A Miyata

Hachinohe Heiwa Hospital, 八戸, Aomori Prefecture, Japan

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Publications (21)18.18 Total impact

  • Takeshi Kubota, Akimasa Miyata
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    ABSTRACT: We herein report a case of postoperative respiratory failure caused by acute exacerbation of undiagnosed interstitial pneumonia (IP). A 76-year-old woman underwent two subsequent operations, cholecystectomy and resection of lipoma in the neck, under general anesthesia at an interval of 12 days. Although the postoperative course of the first operation was uneventful, the patient abruptly developed respiratory failure on the 4th postoperative day (POD) of the second operation. Although steroid therapy was transiently effective to improve oxygenation, respiratory failure was gradually deteriorated. She died on the 25th POD. She had a past history of right upper lobectomy for pseudotumor resulting from cryptogenic organizing pneumonia in another hospital 4 years ago. The follow-up CT performed in this hospital demonstrated subtle foci of ground-glass opacities in the left lung; however, no diagnosis of IP had been made. Thus, we concluded that idiopathic IP had gradually advanced preoperatively, and acute exacerbation was triggered by perioperative stress. The present case warned us that acute exacerbation of IP could occur in a patient with mild symptoms. Therefore, preoperative proper diagnosis is thought to be important as acute exacerbation of IP is a highly morbid clinical event.
    Journal of Anesthesia 06/2011; 25(3):422-5. · 1.12 Impact Factor
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    ABSTRACT: Spontaneous hemothorax in the left pleural space occurred suddenly in a patient with thrombotic thrombocytopenic purpura (TTP). In spite of massive blood transfusion, the hemorrhage could not be stopped. The patient suffered shock due to tension hemothorax and hypovolemia, resulting in cardiac arrest. After successful cardiopulmonary resuscitation, surgical hemostasis was performed. The main cause of the bleeding was rupture of the left intercostal vein. TTP is a severe microvascular occlusive thrombotic microangiopathy that can induce congestion, vasculitis, and ischemia. This mechanism is thought to have been involved in the rupture of the intercostal vein in the present patient.
    Journal of Anesthesia 02/2009; 23(1):129-31. · 1.12 Impact Factor
  • Takeshi Kubota, Akimasa Miyata
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    ABSTRACT: A 71-year old man with failed back syndrome was admitted to hospital with oliguria that had occurred 4 days after his dose of paroxetine had been increased to 40 mg x day(-1). Laboratory data on admission revealed hyponatremia (124 mmol x l(-1)), low serum osmolarity (267 mOsm x l(-1)) with a normal level of serum antidiuretic hormone (1.7 pg x ml(-1)), and concentrated urine (430 mOsm x l(-1)). He was diagnosed as having syndrome of inappropriate secretion of antidiuretic hormone, associated with paroxetine; this drug was discontinued immediately after admission. The hyponatremia was treated with saline infusion, water restriction, and furosemide; serum sodium level returned to normal on hospital day 5. Paroxetine is being increasingly used for depression and chronic pain management because of its favorable side-effect profile; however, we should be alert to hyponatremia in patients on paroxetine by carrying out periodic monitoring of serum electrolytes, especially in elderly patients.
    Journal of Anesthesia 02/2006; 20(2):126-8. · 1.12 Impact Factor
  • Takeshi Kubota, Akimasa Miyata
    Journal of Pain and Symptom Management 12/2005; 30(5):397-9. · 2.74 Impact Factor
  • Takeshi Kubota, Akimasa Miyata
    Clinical Toxicology 06/2005; 43(4):305-308. · 3.12 Impact Factor
  • Takeshi Kubota, Akimasa Miyata
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    ABSTRACT: We report 43 cases of chlorodifluoromethane (Freon-22) intoxication that occurred on August 5, 2003 when a freezer in a seafood factory exploded. In this accident, 80 workers were exposed to Freon-22 gas and 43 workers developed symptoms and were transferred to six hospitals. Neurological symptoms including dizziness, headache, and nausea were most frequently observed (40 of 43 patients). One patient was comatose but recovered within 1 h with oxygen inhalation. Airway and respiratory symptoms including dysesthesia of the tongue, pharyngitis, and shortness of breath were also frequently observed (26 of 43 patients). These symptoms disappeared within a few days in all patients. There were no fatalities. Although Freon-22 has been considered to be a chlorofluorocarbon of relatively low toxicity, this incident suggests that potentially significant toxic effects may occur following large exposures.
    Clinical Toxicology 02/2005; 43(4):305-8. · 3.12 Impact Factor
  • Takeshi Kubota, Akimasa Miyata
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    ABSTRACT: Shakuyaku-kanzo-to (SKT) is a traditional herbal medicine that is widely used for muscular cramp and abdominal pain. We administered SKT for a patient with thoracic outlet syndrome (TOS) complaining of several resting symptoms. A 28-year-old female patient complained of intractable pain in the left arm, shoulder, and back and weakness, numbness, and muscular cramp in the left arm. She was diagnosed as TOS by digital subtraction angiography. Two days after the start of administration of SKT, her severe pain was markedly improved. Although numbness of the left arm was not improved, her overall pain score was reduced by 2 on the 7th day after the start of SKT. SKT has several pharmacological effects including analgesic and antiinflammatory effects, vasodilation, and muscle relaxation. Thus, our report suggests that SKT could be a first-line agent for the conservative treatment of TOS.
    Journal of Anesthesia 02/2005; 19(2):157-9. · 1.12 Impact Factor
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    ABSTRACT: Total intravenous anesthesia with propofol, fentanyl and ketamine (PFK) was given to two patients complicated with myotonic dystrophy. Case-1: A 42-year-old female underwent a hemithyroidectomy. Anesthesia was induced slowly with intravenous ketamine 20 mg and propofol 60 mg. Her tracheal intubation was performed smoothly without any muscle relaxants. Anesthesia was maintained with propofol infusion of 5 mg.kg-1.h-1, ketamine infusion of 0.3 mg.kg-1.h-1 and fentanyl 200 micrograms in total. She regained consciousness 20 minutes after the end of propofol infusion, and 15 minutes later, her trachea was extubated without any troubles. Case-2: A 41-year-old female underwent a removal of left parotid tumor. Anesthesia was induced slowly with ketamine 40 mg and propofol 100 mg intravenously. Anesthesia was maintained with propofol infusion of 5-10 mg.kg-1.h-1, ketamine infusion of 0.5 mg.kg-1.h-1 and fentanyl 350 micrograms in total. No muscle relaxant was used through the surgical procedure. Emergence from anesthesia was observed 10 minutes after the end of propofol infusion and her trachea was extubated. When a nasogastric tube was pulled out, her respiration stopped suddenly and she was intubated again only for two hours without any troubles. In both cases their serum CPK levels and rectal temperatures were very stable. PFK method would be a choice for patients with myotonic dystrophy.
    Masui. The Japanese journal of anesthesiology 03/1999; 48(2):181-4.
  • Journal of Anesthesia 02/1999; 13(1):44-7. · 1.12 Impact Factor
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    ABSTRACT: PurposeAs the middle-ear cavity is one of the noncompliant gas-filled cavities, an increase in middle-ear pressure (MEP) instead of volume expansion is observed with inhalation of nitrous oxide (N2O). Changes in MEP cause many complications, such as ear pain, temporary hearing impairment, and postoperative emesis. Therefore, we investigated changes in MEP during total intravenous anesthesia (TIVA) with propofol, fentanyl, and ketamine (PFK) and inhalation of N2O. MethodsTwelve patients were anesthetized with PFK until 60 min after the induction of anesthesia, and then N2O (60%) inhalation was started. MEP was measured by impedance audiometry (ranging from −300 daPa to +200 daPa) at 10-min intervals during PFK, and at 2-min intervals after the inhalation of N2O. ResultsMEP gradually but significantly increased from the preanesthetic value of 16±8 to 34±12 (SEM) daPa 50 min after the induction of PFK. However, MEP did not exceed the normal limit. The values of MEP in all patients were more than 200 daPa within 36 min after the start of inhalation of N2O in oxygen. ConclusionPFK had a minimal effect on MEP, whereas addition of N2O to PFK increased MEP dramatically. Therefore, TIVA, or at least PFK, would be a better choice for patients with middle-ear or upper-airway diseases.
    Journal of Anesthesia 03/1998; 12(1):17-20. · 1.12 Impact Factor
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    ABSTRACT: PurposeContinuous haemodiafiltration (CHDF) is a technique enhancing the efficiency of solute clearance of continuous haemofiltration by infusing dialysis fluid through the haemofilter. It has been reported to control water and electrolyte balance continuously without haemodynamic instability in critically ill patients with renal failure. Therefore, we used CHDF during and after cardiopulmonary bypass (CPB) in two renal failure patients, and discuss its efficacy. Clinical featuresThe first patient undergoing aortic valve replacement had dialysis-dependent renal failure. Chronic renal failure in the second patient undergoing mitral valve replacement and coronary revasculanzation was controlled preoperatively with diuretics. In both cases, CHDF was performed not only during CPB but also in the post-CPB period. Serum concentrations of potassium, urea and creatmine were well-controlled in spite of large amount of blood transfused in the post-CPB penod (1000 ml fresh blood and 400 ml fresh frozen plasma in the fist patient, and 1400 ml fresh blood in the second patient). There was no difficulty in haemostasis dunng the use of nafamostat mesilate as an anticoagulant to keep activated clotting time at about 150 sec for CHDF in the post-CPB period. ConclusionOur initial expenences of CHDF dunng and after CPB suggest that the technique provides excellent electrolyte, metabolite and fluid management for the cardiac patients with chronic renal failure. Combined with nafarnostat mesilate for anticoagulation, CHDF was simple and safe and did not increase the nsk of bleeding. ObjectifLa technique de l’hémodiafittration continue (HDFC) permet d’améliorer la clairance du soluté d’hémofiltration continue en perfusant le liquide de dyalise à travers un hémofiltre. Cette technique pourrait contrôler l’équilibre hydroélectrolytique en continu sans provoquer d’instabilité hémodynamique chez les insuffisants rénaux graves. L’utilisation de l’HDFC chez deux insuffisants rénaux pendant et après la circulation extracorporelle (CEC) nous offre l’occasion d’en discuter l’efficacité. Éléments cliniquesLe premier patient opéré pour un remplacement valvulaire aortique souffrait d’une insuffisance rénale nécessitant dyalise. L’insuffisance rénale chronique du deuxième patient soumis à un remplacement valvulaire mitral et à une chirurgie de revascularisation myocardique était contrôlée en préopératoire par des diurétiques. Dans les deux cas. nous avons utilisé l’HDFCnon seulement avant mais aussi après la CEC. Nous avons réussi à contrôler les concentrations sériques du potassium, de l’urée et de la créatinine malgré les grandes quantités de sang transfusées à la pénode post-CEC (l 000 ml de sang frais et 400 ml de plasma frais congelé pour le premier patient et l 400 ml de sang frais pour le second patient). L’hémostase s’est maintenue pendant l’anticoagulation au mésilate de nafamostat administré à la pénode post-CEC de façon à conserver sous HDFC un temps de coagulation à 150 s environ. ConclusionNos essais initiaux avec l’HDFC suggèrent que cette technique procure un excellent contrôle hydroélectrolytique et métabolique chez le patient cardiaque atteint d’insuffisance rénale chronique. Associée au mésilate de nafamostat pour I anticoagulation. l’HDFC s’est avérée sécuritaire et n’a pas augmenté le nsque de saignement.
    Canadian Journal of Anaesthesia 10/1997; 44(11):1182-1186. · 2.50 Impact Factor
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    ABSTRACT: This study aimed to investigate the effect of 150 ml of either tea or apple juice on the volume and pH of gastric contents in 40 elective surgical patients, ranging in age from 18 to 70 years. They were given diazepam 5 approximately 10 mg and roxatidine 75 mg orally 2 hours before the start of isoflurane anesthesia or modified neuroleptic anesthesia. Immediately following the induction of anesthesia with thiopental and vecuronium, a nasogastric tube was placed to aspirate the gastric content to measure its volume and pH. The volume and pH of gastric contents were 6.4 +/- 8.5 ml, 6.0 +/- 2.2 in tea group and 17.1 +/- 18.4 ml, 4.4 +/- 2.6 in apple juice group, respectively. There was a significant difference in the gastric volume between the two groups (P < 0.05), while no significant difference in gastric pH was observed. This result suggests that apple juice is not appropriate as preoperative drink because apple juice increases gastric contents, and may cause aspiration pneumonia.
    Masui. The Japanese journal of anesthesiology 08/1996; 45(8):967-70.
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    ABSTRACT: The effect of preoperative oral fluid intake on the volume and pH of gastric fluid was examined in 45 elective surgical patients ranged in ages from 18 to 70 years. Two hours preoperatively they all received oral roxatidine 75 mg with 10 ml water, immediately followed by 150 ml oral water or 150 ml refreshing drink or no fluid as control. Just after the induction of anesthesia, a Salem-sump tube was put down to the stomach to collect gastric fluid in each patient. The volume and pH of gastric fluid taken were 10.9 +/- 7.9 ml, 16.3 +/- 2.3 in control group, 8.0 +/- 6.0 ml, 6.2 +/- 2.4 in the water group and 6.3 +/- 6.0 ml, 7.1 +/- 1.7 in the refreshing drink group. As there were no significant differences in gastric pH values in the three groups, the highest value was found in the refreshing drink group. No significant difference in VAS of hungry and thirsty feeling was found among the three groups. We conclude that preoperative oral water or refreshing drink with roxatidine 75 mg 2 hours before the start of anesthesia may not increase the risk of aspiration during the induction of anesthesia.
    Masui. The Japanese journal of anesthesiology 03/1996; 45(2):200-4.
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    ABSTRACT: We reported our intensive care experience of a postpartum patient with HELLP syndrome. We administered haptoglobin immediately after the delivery in order to prevent renal insufficiency following hemoglobinuria. Continuous veno-venous hemofiltration was undertaken and plasma exchange was also employed to overcome hepatorenal insufficiency. After these procedures an improvement was observed in her hepatic and renal functions. Administration of haptoglobin and blood purification would be beneficial for patients complicated with HELLP syndrome.
    Masui. The Japanese journal of anesthesiology 07/1993; 42(6):918-21.
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    ABSTRACT: A 20-year-old female patient with chronic renal failure received renal transplantation under total intravenous anesthesia with droperidol, fentanyl and ketamine. Anesthesia was induced with droperidol 12.5 mg, fentanyl 100 micrograms, ketamine 100 mg and vecuronium bromide 5 mg, and maintained with fentanyl and ketamine. Ketamine was given continuously at a rate of 2.0 mg.kg-1.h-1. After the renal artery and vein of the donor kidney were anastomosed with the patient's internal iliac artery and vein, the urine output of 7.7 ml.min-1 was obtained. The patient recovered from anesthesia smoothly and her postoperative course was uneventful. Although plasma epinephrine, cortisol and ADH levels showed significant changes during anesthesia mainly due to surgical stress, they returned to normal values after the end of operation. We conclude that this method of anesthesia would be a choice for renal transplantation.
    Masui. The Japanese journal of anesthesiology 04/1993; 42(3):435-40.
  • Masui. The Japanese journal of anesthesiology 10/1987; 36(9):1444-9.
  • M Kudo, T Kudo, N Kotani, A Miyata, T Oyama
    Masui. The Japanese journal of anesthesiology 10/1986; 35(9):1340-6.
  • Masui. The Japanese journal of anesthesiology 05/1986; 35(4):587-92.
  • Masui. The Japanese journal of anesthesiology 11/1985; 34(10):1378-83.
  • Masui. The Japanese journal of anesthesiology 05/1985; 34(4):508-11.

Publication Stats

24 Citations
18.18 Total Impact Points


  • 2005–2011
    • Hachinohe Heiwa Hospital
      八戸, Aomori Prefecture, Japan
  • 1993
    • Hirosaki University
      • Department of Anesthesiology
      Khirosaki, Aomori Prefecture, Japan