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Nishikawa M, Takaishi K, Takata M, Sasajima O, Fujiwara SJL, Eguchi S, Kawahito S. Pronounced QT Prolongation During General Anesthesia in a Child with Left Ventricular Noncompaction Cardiomyopathy: A Case Report. Anesth Prog 2023; 70:137-139. [PMID: 37850676 DOI: 10.2344/anpr-70-02-12] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 10/19/2023] Open
Abstract
We report the case of an 8-year-old boy with left ventricular noncompaction cardiomyopathy (LVNC) and QT prolongation who experienced further prolongation of the QTc during general anesthesia for extraction of a maxillary mesiodens. Pronounced prolongation of the QTc was observed after induction of general anesthesia with thiamylal and during emergence. No notable fluctuations in blood pressure, heart rate, and estimated continuous cardiac output were observed. We considered it likely that the QT prolongation was triggered by thiamylal and increased sympathetic nervous system activity. During general anesthesia for children with LVNC and QT prolongation, it is necessary to monitor intraoperative hemodynamic fluctuations and prepare for the possible occurrence of arrhythmias.
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Affiliation(s)
- Mika Nishikawa
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Marina Takata
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Osamu Sasajima
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Shigeki Joseph Luke Fujiwara
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Satoru Eguchi
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Shinji Kawahito
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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2
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Takaishi K, Takata M, Aoki R, Fujiwara SJL, Kawahito S, Kitahata H. Total Intravenous Anesthesia Using Remimazolam and Continuous Cardiac Output Monitoring for Dental Anesthesia in a Patient With Takayasu’s Arteritis: A Case Report. A A Pract 2022; 16:e01599. [DOI: 10.1213/xaa.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Yagi S, Fukuda D, Ise T, Yamaguchi K, Kusunose K, Kadota M, Kawabata Y, Matsuura T, Soga T, Yamada H, Soeki T, Wakatsuki T, Kawahito S, Sata M. Clinical clerkship students' preferences and satisfaction regarding online lectures during the COVID-19 pandemic. BMC Med Educ 2022; 22:43. [PMID: 35042505 PMCID: PMC8765107 DOI: 10.1186/s12909-021-03096-7] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has caused an unprecedented disruption in medical education. Students and lecturers had to adapt to online education. The current study aimed to investigate the level of satisfaction and future preference for online lectures among clinical clerkship students and elucidated the factors that affect these outcomes. METHODS We selected a sample of 114 medical students undergoing clinical clerkship during the COVID-19 pandemic. We conducted onsite lectures before the pandemic and online lectures after the outbreak. A survey was conducted, and the sample included students and 17 lecturers. The average scores of total satisfaction and future preference related to online lectures were computed. RESULTS Students' scores on total satisfaction with online lectures and their future preference were higher than those for onsite lectures. Scores on the ease of debating dimension were low and those on accessibility of lectures in online lectures were higher than those in onsite lectures. There was no difference between the two groups in the scores on the comprehensibility and ease of asking questions dimensions. Results of the multiple regression analysis revealed that accessibility determined total satisfaction, and future preference was determined by comprehensibility as well as accessibility. Contrary to students' future preferences, lecturers favored onsite lectures to online ones. CONCLUSION Online lectures are an acceptable mode of teaching during the COVID-19 pandemic for students undergoing clinical clerkship. Online lectures are expected to become more pervasive to avoid the spread of COVID-19.
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Affiliation(s)
- Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Muneyuki Kadota
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yutaka Kawabata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Tomomi Matsuura
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Tomohiro Soga
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Shinji Kawahito
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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Takaishi K, Kawahito S, Kitahata H. Management of a Patient With Tracheal Stenosis After Previous Tracheotomy. Anesth Prog 2021; 68:224-229. [PMID: 34911067 DOI: 10.2344/anpr-68-03-08] [Citation(s) in RCA: 1] [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] [Received: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/11/2022] Open
Abstract
Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.
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Affiliation(s)
- Kazumi Takaishi
- Associate Professor, Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Kawahito
- Designated Professor, Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroshi Kitahata
- Professor, Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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5
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Takaishi K, Otsuka R, Fujiwara SJ, Eguchi S, Kawahito S, Kitahata H. A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts. Anesth Prog 2021; 68:168-177. [PMID: 34606575 PMCID: PMC8500314 DOI: 10.2344/anpr-68-01-01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 09/04/2020] [Indexed: 11/11/2022] Open
Abstract
Previously undiagnosed or asymptomatic epiglottic cysts may be coincidentally detected during intubation. This retrospective case series identified undiagnosed epiglottic cysts that were discovered during intubation in 4 patients who underwent oral surgery under general anesthesia at our hospital during a 6-year period. Including 2 additional cases, 1 previously diagnosed and 1 detected during preoperative imaging, epiglottic cysts were observed in 6 of 1112 cases (0.54%) total. Among the undiagnosed epiglottic cyst cases, mild dyspnea on effort or snoring was reported in 2 patients, but all others were asymptomatic. Upon discovering previously undiagnosed epiglottic cysts during intubation, it is essential to proceed cautiously, remain alert for potential airway management difficulties, and avoid injuring or rupturing the cysts. In addition, any available preoperative imaging should be reviewed as information pertinent to the airway and any abnormalities may be useful. This report discusses the anesthetic care of 6 patients with epiglottic cysts that were previously known or initially discovered during intubation.
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Affiliation(s)
| | | | | | - Satoru Eguchi
- Assistant Professor, Department of Dental Anesthesiology,
Tokushima University Hospital, Tokushima, Japan
| | - Shinji Kawahito
- Designated Professor, Department of Community Medicine and
Human Resource, Tokushima University Graduate School of Biomedical Sciences,
Tokushima, Japan
| | - Hiroshi Kitahata
- Professor and Chairman, Department of Dental Anesthesiology,
Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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6
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Takaishi K, Kudo Y, Kawahito S, Kitahata H. Clinically relevant concentration of propofol and benzodiazepines did not affect in vitro angiogenesis. J Anesth 2021; 35:870-878. [PMID: 34460008 DOI: 10.1007/s00540-021-02993-x] [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] [Received: 12/11/2020] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Angiogenesis, one of regenerative medicine, is essential in the process of wound healing. The detailed effects of intravenous anesthetics and sedatives used during perioperative period have not yet been clarified. We investigated the effects of benzodiazepines and propofol on in vitro capillary tube formation. METHODS The effects of midazolam, diazepam and propofol (1, 10, 50 µM each) on proliferation of human umbilical vein endothelial cells (HUVEC) and normal human diploid fibroblasts (NHDF) were determined. Quantitation of migration was achieved by measuring the fluorescence of migrating HUVEC using angiogenesis system. The effects of midazolam, diazepam and propofol on in vitro angiogenesis were investigated in co-cultured HUVEC and NHDF incubated. The effects of midazolam on activation of p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinases were examined by Western blot analysis using phospho-specific antibodies. Parametric data were analyzed with one-way repeated measures analysis of variance followed by the Scheffé test. A value of P < 0.05 was considered statistically significant. RESULTS Fifty µM of midazolam significantly impaired endothelial cell proliferation, migration, and in vitro capillary tube formation. Propofol, diazepam or lower dose midazolam did not show any enhancing or suppressive effects on in vitro angiogenesis. Fifty µM of midazolam remarkably activated ERK, but not p38 MAPK in HUVEC. CONCLUSION Propofol and benzodiazepines except high-dose midazolam did not affect in vitro angiogenesis. High-dose midazolam may impair in vitro capillary tube formation due to by suppressing proliferation and migration of endothelial cells via activation of ERK.
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Affiliation(s)
- Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan.
| | - Yasusei Kudo
- Department of Oral Bioscience, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan
| | - Shinji Kawahito
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan
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7
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Takaishi K, Kinoshita H, Kawashima S, Kawahito S. Human Vascular Smooth Muscle Function and Oxidative Stress Induced by NADPH Oxidase with the Clinical Implications. Cells 2021; 10:cells10081947. [PMID: 34440716 PMCID: PMC8393371 DOI: 10.3390/cells10081947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/05/2023] Open
Abstract
Among reactive oxygen species, superoxide mediates the critical vascular redox signaling, resulting in the regulation of the human cardiovascular system. The reduced form of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase, NOX) is the source of superoxide and relates to the crucial intracellular pathology and physiology of vascular smooth muscle cells, including contraction, proliferation, apoptosis, and inflammatory response. Human vascular smooth muscle cells express NOX1, 2, 4, and 5 in physiological and pathological conditions, and those enzymes play roles in most cardiovascular disorders caused by hypertension, diabetes, inflammation, and arteriosclerosis. Various physiologically active substances, including angiotensin II, stimulate NOX via the cytosolic subunits’ translocation toward the vascular smooth muscle cell membrane. As we have shown, some pathological stimuli such as high glucose augment the enzymatic activity mediated by the phosphatidylinositol 3-kinase-Akt pathway, resulting in the membrane translocation of cytosolic subunits of NOXs. This review highlights and details the roles of human vascular smooth muscle NOXs in the pathophysiology and clinical aspects. The regulation of the enzyme expressed in the vascular smooth muscle cells may lead to the prevention and treatment of human cardiovascular diseases.
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Affiliation(s)
- Kazumi Takaishi
- Department of Dental Anesthesiology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15, Kuramoto, Tokushima 770-8504, Japan; (K.T.); (S.K.)
| | - Hiroyuki Kinoshita
- Department of Anesthesiology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15, Kuramoto, Tokushima 770-8504, Japan
- Department of Anesthesiology and Intensive Care, School of Medicine, Hamamatsu University, 1-20-1, Handayama, Hamamatsu City 431-3192, Japan;
- Correspondence: ; Tel.: +81-53-436-1251
| | - Shingo Kawashima
- Department of Anesthesiology and Intensive Care, School of Medicine, Hamamatsu University, 1-20-1, Handayama, Hamamatsu City 431-3192, Japan;
| | - Shinji Kawahito
- Department of Dental Anesthesiology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15, Kuramoto, Tokushima 770-8504, Japan; (K.T.); (S.K.)
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8
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Kinoshita H, Kawahito S. The uterine contraction evaluation is tricky in the in vivo. J Anesth 2021; 35:464. [PMID: 33687547 DOI: 10.1007/s00540-021-02919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Hiroyuki Kinoshita
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, Tokushima, 770-8503, Japan.
| | - Shinji Kawahito
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, Tokushima, 770-8503, Japan
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9
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Kawahito S, Soga T, Yagi S, Mita N, Takaishi K, Kinoshita H, Kitagawa T, Kitahata H. Pathophysiology and Complications during Extracorporeal Circulation. J Med Invest 2020; 67:229-235. [PMID: 33148893 DOI: 10.2152/jmi.67.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shinji Kawahito
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomohiro Soga
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shusuke Yagi
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Naoji Mita
- Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroyuki Kinoshita
- Department of Anesthesiology, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Tetsuya Kitagawa
- Department of Cardiovascular Surgery, Shikoku Central Hospital of the Mutual Aid Association of Public School Teachers, Ehime, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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10
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Takaishi K, Kinoshita H, Feng GG, Azma T, Kawahito S, Kitahata H. Cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle. J Pharmacol Sci 2020; 144:197-203. [PMID: 33070838 DOI: 10.1016/j.jphs.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/14/2020] [Revised: 08/01/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
The role of cytoskeleton dynamics in the oxidative stress toward human vasculature has been unclear. The current study examined whether the cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle. All experiments in the human omental arteries without endothelium or the cultured human coronary artery smooth muscle cells were performed in d-glucose (5.5 mmol/L). The exposure toward d-glucose (20 mmol/L) for 60 min reduced the relaxation or hyperpolarization to an ATP sensitive K+ channel (KATP) opener levcromakalim (10-8 to 3 × 10-6 mol/L and 3 × 10-6 mol/L, respectively). Cytochalasin B and a superoxide inhibitor Tiron, restored them similarly. Cytochalasin B reduced the NADPH oxidase activity, leading to a decrease in superoxide levels of the arteries treated with high d-glucose. Also, cytochalasin B impaired the F-actin constitution and the membrane translocation of an NADPH oxidase subunit p47phox in artery smooth muscle cells treated with high d-glucose. A clinical concentration of cytochalasin B prevented human vascular smooth muscle malfunction via the oxidative stress caused by high glucose. Regulation of the cytoskeleton may be essential to keep the normal vascular function in patients with hyperglycemia.
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Affiliation(s)
- Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Hiroyuki Kinoshita
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan; Department of Anesthesiology, Aichi Medical University School of Medicine, Aichi, Japan.
| | - Guo-Gang Feng
- Department of Anesthesiology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Toshiharu Azma
- Department of Anesthesiology & Pain Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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11
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Kinoshita H, Kawahito S. The Clinically Relevant Concentration of Local Anesthetics Is a Matter of Consideration in the In Vitro Study. Anesth Analg 2020; 131:e86. [DOI: 10.1213/ane.0000000000004894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Yagi S, Zheng R, Nishiyama S, Kawabata Y, Ise T, Sugiura K, Yoshinari H, Nishisho T, Bando Y, Kagawa K, Fukuda D, Soga T, Saijo Y, Kusunose K, Yamaguchi K, Yamada H, Soeki T, Wakatsuki T, Kawahito S, Akaike M, Sata M. Osteolytic primary bone lymphoma in the multiple bones. J Med Invest 2019; 66:347-350. [PMID: 31656303 DOI: 10.2152/jmi.66.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Primary non-Hodgkin bone lymphoma (PBL) can involve solitary or multiple destructive bone lesions such as those of the femur or pelvis humerus, and some cases have osteolytic lesions. PBL is a rare disease in adults. Thus, PBL is rarely considered a differential diagnosis of the osteolytic tumor. In addition, PBL can be underdiagnosed because patients do not experience symptoms or show objective abnormalities in the early stage. Here, we reported an elderly patient with PBL in multiple bones, including the cranial and femoral bones that were fractured due to falling. J. Med. Invest. 66 : 347-350, August, 2019.
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Affiliation(s)
- Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Shikoku Central Hospital, Ehime, Japan
| | - Robert Zheng
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | | | - Yutaka Kawabata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedic Surgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Haruhiko Yoshinari
- Department of Orthopedic Surgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Toshihiko Nishisho
- Department of Orthopedic Surgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Kumiko Kagawa
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomohiro Soga
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Shikoku Central Hospital, Ehime, Japan.,Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Kawahito
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Shikoku Central Hospital, Ehime, Japan.,Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masashi Akaike
- Department of Medical Education, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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13
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Yagi S, Endo I, Murakami T, Hida T, Yamamoto Y, Soga T, Ise T, Kusunose K, Yamaguchi K, Fukuda D, Yamada H, Soeki T, Wakatsuki T, Kawahito S, Sata M. Adult onset of Immunoglobulin A vasculitis – A case report. J Med Invest 2019; 66:344-346. [DOI: 10.2152/jmi.66.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shusuke Yagi
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Itsuro Endo
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Taichi Murakami
- Department of Nephrology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuya Hida
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Dermatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | | | - Tomohiro Soga
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Kawahito
- Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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14
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Kinoshita H, Kawahito S, Takaishi K. The unique action of nicorandil on cerebral circulation. J Anesth 2018; 32:462. [DOI: 10.1007/s00540-018-2499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
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15
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Kinoshita H, Kawahito S. Will stroke volume variation be a parameter to manage intraoperative bleeding in the functional endoscopic sinus surgery? Minerva Anestesiol 2018; 84:1235-1236. [PMID: 29774736 DOI: 10.23736/s0375-9393.18.12969-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hiroyuki Kinoshita
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan - .,Department of Anesthesiology, IMS Fujimi General Hospital, Fujimi, Japan -
| | - Shinji Kawahito
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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16
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Kinoshita H, Akahori T, Nakamura E, Okawa H, Kawahito S, Kitahata H, Fujiwara Y. Tissue oxygenation index reflects changes in forearm blood flow after brief ischemia. J Med Invest 2017; 64:228-232. [PMID: 28954987 DOI: 10.2152/jmi.64.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Whether the near-infrared spectroscopy (NIRS) technology correctly detects the changes in oxygenation related to ischemia and reperfusion of organs and tissues other than brain remains unclear. The present study examined how different tissue oxygenation parameters derived from NIRS reflect the changes in the forearm blood flow (FBF) according to the brief ischemia and the subsequent reperfusion, and whether values of these parameters move in parallel with the medial and lateral sides of FBF. Thirteen volunteers underwent the prospective observational study. The tissue oxygenation index (TOI), regional saturation of oxygen (rSO2), skin tissue oxygenation (StO2), and FBF values were evaluated in the forearm. Medial rSO2 values at 1 to 3 minutes after the termination of brief ischemia were higher than lateral rSO2 and respective TOI values. FBF and StO2 values quickly increased according to the cessation of brief ischemia, whereas the medial and lateral values did not differ during and after the brief ischemia. TOI and StO2, but not rSO2, reflected changes in FBF of both medial and lateral sides simultaneously in response to the reperfusion after brief ischemia. The muscle tissue oxygenation during reperfusion favors the use of TOI and StO2, but not rSO2, as the surrogate parameter. J. Med. Invest. 64: 228-232, August, 2017.
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Affiliation(s)
- Hiroyuki Kinoshita
- Department of Anesthesiology, Aichi Medical University School of Medicine.,Departments of Anesthesiology, Tokushima University Hospital
| | - Takahiko Akahori
- Department of Anesthesiology, Aichi Medical University School of Medicine
| | - Emi Nakamura
- Department of Anesthesiology, Aichi Medical University School of Medicine
| | - Hazuki Okawa
- Department of Anesthesiology, Aichi Medical University School of Medicine
| | - Shinji Kawahito
- Departments of Anesthesiology, Tokushima University Hospital
| | - Hiroshi Kitahata
- Departments of Dental Anesthesiology, Tokushima University Hospital
| | - Yoshihiro Fujiwara
- Department of Anesthesiology, Aichi Medical University School of Medicine
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17
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Kawahito S, Soga T, Mita N, Satomi S, Kinoshita H, Arase T, Kondo A, Miki H, Takaishi K, Kitahata H. Successful treatment of mixed (mainly cancer) pain by tramadol preparations. J Med Invest 2017; 64:311-312. [PMID: 28955004 DOI: 10.2152/jmi.64.311] [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] [Indexed: 11/14/2022]
Abstract
The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache. Because this pain could not be controlled by an increase to eight combination tablets per day, we switched her medication to a tramadol capsule. At 11 months post-surgery, we then switched her medication to an orally disintegrating tramadol tablet to improve medication adherence of the drug. From 14 months post-surgery, the patient also used a sustained-release tramadol preparation, and she was then able to sleep well. Her current regimen is an orally disintegrating sustained-release tablet combination (total 300 mg tramadol) per day, and she achieved sufficient pain relief. Because tramadol is not classified as a medical narcotic drug, it widely available and was shown here to be extremely useful for the treatment of our patient's mixed (mainly cancer) pain. J. Med. Invest. 64: 311-312, August, 2017.
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Affiliation(s)
| | - Tomohiro Soga
- Department of Anesthesiology, Tokushima University Hospital
| | - Naoji Mita
- Department of Anesthesiology, Tokushima University Hospital
| | - Shiho Satomi
- Department of Anesthesiology, Tokushima University Hospital
| | | | | | - Akira Kondo
- Division of Palliative Medicine, Kondo Hospital
| | | | - Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Hospital
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Hospital
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18
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Kambe N, Kawahito S, Mita N, Takaishi K, Katayama T, Sakai Y, Soga T, Kawano H, Matsuhisa M, Shimada M, Kitagawa T, Kitahata H. Impact of newly developed, next-generation artificial endocrine pancreas. J Med Invest 2016; 62:41-4. [PMID: 25817282 DOI: 10.2152/jmi.62.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Recent studies have shown that strict perioperative blood glucose management may reduce mortality and morbidity in critically ill adult patients. The purpose of this study was to assess the accuracy and efficacy of the intraoperative application of a newly developed, next-generation artificial endocrine pancreas (STG-55, Nikkiso Co., Ltd., Tokyo, Japan). METHODS Twenty patients scheduled to undergo surgery were enrolled in this study. The STG-55 is designed to be more user-friendly than its conventional counterpart (STG-22) while maintaining the latter's fundamental functions, such as a closed-loop system using algorithms for insulin and glucose infusion. After anesthetic induction, a 20G intravenous catheter was inserted into a peripheral forearm vein and connected to a continuous blood glucose monitor. The resultant 105 scores for paired blood glucose values were compared by Bland-Altman analysis. RESULTS Stable blood glucose values were maintained automatically, and there were no complications related to use of the STG-55. A close correlation (r=0.96) was observed between continuous glucose measurements using the STG-55 and conventional intermittent glucose measurements. The difficulty of manipulation using this system was decreased by improved preparation procedures. CONCLUSION The glycemic control system using the STG-55 could provide an alternative way to achieve effective and safe perioperative glycemic control.
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Affiliation(s)
- Noriko Kambe
- Department of Anesthesiology, Tokushima University Hospital
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19
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Ozaki M, Kagawa K, Arimoto H, Kominami Y, Sanomura Y, Yoshida S, Seo MW, Kawahito S, Tanaka S. Spectral study of metabolism-based autofluorescence and white-light reflectance for endoscopic tumor imaging. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5879-83. [PMID: 26737629 DOI: 10.1109/embc.2015.7319729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Metabolism-based autofluorescence redox imaging is one of the promising options for non-invasive screening of digestive tumors. In this paper, autofluorescence from fluorescent coenzymes such as NADH and FAD related to cellular metabolism as well as total hemoglobin and oxygen saturation are analyzed based on a point spectrum. As a redox index based on the metabolism, the ratio of the 450nm-490nm fluorescence intensities for 365nm and 405nm excitation wavelengths (F365/F405) is used. Although F365/F405 is a good index in many samples, inversion and weakened contrast are observed. A Simplified models with and without collagen based on Lambert-Beer law are built to explain how F365/F405 depicts the tumor region.
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20
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Kawano H, Ohshita N, Katome K, Kadota T, Kinoshita M, Matsuoka Y, Tsutsumi YM, Kawahito S, Tanaka K, Oshita S. Efeitos de um novo método de anestesia combinando propofol e anestesia volátil sobre a incidência de náusea e vômito no pós‐operatório em pacientes submetidas à laparoscopia ginecológica. Braz J Anesthesiol 2016; 66:12-8. [DOI: 10.1016/j.bjan.2014.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/03/2014] [Indexed: 10/23/2022] Open
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21
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Hamaguchi E, Tsutsumi YM, Kume K, Sakai Y, Kakuta N, Uemura Y, Kawahito S, Tanaka K. General anesthesia of a Japanese infant with Barber-Say syndrome: a case report. JA Clin Rep 2016; 2:11. [PMID: 29497666 PMCID: PMC5818726 DOI: 10.1186/s40981-016-0033-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/28/2016] [Indexed: 11/17/2022] Open
Abstract
Background Barber-Say syndrome (BSS) is a very rare congenital disorder characterized by macrostomia, cutis laxa, and other features. We report our experience of performing general anesthesia on a Japanese child with BSS. Case presentation A bilateral repair of the corners of the mouth under general anesthesia was planned for an 18-month-old male with macrostomia; the child was 75 cm in height and weighed 9.9 kg. As insertion of the peripheral intravenous catheter was difficult, it was inserted before the surgery by a pediatrician. The patient wore a mask and was ventilated manually after loss of consciousness with intravenous anesthesia. A mask for adults provided a superior fit and was effective in preventing air leakage from the corners of the mouth. After rocuronium was administered, the larynx was spread with a Macintosh laryngoscope. There was no laryngeal anatomical abnormality, and tracheal intubation was readily possible. The operation was completed without incident. Stiffening of both arms occurred for several seconds one hour after the operation ended, but the patient did not develop other complications. Conclusions Mask ventilation and the insertion of an intravenous catheter may be difficult in the general anesthesia of patients with BSS, and anesthetic management requires caution.
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Affiliation(s)
- Eisuke Hamaguchi
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Katsuyoshi Kume
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Yoko Sakai
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Nami Kakuta
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Yuta Uemura
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
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22
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Azma T, Tuluc F, Ito T, Aoyama-Mani C, Kawahito S, Kinoshita H. Mechanisms of action of anesthetics for the modulation of perioperative thrombosis: evidence for immune mechanisms from basic and clinical studies. Curr Pharm Des 2015; 20:5779-93. [PMID: 24502580 DOI: 10.2174/1381612820666140204102044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/03/2014] [Indexed: 11/22/2022]
Abstract
Thrombotic events occurring in either arteries or veins are the primary causes of fatal perioperative cardiovascular events. Risk factors for deep vein thrombosis, several of which are evidently associated with specific surgical procedures, are quite different from those for arterial thrombosis (e.g., aging or atherosclerotic diseases). Thrombus formed in arteries consists mainly of platelets coated with fibrin (i.e., white thrombus), while venous thrombus formed at relatively lower shear stress consists of all blood components including erythrocytes as well as leukocytes infiltrated with fibrin (red thrombus). Clinical evidence indicates beneficial roles of neuraxial anesthesia/analgesia in the prevention of VTE for patients undergoing high risk surgical procedures. To date, mechanisms of action of drugs used for neuraxial anesthesia/analgesia to prevent venous thrombosis are uncertain. However, accumulation of clinical as well as experimental findings points to the involvement of immune cells (especially monocytes) in red thrombus generation and to the interaction of anesthetics with these cells. We also suggest that adhesion molecules associated with the formation of monocyte platelet aggregates as well as substance P: neurokinin-1 receptor (SP/NK1R) pathway that involves neurogenic inflammation are crucial. Local anesthetics and NK1R antagonists are candidate drugs that may possess the capability to prevent venous thrombotic disorders in perioperative settings.
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23
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Kawahito S, Nakahata K, Azma T, Kuroda Y, Cook DJ, Kinoshita H. Protective effects of anesthetics on vascular function related to K⁺ channels. Curr Pharm Des 2015; 20:5727-37. [PMID: 24502572 DOI: 10.2174/1381612820666140204115647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/03/2014] [Indexed: 11/22/2022]
Abstract
K(+) channels play an essential role in the membrane potential of arterial smooth muscle, and also in regulating contractile tone. Especially, in vascular smooth muscle, the opening of adenosine triphosphate (ATP)-sensitive K(+) (KATP) channels leads to membrane hyperpolarization, resulting in muscle relaxation and vasodilation. This activation also plays a role in tissues during pathophysiologic events such as ischemia, hypoxia, and vasodilatory shock. In this review, we will describe the physiological and pathophysiological roles of vascular smooth muscle KATP channels in relation to the effects of anesthetics. Although accumulated evidence suggests that many anesthetics modify the above function of K(+) channels as a metabolic sensor, further studies are certainly needed to resolve certain issues, especially in clinical settings of anesthesia use.
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Affiliation(s)
| | | | | | | | | | - Hiroyuki Kinoshita
- Department of Anesthesiology, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770- 8503, Japan.
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24
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Kawano H, Ohshita N, Katome K, Kadota T, Kinoshita M, Matsuoka Y, Tsutsumi YM, Kawahito S, Tanaka K, Oshita S. 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. Braz J Anesthesiol 2014; 66:12-8. [PMID: 26768924 DOI: 10.1016/j.bjane.2014.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 05/20/2014] [Accepted: 07/03/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION Combined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea. We term this novel method of anesthesia "combined intravenous-volatile anesthesia (CIVA)".
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Affiliation(s)
- Hiroaki Kawano
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan.
| | - Naohiro Ohshita
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Kimiko Katome
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Takako Kadota
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Michiko Kinoshita
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Yayoi Matsuoka
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Shuzo Oshita
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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25
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Sakai Y, Kawahito S, Takaishi K, Mita N, Kinoshita H, Hatakeyama N, Azma T, Nakaya Y, Kitahata H. Propofol-induced relaxation of rat aorta is altered by aging. J Med Invest 2014; 61:278-84. [PMID: 25264045 DOI: 10.2152/jmi.61.278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Propofol causes vasodilation via endothelium-dependent and -independent mechanisms. Because endothelial function is impaired with aging, the effects of propofol on endothelium-dependent vasodilation might be altered by aging. The aim of this study was thus to determine the effects of aging on vascular responses to propofol. METHODS Young (4-6 weeks old) or adult (16-25 weeks old) rats were anesthetized with sevoflurane. The thoracic aorta was dissected and cut into pieces 3-4 mm in length. In some rings, the endothelium was deliberately removed. The ring segment of the aorta was mounted for isometric force recording at a resting tension of 0.5-1.0 g in a 2 ml organ bath, containing Krebs-Ringer bicarbonate buffer. Arteries were precontracted with phenylephrine, and the function of endothelium was confirmed with acetylcholine. Then, we studied the concentration-dependent effects of propofol in endothelium-intact (control group) and -denuded aortic rings (denuded group), as well as those treated with N(ω)-nitro-L-arginine methylester (L-NAME group). RESULTS Relaxation due to propofol was observed in the control groups of both young and adult rats in a concentration-dependent manner, but the magnitude of relaxation was significantly greater in young rats. In addition, in young rats, relaxation due to propofol was significantly and equally reduced in both L-NAME and denuded groups at all propofol concentrations that we studied (10(-6)-10(-3) M). In adult rats, relaxation due to propofol was quite similar between control and L-NAME groups at all propofol concentrations, whereas it was significantly reduced in the denuded group. CONCLUSION These results suggest that endothelium-derived nitric oxide plays an important role in propofol-induced vasodilation in young rats, but not in adult rats.
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Affiliation(s)
- Yoko Sakai
- Department of Anesthesiology, Tokushima University Hospital
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26
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Abstract
Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.
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Affiliation(s)
- Kazumi Takaishi
- Assistant Professor, The University of Tokushima Graduate School, Tokushima, Japan
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27
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Hirose K, Kawahito S, Mita N, Takaishi K, Kawahara T, Soga T, Katayama T, Imura S, Morine Y, Ikemoto T, Shimada M, Matsuhisa M, Kitahata H. Usefulness of artificial endocrine pancreas during resection of insulinoma. J Med Invest 2014; 61:421-5. [DOI: 10.2152/jmi.61.421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kayo Hirose
- Department of Pharmacology, Institute of Health Biosciences, the University of Tokushima Graduate School
- Department of Anesthesiology, Tokyo University Graduate School of Medicine
| | | | - Naoji Mita
- Department of Anesthesiology, Tokushima University Hospital
| | - Kazumi Takaishi
- Department of Dental Anesthesiology, Institute of Health Biosciences, the University of Tokushima Graduate School
| | | | - Tomohiro Soga
- Department of Anesthesiology, Tokushima University Hospital
| | | | - Satoru Imura
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Yuji Morine
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Tetsuya Ikemoto
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Mitsuo Shimada
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | | | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Institute of Health Biosciences, the University of Tokushima Graduate School
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28
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Abstract
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.
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29
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Kakuta N, Kawahito S, Mita N, Kambe N, Kasai A, Wakamatsu N, Katayama T, Soga T, Tada F, Kitaichi T, Kitagawa T, Kitahata H. Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt. J Med Invest 2013; 60:272-5. [PMID: 24190047 DOI: 10.2152/jmi.60.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A PediaSat™ oximetry catheter (PediaSat: Edwards Lifesciences Co., Ltd., Irvine, CA, U. S. A.), which facilitates continuous measurement of central venous oxygen saturation (ScvO2), may be useful for surgery for pediatric congenital heart disease. We used PediaSat during a bidirectional Glenn shunt. The patient was a 13-month-old boy. Under a diagnosis of left single ventricle (pulmonary atresia, right ventricular hypoplasia, atrial septal defect) and residual left aortic arch/left superior vena cava, a modified right Blalock-Taussig shunt was performed. Cyanosis deteriorated, so a bidirectional Glenn shunt was scheduled. After anesthesia induction, a 4.5 Fr double-lumen (8 cm) PediaSat was inserted through the right internal jugular vein for continuous ScvO2 monitoring. Furthermore, the probe of a near-infrared, mixed blood oxygen saturation-measuring monitor was attached to the forehead for continuous monitoring of the regional brain tissue mixed blood oxygen saturation (rSO2) (INVOS™ 5100C, Covidien; Boulder, CO, U. S. A.). Blockage of the right pulmonary artery and right superior vena cava decreased the oxygen saturation, ScvO2, and rSO2, but increased the central venous pressure. Although changes in ScvO2 were parallel to those in rSO2, the former showed more marked changes. A combination of ScvO2 and rSO2 for monitoring during Glenn shunt may be safer.
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Affiliation(s)
- Nami Kakuta
- Department of Anesthesiology, Tokushima University Hospital
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30
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Kagawa K, Zhang B, Seo MW, Kawahito S, Kominami Y, Yamada K, Yoshida S, Tanaka S. Dual-band multi-aperture enhanced redox imaging of colonic adenomas for endoscopes with a high-performance CMOS imager. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:1414-7. [PMID: 24109962 DOI: 10.1109/embc.2013.6609775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dual-band multi-aperture imaging of colonic adenomas based on the redox condition of mucosal cells for next-generation endoscopes is proposed. A low-noise and high-dynamic-range CMOS imager with the folding integration and the cyclic ADC is utilized in the single-imager multi-aperture camera system with 475-nm and 530-nm band-pass filters. A redox image is calculated from four kinds of images, 475-nm and 530-nm fluorescence images for 365-nm and 405-nm excitation lights. Dark current and random noise are reduced with a selective averaging method. The contrast of the redox image has been successfully enhanced.
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Takaishi K, Kawahito S, Yamada H, Soeki T, Sata M, Kitahata H. Increase in prominence of electrocardiographic J waves after a single dose of propofol in a patient with early ventricular repolarisation. Anaesthesia 2013; 69:170-5. [DOI: 10.1111/anae.12448] [Citation(s) in RCA: 5] [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: 08/28/2013] [Indexed: 11/26/2022]
Affiliation(s)
- K. Takaishi
- Department of Dental Anaesthesiology; The University of Tokushima Graduate School; Tokushima Japan
| | - S. Kawahito
- Department of Anaesthesiology; Tokushima University Hospital; Tokushima Japan
| | - H. Yamada
- Department of Cardiovascular Medicine; Tokushima University Hospital; Tokushima Japan
| | - T. Soeki
- Department of Cardiovascular Medicine; Tokushima University Hospital; Tokushima Japan
| | - M. Sata
- Department of Cardiovascular Medicine; The University of Tokushima Graduate School; Tokushima Japan
| | - H. Kitahata
- Department of Dental Anaesthesiology; The University of Tokushima Graduate School; Tokushima Japan
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Kawahito S, Higuchi S, Mita N, Kitagawa T, Kitahata H. Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit. J Artif Organs 2013; 16:508-9. [DOI: 10.1007/s10047-013-0725-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
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Soga T, Kawahito S, Oi R, Kakuta N, Katayama T, Wakamatsu N, Takaishi K, Yamaguchi K, Izaki H, Kanayama HO, Kitahata H, Oshita S. Recent less-invasive circulatory monitoring during renal transplantation. J Med Invest 2013; 60:159-63. [PMID: 23614926 DOI: 10.2152/jmi.60.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
For anesthetic management during renal transplantation, it is necessary to maintain the blood flow and function of the transplanted kidney by performing massive fluid management and stabilizing blood pressure. We report anesthetic management for renal transplantation with a less-invasive circulatory monitoring system (Edwards Life Sciences Co., Ltd., Irvine, California, U.S.A.). In November 2010, renal transplantation was started in our hospital, and performed in 6 patients. In the first patient, fluid/circulatory management was conducted by connecting a standard arterial line and a standard central venous (CV) line. In the second patient, a FloTrac(TM) system and a standard CV line were used. In the third patient, a standard arterial line and a PreSep(TM) CV Oximetry Catheter were used. In the fourth and fifth patients, a FloTrac(TM) and a PreSep(TM) were used. In the latest patient, FloTrac(TM) and PreSep(TM) were connected to an EV1000(TM) Clinical Platform for fluid/circulatory management. The establishment of high-visibility monitors was useful for evaluating the condition and confirming the effects. As there are marked changes in hemodynamics, the CV pressure, which has been used as a parameter of fluid management, is not reliable in renal failure patients with a high incidence of cardiovascular complications. Advances in noninvasive circulatory monitoring with dynamic indices may improve the safety of anesthetic management during renal transplantation.
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Affiliation(s)
- Tomohiro Soga
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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Takaishi K, Kitahata H, Kawahito S. Local anesthetics inhibit nitric oxide production and l-arginine uptake in cultured bovine aortic endothelial cells. Eur J Pharmacol 2013; 704:58-63. [DOI: 10.1016/j.ejphar.2013.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 11/15/2022]
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35
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Minonishi T, Kinoshita H, Hirayama M, Kawahito S, Azma T, Hatakeyama N, Fujiwara Y. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement. J Clin Anesth 2013; 25:28-31. [DOI: 10.1016/j.jclinane.2012.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/27/2012] [Accepted: 05/25/2012] [Indexed: 11/26/2022]
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36
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Okada T, Kawahito S, Mita N, Matsuhisa M, Kitahata H, Shimada M, Oshita S. Usefulness of continuous blood glucose monitoring and control for patients undergoing liver transplantation. J Med Invest 2013; 60:205-12. [DOI: 10.2152/jmi.60.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Naoji Mita
- Department of Anesthesiology, Tokushima University Hospital
| | | | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Hospital
| | - Mitsuo Shimada
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Shuzo Oshita
- Department of Anesthesiology, Tokushima University Hospital
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37
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Kawano H, Nomura K, Kawahito S, Ohshita N, Tanaka K, Oshita S. [Dextran-induced anaphylactic shock during general anesthesia: a case report]. Masui 2012; 61:1265-1268. [PMID: 23236936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We describe a case of dextran-induced anaphylactic shock during general anesthesia. A 34-year-old woman was scheduled for partial hepatic resection under general anesthesia. General anesthesia was induced with intravenous remifentanil, thiamylal and rocuronium, and was maintained with oxygen, air, sevoflurane and remifentanil. The patient developed hypotension (from 90/50 to 49/27 mmHg in 20 min) together with tachycardia (111 beats x min(-1)) and desaturation (83%) subsequent to intravenous infusion of Saviosol (dextran 40). We made a diagnosis of anaphylactic shock on the basis of clinical manifestations and administered adrenaline and hydrocortisone. The patient's blood pressure and oxygen saturation immediately improved, and the operation was resumed. No postoperative complications were evident, and the postoperative course was uneventful. Although low molecular weight dextran is often used as plasma expander or to prevent thromboembolism, it can cause severe hypotension or bronchospasm during general anesthesia.
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Affiliation(s)
- Hiroaki Kawano
- Department of Anesthesiology and Clinical Research, National Hospital Organization Zentsuji Hospital, Zentsuji 765-8507
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38
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Kawahito S. [Extracorporeal circulation for anesthesiologists]. Masui 2012; 61 Suppl:S75-S85. [PMID: 23513521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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39
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Kinoshita H, Matsuda N, Iranami H, Ogawa K, Hatakeyama N, Azma T, Kawahito S, Yamazaki M. Isoflurane pretreatment preserves adenosine triphosphate-sensitive K(+) channel function in the human artery exposed to oxidative stress caused by high glucose levels. Anesth Analg 2012; 115:54-61. [PMID: 22467893 DOI: 10.1213/ane.0b013e318254270d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adenosine triphosphate (ATP)-sensitive K(+) channels contribute to significant regulatory mechanisms related to organ blood flow in both physiological and pathological conditions. High glucose impairs arterial ATP-sensitive K(+) channel activity via superoxide production. However, the effects of anesthetics on this pathological process have not been evaluated in humans. In the present study, we investigated whether pretreatment with the volatile anesthetic isoflurane preserves ATP-sensitive K(+) channel activity in the human artery exposed to oxidative stress caused by high glucose. METHODS All experiments were performed using human omental arteries without endothelium in the presence of d-glucose (5.5 mmol/L). Some arteries were treated with isoflurane (1.15% or 2.3%) in combination with d- or l-glucose (20 mmol/L) for 60 minutes, and then only isoflurane was discontinued. Relaxation and hyperpolarization of arterial segments in response to an ATP-sensitive K(+) channel opener levcromakalim were evaluated using the isometric force recording or electrophysiological study, respectively. Superoxide production was determined by dihydroethidium fluorescence. Immunohistochemical analysis for a subunit of reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase p47phox was performed. Data were evaluated using repeated-measures analysis of variance or a factorial analysis of variance as appropriate, followed by Scheffé test. RESULTS The ATP-sensitive K(+) channel antagonist glibenclamide (10(-6) mol/L) abolished relaxation induced by cumulative addition of levcromakalim (10(-8) to 10(-5) mol/L) in arteries treated with l-glucose (20 mmol/L). Incubation with d-glucose (20 mmol/L) impaired the vasorelaxation induced by levcromakalim. The selective NADPH oxidase NOX2 inhibitor gp91ds-tat (10(-6) mol/L) and pretreatment with isoflurane (1.15% and 2.3%) restored relaxation in response to levcromakalim in arteries treated with d-glucose (20 mmol/L). Isoflurane (2.3%), gp91ds-tat (10(-6) mol/L), and their combination similarly restored hyperpolarization in response to levcromakalim (3 × 10(-6) mol/L) in arteries treated with d-glucose (20 mmol/L). Along with these results, isoflurane (2.3%) reduced superoxide production and the intracellular mobilization of the cytosolic NOX2 subunit p47phox toward smooth muscle cell membrane in arteries treated with d-glucose (20 mmol/L). CONCLUSIONS We have demonstrated for the first time a beneficial effect from the pretreatment with isoflurane on the isolated human artery. Pretreatment with isoflurane preserves ATP-sensitive K(+) channel activity in the human omental artery exposed to oxidative stress induced by high glucose, whereas the effect seems to be mediated by NADPH oxidase inhibition. Volatile anesthetics may protect human visceral arteries from malfunction caused by oxidative stress.
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Affiliation(s)
- Hiroyuki Kinoshita
- Department of Anesthesiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan.
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Hama-Tomioka K, Kinoshita H, Nakahata K, Kondo T, Azma T, Kawahito S, Hatakeyama N, Matsuda N. Roles of neuronal nitric oxide synthase, oxidative stress, and propofol in N -methyl- d -aspartate-induced dilatation of cerebral arterioles. Br J Anaesth 2012; 108:21-9. [DOI: 10.1093/bja/aer368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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41
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Kawahito S, Kitahata H. [Principles, usefulness, and limitations of recent circulatory monitoring]. Masui 2012; 61:25-34. [PMID: 22338857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Less invasive measuring procedures for hemodynamic status and function are increasingly being used. Surgical patients are frequently undifferentiated, need accurate risk assessment and stratification, while their need for diagnosis and therapy is often time-critical. Valid, less invasive hemodynamic monitoring modalities are essential to differentiate high- from low-risk patients, and for goal-directed management. Pulmonary artery catheters, transesophageal echocardiography, pressure pulse waveform analysis, and other less invasive monitoring techniques all are potentially effective for diagnosis and hemodynamic monitoring. This article provides information on the usefulness and limitations of recent circulatory monitoring procedures.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima 770-8503
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Kagawa K, Shogenji R, Tanaka E, Yamada K, Kawahito S, Tanida J. Variable field-of-view visible and near-infrared polarization compound-eye endoscope. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2012:3720-3723. [PMID: 23366736 DOI: 10.1109/embc.2012.6346775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A multi-functional compound-eye endoscope enabling variable field-of-view and polarization imaging as well as extremely deep focus is presented, which is based on a compact compound-eye camera called TOMBO (thin observation module by bound optics). Fixed and movable mirrors are introduced to control the field of view. Metal-wire-grid polarizer thin film applicable to both of visible and near-infrared lights is attached to the lenses in TOMBO and light sources. Control of the field-of-view, polarization and wavelength of the illumination realizes several observation modes such as three-dimensional shape measurement, wide field-of-view, and close-up observation of the superficial tissues and structures beneath the skin.
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Affiliation(s)
- K Kagawa
- Research Institute of Electronics, Shizuoka University, 3-5-1 Johoku, Naka-ku, Hamamatsu, Shizuoka 432-8011, Japan.
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Kawano T, Yamazaki F, Chi H, Kawahito S, Eguchi S. Dexmedetomidine directly inhibits vascular ATP-sensitive potassium channels. Life Sci 2011; 90:272-7. [PMID: 22155038 DOI: 10.1016/j.lfs.2011.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 10/30/2011] [Accepted: 11/17/2011] [Indexed: 11/17/2022]
Abstract
AIMS Dexmedetomidine is reported to have an effect on peripheral vasoconstriction; however, the exact mechanisms underlying this process are unclear. In this study, we hypothesized that dexmedetomidine-induced inhibition of vascular ATP-sensitive K(+) (K(ATP)) channels may be associated with this vasoconstriction. To test this hypothesis, we investigated the effects of dexmedetomidine on vascular K(ATP)-channel activity at the single-channel level. MAIN METHODS We used cell-attached and inside-out patch-clamp configurations to examine the effects of dexmedetomidine on the activities of native rat vascular K(ATP) channels, recombinant K(ATP) channels with different combinations of various inwardly rectifying potassium channels (Kir6.0 family: Kir6.1, 6.2) and sulfonylurea receptor subunits (SUR1, 2A, 2B), and SUR-deficient channels derived from a truncated isoform of Kir6.2 subunit, namely, Kir6.2ΔC36 channels. KEY FINDINGS Dexmedetomidine was observed to inhibit the native rat vascular K(ATP) channels in both cell-attached and inside-out configurations. This drug also inhibited the activity of all types of recombinant SUR/Kir6.0 K(ATP) channels as well as Kir6.2ΔC36 channels with equivalent potency. SIGNIFICANCE These results indicate that dexmedetomidine directly inhibits K(ATP) channels through the Kir6.0 subunit.
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Affiliation(s)
- Takashi Kawano
- Department of Anesthesiology and Critical Care Medicine, Kochi Medical School, Kochi, Japan.
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Kawahito S, Kawano T, Kitahata H, Oto J, Takahashi A, Takaishi K, Harada N, Nakagawa T, Kinoshita H, Azma T, Nakaya Y, Oshita S. Molecular Mechanisms of the Inhibitory Effects of Clonidine on Vascular Adenosine Triphosphate–Sensitive Potassium Channels. Anesth Analg 2011; 113:1374-80. [DOI: 10.1213/ane.0b013e3182321142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hamaguchi E, Kawano H, Kawahito S, Kitahata H, Oshita S. [Torsade de pointes associated with severe bradycardia after induction of general anesthesia]. Masui 2011; 60:1097-1100. [PMID: 21950046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An 80-year-old woman with chronic atrial flutter/fibrillation, and chronic renal failure underwent ileocecal resection. The preoperative electrocadiogram showed normal QT interval. Temporary pacemaker catheter was inserted for sinus arrest (5-6 sec) the day before operation. Anesthesia was induced with remifentanil 0.5 micro x kg(-1) min(-1), thiamylal 125 mg, and rocuronium 30 mg after intravenous atropine sulfate 0.5 mg. Because the heart rate was increased with atropine sulfate, the pacemaker was not started. Anesthesia was then maintained with intravenous remifentanil and sevoflurane-air-oxygen. Just after induction of anesthesia, sinus bradycardia occurred, and 9 minutes after tracheal intubation, ECG suddenly showed torsade de pointes (TdP) and the arterial blood pressure decreased leading to asystole. We immediately started cardiopulmonary resuscitation, and TdP stopped spontaneously within 1 minute. We started pacemaker (VVI, 60 beats x min(-1)) and intravenous injection of lidocaine, and TdP did not recur. In this case, TdP seemed to have occurred because of bradycardia-induced abnormal QT prolongation. This should be considered the risk of lethal arrhythmia in patients with severe bradycardia including TdP.
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Affiliation(s)
- Eisuke Hamaguchi
- Department of Anesthesiology, Tokushima University Hospital, Tokushima 770-8503
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46
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Kawano H, Hamaguchi E, Kawahito S, Tsutsumi YM, Tanaka K, Kitahata H, Oshita S. Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-D-aspartate receptor antibodies. Anaesthesia 2011; 66:515-8. [PMID: 21457154 DOI: 10.1111/j.1365-2044.2011.06707.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- H Kawano
- Department of Anesthesiology and Clinical Research, National Hospital Organization Zentsuji Hospital, Zentsuji, Japan.
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Abstract
Recent evidence in the fields of surgery, emergency and critical care medicine indicates that strict glycemic control results in lower mortality. Hyperglycemia occurs frequently in patients with and without diabetes during cardiovascular surgery, especially during cardiopulmonary bypass. However, strict glucose control is difficult to achieve during cardiovascular procedures. To establish effective intensive insulin therapy during cardiovascular surgery, we conduct continuous blood glucose monitoring and employ automatic control by using an artificial endocrine pancreas (the STG-22, Nikkiso, Tokyo, Japan). In this review, we will outline the present status and problems of conventional glycemic control for perioperative cardiovascular surgery and introduce the new perioperative blood glucose management method that we are testing now. We will also discuss the importance of perioperative glycemic control for cardiovascular surgery as well as future prospects.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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Abstract
Glucose homeostasis deficiency leads to a chronic increase in blood glucose concentration. In contrast to physiological glucose concentration, chronic superphysiological glucose concentration negatively affects a large number of organs and tissues. Glucose toxicity means a decrease in insulin secretion and an increase in insulin resistance due to chronic hyperglycemia. It is now generally accepted that glucose toxicity is involved in the worsening of diabetes by affecting the secretion of β-cells. Several mechanisms have been proposed to explain the adverse effects of hyperglycemia. It was found that persistent hyperglycemia caused the functional decline of neutrophils. Infection is thus the main problem resulting from glucose toxicity in the acute phase. In other words, continued hyperglycemia is a life-threatening risk factor, not only in the chronic but also the acute phase, and it becomes a risk factor for infection, particularly in the perioperative period.
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Nakamura T, Kawahito S, Kawano H, Okada T, Kitahata H, Oshita S. [Anesthetic management for repair of Ebstein's anomaly with WPW syndrome]. Masui 2009; 58:438-441. [PMID: 19364004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with Wolff-Parkinson-White (WPW) syndrome. We report the perioperative management of 3 patients (a 34-year-old man, a 5-month-old boy and a 5-year-old girl) with Ebstein's anomaly associated with WPW syndrome. Anesthetic managements for valvuloplasty of the tricuspid valve and ablation of accessory pathway in 3 patients were successfully accomplished with a combination of fentanyl, sevoflurane, and midazolam. The management of Ebstein's anomaly is based on its severity. The major concerns with anesthesia for children with Ebstein's anomaly include decreased cardiac output, right-to-left atrial level shunting with cyanosis, and the propensity for atrial tachyarrhythmias. We conclude that perioperative management of arrhythmia and evaluation of residual tricuspid regurgitation using transesophageal echocardiography are essential.
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Affiliation(s)
- Tomoka Nakamura
- Department of Anesthesiology, Tokushima University Medical and Dental Hospital, Tokushima 770-8503
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Kitahata H, Nozaki J, Kawahito S, Tomino T, Oshita S. Low-Dose Sevoflurane Inhalation Enhances Late Cardioprotection from the Anti-Ulcer Drug Geranylgeranylacetone. Anesth Analg 2008; 107:755-61. [DOI: 10.1213/ane.0b013e31817f0e61] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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