Tetsuhiro Sakai

Hirosaki University, Khirosaki, Aomori Prefecture, Japan

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Publications (15)9.17 Total impact

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    ABSTRACT: We experienced an accidental use of suxamethonium for general anesthesia in a 26-year-old woman with hereditary hypocholinesterasemia that had not been recognized preoperatively. The patient was scheduled for total colectomy as her chronic ulcerative colitis could not be controlled with medications. Routine preoperative screening such as blood cell counts, biochemical data, chest x-ray and electrocardiogram were performed but serum cholinesterase (ChE) activity was not measured. As the preoperative patient condition was good with no abnormal history, anesthesia was induced and maintained with propofol, ketamine and fentanyl as usual. For muscle relaxation, suxamethonium was used for tracheal intubation, and vecuronium was used for the maintenance. After surgery, postanesthetic course was uneventful. One year later, as the patient was pregnant and scheduled for cesarean section, the preoperative screening was done. The biological data showed a hypocholinesterasemia without liver dysfunction. Thus, previous medical records of internal medicine were cheked. Surprisingly the record showed hypocholinesterasemia when she was 15 and 21 years of ages. However, as the physicians did not recognize hypocholinesterasemia, they did not inform the patient of it. Why did the patient have no prolonged apnea and emergence after the previous anesthesia? As the surgical time was exceeded 4 hrs, plasma suxamethonium could fortunately be less than its effective concentration at emergence. However, this case strongly suggests us that preoperative screening should be done without any omission. In addition, if serum ChE activity is not examined, use of suxamethonium should be avoided.
    Masui. The Japanese journal of anesthesiology 09/2006; 55(8):1014-7.
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    ABSTRACT: We report here a case of obstruction of an reinforced endotracheal tube during laryngomicrosurgery under total intravenous anesthesia. In this case, we used a 6.0 mm ID reinforced endotracheal tube that had been used previously for other patients and sterilized two times by ethylene oxide gas. During the operation, the peak airway pressure increased gradually and eventually reached to 35 cmH2O. After the exchange of the endotracheal tube, ventilation was improved immediately. The endotracheal tube was occluded by dissection of internal wall. Several cases of reinforced tube obstruction have already been reported and in most of these cases the obstruction was related to their repeated use and nitrous oxide anesthesia. However, the present case showed that dissection of reinforced endotracheal tube could also occur during general anesthesia without using nitrous oxide. We should bear in mind that repeated use of reinforced endotracheal tube could induce a critical airway obstruction.
    Masui. The Japanese journal of anesthesiology 12/2003; 52(11):1218-20.
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    ABSTRACT: Apparently large plasma volumes derived by indocyanine green (PV-ICG) have been determined in the initial period after induction of anesthesia. We tested the hypothesis that possible overestimation of PV-ICG occurs shortly after anesthetic induction. Anesthesia was induced in 13 patients with fentanyl bolus 2 microg/kg and propofol infusion 0.5 mg x kg(-1) x min(-1) IV until patients lost consciousness and was then maintained with a propofol infusion. PV-ICG and the initial distribution volume of glucose (IDVG) were assessed at 15 min before and at 15 min after anesthetic induction. Plasma ICG and glucose concentrations were measured from serial blood samples taken before and through 7 min after injection of ICG 25 mg and glucose 5 g. PV-ICG and IDVG were calculated using a one-compartment model. PV-ICG was significantly increased by an average of 15.3% after induction, from 2.29 +/- 0.38 (SD) L to 2.64 +/- 0.31 L (P < 0.001). The mean hematocrit (Hct), concentrations of hemoglobin (Hb), and total plasma proteins at postinduction decreased compared with those at preinduction by 2.9%, 2.2%, and 2.3%, respectively (P < 0.05). Percentile increase in plasma volume calculated from Hb and Hct before and after induction was 4%. Consequently, an 11% overestimation in PV-ICG was observed. IDVG remained unchanged. Therefore, the ratio of PV-ICG/IDVG increased from 0.40 +/- 0.05 before induction to 0.48 +/- 0.06 after induction (P < 0.01). These results validate the hypothesis that possible overestimation of PV-ICG occurs during a definable period of time after propofol anesthetic induction. The present results also support the PV-ICG/IDVG ratio as a measure of possible overestimation of PV-ICG or fluid redistribution from the central to the peripheral tissues. IMPLICATIONS: An approximate 11% overestimation in indocyanine green derived plasma volume was observed after induction of anesthesia using propofol and fentanyl. Simultaneous measurement of the initial distribution volume of glucose may help investigate the presence of overestimation in indocyanine green derived plasma volume.
    Anesthesia & Analgesia 11/2003; 97(5):1421-7. · 3.30 Impact Factor
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    ABSTRACT: To investigate the effect of different plasma levels of fentanyl on the concentration of propofol and the Bispectral Index (BIS) required for patients to regain consciousness and orientation following surgery. Prospective, open-label study. Operating room of a university hospital. 28 patients, aging 20 to 50 years, scheduled for elective, 1- to 4-hour surgeries under general anesthesia. BIS was continuously monitored from bifrontal montage (At1-Fpz and At2-Fpz) using an Aspect A-1,050 EEG system (Aspect, Natick, MA). Anesthesia was induced with bolus injections of fentanyl 2 microg/kg and propofol 2 mg/kg, and maintained with intermittent injections of fentanyl and constant infusion of propofol. Propofol infusion was stopped at the end of surgery. Consciousness and orientation were assessed as clinical endpoints once every 2 minutes following the end of the surgery. Blood samples were extracted for plasma propofol and fentanyl concentrations (PCp and FCp, respectively), and BIS values were recorded when patients regained consciousness and orientation. Patients were allocated to one of three groups depending on FCp on awakening: Group 1, FCp > 1 microg/L (n = 8); Group 2, FCp < 1 microg/L and >0.45 microg/L (n = 9); and Group 3, FCp < 0.45 microg/L (n = 11). PCp, BIS, recovery time, and other data were compared between the three groups. Demographic values, duration of surgery, and consumption of propofol and fentanyl were not different between the three groups. Group 3 patients regained consciousness with significantly higher propofol concentration (mean PCp = 3.2 mg/L) compared with those in Groups 1 and 2 (p < 0.05). However, the BIS values at both recovery endpoints were not different among the three groups. The plasma levels of fentanyl affect the concentrations of propofol required for patients to regain consciousness. The BIS values for wakefulness are unaltered at the different combinations of propofol and fentanyl concentrations. Thus, the BIS appears to be a useful and consistent indicator for level of consciousness during emergence from propofol/fentanyl intravenous anesthesia.
    Journal of Clinical Anesthesia 03/2003; 15(2):103-7. · 1.15 Impact Factor
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    ABSTRACT: Study objectiveTo investigate the effect of different plasma levels of fentanyl on the concentration of propofol and the Bispectral Index (BIS) required for patients to regain consciousness and orientation following surgery.
    Journal of Clinical Anesthesia - J CLIN ANESTH. 01/2003; 15(2):103-107.
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    ABSTRACT: During a period of five years from January 1996 through December 2000 total intravenous anesthesia with mainly propofol, fentanyl and ketamine was administered to 26,079 patients including cardiac and neurosurgical patients at the University of Hirosaki Hospital and five other affiliated hospitals. The patients studied ranged from 1 year 8 months to 93 years in age, 9.2 kg to 135.0 kg in body weight and from 18 min to 22 hours 50 min in anesthetic time. With adequate monitoring, fentanyl 1-2 micrograms.kg-1 was given at first, then total-dose of ketamine 1 mg.kg-1 and propofol 1-2 mg.kg-1 were administered for the induction of anesthesia in adult patients. A total dose of fentanyl 3-15 micrograms.kg-1 was given combined with propofol 5-10 mg.kg-1 and ketamine 0.3-1.0 mg.kg.h-1. In craniotomy patients, ketamine was excluded. For pediatric patients, sevoflurane anesthesia was employed to establish i.v. route, and intravenous agents were given almost same as in the same manner as in adult patients. None of them developed either cardiac arrest or severe cardiovascular insufficiencies due to anesthesia alone. Their postoperative hepatic and renal functions evaluated by various biochemical indices and urine output were adequately maintained during anesthesia and for a week postoperatively. They were followed up to 3 months postoperatively only to fail to detect any adverse events related directly to this method of anesthesia. These data suggest that total intravenous anesthesia with propofol, fentanyl and ketamine has a very wide margin of safety.
    Masui. The Japanese journal of anesthesiology 01/2003; 51(12):1336-42.
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    ABSTRACT: Transcription of the genes for proinflammatory cytokines is regulated by nuclear factor kappa B (NF-κB) activation. Cardiopulmonary bypass (CPB) is characterized by a systemic endotoxemia demonstrated immediately following CPB institution followed by the systemic release of proinflammatory cytokines, including tumor necrosis factor-α (TNF-α) and the interleukins (IL) 1, 6 and 8. However, the mechanism of the release of these proinflammatory cytokines remains to be determined.NF-κB is an inducible transcription factor implicated in activating various genes including those genes which encode for cytokines such as TNF, IL-1 and IL-6. The NF-κB protein is found in several cell types including inflammatory cells, for example peripheral blood monocytes, one of the cell types responsible for LPS-induced proinflammatory cytokine production. Therefore, we examined whether NF-κB is activated during CPB in order to define a mechanism of CPB-induced proinflammatory cytokine production and release.
    International Congress Series 01/2002; 1244:127–130.
  • Anesthesia and Analgesia - ANESTH ANALG. 01/1998; 86.
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    ABSTRACT: PurposeTo observe the changes in EEG bispectral index (BIS), 95% spectral edge frequency (95% SEF) and median frequency (MF) with haemodynamic changes to intubation during induction with propofol or propofol and 2 μg· kg−1 fentanyliv. MethodsTwenty four ASA 1–11 patients were randomized to receive either propofol infusion preceded by normal saline (group P, n= 12) or propofol preceded by 2 μg· kg−1 fentanyl (group PF, n= 12). Intubation was performed five minutes after maintenance of BIS within 45 ± 5. EEG and haemodynamic variables were recorded at before induction, and before and after intubation. ResultsHaemodynamic responses to intubation were greater in group P than in group PF (P < 0.05). Postintubation SBP, DBP and HR increased, compared with preinduction values, more in group P than in group PF Postintubation BIS values increased from 45.5 ± 3.5 and 44.2 ± 4.1 to 51.1 ± 4.1 and 50.9 ± 5.3 in groups P and PF, respectively, compared with preintubation values. The BIS values were not different between treatment groups before and after intubation, and 95% SEF and MF values did not increase after intubation. ConclusionFentanyl, 2 μg· kg−1 iv, blunted the haemodynamic responses to intubation, but failed to attenuate the arousal of cerebral cortical activity. The different haemodynamic responses postintubation but similar BIS and 95% SEF changes in the two groups suggest that BIS or 95% SEF cannot predict the haemodynamic responses to intubation during anaesthesia induction with propofol and fentanyl. ObjectifObserver les altérations de l’index ÉEG bispectral (BIS), sur la fréquence spectrale de marge (95% SEF) et la fréquence moyenne (FM) causées par les changements hémodynamiques de l’intubation pendant l’induction au propofol ou au propofol associé au fentanyl 2 μg· kg−1 iv. MéthodesVingt-quatre patients ASA 1–11 ont reçu aléatoirement soit une perfusion de propofol précédée de sol. phys. (groupe P, n = 12) ou de propofol précédé de fentanyl 2 μg· kg−1 (groupe PF, n = 12). On intubait cinq minutes après la stabilisation du BIS entre 45 ± 5. L’ÉEg et les variables hémodynamiques étaient enregistrées avant l’induction, et avant et après l’intubation. RésultatsLes réponses hémodynamiques à l’intubation étaient plus importantes dans le groupe P que dans le groupe PF (P< 0,05). Après l’intubation, la pression artérielle systolique et diastolique et la Fc augmentaient comparativement aux valeurs de préinduction, mais plus dans le groupe P que dans le groupe PF Après l’intubation, les valeurs du BIS augmentaient de 45 ± 3,5 à 51 ± 4.1 dans le groupe P et de 44 ± 4,1 à 50,9 ± 5,3 dans les groupes PF comparativement aux valeurs précédant l’intubation ; les valeurs SEF 95% et MF n’augmentaient pas après l’extubation. ConclusionLe fentanyl 2 μg· kg−1 iv atténue les réponses hémodynamiques à l’intubation mais ne parvient pas à atténuer l’éveil de l’activité corticale cérébrale. La différence des réponses hémodynamiques postintubation mais la similarité des changements de BIS et de SEF95% dans les deux groupes suggèrent que BIS et SEF 95% ne peuvent prédire les réponses hémodynamique à l’intubation pendant l’induction de l’anesthésie au propofol et au fentanyl.
    Canadian Journal of Anaesthesia 12/1997; 45(1):19-22. · 2.13 Impact Factor
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    ABSTRACT: Ketamine-induced sympathetic stimulation can be inhibited by administration of sedatives such as benzodiazepines, droperidol, or opioids. We have developed total intravenous anesthesia with ketamine in combination with droperidol and fentanyl (DFK) and have used this anesthetic method in more than 4000 surgical cases. In this study, we compared DFK in cardiac surgery with isoflurane-fentanyl anesthesia (AOI-F). Fourteen patients undergoing aortocoronary artery bypass graft surgery were randomly assigned to the DFK or AOI-F groups. The endocrine responses of the patients were evaluated from the plasma, levels of cortisol, antidiuretic hormone (ADH), atrial natriuretic peptide (ANP), and aldosterone. In both groups, anesthesia per se did not induced any significant changes in the hormones. Although cortisol and ADH increased during surgery, ANP and aldosterone did not change appreciably. All hormones were significantly elevated after the end of cardiopulmonary bypass. There were no significant differences in any of the hormones, blood pressure, and heart rate measured at different points in both groups. These results showed that DFK anesthesia as a total intravenous anesthesia deserves to be studied in more depth.
    Journal of Anesthesia 09/1995; 9(3):224-228. · 0.87 Impact Factor
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    ABSTRACT: Endocrine factors and cytokines are crucial to host responses to stress and infection. Because surgery is a major stressful condition, it is necessary to understand the influence of specific anesthetic procedures on immune-endocrine responses. The purpose of this study was to compare total intravenous anesthesia with propofol with conventional inhalational anesthesia on circulating cortisol, adrenocorticotropic hormone (ACTH), prolactin, alpha-melanocyte-stimulating hormone (αMSH), and the cytokine, interleukin-6 (IL-6) in healthy patients undergoing tubal ligation. The results show that circulating cortisol was significantly suppressed ous propofol completely abolished the response of circulating cortisol to surgery. Because ACTH responses to surgery were similar in the two groups, the inhibition likely occurred directly on the adrenal glands. This study is the first to report the effects of anesthesia on circulating αMSH, which was decreased significantly after induction with both anesthetic techniques and was still depressed at 90 min in the propofol patients. Other aspects of immune-endocrine responses to surgery were similar irrespective of anesthetic type, which further suggests a specific suppression of adrenal function by propofol.
    Journal of Anesthesia 07/1995; 9(3):214-219. · 0.87 Impact Factor
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    ABSTRACT: Cardiopulmonary bypass (CPB) makes prediction of any drug concentration diffcult because both hypothermia and hemodilution can alter the pharmacokinetics of the drug. Eleven patients undergoing cardiac surgery under CPB were anesthetized with continuous infusion of ketamine combined with intermittent administration of droperidol and fentanyl. The infusion rate of ketamine was 2 mg·kg−1·hr−1 following a bolus administration of 1.5 mg·kg−1 for the induction of anesthesia. Blood concentrations of ketamine and its main metabolite, norketamine, were measured at 0, 30, and 60 min after the start of and the end of CPB, and 0, 1, 2, and 24 h after the cessation of ketamine infusion. Hypothermia increased blood ketamine levels during CPB, but the norketamine levels did not change. Although acute hemodilution would decrease blood ketamine levels, their levels were already significantly increased at 30 min after CPB. Hypothermic factors have a more kinetically important role during CPB than hemodilution. Increases in blood norketamine levels following rewarming indicate that hypothermia could impair ketamine metabolism in the liver. Further increase in the plasma concentration of ketamine until 30 min after the end of CPB might be due to blood transfusion containing ketamine from the CPB reservoir.
    Journal of Anesthesia 05/1995; 9(2):142-145. · 0.87 Impact Factor
  • Nihon Kyukyu Igakukai Zasshi 01/1995; 6(3).
  • Anesthesia and Analgesia - ANESTH ANALG. 01/1994; 79(1).
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    ABSTRACT: In the present study, we have conducted cDNA microarray in C6, rat brain glioma cell line, to assess anti-infl ammatory eff ects of ketamine and sevofl urane in the central nervous system. The cultured C6 cells were treated with ketamine (0-100 μM) and sevofl urane (0 and 0.66 mM). Total RNA was extracted from the cells and labeled with fl uorescent dye and then hybridized with microarray slide, containing 1936 genes. Quantitative analysis of each gene expression was confi rmed by real-time polymerase chain reaction (PCR). Microarray analyses showed that ketamine downregulated the expression of 4 proinfl ammatory cytokine genes and upregulated that of 2 antiinfl ammatory cytokine genes. On the other hand, sevofl urane downregulated the expression of 2 proinfl ammatory cytokines but upregulated that of two other proinfl ammatory cytokines. Furthermore, sevofl urane failed to stimulate the expressions of anti-infl ammatory cytokines. Although patterns of cytokine expression in response to ketamine and sevofl urane were diff erent from each other described above, both anesthetics downregulated a key cytokine, interleukin( IL)-1β remarkably in microarray analysis, which was confi rmed by real time PCR. These results suggest that both ketamine and sevofl urane show mainly anti-infl ammatory properties through the inhibition of IL-1β.