Search

Purpose : We evaluated the effect of 10-min prewarming on core temperature maintenance during general anesthesia. Patients : We randomized 40 women scheduled for breast cancer surgery into 10-min Prewarming and Control groups. In the Prewarming group, a forced-air warming system was used to warm the patients at 43℃ for 10 min immediately before general anesthesia induction. In the Control group, the patients were kept warm using cotton thermal blankets for 10 min. We measured tympanic temperature every 15 min from anesthesia induction for 90 min. Findings : Since two patients deviated from the protocol, we used the data of 38 patients (Prewarming [n = 18] and Control [n = 20]). There was a significant between-group difference in changes in core temperature (P = 0.03), including a significant difference in core temperature decrease during the first 60 min from anesthesia induction (Prewarming : −0.3 [0.3] ℃ vs. Control : −0.6 [0.2] ℃, P = 0.02). In addition, the duration of normal core temperature maintenance was significantly longer in the Prewarming group (66 [34] min vs. 39 [32] min, P = 0.01). Conclusions : Ten-min prewarming decreases core temperature loss and contribute to maintaining normal core temperature during breast surgery.

Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disease with diverse clinical manifestations, including dementia and muscle weakness. We summarize anesthetic considerations in reporting general anesthesia for a 58-year-old man with bladder dysfunction and cerebellar ataxia who was diagnosed with NIID. The patient developed postinduction hypotension relevant to autonomic neuropathy. The potential risks, such as prolonged reaction to neuromuscular blocking agent, postoperative delirium, and worsening of NIID-related symptoms, were also considered. The responsiveness to anesthetics may vary widely from case t case. As the number of NIID cases increases, a better understanding of NIID is needed.

Background Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia. Methods Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 μg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV). Results MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (− 41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: − 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p p = 0.341). Conclusions Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, not only the choice but also the dose and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol. Trial registration UMIN-CTR (UMIN000045612).

Malignant hyperthermia (MH) is a severe hypermetabolic disorder associated with dysregulation of calcium homeostasis and is triggered by inhalational anesthetics (isoflurane, sevoflurane, desflurane) and a depolarizing muscle relaxant (succinylcholine). We report the case of a 16-day-old infant undergoing laparoscopic surgery. The patient developed hyperthermia and hypercarbia with muscle rigidity. After the diagnosis of MH, dantrolene was administered with sufficient hydration. The patient was transferred to the pediatric intensive care unit for monitoring and treatment of acute renal injury due to myoglobinuria. Subsequently, two variants of the ryanodine receptor 1 (RYR1) gene were identified in the patient as the mutation point at c.1589G > A p.Arg530His and c.1841G > T p.Arg614Leu, which are known to be associated with MH. This was a rare case of MH in a 16-day-old infant that might be related to two RYR1 mutations inherited from the parents.

Background Previous studies showed that remifentanil-induced anesthesia can inhibit surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate fat catabolism. However, little is known about the influence of glucose loading on metabolism in elderly patients, whose condition may be influenced by decreased basal metabolism and increased insulin resistance. We hypothesized that, in elderly patients, intraoperative low glucose infusion may attenuate the catabolism of fat without causing harmful hyperglycemia during remifentanil-induced anesthesia. Methods Elderly, non-diabetic patients scheduled to undergo elective surgery were enrolled and randomized to receive no glucose (0G group) or low-dose glucose infusion (0.1 g/kg/hr. for 1 h followed by 0.05 g/kg/hr. for 1 h; LG group) during surgery. Glucose, adrenocorticotropic hormone (ACTH), 3-methylhistidine (3-MH), insulin, cortisol, free fatty acid (FFA), creatinine (Cr), and ketone body levels were measured pre-anesthesia, 1 h post-glucose infusion, at the end of surgery, and on the following morning. Results A total of 31 patients (aged 75–85) were included (0G, n = 16; LG, n = 15). ACTH levels during anesthesia decreased significantly in both groups. In the LG group, glucose levels increased significantly after glucose loading but hyperglycemia was not observed. During surgery, ketone bodies and FFA were significantly lower in the LG group than the 0G group. There were no significant differences in insulin, Cr, 3-MH, and 3-MH/Cr between the two groups. Conclusion Remifentanil-induced anesthesia inhibited surgical stress response in elderly patients. Intraoperative low-dose glucose infusion attenuated catabolism of fat without inducing hyperglycemia. Trial registration This study has been registered with the University hospital Medical Information Network Center (http://www.umin.ac.jp/english/). Trial registration number: UMIN000016189. The initial registration date: January 12th 2015.

Two types of amniotic fluid embolism (AFE) have been described : cardiopulmonary collapse type and disseminated intravascular coagulation (DIC) type, with the latter proposed as uterine type. This report describes a healthy 28-year-old woman who developed AFE during a cesarean section. Because of a previous cesarean section, the patient underwent an elective cesarean section, under combined spinal-epidural anesthesia, at 38 weeks of pregnancy. She began coughing 5 minutes after delivery of the fetus, subsequently becoming unconscious and developing glossoptosis and bradycardia. Her blood pressure decreased to 76/43 mmHg, and AFE was suspected. Her uterus was atonic, and she experienced persistent noncoagulant bleeding, with a final blood loss of 6300 ml. Considerable blood transfusion was required. The patient survived, and she and her baby were discharged without any sequelae on the eighth postoperative day. This patient met the Japanese criteria for clinical AFE, with an obstetrical DIC score of 21 meeting the criteria for obstetrical DIC. Early diagnosis and treatment likely resulted in patient survival. J. Med. Invest. 67 : 207-210, February, 2020.

Here, we report two cases involving a neonate and child in which a slip joint section was used to thread a Fogarty catheter into the endotracheal tube for one-lung ventilation (OLV). Both the neonate and infant required OLV, and were placed under general anesthesia. A Fogarty catheter was used for OLV. The Fogarty catheter was passed into the intraluminal side of the endotracheal tube through a slip joint section. OLV was maintained successfully without severe air leakage or Fogarty catheter displacement. The neonate had been intubated pre-operatively with a 3.5-mm inner diameter endotracheal tube, and we used that tube. These cases indicate that the technique can be applied to pre-operatively intubated patients and does not require surgeons to exchange endotracheal tubes. Use of the slip joint section technique facilitates Fogarty catheter fixation without additional dead space. J. Med. Invest. 68 : 209-212, February, 2021.

Automatization for the picking and placing of a variety of objects stored on shelves is a challenging problem for robotic picking systems in distribution warehouses. Here, object recognition using image processing is especially effective at picking and placing a variety of objects. In this study, we propose an efficient method for object recognition based on object grasping position for picking robots. We use a convolutional neural network (CNN) that can achieve highly accurate object recognition. In typical CNN methods for object recognition, objects are recognized by using an image containing picking targets from which object regions suitable for grasping can be detected. However, these methods increase the computational cost because a large number of weight filters are convoluted with the whole image. The proposed method detects all graspable positions from an image as a first step. In the next step, it classifies an optimal grasping position by feeding an image of the local region at the grasping point to the CNN. By recognizing the grasping positions of the objects first, the computational cost is reduced because of the fewer convolutions of the CNN.

Bin picking of various daily items is an important research problem in robotics. If the target items are diverse, multiple grippers are normally used. A design of gripper combinations depends not only on the item variations but also on the state of the bins, which changes while robots pick items from them. In this paper, we propose a gripper combination strategy to change the gripper combination during a bin-picking task based on the sparseness of objects inside bins. As an experiment, we build a robot system which has three different types of grippers. By using the proposed combination strategy, the system effectively changed the gripper combination during the task, and picked 18/20 items to obtain the 3rd place in the Stow task at the Amazon Robotics Challenge 2017. The successful picking rate and Mean Picks Per Hour (MPPH) were higher than the 1st place team. In this paper, we describe the problem, method to switch the combination, system including gripper design and recognition algorithm, and experimental results from the competition.

Background During perioperative fasting, lipid metabolism gradually increases, resulting in free fatty acids (FFA) and/or ketone bodies. Suppression of surgical stress by remifentanil may allow the safe administration of glucose infusions, avoiding both hyperglycemia and ketogenesis. The effects of glucose infusion on glucose and lipid metabolism were therefore investigated in patients undergoing minor surgery with remifentanil anesthesia. Methods Thirty-four patients were randomized 1 : 1 to receive no glucose (0G group) or low-dose glucose (0.1 g/kg/h for 1 h followed by 0.05 g/kg/h for 1 h; LG group). The concentrations of glucose, adrenocorticotropic hormone (ACTH), 3-methylhistidine (3-MH), insulin, cortisol, FFA, creatinine (Cr), and ketone bodies were measured before anesthetic induction, 1 and 2 h after glucose infusion, at the end of surgery, and the next morning. Results The concentrations of cortisol and ACTH decreased during surgery in both groups when compared with the concentrations before anesthesia and at the end of surgery (P

In our hospital, lumbar epidural analgesia had been used for postoperative analgesia following vaginal total hysterectomy (VTH). But some patients experienced severe abdominal pain or numbness of the legs. Therefore we planned a randomized prospective study to compare lower thoracic epidural analgesia and lumbar epidural analgesia following VTH.Fifty patients were allocated to two groups: those who received lower thoracic epidural analgesia(T group)and the other who received lumbar epidural analgesia (L group). Both groupsreceived the same continuous epidural analgesia using fentanyl and ropivacaine after the operation.The T group required significantly lower frequency of analgesic agents compared with that of the L group (2.5±1.9 times vs. 1.2±1.1 times, P0.05). Fewer patients in the T group had felt numbness in their legs compared to the L group (8% vs. 55%, P0.05).Lower thoracic epidural analgesia is more effective to provide postoperative analgesic effect following VTH compared with lumbar epidural analgesia.

We describe a case of a 39-year-old woman diagnosed with placenta percreta complicated by massive hemorrhage during a cesarean section. At 27 weeks of gestation, she underwent an emergency cesarean section under general anesthesia for vaginal bleeding and an intrauterine infection. Soon after delivery, a massive hemorrhage was encountered while attempting to separate the placenta percreta from the bladder wall. Although total abdominal hysterectomy and partial cystectomy were performed, massive hemorrhaging persisted. Bleeding was finally controlled following bilateral internal iliac artery embolization. We used a cell salvage device and a rapid infuser for hemodynamics stabilization. Total blood loss was 47,000 mL, and anesthesia time was 12 h and 47 min. The patient was discharged on the 32(nd) postoperative day without major complications. Placenta accreta can be associated with life-threatening hemorrhage and it is vital to plan accordingly preoperatively.

In this paper, we propose a method for a mobile robot to avoid obstacles in its environment using an omni-directional camera. The method makes an environment map consisting of 3D edge points obtained from omni-directional camera images and estimates the locations of planes by analysing these 3D edge points so that the robot can avoid walls as obstacles. The method has the advantage that it can generate a 3D map in environments constructed by textureless planes. Experimental results show the effectiveness of the proposed method.

In this paper, we propose a method for a mobile robot to navigation in textureless environment using an omni-directional camera. The method makes an environment map consisting of 3D edge points obtained from omni-directional camera images and estimates the locations of planes by analysing these 3D edge points so that the robot can autonomously travel while avoiding walls as obstacles. The method has the advantage that it can generate a 3D map in environments constructed by textureless planes. It is important to improve robustness of obstacle detection in order to realize navigation with a long distance. The proposed method was evaluated in more complex environment such as a long corridor and a corner.

We experienced three cases of latex anaphylaxis during cesarean section in one year.1 A 26-year-old woman underwent emergency cesarean section. Combined spinal-epidural anesthesia was performed and drip infusion of cefazolin sodium was started before operation. After delivery, intravenous injection of methylergometrine maleate and intramyometrial injection of oxytocin were given. Eight minutes after delivery, she complained of dyspnea and edema of eyelids; no change in vital signs were noted. We suspected an anaphylactic reaction and administered antihistamines as well as methylprednisolone. Inhalation of beta-stimulators and sevoflurane using a face mask improved her respiratory symptoms.A 25-year-old woman underwent emergency cesarean section. We noticed wheals involving her eyelids and legs after operation and administered methylprednisolone. CASE 3: A 23-year-old woman underwent elective cesarean section. Five minutes after delivery and oxytocin injection, she complained of edema of eyelids, facial erythematous edema, and dyspnea. We suspected latex anaphylaxis and stopped using latex products. Then, we treated her with antihistamines, methylprednisolone and beta-stimulators. The diagnosis of latex anaphylaxis was made by positive results of skin tests to latex and an increase in the levels of latex-specific immunoglobulin E. We conclude that cesarean section is an important risk factor for latex anaphylaxis.

In this paper, we propose an efficient estimation method of an omnidirectional camera movement. The proposed method is based on Structure from Motion utilizing a constraint of parallel lines. In an environment having manmade structures, parallel lines can be extracted from an omnidirectional image easily and constantly, because of its wide field of view. Parallel lines provides a valuable constraint for camera movement estimation. The proposed method can estimate 3-D camera movements by solving one degree of freedom problem three times without regard to the number of viewpoints. Experimental results show the effectiveness of our proposed method.

Three-dimensional map is available for autonomous robot navigation (path planning, selflocalization and object recognition). In unknown environment, robots should measure environments and construct their maps by themselves. Three-dimensional measurement using image data makes it possible to construct an environment map (Davison, 2003). However, many environmental images are needed if we use a conventional camera having a limited field of view (Ishiguro et al., 1992). Then, an omnidirectional camera is available for wide-ranging measurement, because it has a panoramic field of view (Fig. 1). Many researchers showed that an omnidirectional camera is effective in measurement and recognition in environment (Bunschoten & Krose, 2003; Geyer & Daniilidis, 2003; Gluckman & Nayar, 1998).

Self localization of mobile robots is necessary when they accomplish autonomous tasks in a given environment. In this paper, we propose a method for self localization of mobile robots equipped with an omnidirectional camera. The proposed method is composed of two phases. The first phase is for global localization. The robot estimates its position and orientation by matching an acquired omnidirectional image to arbitrary viewpoint images generated from a 3D environment model. The second phase is for local localization. Position and orientation are estimated by matching 2D edge points to 3D measurement data of lines. Experimental results showed the effectiveness of the proposed method.

Map information is important for path planning and selflocalization when mobile robots accomplish autonomous tasks. In unknown environments, they should generate environment maps by themselves. An omnidirectional camera is effective for environment measurement, because it has a wide field of view. There are binocular stereo and motion stereo in traditional methods for measurement by omnidirectional camera. However, each method has advantages and disadvantages. In this paper, we aim to improve measurement accuracy by integrating binocular stereo and motion stereo using two omnidirectional cameras installed on a mobile robot. In addition, stereo matching accuracy is improved by considering omnidirectional image distortion. Experimental results show the effectiveness of our proposed method.

Map information is important for path planning and self-localization when mobile robots accomplish autonomous tasks. In unknown environments, mobile robots should generate an environment map by themselves. Then, we propose a method for 3D environment modeling by a mobile robot. For environmental measurement, we use a single omni-directional camera. We propose a new estimation method of camera motions for improvement in measurement robustness and accuracy. The method takes advantage of a wide field of view of an omni-directional camera. Experimental results showed the effectiveness of the proposed method.

Ryosuke Kawanishi,1 Kaori Yamamoto,2 Yoko Tobetto,2 Kayo Nomura,2 Michihisa Kato,2 Ritsuko Go,2 Yasuo M Tsutsumi,3 Katsuya Tanaka,3 Yoshitsugu Takeda4 1Department of Anesthesiology, Tokushima University Hospital, Tokushima, 2Division of Anesthesiology, Tokushima Red Cross Hospital, Komatsushima, 3Department of Anesthesiology, Institute of Health Bioscience, University of Tokushima Graduate School, Tokushima, 4Division of Orthopedics, Tokushima Red Cross Hospital, Komatsushima, Japan Purpose: To determine the effects of intravenous and perineural dexamethasone on the duration of interscalene brachial plexus block (ISB) with ropivacaine in patients undergoing arthroscopic shoulder surgery. Patients and methods: In this prospective, randomized, placebo-controlled trial, patients presenting for arthroscopic shoulder surgery with an ISB were randomized to receive ropivacaine 0.75% (group C), ropivacaine 0.75% plus perineural dexamethasone 4 mg (group Dperi), or ropivacaine 0.75% plus intravenous dexamethasone 4 mg (group Div). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first request for analgesic. Results: Thirty-nine patients were randomized. The median times of sensory block in groups C, Dperi, and Div were 11.2 hours (interquartile range [IQR] 8.0–15.0 hours), 18.0 hours (IQR 14.5–19.0 hours), and 14.0 hours (IQR 12.7–15.1 hours), respectively. Significant differences were observed between groups Dperi and C (P=0.001). Kaplan–Meier analysis for the first analgesic request showed significant differences between groups Dperi and C (P=0.005) and between groups Dperi and Div (P=0.008), but not between groups C and Div. Conclusion: Perineural but not intravenous administration of 4 mg of dexamethasone significantly prolongs the duration of effective postoperative analgesia resulting from a single-shot ISB with ropivacaine 0.75%. Keywords: ropivacaine, interscalene nerve block, dexamethasone, postoperative pain, perineural