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Hirai S, Ida M, Kawaguchi M. Comparison of prophylaxis strategy for postoperative nausea and vomiting and its incidence before and after the implementation of 5-hydroxytryptamine 3 in surgical setting: a single-center, retrospective study. J Anesth 2024; 38:398-404. [PMID: 38436772 DOI: 10.1007/s00540-024-03327-3] [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: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To investigate the association between adherence to guideline-recommended risk-based postoperative nausea and vomiting (PONV) prophylaxis, the antiemetics used for PONV prophylaxis, and the incidence of PONV in patients who were underwent general anesthesia before and after 5-HT3 receptor antagonists became available. METHODS Patients (≥ 20 years old) who were extubated after scheduled surgery and returned to general wards between January 2021 and February 2022 and between June 2022 and July 2023 were included. Risk factors included age < 50, female, motion sickness, nonsmoker, surgical factors, and postoperative opioid use. Two and three or more prophylaxis were recommended for patients with one or two and three or more risk factors, respectively. The primary outcome was the number of patients who received adequate prophylaxis, and the secondary outcomes were antiemetic agents used during anesthesia and the incidence of PONV on postoperative days 0 and 1. PONV was defined as documented PONV or rescue antiemetic administration. RESULTS From January 2021 to February 2022 and from June 2022 to July 2023, 2342 and 2682 patients were included, respectively. Before ondansetron became available, more D2 receptor antagonists were used (p < 0.001), and after ondansetron became available, both ondansetron (p < 0.001) and propofol (p < 0.001) were given more frequently. Before and after ondansetron became available, the number of patients with adequate prophylaxis was 3.7% and 9.2%, respectively (p < 0.001), and the incidence of PONV on postoperative days 0 and 1 was 44.6% and 44.0%, respectively (p = 0.67). CONCLUSION The availability of ondansetron increased the number of patients with adequate PONV prophylaxis, but did not decrease the incidence of PONV.
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Affiliation(s)
- Sayaka Hirai
- Department of Perioperative Management Center, Nara Medical University Hospital, Nara, Japan
| | - Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, 840 Nara, Kashihara, Shijo, 634-8522, Japan.
| | - Masahiko Kawaguchi
- Department of Perioperative Management Center, Nara Medical University Hospital, Nara, Japan
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Kotani T, Ida M, Naito Y, Kawaguchi M. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on hemodynamics during anesthesia induction in patients undergoing transcatheter aortic valve replacement: a randomized controlled trial. J Anesth 2024; 38:330-338. [PMID: 38347233 DOI: 10.1007/s00540-024-03311-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/10/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This study aimed to compare the hemodynamic effects of remimazolam- and propofol-based total intravenous anesthesia in patients who underwent transcatheter aortic valve replacement. METHODS This was a single-center, single-blind, randomized controlled trial set at Nara Medical University, Kashihara, Japan. We included 36 patients aged ≥ 20 years scheduled to undergo elective transfemoral transcatheter aortic valve replacement (TAVR) under general anesthesia. The participants were randomly assigned to the remimazolam and propofol groups (n = 18 each). Remimazolam- or propofol-based total intravenous anesthesia was initiated at 12 mg/kg/min or 2.5 mcg/mL via target-controlled infusion, respectively, along with remifentanil. After confirming the loss of consciousness, the administration rate was adjusted using electroencephalographic monitoring. The primary outcome was the rate of arterial hypotension, defined as a mean arterial pressure < 60 mmHg, from anesthesia induction until the beginning of the surgical incision. The total doses of ephedrine and phenylephrine were also assessed. RESULTS During anesthesia induction, the arterial hypotension rates were 11.9% and 21.6% in the remimazolam and propofol groups, respectively (P = 0.01). The total dose of ephedrine was higher in the propofol group (14.4 mg) than in the remimazolam group (1.6 mg) (P < 0.001); however, the total dose of phenylephrine was not significantly different between the two groups (propofol 0.31 mg vs. remimazolam: 0.17 mg, P = 0.10). CONCLUSION Remimazolam-based total intravenous anesthesia resulted in a lower hypotension rate than propofol-based total intravenous anesthesia during induction in patients undergoing TAVR. Remimazolam-based total intravenous anesthesia can be used safely during anesthetic induction in patients with severe aortic stenosis.
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Affiliation(s)
- Taichi Kotani
- Department of Anesthesiology, Nara Medical University Kashihara, Shijo 840, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University Kashihara, Shijo 840, Nara, 634-8522, Japan.
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University Kashihara, Shijo 840, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University Kashihara, Shijo 840, Nara, 634-8522, Japan
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Kawaguchi M, Kato H, Kobayashi K, Miyazaki T, Nagano A, Noda Y, Hyodo F, Matsuo M. Radiologic-histopathologic correlation of fatty island sign with fat necrosis in atypical lipomatous tumor and lipoma. Clin Radiol 2024; 79:446-452. [PMID: 38580482 DOI: 10.1016/j.crad.2024.02.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 04/07/2024]
Abstract
AIM This study aimed to assess the imaging features of atypical lipomatous tumors (ALTs) and lipoma with fat necrosis. METHODS This study included patients with histopathologically proven fat necrosis within adipocytic tumors who underwent preoperative imaging. Magnetic resonance imaging (MRI) and/or computer tomography (CT) findings of fat necrosis associated with lipomatous tumors were retrospectively reviewed, emphasizing the "fatty island sign (FIS)." FISs were defined as well-demarcated, focal fat-containing areas surrounded by more thickened septa compared with other intratumoral septa. Imaging findings of FIS were compared between ALT and lipoma. RESULTS Fat necrosis was histopathologically confirmed in 17 patients (6 ALTs and 11 lipomas). Among them, 18 FISs were observed in 10 lesions (59%). Multiple FISs within a lesion were observed in 4 (40%) patients. The median maximum diameter of the FISs was 37 mm. Hypointense areas within FISs relative to the subcutaneous fat on T1- and T2-weighted images were observed in 8 (80%) and 9 (90%), respectively, whereas hyperintense areas within FISs on fat-suppressed T2-weighted images were observed in 2 (20%). Nonfatty solid components within FISs were observed in 2 (20%). On CT, increased fat attenuation and pure fat attenuation within FISs were observed in 6 (86%) and 1 (14%), respectively. The imaging findings of FIS were not significantly different between ALT and lipoma. CONCLUSION FISs were observed in 59% of the histologically proven ALT and lipoma patients with fat necrosis. The hypointense areas relative to the subcutaneous fat on T1- and T2-weighted images and increased fat attenuation on CT were usually observed within FISs.
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Affiliation(s)
- M Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - H Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - K Kobayashi
- Department of Pathology, Gifu University, Gifu, Japan
| | - T Miyazaki
- Department of Pathology, Gifu University, Gifu, Japan
| | - A Nagano
- Department of Orthopedic Surgery, Gifu University, Gifu, Japan
| | - Y Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - F Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Center for One Medicine Innovative Translational Research (COMIT), Institute for Advanced Study, Gifu University, Gifu, Japan
| | - M Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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Hirai N, Tanaka N, Suzuka T, Kadoya Y, Kawaguchi M. Letter to the editor regarding 'Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): an anatomical study evaluating dye spread following simulated injection in soft embalmed Thiel cadaver'. Reg Anesth Pain Med 2024; 49:376-377. [PMID: 37258033 DOI: 10.1136/rapm-2023-104686] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Natsuko Hirai
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
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Kinugasa Y, Ida M, Kawaguchi M. Fried Frailty Phenotype Questionnaire scores and postoperative patient-reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis. Geriatr Gerontol Int 2024; 24:464-469. [PMID: 38597119 DOI: 10.1111/ggi.14872] [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: 11/04/2023] [Revised: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
AIM This study aimed to evaluate the effects of Fried Frailty Phenotype Questionnaire (FFPQ) scores on patient-reported postoperative outcomes. METHODS This secondary analysis of a prospective observational study included 230 inpatients aged ≥65 years undergoing elective abdominal cancer surgery. The primary outcome was the Quality of Recovery-15 score on postoperative days 2, 4 and 7. The secondary outcomes included disability-free survival, defined as a 12-item World Health Organization Disability Assessment Schedule 2.0 score of <16% at 3 months. The associations of the FFPQ scores, ranging from 0 (robust) to 5 (frailty), with the primary and secondary outcomes were assessed using multiple analysis. RESULTS After confirming the linearity of the FFPQ score for the outcomes, multiple regression analysis adjusted for prominent factors showed that the FFPQ score was a significant factor influencing the decrease in the Quality of Recovery-15 score on postoperative day 2 (β = -2.67, 95% confidence interval -5.20, -0.15), 4 (β = -3.54, 95% confidence interval -5.77, -1.30) and 7 (β = -3.70, 95% confidence interval -5.75, -1.65). The adjusted odds ratio of the FFPQ score for disability-free survival postoperatively was 0.66 (95% confidence interval 0.49-0.90). CONCLUSIONS Patients with higher FFPQ scores before elective major abdominal cancer surgery were likely to have lower postoperative Quality of Recovery-15 scores and poor disability-free survival. Geriatr Gerontol Int 2024; 24: 464-469.
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Affiliation(s)
- Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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Mui T, Shigematsu H, Takatani T, Ikejiri M, Kawasaki S, Hayashi H, Kawaguchi M, Tanaka Y. Which patients do we need to consider augmentation of muscle active potentials regarding transcranial electrical stimulation motor-evoked potentials monitoring before spine surgery? Spine J 2024:S1529-9430(24)00188-8. [PMID: 38679074 DOI: 10.1016/j.spinee.2024.04.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/20/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND CONTEXT Transcranial electrical stimulation motor-evoked potentials (Tc-MEPs) are the current trend and are important in preventing intraoperative neurological deficits. Post-tetanic Tc-MEPs (p-MEP) can augment the amplitudes of compound muscle active potentials (CMAPs), especially in the case of insufficient conventional Tc-MEPs (c-MEP). PURPOSE To retrospectively investigate pre- and intraoperative factors necessitating p-MEP monitoring and to examine changes in the success rates of baseline Tc-MEP monitoring before and after tetanic stimulation in patients with such factors. STUDY DESIGN Retrospective observational study. PATIENT SAMPLE Patients (n=184) who underwent spinal surgery with Tc-MEP monitoring in our department between August 2020 and July 2022. OUTCOME MEASURES Manual muscle testing (MMT) scores were calculated to identify patients with preoperative motor deficits. c-MEP and p-MEP amplitudes were recorded from the defined muscles. METHODS We compared preoperative and intraoperative factors between the c-MEP and p-MEP groups (study 1). In cases where the factors were identified, we investigated the success rate of the baseline MEP measurement of each muscle before and after tetanic stimulation (study 2). RESULTS One hundred fifty-seven patients were included. Of those, 87 showed sufficient CMAPs with c-MEP. Meanwhile, 70 needed p-MEP because of insufficient CMAPs. In univariate analysis, cervical/thoracic surgery (p<.001), preoperative MMT 3 or below (p=.009), shorter duration of illness (p=.037), previous cerebrovascular disease (p=.014), and dialysis (p=.031) were significantly associated with p-MEP group. Preoperative MMT 3 or below was the only factor requiring p-MEP (odds ratio, 3.34; 95% confidence interval, 1.28-8.73, p=.014) in multivariate analysis. In the p-MEP group, 24 patients had preoperative motor deficits; 16 patients with complete data were included in the analysis (study 2). The success rates of MEP monitoring before and after tetanic stimulation of the entire lower-extremity muscles were 42.7 and 57.3%, respectively (p<.001). The success rates for each muscle before and after tetanic stimulation were abductor pollicis brevis: 81.3% and 96.9%, tibialis anterior: 34.4% and 50.0%, gastrocnemius: 25% and 40.6%, and abductor hallucis: 68.8% and 81.3%, respectively. No significant differences were observed in success rates for any of the muscles. CONCLUSIONS Patients with preoperative MMT 3 or below highly needed p-MEP. The success rate of baseline MEP monitoring increased with tetanic stimulation, even in patients with preoperative motor deficits. We believe that p-MEP monitoring can result in reliable CMAP recording, especially in cases of preoperative motor deficits with MMT scores of 3 or below.
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Affiliation(s)
- Takahiro Mui
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan
| | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan.
| | | | - Masaki Ikejiri
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan
| | - Sachiko Kawasaki
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan
| | - Hironobu Hayashi
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | | | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan
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Phoowanakulchai S, Hayashi H, Oi A, Takeshima Y, Takatani T, Kawaguchi M. Unilateral abnormality of initial motor-evoked potential in the upper limb detected during lumbar spine surgery: a case report. JA Clin Rep 2024; 10:23. [PMID: 38598105 PMCID: PMC11006633 DOI: 10.1186/s40981-024-00708-1] [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: 03/10/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND We present a case with abnormal findings of initial motor-evoked potential (MEP) in the left upper limb after prone positioning during lumbar spine surgery. CASE PRESENTATION A 71-year-old man with bilateral lower extremity numbness without a history of preexisting motor weakness underwent L3-5 spinal fenestration. Initial MEP monitoring after prone positioning revealed markedly prolonged latency and lower amplitude in the left abductor pollicis brevis (APB). Because the left upper limb somatosensory-evoked potentials had normal values, a position-related impending peripheral nerve injury located between the neck and the forearm was excluded. Postoperative examination revealed that MEP abnormality in the left APB was caused by carpal tunnel syndrome. CONCLUSIONS Abnormal initial MEP from the upper limb was unexpectedly detected after prone positioning during lumbar spine surgery. The condition was caused by preexisting carpal tunnel syndrome.
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Affiliation(s)
- Sirima Phoowanakulchai
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hironobu Hayashi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, 634-8522, Japan.
| | - Ayako Oi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tsunenori Takatani
- Division of Central Operation, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, 634-8522, Japan
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Ishida A, Ida M, Kinugasa Y, Nakatani H, Uyama K, Kawaguchi M. Early Quality of Recovery after Elective Cardiothoracic and Aortic Surgeries in Adult Patients: A Pilot Report. Ann Card Anaesth 2024; 27:144-148. [PMID: 38607878 PMCID: PMC11095783 DOI: 10.4103/aca.aca_183_23] [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: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Patient-centered outcome measures should be evaluated postoperatively as the recovery after surgery varies between patients. We aimed to evaluate the feasibility, reliability, and trajectory of the quality of recovery-15 (QoR-15) in patients undergoing cardiothoracic and aortic surgeries. MATERIALS AND METHODS This retrospective study included adult patients who underwent elective cardiothoracic and aortic surgeries. The primary outcome was the QoR-15, with a minimal clinically important difference of 6.8, assessed on postoperative days (POD) 2, 4, and 7. The final analysis included patients with at least one valid outcome. Feasibility and reliability were assessed by the successful completion rate on each POD and using Cronbach's alpha of the QoR-15 on POD 4. A linear mixed model was used to evaluate the trajectory of the postoperative QoR-15 scores. RESULTS Of the 36 eligible patients, 30 with a mean age of 70 years were included in the final analysis. The successful completion rates on POD 2, 4, and 7 were 72.7%, 87.8%, and 87.8%, respectively. The mean QoR-15 scores on POD 2, 4, and 7 were 89.9, 98.0, and 108.3, respectively. The QoR-15 scores on POD 2 and 4 were not statistically different (P = 0.06) but were clinically significant. The QoR-15 score on POD 7 was statically (P < 0.001) and clinically higher than the QoR-15 score on POD 2. Cronbach's alpha for the QoR-15 score measured on POD 4 was 0.85. CONCLUSION The QoR-15 is a feasible and valid measurement after elective cardiothoracic surgery, which increases significantly over time after surgery.
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Affiliation(s)
- Ayu Ishida
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
- Department of Medical Technical Center, Nara Medical University, Kashihara, Nara, Japan
| | - Hitomi Nakatani
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
- Department of Resource Nurse Center, Nara Medical University, Kashihara, Nara, Japan
| | - Kayo Uyama
- Department of Nursing, Nara Prefecture General Medical Center, Shichijo Nishimachi, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
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Hirai S, Ida M, Naito Y, Kawaguchi M. Comparison between the effects of epidural and intravenous patient-controlled analgesia on postoperative disability-free survival in patients undergoing thoracic and abdominal surgery: A post hoc analysis. Eur J Pain 2024. [PMID: 38511627 DOI: 10.1002/ejp.2266] [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] [Received: 01/19/2024] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) are widely used to mitigate immediate postoperative pain; however, their effects on long-term disability-free survival are poorly documented. This study aimed to compare the effects of postoperative TEA and IV-PCA on disability-free survival in patients who underwent thoracic or abdominal surgery. METHODS This post hoc analysis of a prospective observational study included 845 inpatients aged ≥55 years that underwent elective thoracic and abdominal surgery between 1 April 2016 and 28 December 2018 in a tertiary care hospital. Inverse probability of treatment weighted (IPTW) using stabilized inverse propensity scores was adopted to minimize bias. The primary outcome in this study was disability-free survival, defined as survival with a 12-item World Health Organization Disability Assessment Schedule 2.0 score of <16%, assessed at 3 months and 1 year after surgery. RESULTS The final analysis included 601 patients who received TEA and 244 who received IV-PCA. After IPTW, the weighted incidence of disability-free survival at 3 months and 1 year was 60.5% and 61.4% in the TEA group and 78.3% and 66.2% in the IV-PCA group, respectively. The adjusted OR for disability-free survival at 3 months and 1 year was 0.84 (95% confidence interval [CI]: 0.50-1.39) and 1.21 (95% CI: 0.72-2.05), respectively, for the TEA group. CONCLUSION No significant differences were observed in the disability-free survival at 3 months and 1 year after elective thoracic and abdominal surgery in patients aged ≥55 years who received TEA or IV-PCA. SIGNIFICANCE STATEMENT This study is the first in our setting to document the long-term effects of patient-controlled analgesia. In a post hoc analysis of our prospective cohort study, we show that although differences in chronic postsurgical pain exist at 3 months post-surgery, disability-free survival rates at 1 year do not differ irrespective of the choice of patient-controlled analgesia. The findings of this study highlight the need for shared decision-making between clinicians and patients.
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Affiliation(s)
- S Hirai
- Department of Perioperative Management Center, Nara Medical University Hospital, Nara, Japan
| | - M Ida
- Department of Anaesthesiology, Nara Medical University, Nara, Japan
| | - Y Naito
- Department of Anaesthesiology, Nara Medical University, Nara, Japan
| | - M Kawaguchi
- Department of Anaesthesiology, Nara Medical University, Nara, Japan
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Okamoto K, Fukushima H, Kawaguchi M, Tsuruya K. Low-Dose Continuous Kidney Replacement Therapy and Mortality in Critically Ill Patients With Acute Kidney Injury: A Retrospective Cohort Study. Am J Kidney Dis 2024:S0272-6386(24)00673-5. [PMID: 38490319 DOI: 10.1053/j.ajkd.2024.01.526] [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: 08/04/2023] [Revised: 01/07/2024] [Accepted: 01/20/2024] [Indexed: 03/17/2024]
Abstract
RATIONALE & OBJECTIVE Continuous kidney replacement therapy (CKRT) is preferred when available for hemodynamically unstable acute kidney injury (AKI) patients in the intensive care unit (ICU). The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a delivered CKRT dose of 20-25mL/kg/h; however, in Japan the doses are typically below this recommendation due to government health insurance system restrictions. This study investigated the association between mortality and dose of CKRT. STUDY DESIGN Single-center retrospective cohort study. SETTING & PARTICIPANTS Critically ill patients with AKI treated with CKRT at a tertiary Japanese university hospital between January 1, 2012, and December 31, 2021. EXPOSURE Delivered CKRT doses below or above the median. OUTCOME 90-day mortality after CKRT initiation. ANALYTICAL APPROACH Multivariable Cox regression analysis and Kaplan-Meier analysis. RESULTS The study population consisted of 494 patients. The median age was 72 years, and 309 patients (62.6%) were men. Acute tubular injury was the leading cause of AKI, accounting for 81.8%. The median delivered CKRT dose was 13.2mL/kg/h. Among the study participants, 456 (92.3%) received delivered CKRT doses below 20mL/kg/h, and 204 (41.3%) died within 90 days after CKRT initiation. Multivariable Cox regression analysis revealed increased mortality in the below-median group (HR, 1.73 [95% CI, 1.19-2.51], P=0.004). Additionally, a significant, inverse, nonlinear association between 90-day mortality and delivered CKRT dose was observed using delivered CKRT dose as a continuous variable. LIMITATIONS Single-center, retrospective, observational study. CONCLUSIONS A lower delivered CKRT dose was independently associated with higher 90-day mortality among critically ill patients who mostly received dosing below the current KDIGO recommendations. PLAIN-LANGUAGE SUMMARY The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend delivering a continuous kidney replacement therapy (CKRT) dose of 20-25mL/kg/h. However, it is not clear if it is safe to use delivered CKRT doses below this recommendation. In this study, over 90% of the patients received CKRT with a delivered dose below the KDIGO recommendation. We divided these patients into 2 groups based on the median delivered CKRT dose. Our findings show that a delivered CKRT dose below the median was associated with increased risk of death within 90 days. These findings show that a lower delivered CKRT dose was independently associated with higher 90-day mortality among critically ill patients who mostly received dosing below current KDIGO recommendations.
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Affiliation(s)
- Keisuke Okamoto
- Department of Nephrology, Nara Medical University, Nara, Japan.
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
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Phoowanakulchai S, Kawaguchi M. Updated review on the use of neuromuscular blockade during intraoperative motor-evoked potential monitoring in the modern anesthesia era. J Anesth 2024; 38:114-124. [PMID: 37843561 DOI: 10.1007/s00540-023-03265-6] [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: 05/23/2023] [Accepted: 09/23/2023] [Indexed: 10/17/2023]
Abstract
Transcranial electrical stimulation motor-evoked potentials (Tc-MEP) monitoring is a common practice in neurosurgery to prevent postoperative neurological damage. However, the use of neuromuscular blocking agents (NMBAs) during Tc-MEP monitoring is a subject of controversy. In addition, the effectiveness of sugammadex, a selective reversal agent, in the context of Tc-MEP monitoring requires further investigation. This review aimed to clarify the considerations involved in achieving optimal Tc-MEP monitoring while ensuring patient safety. Preoperative patient selection, comorbidity assessment, motor power evaluation, and the nature of the planned surgery are critical factors. Accurate paralysis assessment, continuous NMBA infusion, and post-tetanic stimulation techniques are essential for achieving optimal partial NMB. The decision to administer an NMB during Tc-MEP monitoring necessitates a careful evaluation of the balance between accuracy and potential complications. This review emphasizes the challenges associated with NMB administration during Tc-MEP monitoring and highlights the need for personalized patient assessment.
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Affiliation(s)
- Sirima Phoowanakulchai
- Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan.
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12
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Suzuka T, Tanaka N, Kadoya Y, Ida M, Iwata M, Ozu N, Kawaguchi M. Comparison of Quality of Recovery between Modified Thoracoabdominal Nerves Block through Perichondrial Approach versus Oblique Subcostal Transversus Abdominis Plane Block in Patients Undergoing Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial. J Clin Med 2024; 13:712. [PMID: 38337406 PMCID: PMC10856699 DOI: 10.3390/jcm13030712] [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: 12/18/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) provides a wide analgesic range. Herein, we examined the quality of recovery (QoR) of M-TAPA for total laparoscopic hysterectomy (TLH) compared with oblique subcostal transversus abdominis plane block (OSTAPB) and measured plasma levobupivacaine concentrations (PClevo). Forty female patients undergoing TLH were randomized to each group. Nerve blocks were performed bilaterally with 25 mL of 0.25% levobupivacaine administered per side. The primary outcome was changes in QoR-15 scores on postoperative days (POD) 1 and 2 from the preoperative baseline. The main secondary outcomes were PClevo at 15, 30, 45, 60, and 120 min after performing nerve block. Group differences (M-TAPA-OSTAPB) in mean changes from baseline in QoR-15 scores on POD 1 and 2 were -11.3 (95% confidence interval (CI), -24.9 to 2.4, p = 0.104; standard deviation (SD), 22.8) and -7.0 (95% CI, -20.5 to 6.6, p = 0.307; SD, 18.7), respectively. Changes in PClevo were similar in both groups. The post hoc analysis using Bayesian statistics revealed that posterior probabilities of M-TAPA being clinically more effective than OSTAPB were up to 22.4 and 24.4% for POD 1 and 2, respectively. In conclusion, M-TAPA may not be superior to OSTAPB for TLH.
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Affiliation(s)
- Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Yuma Kadoya
- Department of Anesthesiology, Ikeda City Hospital, 3-1-18 Jonan, Ikeda 635-8501, Osaka, Japan;
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Masato Iwata
- Department of Anesthesiology, Yamatotakada Municipal Hospital, 1-1, Isonokita-cho, Yamatotakada 635-8501, Nara, Japan;
| | - Naoki Ozu
- Institute for Clinical and Translational Science, Nara Medical University Hospital, 840 Shijocho, Kashihara 634-8522, Nara, Japan;
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
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Hirai S, Ida M, Kinugasa Y, Kawaguchi M. Association between preoperative frailty and surgical Apgar score in abdominal cancer surgery: a secondary analysis of a prospective observational study. JA Clin Rep 2024; 10:2. [PMID: 38217669 PMCID: PMC10787715 DOI: 10.1186/s40981-024-00687-3] [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: 12/20/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION The surgical Apgar score is useful for predicting postoperative morbidity and mortality. However, its applicability in frail patients with minimal hemodynamic variation remains unknown. This study aimed to investigate the association between frailty and surgical Apgar score. METHODS This secondary analysis included 210 patients ≥ 65 years of age undergoing elective major abdominal surgery for cancer. Frailty was assessed using the Fried Frailty Phenotype Questionnaire and defined as a total score of ≥ 3. The surgical Apgar score (range, 0-10; including mean blood pressure, heart rate, and blood loss volume) was compared between patients with or without frailty using the Mann-Whitney U test. Postoperative severe complications and length of postoperative stay were compared between patients with surgical Apgar scores ≤ 7 and > 7. RESULTS Among the included patients, 45 were classified as frail. The median [1st quartile, 3rd quartile] surgical Apgar scores in patients with and without frailty were 7.0 [7.0, 8.0] and 8.0 [7.0, 8.0], respectively (P = 0.03). Patients with surgical Apgar score ≤7 had a higher incidence of serious postoperative complications (P = 0.03) and longer hospital stays (P < 0.001) compared with patients with surgical Apgar score >7. CONCLUSION Frail patients have lower SAS, and patients with lower SAS have higher postoperative complication rates and longer hospital stays in patients who underwent cancer surgery.
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Affiliation(s)
- Sayaka Hirai
- Department of Anaesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, Kashihara, Japan.
| | - Yuki Kinugasa
- Department of Medical Technical Center, Nara Medical University Hospital, Kashihara, Japan
| | - Masahiko Kawaguchi
- Department of Anaesthesiology, Nara Medical University, Kashihara, Japan
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Tanaka N, Kadoya Y, Suzuka T, Kawaguchi M. Reply to letter to the editor: Inter-transverse process blocks: caution about difference in methods. Anesth Pain Med (Seoul) 2024; 19:68-69. [PMID: 38311357 PMCID: PMC10847001 DOI: 10.17085/apm.23121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
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Hirai S, Ida M, Arima A, Kawaguchi M. Suspected anaphylaxis during anesthesia induction without identified allergens: a case report. JA Clin Rep 2023; 9:89. [PMID: 38108931 PMCID: PMC10728379 DOI: 10.1186/s40981-023-00684-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Sayaka Hirai
- Department of Anaesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, Kashihara, Nara, Japan.
| | - Ai Arima
- Department of Dermatology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anaesthesiology, Nara Medical University, Kashihara, Nara, Japan
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Kinugasa Y, Ida M, Nakatani S, Uyama K, Kawaguchi M. Effects of preoperative nutritional status on postoperative quality of recovery: a prospective observational study. Br J Nutr 2023; 130:1898-1903. [PMID: 37144392 DOI: 10.1017/s0007114523001046] [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] [Indexed: 05/06/2023]
Abstract
Quality of Recovery-15 (QoR-15) has received attention as a postoperative patient-reported outcome measure. Preoperative nutritional status has negative effects on postoperative outcomes; however, these associations have not yet been investigated. We included inpatients aged ≥ 65 years who underwent elective abdominal cancer surgery under general anaesthesia between 1 June 2021 and 7 April 2022 at our hospital. Preoperative nutritional status was assessed using the Mini Nutritional Assessment Short-Form (MNA-SF), and patients with an MNA-SF score ≤ 11 were categorised into the poor nutritional group. The outcomes in this study were the QoR-15 scores at 2 d, 4 d and 7 d after surgery, which were compared between groups by unpaired t test. Multiple regression analysis was applied to assess the effects of poor preoperative nutritional status on the QoR-15 score on postoperative day 2 (POD 2). Of the 230 included patients, 33·9 % (78/230) were categorised into the poor nutritional status group. The mean QoR-15 value was significantly lower in the poor nutritional group than in the normal nutritional group at all postoperative time points (POD 2:117 v. 99, P = 0·002; POD 4:124 v. 113, P < 0·001; POD 7:133 v. 115, P < 0·001). Multiple analyses showed that poor preoperative nutritional status was associated with the QoR-15 score on POD 2 (adjusted partial regression coefficient, -7·8; 95 % CI -14·9, -0·72). We conclude that patients with a poor preoperative nutritional status were more likely to have a lower QoR-15 score after abdominal cancer surgery.
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Affiliation(s)
- Yuki Kinugasa
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
| | - Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
| | - Shohei Nakatani
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
- Department of Anaesthesiology, Akashi Medical Centre, Akashi, Japan
| | - Kayo Uyama
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
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17
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Kinugasa Y, Ida M, Nakatani S, Uyama K, Kawaguchi M. Quality of recovery in hospital and disability-free survival at three months after major abdominal surgery. Korean J Anesthesiol 2023; 76:567-574. [PMID: 37165623 PMCID: PMC10718636 DOI: 10.4097/kja.23082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/03/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The Quality of Recovery-15 (QoR-15) and 12-item World Health Organization Disability Assessment Schedule 2.0 scales are post-surgery patient-reported outcome measures. We aimed to evaluate the association between immediate in-hospital postoperative recovery and mid-term disability-free survival (DFS) after discharge. METHODS We conducted a prospective observational study at a university hospital and enrolled 260 patients aged ≥ 65 years with cancer who were undergoing elective major abdominal surgery. The association between poor postoperative recovery, defined as a QoR-15 score < 90 on postoperative day (POD) 2, and the DFS three months later was assessed using Fisher's exact test. The odds ratio of poor recovery on POD 2 to DFS was calculated using multiple logistic regression analysis adjusted for prominent factors (age, preoperative frailty, preoperative DFS, surgical duration, and intraoperative blood loss volume). RESULTS A total of 230 patients completed the 3-month follow-up. On POD 2, 27.3% of the patients (63/230) had poor recovery. A greater number of patients without poor recovery on POD 2 had DFS at three months after surgery (79.6%) than those with poor recovery (65.1%) (P = 0.026). The adjusted odds ratio of poor recovery on POD 2 to DFS at three months was 0.481 (95% CI [0.233, 0.994]). CONCLUSIONS Patients with poor recovery on POD 2 were less likely to have DFS three months after abdominal surgery. These findings may allow for early and effective interventions to be initiated based on each patient's condition after abdominal surgery.
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Affiliation(s)
- Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Shohei Nakatani
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
- Department of Anesthesiology, Akashi Medical Center, Akashi, Japan
| | - Kayo Uyama
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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18
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Kawaguchi M, Shimada H, Bessho Y, Nemoto N. Profiling of lipids in Thermus thermophilus HB8 grown under various conditions. J GEN APPL MICROBIOL 2023; 69:79-90. [PMID: 37394432 DOI: 10.2323/jgam.2023.06.006] [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] [Indexed: 07/04/2023]
Abstract
The membrane lipids of Thermus species have unique structures. Only four polar lipid species have so far been identified in Thermus thermophilus HB8; namely, are two phosphoglycolipids and two glycolipids, both of which have three branched fatty acid chains. Other lipid molecules may be present; however, they have not been identified so far. To clarify the whole lipid profile of T. thermophilus HB8, we cultured this organism under four different growth (temperature and/or nutrition) conditions and analyzed the compositions of polar lipids and fatty acids by high-performance thin-layer chromatography (HPTLC) and gas chromatograph-mass spectrometry (GCーMS), respectively. Thirty-one lipid spots were detected on HPTLC plates and profiled in terms of the presence or absence of phosphate, amino, and sugar groups. Then, we allocated ID numbers to all the spots. Comparative analyses of these polar lipids showed that the diversity of lipid molecules increased under high temperature and minimal medium conditions. In particular, aminolipid species increased under high temperature conditions. As for the fatty acid comparison by GC-MS, iso-branched even-numbered carbon atoms, which are unusual in this organism, significantly increased under the minimal medium condition, suggesting that kinds of branched amino acids at the fatty acid terminus varies under different nutrition conditions. In this study, several unidentified lipids were detected, and elucidation of the lipid structures will provide important information on the environmental adaptation of bacteria.
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Affiliation(s)
| | - Haruo Shimada
- BioChromato, Inc
- School of Life Sciences, Tokyo University of Pharmacy and Life Sciences
| | - Yoshitaka Bessho
- RIKEN SPring-8 Center, Harima Institute
- Center for Interdisciplinary AI and Data Science, Ochanomizu University
| | - Naoki Nemoto
- Faculty of Advanced Engineering, Chiba Institute of Technology
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19
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Konda M, Kitabatake M, Ouji-Sageshima N, Tonomura R, Furukawa R, Sonobe S, Terada-Ikeda C, Takeda M, Kawaguchi M, Ito T. A Disintegrin and Metalloproteinase with Thrombospondin Motifs 4 Regulates Pulmonary Vascular Hyperpermeability through Destruction of Glycocalyx in Acute Respiratory Distress Syndrome. Int J Mol Sci 2023; 24:16230. [PMID: 38003418 PMCID: PMC10671186 DOI: 10.3390/ijms242216230] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) has no specific and effective treatment, and there is an urgent need to understand its pathogenesis. Therefore, based on the hypothesis that molecules whose expression is upregulated in injured pulmonary vascular endothelial cells (VECs) are involved in the pathogenesis of ARDS, we conducted a study to elucidate the molecular mechanisms and identify target factors for treatment. Primary human lung microvascular endothelial cells (HMVEC-Ls) were stimulated with lipopolysaccharide (LPS) or poly (I:C) and analyzed via a microarray to identify target genes for ARDS. We found that a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS4) was induced in murine lung VECs in an LPS-mediated ARDS model. Elevated ADAMTS4 was also observed by the immunostaining of lung samples from ARDS patients. The suppression of ADAMTS4 by siRNA in VECs ameliorated LPS-stimulated vascular permeability. The impairment of the cell surface expression of syndecan-1, a marker of the glycocalyx that is an extracellular matrix involved in vascular permeability, was dramatically inhibited by ADAMTS4 suppression. In addition, the suppression of ADAMTS4 protected against LPS-induced reductions in syndecan-1 and the adherens junction protein vascular endothelial cadherin. These results suggest that ADAMTS4 regulates VEC permeability in ARDS and may be a predictive marker and therapeutic target for ARDS.
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Affiliation(s)
- Makiko Konda
- Department of Immunology, Nara Medical University, Kashihara 6348521, Japan
- Department of Anesthesiology, Nara Medical University, Kashihara 6348521, Japan
| | | | | | - Rei Tonomura
- Department of Immunology, Nara Medical University, Kashihara 6348521, Japan
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara 6348521, Japan
| | - Ryutaro Furukawa
- Department of Immunology, Nara Medical University, Kashihara 6348521, Japan
| | - Shota Sonobe
- Department of Immunology, Nara Medical University, Kashihara 6348521, Japan
- Department of Anesthesiology, Nara Medical University, Kashihara 6348521, Japan
| | - Chiyoko Terada-Ikeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara 6348521, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara 6348521, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara 6348521, Japan
| | - Toshihiro Ito
- Department of Immunology, Nara Medical University, Kashihara 6348521, Japan
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Kawasaki S, Shigematsu H, Tanaka M, Kawaguchi M, Hayashi H, Takatani T, Suga Y, Yamamoto Y, Tanaka Y. Utility of desflurane as an anesthetic in motor-evoked potentials in spine surgery and the facilitating effect in tetanic stimulation of bilateral median nerves. J Clin Monit Comput 2023:10.1007/s10877-023-01096-0. [PMID: 37917209 DOI: 10.1007/s10877-023-01096-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023]
Abstract
Although desflurane is a safe and controllable inhalation anesthetic used in spinal surgery, to our knowledge, there have been no reports of successful motor-evoked potential (MEP) recordings under general anesthesia with desflurane alone. A high desflurane concentration may reduce the risk of intraoperative awareness but can also reduce the success of MEP recording. Therefore, we aimed to evaluate the reliability of MEP monitoring and investigate whether tetanic stimulation can augment MEP amplitude under general anesthesia with high-concentration desflurane during spinal surgery. We prospectively evaluated 46 patients who were scheduled to undergo lumbar surgery at a single center between 2018 and 2020. Anesthesia was maintained with an end-tidal concentration of 4% desflurane and remifentanil. Compound muscle action potentials were recorded bilaterally from the abductor pollicis brevis, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps. For post-tetanic MEPs (p-MEPs), tetanic stimulation was applied to the median nerves (p-MEPm) and tibial nerves (p-MEPt) separately before transcranial stimulation. The average success rates for conventional MEP (c-MEP), p-MEPm, and p-MEPt were 77.9%, 80%, and 79.3%, respectively. The p-MEPm amplitudes were significantly higher than the c-MEP amplitudes in all muscles (P < 0.05), whereas the p-MEPt amplitudes were not significantly different from the c-MEP amplitudes. The MEP recording success rates for the gastrocnemius and quadriceps were inadequate. However, bilateral median nerve tetanic stimulation can effectively augment MEPs safely under general anesthesia with high-concentration desflurane in patients who undergo spinal surgery.
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Affiliation(s)
- Sachiko Kawasaki
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Masato Tanaka
- Department of Orthopedic Surgery, Otemae Hospital, Osaka, Japan
| | | | - Hironobu Hayashi
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Nara, Japan
| | - Yuma Suga
- Department of Orthopedic Surgery, Higashi Osaka City General Hospital, Osaka, Japan
| | - Yusuke Yamamoto
- Department of Orthopedic Surgery, Nara City Hospital, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Dahal R, Tamura K, Pan DS, Sasaki R, Takeshima Y, Matsuda R, Yamada S, Nishimura F, Nakagawa I, Park YS, Hayashi H, Kawaguchi M, Nakase H. Effect of Sevoflurane Anesthesia on Intraoperative Spikes, High-Frequency Oscillations, and Phase-Amplitude Coupling in MRI-Normal Hippocampus. J Clin Neurophysiol 2023:00004691-990000000-00107. [PMID: 37934075 DOI: 10.1097/wnp.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION The purpose of this study was to determine the effect of sevoflurane anesthesia on spikes, high-frequency oscillations (HFOs), and phase-amplitude coupling using a modulation index in MRI-normal hippocampus, with the aim of evaluating the utility of intraoperative electrocorticography in identifying the epileptogenic hippocampus during sevoflurane administration. METHODS Eleven patients with intractable temporal lobe epilepsy with a normal hippocampus on MRI underwent extra-operative electrocorticography evaluation. Patients were assigned to the Ictal (+) or Ictal (-) group depending on whether the parahippocampal gyrus was included in the seizure onset zone. Intraoperative electrocorticography was performed under 0.5 and 1.5 minimum alveolar concentration of sevoflurane. The rates of spikes, ripples, fast ripples (FRs), ripples on spikes, FRs on spikes, and MI HFO(3-4 Hz) were evaluated. RESULTS During the intraoperative electrocorticography procedure, sevoflurane administration was found to significantly increase the rate of spikes, ripples on spikes, fast ripples on spikes, and MI HFO(3-4 Hz) in the Ictal (+) group (P < 0.01). By contrast, the Ictal (-) group exhibited a paradoxical increase in the rate of ripples and fast ripple (P < 0.05). CONCLUSIONS Our findings indicate that the administration of sevoflurane during intraoperative electrocorticography in patients with MRI-normal hippocampus can lead to a dose-dependent enhancement of epileptic biomarkers (spikes, ripples on spikes, fast ripples on spikes, and MI (HFO 3-4)) in the epileptogenic hippocampus, while paradoxically increasing the rate of ripples and fast ripple in the nonepileptogenic hippocampus. These results have significant implications for the identification of the MRI-normal hippocampus that requires surgical intervention and preservation of the nonepileptogenic hippocampus.
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Affiliation(s)
- Riju Dahal
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Dong-Sheng Pan
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China; and
| | - Ryota Sasaki
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hironobu Hayashi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
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Fujiwara A, Watanabe K, Shigematsu H, Kimoto K, Ida M, Tanaka Y, Kawaguchi M. Does a Positive Response to Transforaminal Epidural Steroid Injection Identify Patients Who Can Avoid Surgery for Two Years? Pain Res Manag 2023; 2023:4298436. [PMID: 37869446 PMCID: PMC10590266 DOI: 10.1155/2023/4298436] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/19/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
Background Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbar radiculopathy. In clinical settings, patients often undergo repeated transforaminal epidural injections with or without steroid administration. Objectives To examine whether a positive response to TFESI at the first month, can in clinical settings, identify patients with radiculopathy who can avoid surgery for two years. Study Design/Setting. This prospective observational study was conducted at an academic medical center. Methods Individuals aged ≥20 years who had been referred to our pain center by spine surgeons were enrolled. All patients were assessed using the Numerical Rating Scale (NRS) at baseline and 1 month after the first TFESI. Patients were divided into two groups according to the NRS decrement: the positive response (PR) group achieved a ≥2.0 decrease on the NRS 1 month after the first TFESI compared to baseline and the no response (NR) group achieved a <2.0 decrease on the NRS. The incidence rates of surgery over two years were compared between the two groups. In addition, we calculated the hazard ratio of the PR group to the NR group regarding the incidence of surgery over two years using the Cox proportional hazard model, adjusting for baseline NRS. Results Seventy-six patients completed the two-year follow-up. In total, 8 and 68 patients had bilateral and unilateral radiculopathy, respectively. The PR and NR groups included 35 and 41 patients, respectively. The rate of surgery avoidance was 85.7% and 73.2% in the PR and NR groups, respectively. This difference was not statistically significant (p=0.26). After adjusting for baseline NRS, the hazard ratio of the PR group to the NR group regarding the incidence of surgery within two years was 0.35 (95% confidence interval: 0.11-1.11, p=0.08). Conclusion A positive response to TFESI may not identify patients who can avoid surgery for two years.
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Affiliation(s)
- Aki Fujiwara
- Department of Anesthesiology, Nara Medical University, Nara 634-8522, Japan
| | - Keisuke Watanabe
- Department of Anesthesiology, Nara Medical University, Nara 634-8522, Japan
| | - Hideki Shigematsu
- Department of Orthopaedics, Nara Medical University, Nara 634-8522, Japan
| | - Katsuhiro Kimoto
- Department of Anesthesiology, Nara Medical University, Nara 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Nara 634-8522, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedics, Nara Medical University, Nara 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Nara 634-8522, Japan
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Kawaguchi M, Kato H, Hanamatsu Y, Suto T, Noda Y, Kaneko Y, Iwata H, Hyodo F, Miyazaki T, Matsuo M. Computed Tomography and 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Imaging Biomarkers of Lung Invasive Non-mucinous Adenocarcinoma: Prediction of Grade 3 Tumour Based on World Health Organization Grading System. Clin Oncol (R Coll Radiol) 2023; 35:e601-e610. [PMID: 37587000 DOI: 10.1016/j.clon.2023.08.002] [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: 08/24/2022] [Revised: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
AIMS To evaluate computed tomography (CT) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) findings of invasive non-mucinous adenocarcinoma (INMA) of the lung as a predictor of histological tumour grade according to 2021 World Health Organization (WHO) classification. MATERIALS AND METHODS This retrospective study included consecutive patients with surgically resected INMA who underwent both preoperative CT and 18F-FDG-PET/CT. A three-tiered tumour grade was performed based on the fifth edition of the WHO classification of lung tumours. CT imaging features and the maximum standardised uptake value (SUVmax) were compared among the three tumour grades. RESULTS In total, 214 patients with INMA (median age 70 years; interquartile range 65-76 years; 123 men) were histologically categorised: 36 (17%) as grade 1, 102 (48%) as grade 2 and 76 (35%) as grade 3. Pure solid appearance was more frequent in grade 3 (83%) than in grades 1 (0%) and 2 (26%) (P < 0.001). The SUVmax of the entire tumour was higher in grade 3 than in grades 1 and 2 (P < 0.001). Multivariable analysis revealed that pure solid appearance (odds ratio = 94.0; P < 0.001), round/oval shape (odds ratio = 4.01; P = 0.001), spiculation (odds ratio = 2.13; P = 0.04), air bronchogram (odds ratio = 0.40; P = 0.03) and SUVmax (odds ratio = 1.45; P < 0.001) were significant predictors for grade 3 INMAs. CONCLUSION Pure solid appearance, round/oval shape, spiculation, absence of air bronchogram and high SUVmax were associated with grade 3 INMAs. CT and 18F-FDG-PET/CT were potentially useful non-invasive imaging methods to predict the histological grade of INMAs.
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Affiliation(s)
- M Kawaguchi
- Department of Radiology, Gifu University, Gifu, Japan.
| | - H Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Hanamatsu
- Department of Pathology and Translational Research, Gifu University, Gifu, Japan
| | - T Suto
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Noda
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Kaneko
- Department of Radiology, Gifu University, Gifu, Japan
| | - H Iwata
- Department of General and Cardiothoracic Surgery, Gifu University, Gifu, Japan
| | - F Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
| | - T Miyazaki
- Department of Pathology, Gifu University, Gifu, Japan
| | - M Matsuo
- Department of Radiology, Gifu University, Gifu, Japan
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Nakatani H, Naito Y, Ida M, Sato M, Okamoto N, Nishiwada T, Kawaguchi M. Association between intraoperative hypotension and postoperative nausea and vomiting: a retrospective analysis of 247 thyroidectomy cases. Braz J Anesthesiol 2023; 73:635-640. [PMID: 33766682 PMCID: PMC10533957 DOI: 10.1016/j.bjane.2021.02.029] [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] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are major complications after general anesthesia. Although various pathways are involved in triggering PONV, hypotension plays an important role. We hypothesized that intraoperative hypotension during general anesthesia might be responsible for the incidence of PONV. METHODS We retrospectively investigated patients who underwent thyroidectomy. The initial blood pressure measured before induction of anesthesia was used as the baseline value. The systolic blood pressure measured during the operation from the start to the end of anesthesia was extracted from anesthetic records. The time integral value when the measured systolic blood pressure fell below the baseline value was calculated as area under the curve (AUC) of s100%. RESULTS There were 247 eligible cases. Eighty-eight patients (35.6%) had PONV. There was no difference in patient background between the patients with or without PONV. Univariate analysis showed that the total intravenous anesthesia (TIVA) (p=0.02), smoking history (p=0.02), and AUC-s100% (p=0.006) were significantly associated with PONV. Multiple logistic regression analysis revealed that TIVA (OR: 0.54, 95% CI: 0.29...0.99), smoking history (OR: 0.60, 95% CI: 0.37...0.96), and AUC-s100% (OR: 1.006, 95% CI: 1.0...1.01) were significantly associated with PONV. CONCLUSION Intraoperative hypotension evaluated by AUC-s100% was related to PONV in thyroidectomy.
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Affiliation(s)
- Hitomi Nakatani
- Nara Medical University, Graduate School of Nursing, Course of Perianesthesia Nursing, Nara, Japan
| | - Yusuke Naito
- Nara Medical University, Department of Anesthesiology, Nara, Japan.
| | - Mitsuru Ida
- Nara Medical University, Department of Anesthesiology, Nara, Japan
| | - Mariko Sato
- Nara Medical University, Graduate School of Nursing, Course of Perianesthesia Nursing, Nara, Japan
| | - Naoko Okamoto
- Nara Medical University, Graduate School of Nursing, Course of Perianesthesia Nursing, Nara, Japan
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Okada M, Tanaka N, Suzuka T, Kadoya Y, Saisu T, Kawaguchi M. Anesthetic management of scapular Y-osteotomy using a combination of suprascapular nerve block and erector spinae plane block for Sprengel deformity associated with Klippel-Feil syndrome: a case report. JA Clin Rep 2023; 9:55. [PMID: 37640974 PMCID: PMC10462535 DOI: 10.1186/s40981-023-00647-3] [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: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Klippel-Feil syndrome (KFS) occurs in 1/40,000 individuals and is characterized by cervical fusion. Thirty percent of patients with KFS present with Sprengel deformity, leading to orthopedic problems and limited shoulder abduction. No reports exist regarding anesthetic procedures for pediatric scapular osteotomies. CASE PRESENTATION We report a case of a 4-year-and-7-month-old boy (95.6 cm, 14.7 kg) who underwent left scapular osteotomy. At the age of 8 months, he also underwent a right lower lobectomy due to a congenital pulmonary airway malformation. We decided to use a combination of suprascapular nerve block (SSNB), erector spinae plane block (ESPB), and general anesthesia. He received regular acetaminophen administration and fentanyl 5-10 μg/hour intravenously until 20 h postoperatively and remained on ≤ 2/10 in the Wong-Baker Face Scale (0: no hurt; 10: hurts worst). CONCLUSION The combination of SSNB and ESPB could be an option for perioperative analgesia for scapular osteotomies.
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Affiliation(s)
- Mizuho Okada
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522 Japan
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522 Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522 Japan
| | - Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522 Japan
| | - Takashi Saisu
- Chiba Child & Adult Orthopaedic Clinic, 3-24-2 Ayumino Minami, Chiba, Midori-ku 266-0033 Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522 Japan
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Nakatani H, Ida M, Kotani T, Kawaguchi M. Relationship between estimated and observed heparin sensitivity indices in cardiac and thoracic aortic surgery. JA Clin Rep 2023; 9:50. [PMID: 37541982 PMCID: PMC10403474 DOI: 10.1186/s40981-023-00642-8] [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: 06/27/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Little evidence exists on the relationship between the estimated heparin sensitivity index (HSI) based on commonly available clinical and laboratory data and observed HSI in the adult population. This retrospective study assessed the relationship between the observed and estimated HSIs. METHODS This study was conducted in an academic, single-institution setting. Patients aged ≥ 20 years who underwent cardiac and thoracic aortic surgery and requiring cardiopulmonary bypass were included. Clinical and laboratory data, including age, sex, and platelet count, were collected. The fibrinogen-albumin ratio index was calculated by dividing the fibrinogen value by the albumin value, multiplied by 10.The HSI was calculated using the formula: (activated clotting time after initial heparin administration-baseline activated clotting time)/initial heparin dose (IU/kg). The estimated HSI was based on the results of multiple regression analysis that included clinically relevant factors. The intraclass correlation coefficient between the observed and estimated HSIs was used to assess. RESULTS In total, 560 patients with valid activated clotting time (ACT) values after initial heparin administration were included in the final analysis to explore associated factors using the estimated HSI. Multiple regression analysis revealed that hemodialysis, platelet count, fibrinogen-to-albumin ratio index, baseline activated clotting time, and initial heparin dose were significantly associated with the HSI. The mean (standard deviation) observed and estimated HSIs were 1.38 (0.43) and 1.55 (0.13), respectively, with an intra-class correlation coefficient of 0.10. CONCLUSIONS The correlation between the observed and estimated HSIs was low, and a formula with high accuracy for estimating the HSI is needed.
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Affiliation(s)
- Hitomi Nakatani
- Department Resource Nurse Center, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Taichi Kotani
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Ogawa Y, Hayashi H, Sasaki R, Takatani T, Oi A, Uemura K, Kawaguchi M. Motor-evoked potential monitoring from urinary sphincter muscle during pediatric untethering surgery: a case series. Childs Nerv Syst 2023; 39:2147-2153. [PMID: 36890423 DOI: 10.1007/s00381-023-05895-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Postoperative urinary dysfunction following untethering surgery for spinal lipoma is devastating. To assess urinary function, we invented a pediatric urinary catheter equipped with electrodes for the direct transurethral recording of myogenic potential from the external urethral sphincter (EUS). This paper presents two cases in which urinary function was monitored intraoperatively by recording of motor-evoked potential (MEP) from EUS during untethering surgery in children. METHODS Two children (aged 2 and 6 years) were included in this study. One patient had no preoperative neurological dysfunction, while the other had frequent urination and urinary incontinence. A pair of surface electrodes was attached to a silicone rubber urethral catheter (6 or 8 Fr; diameter, 2 or 2.6 mm). The MEP from the EUS was recorded to assess the function of the centrifugal tract from the motor cortex to the pudendal nerve. RESULTS Baseline MEP waveforms from the EUS were successfully recorded with latency and amplitude of 39.5 ms and 66 µV in patient 1 and 39.0 ms and 113 µV in patient 2, respectively. A significant decrease in amplitude was not observed during surgery in the two cases. No new urinary dysfunction and complications associated with the urinary catheter-equipped electrodes developed postoperatively. CONCLUSION Using an electrode-equipped urinary catheter, monitoring of MEP from the EUS could be applicable during untethering surgery in pediatric patients.
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Affiliation(s)
- Yuki Ogawa
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Hironobu Hayashi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Ryota Sasaki
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Tsunenori Takatani
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Ayako Oi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Keiko Uemura
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
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Fujiwara A, Watanabe K, Yoshimura K, Yamamura Y, Ida M, Kawaguchi M. Correlation between pain catastrophizing in acute herpes zoster and postherpetic neuralgia: a retrospective analysis. J Anesth 2023; 37:589-595. [PMID: 37285023 DOI: 10.1007/s00540-023-03208-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/04/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The objective of this study was to examine the association between pain catastrophizing in acute phase herpes zoster and the development of postherpetic neuralgia. METHODS The medical records of all patients diagnosed with herpes zoster between February 2016 and December 2021 were retrieved. Inclusion criteria were patients aged > 50 years who visited our pain center within 60 days after rash onset and reported a pain intensity of ≥ 3 in a numerical rating scale. Patients with a score of 30 or more in the pain catastrophizing scale at baseline were assigned to the catastrophizer group, and those with a score < 30 were assigned to the non-catastrophizer group. We defined patients with "postherpetic neuralgia" and "severe postherpetic neuralgia" as those with a numerical rating scale score of 3 or more and 7 or more at 3 months after baseline, respectively. RESULTS Data of 189 patients were available for complete analysis. Age, baseline numerical rating scale, and prevalence of anxiety and depression were significantly higher in the catastrophizer than those in the non-catastrophizer group. Incidence of postherpetic neuralgia did not differ significantly between the groups (p = 0.26). Multiple logistic regression analysis showed that age, severe pain at baseline, and immunosuppressive state were the factors which were independently associated with developing postherpetic neuralgia. Severe pain at baseline was the only factor related to developing severe postherpetic neuralgia. CONCLUSION Pain catastrophizing in the acute phase of herpes zoster may not be related to the development of postherpetic neuralgia.
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Affiliation(s)
- Aki Fujiwara
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan.
| | - Keisuke Watanabe
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kie Yoshimura
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yuji Yamamura
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
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Wang X, Ida M, Uyama K, Naito Y, Kawaguchi M. Impact of different doses of remifentanil on chronic postsurgical pain after video-assisted thoracic surgery: A propensity score analysis. Medicine (Baltimore) 2023; 102:e34442. [PMID: 37505168 PMCID: PMC10378888 DOI: 10.1097/md.0000000000034442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023] Open
Abstract
A remifentanil infusion dose of >0.2 μg/kg/min is associated with hyperalgesia, leading to acute postsurgical pain; however, its contribution to the development of chronic postsurgical pain after video-assisted thoracic surgery remains unclear. This study aimed to evaluate the impact of different remifentanil doses on chronic postsurgical pain after video-assisted thoracic surgery. This study included inpatients aged ≥ 55 years who underwent video-assisted thoracic surgery under general anesthesia between April 2016 and December 2018. An inverse probability of treatment weighted using stabilized inverse propensity scores was adopted to minimize bias. After adjustments based on patient data, the outcomes of interest were compared with intraoperative covariates using a generalized estimating equation. The primary study outcome was chronic postsurgical pain 1 year after surgery, defined as a pain score ≥1 on a numerical rating scale. Of the 262 eligible patients, 258 with a mean age of 71.2 years were included in this analysis. Chronic postsurgical pain occurred in 23.6% of patients. The generalized estimating equation revealed that a remifentanil infusion dose >0.2 μg/kg/min was associated with chronic postsurgical pain at 1 year after surgery (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.03-2.27), while remifentanil infusion doses >0.15 μg/kg/min (OR 1.12; 95% CI 0.79-1.59) and >0.175 μg/kg/min (OR 1.17; 95% CI 0.83-1.64) were not associated with our primary outcome. Remifentanil infusions >0.2 μg/kg/min were associated with chronic postsurgical pain 1 year after video-assisted thoracic surgery.
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Affiliation(s)
- Xiaoying Wang
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Kayo Uyama
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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Sonobe S, Kitabatake M, Hara A, Konda M, Ouji-Sageshima N, Terada-Ikeda C, Furukawa R, Imakita N, Oda A, Takeda M, Takamura S, Inoue S, Kunkel SL, Kawaguchi M, Ito T. THE CRITICAL ROLE OF THE HISTONE MODIFICATION ENZYME SETDB2 IN THE PATHOGENESIS OF ACUTE RESPIRATORY DISTRESS SYNDROME. Shock 2023; 60:137-145. [PMID: 37195726 PMCID: PMC10417228 DOI: 10.1097/shk.0000000000002145] [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: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
ABSTRACT Introduction: Acute respiratory distress syndrome (ARDS) is a severe hypoxemic respiratory failure with a high in-hospital mortality. However, the molecular mechanisms underlying ARDS remain unclear. Recent findings have indicated that the onset of severe inflammatory diseases, such as sepsis, is regulated by epigenetic changes. We investigated the role of epigenetic changes in ARDS pathogenesis using mouse models and human samples. Methods: Acute respiratory distress syndrome was induced in a mouse model (C57BL/6 mice, myeloid cell or vascular endothelial cell [VEC]-specific SET domain bifurcated 2 [Setdb2]-deficient mice [Setdb2 ff Lyz2 Cre+ or Setdb2 ff Tie2 Cre+ ], and Cre - littermates) by intratracheal administration of lipopolysaccharide (LPS). Analyses were performed at 6 and 72 h after LPS administration. Sera and lung autopsy specimens from ARDS patients were examined. Results: In the murine ARDS model, we observed high expression of the histone modification enzyme SET domain bifurcated 2 ( Setdb2 ) in the lungs. In situ hybridization examination of the lungs revealed Setdb2 expression in macrophages and VECs. The histological score and albumin level of bronchoalveolar lavage fluid were significantly increased in Setdb2 ff Tie2 Cre+ mice following LPS administration compared with Setdb2 ff Tie2 Cre- mice, whereas there was no significant difference between the control and Setdb2 ff Lyz2 Cre+ mice. Apoptosis of VECs was enhanced in Setdb2 ff Tie2 Cre+ mice. Among the 84 apoptosis-related genes, the expression of TNF receptor superfamily member 10b ( Tnfrsf10b ) was significantly higher in Setdb2 ff Tie2 Cre+ mice than in control mice. Acute respiratory distress syndrome patients' serum showed higher SETDB2 levels than those of healthy volunteers. SETDB2 levels were negatively correlated with the partial pressure of oxygen in arterial blood/fraction of inspiratory oxygen concentration ratio. Conclusion: Acute respiratory distress syndrome elevates Setdb2 , apoptosis of VECs, and vascular permeability. Elevation of histone methyltransferase Setdb2 suggests the possibility to histone change and epigenetic modification. Thus, Setdb2 may be a novel therapeutic target for controlling the pathogenesis of ARDS.
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Affiliation(s)
- Shota Sonobe
- Department of Immunology, Nara Medical University, Kashihara, Japan
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | | | - Atsushi Hara
- Department of Immunology, Nara Medical University, Kashihara, Japan
| | - Makiko Konda
- Department of Immunology, Nara Medical University, Kashihara, Japan
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | | | | | - Ryutaro Furukawa
- Department of Immunology, Nara Medical University, Kashihara, Japan
- Center for Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Natsuko Imakita
- Department of Immunology, Nara Medical University, Kashihara, Japan
- Center for Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Akihisa Oda
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Shiki Takamura
- Laboratory for Immunological Memory, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Satoki Inoue
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Steven L. Kunkel
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Toshihiro Ito
- Department of Immunology, Nara Medical University, Kashihara, Japan
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Kadoya Y, Tanaka N, Suzuka T, Yamanaka T, Iwata M, Ozu N, Kawaguchi M. Anterior Quadratus Lumborum Block and Quadriceps Strength: A Prospective Cohort Study. J Clin Med 2023; 12:jcm12113837. [PMID: 37298032 DOI: 10.3390/jcm12113837] [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: 04/20/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
The decrease in quadriceps strength after anterior quadratus lumborum block (AQLB) has not been quantified. This prospective cohort study investigated the incidence of quadriceps weakness after AQLB. We enrolled patients undergoing robot-assisted partial nephrectomy, and AQLB was performed at the L2 level with 30 mL of 0.375% ropivacaine. We evaluated each quadriceps' maximal voluntary isometric contraction using a handheld dynamometer preoperatively and postoperatively at 1 and 4 days. The incidence of muscle weakness was defined as a 25% reduction in muscle strength compared with the preoperative baseline, and "muscle weakness possibly caused by nerve block" was defined as a 25% reduction compared with the non-block side. We also assessed the numerical rating scale and quality of recovery-15 scores. Thirty participants were analyzed. The incidence of muscle weakness compared with preoperative baseline and the non-block side was 13.3% and 30.0%, respectively. Patients with a numerical rating scale ≥ 4 or quality of recovery-15 score < 122, which was classified as moderate or poor, had decreased muscle strength with relative risks of 1.75 and 2.33, respectively. All patients ambulated within 24 h after surgery. The incidence of quadriceps weakness possibly caused by nerve block was 13.3%; however, all patients could ambulate after 1 day.
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Affiliation(s)
- Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
| | - Takayuki Yamanaka
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
| | - Masato Iwata
- Department of Anesthesiology, Yamatotakada Municipal Hospital, Yamatotakada 635-8501, Japan
| | - Naoki Ozu
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
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Onodera H, Ida M, Naito Y, Kinomoto A, Kawaguchi M. Reply to "Is opioid free analgesia first choice for cesarean delivery?". J Anesth 2023; 37:494. [PMID: 37029821 DOI: 10.1007/s00540-023-03188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Hiroki Onodera
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan.
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
| | - Akane Kinomoto
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
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Phoowanakulchai S, Ida M, Naito Y, Kawaguchi M. Persistent incisional pain at 1 year after craniotomy: a retrospective observational study. BMC Anesthesiol 2023; 23:115. [PMID: 37024782 PMCID: PMC10077637 DOI: 10.1186/s12871-023-02068-2] [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: 12/18/2022] [Accepted: 03/25/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND There have been few reports on persistent incisional pain at 1 year after craniotomy. Hence, this study aimed to explore the distribution of pain at 1 year after elective craniotomy and its related factors. METHODS This retrospective study included data prospectively collected to assess postoperative functional disability. We included patients aged > 55 years at the time of recruitment for our initial study and who had complete data regarding the pain numeric rating scale (NRS) score at 1 year post craniotomy. The primary outcome was the pain NRS score, which was assessed at the postanesthetic clinic as well as at 3 months and 1 year after craniotomy. Multivariable negative binomial regression analysis was performed to analyze the relationship between the pain NRS score at 1 postoperative year and 12 clinically meaningful covariates. These included the Short Form-8 scores for bodily pain and mental health, with higher scores indicating better health. RESULTS We analyzed data from 102 patients. The mean (95% confidence interval) pain NRS scores at the three measurement points were 2.8 (2.3-3.3), 1.2 (0.8-1.6), and 0.6 (0.3-0.8), respectively. Multivariable analysis revealed that preoperative bodily pain (risk ratio, 0.93; 95% confidence interval, 0.88-0.98) and the pain NRS score at the postanesthetic clinic (risk ratio, 1.32; 95% confidence interval, 1.14-1.52) were associated with the risk of persistent pain at 1 postoperative year. CONCLUSIONS The pain score at 1 year after elective craniotomy was minor; however, preoperative bodily pain and postoperative pain scores were significantly related factors.
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Affiliation(s)
- Sirima Phoowanakulchai
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan.
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
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Kotani T, Ida M, Inoue S, Naito Y, Kawaguchi M. Association between Preoperative Hand Grip Strength and Postoperative Delirium after Cardiovascular Surgery: A Retrospective Study. J Clin Med 2023; 12:jcm12072705. [PMID: 37048787 PMCID: PMC10095472 DOI: 10.3390/jcm12072705] [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] [Received: 03/11/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
The association of frailty with postoperative delirium has not been fully investigated in patients undergoing cardiovascular surgery. Therefore, this study aimed to investigate whether preoperative hand grip strength is associated with postoperative delirium. This retrospective study included patients aged >65 years who had undergone elective cardiovascular surgery using cardiopulmonary bypass at a Japanese university hospital between April 2020 and February 2022. We defined low hand grip strength as hand grip values of <275 n and <177 n for men and women, respectively. Postoperative delirium was assessed using the confusion assessment method during patients’ intensive care unit stay. The odds ratio of low hand grip strength for postoperative delirium was estimated using multiple logistic analysis, which was adjusted for prominent clinical factors. Ninety-five patients with a median age of 74 years were included in the final analysis, and 31.5% of them had low hand grip strength. Postoperative delirium occurred in 37% of patients, and the odds ratio of low preoperative hand grip strength for postoperative delirium was 4.58 (95% confidence interval: 1.57–13.2). Thirty-seven patients experienced postoperative delirium after cardiovascular surgery using cardiopulmonary bypass, and low preoperative hand grip strength was positively associated with its occurrence.
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Affiliation(s)
- Taichi Kotani
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
| | - Satoki Inoue
- Department of Anesthesiology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara 634-8522, Japan
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Yamamoto Y, Tanaka N, Kadoya Y, Umehara M, Suzuka T, Kawaguchi M. Bolus intertransverse process block and continuous erector spinae plane block for perioperative analgesic management of video-assisted thoracoscopic surgery - Three cases report. Anesth Pain Med (Seoul) 2023; 18:198-203. [PMID: 37183288 PMCID: PMC10183616 DOI: 10.17085/apm.22250] [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: 10/31/2022] [Accepted: 12/22/2022] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Common regional anesthesia approaches for video-assisted thoracoscopic surgery (VATS) include paravertebral block (PVB) and erector spinae plane block (ESPB). PVB is considered a deep nerve block which is contraindicated in antithrombotic therapy. ESPB is effective when administered as a bolus, as well as continuously. However, the recently proposed intertransverse process block (ITPB) ensures more effective diffusion of the local anesthetic into the paravertebral space. CASE We report cases of three patients who received bolus ITPB (costotransverse foramen block and mid-point transverse process-to-pleura block in one and two cases, respectively) combined with continuous ESPB when a deep nerve block could not be administered. Opioids were not required postoperatively, and all postoperative numerical rating scale scores (0-10) at rest were maintained below 4. CONCLUSIONS The combination of bolus ITPB and continuous ESPB may be an alternative analgesic method when deep nerve blocks are contraindicated in VATS.
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Affiliation(s)
- Yuki Yamamoto
- Department of Anesthesiology, Nara Prefecture General Medical Center, Nara, Japan
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Miki Umehara
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
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Matsuura H, Terada Y, Rokkaku Y, Tamagawa H, Taniguchi E, Saito Y, Tsujimura N, Tanaka N, Kawaguchi M. Analgesic efficacy of modified thoracoabdominal nerves block through the perichondrial approach in laparoscopic cholecystectomy: A retrospective study with propensity analysis. Asian J Endosc Surg 2023. [PMID: 36958288 DOI: 10.1111/ases.13183] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Modified thoracoabdominal nerves block through the perichondral approach (M-TAPA) was recently reported to provide broad analgesia with only a single injection of local anesthetics (LA) on each side. However, the effectiveness of M-TAPA in laparoscopic cholecystectomy (LC) is not often reported. We retrospectively evaluated the analgesic efficacy of M-TAPA in patients who underwent LC and compared it with conventional LA infiltration (LAI) by calculating the propensity score. The primary outcome was the frequency of analgesic use after surgery. Although there was no difference in the frequency of analgesic use within 48 hours (P = .063), there was significantly less analgesic use 24-48 hours after surgery in the TAPA group (P = .02). Intraoperative remifentanil administration also significantly decreased in the TAPA group (P < .001). We found that pre-incisional M-TAPA may have an advantage over LAI with respect to analgesia on postoperative day 1.
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Affiliation(s)
- Hideki Matsuura
- Department of Anesthesiology, Otemae Hospital, Osaka, Japan
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Yuki Terada
- Department of Anesthesiology, Otemae Hospital, Osaka, Japan
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Yuki Rokkaku
- Department of Anesthesiology, Otemae Hospital, Osaka, Japan
| | | | | | - Yurina Saito
- Department of Surgery, Otemae Hospital, Osaka, Japan
| | | | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
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Yoshitani K, Ogata S, Kato S, Tsukinaga A, Takatani T, Kin N, Ezaka M, Shimizu J, Furuichi Y, Uezono S, Kida K, Seo K, Kakumoto S, Miyawaki H, Kawamata M, Tanaka S, Kakinohana M, Izumi S, Uchino H, Kakinuma T, Nishiwaki K, Hasegawa K, Matsumoto M, Ishida K, Yamashita A, Yamakage M, Yoshikawa Y, Morimoto Y, Saito H, Goto T, Masubuchi T, Kawaguchi M, Tsubaki K, Mizobuchi S, Obata N, Inagaki Y, Funaki K, Ishiguro Y, Sanui M, Taniguchi K, Nishimura K, Ohnishi Y. Effect of cerebrospinal fluid drainage pressure in descending and thoracoabdominal aortic repair: a prospective multicenter observational study. J Anesth 2023; 37:408-415. [PMID: 36944824 DOI: 10.1007/s00540-023-03179-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Cerebrospinal fluid drainage (CSFD) is recommended during open or endovascular thoracic aortic repair. However, the incidence of CSFD complications is still high. Recently, CSF pressure has been kept high to avoid complications, but the efficacy of CSFD at higher pressures has not been confirmed. We hypothesize that CSFD at higher pressures is effective for preventing motor deficits. METHODS This prospective observational study included 14 hospitals that are members of the Japanese Society of Cardiovascular Anesthesiologists. Patients who underwent thoracic and thoracoabdominal aortic repair were divided into four groups: Group 1, CSF pressure around 10 mmHg; Group 2, CSF pressure around 15 mmHg; Group 3, CSFD initiated when motor evoked potential amplitudes decreased; and Group 4, no CSFD. We assessed the association between the CSFD group and motor deficits using mixed-effects logistic regression with a random intercept for the institution. RESULTS Of 1072 patients in the study, 84 patients (open surgery, 51; thoracic endovascular aortic repair, 33) had motor deficits at discharge. Groups 1 and 2 were not associated with motor deficits (Group 1, odds ratio (OR): 1.53, 95% confidence interval (95% CI): 0.71-3.29, p = 0.276; Group 2, OR: 1.73, 95% CI: 0.62-4.82) when compared with Group 4. Group 3 was significantly more prone to motor deficits than Group 4 (OR: 2.56, 95% CI: 1.27-5.17, p = 0.009). CONCLUSION CSFD is not associated with motor deficits in thoracic and thoracoabdominal aortic repair with CSF pressure around 10 or 15 mmHg.
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Affiliation(s)
- Kenji Yoshitani
- Department of Transfusion, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka, 564-8565, Japan.
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shinya Kato
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akito Tsukinaga
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Anesthesiology, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Kashihara, Nara, Japan
| | - Nobuhide Kin
- Department of Anesthesia, New Tokyo Hospital, Matsudo, Japan
| | - Mariko Ezaka
- Department of Anesthesia, New Tokyo Hospital, Matsudo, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Futyu, Japan
| | - Yuko Furuichi
- Department of Anesthesiology, Sakakibara Heart Institute, Futyu, Japan
| | - Shoichi Uezono
- Department of Anesthesiology, The Jikei University School of Medicine, Minato-ku, Japan
| | - Kotaro Kida
- Department of Anesthesiology, The Jikei University School of Medicine, Minato-ku, Japan
| | - Katsuhiro Seo
- Department of Emergency, Kokura Memorial Hospital, Fukuoka, Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Hiroshi Miyawaki
- Department of Anesthesiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Manabu Kakinohana
- Department of Anesthesiology, Faculty of Medicine, University of Ryukyu, Nishihara, Japan
| | - Shunsuke Izumi
- Department of Anesthesiology, Faculty of Medicine, University of Ryukyu, Nishihara, Japan
| | - Hiroyuki Uchino
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Takayasu Kakinuma
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuko Hasegawa
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mishiya Matsumoto
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuyoshi Ishida
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Atsuo Yamashita
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yusuke Yoshikawa
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuji Morimoto
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hitoshi Saito
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahisa Goto
- Department of Anesthesiology, School of Medicine, Yokohama City University, Yokohama, Japan
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuhito Masubuchi
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kosuke Tsubaki
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Satoshi Mizobuchi
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Norihiko Obata
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimi Inagaki
- Division of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazumi Funaki
- Division of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yoshiki Ishiguro
- Department of Anesthesiology, The Jikei University School of Medicine, Minato-ku, Japan
- Department of Anesthesiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | | | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Oi A, Hayashi H, Motoyama Y, Kawanishi H, Nakagawa I, Nakase H, Kawaguchi M. Application of laser speckle flowgraphy to evaluate cerebral perfusion after carotid endarterectomy. Heliyon 2023; 9:e14400. [PMID: 36925512 PMCID: PMC10010978 DOI: 10.1016/j.heliyon.2023.e14400] [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: 12/12/2022] [Revised: 02/19/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA) is devastating, and postoperative monitoring of cerebral perfusion is essential to prevent CHS. We report two cases of successful measurement of ocular blood flow using laser speckle flowgraphy (LSFG) for bedside assessment of the changes in cerebral perfusion after CEA. An 18.7% (case 1) and 47.7% (case 2) increase in ocular blood flow were measured postoperatively using LSFG compared with the baseline. LSFG might be applicable to evaluate cerebral perfusion after CEA.
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Affiliation(s)
- Ayako Oi
- Department of Anesthesiology, Nara Medical University, Japan
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Sasaki R, Tamura K, Yamazaki S, Kim TK, Takatani T, Hayashi H, Motoyama Y, Nakagawa I, Park YS, Kawaguchi M, Nakase H. Effects of intraoperative motor evoked potential amplification following tetanic stimulation of the pudendal nerve in pediatric craniotomy. J Neurosurg Pediatr 2023; 31:488-495. [PMID: 36840735 DOI: 10.3171/2023.1.peds22505] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/17/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Monitoring the intraoperative motor evoked potentials (MEPs) in pediatric craniotomy is challenging because of its low detection rate, which makes it unreliable. Tetanic stimulation of the peripheral nerves of the extremities and pudendal nerves prior to transcranial electrical stimulation (TES) or direct cortical stimulation (DCS) amplifies the MEPs. The authors investigated the effects of MEP amplification following tetanic stimulation of the median and tibial nerve or the pudendal nerve in pediatric patients undergoing craniotomy. METHODS This prospective observational study included 15 patients ≤ 15 years of age (mean age 8.9 ± 4.9 years) undergoing craniotomy. MEPs were obtained with TES (15 cases) or DCS (8 cases)-conventional MEP without tetanic stimulation (c-MEP) and MEP following tetanic stimulation of the unilateral median and tibial nerves (mt-MEP) or following tetanic stimulation of the pudendal nerve (p-MEP) were used. Compound muscle action potentials were elicited from the abductor pollicis brevis, gastrocnemius, tibialis anterior, and abductor hallucis longus muscles. The authors compared the identification rate and the rate of amplitude increase of each MEP. RESULTS For both TES and DCS, the identification and amplitude increase rates were significantly higher in cases without preoperative hemiparesis for p-MEPs than in those for c-MEPs and mt-MEPs. In comparison to patients with preoperative hemiparesis, p-MEPs displayed a higher identification rate, with fewer false negatives in DCS cases. CONCLUSIONS In pediatric craniotomy, the authors observed the amplification effect of MEPs with pudendal nerve tetanic stimulation and the amplification effect of DCS on MEPs without increasing false negatives. These findings suggested the likelihood of more reliable intraoperative MEP monitoring in pediatric cases.
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Affiliation(s)
| | | | | | | | | | | | - Yasushi Motoyama
- 4Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
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Sato M, Ida M, Naito Y, Kawaguchi M. Quality of death after elective surgery: a questionnaire survey for the bereaved family. JA Clin Rep 2023; 9:4. [PMID: 36740627 PMCID: PMC9899873 DOI: 10.1186/s40981-023-00598-9] [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] [Received: 01/15/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Postoperative death is the third leading cause of death in the world, but the quality of death after surgery has been poorly documented. This study aimed to evaluate the feasibility of a questionnaire survey for the bereaved family regarding the postoperative quality of death and the impact of preoperative functional disability on the quality of death. METHODS Patients aged ≥55 years who underwent scheduled surgery under general anesthesia in a tertiary-care hospital in Japan between April 2016 and December 2018 were enrolled. Patients' functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) before surgery and scored based on the sum of the 12 items (0-48). Postoperative deaths were detected in medical records 3 months and 1 year after surgery. When death had occurred, a questionnaire on the quality of death using the short version of the Good Death Inventory (GDI) was sent to the bereaved family, which was scored as the sum of the 10 domains (10-70). RESULTS Of 4020 eligible patients, 148 patients (3.6 %) died within 1 year after surgery. A hundred and twenty-nine bereaved families were sent the questionnaire, and 83 of them (64.3%) submitted valid responses suggesting the high feasibility of this questionnaire survey. There were no differences between the GDI and WHODAS 2.0 scores (median 49 [interquartile range 41-55] vs. 49 [43-54], respectively, p = 0.90). In addition, multiple regression analysis of related factors using the short version of the GDI as a continuous variable showed that age and death in a facility other than that in which the surgery was performed were associated with lower GDI scores (p = 0.004 and p = 0.04, respectively). CONCLUSION The completion rate was 64.3%. There was no association between the quality of death and preoperative functional disability; however, older age was associated with a higher quality of death, while death in a facility other than that in which the surgery was performed was associated with lower quality of death.
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Affiliation(s)
- Mariko Sato
- grid.416862.fDepartment of Anesthesiology, Takatsuki General Hospital, Takatsuki, Japan ,grid.410814.80000 0004 0372 782XDepartment of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
| | - Mitsuru Ida
- grid.410814.80000 0004 0372 782XDepartment of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
| | - Yusuke Naito
- grid.410814.80000 0004 0372 782XDepartment of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
| | - Masahiko Kawaguchi
- grid.410814.80000 0004 0372 782XDepartment of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
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Tanaka A, Uemura H, Takatani T, Kawaguchi M, Kawasaki S, Hayashi H, Kimura T, Kitahara T. Resection of brachial plexus schwannomas while monitoring transcranial motor evoked potentials: report of two cases. Auris Nasus Larynx 2023; 50:156-160. [PMID: 34922793 DOI: 10.1016/j.anl.2021.11.012] [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: 10/11/2021] [Revised: 11/07/2021] [Accepted: 11/29/2021] [Indexed: 01/28/2023]
Abstract
A schwannoma is a benign nerve sheath tumor treated by enucleation, which carries the risk of intraoperative nerve injury that is observed after awakening. Transcranial motor evoked potential (TcMEP) monitoring has been established as an effective method to predict and prevent intraoperative neurological complications during brain and spinal surgery. However, there have been few reports on its application in head and neck surgeries. We performed enucleation to relieve the symptoms due to schwannomas in the neck of two women, aged 25 years and 70 years. Both women presented with a left cervical mass, paresthesia of the left upper limb, and a Tinel-like sign without muscle weakness. TcMEPs were recorded before beginning surgery, during surgery, and immediately before completing surgery. The dissecting lines were decided using the stimulator attached to the dissecting instrument, which helped warn the surgeon regarding risky areas. Histopathological examinations confirmed the diagnosis of schwannoma. There was no significant difference in the pre- and postoperative TcMEP recordings, and no postoperative motor deficits were identified. Intraoperative TcMEP monitoring is expected to be useful in preventing operative complications while treating head and neck schwannomas.
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Affiliation(s)
- Akihisa Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
| | - Hirokazu Uemura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tsunenori Takatani
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Sachiko Kawasaki
- Department of Orthopaedic surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Hironobu Hayashi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Takahiro Kimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Nakatani S, Ida M, Uyama K, Kinugasa Y, Kawaguchi M. Prevalence of pre-operative undiagnosed cognitive impairment and its association with handgrip strength, oral hygiene, and nutritional status in older elective surgical patients in Japan. J Anesth 2023; 37:64-71. [PMID: 36307608 DOI: 10.1007/s00540-022-03133-9] [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: 09/06/2022] [Accepted: 10/20/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Preoperative cognitive impairment is a significant factor influencing post-operative delirium. We have been performing routine pre-operative comprehensive assessments, including evaluation of cognitive function, handgrip strength, oral hygiene, and nutritional status, in patients aged ≥ 65 years since April 2021. This study aimed to examine the completion rate of pre-operative comprehensive assessment and assess the prevalence of pre-operative undiagnosed cognitive impairment. METHODS In this prospective observational study including patients aged ≥ 65 years scheduled for elective surgery with general or regional anesthesia, cognitive impairment was defined as a Mini-Cog score ≤ 2, and its associations with handgrip strength, oral hygiene, and nutritional status were evaluated. Oral hygiene and nutritional status were assessed using an oral frailty self-checklist and the Mini Nutritional Assessment-Short Form, respectively. The incidence of pre-operative undiagnosed cognitive impairment was estimated, and its associated factors were explored with multiple logistic regression. RESULTS Among 331 eligible patients, the completion rate was 97.7% (305/312). The mean age was 74.8 years, and 13.1% (40/305) (95% confidence interval [CI], 9.7-17.3%) of the patients had pre-operative undiagnosed cognitive impairment. Multiple logistic regression revealed that handgrip strength (odds ratio [OR] = 0.94, 95%CI = 0.89-0.99) and oral frailty self-checklist score (OR = 1.19, 95%CI = 1.02-1.40) were associated with pre-operative undiagnosed cognitive impairment, while the Mini Nutritional Assessment-Short Form score was not significantly associated (OR = 0.97, 95%CI = 0.82-1.14). CONCLUSIONS Preoperative comprehensive assessment was feasible. The prevalence of pre-operative undiagnosed cognitive impairment was 13%, and poor handgrip strength and worse oral hygiene were significantly associated factors.
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Affiliation(s)
- Shohei Nakatani
- Department of Anesthesiology, Akashi Medical Center, Akashi, Japan
- Department of Anesthesiology, Nara Medical University, Kashihara, Shijo 840, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Shijo 840, Nara, 634-8522, Japan.
| | - Kayo Uyama
- Department of Anesthesiology, Nara Medical University, Kashihara, Shijo 840, Nara, 634-8522, Japan
| | - Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Shijo 840, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Shijo 840, Nara, 634-8522, Japan
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Onodera H, Ida M, Naito Y, Kinomoto A, Kawaguchi M. Respiratory depression following cesarean section with single-shot spinal with 100 μg morphine. J Anesth 2023; 37:268-273. [PMID: 36626021 DOI: 10.1007/s00540-023-03163-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: 07/22/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
PURPOSE Little evidence is available regarding bradypnea measured using continuous monitoring following cesarean section. We aimed to evaluate the rate of cumulative bradypnea time (total bradypnea time/total monitoring time) and its related factors in these parturients. METHODS This prospective observational study included women undergoing cesarean section under single-shot spinal anesthesia of 0.1 mg morphine. The Berlin Questionnaire was used to screen for sleep apnea syndrome preoperatively. Respiratory rate and oxygen saturation (SpO2) were monitored continuously using an adhesive acoustic respiration sensor and pulse oximeter, respectively, at least 6 h after cesarean section. Bradypnea was defined as a respiratory rate < 8 breaths/min lasting at least 25 s (sustained bradypnea) or at least 15 s (immediate bradypnea). Hypoxemia was defined as SpO2 < 92% lasting at least 25 s (sustained hypoxemia) or at least 15 s (immediate hypoxemia). Multiple regression analysis was applied to assess factors related to the rate of cumulative sustained bradypnea. RESULTS Of 159 patients, the Berlin Questionnaire was positive in 16.3%, and 77 (48.4%) experienced sustained bradypnea. The median rate of cumulative sustained bradypnea time was 0.70% (interquartile range 0.35-1.45%) without any related factors. The incidence of immediate bradypnea and sustained and immediate hypoxemia were 58.5%, 24.5%, and 37.7%, respectively. However, none of the factors were significant. CONCLUSION After cesarean section was performed with 0.1 mg intrathecal morphine, respiratory depression events were commonly observed. However, the rate of cumulative bradypnea time was very low and there were no related factors.
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Affiliation(s)
- Hiroki Onodera
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan.
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
| | - Akane Kinomoto
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan
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Doden K, Watanabe T, Yoshimura T, Shibata S, Yamagishi Y, Kimura K, Iwaki Y, Kawaguchi M, Kato H, Inaki N. Indocyanine green fluorescence imaging-guided laparoscopy-assisted distal gastrectomy for early gastric cancer in a patient with situs inversus totalis: A case report with video. Asian J Endosc Surg 2023; 16:95-100. [PMID: 35799403 DOI: 10.1111/ases.13105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 01/11/2023]
Abstract
Situs inversus totalis is a rare congenital anomaly. Most surgeons have seldom performed laparoscopy-assisted distal gastrectomy for situs inversus totalis. Inadequate knowledge regarding the anatomy of situs inversus totalis can result in increased intraoperative bleeding and prolonged operative time. A 74-year-old man was diagnosed with early gastric cancer with situs inversus totalis. We performed laparoscopy-assisted distal gastrectomy with D1+ lymphadenectomy and Billroth-I reconstruction by reversing the standard laparoscopy-assisted distal gastrectomy setup. Mirror images of the operative video of the standardized laparoscopy-assisted distal gastrectomy were created using video editing software. Lymphadenectomy was performed by indocyanine green fluorescence imaging of the lymphatic flow with operative time of 220 minutes and 100 mL intraoperative bleeding. The patient was discharged on postoperative day 10, without postoperative complications. Laparoscopy-assisted distal gastrectomy with indocyanine green navigation is safe and effective in patients with situs inversus totalis and is comparable with standard laparoscopy-assisted distal gastrectomy.
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Affiliation(s)
- Kenta Doden
- Department of Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Toru Watanabe
- Department of Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | | | - Shiori Shibata
- Department of Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yutaka Yamagishi
- Department of Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Karin Kimura
- Department of Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yoshitaka Iwaki
- Department of Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | | | - Hideaki Kato
- Department of Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/ Breast Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Imanishi S, Ida M, Yagi N, Kawaguchi M. A Survey of the General Hospital Environment: Focusing on Pajama Design in a Japanese University Hospital. Hosp Top 2023; 101:9-15. [PMID: 34592913 DOI: 10.1080/00185868.2021.1963901] [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: 02/07/2023]
Abstract
This study investigated nurses' and patients' perceptions of hospital room environment and patient pajama design. Nurses working in a Japanese university hospital and patients aged 20 and older were surveyed. Over 75% of patients rated the hospital environment and hospital rooms as "very good" or "good," but less than one in three nurses rated them similarly. Patients were more likely than nurses to rate rental pajamas as "very good" or "good." Contrary to the nurses, only about one in four patients valued wearing well-designed pajamas. Nurses' and patients' perceptions differed regarding hospital pajamas, but not about improving hospital rooms.
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Affiliation(s)
- Sachiko Imanishi
- Department of Medical Safety Promotion Office, Nara Medical University Hospital, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University Hospital, Kashihara, Japan
| | - Naomi Yagi
- Department of Nursing, Nara Medical University Hospital, Kashihara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University Hospital, Kashihara, Japan
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Wang X, Ida M, Uyama K, Naito Y, Kawaguchi M. Persistent postoperative pain at 1 year after orthopedic surgery and its association with functional disability. J Anesth 2022; 37:248-253. [PMID: 36565365 DOI: 10.1007/s00540-022-03156-2] [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: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Orthopedic hip, knee, and spinal surgeries have a relatively high incidence of persistent postoperative pain, with the highest risk observed in Asian ethnicity. This study aimed to investigate the distribution of persistent pain at 1 year after surgery and its associated factors and effects on functional disability. METHODS This secondary analysis of a prospective observational study included 297 patients aged ≥ 55 years who underwent elective total hip arthroplasty, total knee arthroplasty, and spine and spinal cord surgeries under general anesthesia. Data were collected perioperatively and at 3 months and 1 year postoperatively to assess persistent postoperative pain on a numerical rating scale. RESULTS At 1 year postoperatively, 34.6% (103/297) of patients reported pain, with a score of ≥ 1 and a mean score of 1.2. Multivariable negative binomial regression analysis revealed that less preoperative bodily pain (risk ratio [RR], 0.97; 95% confidence interval [CI] 0.94-0.99), preoperative C-reactive protein (CRP) level (RR, 1.19; 95% CI 1.01-1.39), and spine and spinal cord surgeries (RR, 2.48; 95% CI 1.30-4.75) increased the risk of persistent pain at 1 year after surgery, which was a significant factor for predicting the 12-item World Health Organization Disability Assessment Schedule 2.0 score (p < 0.001). CONCLUSION The mean score for persistent pain at 1 year after surgery on the numerical rating scale was 1.2. Worse preoperative bodily pain, higher preoperative serum CRP level, and spine and spinal cord surgeries increased the persistent pain score at 1 year after surgery, which was associated with functional disability CLINICAL TRIAL REGISTRATION: This prospective observational study was registered on the University Hospital Medical Information Network (31 December 2015; UMIN000021671).
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Affiliation(s)
- Xiaoying Wang
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Kayo Uyama
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Suzuka T, Naito Y, Uemura K, Ida M, Egawa J, Kawaguchi M. A case of afterload mismatch associated with shivering leading to fatal hypoxia in a COVID-19 patient. JA Clin Rep 2022; 8:51. [PMID: 35840861 PMCID: PMC9287127 DOI: 10.1186/s40981-022-00542-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Fever and associated shivering are frequent symptoms in patients with coronavirus disease 2019 (COVID-19). High body temperature activates the immune system, which might be beneficial. However, shivering leads to high oxygen demand. Case presentation A 38-year-old man diagnosed with COVID-19 was transferred to our intensive care unit (ICU). His oxygen saturation (SpO2) level was approximately 92–95% and was managed with a high flow nasal cannula. Six hours after admission to the ICU, he started shivering, and his systolic blood pressure rose above 200 mmHg. Concomitantly, his SpO2 levels decreased rapidly. Mechanical ventilation was started, but oxygenation could not be maintained, requiring the establishment of extracorporeal membrane oxygenation (ECMO). Conclusions COVID-19 is known to cause thrombosis in the pulmonary microvasculature at the early stage of the disease. Under these circumstances, caution should be paid since shivering may worsen the patient’s condition.
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Hirai N, Konda M, Naito Y, Tanaka N, Egawa J, Kawaguchi M. A case of refractory pneumothorax and contralateral atelectasis after thoracoscopic subtotal esophagectomy treated with independent lung ventilation. JA Clin Rep 2022; 8:47. [PMID: 35764833 PMCID: PMC9240168 DOI: 10.1186/s40981-022-00537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/10/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Independent lung ventilation (ILV) allows separate positive end-expiratory pressures (PEEP) and inspiratory pressures for each lung. However, only a few articles have reported ILV management for lungs affected by different pathologies.
Case presentation
A 56-year-old man underwent video-assisted thoracic surgery for esophageal cancer. The right lung was injured during surgery, causing a bronchopleural fistula and necessitating chest drainage. On the third day in the intensive care unit, the patient’s oxygenation worsened during pressure support with continuous positive airway pressure ventilation. ILV was initiated for right-sided severe pneumothorax and left-sided atelectasis and pneumonia. ILV was continued for 2 days, and the patient’s trachea was successfully extubated the following day.
Conclusion
Applying high-level PEEP to the one lung and minimizing the airway pressure on the other lung could be achieved using ILV, which might contribute to successful tracheal extubation.
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Suzuka T, Naito Y, Uemura K, Ida M, Egawa J, Kawaguchi M. Correction: A case of afterload mismatch associated with shivering leading to fatal hypoxia in a COVID-19 patient. JA Clin Rep 2022; 8:57. [PMID: 35922725 PMCID: PMC9349331 DOI: 10.1186/s40981-022-00548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tanaka N, Ida M, Nishiwada T, Kawaguchi M. Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in Pediatrics: A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:705-707. [PMID: 36344405 DOI: 10.1016/j.redare.2022.10.001] [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] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/04/2021] [Indexed: 11/06/2022]
Abstract
The costoclavicular brachial plexus block (CBPB) has been receiving increasing attention as an effective technique for upper arm surgery conducted without phrenic paralysis. However, studies in children are lacking. CBPB was applied to a 10 year-old girl undergoing scheduled radial and ulnar osteotomy due to multiple cartilaginous exostoses and ulnar lengthening. CBPB was performed with a bolus administration of 10 mL of 0.25% levobupivacaine, and the catheter was sequentially replaced in the right costoclavicular space. After surgery, a continuous infusion of 0.17% levobupivacaine through a catheter was initiated at 2 mL/h, along with patient-controlled analgesia (PCA) of 3 mL 0.17% levobupivacaine with a 60-min lock out. The patient complained of 5/10 pain on the numerical rating scale (NRS) 2 h after surgery, which improved immediately after bolus administration. The analgesia induced by CBPB was otherwise effective (NRS ≤ 2). CBPB with PCA may provide adequate analgesia in paediatric cases.
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Affiliation(s)
- N Tanaka
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan.
| | - M Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - T Nishiwada
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - M Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
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