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Yoshikawa Y, Maeda M, Kunigo T, Sato T, Takahashi K, Ohno S, Hirahata T, Yamakage M. Effect of using hypotension prediction index versus conventional goal-directed haemodynamic management to reduce intraoperative hypotension in non-cardiac surgery: A randomised controlled trial. J Clin Anesth 2024; 93:111348. [PMID: 38039629 DOI: 10.1016/j.jclinane.2023.111348] [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: 09/05/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
STUDY OBJECTIVE It remains unclear whether it is the hypotension prediction index itself or goal-directed haemodynamic therapy that mitigates intraoperative hypotension. DESIGN A single centre randomised controlled trial. SETTING Sapporo Medical University Hospital. PATIENTS A total of 64 adults patients undergoing major non-cardiac surgery under general anaesthesia. INTERVENTIONS Patients were randomly assigned to either group receiving conventional goal-directed therapy (FloTrac group) or combination of the hypotension prediction index and conventional goal-directed therapy (HPI group). To investigate the independent utility of the index, the peak rates of arterial pressure and dynamic arterial elastance were not included in the treatment algorithm for the HPI group. MEASUREMENTS The primary outcome was the time-weighted average of the areas under the threshold. Secondary outcomes were area under the threshold, the number of hypotension events, total duration of hypotension events, mean mean arterial pressure during the hypotension period, number of hypotension events with mean arterial pressure < 50 mmHg, amounts of fluids, blood products, blood loss, and urine output, frequency and amount of vasoactive agents, concentration of haemoglobin during the monitoring period, and 30-day mortality. MAIN RESULTS The time-weighted average of the area below the threshold was lower in the HPI group than in the control group; 0.19 mmHg (interquartile range, 0.06-0.80 mmHg) vs. 0.66 mmHg (0.28-1.67 mmHg), with a median difference of -0.41 mmHg (95% confidence interval, -0.69 to -0.10 mmHg), p = 0.005. Norepinephrine was administered to 12 (40%) and 5 (17%) patients in the HPI and FloTrac groups, respectively (p = 0.045). No significant differences were observed in the volumes of fluid and blood products between the study groups. CONCLUSIONS The current randomised controlled trial results suggest that using the hypotension prediction index independently lowered the cumulative amount of intraoperative hypotension during major non-cardiac surgery.
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Affiliation(s)
- Yusuke Yoshikawa
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan.
| | - Makishi Maeda
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan
| | - Tatsuya Kunigo
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan
| | - Tomoe Sato
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan
| | - Kanako Takahashi
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan
| | - Sho Ohno
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan
| | - Tomoki Hirahata
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan
| | - Michiaki Yamakage
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, South1 West16 291, Chuoku, Sapporo 060-8543, Japan
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Hirahata T, Hashimoto S, Watanabe H, Yagi SI, Edanaga M, Yamakage M. The 10 Hz dynamic response of a fluid-filled pressure monitoring system is a novel alternative to the fast flush test and indicative of unacceptable systolic pressure overshoot. J Clin Monit Comput 2024:10.1007/s10877-023-01122-1. [PMID: 38310593 DOI: 10.1007/s10877-023-01122-1] [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: 03/24/2023] [Accepted: 12/19/2023] [Indexed: 02/06/2024]
Abstract
The standard method for qualitatively evaluating the dynamic response is to see if the gain of the amplitude spectrum curve approaches 1 (input signal = output signal) over the frequency band of the blood pressure waveform. In a previous report, Watanabe reported that Gardner's natural frequency and damping coefficient, which are widely used as evaluation methods, do not reflect the dynamic response of the circuit. Therefore, new parameters for evaluating the dynamic response of pressure monitoring circuits were desired. In this study, arterial pressure catheters with length of 30, 60, 150, and 210 cm were prepared, and a blood pressure wave calibrator, two pressure monitors with analog output and a personal computer were used to analyze blood pressure monitoring circuits. All data collection and analytical processes were performed using step response analysis program. The gain at 10 Hz was close to 1 and the systolic blood pressure difference was small in the short circuits (30 cm, 60 cm), and the gain at 10 Hz was 1.3-1.5 in the 150 cm circuit and over 1.7 in the 210 cm circuit. The difference in systolic blood pressure increased in proportion to the length of the circuit. It could also be inferred that the gain at 10 Hz should be less than 1.2 to meet a clinically acceptable blood pressure difference. In conclusion, the gain at 10 Hz is sufficiently useful as an indicator to determine the correct systolic blood pressure.
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Affiliation(s)
- Tomoki Hirahata
- Department of Anesthesiology, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Shuichi Hashimoto
- Department of Anesthesiology, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroaki Watanabe
- Department of Anesthesiology, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Shin-Ichi Yagi
- School of Information Science, School of Information Science, Department of Information Science, Meisei University, Tokyo, Japan
| | - Mitsutaka Edanaga
- Department of Anesthesiology, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Chaki T, Tachibana S, Kumita S, Sato S, Hirahata T, Ikeshima Y, Ohsaki Y, Yamakage M. I-gel Plus acts as a superior conduit for fiberoptic intubation than standard i-gel. Sci Rep 2023; 13:18381. [PMID: 37884591 PMCID: PMC10603072 DOI: 10.1038/s41598-023-45631-0] [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: 06/30/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023] Open
Abstract
The supraglottic airway (SGA) is widely used. I-gel Plus is a next-generation i-gel with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel Plus and standard i-gel as conduits for FOI, a Thiel-embalmed cadaveric study was conducted. Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel Plus and standard i-gel were inserted into one cadaver, and the FOI was performed through each SGA. The primary outcome was time required for FOI. The secondary outcomes were the number of attempts and visual analog scale (VAS) score for difficulty in FOI. Moreover, fiberoptic views of the vocal cords in each SGA were assessed by an attending anesthesiologist using nine cadavers in Experiment 2. The percentage of glottic opening (POGO) score without fiberscope tip upward flexion and upward angle of the fiberscope tip to obtain a 100% POGO score were evaluated as secondary outcomes. The time for FOI through i-gel Plus was significantly shorter than that through standard i-gel (median (IQR), i-gel Plus: 30.3 (25.4-39.0) s, vs standard i-gel: 54.7 (29.6-135.0) s; median of differences, 24.4 s; adjusted 95% confidence interval, 3.0-105.7; adjusted P = 0.040). Although the number of attempts for successful FOI was not significantly different, the VAS score for difficulty in the i-gel Plus group was significantly lower (easier) than that in the standard i-gel group. Moreover, i-gel Plus required a significantly smaller upward angle of the fiberscope tip to obtain a 100% POGO score. FOI can be performed more easily using i-gel Plus than using standard i-gel because of the improved fiberoptic visibility of vocal cords.
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Affiliation(s)
- Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Shunsuke Tachibana
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sho Kumita
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Sato
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoki Hirahata
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuta Ikeshima
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuki Ohsaki
- Department of Anatomy (I), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Yoshikawa Y, Maeda M, Ohno S, Takahashi K, Sawashita Y, Hirahata T, Iba Y, Kawaharada N, Edanaga M, Yamakage M. Validity and Utility of Early Parameters in TEG6s Platelet Mapping to Assess the Coagulation Status During Cardiovascular Surgery With Cardiopulmonary Bypass. Cureus 2023; 15:e38044. [PMID: 37228566 PMCID: PMC10208008 DOI: 10.7759/cureus.38044] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background The aim of this retrospective observational study was to explore the early predictive parameters for maximum amplitudein the kaolin with heparinase (HKH) assay (MAHKH) of TEG6s Platelet Mapping in cardiovascular surgery including cardiopulmonary bypass (CPB) period. The relationship between each parameter of the assay and laboratory data was also assessed. Methods We included the patients who underwent TEG6s Platelet Mapping during cardiovascular surgery under CPB between November 2021 and May 2022. The correlation between MAHKH and the early parameters was assessed. The association between each parameter of Platelet Mapping and a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000µL was also evaluated by the receiver operating characteristic (ROC) curve. Results In 23 patients who underwent TEG6s Platelet Mapping during the study period, 62 HKH assay data including 59 pairs of data (HKH assay and laboratory data) were analyzed. K and angle, but not R, were significantly correlated with MAHKH (r [95% CI]: -0.90 [-0.94, -0.83], p < 0.0001 for K, and 0.87 [0.79, 0.92], p < 0.0001 for angle). Furthermore, ROC curves suggested that these parameters predicted a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000/µL with high accuracy. Similar results were confirmed in the heparinized blood samples obtained during CPB. Conclusion These findings suggest that not only MAKHK but also K and angle, which are early parameters in the HKH assay, provide clinically significant information that will facilitate rapid decision-making regarding coagulation strategies during cardiovascular surgery including the CPB period.
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Affiliation(s)
- Yusuke Yoshikawa
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
| | - Makishi Maeda
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
| | - Sho Ohno
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
| | - Kanako Takahashi
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
| | - Yasuaki Sawashita
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
| | - Tomoki Hirahata
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JPN
| | | | - Mitsutaka Edanaga
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
| | - Michiaki Yamakage
- Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN
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Hirahata T, Bjorkman D, Chamberlain JK. Endotoxin: a twofold effect on bone marrow ultrastructure. Scanning Microsc 1987; 1:1349-58. [PMID: 3659866] [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: 01/06/2023]
Abstract
Ultrastructural studies of mouse bone marrow reveal that reduction of the marrow-blood barrier precedes the two waves of leukocytosis which follow endotoxin administration. These ultrastructural changes include a decrease in adventitial cover of the marrow sinus wall, an increase in sinus circumference, and a decrease in endothelial cell overlap. The marrow-blood barrier changes which precede the first wave of leukocytosis are transient and are associated with depletion of marrow granulocytes. The changes that precede the second wave of leukocytosis 5 to 6 days later are more sustained and are associated with marked granulocyte hyperplasia. We suggest that endotoxin has two effects on marrow ultrastructure: (1) an early, direct effect on the sinus wall and (2) a later, indirect effect associated with granulocyte proliferation. The late effect may be mediated through endotoxin induced release of colony stimulating factor. Both effects diminish the normal marrow-blood barrier and appear to facilitate cell release from the marrow.
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Affiliation(s)
- T Hirahata
- East Carolina University School of Medicine, Greenville, NC 27858-4354
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Kiga Y, Umeda M, Kaneko H, Hirahata T, Ishikawa I, Takatsuki Y, Mugitani H, Tsukahara T, Shirai T, Ishihara K. [A case of paroxysmal nocturnal hemoglobinuria which occurred during the course of erythroleukemia (author's transl)]. Rinsho Ketsueki 1980; 21:1193-200. [PMID: 6934325] [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: 01/22/2023]
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Kato M, Shirai T, Umeda M, Kiga Y, Maki K, Kaneko H, Watanabe S, Hirahata T, Ishikawa I, Takatsuki Y, Masaki T, Yamauchi M, Tsukahara T. [A case of pure red cell aplasia which progressed to acute myelomonocytic leukemia after 8 months (author's transl)]. Rinsho Ketsueki 1979; 20:1451-8. [PMID: 295086] [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: 12/14/2022]
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