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Purpose We compared the reversal doses of sugammadex in surgical cases in which intraoperative neuromuscular monitor were used, to cases in which intraoperative neuromuscular monitoring was not used, retrospectively. Methods Data were collected by reviewing the electronic medical records of patients who received rocuronium and sugammadex during general anesthesia at Asahikawa Medical University Hospital between May 1, 2017 and April 30, 2018. The primary outcome was the reversal dose of sugammadex per patient actual body weight (mg/kg) between the group in which intraoperative neuromuscular monitoring was used (NM+ group) and the group in which intraoperative neuromuscular monitoring was not used (NM- group). Results A total of 3496 patients were evaluated, with 2544 patients (73%) included in NM+ group and 952 patients (27%) in NM- group. The reversal doses of sugammadex per actual body weight were significantly higher in NM- group compared to NM+ group. In the NM+ group, 521 patients (20%) received 2.5 mg/kg sugammadex. In contrast, 128 patients (13%) received 2.5 mg/kg sugammadex in NM- group. Conclusion This single-center retrospective study demonstrated that the use of intraoperative neuromuscular monitor reduced the reversal dose of sugammadex., Author(s): Hajime Iwasaki [sup.1], Atsushi Kurosawa [sup.1], Takafumi Iida [sup.1], Tomoki Sasakawa [sup.1], Hirotsugu Kanda [sup.1] Author Affiliations: (1) grid.252427.4, 0000 0000 8638 2724, Department of Anesthesiology and Critical Care [...]

We report three cases with systolic anterior motion (SAM) after mitral valve plasty. Preoperative mitral valve morphology is a risk factor for SAM. The morphological characteristics of SAM have been revealed in several studies. We found a small distance between coaptation and the interventricular septum in all cases, and cases 2, and 3 had a low AL/PL ratio, whereas case 3 had a large PML, which was revealed by transesophageal echocardiography. With the use of 3D transesophageal echocardiography, when mitral valve prolapse was investigated, in all three cases, it was easy to specify lesions. The issue for the future is 3D analysis when SAM is occurring. Keywords Systolic anterior motion of the mitral valve (SAM) * Transesophageal echocardiography (TEE) * Mitral valve annuloplasty (MVP) * Landiolol hydrochloride, Introduction Systolic anterior motion (SAM) of the mitral valve has been described after mitral repair in patients with mitral regurgitation (MR) [1, 2]. The occurrence of SAM leads to left [...]

Dexmedetomidine (DEX) for sedation in diagnostic and interventional cardiac catheterization (DICC) has been reported to require other drugs or rescue drugs because of its insufficient sedative effect when used alone. We administered DEX and adjusted its dose according to the bispectral index (BIS) monitor™ for DICC in a toddler; consequently, a high dose of DEX had to be administered. The patient was a 1-year and 4-month-old boy who was scheduled to undergo DICC after intracardiac repair. We used DEX alone as the sedative because this was expected to avoid oxygen supply and mechanical ventilation and to produce a safe situation for procedures around the neck. DEX was administered at the dose of 1-15 µg/kg/h according to BIS monitor™; administration of cardiovascular drugs or oxygen supply or assist ventilation, except chin lift, were not needed. The maximum predicted plasma concentration (pCp) of DEX and mean pCp were calculated as 6.1 and 4.1 ng/mL, respectively. A high dose of DEX may be required for DICC sedation, as for MRI sedation, in many cases. Although further studies should be conducted to reveal the merits and demerits of DEX in cardiac catheterization, a high dose of DEX may be useful in some cases. Keywords Dexmedetomidine * Diagnostic and interventional cardiac catheterization * Congenital heart disease, Introduction Previous studies have indicated the usefulness of dexmedetomidine (DEX) for diagnostic cardiac catheterization (DCC) in children; however, ketamine as combined or supplemental drugs or propofol as rescue drugs were [...]

Purpose We previously confirmed the effectiveness of dexmedetomidine (DEX) for stabilizing hemodynamics as well as sparing anesthetics during anesthetic induction in patients undergoing cardiac surgery (Kunisawa et al. in J Clin Anesth 21:194-199, 1). In this study, we investigated whether these effects of DEX continue until the start of cardiopulmonary bypass (CPB). Methods Twenty-two patients with mild to moderate cardiovascular disease were randomized into two groups [DF2 group: DEX dose of 0.7 µg/kg/h after initial dose and effect-site concentration (ESC) of fentanyl of 2 ng/ml; PF4 group: saline and ESC of fentanyl of 4 ng/ml]. Propofol was administered for anesthetic induction and maintenance. Hemodynamics, cardiovascular drugs, ESC of propofol, and cardiovascular responses to skin incision (SI) and sternotomy (St) were measured or calculated. Results Blood pressure (BP) at the pre-/post-SI periods was higher in the DEX group (137 ± 17/140 ± 16 mmHg) than in the placebo group (85 ± 9/109 ± 24 mmHg). Percent increases in cardiovascular response to SI or St were lower in the DEX group than in the placebo group (for example, 1.9 ± 2.2 vs. 27.4 ± 19.9% in systolic BP due to SI). ESCs of propofol at SI and St in the DEX group were lower than those in the placebo group. Conclusions DEX combined with 2 ng/ml fentanyl before CPB can suppress the decrease in blood pressure at the pre- and post-SI periods, can blunt the cardiovascular responses to SI and St, and can spare the required ESC of propofol despite fentanyl concentration, which was half of that in the placebo group. Keywords Dexmedetomidine * Anesthetic-sparing effect * Adjuvant * Before cardiopulmonary bypass, Introduction Hypotension caused by anesthesia and hypertension resulting from surgical stimuli should be avoided because these conditions can cause undesirable events leading to severe complications. Previously, we reported that dexmedetomidine [...]

We report the clinical management of 2 adults with mental retardation because of trisomy 21 who were sedated with high-dose dexmedetomidine (DEX) alone during diagnostic cardiac catheterization (DCC). The first patient was a 25-year-old man with aortic regurgitation and ventricular septal defect. DEX increased his Ramsay sedation score; however, a high dose and bolus injection of DEX were required to perform an invasive procedure. Cardiovascular drugs were not administered and heart rate was maintained in the low 40s. The maximum predicted plasma concentration (pCp) of DEX was 2.3 ng/mL. The second patient was a 26-year-old woman who had developed hypoxia 20 years after palliative surgery for tetralogy of Fallot. High-dose DEX was administered to keep the bispectral index value below 70 and maintain an immobile state; her maximum pCp of DEX was 4.3 ng/mL. Percutaneous oxygen saturation was kept above 83%, because of the suspicion that DEX may increase the ratio of pulmonary artery flow to systemic artery flow. In both cases, no respiratory system complications occurred despite inspiration of room air, indicating the usefulness of DEX for DCC. However, because of DEX may affect DCC data, it is necessary to pay careful attention to the use of DEX during DCC. Keywords Dexmedetomidine * Diagnostic cardiac catheterization * Congenital heart disease, Introduction The usefulness of dexmedetomidine (DEX) in diagnostic cardiac catheterization (DCC) in children has been reported; however, the ratio of patients managed by DEX alone is still low and other [...]

We safely administered dexmedetomidine (DEX) for sedation during spinal anesthesia in a very elderly patient. The patient was a 98-year-old woman who had hypertension, renal failure, and first-grade atrioventricular block. She was scheduled to undergo internal fixation for fracture of the femoral neck. Initially, DEX (6.0 µg/kg/h) was administered over 10 min, followed by continuous infusion at a dose of 0.7 µg/kg/h. Consequently, her Ramsay sedation score (RSS) increased to 5, and the patient did not grimace in pain while being turned to the lateral position. Epidural catheterization and spinal anesthesia were performed under sedation without any problem. The DEX dose was adjusted to maintain the RSS within 3-4. The surgical operation was performed smoothly without any problem. Since the hemodynamic condition was stable, administration of ephedrine (5 mg) was required only once during surgery. Percutaneous oxygen saturation was maintained at 98% or more; respiratory rate was within 15-21 tpm, and no ventilatory assistance was required. The maximum predicted plasma concentration (pCp) of DEX was 1.56 ng/mL, and the mean pCp of DEX during surgery was approximately 0.45 ng/mL. We found that DEX can be safely used for sedation during spinal anesthesia in a very elderly patient. Keywords Dexmedetomidine * Very elderly patient * Spinal anesthesia, Introduction Dexmedetomidine (DEX) is a selective alpha2-adrenoreceptor agonist and is useful for the sedation of patients undergoing invasive procedures as well as for those admitted to intensive care units (ICU) [...]

Future global warming may depend strongly on the potential for abating emissions of greenhouse gases (GHGs). Flexibility in implementing climate change mitigation policies can significantly reduce mitigation costs and has [...]

This paper proposes a new framework for integrated assessment models of global environmental issues, including energy, climate, land use, macroeconomics, and environmental impacts. We conducted simulations on carbon emission stabilization [...]

To the Editor: When using a non-commercial target-controlled infusion (TCI) system, it is important to confirm that the patient matches the population in the study on which the pharmacokinetic parameters [...]

To the Editor: A target-controlled infusion (TCI) pump with a built-in Diprifusor™ (Astrazeneca, London, UK) can show the required decrement time (RDT) to a certain concentration of propofol (expected waking [...]

To the Editor: Pentax-AWS Airway Scope (AWS: Hoya, Tokyo), a new rigid, indirect videolaryngoscope with integrated tube guidance, has been successfully used in patients with both normal and difficult airways. [...]

To the Editor: Ultrasound (US) has become a useful tool for achieving safer central venous catheter (CVC) insertion. The utilization of US before vein puncture (pre-scan) can provide important anatomical [...]