Publications (9)29.92 Total impact
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Article: Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression
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ABSTRACT: Purpose: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians’ guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Methods: Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird random-effects model. Results: Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI=1.29–1.54,P<0.001), and that for one-year mortality was 1.32 (95% CI=1.21–1.43,P<0.001). Conclusions: In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young. Objectif: Le taux de mortalité associée à la fracture de la hanche est élevé chez les patients âgés. Les Directives du Collège royal des médecins recommandent une intervention chirurgicale de réparation de la hanche dans les 24 h suivant l’admission ; cependant, l’effet d’un délai opératoire sur le taux de mortalité demeure controversé. L’objectif de cette étude était de déterminer si un délai opératoire augmentait le taux de mortalité chez les patients âgés souffrant de fracture de la hanche. Méthode: Les bases de données électroniques nous ont permis d’identifier les comptes-rendus publiés en anglais étudiant l’effet d’un délai chirurgical sur le taux de mortalité des patients subissant une chirurgie de la hanche. Nous avons défini le critère principal comme la mortalité associée à toutes causes à 30 jours et à un an. Les effets de taille avec des intervalles de confiance à 95 % correspondants ont été calculés en utilisant le modèle de DerSimonian-Laird à effets aléatoires. Résultats: Seize études d’observation prospectives et rétrospectives (257,367 patients) traitant du délai de la chirurgie et du taux de mortalité chez des patients souffrant de fracture de la hanche ont été sélectionnées. Lorsqu’un seuil de 48 h depuis l’heure d’admission du patient était utilisée pour définir le délai opératoire, le rapport de cotes pour la mortalité à 30 jours était de 1,41 (95 % IC=1,29–1,54, P<0,001), et le rapport de cotes pour la mortalité à un an atteignait 1,32 (95 % IC=1,21–1,43, P<0,001). Conclusions: Chez les patients atteints d’une fracture de la hanche, un délai opératoire de plus de 48 h depuis l’heure d’admission pourrait faire augmenter les risques de mortalité, toutes causes confondues, à 30 jours de 41 %, et de mortalité à un an, toutes causes confondues, de 32 %. Dans les études d’observation, des facteurs confondants résiduels potentiels pourraient empêcher d’arriver à des conclusions définitives. Bien qu’il soit difficile d’effectuer les chirurgies de routine en moins de 48 h dans la plupart des établissements, les anesthésiologistes devraient avoir conscience qu’un délai excessif pourrait être néfaste pour les patients atteints d’une fracture de la hanche, particulièrement pour ceux à faible risque ou qui sont jeunes.Canadian Journal of Anaesthesia 04/2012; 55(3):146-154. · 2.35 Impact Factor -
Article: The prediction of effect of lumbar epidural anesthesia
Canadian Journal of Anaesthesia 04/2012; 48(11):1168-1169. · 2.35 Impact Factor -
Article: The relationship between the efficacy of epidural anesthesia and the concentration of lidocaine in cerebrospinal fluid.
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ABSTRACT: Addition of bicarbonate to local anesthetics improves the efficacy of epidural anesthesia. We evaluated whether the addition of bicarbonate to lidocaine enhanced pain threshold in cesarean section. We speculated that bicarbonate would increase the concentration of lidocaine in cerebrospinal fluid (CSF). To examine this possibility, we evaluated the relationship between the lidocaine concentration in the CSF and the pain threshold. Twenty eight full-term parturients undergoing cesarean section under epidural anesthesia at L2-3 were divided into two groups: the first group (lidocaine group) received 17 mL of 2% lidocaine-epinephrine (1:200,000) and the second group (lidocaine-bicarbonate group) received the same concentration of lidocaine-epinephrine supplemented bicarbonate. Twenty min after administration of local anesthetics, we collected 1 mL samples of the CSF. The pain threshold after the repeated electrical stimulation was used to assess sensory blockade at the L2, S1, and S3 dermatomes. Demographic data were comparable between the groups. There were no differences in the pain threshold at all dermatomes and the lidocaine concentration between the groups. There was a significant correlation between the pain threshold and the lidocaine concentration at the combined S1 and S3 dermatomes in the lidocaine-bicarbonate group. We find neither bicarbonate caused a significant difference in the efficacy of epidural anesthesia nor it caused an increase of lidocaine concentration in the CSF. The result that we found a significant correlation between the lidocaine concentration in the CSF and the pain threshold at the sacral region in the lidocaine bicarbonate group suggests that, bicarbonate enhances the efficacy of anesthesia at outside of spinal canal.Medical science monitor: international medical journal of experimental and clinical research 03/2009; 15(3):CR95-100. · 1.70 Impact Factor -
Article: Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.
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ABSTRACT: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians' guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird randomeffects model. Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI = 1.29-1.54, P < 0.001), and that for one-year mortality was 1.32 (95% CI = 1.21-1.43, P < 0.001). In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.Canadian Journal of Anaesthesia 03/2008; 55(3):146-54. · 2.35 Impact Factor -
Article: Influence of intraoperative conversion from off-pump to on-pump coronary artery bypass grafting on costs and quality of life: a cost-effectiveness analysis.
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ABSTRACT: Off-pump coronary artery bypass (OPCAB) surgery has become a widely accepted alternative to standard coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass; however, the influence of intraoperative conversion from OPCAB to standard CABG on costs and quality of life is unclear. The objective of this study was to determine whether intraoperative conversion affects costs and quality of life. A decision-analysis model and Monte Carlo simulation. The US healthcare system over a maximum 10-year lifetime horizon. A hypothetical cohort of 60-year-old male patients undergoing elective OPCAB surgery or standard CABG surgery. Each patient was entered into the decision tree with varying transition probabilities. Outcome measures included quality-adjusted life-years (QALYs) and costs in US dollars. In base-case analysis, OPCAB surgery led to a discounted lifetime cost of $91,282 and 7.64 discounted QALYs, and standard CABG surgery led to $91,685 and 7.52 QALYs. Patients who required conversion from off-pump to on-pump surgery incurred a cost of $103,909 and gained 6.63 QALYs. OPCAB is dominant (less costly and more effective) if the conversion rate is below 8.5%, whereas costs increase exponentially if the probability of conversion exceeds 15%. Sixty-one percent of the Monte Carlo simulations favored cost-effectiveness of the OPCAB strategy. In low-risk patients, OPCAB surgery, in comparison to standard CABG surgery, would increase QALYs by reducing complications related to cardiopulmonary bypass, but it would result in lifetime costs similar to those of standard CABG surgery. The benefit of OPCAB may be offset by the risk of intraoperative conversion.Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):793-9. · 1.64 Impact Factor -
Article: Pharmacokinetics/pharmacodynamics of acetaminophen analgesia in Japanese patients with chronic pain.
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ABSTRACT: Acetaminophen (APAP) is a popular analgesic. In the present study, we characterized the pharmacokinetics and pharmacodynamics of APAP in the Japanese. Five healthy volunteers were administered 1000 mg of APAP orally. Five patients with chronic pain were administered the optimal oral dose of APAP ranging from 600 to 1000 mg to allow for an adequate analgesic effect. Plasma APAP and APAP metabolite concentrations were measured in the volunteers, plasma APAP concentrations and pain scores using a visual analog scale were measured in the patients with chronic pain. Patient data were fitted to a first-order absorption one-compartment model with delayed effects accounted for by an effect compartment. A sigmoid Emax model was used as the pharmacodynamic model. Acetaminophen-cysteine metabolites, which are conjugates of the toxic metabolite N-acetyl-p-benzoquinone-imine, were detected in the plasma at levels lower than 0.2 microg/ml, but no side effects were observed. The pharmacokinetic and pharmacodynamic parameter (mean+/-S.D.) estimates were as follows: clearance, 18.7+/-4.7 l/h; distribution volume, 30.9+/-6.8 l; absorption rate constant, 2.4+/-1.3 h(-1); rate constant for the elimination of APAP from the effect compartment, 1.3+/-0.5 h(-1); maximum pain relief score, 4.6+/-2.2 units; effect compartment concentration at 50% maximum, 2.0+/-1.2 microg/ml; and sigmoid factor, 1.3+/-0.7. These results suggest that these parameters can be used to determine an effective APAP dosage regimen for Japanese patients with chronic pain.Biological & Pharmaceutical Bulletin 02/2007; 30(1):157-61. · 1.66 Impact Factor -
Article: Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis.
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ABSTRACT: Patients with suspected thoracic aortic dissection require early and accurate diagnosis. Aortography has been replaced by less invasive imaging techniques including transesophageal echocardiography (TEE), helical computed tomography (CT), and magnetic resonance imaging (MRI); however, accuracies have varied from trial to trial, and which imaging technique should be applied to which risk population remains unclear. We systematically reviewed the diagnostic accuracy of these imaging techniques in patients with suspected thoracic aortic dissection. Published English-language reports on the diagnosis of thoracic aortic dissection by TEE, helical CT, or MRI were identified from electronic databases. Sensitivity, specificity, and positive and negative likelihood ratios were pooled in a random-effects model. Sixteen studies involving a total of 1139 patients were selected. Pooled sensitivity (98%-100%) and specificity (95%-98%) were comparable between imaging techniques. The pooled positive likelihood ratio appeared to be higher for MRI (positive likelihood ratio, 25.3; 95% confidence interval, 11.1-57.1) than for TEE (14.1; 6.0-33.2) or helical CT (13.9; 4.2-46.0). If a patient had shown a 50% pretest probability of thoracic aortic dissection (high risk), he or she had a 93% to 96% posttest probability of thoracic aortic dissection following a positive result of each imaging test. If a patient had a 5% pretest probability of thoracic aortic dissection (low risk), he or she had a 0.1% to 0.3% posttest probability of thoracic aortic dissection following a negative result of each imaging test. All 3 imaging techniques, ie, TEE, helical CT, and MRI, yield clinically equally reliable diagnostic values for confirming or ruling out thoracic aortic dissection.Archives of Internal Medicine 08/2006; 166(13):1350-6. · 11.46 Impact Factor -
Article: Epidural bolus injection with alkalinized lidocaine improves blockade of the first sacral segment--a brief report.
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ABSTRACT: It has been reported that the addition of epinephrine and/or bicarbonate to local anesthetic enhances the depth of epidural blockade and that initial partial bolus injection results in greater caudal spread. We evaluated the anesthetic effects of lidocaine with epinephrine and/or bicarbonate injected into the epidural space by bolus or catheter injection. Forty-four patients undergoing epidural anesthesia with 17 mL of 2% lidocaine containing 1:200,000 epinephrine at L4-5 or L5-S1 were randomly divided into four groups. Lidocaine was administrated via epidural catheter [lidocaine catheter (LC) group] or Tuohy needle (lidocaine bolus group), lidocaine-bicarbonate was administrated via catheter (lidocaine-bicarbonate catheter group) or needle [lidocaine-bicarbonate bolus (LBB) group]. Pain threshold after repeated electrical stimulation was performed at L2 and S1 regions. Motor blockade was evaluated using the Bromage scale. Sympathetic blockade was assessed with plethysmographic waveforms from the toe. The pain threshold of the S1 dermatome in LBB group was significantly higher than in the lidocaine only groups, however, differences in the pain threshold at the L2 dermatome among the groups were insignificant. The onset of sensory blockade in the S1 dermatome in the LBB group was significantly shorter than in the LC group. Significantly greater motor blockade was achieved in the lidocaine-bicarbonate groups than in the lidocaine-only groups. The amplitude of plethysmographic waveforms significantly increased within each group. Epidural bolus injection of lidocaine-bicarbonate with epinephrine improves the pain threshold and speeds the onset of the blockade of the first sacral region.Canadian Journal of Anaesthesia 49(6):566-70. · 2.35 Impact Factor -
Article: Efficacy of 1% ropivacaine at sacral segments in lumbar epidural anesthesia.
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ABSTRACT: It is suggested that the potency of 1% ropivacaine is comparable to that of 0.75% bupivacaine and higher than that of 2% lidocaine. Alkalinized lidocaine reportedly enhances the block of sacral segments during lumbar epidural anesthesia. We hypothesized that 1% ropivacaine might also block at the lumbosacral segments adequately during lumbar epidural anesthesia. Forty-two patients undergoing lumbar epidural anesthesia at L4-5 or L5-S1 were randomly divided into 3 groups and received either 14 mL 2% lidocaine (lidocaine group), 2% lidocaine with epinephrine 1:200,000 and bicarbonate (lidocaine-epinephrine-bicarbonate group), or 1% ropivacaine (ropivacaine group). Pain threshold after repeated electrical stimulation was used to assess sensory block at the L2, S1, and S3 segments while motor block was evaluated using the modified Bromage Scale. Demographic data were comparable between the groups. Significant differences in the pH of each local anesthetic solution were found between the 3 groups. Pain thresholds at the S1 and S3 segments in the lidocaine-epinephrine-bicarbonate group were significantly higher and sensory block onset faster than in the other groups. However, no significant differences were found in either the pain threshold or the onset of sensory block of the L2 segment between the groups. No significant differences in the pain threshold, onset of sensory block, or Bromage Scale were found between the lidocaine and ropivacaine groups. We conclude that 1% ropivacaine does not improve block of sacral segments within 20 minutes following epidural ropivacaine administration.Regional Anesthesia and Pain Medicine 28(3):208-14. · 4.08 Impact Factor
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2007–2012
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Toho University
Funabashi, Chiba-ken, Japan
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