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Volume 26 (2006)
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Volume 26, Issue 2
Displaying 1-17 of 17 articles from this issue
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Educational Articles
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Akihiro SUZUKI2006 Volume 26 Issue 2 Pages 133-139
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSAnesthesiologists should have equal skill in not only administering anesthesia to the patient, but also in teaching anesthesia techniques to residents and medical students regardless of whether the anesthesia is maintained TIVA or VIMA.
Recently, the Japanese Society of Anesthesiologists issued an educational guideline for anesthesiologists, which encourage anesthesiologists to learn TIVA in-depth including pharmacodynamics.
Our institute has been providing volatile anesthesia as a maintenance anesthetic, so there were not many anesthesiologists who had enough TIVA experience. We therefore arranged a special seminar including lecture, and also a clinical case guidance.
Participants learned how to use special “tools” such as BIS monitor, propofol TCI, and pharmacokinetics simulation software, and interpretation of their values at each stage of anesthetic procedure.
After the seminar, the amount of TIVA in total anesthetic case in our institute increased, and most of our staff have felt confident maintaining TIVA since then. The tools are very effective when learning TIVA, since they provide an objective index for both preceptor and the individual anesthesiologist on duty.View full abstractDownload PDF (380K) -
Shunichi TAKAGI2006 Volume 26 Issue 2 Pages 140-145
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSAt first we experience the case anesthetized with TIVA, and we should determine the anesthetic quality of TIVA in order to promote TIVA. To educate others about TIVA, we must experience TIVA, and it is vital to understand the pharmacokinetics and pharmacodynamics. By case simulation such as delayed awakening, we can image the relationship with blood concentration, effect site concentration and clinical condition. In addition, we know that residents takes TIVA easily, from the result of questionnaire for the residents.View full abstractDownload PDF (370K) -
Osamu NAGATA2006 Volume 26 Issue 2 Pages 146-149
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSThere seems to be few Japanese anesthetic departments where total intravenous anesthesia (TIVA) is common in their daily management of anesthesia, though TIVA is indicated as a technique necessary to earn an anesthesiologist in the educational guidelines for the anesthesiologist of the Japanese Society of Anesthesiologists. In our hospital, we reviewed the difficulties of learning and managing the general anesthesia with TIVA and summarized them into six aspects. With the lectures and training on these aspects, we determined that not only anesthesia residents but also trained specialists in anesthesiology could obtain good skills for the daily management of TIVA in a few months. On the contrary, in an environment in which TIVA is not popular, sending out TIVA instructors to the hospitals for many anesthesiologists who are not familiar with the TIVA technique in their management of general anesthesia, and demonstrating it directly in front of them at their hospitals will effectively introduce the benefits and know-how of TIVA anesthesia as well.View full abstractDownload PDF (262K)
Original Articles
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Noriko SHIOTA, Hiromichi IZUMI, Tomomichi KOGA, Ryuji NAKAMURA2006 Volume 26 Issue 2 Pages 150-155
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSEncapsulating peritoneal sclerosis (EPS) is a complication of long-term peritoneal dialysis in chronic renal failure (CRF) patients. Patients suffer various complications, such as CRF and hypoproteinemia, and total intestinal enterolysis takes a long time, as well making fluid management during the operation difficult. We inserted a pulmonary artery catheter to monitor pulmonary arterial diastolic pressure (PADP) and central venous pressure (CVP) as markers of blood volume, and mixed venous oxygen saturation (SvO2) and continuous cardiac index (CCI) . When PADP and CVP were low, fluid was infused until they reached appropriate levels. When SvO2 and CCI were low, with appropriate values of blood volume markers, we administered catecholamine. As a result, there was no need for emergency hemodialysis and there were no complications caused by dehydration or overhydration. In conclusion, our fluid management by pulmonary artery catheter during anesthesia played an important role in preventing complications in patients undergoing total intestinal enterolysis.View full abstractDownload PDF (408K) -
Hirofumi HINO, Miki SAKAMOTO, Kazuko NAGANO, Jun SASANO, Harukazu NAGA ...2006 Volume 26 Issue 2 Pages 156-163
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSWe describe the first reported study comparing the neuromuscular blocking effects of propofol in 10 patients with myasthenia gravis (MG group) with those in 10 patients without MG (Control group) undergoing transsternal (extended) thymectomy. Propofol inhibited twitch tension (T1) but not the train-of-four ratio (T4/T1) in the MG group (T1: Control group, 97±1% vs. MG group, 84±2%, p<0.001; T4/T1: Control group, 99±1% vs. MG group, 97±1%, p = 0.487) . The decrease in T1 induced by propofol during the intubation phase was significantly related to the preoperative acetylcholine receptor antibody titer (r = -0.722, p = 0.018) in the MG group. The intubation score was higher in the MG group than in the Control group. Whereas propofol reduced T1 in the intubation and maintenance phases, tension restored to normal after the termination of propofol. Extubation was successfully performed in all MG patients within 30min after the termination of propofol. These findings suggest that propofol has postsynaptic effects generated by evoked twitch tension. Propofol is a suitable drug for intubation and maintenance anesthesia due to the light neuromuscular blocking effects, allowing a fast recovery suitable for MG patients undergoing (extended) thymectomy.View full abstractDownload PDF (373K) -
Yuji KADOI, Akihiro TOMIOKA, Shigeru SAITO, Fumio GOTO2006 Volume 26 Issue 2 Pages 164-170
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSWe analyzed the profitability of anesthesia subspecialties in our institution for a month. Except for cardiac surgery, anesthesia was induced by propofol with vecuronium, and maintained with sevoflurane, 66% N2O in oxygen. Each anesthetist was free to control sevoflurane concentration and use additional anesthetics or other drugs to keep systemic hemodynamics stable. Anesthesia durations in cardiac and neurosurgical anesthesia were longer than those in the other anesthesias. The relationship between anesthesia and benefit per case in cardiac anesthesia (371,550±242,360 yen/case) was better than those in the other anesthesias, but, in contrast, the relationship of anesthesia to benefit per minute was better in thoracic and obstetric anesthesias than those in the other anesthesias (thoracic anesthesia: 706±208 yen/minute, obstetric anesthesia: 717±246 yen/minute, neurosurgical anesthesia: 367±91 yen/minute, p<0.05). Although there was a positive linear relationship between anesthesia duration and benefit per case (y=332x+29513, r2=0.61), there was an inverse relationship between anesthesia duration and benefit per minute (y= -600logX+1923, r2=0.77). Our data showed that shorter anesthesia duration is more beneficial in our institute.View full abstractDownload PDF (1264K) -
Akiyoshi KUJI, Mayumi ICHIKAWA, Kazuko KIKUCHI, Akiko OKAMOTO, Miho KU ...2006 Volume 26 Issue 2 Pages 171-178
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSWe analyzed 49 cases of propofol anesthesia with flexible laryngeal mask airway (FLMA) in order to establish safe outpatient anesthesia for dental treatment in the handicapped. Points discussed here are gender, age, coexisting problems, medication, dental treatments, treatment time, general assessment before anesthesia, premedication, induction techniques, dosage of midazolam, dosage of propofol, airway stability with FLMA, infusion volume, temperature, duration of anesthesia, time to discharge, and the state of the patient after discharge. The results are that 1) airway management by FLMA was secure in 84% of cases (41/49) , 2) mean time to discharge was 69 (±15) min, 3) no adverse events happened after discharge except for 1 case of postoperative nausea and vomiting. We conclude that 1) airway management by FLMA is non-invasive and reliable, 2) propofol is suitable for outpatient anesthesia because there are few post-anesthetic problems associated with it, 3) anesthesia with FLMA and propofol is suitable for outpatient anesthesia for the handicapped patients not suited to admission.View full abstractDownload PDF (429K)
Case Report
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Yusuke ASAKURA, Kimitoshi NISHIWAKI, Kosei SATO, Yoshihiro FUJIWARA, T ...2006 Volume 26 Issue 2 Pages 179-183
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSA case of an infant with hepatoblastoma complicated with central core disease (CCD) who underwent right hepatic trisegmentectomy is reported. A one-year-old infant weighing only 7.7kg was born via a normal delivery, but the resuscitation was required at birth, and he has been on a mechanical ventilation ever since. He was diagnosed as having CCD, because his brother died at birth and the muscle biopsy showed typical signs of CCD. When he was one, a mass was coincidently found in his liver, and he was diagnosed as having hepatoblastoma by a computed tomography and by a blood biochemistry examination which showed a high value of α-fetoprotein. Though it is well known that a case with CCD is highly susceptible to malignant hyperthermia, he underwent right hepatic trisegmentectomy under general anesthesia with nitrous oxide, oxygen, continuous intravenous infusion of fentanyl, and vecuronium bromide. Although the general anesthesia with these agents was well tolerated by the patient, a massive hemorrhage during the hepatectomy was noted, reaching 3,265 grams when the surgery was over. One possible cause of this massive hemorrhage was a hepatic steatosis, which presumably had been resulted from total parenteral nutrition. He successfully recovered from the surgery without any complications, and was discharged from the intensive care unit on the third post-operative day.View full abstractDownload PDF (279K) -
Keiko OHNISHI, Kyoko KAGEYAMA, Maki NANBA, Yoshiaki ISHIKAWA, Yasufumi ...2006 Volume 26 Issue 2 Pages 184-188
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSIn progressive ankylosing spondylitis, the possibility of complications during ventilation and intubation are possible. We used a bronchofiberscope because difficulties at intubation were expected. At the time of extubation it became clear that laryngofissure of the respiratory tract was necessary because of the difficulties associated with typical tracheotomy. Informed consent to the patient or their family is necessary because of the rare possibility of semipermanent loss of vocal cord function.View full abstractDownload PDF (347K) -
Kana OKAMOTO, Masahiro MURAKAMI, Kei GOTOH, Koichiro NANDATE, Keiji AI ...2006 Volume 26 Issue 2 Pages 189-193
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSA 75-year-old woman with a chief complaint of severe chest pain with respiratory distress was admitted to the intensive care unit (ICU) . The patient was diagnosed as having acute myocardial infarction and soon underwent percutaneous transluminal coronary angioplasty and stent insertion. In the ICU, the patient received mechanical ventilation and intraaortic balloon pumping (IABP) . She gradually improved and was weaned off the IABP and extubated. However, immediately after the extubation, her pulse was unpalpable, showing pulseless electrical activity. Prompt cardiopulmonary resuscitation (CPR) was started. During CPR, the echocardiogram revealed massive pericardial effusion with the diagnosis of cardiac tamponade, probably caused by cardiac rupture. Massive blood transfusion and pericardiocentesis restored the patient temporarily, but she died about one and a half hours after the extubation.View full abstractDownload PDF (327K) -
Shima TAGUCHI, Miwako NAKAO, Ryoji KAWAGUCHI2006 Volume 26 Issue 2 Pages 194-198
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSA 70-year-old male underwent segmental esophagogastrectomy and esophagocardioplasty for resection of a stomach cancer. Twenty minutes after the beginning of the operation, severe hypotension, tachycardia and skin blush developed.
After the administration of a large volume of intravenous fluids and epinephrine, his blood pressure gradually improved. As anaphylactic shock was suggested, the operation was postponed.
Nineteen days after this episode, a second operation was performed. There were no major problems during the operation and the endotracheal tube was extubated. The patient had no difficulty in breathing. However, soon after returning to the ward, he complained of dyspnea. Following the administration of epinephrine, the trachea was re-intubated without difficulty.
Anaphylaxis, residual effects of muscle relaxant, pneumothorax caused by operation, and laryngopharyngeal edema caused by suctioning were suggested as causes of postoperative dyspnea.
Because there are many causes of dyspnea, we should eliminate the factor of other ventilatory disturba during the perioperative management of patients with a past history of anaphylaxis.View full abstractDownload PDF (344K) -
Kazuhisa SHIROYAMA, Tomoko YAMADA, Tomota OHTANI, Akihiko SAKAI, Masak ...2006 Volume 26 Issue 2 Pages 199-202
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSWe experienced anesthetic management of a patient with a right atrial mass. A 79-year-old woman was scheduled to undergo colectomy for advanced colon cancer. Preoperative chest CT revealed a right atrial mass approximately 20mm in diameter. Echocardiography showed that the mass was immobile, and heparinization during the surgical excision of the atrial mass would potentially cause massive bleeding from the hemorrhagic cancer. Therefore, the patient underwent colectomy first under general anesthesia with epidural anesthesia. During the operation the mass was continuously observed with transesophageal echocardiography. The femoral artery and vein were cannulated with 16G needles for percutaneous cardiopulmonary support to prepare for the cardiopulmonary collapse caused by incarceration or embolism of the mass. The intraoperative hemodynamic condition was stable without cardiopulmonary complications. On the 53rd day after the colectomy the right atrial mass was surgically excised under general anesthesia using cardiopulmonary bypass. Pathological examination of the excised mass identified it as a thrombus. In conclusion, anesthetic management to stabilize the hemodynamic condition and prepare for the cardiopulmonary collapse is important during non-cardiac surgery in a patient with an intracardiac mass.View full abstractDownload PDF (318K) -
Zen'ichiro WAJIMA, Ritsuko MASUDA, Toshiya SHIGA, Kazuyuki IMANAGA, Te ...2006 Volume 26 Issue 2 Pages 203-206
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSEsmolol is a short-acting β1-adrenoceptor antagonist that can be used for treating supraventricular tachyarrhythmias during surgery in Japan. Although many reports concerning the effects of esmolol on supraventricular tachyarrhythmias have been published abroad, few have been reported in Japan yet. We presented a case in which esmolol, 1mg/kg, was quite effective for the treatment of running atrial premature beats during rigid head pin fixation.View full abstractDownload PDF (273K) -
Etsu IWASAKI, Mutsuko MATSUMOTO, Toshiaki KURASAKO, Takae NIGUMA, Yuta ...2006 Volume 26 Issue 2 Pages 207-210
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSBenign symmetrical lipomatosis is characterized by progressive growth of fat masses which are located symmetrically on the neck, shoulders, chest, abdomen and groin.
A 56-year-old man had no respiratory problems when the first surgery to remove lipomatous tissues on the left side of the nape, back and shoulder was performed. During the second surgery 40 days after the first surgery, however, the symptoms of airway obstruction occurred just after the resection of the right-side lipomatous tissues in the recovery room. The magnetic resonance imaging taken before the surgery revealed a little fat accumulation in the pharyngeal region in this patient.
In the cases that have these manifestations, airway obstruction due to benign symmetrical lipomatosis should be carefully assessed and deliberately prevented.View full abstractDownload PDF (308K) -
Mizuho KAWAMOTO, Kazuyoshi TATEOKA, Kouichi SAKURAI, Noritoshi IGARI, ...2006 Volume 26 Issue 2 Pages 211-214
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSAn emergent tracheal stent insertion was scheduled under general anesthesia with percutaneous cardiopulmonary support (PCPS) in a 55 year old woman with an esophageal tumor that was invading her trachea. After PCPS was started, oral intubation was performed. During the surgery, we had to extubate because of the procedure. However, 15 minutes after extubating, the oxygen saturation and arterial oxygen tension in her right hand dropped temporarily. This occurred because the oxygenated arterial blood was circulating in the left limb, whereas the arterial blood not fully oxygenated was circulating in the right limb. We overcame this problem by oxygen-insufflating and controlling her blood pressure. If a patient with good cardiac function must be managed with PCPS, special attention should be paid to the patient's saturation and arterial oxygen tension in the right hand.View full abstractDownload PDF (345K)
Educational Articles
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Yasuko ICHIHARA, Carlos A. Ibarra Moreno, Hirosato KIKUCHI2006 Volume 26 Issue 2 Pages 215-224
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSMalignant hyperthermia (MH) in humans is an autosomal dominant disorder of skeletal muscle Ca2+-regulation. In MH-susceptible patients, a potentially lethal hypermetabolic reaction is triggered after exposure to volatile anesthetics and/or succinylcholine.
Central core disease (CCD) is an inherited congenital myopathy allelic to MH histologically characterized by degenerative central areas deprived of mitochondria along the full length of muscle fibers. CCD patients are regarded usually as MH-susceptible but, unlike other MH patients, they present with delayed motor milestones in infancy and hypotonia.
More than 50% of MH cases and almost all CCD cases are associated with mutations in the ryanodine receptor (RYR1) gene, which encodes for the major Ca2+ release channel in skeletal muscle sarcoplasmic reticulum. Most RYR1 mutations are clustered in (but not limited to) three “Hot Spots” near the gene regions of domain mamed the foot structure and Ca2+ release channel in the membrane of the sarcoplasmic reticulum, respectively. MH/CCD phenotype overlaps due to some mutations located in the first two hot spots, corresponding to the myoplasmic domain of the protein. However, most patients with typical CCD have mutations at the C-terminal region, which comprises the pore-forming domain. Although C-terminal mutations seemingly produce either MH or CCD phenotype, but not both, CCD patients must be considered to be MH-susceptible until proven otherwise.View full abstractDownload PDF (457K) -
Shinichi NAKAGAWA, Koichi TAMURA, Koji ABE, Noriaki TAKEDA2006 Volume 26 Issue 2 Pages 225-232
Published: 2006
Released on J-STAGE: March 29, 2006
JOURNAL FREE ACCESSLaryngofissure is the surgical approach to the larynx through an anterior neck incision in which the thyroid cartilage is opened with a vertical anterior midline cut. Laryngofissure provides ample exposure to the anterior and posterior laryngeal anatomy. This procedure is the most utilized transcutaneous approach to the endolarynx. The most frequent indications for laryngofissure are cancer (T1 to T2 cancers of the vocal cord) , laryngeal trauma, stenosis and benign tumors inadequeate size to a laryngoscopic approach. Technique and complications of laryngofissure are described. We then reported two cases (one is recurrent laryngeal cancer, another is complete subglottic stenosis) . In these cases, laryngofissure resulted in resolution of the airway problem.View full abstractDownload PDF (548K)
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