[Show abstract][Hide abstract] ABSTRACT: Although sevoflurane and propofol are commonly used anesthetics in rabbits, optimal doses of remain unclear. We thus assessed the optimal hypnotic doses of sevoflurane and propofol, and evaluated the influence of dexmedetomidine on sevoflurane and propofol requirements.
Twenty-eight Japanese white rabbits were randomly assigned to one of four groups (n =7 each). Rabbits were given either sevoflurane, propofol, sevoflurane + dexmedetomidine, or propofol + dexmedetomidine (injected 30 mug[bullet operator]kg-1[bullet operator]hr-1 for 10 min followed by an infusion of 3.5 mug[bullet operator]kg-1[bullet operator]hr-1). Hypnotic level was evaluated with Bispectral Index (BIS), a well-validated electroenchalographic measure, with values between 40 and 60 representing optimal hypnosis. BIS measurements were made 10 minutes after the adjustment of target end-tidal sevoflurane concentration in the sevoflurane group and sevoflurane + dexmedetomidine group, and at 10 min after the change of infusion rate in the propofol group and propofol + dexmedetomidine group.
BIS values were linearly related to sevoflurane concentration and propofol infusion rate, with or without dexmedetomidine. Sevoflurane concentration at BIS =50 was 3.9 +/- 0.2% in the sevoflurane group and 2.6 +/- 0.3% in the sevoflurane + dexmedetomidine group. The propofol infusion rate to make BIS =50 was 102 +/- 5 mg[bullet operator]kg-1[bullet operator]hr-1in the propofol group, and 90 +/- 10 mg[bullet operator]kg-1[bullet operator]hr-1 in the propofol + dexmedetomidine group.
The optimal end-tidal concentration of sevoflurane alone was thus 3.9%, and optimal infusion rate for propofol alone was 102 mg[bullet operator]kg-1[bullet operator]hr-1. Dexmedetomidine reduced sevoflurane requirement by 33% and propofol requirement by 11%.
[Show abstract][Hide abstract] ABSTRACT: We measured the effect of Patent Blue dye on oxyhaemoglobin saturations after injection into breast tissue: 40 women had anaesthesia for breast surgery maintained with sevoflurane or propofol (20 randomly allocated to each). Saturations were recorded with a digital pulse oximeter, in arterial blood samples and with a cerebral tissue oximeter before dye injection and 10, 20, 30, 40, 50, 60, 75, 90, 105 and 120 min afterwards. Patent Blue did not decrease arterial blood oxyhaemoglobin saturation, but it did reduce mean (SD) digital and cerebral oxyhaemoglobin saturations by 1.1 (1.1) % and 6.8 (7.0) %, p < 0.0001 for both. The falsely reduced oximeter readings persisted for at least 2 h. The mean (SD) intra-operative digital pulse oxyhaemoglobin readings were lower with sevoflurane than propofol, 97.8 (1.2) % and 98.8 (1.0) %, respectively, p < 0.0001.
[Show abstract][Hide abstract] ABSTRACT: Rho-kinase inhibitor is widely used for prevention of cerebral vascular spasm. However, the cerebral pial vascular action of Rho-kinase inhibitor has not been investigated. We therefore evaluated the direct effects of Y-27632, a Rho-kinase inhibitor, on pial microvessels.
[Show abstract][Hide abstract] ABSTRACT: Femoral nerve block and sciatic nerve block are used to provide intraoperative and postoperative analgesia for total knee arthroplasty. Sciatic nerve block is contraindicated in our hospital, because orthopedists want to assess peroneal nerve function after the surgery. We retrospectively assessed postoperative analgesic effect and complications of the continuous femoral nerve block for total knee arthroplasty.
Masui. The Japanese journal of anesthesiology 08/2014; 63(8):872-6.
[Show abstract][Hide abstract] ABSTRACT: A 70-year-old man was scheduled to undergo laparoscopic total gastrectomy for stomach cancer. He had no history of atopy, fruit allergies, or frequent exposure to natural rubber. Preoperative latex-specific IgE antibodies were negative. Anesthesia was induced, and the surgery was started uneventfully. Soon after the surgeon had begun to manipulate the intestine, the blood pressure suddenly dropped to 27/21 mmHg. Facial flushing was also observed. Anaphylactic shock caused by latex was strongly suspected, and surgery was immediately halted. The surgical gloves were changed to latex-free ones, and adrenaline was administered. The blood pressure was gradually normalized within 30 min, and the facial flushing mostly disappeared. Postoperative laboratory examination revealed that serum tryptase had increased to 34.4 microg l-1, 40 minutes after the onset of anaphylaxis, and decreased to 19.4 microg l-1, 24 hours than later. Latex-specific IgE antibodies and a prick test with latex were both positive. Consequently, the diagnosis of latex-induced anaphylactic reaction was confirmed. Because even detailed questioning and examination does not always identify such a predisposition, avoiding contactwith latex products is more rational exhaustively checking every preoperative patient for latex allergy
Masui. The Japanese journal of anesthesiology 12/2013; 62(12):1469-71.
[Show abstract][Hide abstract] ABSTRACT: Wolf-Hirschhorn syndrome (WHS) is a rare chromosomal abnormality in which there is deletion of the short arm of chromosome no. 4. Features of the condition include severe psychomotor retardation, characteristic facies and various congenital midline fusion anomalies. We report the anesthetic management in a 6-year-old boy with WHS, scheduled for renal biopsy under general anesthesia. Anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Mask ventilation was performed easily. After establishment of mask ventilation, laryngeal mask airway (LMA) was inserted smoothly without muscle relaxant and an adequate airway was established with a LMA. He has episodes of transient deterioration in renal function with physical stress. To decrease renal effects of perioperative stress, transversus abdominis plane (TAP) block and intravenous patient controlled analgesia (IV-PCA) were administered for postoperative analgesia. The operation ended without any complications. Anesthetic emergence was rapid and he had no pain and decline in renal function.
Masui. The Japanese journal of anesthesiology 12/2013; 62(12):1466-8.
[Show abstract][Hide abstract] ABSTRACT: There are several causes of hypotension during anesthesia. We report a case of severe hypotension caused by external cardiac compression. A 72-year-old man was scheduled for resection of mediastinal tumor under general anesthesia. He had undergone mediastinal tumor resection four times uneventfully. Anesthesia was induced and maintained with target controlled infusion of propofol and continuous infusion of remifentanil. Tracheal intubation was facilitated with rocuronium. Massive bleeding and severe hypotension developed during the operation. Blood transfusion, cryoprecipitate, fresh frozen plasma, and percutaneous cardiopulmonary support were commenced. However, hemorrhage was not the only cause of hypotension. The transesophageal echocardiography revealed external cardiac compression by tumor and doctor's hand. Transesophageal echocardiography was useful for verifying the causes of hypotension. It is necessary to evaluate the causes of hypotension during the operation, because a certain number of problems may exist.
Masui. The Japanese journal of anesthesiology 02/2013; 62(2):204-8.
[Show abstract][Hide abstract] ABSTRACT: A case of high-frequency jet ventilation (HFJV) during video-assisted thoracoscopicsurgery (VATS) in a patient with previous contralateral pneumonectomy is presented. A 77yearold man with a right pneumothorax was scheduled for bullectomy by VATS. He had undergone left pneumonectomy due to lung cancer 6 years earlier.Anesthesia was induced and maintained with propofol and fentanyl. The patient was intubated with a normal, single-lumen endotracheal tube (ETT).HFJV was applied through the ETT during the VATS procedure. Although PaCO(2) gradually increased from 51.9 mmHg to 80.0 mmHg, appropriate surgical conditions were provided, PaO(2) was well preserved, and blood pressure and heart rate were stable throughout the VATS procedure.
Journal of clinical anesthesia 12/2012; · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 30-year-old pregnant woman (151 cm, 49 kg) with twin gestation who had got pregnant with frozen-thawed embryo transfer was scheduled to undergo cesarean section at 37 weeks of gestation. Combined spinal and epidural anesthesia was performed separately at the T12-L1 (epidural) and at the L3-4 interspace (spinal). The sensory anesthesia was extended to T2 and the operation was started. The cesarean delivery was uneventful and healthy 2,370 g and 2,334 g neonates were delivered. Five minutes after the delivery, placenta was removed manually from the uterus. Despite using oxytocin, methylergometrine and prostaglandin F2alpha, uterine contraction was severely impaired and massive bleeding occurred. General anesthesia was not commenced and packed red blood cells, fresh frozen plasma and cryoprecipitate were given. Uterus gradually contracted and the patient was transferred to the ward. However, massive bleeding continued postoperatively, and magnetic resonance imaging indicated retained placenta. Total hysterectomy was performed on the second postoperative day. Atonic bleeding and placental invasion should be the main causes of massive bleeding. Frozen-thawed embryo transfer might be one of the important factors for placental invasion. We have to prepare for massive bleeding during and after the cesarean section in patients receiving frozen-thawed embryo transfer.
Masui. The Japanese journal of anesthesiology 12/2012; 61(12):1373-5.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE Surgical trauma impairs intraoperative insulin sensitivity and is associated with postoperative adverse events. Recently, preprocedural statin therapy is recommended for patients with coronary artery disease. However, statin therapy is reported to increase insulin resistance and the risk of new-onset diabetes. Thus, we investigated the association between preoperative statin therapy and intraoperative insulin sensitivity in nondiabetic, dyslipidemic patients undergoing coronary artery bypass grafting. RESEARCH DESIGN AND METHODS In this prospective, nonrandomized trial, patients taking lipophilic statins were assigned to the statin group and hypercholesterolemic patients not receiving any statins were allocated to the control group. Insulin sensitivity was assessed by the hyperinsulinemic-normoglycemic clamp technique during surgery. The mean, SD of blood glucose, and the coefficient of variation (CV) after surgery were calculated for each patient. The association between statin use and intraoperative insulin sensitivity was tested by multiple regression analysis. RESULTS We studied 120 patients. In both groups, insulin sensitivity gradually decreased during surgery with values being on average ∼20% lower in the statin than in the control group. In the statin group, the mean blood glucose in the intensive care unit was higher than in the control group (153 ± 20 vs. 140 ± 20 mg/dL; P < 0.001). The oscillation of blood glucose was larger in the statin group (SD, P < 0.001; CV, P = 0.001). Multiple regression analysis showed that statin use was independently associated with intraoperative insulin sensitivity (β = -0.16; P = 0.03). CONCLUSIONS Preoperative use of lipophilic statins is associated with increased insulin resistance during cardiac surgery in nondiabetic, dyslipidemic patients.
Diabetes care 07/2012; 35(10):2095-9. · 7.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cushing's syndrome is extremely rare during pregnancy, because it often causes amenorrhea and infertility. We experienced a case of Cushing's syndrome in the 23rd week of pregnancy receiving laparoscopic surgery. It was difficult to control the blood pressure and heart rate, but we succeeded in the safe management of both mother and fetus.
Masui. The Japanese journal of anesthesiology 06/2012; 61(6):605-9.
[Show abstract][Hide abstract] ABSTRACT: Purpose: To evaluate the accuracy and precision of “deep-forehead” temperature with rectal, esophageal, and tympanic membrane temperatures,
compared with blood temperature.
Methods: We studied 41 ASA physical status 1 or 2 patients undergoing abdominal and thoracic surgery scheduled to require at least
three hours. “Deep-forehead” temperature was measured using a Coretemp® thermometer (Terumo, Tokyo, Japan). Blood temperature
was measured with a thermistor of a pulmonary artery. Rectal, tympanic membrane, and distal esophageal temperatures were measured
with thermocouples. All temperatures were recorded at 20 min intervals after the induction of anesthesia. We considered blood
temperature as the reference value. Temperatures at the other four sites were compared with blood temperature using correlation,
regression, and Bland and Altman analyses. We determined accuracy (mean difference between reference and test temperatures)
and precision (standard deviation of the difference) of 0.5°C to be clinically acceptable.
Results: “Deep-forehead” temperature correlated well with blood temperature as well as other temperatures, the determination coefficients
2) being 0.85 in each case. The bias for the “deep-forehead” temperature was 0.0°C which was the same as tympanic membrane
temperature and was smaller than rectal and esophageal temperatures. The standard deviation of the differences for the “deep-forehead”
temperature was 0.3°C, which was the same as rectal temperature.
Conclusions: We have demonstrated that the “deep-forehead” temperature has excellent accuracy and clinically sufficient precision as well
as other three core temperatures, compared with blood temperature.
Objectif: Évaluer l’exactitude et la précision de la température frontale «cutanée profonde» et les températures rectale, œsophagienne
et tympanique, comparées à la température du sang.
Méthode: L’étude a porté sur 41 patients d’état physique ASA I ou II devant subir une intervention chirurgicale abdominale et thoracique
d’au moins deux heurs. La température «cutanée profonde» a été mesurée à l’aide du thermomètre Coretemp® (Terumo, Tokyo, Japon).
Celle du sang a été prise avec une thermistance d’une artère pulmonaire et les températures rectale, tympanique et œsophagienne
distale, avec des thermocouples. Elles ont toutes été enregistrées à 20 min d’intervalle après l’induction de l’anesthésie.
La température du sang a servi de référence. Les températures des quatre autres sites ont été comparées avec celle du sang
à l’aide d’analyses de corrélation, de régression et des analyses de Bland et Altman. Nous avons reconnu une exactitude (différence
moyenne entre la température de référence et les autres) et une précision (écart type de la différence) de 0,5 °C près comme
une différence acceptable en clinique.
Résultats: La température «cutanée profonde» était en corrélation avec celle du sang, et avec celle des autres sites, le cofficient
de détermination (r
2) étant de 0,85 dans chaque cas. Le biais de la température «cutanée profonde» était de 0,0 °C, comme celui de la température
tympanique, et plus faible que ceux des températures rectale et œsophagienne. L’écart type de la différence pour la température
«cutanée profonde» était de 0,3 °C, comme pour la température rectale.
Conclusion: Nous avons démontré que la température frontale pronfonde présentait une grande exactitude et une précision utile suffisante,
autant que les trois autres températures centrales, comparée à la température du sang.
Canadian Journal of Anaesthesia 04/2012; 47(10):980-983. · 2.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We experienced a case of dilution coagulopathy successfully treated with cryoprecipitate. A seven-month-old male infant with tetralogy of Fallot and right femoral arteriovenous fistula had undergone a modified Blalock-Taussig shunt at 63 days of age. He was scheduled to undergo complete repair of TOF and closure of femoral arteriovenous fistula. The patient was transferred to the operating room with tracheal intubation. Anesthesia was induced with midazolam and fentanyl and maintained with sevoflurane and fentanyl. Before cardiopulmonary bypass (CPB), femoral arteriovenous fistula was corrected. Then complete repair of TOF was performed under CPB. Massive bleeding was observed and laboratory results showed low plasma fibrinogen level (45 mg x dl(-1)). Cryoprecipitate 2 units were given and fibrinogen level was restored (171 mg x dl(-1)). Bleeding quickly slowed down sufficiently for weaning from CPB. The patient was separated easily from CPB on dopamine and dobutamine infusion. Post-CPB bleeding was minimal and the patient was transferred to intensive care unit. The patient was discharged from the hospital on postoperative day 50. In the present case, dilution coagulopathy occurred as a result of the combination of excessive fluid infusion due to massive bleeding and blood dilution due to CPB. Fresh frozen plasma could have been contraindicated to supplement fibrinogen because the patient's body weight was low. Cryoprecipitate, a highly concentrated source of fibrinogen, was effective for correcting fibrinogen deficit.
Masui. The Japanese journal of anesthesiology 04/2012; 61(4):404-6.
[Show abstract][Hide abstract] ABSTRACT: We present the case of cardiac arrest in a patient with neurally mediated syncope (NMS). A 66-year-old male patient was scheduled to undergo right inguinal hernioplasty. He had a history of syncope, which occurred a few times a year in childhood and once a year recently. One minute after the second spinal injection, cardiac arrest (asystole) developed. Sinus rhythm was restored by cardiac massage and intravenous administration of atropine and ephedrine. The operation was cancelled. The patient was diagnosed as NMS by a cardiologist. Four months later, right inguinal hernioplasty was performed, uneventfully, under general anesthesia. High sympathetic blockade due to spinal anesthesia and transient withdrawal of sympathetic tone and increase in vagal discharge due to NMS could be the main causes of the cardiac arrest. If the patient has any possibility of NMS, anesthesiologists should consider the possibility of cardiac arrest after spinal anesthesia.
Journal of Anesthesia 02/2012; 26(1):103-6. · 1.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An 83-year-old man (158 cm, 42 kg) was scheduled for cholecystectomy. He had a history of hypertension and atrial fibrillation. The patient received no premedication. An epidural catheter was inserted via the T9-10 interspace and 2% mepivacaine 7 ml was injected, producing a sensory block from T4 to T12. Anesthesia was induced with propofol and remifentanil, and was maintained with propofol, remifentanil, and nitrous oxide in oxygen. Rocuronium was given to provide neuromuscular block. Just before the completion of surgery, a bolus epidural injection of 2% mepivacaine 2 ml with fentanyl 50 microg was performed. Then epidural solution of ropivacaine 0.1% with fentanyl 6.25 microg x ml(-1), and droperidol 25 microg x ml(-1) was infused at 4 ml x hr(-1). Soon after the surgery, the patient developed atrial fibrillation that was treated with external electrocardioversion with 100 watt x sec. After the restoration of sinus rhythm, anesthetics were discontinued. The patient did not emerge from anesthesia though he breathed spontaneously Doxapram was slightly effective, but he did not respond to the verbal command. Epidural infusion was stopped and the patient was transferred to the ward. The patient fully recovered from anesthesia after 2 hours. Epidural infusion was restarted 17 hours later, and the patient fell asleep. He woke up after stopping epidural infusion. Epidurally administered fentanyl must have been the cause of delayed recovery from anesthesia. He could have been highly sensitive to fentanyl. Patient controlled epidural anesthesia may have been useful for this patient.
Masui. The Japanese journal of anesthesiology 01/2012; 61(1):85-7.
[Show abstract][Hide abstract] ABSTRACT: Body temperature regulation is at the basis of life maintenance and for humans to maintain the central body temperature within the range of 37 +/- 0.2 degrees Celsius. In the case of anesthesia, a patient would have a high possibility of lower body temperature and also could have more complications with low body temperature. In addition, it would generate more complications and extend a period of hospitalization. For that reason, anesthetists must pay full attention to body temperature management during surgery. Measurement for central body temperature is necessary as a monitor for body temperature measurement and the measurement for nasopharyngeal temperature, tympanic temperature, and lung artery temperature is effective for this purpose. Therapeutic hypothermia for brain injury is receiving attention recently as a preventive method for brain disorder and the method is utilized in hospital facilities. In future, it is expected to attain the most suitable treatment method by clinical studies on low body temperature.
Masui. The Japanese journal of anesthesiology 01/2012; 61(1):42-6.
[Show abstract][Hide abstract] ABSTRACT: We present a case of diltiazem intoxication resulting in repeated asystole after the induction of anesthesia. A 39-year-old man was diagnosed as subarachnoid hemorrhage, and cerebral aneurysm clipping was scheduled on the next day. Electrocardiogram revealed normal sinus rhythm with complete right bundle branch block. Continuous intravenous administration of diltiazem, nicardipine and midazolam were started for intractable hypertension and tachycardia. In the operating room, electrocardiogram showed atrioventricular nodal rhythm. Nicardipine and midazolam were stopped and anesthesia was induced with thiamylal, fentanyl and vecuronium, and was maintained with sevoflurane. After tracheal intubation, the patient developed asystole, and cardiopulmonary resuscitation was provided immediately. Diltiazem was stopped. Cardiac rhythm was restored 8 min afterwards; however, asystole recurred six times. Temporary cardiac pacing was effective, and percutaneous cardiopulmonary support (PCPS), intraaortic balloon pumping (IABP), and continuous hemodiafiltration (CHDF) were initiated. The operation was canceled. On the next day, normal sinus rhythm was restored and the temporary pacing, PCPS, IABP, and CHDF were discontinued. Cerebral aneurysm was treated by endovascular coiling and the patient was discharged from the hospital without sequelae. This case illustrates asystole associated with diltiazem intoxication. It is necessary to consider this potential complication when diltiazem is used.
Masui. The Japanese journal of anesthesiology 01/2012; 61(1):104-7.
[Show abstract][Hide abstract] ABSTRACT: Background / Purpose:
Recent evidence has demonstrated an increased incidence of developing type 2 diabetes mellitus with the use of lipophilic statins (1). Decreased insulin sensitivity is an independent risk factor for perioperative complications (2). Here, we investigated the effect of preoperative statin intake on insulin sensitivity during elective cardiac surgery.
In non-diabetic hypercholesterolemic patients undergoing coronary artery bypass graft (CABG) surgery, perioperative statin therapy exacerbated insulin resistance associated with the surgery.
[Show abstract][Hide abstract] ABSTRACT: There is accumulating evidence that the activation of spinal glial cells, especially microglia, is a key event in the pathogenesis of neuropathic pain. However, the inhibition of microglial activation is often ineffective, especially for long-lasting persistent neuropathic pain. So far, neuropathic pain remains largely intractable and a new therapeutic strategy for the pain is still required.
Using Seltzer model mice, we investigated the temporal aspect of two types of neuropathic pain behaviors, i.e., thermal hyperalgesia and mechanical allodynia, as well as that of morphological changes in spinal microglia and astrocytes by immunohistochemical studies. Firstly, we analyzed the pattern of progression in the pain behaviors, and found that the pain consisted of an "early induction phase" and subsequent "late maintenance phase". We next analyzed the temporal changes in spinal glial cells, and found that the induction and the maintenance phase of pain were associated with the activation of microglia and astrocytes, respectively. When Bushi, a Japanese herbal medicine often used for several types of persistent pain, was administered chronically, it inhibited the maintenance phase of pain without affecting the induction phase, which was in accordance with the inhibition of astrocytic activation in the spinal cord. These analgesic effects and the inhibition of astrocytic activation by Bushi were mimicked by the intrathecal injection of fluorocitrate, an inhibitor of astrocytic activation. Finally, we tested the direct effect of Bushi on astrocytic activation, and found that Bushi suppressed the IL-1β- or IL-18-evoked ERK1/2-phosphorylation in cultured astrocytes but not the ATP-evoked p38- and ERK1/2-phosphorylation in microglia in vitro.
Our results indicated that the activation of spinal astrocytes was responsible for the late maintenance phase of neuropathic pain in the Seltzer model mice and, therefore, the inhibition of astrocytic activation by Bushi could be a useful therapeutic strategy for treating neuropathic pain.
PLoS ONE 09/2011; 6(8):e23510. · 3.53 Impact Factor