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Yasushi Nakazawa,
Ryoko Ii,
Taku Tamura,
Tokio Hoshina,
Kumiko Tamura,
Shinji Kawano,
Tetsuro Kato,
Fumiya Sato,
Tetsuya Horino,
Masaki Yoshida,
Seiji Hori, Masamitsu Sanui,
Yoshikazu Ishii,
Kazuhiro Tateda
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ABSTRACT: A 52-year-old male Japanese businessman with massive cerebral bleeding was transferred from India to Japan and was admitted to our hospital. Multidrug-resistant Acinetobacter baumannii was isolated from his sputum. The minimum inhibitory concentrations for this strain were as follows: imipenem, 64 μg/ml; meropenem, 32 μg/ml; ciprofloxacin, 16 μg/ml; amikacin, 16 μg/ml; aztreonam, 16 μg/ml; colistin, <1 μg/ml. This A. baumannii strain had both bla (NDM-1) and bla (OXA-23) by polymerase chain reaction analysis. In Japan, NDM-1-producing bacteria are extremely rare in clinical specimens. To date, three NDM-1-positive cases have been detected in Japan, and this is the first case of A. baumannii-producing NDM-1 in Japan. Our case suggests that NDM-1-producing bacteria could be introduced into our country easily. There is concern that various resistant bacteria may be transferred from epidemic countries as a result of international medical care.
Journal of Infection and Chemotherapy 09/2012; · 1.80 Impact Factor
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Kenji Itou,
Tatsuya Fukuyama,
Yusuke Sasabuchi,
Hiroyuki Yasuda,
Norihito Suzuki,
Hajime Hinenoya,
Chol Kim, Masamitsu Sanui,
Hideki Taniguchi,
Hideki Miyao,
Norimasa Seo,
Mamoru Takeuchi,
Yasuhide Iwao,
Atsuhiro Sakamoto,
Yoshihisa Fujita,
Toshiyasu Suzuki
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ABSTRACT: In many countries, patients are generally allowed to have clear fluids until 2-3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of oral rehydration therapy until 2 h before surgery.
Three hundred low-risk patients scheduled for morning surgery in six university-affiliated hospitals were randomly assigned to an oral rehydration solution (ORS) group or to a fasting group. Patients in the ORS group consumed up to 1,000 ml of ORS containing balanced glucose and electrolytes: 500 ml between 2100 the night before surgery and the time they woke up the next morning and 500 ml during the morning of surgery until 2 h before surgery. Patients in the fasting group started fasting at 2100 the night before surgery. Primary endpoints were gastric fluid volume and pH immediately after anesthesia induction. Several physiological measures of hydration and electrolytes including the fractional excretion of sodium (FENa) and the fractional excretion of urea nitrogen (FEUN) were also evaluated.
Mean (SD) gastric fluid volume immediately after anesthesia induction was 15.1 (14.0) ml in the ORS group and 17.5 (23.2) ml in the fasting group (P = 0.30). The mean difference between the ORS group and fasting group was -2.5 ml. The 95% confidence interval ranged from -7.1 to +2.2 ml and did not include the noninferior limit of +8 ml. Mean (SD) gastric fluid pH was 2.1 (1.9) in the ORS group and 2.2 (2.0) in the fasting group (P = 0.59). In the ORS group, mean FENa and FEUN immediately after anesthesia induction were both significantly greater than those in the fasting group (P < 0.001 for both variables). The ORS group reported they had been less thirsty and hungry before surgery (P < 0.001, 0.01).
Oral rehydration therapy until 2 h before surgery is safe and feasible in the low-risk Japanese surgical population. Physicians are encouraged to use this practice to maintain the amount of water in the body and electrolytes and to improve the patient's comfort.
Journal of Anesthesia 02/2012; 26(1):20-7. · 0.83 Impact Factor
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ABSTRACT: Recent studies have suggested that low levels of 25-hydroxyvitamin D (25OHD) are associated with cardiovascular risks in medical patients. However, these associations have not been well documented in high risk surgical patients. We hypothesized that serum 25OHD, 1,25-dihydroxyvitamin D (1,25OHD) would be associated with the cardiac operative risk stratification score. The study was conducted with a cross-sectional design at a single academic medical center in Japan. Two hundred five adult patients scheduled for major cardiovascular surgery were included consecutively. Cardiac operative risk was evaluated with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) scoring system. Correlations between 25OHD and 1,25OHD, and EuroSCORE were assessed using simple and multiple linear regression models. Mean 25OHD and 1,25OHD were 20.1±7.1 ng/mL and 51.2±19.2 pg/mL, respectively. Half and 88% of the study population showed deficient (<20 ng/mL) and insufficient (<30 ng/mL) 25OHD levels, respectively. In contrast, only 3% showed 1,25OHD levels lower than normal (<20 pg/mL). Circulating 25OHD levels, but not 1,25OHD levels, were negatively correlated with EuroSCORE (p=0.005) even after adjusted for body mass index, albumin, hypertension, dyslipidemia, diabetes mellitus, creatinine, use of statin, high sensitive C-reactive protein, and intact parathyroid hormone. These results suggest that serum 25OHD levels are inversely associated with operative risk severity of patients undergoing major cardiovascular surgery.
Journal of Nutritional Science and Vitaminology 01/2012; 58(5):327-332. · 1.20 Impact Factor
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ABSTRACT: A 69-year-old woman underwent thoraco-abdominal aortic aneurysm repair with cerebrospinal fluid drainage (CSFD). The initial CSF pressure was elevated to approximately 25 cmH(2)O, and clear CSF was continuously drained at a rate of 30 ml/h with the drainage level at 10-20 cmH(2)O. The CSF became bloody when cardiopulmonary bypass was terminated. The total volume of CSF drained was approximately 300 ml at the conclusion of the 638 min operation. Three hours later, she suffered a series of generalized seizures because of intracranial hemorrhage (ICH). It was suggested that excessive drainage of CSF was associated with ICH. Meticulous control of drainage volume combined with standard pressure-based management may be the key to avoiding these complications.
Journal of Anesthesia 08/2010; 24(4):603-6. · 0.83 Impact Factor
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Journal of Anesthesia 02/2010; 24(2):309-10. · 0.83 Impact Factor
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Masamitsu Sanui
Nippon Geka Gakkai zasshi 06/2009; 110(3):172-6.
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ABSTRACT: The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes.
A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group B; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP <90 mmHg; p=0.007), postoperative renal dysfunction (creatinine >2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group B, 76.8%).
Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients.
Circulation Journal 10/2008; 72(11):1751-7. · 3.77 Impact Factor
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ABSTRACT: While ventricular premature contractions have been noted during colonoscopy (CS), ventricular fibrillation (VF) is rare. We recently had a patient who developed VF during CS and recovered without any sequelae despite severe complications after cardiopulmonary resuscitation (CPR). If electrocardiogram (ECG) monitoring had been done during CS, a direct current shock defibrillation could have been accomplished and prevented complications. CS in high-risk patients should be done with ECG monitoring.
Internal Medicine 02/2008; 47(7):609-12. · 0.94 Impact Factor
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ABSTRACT: A shortage of anesthesiologists is having a serious impact on Japanese medicine. The adoption of nurse anesthetists is currently a matter of debate among Japanese surgeons and anesthesiologists. To probe whether future nurse anesthetists exist in Japan, a questionnaire survey of nurses was carried out.
Anonymous questionnaires were sent to 99 acute-care nurses in our hospital. Inquiries included those on their backgrounds, the shortage of the anesthesiologists, and issues related to the nurse anesthetists.
Eighty-four answers (85%) were obtained. Sixty-seven nurses (80%) were aware of the shortage of the anesthesiologists. Although only 19 (23%) had certain knowledge of nurse anesthetists before this survey, 71 (85%) were willing to become, or interested in nurse anesthetists. The majority (56%) described nurse anesthetists' job should be limited to endotracheal intubation, vascular catheter placement, and intravenous medication solely under the supervision of the anesthesiologists. Virtually all respondents claimed the qualifications of the nurse anesthetists should include both training in the acute care setting as certified nurses and training in anesthesia school.
Our preliminary survey denotes that future nurse anesthetists exist in Japan.
Masui. The Japanese journal of anesthesiology 02/2008; 57(1):95-9.
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Journal of Anesthesia 02/2008; 22(2):195-6. · 0.83 Impact Factor
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ABSTRACT: Two series of experiments were designed to evaluate whether early arginine vasopressin improves acute outcome following resuscitation from traumatic brain injury and severe hemorrhagic hypotension.
Prospective randomized, blinded animal study.
University laboratory.
Thirty-three swine.
In series 1 (n = 19), after traumatic brain injury with hemorrhage and 12 mins of shock (mean arterial pressure approximately 20 mm Hg), survivors (n = 16) were initially resuscitated with 10 mL/kg crystalloid. After 30 mins, crystalloid and blood with either 0.1 unit x kg(-1) x hr(-1) arginine vasopressin or placebo was titrated to a mean arterial pressure target >or=60 mm Hg. After 90 mins, all received mannitol and the target was cerebral perfusion pressure >or=60 mm Hg. To test cerebrovascular function, 7.5% inhaled CO2 was administered periodically. In series 2 (n = 14), the identical protocol was followed except the shock period was 20 mins and survivors (n = 10) received a bolus of either arginine vasopressin (0.2 units/kg) or placebo during the initial fluid resuscitation.
In series 1, by 300 mins after traumatic brain injury with arginine vasopressin (n = 8) vs. placebo (n = 8), the fluid and transfusion requirements were reduced (both p < .01), intracranial pressure was improved (11 +/- 1 vs. 23 +/- 2 mmHg; p < .0001), and the CO2-evoked intracranial pressure elevation was reduced (7 +/- 2 vs. 26 +/- 3 mm Hg, p < .001), suggesting improved compliance. In series 2, with arginine vasopressin vs. placebo, cerebral perfusion pressure was more rapidly corrected (p < .05). With arginine vasopressin, five of five animals survived 300 mins, whereas three of five placebo animals died. The survival time with placebo was 54 +/- 4 mins (p < .05 vs. arginine vasopressin).
Early supplemental arginine vasopressin rapidly corrected cerebral perfusion pressure, improved cerebrovascular compliance, and prevented circulatory collapse during fluid resuscitation of hemorrhagic shock after traumatic brain injury.
Critical Care Medicine 03/2006; 34(2):433-8. · 6.33 Impact Factor
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ABSTRACT: Arginine vasopressin (AVP) is a promising treatment for several types of irreversible shock, but its therapeutic potential has not been examined after severe chest trauma. Two series of experiments were performed to fill this gap.
Series 1: anesthetized, mechanically-ventilated pigs (n = 20, 29 +/- 1 kg) received a blast to the chest, followed by a "controlled" arterial hemorrhage to a mean arterial pressure (MAP) <30 mm Hg. At 20 minutes, a 10 mL/kg normal saline (NS) bolus was followed by either 0.1 U/kg AVP bolus or NS, in randomized, blinded fashion. From 30-300 minutes, either AVP (0.4 U/kg/hr plus NS) or NS alone was infused as needed to MAP>70 mm Hg. Series 2: Swine (n = 15) received the chest injury followed by partial left hepatectomy to produce "uncontrolled" hemorrhage. Resuscitation was the same as in series 1.
The blast created bilateral parenchymal contusions (R > L), hemo/pneumothorax and progressive cardiopulmonary distress. In Series 1, there were 3/20 deaths before randomization, 0/8 deaths after resuscitation with AVP versus 4/9 deaths with NS (p = 0.029). In surviving animals, with AVP versus NS, fluid requirements and peak airway pressures were lower while P/F was higher (all p < 0.05). In Series 2, with uncontrolled hemorrhage, there were 5/15 deaths before randomization. Upon resuscitation with AVP versus NS, survival time and blood loss were both improved, but the differences did not reach statistical significance.
After severe chest trauma with controlled hemorrhage, early AVP decreased mortality, reduced fluid requirements and improved pulmonary function. With uncontrolled hemorrhage, early AVP did not increase the risk for bleeding.
The Journal of trauma 11/2005; 59(4):876-82; discussion 882-3. · 2.48 Impact Factor
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ABSTRACT: The purpose of the study was to compare initial resuscitation with arginine vasopressin (AVP), phenylephrine (PE), or isotonic crystalloid fluid alone after traumatic brain injury and vasodilatory shock.
Anesthetized, ventilated swine (n = 39, 30 +/- 2 kg) underwent fluid percussion traumatic brain injury followed by hemorrhage (30 +/- 2mL/kg) to a mean arterial pressure < 30mmHg, then were randomized to 1 of 5 groups to maintain mean arterial pressure > 60mmHg for 30 to 60minutes, then cerebral perfusion pressure > 60mmHg for 60 to 300minutes, either unlimited crystalloid fluid only (n = 9), arginine vasopressin + fluid (n = 9), phenylephrine + fluid (n = 9), arginine vasopressin only (n = 5), or phenylephrine only (n = 5). Heterologous transfusions were administered if hematocrit was < 13, and mannitol was administered if intracranial pressure was > 20 mmHg. Cerebrovascular reactivity was evaluated with serial CO(2) challenges.
In all groups, physiologic variables were similar at baseline and at the end of shock. On resuscitation, all achieved mean arterial pressure and cerebral perfusion pressure goals. Brain tissue PO(2)s were similar. With fluid only, more blood and mannitol were required, intracranial pressure and peak inspiratory pressure were higher, and cerebrovascular reactivity was decreased (all p < 0.05 versus pressor + fluid). With either pressor + fluid, cardiac output, heart rate, lactate, and mixed venous O(2) saturation were similar to fluid only, but total fluid requirements and urine output were both reduced (p < 0.05). With either pressor only, intracranial pressure remained low, but mixed venous O(2) saturation, cardiac output, and urine output were decreased (all p < 0.05 versus other groups).
To correct vasodilatory shock after traumatic brain injury, a resuscitation strategy that combined either phenylephrine or arginine vasopressin plus crystalloid was superior to either fluid alone or pressor alone.
Journal of the American College of Surgeons 10/2005; 201(4):536-45. · 4.55 Impact Factor
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ABSTRACT: In the past few years, arginine vasopressin (AVP) has emerged as a rational alternative to catecholamines for the hemodynamic support of refractory vasodilatory shock and cardiopulmonary arrest. The therapeutic potential of AVP in traumatic shock is now being evaluated. Our laboratory investigations have revealed an apparent benefit of AVP when compared to standard fluid resuscitation in clinically relevant models of brain injury and chest injury. Further experimental work and subsequent clinical trials appear justified to validate the efficacy of AVP for resuscitation of trauma patients.
08/2004;
