CI) 1.43 (1.18-1.73), p < 0.001.
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Affiliation(s)
- Y Sasabuchi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
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Matsubara S, Takahashi H, Lefor AK. A novel hemostatic technique during cesarean section for placenta previa: combining "cervical inversion" and "holding the cervix". Minerva Ginecol 2015; 67:488-489. [PMID: 26491828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Matsubara
- Department of Obstetric and Gynecology, Jichi Medical University, Tochigi, Japan -
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