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ABSTRACT: A 60-year-old male patient with esophageal carcinoma underwent esophagectomy and gastric tube construction with cervical esophagogastrostomy. A tonometer catheter (Tonometrics™ Catheter, TONO-16 F, Datex-Ohmeda, Finland) was placed transnasally into the lumen of the gastric tube just after the gastric tube formation. The catheter was connected to a TONOCAP (Datex Ohmeda) monitor. The intramucosal partial pressure of carbon dioxide (PiCO2) was then measured intermittently. A PiCO2 of 105 mmHg just after the gastric tube formation indicated the possibility of an impaired blood flow in the gastric tube. Reanastomosis of the artery and vein to the gastric tube was performed immediately to improve perfusion. This procedure salvaged the gastric tube and PiCO2 decreased to 43 mmHg at the end of the operation. Subsequently, PiCO2 returned to the normal range. PiCO2 is regularly measured to assess the state of the reconstructed gastric tube during the postoperative period in the intensive care unit (ICU). The clinical course of the patient suggests that measuring PiCO2 using a tonometer catheter is useful to detect any abnormal blood supply to the reconstructed gastric tube not only in the postoperative period in the ICU but also in the intraoperative period.
The Tokai journal of experimental and clinical medicine 04/2011; 36(1):5-7.
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ABSTRACT: There are some problems in the training of endotracheal intubation enforced for the emergency medical technicians. It is important to obtain the informed consent from preoperative patients which is difficult, and time is spent. In addition, patients sometimes refuse in spite of full explanation about this training.
We examined the situation where we can obtain the informed consent and what were the reasons the patient refuse this training.
The refusal rate was 22.5% and women of their 50's to 60's of ages tended to decline more. And there seemed to be difference in each department slightly. The reasons of the patients who refused the informed consent were an anxiety to the training of endotracheal intubation and unwilling to be sacrificed for that. These reasons comprised about 66%.
We could not find the important point to obtain more informed consent. But it was thought that we should know these results to obtain consent more effectively from now.
Masui. The Japanese journal of anesthesiology 06/2010; 59(6):798-801.
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ABSTRACT: Pulse oximeter expressed by SpO2 is used for monitoring respiratory state during operation and in ICU. Perfusion index (PI) and pleth variability index (PVI) as new indexes are calculated from pulse oximeter (Masimo SET Radical-7, Masimo Corp., USA, 1998) waveforms. And these indices were used as parameters to evaluate the circulatory state. For PI calculation, the pulsatile infrared signal is indexed against the nonpulsatile infrared signal and expressed as a percentage. It might thus be of future value in assessment of perioperative changes in peripheral perfusion. PVI is a measure of a dynamic change in PI that occurs during complete respiratory cycle. It might be thought that PVI, an index automatically derived from the pulse oximeter waveform analysis, had potentially clinical applications for noninvasive hypovolemia detection and fluid responsiveness monitoring.
Masui. The Japanese journal of anesthesiology 08/2009; 58(7):860-5.
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ABSTRACT: A 90-year-old man underwent emergency thrombectomy for acute occlusion of the right femoral and popliteal arteries. After an epidural catheter (used for intraoperative/postoperative management) was removed, a spinal epidural hematoma involving the Th12 to L3 areas developed. Emergency removal of the hematoma and decompression of the spinal cord were performed. Possibly, the hematoma had developed due to therapy with an antiplatelet agent, cilostazol, which had been started on the first postoperative day, and due to the removal of the catheter, on the third postoperative day, in addition to the patient's advanced age. This case may be the first report of spinal epidural hematoma associated with both cilostazol and epidural anesthesia. From the time course in this patient, important knowledge of drug actions and follow-up may be gained for determining the timing of catheter removal in a patient receiving antiplatelet therapy with cilostazol.
Journal of Anesthesia 02/2008; 22(3):290-3. · 0.83 Impact Factor
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ABSTRACT: Three pregnant women with diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), received emergency cesarean section in our hospital. Considering low platelet counts, in all three patients, operations were performed under general anesthesia using sevoflurane without epidural or spinal anesthesia. Special attention was paid to management of blood pressure, especially intra-operative hypertension. Moreover, if necessary, platelet and fresh frozen plasma were transfused, and therapy to prevent disseminated intravascular coagulation (DIC) and to protect liver and renal function, was performed perioperatively. As a result, laboratory data of all three patients recovered to almost within normal ranges after operation, and they were discharged without untoward complications. HELLP syndrome is a severe complication of pregnancy. Complications of this syndrome were severe including acute renal failure, DIC, pulmonary edema, cerebral hemorrhage and liver rupture. It is reported that maternal mortality is 2-24%. In the management of pregnant women complicated with HELLP syndrome, early diagnosis and adequate therapy, including preventive therapy for complications, are necessary.
Masui. The Japanese journal of anesthesiology 08/2007; 56(7):838-41.
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ABSTRACT: A patient, 35 weeks and 2 days gestation with twins, was scheduled for cesarean section. Spinal anesthesia was induced with the patient in lateral decubitus position using 2.2 ml hyperbaric bupivacaine 0.5% at the L3-4 interspace. The patient was placed immediately in supine position. After 5 min, sensory block level was confirmed T5. Operation was performed with no complications. Patient left the operating room 60 min after the induction. In the ward, the patient complained of respiratory distress and inability to move hands. Sensory block level reached C4 2 hours after spinal anesthesia induction. Four hours after induction, patient's sensory and motor paralysis recovered completely. In our operating room, patient enters and leaves with moving slide hatch machine. So patient's body moves to right and left side. We think that the increased anesthesia level was caused by this rolling of the body. We must be cautious about the increased anesthesia level when spinal anesthesia is induced.
Masui. The Japanese journal of anesthesiology 07/2007; 56(6):708-10.
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ABSTRACT: It is said that airway management is an important part of lifesaving at the prehospital care for a seriously ill emergency patient. We performed the training of endotracheal intubation for an emergency medical technician, and in this report we discussed the results of trainings and examined 3 cases of endotracheal intubation in the emergency situation after training. Various kinds of problem arose through this training, for example, difficulty to get the consent from patients, overlap of a case for clinical resident and emergency medical technician, large responsibility of the anesthesiologist as a teaching staff. In addition, there may be no useful case for lifesaving at the emergency situation in 3 cases of endotracheal intubation. We consider that it may be difficult, but possibility cannot deny if endotracheal intubation by emergency medical technicians contribute to lifesaving rate improvement from viewpoint of prehospital care.
Masui. The Japanese journal of anesthesiology 06/2007; 56(5):595-600.
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ABSTRACT: We performed anesthesia for a subtotal gastrectomy in a 70-year-old female patient with paramyotonia congenita (PC). She had been diagnosed with PC at the age of 47 years by electromyogram analysis. Several points to consider have been revealed regarding the management of anesthesia in patients with PC. In this patient, anesthesia was safely maintained using sevoflurane and nitrous oxide together with concomitant epidural anesthesia using mepivacaine. Efforts should be made to prevent perioperative attacks of muscle weakness when planning anesthesia for patients with this kind of disorder. Specifically, refraining from the use of muscle relaxants, care with regard to the composition of infusion fluids during operations, and the maintenance of body temperature are required for anesthesia. In addition, postoperative pain management using a continuous epidural block proved to be a useful method.
Journal of Anesthesia 02/2007; 21(4):500-3. · 0.83 Impact Factor
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ABSTRACT: A 76-year-old man who had an abdominal aortic aneurysm underwent vascular replacement, and an acute spinal epidural hematoma developed postoperatively despite the absence of abnormal preoperative laboratory data other than hypertension. General anesthesia was induced using nitrous oxide, oxygen, and sevoflurane (GOS), and epidural anesthesia was also performed at the intervertebral space between Th10 and Th11. At 5 days after operation, an emergency operation was carried out to remove the epidural hematoma, which was noted at the Th5-Th9 vertebral level. The patient's clinical course was relatively favorable, and he was eventually able to walk with a stick. The cause of this acute hematoma remains unclear, but the following important factors might have been involved in its development: a transient bleeding tendency caused by intraoperative use of heparin as well as adverse effects to the epidural blood vessels due to an increased venous pressure following the surgical procedures. Our patient, fortunately, had no significant sequelae. However, when performing epidural anesthesia, it is necessary to keep in mind that epidural hematoma, though observed very rarely, may develop, particularly in patients with a tendency for bleeding.
The Tokai journal of experimental and clinical medicine 01/2006; 31(1):45-8.
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ABSTRACT: The choices for practical monitoring of free jejunal transfer have been quite limited because of its own characteristics, such as buried form, lack of skin surface, and the structure of a hollow viscous tract. Physiologically, it is known that tissue hypoxia caused by compromised perfusion leads to an increase of partial pressure of carbon dioxide (PCO2). Because of its physiological properties, the diffusion of carbon dioxide is always equilibrated between the mucosa of a hollow viscous organ and its lumen. The intramucosal PCO2 (PiCO2) of the gastrointestinal tract can therefore be determined indirectly from the intraluminal PCO2, which is measured with the aid of the tonometer catheter. To develop an optimal monitoring method for free jejunal transfer, the authors proposed the application of PiCO2 measurement by a modified use of a tonometer catheter. Since May of 1999, the authors performed postoperative PiCO2 monitoring on 20 cases of reconstructed pharyngoesophageal tracts in 18 patients who underwent radical tumor resection and one-stage reconstruction at the Shizuoka Red Cross Hospital. All 20 cases were safely monitored by PiCO2 measurement without any complications associated with the use of the tonometer catheter. In the 17 cases that succeeded uneventfully, the mean values of PiCO2 were kept lower than 40 mmHg throughout the monitoring period. On the other hand, the other three cases (15 percent) needed reexploration due to development of vascular complications, which was alerted by an abrupt increase of PiCO2 in each case (229, 130, and 99.6 mmHg). Two of the patients were fortunately successfully treated by immediate reexploration, leading to a 95 percent overall success rate. No false-negative or false-positive cases were observed. The authors' experience suggests that PiCO2 measurement using a tonometer catheter can provide the surgeon with reliable information for evaluating the perfusion and viability of a free jejunal transfer. Simplified manipulation and the objectivity of the numerical data allow stable measurement of PiCO2 and prompt judgment of the adequacy of the perfusion, which could minimize the burden and anxiety of the surgeon, particularly in the early postoperative period.
Plastic & Reconstructive Surgery 11/2003; 112(5):1247-56. · 3.38 Impact Factor
