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Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

Ribitol phosphate modifications to the core M3

Intraoperative anaphylaxis caused by blood products is uncommon, but it is unclear whether the rarity of this reaction is attributable to the difficulty of diagnosis, underreporting, or both. We investigated the incidence of intraoperative transfusion anaphylaxis and its reporting to the hemovigilance system.We retrospectively reviewed cases wherein general anesthesia was used at a single hospital during a 12-year period. Cases of intraoperative anaphylaxis were extracted using an electronic search strategy and determined using the recently developed grading and clinical scoring system. The causative blood products were determined by the onset duration based on literature regarding intraoperative transfusion anaphylaxis cases.Among the 62,146 general anesthesia cases, 22 cases of intraoperative anaphylaxis were identified, and 11 of the 22 cases received transfusions before the onset of anaphylaxis. Intraoperative transfusion anaphylaxis was defined as occurring within 30 min of transfusion. Finally, nine cases of intraoperative transfusion anaphylaxis were analyzed. The overall incidence of intraoperative transfusion anaphylaxis was 1/3,994, with the highest incidence noted for fresh frozen plasma (1/2146; 95% confidence interval [CI] 1/6610-1/920), platelet concentrate (1/2348; 95% CI 1/92,742-1/422), and red blood cells (1/22,867; 95% CI 1/903,199-1/4,105). No evidence indicated that these cases were reported to the Japanese hemovigilance system, although all intraoperative transfusion anaphylaxis cases were diagnosed by anesthesiologists.The incidence of intraoperative anaphylaxis caused by blood products was higher than that reported and may be underreported to the Japanese hemovigilance system. Further research, particularly multicenter studies, is needed to confirm our results.

本稿は，日本における保育者（幼稚園教員・保育所保育士，認定こども園保育教諭）の教員免許と研修に関して検討を行うことを目的としている。多くの保育者は，短期大学で養成されており，幼稚園2種免許を保有している。文部科学省は現在，2種から1種への教員免許の上進を進めている。また，専門職である保育者は，継続的に研修を受けて彼らの持つ専門性を向上しなければならない。本稿においては，幼稚園教員と認定こども園保育教諭に焦点化し，彼ら自身が教員免許の上進や研修についてどのように考えているのか，アンケート調査によって明らかにした。彼らはこれまで，生活・仕事の多忙や上進方法が分からなかったこと，上進の必要性を感じないことなどによって，教員免許を上進してこなかった。今回の研修によって彼らが上進しようと考えた理由は，管理職になるために1種免許が必要になったこと，近隣で研修が開催されたこと，専門性を向上させるため，といったことである。私たちは今後も，教員免許上進と研修を結び付けた有効なシステムを考えていかなければならない。, This paper aims to study early childhood education (ECE) teacher certification and in-service teacher training in Japan. In Japan, most ECE teachers are trained in junior college and hold second class teachersʼ licenses. The Ministry of Education, Culture, Sports, Science and Technology (MEXT) recommends that ECE teachers hold upgraded licenses. ECE teachers continuously take training and certificate their professional abilities. We study how ECE teachers who took license upgrade training consider their own license upgrade and teacher training. The questionnaire survey shows that teachers who have not upgraded their licenses until now were motivated by being busy at work and in life, not knowing how to upgrade, seeing no necessity in upgrading, and so on. Moreover, teachersʼ reasons for taking upgrade training include improving their professional ability, the necessity of having an upgraded license to become an ECE administrator, the fact that a training course was held near their home, and so on. We must consider expanding the useful system of teacher training and the related license upgrading process.

Matriglycan hexasaccharide (-3Xylα1-3GlcAβ1)3-O(C2H4O)3CH2CCH and the biotin conjugate was synthesized. The hexasaccharide showed good interaction with laminin-G-like domains 4 and 5 of laminin-α2 using saturation transfer difference-NMR and bio-layer interferometry.

Perioperative hyperglycemia leads to poor postoperative clinical outcomes, including compromised immune function, cardiovascular events, and mortality. The optimal perioperative blood glucose levels during cardiac surgery remain unclear. A closed-loop glycemic control system (artificial pancreas, target blood glucose range:120-150 mg/dl) prevents postoperative inflammatory response more effectively than conventional insulin therapy (200 mg/dl). However, the clinical effects of intensive insulin therapy with strict glycemic control (80-110 mg/dl) are controversial. This study aimed to determine whether intensive insulin therapy would further suppress postoperative inflammatory reactions.This study analyzed 262 patients who underwent cardiovascular surgery with cardiopulmonary bypass. The patients were divided into two groups according to their target blood glucose range: 80-110 mg/dl and 120-150 mg/dl. The primary outcome was the difference in the C-reactive protein levels between the two groups.Propensity score matching resulted in 95 patients in each group based on their covariates. There was no difference in the postoperative maximum C-reactive protein levels between the two groups (14.81 ± 5.93 mg/dl vs. 14.34 ± 5.52 mg/dl; p = 0.571) following propensity score matching. Hypoglycemia did not occur during intensive insulin therapy.Intensive insulin therapy following cardiac surgery with cardiopulmonary bypass did not demonstrate significant advantages in the suppression of postoperative inflammatory reactions compared to that with mild glycemic control. However, intensive insulin therapy using an artificial pancreas was found to be safe, with no hypoglycemic events.

Naruto University of Education offers an undergraduate class called "Awa (Tokushima) Studies", which is taught by twelve instructors whose specialties span history, geography, psychology, art, physical education, and linguistics. In this class, after studying the background and history of Ohenro, a pilgrimage route in Shikoku, in classroom lectures, the students and the instructors walk a part of the pilgrimage route on a one-night-two-day trip, in which interdisciplinary studies are practiced. This class is an ideal opportunity for teacher training and therefore can serve to strategically promote Naruto University of Education as a unique university in offering such a class.

Drug interactions are significant in anesthesiology because drug combinations can potentially possess novel properties. The pharmacological advantages of a new combination of the benzodiazepine receptor agonist JM-1232(-) and propofol were investigated in mice. Male adult mice were administered JM-1232(-) or propofol or combinations of the two drugs intravenously. Loss of the righting reflex was evaluated as achieving hypnosis, and the time until recovery of the reflex was measured as hypnosis time. After determining the ED50, doses double and triple the ED50 of propofol were injected with JM-1232(-) to compare hypnosis time. The injections were repeated four times, and the hypnosis times were compared. Flumazenil was administered separately immediately after the last dose was injected. The ED50 values ([95% confidence interval]) for hypnosis were 3.76 [3.36-4.10] for JM-1232(-) and 9.88 [8.03-11.58] mg kg-1 for propofol. Co-administration of 0.5 and 1 mg kg-1 JM-1232(-) reduced the ED50 values of propofol to 1.76 [1.21-2.51] and 1.00 [0.46-1.86] mg kg-1, respectively. The drug combination for hypnosis produced a supra-additive interaction. Hypnosis time was significantly shorter in the groups given the mixtures compared to each hypnotic administered alone. After repeated injections, hypnosis time with the mixtures showed smaller prolongation than that with the hypnotic alone. Flumazenil completely restored the recovery time after anesthesia. The combination of JM-1232(-) and propofol showed a supra-additive interaction, and the reduced hypnotic dose contributed to a faster recovery even after multiple injections.

We firstly experienced a rare case demonstrating that massive volume of free air was aspirated from a large bore intravenous catheter sheath of the pulmonary arterial catheter during placement. A 44-year-old male patient underwent the emergency induction of anesthesia for transplantation of liver donated by the brain death subject. After the induction, the central venous and pulmonary artery catheter placement was conducted. The aspiration of venous blood confirmed the intravascular insertion, but massive free air was aspirated when we advanced the sheath proximally. A perforation of subclavian vein and subsequent pneumothorax was strongly suspected. The emergency computed tomography revealed no sign of pneumothorax, pneumomediastinum nor extravasation. The operation was undergone with intensive monitoring and no further adverse complication was observed. The postoperative medical inquiry concluded that the massive free air was not aspirated from extravascular space, for example, thorax or mediastinum through the tip of the sheath, but from the proximal main port of the sheath. When the tip of sheath is occluded by the migration into small vessels, the large negative pressure through side port might easily aspirate the air through the 1-way valve of the main proximal port. Physicians should keep in mind of the structure of the catheter sheath.

Several strategies are employed for administering fresh frozen plasma (FFP) during weaning from cardiopulmonary bypass (CPB). This study evaluated by coagulation function aimed to compare two strategies of administering FFP in cardiovascular surgery: administering 4 units of FFP before separating from CPB or administering it after weaning from CPB. Thirty patients who underwent CPB and were expected to receive 8 units of FFP and 20 units of platelet concentrate were randomly allocated into group A (8 units of FFP and 20 units of platelet concentrate administered after separating from CPB) and group B (4 units of FFP administered before separation, and 4 units of FFP and 20 units of platelet concentrate administered after separating from CPB). Thromboelastography (TEG6s®, HAEMONETICS Japan GK, Tokyo, Japan) was conducted at four time points before and after separation. Blood test results, blood loss, and required amounts of blood transfusion were compared. The primary outcome was the difference in coagulation function evaluated by TEG6s 90 min after protamine administration. Twenty-eight patients were enrolled in the study. Coagulation function after separating from CPB was not significantly different between the groups. Additionally, no significant differences were found in intensive care unit outcomes, such as 24-h transfusion requirements. Coagulation function 90 min after separating from CPB was not significantly different between the groups. Prior FFP administration before separation did not provide significant improvement in coagulation function.

Background PaO2 /FIO2 (P/F) ratio has been used to define the severity of acute respiratory distress syndrome (ARDS) despite the controversy of its clinical utility. This systematic review and meta-analysis (SRMA) aimed to obtain summary estimates of predictive performance of the P/F ratio for predicting mortality in ARDS patients. Methods We included a study wherein the study population comprised ARDS patients in any clinical setting. Medline and Cochrane Central Registry of Controlled Trials were searched for all English language articles. We performed a SRMA on the accuracy of diagnostic prognostic tests using QUADAS-2 tool to evaluate the risk of bias. To pool the results, we applied the bivariate model and obtained summary point estimates of sensitivity and specificity with 95% CIs. Results Twenty-eight trials and 38270 patients were included in the meta-analysis. Most of the study settings were in the intensive care units. The overall risk of bias was high. The pooled sensitivity of the P/F ratio in all included studies for a P/F ratio of 100 was 43.6% (95% CI, 36.9-50.5%) and the specificity was 71.1% (95% CI, 66.7-75.1%) and those for a P/F ratio of 200 were 83.2% (95% CI, 78.2-87.2%) and 26.2% (95% CI, 21.2-31.9%). Interpretation The P/F ratio had high sensitivity and moderate specificity at a P/F ratio of 200 and 100 respectively, which supports the use of the P/F ratio for screening ARDS patients who are at risk of deterioration.Trial registration: The study was registered in UMIN with registration number 64 000041058.

Several pieces of evidence suggest that volatile anesthetics (VAs), which were originally used as sedatives, have myocardial protective effects against cardiac ischemia-reperfusion injury. In Europe and the United States, the use of VAs during cardiopulmonary bypass (CPB) is widespread, as 2019 European Association for Cardio-Thoracic Surgery (EACTS)/European Association of Cardiothoracic Anaesthesiology/European Board of Cardiovascular Perfusion, 2011 American College of Cardiology/American Heart Association, and 2017 EACTS guidelines recommend their use in cardiovascular surgery, based on their potential myocardial protective effects. In other countries, including Japan, the use of VAs is gradually increasing. Therefore, it is important to be aware of the risks and possible adverse events associated with VA use during CPB to ensure safe sedation management. Herein, we describe in detail issues such as intraoperative awareness, air pollution, and damage to oxygenators due to VA use and propose precautions.

To report maternal outcomes in a cohort of women who received autotransfusion of vaginally shed blood and to describe the feasibility of blood collection and cell salvage processing at the time of vaginal hemorrhage.We conducted a retrospective case series of patients who received autotransfusion of vaginally shed blood at the time of obstetric hemorrhage from January 2014 to August 2020. Maternal data and cell salvage utilization characteristics were abstracted from the electronic medical record.Sixty-four cases were identified in which autotransfusion of vaginally shed blood occurred during an obstetric hemorrhage. Median quantitative blood loss was 2175 ml (interquartile range 1500-2250 ml) with 89% of cases having a blood loss greater than 1000 ml. Patients on average received approximately 1.3 units of autologous blood product (384 ml, interquartile range 244-520 ml) and no direct adverse events were observed during transfusion. We observed heterogeneity in autologous blood volume across all values of quantitative blood loss. The need for allogenic blood transfusion was common and occurred in 72% of all cases (N = 46). There were no documented cases of maternal sepsis or severe infectious morbidity.In 64 cases where autotransfusion of vaginally shed blood occurred, autotransfusion was well tolerated. Heterogeneity in autologous blood volume collection likely represents the lack of standardized protocols for blood collection in the delivery room. Autotransfusion of vaginally shed blood is a feasible and reasonable technique to employ during severe obstetric hemorrhage.

In Japan, the use of concrete pavements gradually decreased since the 1960s owing to the fact that they require some days to cure. However, recent research revealed that concrete pavements are effective for the Life Cycle Cost and the heat island phenomenon. A novel method of making concrete pavements, with which the traffic can be opened after only one-day curing, has been proposed in Japan. Furthermore, authors have developed porous concrete for road pavement, which can also cure in one day. This study proposes a new design method to reduce the production cost of porous concrete. To achieve this, the high early-strength Portland cement was replaced with ordinary Portland cement and coarse aggregate of various sizes with a single-sized coarse aggregate. Various tests revealed that the concrete prepared by the proposed design method satisfies the standard values of the bending strength and the permeability coefficient for concrete pavement for early traffic opening. Therefore, it is considered that the design method proposed herein is vital in reducing the cost of porous concrete pavements.

Paravertebral block and epidural block are frequently employed for post-thoracotomy pain relief. It is not clear which postoperative analgesia method is effective for the chronic pain after the postoperative long term progress. Our hypothesis was that paravertebral block would be more effective than epidural block for chronic pain 1.5-2 years after thoracotomy. A cohort study investigating postoperative pain was performed in lung cancer patients undergoing thoracotomy between the ages of 20-80 year-old, employed for another randomized controlled trial. In previously study, the patients were randomly allocated into either the epidural block or paravertebral block group (

Background This study aimed to compare the postoperative analgesic effects of ultrasound-guided posterior quadratus lumborum block with spinal morphine, after cesarean section, using the visual analogue scale pain score. Methods One-hundred-and-seventy-six pregnant women scheduled for elective cesarean section with spinal anesthesia were randomly allocated into four groups to receive spinal morphine 0.1 mg (group M+); spinal saline (M−); posterior quadratus lumborum block using either 0.3% ropivacaine (0.45 mL/kg each side, maximum 150 mg) group pQ+); or saline (pQ−). All patients received 11–13 mg hyperbaric bupivacaine 0.5% and 10 μg fentanyl. Intravenous droperidol, fentanyl and acetaminophen were administered during surgery. Bilateral posterior quadratus lumborum block was performed immediately after surgery. Postoperative pain was assessed at 0.5, 1, 2, 4, 6, 18 and 24 h after surgery, and the pain score 6 h after surgery was the primary endpoint. Results One-hundred-and-forty-six patients were included in the final analysis. Pain scores 6 h after surgery, both at rest and when moving, were significantly different when comparing the M+pQ+ group with the M−pQ+ or M−pQ− groups, and when comparing the M+pQ− group with the M− pQ+ or M− pQ− groups (all P Conclusion Spinal morphine improved postoperative analgesia but the combination of posterior quadratus lumborum block with spinal morphine did not lead to further improvement.

O-mannosyl glycan is a pivotal glycan part of α-dystroglycan, which serves as a transmembrane linker connecting the intracellular cytoskeleton and extracellular matrix, such as laminin in skeletal muscle. We synthesized β- d -Xyl-(1–4)- d -Rbo-5P (1), β- d -Xyl-(1–4)- d -Rbo (2), and β- d -Xyl-(1–4)- d -Rbo-5P1- d -Rbo (3), partial structures of O-mannosyl glycan, in regio- and stereo-controlled manners, and demonstrated compatibility with the natural product.

Volatile anesthetics (VAs) protect myocardial cells during cardiovascular surgeries, including cardiopulmonary bypass (CPB). In CPB, blood is gradually transferred from the body to a CPB unit until the target cardiac index is achieved, following which human lung (HL) ventilation is stopped. This pilot study aimed to evaluate changes in the blood sevoflurane concentrations 5 min after the start of CPB when its delivery to the oxygenator began after HL ventilation with sevoflurane was completed. Six patients were recruited and participated in this study. For each patient, the equilibrated blood sample, collected 20 min after starting the delivery of 1.7% sevoflurane (HL group), and another blood sample, collected 5 min after starting the CPB, were analyzed using gas chromatography equipped with a flame ionization detector. The mean (± standard deviation) sevoflurane concentrations in the HL and 5 min after starting CPB groups were 58.6 ± 4.7 and 14.5 ± 5.0 μg/ml, respectively (

Effect of grinding factor and scaling up were carried out by grinding using horizontal dry bead mill. For the experiments, 2 sizes of horizontal dry bead mills with different capacities, lab and manufacturing scale, were used to study scaling up and down. The grinding experiments were performed by changing each typical grinding factor for bead mills, including the agitator peripheral speed, bead packing density, bead diameter, and material feeding speed. This set of experiments was conducted for 3 kinds of materials, silica sand of natural inorganic materials, alumina of synthetic inorganic materials, and activated carbon of organic materials. As a result, common for all materials, similar rules were found between the particle size and specific energy, the amount of mechanical energy per unit amount of material. In addition, these rules were applicable for the different-size mills, indicating that the scale can be controlled by the rules and specific energy. Also, it is revealed that when using a single type of material, changing the bead diameter changes the energy efficiency, indicating that using small-diameter bead was effective for efficient grinding.

We aimed to compare the effects of saline with and without heparin on the catheter-occlusion rate and coagulation-related blood test results for the management of arterial catheters among patients admitted to a short-term intensive care unit postoperatively. This prospective, triple-blinded, randomized controlled study recruited patients aged 20–90 years scheduled to undergo radial arterial catheter insertion and postoperative intensive care unit admission between February and August 2019. Patients were randomly allocated to two groups (1:1 ratio) depending on the use of heparin: study (normal saline with heparin, 3000 units to 500 ml of normal saline) and control (normal saline without heparin) groups with arterial catheters. The allocated management method was employed immediately after intensive care unit admission. Occlusion assessment (every 12 h), arterial blood gas tests (every 6 h), and blood sample collection (every 24 h) were performed. The occlusion of arterial catheter was assessed using occlusion rate, and blood test results were assessed using a linear mixed model. There were 147 patients in the arterial catheter groups. There were no significant differences in occlusion rates and changes in platelet counts and activated partial thromboplastin time between the groups with arterial (p = 0.98, 0.16, and 0.32, respectively) catheters during the first 6 days after intensive care unit admission. Normal saline with and without heparin showed similar efficiency for both the prevention of occlusion and the results of coagulation.

Platelet Mapping can measure both the degree of platelet inhibition and fibrinogen activation, was not originally designed to measure fibrinogen concentration. Traditional laboratory fibrinogen concentration testing requires around 60 minutes; however, fibrinogen activation only takes 10 minutes, and is indicated as maximum amplitude of activator f. If Platelet Mapping can predict fibrinogen concentration during cardiopulmonary bypass, this could facilitate rapid hemostasis management. The aim of this study was to verify whether fibrinogen concentration could be predicted using Platelet Mapping results. Thus, a pilot study was conducted to evaluate this concept during cardiopulmonary bypass. This prospective, observational pilot study investigated 15- to 90-year-old patients who underwent cardiac or aortic surgery from August 2019 to September 2019. Twenty-one patients enrolled in this study, and 43 blood samples were obtained for both fibrinogen activation measurements using Platelet Mapping and traditional laboratory-based tests, respectively. Correlations between results were analyzed using linear regression and the receiver operating characteristic curve. Correlation by Pearson’s correlation analysis indicates a significant relationship (correlation coefficient of r = 0.91), and a receiver operating characteristic curve indicated that sensitivity, specificity, and receiver operating characteristic area were 100% (95% confidence interval, 75.3–100%), 93.8% (79.2–99.2%), and 0.995 (0.984–1.00), respectively. Our results indicate a strong correlation between fibrinogen activation and serum fibrinogen concentration. The maximum amplitude of activator f can estimate low fibrinogen concentration faster than traditional methods; this method quickly provides important information for anesthesia and hemostatic management in cardiac surgery.

Cell salvage is frequently used to avoid unnecessary allogeneic blood transfusions, which results in a reduction in blood transfusion volume and cost. The aspirated blood is washed with normal saline and centrifuged to recover only blood cells, salvaged blood is then made. In cardiovascular surgery, heparin is used to maintain activated clotting time over 400 seconds. Some practitioners believe that heparin remains in the salvaged blood. Therefore, we hypothesized that salvaged blood during cardiovascular surgery includes heparin. A pilot study was conducted to evaluate our hypothesis using three different salvage systems. This study was a prospective, observational, pilot study, with patients aged 20–85 years old who were scheduled for cardiovascular surgery from May 2018 to October 2018. The intent of this study was to evaluate whether salvaged blood with three different devices includes large enough quantities of heparin to influence activated clotting time in cardiovascular surgery. Between May and October 2018, 12 samples during heparinization were collected, and 12 samples of salvaged blood from 3 devices were collected after administrating protamine. The heparin concentration of the 24 samples was measured. All heparin concentrations in salvage blood sample from two devices was below the limit of measurement (0.10 IU/mL). Slightly measurable heparin was detected in salvaged blood sample from one device (mean 0.15 IU/mL). Salvaged blood during cardiovascular surgery intervention does not contain enough heparin to influence activated clotting time.

Purpose Volatile anesthetics (VAs) protect myocardial cells in cardiovascular surgery. A recent clinical trial of cardiopulmonary bypass (CPB) surgery reported no significant difference in mortality rates between the use of VAs and total intravenous anesthetics at 1 year postoperatively. However, oxygenator function may affect the VA pharmacokinetics. Thus, we measured the VA blood concentrations during CPB in patients managed with four different microporous polypropylene hollow fiber membrane oxygenators. Methods Twenty-four patients scheduled for elective CPB were randomly allocated to one of the two VA groups (desflurane and sevoflurane groups) and, then, randomly divided into one of four oxygenator groups: Terumo, LivaNova, Medtronic, and Senko (n = 3). Additionally, in each VA group, three patients were randomly selected and redundantly allocated to the human lung group (for control blood VA concentration without oxygenator). Blood samples collected 20 min after starting 6.0 vol% desflurane or 1.7 vol% sevoflurane were analyzed using gas chromatography. Oxygenator-related complications and structural changes in the membrane surface of each oxygenator after surgery were evaluated. Results The mean (standard deviation) concentrations of desflurane and sevoflurane in the human lung were 182.4 (23.2) and 54.0 (9.6) μg/ml, respectively; not significantly different from those in the four oxygenator groups. No oxygenator-related complications occurred. Structural changes in membrane fibers did not occur after clinical use, except for difficulty in image acquisition with Senko products. Conclusion Our results demonstrated that the blood concentrations of desflurane and sevoflurane passing through oxygenators used during CPB were similar to those in the human lung control. Electronic supplementary material The online version of this article (10.1007/s00540-020-02844-1) contains supplementary material, which is available to authorized users.

Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS. This crossover volunteer study included five healthy men. For comparison, both the ultrasound-guided QLB type 2 (QLB2) and QLBi were employed on opposite sides of each volunteer, and the spread of LA solution (0.7 mL/kg) mixed with contrast media in the PVS was assessed 1 h after the first injection using magnetic resonance imaging. Sensory loss was evaluated by pinprick 90 min post-injection. Each volunteer underwent both QLB types, and the same procedures were administered on opposite sides 7 days after the first experiment. In total, 20 QLB blocks (10 QLB2 and 10 QLBi) were performed. LA did not spread into the PVS after the QLBi. The sensory block area included the lower abdomen after the QLB2, but not after the QLBi. The sensory block area did not extend to the upper abdominal region or the midline of the lower abdomen with either block method. LA administered by the QLB2 spreads into the PVS of T10–T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.