Search

The COVID-19 pandemic is ongoing as of September 2022. Since January 2020 when the first case was reported in Japan, the medical community faced a variety of problems both domestically and internationally. It is meaningful to review the impact of COVID-19 from an anesthesiologist's perspective to clarify our policy for future infectious disease outbreaks. In this year's Journal of Anesthesia (JA) symposium, five experts who were deeply involved in the COVID-19 response reviewed the past 2.5 years and made recommendations for potential future pandemics. Anesthesiologists are specialists in airway management and their role in intubating patients with COVID-19 has received much attention. However, they have also played an important backup role in intensive care as critical care physicians and must be more involved in critical care in regular (non-pandemic) times to properly fulfill this role. It is especially important for the Japan Society of Anesthesiologists and JA to quickly disseminate accurate information on unknown infectious diseases to the medical community and wider society. Therefore, it is important to promptly publish papers that are quality-assured through peer review., Author(s): Kanji Uchida [sup.1], Osamu Nishida [sup.2], Hiroshi Morimatsu [sup.3], Takahisa Goto [sup.4], Yutaka Oda [sup.5], Takashi Asai [sup.6] Author Affiliations: (1) grid.26999.3d, 0000 0001 2151 536X, Department of Anesthesiology, [...]

Recently published case reports relating to anesthesia in patients with coronavirus disease (COVID-19) were reviewed. The diagnosis of COVID-19 was confirmed by positive results of reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Numerous reports handled emergency cesarean delivery. Primary symptoms and laboratory data of pregnant women with COVID-19 were similar to those of non-pregnant patients. Although the mortality rate is reported to be high after surgery in patients with COVID-19, cesarean delivery was successfully performed under regional anesthesia in most cases and postoperative course was favorable both in the parents and newborns. There is no direct evidence of vertical mother-to-child transmission of SARS-CoV-2; however, a diagnosis of COVID-19 was made in a newborn two hours after delivery from a pregnant woman with COVID-19, based on the increased immunoglobulin levels and deranged liver function, suggesting that its possibility cannot be completely eliminated. Emergency cerebral shunt reconstruction was performed repeatedly in an eight-month-old boy with COVID-19. The tracheal tube was removed in the operating room after surgery and postoperative course was uneventful. All the procedures should be performed in isolated operating rooms with medical staff with level-3 personal protection to ensure the safety of patients and health care providers., Author(s): Yutaka Oda [sup.1] Author Affiliations: (1) Department of Anesthesiology, Osaka City Juso Hospital, , 2-12-27, Nonaka-kita, Yodogawa-ku, 532-0034, Osaka, Japan Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly [...]

Purpose To characterize the clinical features and outcome of patients treated at a specialized hospital for coronavirus disease 2019 (COVID-19). Methods We retrospectively reviewed the symptoms on admission, treatment, and outcome of a total of 300 patients with mild (peripheral oxygen saturation (SpO.sub.2) [greater than or equal to] 96%), moderate I (93% < SpO.sub.2 < 96%), moderate II (SpO.sub.2 [less than or equal to] 93%) and severe (requiring admission to the ICU or mechanical ventilation) COVID-19. Results Median age was 53 (interquartile range [IQR] 33-72) years and 57% was male. The number of patients with mild, moderate I, II and severe condition was 85, 138, 61 and 16, respectively. Common presenting symptoms were cough (n = 71), loss of taste (42), loss of smell (39), fever [greater than or equal to] 37.5 °C (36). Dyspnea was observed only 21 cases; 57 reported no symptoms on admission. Favipiravir, ciclesonide, dexamethasone, and heparin were administered in 106, 168, 65, and 38 patients, respectively, but not remdesivir. The median duration of hospitalization was 10 (7-15) days. All patients with mild and moderate I severity were discharged. Among the 77 patients classified as moderate II or severe, 3 were transferred to tertiary hospitals for further treatment on the day of admission. The respiratory condition worsened in 21 patients; 18 required transfer to tertiary hospitals 3 (median) days after admission and 3 died. Conclusion Respiratory condition recovered in 92%; whereas it worsened in 7% and the mortality rate was 1%. The ratios of male patients, of patients with diabetes mellitus in those with the decreased respiratory condition, were significantly higher than recovered., Author(s): Yutaka Oda [sup.1], Satoshi Shiraishi [sup.2], Motoko Shimada [sup.1], Osamu Kurai [sup.3] Author Affiliations: (1) Department of Anesthesiology, Osaka City Juso Hospital, , 2-12-27 Nonaka-kita, Yodogawa-ku, 532-0034, Osaka, Japan [...]

Author(s): Yutaka Oda [sup.1] Author Affiliations: (1) Department of Anesthesiology, Osaka City Juso Hospital, , 2-12-27, Nonaka-kita, Yodogawa-ku, 533-0034, Osaka, Japan Sugammadex is extensively used since its introduction to our [...]

Author(s): Yutaka Oda [sup.1] Author Affiliations: (Aff1) Department of Anesthesiology, Osaka City Juso Hospital, , 2-12-27, Nonaka-kita, Yodogawa-ku, 532-0034, Osaka, Japan Introduction 'Practical guide for the management of systemic toxicity [...]

Purpose We examined the hypothesis that 1 minimum alveolar concentration (MAC) of desflurane and sevoflurane provides different depth of anesthesia. Methods One hundred and twenty young (20-30 years), middle-aged (31-65 years), and elderly (66-80 years) patients were randomly allocated to receive either desflurane or sevoflurane (n = 20, each group). General anesthesia was induced with propofol 2 mg/kg bolus and remifentanil 0.25 [micro]g/kg/min, which was stopped after tracheal intubation. Maintenance of anesthesia was started with an end-tidal concentration of desflurane or sevoflurane at age-adjusted 1 MAC and maintained for 10 min, followed by 1-min assessment of bispectral index (BIS), 95% spectral edge frequency (SEF95), and amplitude of the electroencephalogram taken at 10-s intervals. Results BIS and SEF95 in patients receiving 1 MAC desflurane were significantly lower than those receiving 1 MAC sevoflurane including all age groups [35 (29, 39) vs. 41 (38, 49); 12.53 (10.99, 13.95) Hz vs. 14.42 (12.99, 17.17) Hz median (25, 75 percentile), respectively, P < 0.001 for both]. Both BIS and SEF95 in young patients were lower than in middle-aged and elderly patients receiving either desflurane or sevoflurane (P < 0.001 for both). There were no differences in amplitude between patients receiving desflurane and sevoflurane. Conclusions BIS as well as SEF95 were lower in patients receiving 1 MAC desflurane than those receiving 1 MAC sevoflurane, suggesting that desflurane provides higher depth of anesthesia than sevoflurane at 1 MAC., Author(s): Shinya Kanazawa [sup.1] , Yutaka Oda [sup.1] , Chika Maeda [sup.1] , Ryu Okutani [sup.1] Author Affiliations: (Aff1) 0000 0004 1764 9308, grid.416948.6, Department of Anesthesiology, Osaka City General [...]

Author(s): Yutaka Oda[sup.1] Author Affiliations: (1) Department of Anesthesiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, 534-0021, OsakaJapan Introduction With the development of ultrasound-guided regional anesthetic techniques, peripheral nerve block [...]

Many education critics, teachers, and parents have lamented the recent poor achievement scores of Japanese school-age children, and have sought the reasons for the decline. Some critics, including the Minister of Education, Culture, Sports, and Science and Technology, blame the practice known as yutori-kyoiku (literally translated as "relaxed-education"), initiated in 2002, which cut the school week from six days to five days and slashed curriculum content by 30 percent. At first glance, this debate does not seem to affect kindergarten or preschool education directly. However, some critics make kindergarten the scapegoat for poor school performance, saying that kindergarten education overemphasizes free play. Thus, this article provides an overview of the history of kindergarten education in Japan, focusing on the development of curriculum content and practice. The authors illustrate the current Japanese kindergarten curriculum and prospects for the future.

PHACE syndrome is a neurocutaneous syndrome characterized by the association of large cutaneous hemangiomas and the cardiac and cerebral vascular anomalies. We report a 6-year-old female with PHACE syndrome presented with left facial hemangiomas, cystic lesion in the cerebral posterior fossa, coarctation of the aorta, aplasia of the left vertebral artery and stenosis of the left internal carotid artery. Surgical repair of the aorta with left heart bypass under beating heart was scheduled. We monitored regional cerebral oxygen saturation (rS[O.sub.2]) with infrared spectroscopy in order to detect cerebral hypoperfusion. A decrease of rS[O.sub.2] ipsilateral to the cerebrovascular anomalies occurred during anastomosis of the aorta, which was treated by reducing the flow rate of left heart bypass and by increasing the inhalational oxygen concentration. As children with PHACE syndrome are frequently accompanied with cerebrovascular anomalies and at a risk of cerebral hypoperfusion, prevention of cerebral hypoperfusion is crucially important during general anesthesia. Keywords Coarctation of the aorta * Dandy-Walker syndrome * Left heart bypass * PHACE syndrome * Regional cerebral oxygen saturation, Introduction PHACE syndrome (1) is a coined acronym consisting of the initial letters of the following features: posterior fossa brain malformations, hemangiomas on face, anomaly of the cerebral arteries, coarctation [...]

Background It has been nearly 15 years since the effectiveness of intravenous lipid emulsion in resuscitation from bupivacaine-induced cardiac arrest was reported by Weinberg et al. [1]. Despite the outstanding [...]

Purpose Despite numerous studies examining the effect of lipid emulsion on bupivacaine-induced cardiac toxicity, few studies have examined its effect on central nervous system (CNS) toxicity of local anesthetics. We investigated the effect of lipid emulsion on the CNS and cardiac toxicity of bupivacaine and levobupivacaine in awake, spontaneously breathing rats. Methods Male Sprague-Dawley rats were randomly allocated to control-bupivacaine (CB), control-levobupivacaine (CL), lipid-bupivacaine (LB), and lipid-levobupivacaine (LL) groups (n = 8 in each group). After infusion of saline (CB and CL groups) or 20% lipid emulsion (LB and LL groups) for 5 min, bupivacaine (CB and LB groups) or levobupivacaine (CL and LL groups) was administered IV at 1 mg/kg/min. Cumulative dose of anesthetics and their plasma concentrations at the onset of convulsions and cardiac arrest were measured. Results The doses of bupivacaine for inducing convulsions and cardiac arrest in the LB group (8.8 ± 1.7 and 10.2 ± 1.5 mg/kg, respectively) were significantly larger than those in the CB group (5.9 [+ or -] 1.1 and 7.1 ± 1.3 mg/ kg, respectively, p < 0.001 for both). The doses of levobupivacaine for inducing convulsions and cardiac arrest in the LL group (10.0 ± 2.0 and 13.7 ± 3.6 mg/kg, respectively) were significantly larger than those in the CL group (7.7 ± 1.6 and 9.4 [+ or -] 2.4 mg/kg, p = 0.03 and p = 0.02, respectively). Plasma concentrations of bupivacaine at the onset of convulsions and cardiac arrest in the LB group (12.9 ± 2.9 and 41.4 ± 5.2 µg/ml, respectively) were significantly higher than those in the CB group (7.9 ± 1.2 and 21.6 [+ or -] 3.3 µg/ml, respectively, p < 0.001 for both). Plasma concentrations of levobupivacaine at the onset of convulsions and cardiac arrest in the LL group (17.5 ± 1.5 and 47.6 ± 6.1 µg/ml, respectively) were significantly higher than in the CL group (10.9 ± 2.2 and 29.2 ± 3.5 µg/ml, respectively, p < 0.001 for both). Conclusions Lipid emulsion decreased CNS and cardiac toxicity of both bupivacaine and levobupivacaine. Keywords Bupivacaine * Levobupivacaine * Central nervous system toxicity * Cardiac toxicity * Lipid emulsion, Introduction The effect of lipid emulsion on local-anesthetic-induced cardiac toxicity has been extensively studied [1]. Most of those studies employed anesthetized, mechanically ventilated animal models [2-4]. One reason for this [...]

Purpose We compared the insertion performance of the pediatric size 1.5-3 i-gel airway device with that of the ProSeal laryngeal mask airway (PLMA) in anesthetized children in a prospective, randomized, controlled manner. Methods We included 134 children, aged 3 months to 15 years, scheduled for elective surgery under general anesthesia. They were randomly divided into the i-gel and the PLMA groups according to the airway device used. The primary outcome variable was oropharyngeal leak pressure. Other outcome variables were ease of insertion, required time for insertion, fiberoptic view, and first-attempt and overall success rates. Results There were no differences in the ease of insertion, insertion time, or leak pressure between the devices. Fiberoptic view was significantly better with the i-gel than with the PLMA (P = 0.002). The view was significantly better with the sizes 2, 2.5, and 3 i-gel than with the size 1.5 i-gel (P = 0.02, 0.004 and 0.002, respectively), and the view was significantly better with the sizes 2.5 and 3 PLMA than with the size 1.5 PLMA (P = 0.02 and 0.005, respectively). The first-attempt success rates were 94 and 97 % in the i-gel and the PLMA groups, respectively; the success rates including the second attempt were 100 % in both groups. No children developed side effects requiring treatment with either device. Conclusion Both the pediatric i-gel and the PLMA were successfully inserted in children. The fiberoptic view was better with the i-gel than with the PLMA. Keywords Airway * Device * Intubation * i-gel * ProSeal laryngeal mask airway * Pediatrics, Introduction The pediatric i-gel (Intersurgical, Wokingham, Berkshire, UK) is a new single-use, latex-free supraglottic airway device for children [1]. It is a smaller model of the i-gel device used in [...]

We have opened an operating room in the perinatal care unit (PNCU), separate from our existing central operating rooms, to be used exclusively for cesarean sections. The purpose is to meet the increasing need for both emergency cesarean sections and non-obstetric surgeries. It is equipped with the same surgical instruments, anesthesia machine, monitoring system, rapid infusion system and airway devices as the central operating rooms. An anesthesiologist and a nurse from the central operating rooms trained the nurses working in the new operating room, and discussed solutions to numerous problems that arose before and after its opening. Currently most of the elective and emergency cesarean sections carried out during the daytime on weekdays are performed in the PNCU operating room. A total of 328 and 347 cesarean sections were performed in our hospital during 2011 and 2012, respectively, of which 192 (55.5%) and 254 (73.2%) were performed in the PNCU operating room. The mean occupancy rate of the central operating rooms also increased from 81% in 2011 to 90% in 2012. The PNCU operating room was built with the support of motivated personnel and multidisciplinary teamwork, and has been found to be beneficial for both surgeons and anesthesiologists, while it also contributes to hospital revenue. Keywords Cesarean section * Operating room * Perinatal care unit * Occupancy rate, Introduction In North America and in several European countries, obstetric surgery is routinely performed in an operating room with special facilities such as a delivery suite and perinatal care unit [...]

Lipid emulsion infusion is a first-line therapy against the toxicity of local anesthetics and is a potential treatment for other drug overdoses, especially for highly lipophilic drugs. Considering the lipophilic property of volatile anesthetics, we hypothesized that lipid emulsion could reverse general anesthesia. Using adult rats, we tested the effect of lipid emulsion infusion on time to emergence after discontinuation of sevoflurane and isoflurane, and further evaluated restoration of righting reflex under continuous sevoflurane anesthesia. Electroencephalogram during lipid emulsion infusion was also investigated under continuous sevoflurane inhalation. The effect of lipid emulsion on sevoflurane-induced respiratory and hemodynamic depressions was evaluated by measuring respiratory rate, PaCO2 (arterial partial pressure of CO2), blood pressure, and heart rate. The binding property of lipid emulsion on sevoflurane and isoflurane was assessed using in vitro setting with a conical flask. Lipid emulsion infusion significantly decreased time to emergence from sevoflurane anesthesia (131 ± 53 vs. 237 ± 69 s) and restored righting reflex during continuous sevoflurane inhalation, by comparing normal saline infusion. Consistent with the behavioral findings, the electroencephalogram under continuous sevoflurane showed decreased power of the δ bands at 5 min after the initiation of lipid emulsion infusion. In addition to reversing hypnosis, lipid emulsion recovered respiratory as well as hemodynamic depressions induced by sevoflurane. Decreased time to emergence was observed also in isoflurane anesthesia (203 ± 111 vs. 314 ± 154 s). To investigate the binding mechanism of lipid emulsion infusion, in vitro experiments revealed significantly decreased anesthetic concentrations of sevoflurane and isoflurane by mixing with lipid emulsion. Lipid emulsion facilitated reversal from volatile anesthetics, as shown by several parameters. As lipid emulsion could bind to volatile anesthetics and simply decrease their effects, our findings suggest that lipid emulsion is a potentially useful agent to reverse general anesthesia. [ABSTRACT FROM AUTHOR]

Author(s): Yutaka Oda [sup.1] Author Affiliations: (1) Department of Anesthesiology, Osaka City Juso Hospital, 2-12-27, Nonaka-kita, Yodogawa-ku, 533-0034, Osaka, Japan Rocuronium has become the neuromuscular blocking agent of first choice [...]

The tertiary and quaternary structures of 0.19 alpha-amylase inhibitor (0.19 AI) from wheat kernel were investigated by X-ray analysis. The crystal structure was refined by simulated annealing using diffraction data to 2.06 angstroms resolution. The tertiary structure of 0.19 AI was compared with that of the bifunctional alpha-amylase/trypsin inhibitor from ragi seeds (RBI). Results showed that the arrangements of the major alpha-helices of 0.19 AI, RBI and hydrophobic protein from soybean are similar while the conformations of the remaining residues differ significantly.

Author(s): Yutaka Oda [sup.1] , Shinya Kanazawa [sup.2] , Motoko Shimada [sup.1] Author Affiliations: (Aff1) Department of Anesthesiology, Osaka City Juso Hospital, , 2-12-27, Nonaka-kita, Yodogawa-ku, 533-0034, Osaka, Japan (Aff2) [...]

Purpose: To compare effects of free-hand and mechanically applied uniform irradiation on tensile bond strength of 4- META/MMA-TBB resin to Er:YAG laser-irradiated dentin using an X-Y moving stage. Materials and Methods: Three different laser conditions were evaluated: 1.0 W, 100 mJ/pulse, 10 pps; 1.0 W, 50 mJ/pulse, 20 pps; 1.0 W, 33 mJ/pulse, 30 pps. Samples of bovine dentin were set on a moving stage and mechanically irradiated with an Er:YAG laser at a scanning speed of 1.0 mm/s or subjected to free-hand irradiation. The lased dentin surfaces were acid conditioned with 10% citric acid/3% ferric chloride for 15 s, rinsed, and dried. The surfaces were bonded to PMMA rods with 4-META/MMA-TBB resin, and mini-dumbbell-shaped bonded specimens were prepared. Tensile bond strength was measured and compared with the results for free-hand irradiated samples obtained under the same conditions in an earlier study. SEM observations of fractured surfaces after tensile bond testing were also performed. Results: A significant difference was found in tensile bond strength among the 3 laser settings in both free-hand and mechanically uniform irradiations. A comparison of free-hand laser irradiation and mechanically performed uniform laser irradiation revealed no significant difference under either laser condition (p > 0.05). SEM observation of the fractured surfaces showed no difference between the two irradiation methods under all laser conditions. Conclusion: No significant difference was found in tensile bond strength between free-hand and mechanically irradiated dentin. Significant differences were found, however, with changes in laser setting in both groups. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to measure the flexural strength and the elastic modulus of composite resin with and without reinforcing fibers and to evaluate the reinforcing effect of various fibers. Materials and Methods: A polyethylene fiber (Ribbond), a polyaramid fiber (Fibreflex), and three glass fibers (FibreKor, GlasSpan, Vectris) were used to reinforce composite resins. The flexural strength and elastic modulus of specimens in the three-point bending mode were measured using a universal testing machine at a cross-head speed of 1 mm/min after storage in water at 37°C for 24 hours. All tests were carried out in a water bath at 37°C. The data were analyzed using analysis of variance and the Sheffé test at P = 0.05. After testing, the fractured surface was evaluated using a scanning electron microscope at 50, 500, and 3,000 magnifications. Results: Yield flexural strengths of nonreinforced resins were 48 to 56 MPa, and those of reinforced resins were 56 to 134 MPa. Ultimate flexural strengths of nonreinforced specimens were 96 to 119 MPa, and those of reinforced ones were 203 to 386 MPa. Elastic modulus of nonreinforced resin was 6 to 9 GPa, and fiber reinforcing increased the value to 9 to 15 GPa, while it had no effect in Ribbond. Conclusion: Most of the fibers used in this study increased both yield and ultimate flexural strengths of composite resins, with the exception of the yield strength of Vectris. GlasSpan, Fibreflex, and FibreKor were effective in reinforcing elastic modulus, while Ribbond had no effect on it. Unidirectional glass fibers and polyaramid fiber were effective in reinforcing both flexural strength and elastic modulus of composite resin. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the effect of acid conditioners on resin bonding to dentin following irradiation with an Er:YAG laser and investigated the characteristics of resin bonding to the laser-treated dentin. Materials and Methods: Extracted bovine teeth were cervically sectioned to expose a dentin surface. After polishing, the dentin was irradiated with an Er:YAG laser. Aqueous solutions of 10% citric acid (10-0) or 10% citric acid/3% ferric chloride (10-3) were then applied to the laser-treated surface as acid conditioners. After the acid treatment, a PMMA rod was bonded to the irradiated dentin using 4-META/MMA-TBB resin, and miniaturized dumbbell-shaped bonded specimens were prepared. These specimens were subjected to tensile testing, and fractured surfaces were observed with field-emission scanning electron microscopy (FE-SEM) to determine the mode of fracture. Additionally, the resin-dentin interfaces were observed under FE-SEM. Results: The tensile bond strength of acid-conditioned bonded specimens was lower than that of specimens not subjected to acid treatment (11.1 MPa) in the laser-irradiated group. No significant difference was observed between 10-0 and 10-3 treatments. 10-3 treatment yielded the highest bond strength (24.6 MPa) in the nonirradiated group, as opposed to only 7.7 MPa in the laser-treated group. Cohesive failure in the dentin was observed in almost all specimens in the irradiated group. Furthermore, a 10- to 30-µm-thick resin-penetrated layer was observed at the interface between the dentin and the resin. Conclusion: These results suggest that the effect of acid conditioners on resin bonding to dentin differs according to whether the dentin has been laser irradiated or not. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of fatigue on the strength of materials used in all-ceramic crowns, the biaxial flexural strength of air-ceramic restorative materials was measured with precracked and laminated specimens after cyclic loading. Materials and Methods: Two types of all-ceramic systems were used to prepare specimens: a glass-infiltrated alumina core system (In-Ceram) and a leucite-reinforced feldspathic porcelain system IPS-Empress). Monolayer and laminated disks with a diameter of about 11.75 mm and a thickness of 1.20 ± 0.05 mm were prepared. The biaxial flexural strength of the specimens that were polished and/or created with a precrack was measured. Their strength was also measured following cyclic loading. A cyclic load that was 60% of the mean breaking load of the specimens (before cyclic loading) was applied to specimens for 105 cycles in 37°C water. Results: Although 20% to 30% of the polished specimen samples fractured during cyclic loading, the biaxial flexural strength of specimens that survived the cyclic loading was nearly the same as that of specimens not subjected to the cyclic loading. The strength of the alumina system decreased with the introduction of precracks, and nearly all specimens fractured during cyclic loading. The strength of the leucite system, however, did not decrease with the presence of precracks, and no fractures were observed on these specimens during cyclic loading. Conclusion: These results suggest that although the alumina system has high flexural strength, it is more sensitive to flaws and susceptible to fatigue fracture. The effect of fatigue on the leucite system appears to be low. [ABSTRACT FROM AUTHOR]

To the Editor: Institutional Review Board approval and informed concent were exempted because no ethical problem was involved in this case report. After the operation, informed consent for publication was [...]