Masahiko Kawaguchi

Nara Medical University, Kashihara, Nara, Japan

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Publications (235)532.37 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to evaluate the validityof ocular blood flow measured by laser speckle flowgraphy (LSFG) for assessment of cerebral perfusion during aortic arch surgery.
    No preview · Article · Jan 2016
  • Hideki Matsuura · Satoki Inoue · Kazuaki Atagi · Masahiko Kawaguchi
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    ABSTRACT: A 12-year-old girl receiving chemotherapy for acute myeloid leukemia had a fever of unknown origin in spite of administration of micafungin. Her respiratory condition suddenly deteriorated. Her trachea was intubated, and positive pressure ventilation was initiated; however, her respiratory condition further deteriorated. Expiratory volume was considerably lower than inspiratory volume. Simultaneously, she developed severe hypotension and bradycardia, and tension pneumothorax was suspected. Emergent chest decompression was subsequently performed; however, her airway resistance was still high. Bronchoscopy was performed to remove a foreign body in the carina. Subsequently, her respiratory status improved. Histopathological examination revealed that the foreign body was a fibrinous blood clot mixed with fungal hyphae of Aspergillus niger. Life-threatening check valve formation due to tracheobronchial aspergillosis under positive-pressure ventilation may be rare; however, once it occurs, prompt establishment of an escape route for trapped air, such as thoracentesis, may be required.
    No preview · Article · Dec 2015
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    ABSTRACT: Background Enhanced recovery after surgery (ERAS) protocols may reduce postoperative complications and the length of hospital stay. Studies of the effectiveness of ERAS should include not only doctor-reported outcomes, but also patient-reported outcomes, in order to better estimate their impact on recovery. However, patient-reported outcomes are not commonly reported. Thus, it needs to be assessed whether early discharge from the hospital is compatible with a better outcome from the viewpoint of the patients themselves. Methods The 40-item quality of recovery score (QoR-40) is a recovery-specific, and patient-rated questionnaire, which provides a good measurement of early postoperative recovery. Ninety-four colorectal cancer patients undergoing surgery under ERAS protocol management were asked to answer QoR-40 questionnaires preoperatively and on post-operative day (POD) 1, 3, 6 and one month after surgery. Results The median (25th, 75th percentiles) preoperative global QoR-40 scores as an indicator of the baseline health status, was 189 (176.75, 197). On POD1 and POD3, the scores had decreased significantly to 154 (132.5, 164.25) and 177 (161.75, 190), respectively. On POD 6, the score dramatically recovered up to 183.5 (167.9, 191), which was not significantly different from the baseline level (p = 0.06). The scores at 1 month after surgery were 190 (176, 197). Younger patients, compared to older patients, and rectal cancer patients, compared to colon cancer patients, had significantly lower scores on POD1. Conclusion This study clearly demonstrated that the quality of recovery based on patient-reported outcomes is in agreement with discharge around POD6 for colorectal cancer patients under ERAS.
    Preview · Article · Dec 2015 · BMC Cancer
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    Shota Sonobe · Satoki Inoue · Kazuaki Atagi · Masahiko Kawaguchi
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    ABSTRACT: We report a patient who developed sustained hypotension during craniotomy; further, owing to a mediastinal mass, critical tracheal stenosis and brain edema were observed after craniotomy, despite the absence of preoperative symptomatic superior vena cava (SVC) syndrome. A 62-year-old man underwent removal of a suspected metastatic brain tumor. The main brain tumor was speculated to be a metastatic tumor from lung cancer. A subsequent chest CT revealed a large solid tumor in the mediastinum. The maximum reduction in the cross-sectional area of the trachea was estimated to be 50 %. In addition, bilateral innominate veins were completely obstructed, and the superior vena cava was involved in the mass and was completely compressed. The patient did not show any cardiopulmonary symptoms or upper body edema. Intravenous lines were secured at the right extremity. General anesthesia was induced without any complications and was maintained with sevoflurane, remifentanil, and rocuronium. During the surgery, hemodynamic status fluctuated and was unstable. To maintain systolic blood pressure, continuous, massive infusion of noradrenaline was required. After the surgery, the patient was turned to the supine position. Massive facial edema was apparent. In addition, the bilateral upper extremities were significantly swollen. Despite the removal of the main lesion, brain edema was still observed on head CT. Chest CT revealed that the maximum reduction in the cross-sectional area of the trachea was estimated to be >90 %, which necessitated mechanical ventilation with tracheal intubation. On the day following craniotomy, tracheal stenting was performed uneventfully. The patient’s trachea was finally extubated, and his respiratory condition did not deteriorate. Although he did not develop SVC syndrome, the patient died from asphyxiation after coughing up blood at home 5 months after the procedure. It was suggested that fluid infusion from the upper extremities owing to the mediastinal tumor caused critical SVC syndrome.
    Preview · Article · Dec 2015
  • S Inoue · R Abe · Y Tanaka · M Kawaguchi
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    ABSTRACT: Postoperative throat complications, such as sore throat and hoarseness, are frequent complications of tracheal intubation. To assess whether severity of throat complications is related to the experience of physicians performing tracheal intubation, we compared the incidence and duration of postoperative sore throat and hoarseness and patient satisfaction between tracheal intubation performed by trainees and experienced consultant anaesthetists. This is a retrospective review of an institutional registry containing records of 21 606 patients undergoing general anaesthesia and was conducted with ethics board approval. All tracheal intubations by trainees were performed under the supervision of consultant anaesthetists. To avoid channel bias, the propensity score analysis was used to generate a set of matched cases (intubations by trainees) and controls (intubations by anaesthetists), yielding 3465 (sore throat) and 3267 (hoarseness) matched patient pairs. The incidence and sustained rate of symptoms were compared as primary outcomes. We also compared patient satisfaction with perioperative care. After propensity score matching, there was no difference between tracheal intubation by trainees and tracheal intubation by consultant anaesthetists in the incidences of sore throat (32.9 vs 32.6%, P=0.84) or hoarseness (35.8 vs 35.2%, P=0.60). Odds ratios and 95% confidence intervals for tracheal intubation by trainees were 1.01 (0.91-1.12) for sore throat and 1.03 (0.93-1.14) for hoarseness. The rates of sustained sore throat and hoarseness over the course were low (P=0.85 and P=0.67, respectively). Hazard ratios and 95% confidence intervals for tracheal intubation by trainees were 0.99 (0.94-1.05) for sustained sore throat and 0.99 (0.93-1.05) for sustained hoarseness. Patient satisfaction did not differ between matched groups (P=0.66 and P=0.83). Tracheal intubation by trainees under the supervision of consultant anaesthetists did not worsen the postoperative airway outcomes, such as sore throat and hoarseness. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email:
    No preview · Article · Aug 2015 · BJA British Journal of Anaesthesia
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    ABSTRACT: Diabetes mellitus is associated with morbidity and progression of some cancers, such as hepatocellular carcinoma. It has been reported that sevoflurane, a volatile anesthetic agent commonly used in cancer surgery, can lead to lower overall survival rates than those observed when propofol is used to treat cancer patients, and sevoflurane increases cancer cell proliferation in in vitro studies. It has been also reported that glucose levels in rats anesthetized with sevoflurane were higher than those in rats anesthetized with propofol. We investigated the effect of sevoflurane, under conditions of high glucose and insulin, on cell proliferation in the human hepatocellular carcinoma cell line, HepG2. First, we exposed HepG2 cells to sevoflurane at 1 or 2 % concentration for 6 h in various glucose concentrations and then evaluated cell proliferation using the MTT assay. Subsequently, to mimic diabetic conditions observed during surgery, HepG2 cells were exposed to sevoflurane at 1 or 2 % concentration in high glucose concentrations at various concentrations of insulin for 6 h. One-percent sevoflurane exposure enhanced cell proliferation under conditions of high glucose, treated with 0.05 mg/l insulin. Our study implies that sevoflurane may affect cell proliferation in human hepatocellular carcinoma cells in a physiological situation mimicking that of diabetes.
    No preview · Article · May 2015 · Journal of Anesthesia
  • Hironobu Hayashi · Masahiko Kawaguchi
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    ABSTRACT: Visual evoked potential (VEP) is recorded from the back of the head, which is elicited by retinal stimulation transmitted through optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiation and finally cortical visual area VEP monitoring did not prevail since 1990s because marked intra-individual difference and instability of VEP recording limited the clinical usefulness under inhalation anesthetic management and techniques of VEP monitoring at the time. However, recent advances in techniques including a new light-stimulating device consisting of high-luminosity LEDs and induction of electroretinography to ascertain the arrival of the stimulus at the retina provided better conditions for stable VEP recording under general anesthesia In addition, the introduction of total intravenous anesthesia using propofol is important for the successful VEP recordings because inhaled anesthetics have suppressive effect on VEP waveform. Intraoperative VEP has been considered to monitor the functional integrity of visual function during neurosurgical procedures, in which the optic pathway is at a risk of injury. Intraoperative VEP monitoring may allow us to detect reversible damage to the visual pathway intraoperatively and enable us to prevent permanent impairment.
    No preview · Article · May 2015 · Masui. The Japanese journal of anesthesiology
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    ABSTRACT: Background: Sevoflurane is one of the commonly used volatile anesthetics in cancer patients. The protective effect of sevoflurane preconditioning has raised concerns about whether sevoflurane could act advantageously for survival even of cancer cells. Therefore, we investigated the effects of sevoflurane on proliferation in colon cancer cell lines. Methods: HCT116 and HT29 cells were plated in 96-well plates at a density of 1 x 10(4) cells/well and incubated overnight. On the next day, cells were exposed to 1% or 2% sevoflurane for 6 hr. After 24 hr recovery, we performed MTT assay. The absorbance of the formazan product was measured at a wavelength of 570 nm using 650 nm as the reference. In addition, to investigate the role of adenosine triphosphate-sensitive potassium (K(ATP)) channels, we conducted the same experiment under co-administration of K(ATP) inhibitor, glibenclamide. Results: Only 1% sevoflurane significantly enhanced cell proliferation compared to the control in HCT116 and HT29 cells. Enhanced proliferation by sevoflurane was completely blocked by co-administration with glibenclamide in HCT116 cells. Conclusions: We had shown that 1% sevoflurane for 6 hr potentially enhances cell proliferation via K(ATP) channels in cancer cells.
    No preview · Article · Apr 2015 · Masui. The Japanese journal of anesthesiology
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    ABSTRACT: We conducted a survey on the perioperative use of cerebral near-infrared spectropscopy (NIRS) for monitoring cerebral hemodynamics in Japan. Of the hospitals surveyed, 38% responded to the survey. For cardiovascular surgery, NIRS was used in all cases in 38% of hospitals and was not used in 16% of hospitals mostly for economic reasons. For carotid endarterectomy and carotid artery stent, NIRS was used in all cases in 47% and 33% of hospitals, respectively. NIRS was also used in patients with carotid stenosis or occlusion who underwent other types of surgery. NIRS monitoring was efficient in cardiovascular surgery, surgery with cardiopulmonary bypass, carotid endarterectomy and carotid artery stent in most of the responding hospitals. The data indicated that acquisition of support by the medical payment system as well as appropriate use of NIRS is warranted, especially in patients undergoing cardiovascular surgery and carotid artery surgery.
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    ABSTRACT: The Postoperative Quality of Recovery Scale (PQRS) is a multi-domain tracking scale to assess recovery after surgery. The PQRS is used in seven countries and five languages; however, the Japanese version of the PQRS (PQRSj) has not been established. We therefore translated the PQRS into Japanese, and examined the feasibility, reliability and validity of the PQRSj. The time taken to complete the test was measured to assess feasibility. Cronbach's alpha was calculated to assess reliability. The Mini Mental State Examination (MMSE) and the Japanese version of the Quality of Recovery Scale 40 (QoR-40 J) were performed for comparison with the PQRSj (validity). Fifty-one patients were enrolled in the study. The mean completion time was 3.9 min for baseline (feasibility). Cronbach's alpha was between 0.40 and 0.94 in each domain (reliability). A relationship was shown between cognitive domain and MMSE at baseline (r = 0.65, P < 0.01); however, no relationship was found between the other domains and the MMSE and QoR-40 J. Ceiling effects were observed in 78 % of the questions. These results indicate that the PQRSj can be used to assess recovery after surgery, although it may be better to revise some of the questions to improve the validity of the PQRSj.
    No preview · Article · Nov 2014 · Journal of Anesthesia
  • Mitsuru Ida · Masahiko Kawaguchi
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    ABSTRACT: Postoperative cognitive dysfunction (POCD) is seen not only after cardiac surgery but also after non-cardiac surgery. POCD leads to decreased quality of life and increased mortality. Various reports describe the occurrence and risk factor of POCD in adopting different neuropsychological tests and different follow-up periods. POCD is highly associated with age or inflammation in the central nerve system. Anti-inflammatory strategies including dexmedetomidine, statin or minocycline in the perioperative period may reduce incidence of POCD.
    No preview · Article · Nov 2014 · Masui. The Japanese journal of anesthesiology
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    Masahiko Kawaguchi · Yuu Tanaka · Hitoshi Furuya

    Preview · Article · Oct 2014 · Journal of Anesthesia
  • Junko Ushiroda · Satoki Inoue · Yu Tanaka · Masahiko Kawaguchi
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    ABSTRACT: General anesthesia in patients with comorbid conditions may affect their intermediate or long-term outcomes. In this study, we evaluated the effects of provision of anesthesia on mortality in critical patients with comorbid conditions by retrospectively investigating one-year mortality in patients with ASA physical status more than III who underwent minor surgery for relative indications and nonfatal reasons. Data were collected during the period between January 2006 and December 2011. Eligible patients were those with ASA physical status more than III who underwent minor surgery under general anesthesia for relative indications and nonfatal reasons. Preoperative clinical information was collected from the patient's clinical charts. Comorbidity was quantified using the Charlson comorbidity index. All the patients were evaluated for in-hospital mortality and were followed-up for mortality at one-year. During the study period, 14, 979 patients underwent general anesthesia. Thirty six patients satisfied the eligibility for enrollment. Charlson comorbidity index of the patients ranged from one to five. No patients died during their hospital-stay; however, 4 patients were lost to follow up. Therefore, one-year mortality rates for each Charlson index category were 0%. The postoperative one-year mortality in patients with ASA physical status more than III undergoing minor surgery under general anesthesia for relative indications and nonfatal reasons was expected to be considerably small regardless of the Charlson index category.
    No preview · Article · Oct 2014 · Middle East journal of anaesthesiology
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    ABSTRACT: Background Intraocular pressure(IOP) has been shown to increase during prone position spine surgery. The present study was conducted to evaluate IOP changes and predictive factors associated with increased IOP during prone position spine surgery. Methods After institutional approval and written informed consent, 56 patients undergoing prone position spine surgery were studied. Anesthesia was maintained with propofol or sevoflurane, remifentanil, and fentanyl. IOP was measured using a Tono-Pen XL hand-held tonometer 10 min after induction of anesthesia, every 60 min after prone positioning, and 10 min after returning to the supine position. According to maximum IOP, patients were divided into group H with a maximum IOP value of ≥30 mmHg or group L with a maximum IOP value of
    No preview · Article · Sep 2014 · Journal of Anesthesia
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    ABSTRACT: Background Ki-67, cytokeratin 13, and/or cytokeratin 17 detection by immunohistochemistry has been reported to be useful for the diagnosis of oral precancerous lesions. However, the use of these markers remains controversial because of the lack of appropriately designed statistical studies. We assessed the hypothesis that Ki-67, cytokeratin 13, or cytokeratin 17 immunohistochemistry could facilitate the diagnosis of oral precancerous lesions and/or predict prognosis.Methods Epithelial dysplasia was classified as low grade (none or mild dysplasia) or high grade (moderate dysplasia, severe dysplasia, or carcinoma in situ). This study included 58 low-grade and 36 high-grade dysplasia cases. We used logistic regression to assess the diagnostic values of Ki-67, cytokeratin 13, and cytokeratin 17 for high-grade dysplasia. Correlations between these markers and the prognosis of oral atypical epithelium were assessed using the Cox proportional hazards model.ResultsKi-67 overexpression and cytokeratin 13 loss were independent diagnostic markers for high-grade dysplasia (odds ratios, 1.92 and 2.53; 95% confidence intervals, 1.03–3.58, and 1.19–5.38, respectively). The area under the curve of Ki-67 was 0.73 and that of cytokeratin 13 was 0.72. However, the combination of Ki-67 and cytokeratin 13 yielded the area under the curve of 0.78. Ki-67 overexpression was significantly associated with recurrence and/or malignant transformation of oral atypical epithelium (hazard ratio, 7.25; 95% confidence interval, 1.07–48.92).Conclusions Ki-67 overexpression and cytokeratin 13 loss may be useful for distinguishing oral precancerous lesions from reactive atypical epithelium. Moreover, Ki-67 overexpression may be a risk factor for recurrence and/or malignant transformation of oral atypical epithelium.
    Preview · Article · Sep 2014 · Journal of Oral Pathology and Medicine
  • J. Ushiroda · S. Inoue · T. Kirita · M. Kawaguchi
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    ABSTRACT: Changes in airway dimensions can occur during general anaesthesia and surgery for a variety of reasons. This study explored factors associated with postoperative changes in airway dimensions. Patient airway volume was measured by acoustic reflectometory and neck muscle diameter by ultrasound echography in the pre- and post-anaesthetic periods in a total of 281 patients. Neck circumference was also assessed during these periods. A significant decrease in median (IQR [range]) total airway volume (from 63.8 (51.8–75.7 [14.7–103]) ml to 45.9 (33.5–57.2 [6.4–96.3]) ml, p < 0.0001), and a significant increase in muscle diameter (from 4.3 (3.3–5.6 [2.2–9.0]) mm to 5.8 (4.7–7.3 [2.8–1.3]) mm, p < 0.0001) and neck circumference (from 34.0 (32.5–37.0 [29.5–49.0]) cm to 35.0 (33.5–38.0 [30.5–50.5]) cm, p < 0.0001) were observed. It may be possible that changes in airway volume and neck circumference were influenced by surgical duration or peri-operative fluid management (ρ) = −0.31 (95% CI −0.24 to −0.01), p = 0.0301, −0.17 (−0.23 to −0.06), p = 0.0038, 0.23 (0.12–0.34), p < 0.0001, and 0.16 (0.05–0.27), p = 0.0062, respectively). The intra-oral space can significantly decrease and neck thickness increase after general anaesthesia, and might increase the risk of difficult laryngoscopy and intubation if airway management is required after extubation following general anaesthesia.
    No preview · Article · Aug 2014 · Anaesthesia
  • Satoki Inoue · Ryuichi Abe · Yu Tanaka · Masahiko Kawaguchi
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    ABSTRACT: An urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year" is in circulation, because people in general suppose that inexperienced newcomers start to work at clinical practice during that time period. We tried to determine whether this urban legend was true or not by using data from our operation management system. We retrospectively conducted a study to investigate whether the number of cannulation failures, which was used as an index of patient disadvantages at clinical practice, could be affected by the volume of residents in clinical participation. The number of insertion trials per case was not prominent in the first month of the fiscal year. However, the number of insertion trials per case increased in proportion to the average number of residents per day. It seems that there was no evidence to support the urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year." However, our results suggest that rather than an urban legend, we are now confronting the fact that patients may suffer from medical disadvantages in the teaching hospitals.
    No preview · Article · Jul 2014 · Journal of Anesthesia

  • No preview · Article · Apr 2014 · The FASEB Journal
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    ABSTRACT: Postoperative sore throat should be recognized seriously as an avoidable complication because of high incidence and dissatisfaction with anesthesia. The aim of the study was to identify the risk factors of postoperative sore throats in patients undergoing general anesthesia. We retrospectively studied 1,733 patients (above 18 years of age) who had undergone general anesthesia from January to December 2010 and who had visited Department of Anesthesia, postoperative anesthesia clinic. Age, ASA classification, position, airway device, methods of postoperative pain management and site of surgery were significantly identified as the associated factors for postoperative sore throat using univariate analysis. Under 65 year of age (odds ratio 2.3), operation of head and neck and pharynx (odds ratio 1.6), spine surgeries (odds ratio 0.33), laryngeal mask (odds ratio 0.47), and postoperative intravenous patient-controlled analgesia (IV-PCA, odds ratio 0.4) were significantly identified as the factors with multivariate studies. Six associated factors for postoperative sore throat were identified in this study.
    No preview · Article · Apr 2014 · Masui. The Japanese journal of anesthesiology
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    ABSTRACT: It has been reported that multiple puncture more than or equal to 3 times is a factor associated with the development of CVC-related complications. The present retrospective study was undertaken to evaluate the predictors and risks of multiple puncture during the insertion of CVC. After the IRB approval, 1296 patients who underwent CVC in the operating room were enrolled. Data were collected using CVC report and the medical charts. Multiple puncture was defined as the puncture performed more than or equal to three times during the insertion of CVC. Univariate and multivariate logistic regression analysis were performed to assess the predictors of multiple puncture during the CVC insertion. Univariate analysis revealed that age less than 6 years, complications during insertion and the way to use ultrasound echo were associated with multiple puncture. Multivariate analysis also revealed that age less than 6 years was a significant predictor for multiple puncture (odds ratio 2.08, 95% CI 1.01-4.29). The results of the study indicate that the age less than 6 years is a significant predictor for multiple puncture during the CVC insertion.
    No preview · Article · Feb 2014 · Masui. The Japanese journal of anesthesiology

Publication Stats

2k Citations
532.37 Total Impact Points


  • 1995-2015
    • Nara Medical University
      • • Department of Anesthesiology
      • • Department of Orthopaedic Surgery
      • • Department of Pathology
      • • Department of Neurosurgery
      Kashihara, Nara, Japan
  • 2008-2009
    • National Defense Medical College
      • Department of Anesthesiology
      Tokorozawa, Saitama, Japan
  • 2004
    • Mayo Clinic - Scottsdale
      Scottsdale, Arizona, United States
  • 1993-1994
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan