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Purpose The aim of the present study was to determine whether the ovarian hormones, estrogen and progesterone, had different influences on amino-acid-induced anti-hypothermic effects during general anesthesia. Methods Ovariectomized Sprague-Dawley female rats were divided into four groups: those administered 17[beta]-estradiol plus saline or an amino acid mixture (E2-Sal and E2-AA, respectively) and progesterone plus saline or an amino acid mixture (P-Sal and P-AA, respectively). Five weeks after ovariectomy, rats were given either E2 or P and then administered either Sal or AA solution for 180 min during anesthesia with sevoflurane. Rectal temperatures were measured. Results Rectal temperatures were significantly higher in the E2-AA group than in the E2-Sal group 165 and 180 min after initiating the infusion of the test solutions. However, no significant differences were observed between the P-treated groups. The phosphorylation of 4E-BP1 and S6K1 was significantly greater in the E2-AA group than in the E2-Sal group (P < 0.05, P < 0.001, respectively). In contrast, the phosphorylation of 4E-BP1 was significantly lower in the P-AA group than in the P-Sal group (P < 0.001). Conclusions These results suggest that progesterone reduces amino-acid-induced anti-hypothermic effects during general anesthesia., Author(s): Masahiro Kanazawa[sup.1] , Mariko Watanabe[sup.1] , Toshiyasu Suzuki[sup.2] Author Affiliations: (1) Division of Anesthesia, Tokai University Oiso Hospital, 21-1 Gakkyo, Oiso-machi, 259-0198, Naka-gun, Kanagawa, Japan (2) Department of Anesthesiology, [...]

Special care is required for airway management of patients undergoing emergency Cesarean section. Although the incidence of difficult intubation and difficult ventilation is similar between pregnant and non-pregnant women, the severity of complications in pregnant patients would be much greater than in non-pregnant patients, if tracheal intubation is found to be difficult: increased risk of pulmonary aspiration, hypoxia, airway obstruction due to laryngeal edema, and a 'sleeping baby' being taken out. Rapid-sequence induction of anesthesia is generally indicated to a patient undergoing emergency Cesarean section under general anesthesia. The technique has been evolving, without losing the key premise of minimizing the period of the airway being not protected from pulmonary aspiration, and of permitting rapid wake up if tracheal intubation fails. In this review, I describe the appropriate airway management, based on the current state of knowledge, in a patient undergoing emergency Cesarean section under general anesthesia., Author(s): Takashi Asai[sup.1] Author Affiliations: (1) Department of Anesthesiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, 343-8555, Koshigaya, Saitama, Japan Introduction Cesarean section may frequently be performed as an emergency [...]

Anxiety can affect acute and chronic postoperative pain after breast surgery. Nociceptive response during surgery might also be affected by preoperative anxiety even under unconscious state during general anesthesia. The aim of this retrospective study was to investigate nociceptive responses during breast surgery under general anesthesia in patients with or without preoperative anxiety. Patients (n = 45) were divided into a low-anxiety group (n = 25) and a high-anxiety group (n = 20) in accordance with preoperative scores for the State Trait Anxiety Inventory. We performed discriminant analysis to compare nociception during surgery using three intraoperative averaged values: heart rate; systolic blood pressure; and perfusion index. No significant differences in discriminant score were seen between groups (p = 0.10). Although we performed propensity score-matching to reduce the bias due to confounding variables in this retrospective study, there was also no significant difference in levels of nociceptive response between groups (p = 0.06). In conclusion, the level of nociception during breast surgery is not significantly affected by preoperative anxiety., Author(s): Kazuma Hashimoto[sup.1] , Sachiko Iwayama[sup.1] , Yuka Sano[sup.1] , Tsuneo Tatara[sup.1] , Munetaka Hirose[sup.1] Author Affiliations: (1) Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, [...]

Background Recent years have seen an increase in the use of dexmedetomidine in pediatric patients presenting for surgical procedures. However, only a limited number of studies have evaluated its effects on the QT interval in this patient group. To address this lack of knowledge, we have evaluated the effects of dexmedetomidine on the QT interval in children receiving sevoflurane anesthesia. Methods This study was a prospective case-control study in which pediatric patients presenting for anesthetic care were divided into two groups-the dexmedetomidine (D) and control (C) groups. Three electrocardiograms (ECGs) were obtained on each patient, including a baseline ECG (T.sub.1) prior to anesthetic induction and an ECG after the induction of anesthesia with sevoflurane (T.sub.2). In group D, the third ECG was obtained 2 min after the administration of dexmedetomidine, which in turn was started immediately after the T.sub.2 ECG reading (T.sub.3D); in group C, it was obtained 2 min after the T.sub.2 reading (T.sub.3C). Statistical analysis was performed using analysis of variance to compare the QT intervals at the three time points outlined above. Results A total of 50 patients were recruited to the study, ranging in age from 1 to 16 [mean 7.9 ± 4.1 (SD) years]. There were 25 patients in group C and 25 in group D. There were no statistical differences in the demographics between the 2 groups. In group C, the QTc was noted to increase progressively with the administration of sevoflurane (T.sub.3C vs. T.sub.1; P = 0.006). In group D, following the administration of dexmedetomidine, there was a significant decrease in the QTc relative to the post-induction value [436 ± 25 (T.sub.2) vs. 418 ± 17 ms (T.sub.3D); P < 0.01]. Conclusion A progressive lengthening of the QTc interval following the administration of sevoflurane was observed in the control group. In the dexmedetomidine group, there was a significant shortening of the QTc interval following the administration of dexmedetomidine compared to the length of the post-induction QTc interval and when compared to the control group., Author(s): Hiromi Kako[sup.1] [sup.2] , Senthil G. Krishna[sup.1] [sup.2] , Roby Sebastian[sup.1] [sup.2] , Kyle Smith[sup.1] , Joseph D. Tobias[sup.1] [sup.2] Author Affiliations: (1) Department of Anesthesiology and Pain Medicine, [...]

Objective Many studies have been done to seek the relationship between general anesthesia and neurodevelopment in pediatrics. However, there is no unified conclusion, especially single anesthesia affecting a child before 3 and 4 years. The association between anesthesia and neurodevelopment is studied using a meta-analysis. Methods We summarized the currently available evidence by searching PubMed, EMBASE, and the Cochrane library over the past 10 years. An evaluation of neurodevelopment including learning disability, behavioral disorders, and cognitive problems was conducted. We estimated the synthesized hazard ratios (HR) and 95 % confidence interval (CI) according to inter-study heterogeneity and analyzed the factors for this association using meta-regression method. Results Thirteen eligible studies met the inclusion criteria. The neurodevelopment damage was associated with single general anesthesia before age of 4 (adjusted HR 1.28 95 % CI 1.10-1.45). The pooled adjusted HR was 1.17 (95 % CI 1.07-1.28, p = 0.001) before 4 years old after the influence analysis and the adjusted HR was 1.18 (95 % CI 1.07-1.30, p = 0.001) before 3 years old. There was no significant difference between 3 and 4 years exposed to single general anesthesia (HR.sub.3/HR.sub.4 = 1.008, p = 0.9). Due to limitations of retrospective studies, prospective investigations are needed to determine whether anesthesia is causative. Conclusions The current evidence suggests a modestly elevated risk of neurodevelopmental disorders exists in children near 3 years of age. A single general anesthesia is relatively safe after 3 years, as the outcome is very close before 3 and 4 years old., Author(s): Haifeng Zhang[sup.1] , Lili Du[sup.2] , Zijing Du[sup.1] , Hao Jiang[sup.1] , Dong Han[sup.1] , Qingfeng Li[sup.1] Author Affiliations: (1) Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's [...]

The purpose of this imaging study was to investigate whether the musculocutaneous nerve could be visualized ultrasonographically in childhood and to assess how its visualization changes with age. Forty-two children participated in this prospective imaging study. The musculocutaneous nerve was sought both proximally (near the axillary artery) and distally (within the coracobrachialis muscle) by use of an linear ultrasound probe. Location of the musculocutaneous nerve was good (93 %) for all the children, both proximally and distally. For school-aged children, distal visualization of the musculocutaneous nerve reached 100 %. The musculocutaneous nerve is detectable in childhood by use of ultrasonography; success of detection was high for all the age groups examined., Author(s): Paraskevi K. Matsota[sup.1] , Tilemachos M. Paraskevopoulos[sup.1] , Konstantinos A. Kalimeris[sup.1] , Polyxeni N. Nicolaidou[sup.2] , Georgia G. Kostopanagiotou[sup.1] Author Affiliations: (1) 2nd Department of Anesthesiology, School of Medicine, [...]

In many anesthesia textbooks written in English, lidocaine, tetracaine, bupivacaine, ropivacaine, and chloroprocaine are listed as useful local anesthetics for spinal anesthesia. In contrast, T-cain is not included in these lists, even though it has been reported to be suitable for spinal anesthesia in Japan. T-cain was developed as a local anesthetic in the early 1940s by Teikoku Kagaku Sangyo Inc. in Itami, Japan, by replacing a methyl group on tetracaine (Pantocaine.sup.®) with an ethyl group. T-cain was clinically approved for topical use in Japan in November 1949, and a mixture of dibucaine and T-cain (Neo-Percamin S.sup.®) was approved for spinal use in May 1950. Simply because of a lack of foreign marketing strategy, T-cain has never attracted global attention as a local anesthetic. However, in Japan, T-cain has been used topically or intrathecally (as Neo-Percamin S.sup.®) for more than 60 years. Other than the side effects generally known for all local anesthetics, serious side effects have not been reported for T-cain. In fact, several articles have reported that T-cain decreases the neurotoxicity of dibucaine. In this historical review, the characteristics of T-cain and its rise to become a major spinal anesthetic in Japan are discussed., Author(s): Masaru Tobe[sup.1] , Shigeru Saito[sup.2] Author Affiliations: (1) Intensive Care Unit, Gunma University Hospital, 3-39-22, Showa, 371-8511, Maebashi, Gunma, Japan (2) Department of Anesthesiology, Gunma University Graduate School of [...]

Background The effect of the Mega Acer kit.sup.@, a new heated and humidified breathing circuit (HHBC) containing a fluid-warming device, was investigated on intraoperative core temperature (T.sub.c). Methods A total of 102 patients undergoing elective craniotomies were randomly divided into three groups based on the breathing circuit used: a conventional breathing circuit (group C, n = 34), a Fisher & Paykel HHBC (group F, n = 34), and the Mega (group M, n = 34). From baseline to the end of the surgery, T.sub.c and infusion fluid temperature (T.sub.f) were recorded at 15-min intervals. If T.sub.c became lower than 35.5 °C, a forced-air warmer was used. Results Baseline temperatures were 36.7 ± 0.3, 36.6 ± 0.2, and 36.6 ± 0.2 °C in groups C, M, and F, respectively. T.sub.c at the end of surgery dropped from baseline values by 1.0 ± 0.4, 0.5 ± 0.5, and 0.8 ± 0.5 °C in groups C, M, and F, respectively. From 60 min of post-induction to the end of surgery, T.sub.c was higher in group M than group C (p < 0.05). From 105 min of post-induction to the end of surgery, T.sub.c was higher in group M than group F (p < 0.05). The number of patients receiving forced-air warmer and total forced-air warmer using time were significantly lower in group M than groups C and F (p < 0.05). T.sub.f was higher in group M than groups C and F throughout the study period (31.0 ± 1.0 vs. 23.5 ± 0.5 and 24.0 ± 0.4 °C; p < 0.01). Conclusions The Mega significantly reduced the drop in intraoperative T.sub.c by delivering warm fluids, compared with the other breathing circuits tested. Trial Registration Clinicaltrials.gov identifier: NCT01831843., Author(s): Eugene Kim[sup.1] , Sue-Young Lee[sup.1] , Young-Jin Lim[sup.1] , Jung-Yoon Choi[sup.1] , Young-Tae Jeon[sup.2] , Jung-Won Hwang[sup.2] , Hee-Pyoung Park[sup.1] Author Affiliations: (1) Department of Anesthesiology and Pain Medicine, [...]

Introduction Robot-assisted laparoscopic prostatectomy (RALP) is being increasingly used. However, a steep Trendelenburg position and pneumoperitoneum during RALP has an impact on the respiratory, cardiovascular and cerebrovascular systems. To prevent complications, restrictive fluid management and blood withdrawal have been utilized in our hospital. We examined differences in the anesthetic management between RALP and radical retropubic prostatectomy (RRP), and the efficacy of blood withdrawal. Methods Medical records of patients who underwent radical prostatectomy in our hospital between January 2012 and October 2013 were retrospectively reviewed. Demographic data, intraoperative blood and fluid administration, perioperative complications and the length of hospital stay were compared among patients receiving RRP, and those receiving RALP with and without blood withdrawal (n = 78, 46 and 68, respectively). Results Patients receiving RALP with and without blood withdrawal received a smaller volume of crystalloid during surgery than those receiving RRP (mean ± SD, 5.8 ± 2.3 and 4.2 ± 1.6 vs 14.3 ± 4.1 ml/kg/h, p < 0.001). Median estimated blood loss was 885 g (80-2,800 g) for RRP and 50 g for RALP (3-950 g and 3-550 g, respectively), p < 0.001. None of the patients undergoing RALP received red blood cells, but three patients undergoing RRP did so. RALP with blood withdrawal reduced postoperative hospital stay by 45 % (6 vs 11 days). Four patients receiving RALP without blood withdrawal had delayed extubation due to severe laryngeal edema, which did not occur in any of the patients receiving RALP who had blood withdrawal. Renal function did not differ among the groups. Conclusions RALP was associated with less blood loss, no allogeneic transfusion and shorter postoperative hospital stay. This study indicated that blood withdrawal could prevent severe laryngeal edema., Author(s): Junichi Saito[sup.1] , Satoko Noguchi[sup.1] , Anna Matsumoto[sup.1] , Kei Jinushi[sup.1] , Toshinori Kasai[sup.1] , Tomoyuki Kudo[sup.1] , Masahiro Sawada[sup.1] , Futoshi Kimura[sup.1] , Tetsuya Kushikata[sup.1] , Kazuyoshi Hirota[sup.1] [...]

Carinal pneumonectomy is a challenging procedure because of the difficulties in surgical technique, intraoperative airway management, and postoperative respiratory and anastomotic complications. However, information regarding the anesthetic and intraoperative respiratory management of this procedure is scarce. This report describes our routine anesthetic and respiratory management strategy in patients undergoing carinal pneumonectomy. Medical records of 13 patients who underwent carinal pneumonectomy under combined general and epidural anesthesia between 2008 and 2012 were analyzed retrospectively. Eleven patients underwent right carinal pneumonectomy and two underwent left carinal pneumonectomy. A left double-lumen tube was used in all but one case, in which endobronchial intubation was difficult because of intrabronchial invasion of the tumor. A 6.0-mm-long reinforced endobronchial tube was intubated into the main bronchus of the non-operative side from the surgical field during carinal resection. There were no episodes of severe hypoxemia or hypercapnia during surgery. Twelve patients were extubated immediately after surgery. No patient developed post-thoracotomy acute lung injury or required postoperative reintubation despite poor preoperative respiratory function. The 30-day mortality rate was 0 %. Our airway management protocol for carinal pneumonectomy enables positive surgical outcomes., Author(s): Izumi Kawagoe[sup.1] , Eiichi Inada[sup.1] , Seiji Ishikawa[sup.2] , Takeshi Matsunaga[sup.3] , Kazuya Takamochi[sup.3] , Shiaki Oh[sup.3] , Kenji Suzuki[sup.3] Author Affiliations: (1) Department of Anesthesiology and Pain Medicine, [...]

It is recommended that the period of fasting before elective surgery should be shortened to facilitate a rapid recovery by preventing catabolism. We examined the effects of a short period of fasting on metabolism by performing indirect calorimetry (IC) under general anesthesia. A prospective observational study involving 26 consecutive patients who underwent elective surgery and whose metabolism was evaluated using IC during anesthesia was conducted. The patients were divided into two groups, those who fasted for 10 h (group L). Oxygen consumption, the volume of carbon dioxide emissions (VCO.sub.2), the respiratory quotient (RQ), resting energy expenditure (REE), and basal energy expenditure (BEE) were compared. The REE, VCO.sub.2, and RQ of group L (17.7 ± 2.3 kcal/kg/day, 118.5 ± 20.8 ml/min, and 0.71 ± 0.12, respectively) were significantly lower than those of group S (19.7 ± 2.3 kcal/kg/day, 143.6 ± 30.9 ml/min, and 0.81 ± 0.09, respectively) (P < 0.05). In group L, the relationship between REE and BEE was weaker (r.sup.2 = 0.501) and the BEE-REE slope was less steep (REE = 0.419BEE + 509.477) than those seen in group S (r.sup.2 = 0.749 and REE = 1.113BEE - 376.111, respectively). Our findings suggest that a short period of fasting (, Author(s): Shinichiro Yoshimura[sup.1] , Yoshihito Fujita[sup.1] , Hiroyuki Hirate[sup.1] , Nobuyoshi Kusama[sup.1] , Takafumi Azami[sup.1] , Kazuya Sobue[sup.1] Author Affiliations: (1) Department of Anesthesiology and Medical Crisis Management, Nagoya City [...]

Purpose The airway scope (AWS) improves views of the larynx during orotracheal intubation. However, the role of the AWS in routine nasotracheal intubation has not been studied adequately. Methods One hundred and three patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. The study was approved by our Institution Review Board, and written informed consent was obtained from all patients. We evaluated the success rate of AWS intubation and the incidence of difficult nasotracheal intubation using a modified intubation difficulty scale (IDS) to examine preoperative characteristics and intubation profiles. Categories were difficult intubation (IDS [greater than or equal to] 5), mildly difficult (IDS = 1-4), and intubation without difficulty (IDS = 0). We also assessed the incidence of the use of Magill forceps or cuff inflation (the cuff of endotracheal tube is inflated with 10-15 ml air) to guide the endotracheal tube into the glottis. Results AWS nasotracheal intubation was 100% successful. The cuff inflation technique was used in 37 patients. Neither Magill forceps nor other devices were needed for any patient during AWS use. The incidence of difficult nasotracheal intubation was 10% (n = 10). Of the patients, 61% (n = 63) had mildly difficult intubation and 29% (n = 30) had no difficulty. Patients with difficult intubation were more likely to be male and to have a larger tongue and a higher Cormack grade than in the other two groups. Complications, involving minor soft tissue injury, were observed in only 1 patient (1%). Conclusion The AWS achieves a high success rate for nasotracheal intubation with cuff inflation in patients undergoing dental and maxillofacial surgery. Keywords Airway scope * Video laryngoscope * Difficult nasotracheal intubation, Introduction Nasotracheal intubation usually is accomplished using direct laryngoscopes such as the Machintosh or McCoy. Although direct laryngoscopes provide a sightline view of the airway during nasotracheal intubation, the patient's [...]

Purpose To determine the lowest effective cuff pressure of the esophageal obstruction tube to prevent reflux of gastric contents in rabbits. Methods Twenty-two New Zealand white rabbits (2.0-2.5 kg) were anesthetized. An esophageal obstruction tube, an esophageal observation tube, and a gastric tube were inserted into the esophagus and stomach, respectively. Normal saline containing methylene blue was injected into the stomach for an animal model of gastric contents reflux. Possible saline reflux was observed through the esophageal observation tube. It was considered 'regurgitation' when the saline flowed out, and 'no regurgitation' when the saline did not. When a 'regurgitation' result was obtained in a particular rabbit, the intracuff pressure was increased by 10 cm [H.sub.2]O in the following rabbit and vice versa. The trial was not terminated until six crossover points were observed from 'no regurgitation' to 'regurgitation.' A probit regression model was used to analyze the effective intracuff pressure of the esophagus obstruction tube after 50 % and 95 % of the rabbits showed no reflux. Results The lowest effective intracuff pressure to prevent reflux of gastric contents in 50 % of rabbits from the Dixon up-down method was 61.67 ± 8.16 cm [H.sub.2]O. The intracuff pressures at which there was 50 % and 95 % probability of lack of gastric contents reflux from a probit regression model were 61.95 and 74.39 cm [H.sub.2]O, respectively. Conclusion The insertion of an esophageal obstruction tube before endotracheal intubation can be an acceptable method for preventing the reflux of gastric contents in most rabbits under light anesthesia. Keywords Intracuff pressure * Reflux * Esophagus * General anesthesia, Introduction Reflux and aspiration of gastric contents can cause serious complications, including pulmonary obstruction, chemical pneumonitis, and secondary infection, and can even be life threatening [1, 2]. Aspiration of the [...]

Author(s): Hiroyuki Sumikura[sup.1] Author Affiliations: (1) Department of Anesthesiology and Pain Management, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan There is a common saying that truth never [...]