BMCActa Medica Okayama1471-22532312023Associations of systemic oxygen consumption with age and body temperature under general anesthesia: retrospective cohort study216ENSatoshiKimuraDepartment of Anesthesiology and Resuscitology, Okayama University HospitalKazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalHiroshiMorimatsuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalBackground Body temperature (BT) is thought to have associations with oxygen consumption (VO2). However, there have been few studies in which the association between systemic VO2 and BT in humans was investigated in a wide range of BTs. The aims of this study were 1) to determine the association between VO2 and age and 2) to determine the association between VO2 and BT.<br>
Methods This study was a retrospective study of patients who underwent surgery under general anesthesia at a tertiary teaching hospital. VO2 was measured by the Dräger Perseus A500 anesthesia workstation (Dräger Medical, Lubeck, Germany). The associations of VO2 with age and BT were examined using spline regression and multivariable regression analysis with a random effect.<br>
Results A total of 7,567 cases were included in this study. A linear spline with one knot shows that VO2 was reduced by 2.1 ml/kg/min with one year of age (p < 0.001) among patients less than 18 years of age and that there was no significant change in VO2 among patients 18 years of age or older (estimate: 0.014 ml/kg/min, p = 0.08). VO2 in all bands of BT < 36.0 °C was not significantly different from VO2 in BT > = 36 °C and < 36.5 °C. Multivariable linear regression analysis showed that compared with VO2 in BT > = 36 °C and < 36.5 °C as a reference, VO2 levels were significantly higher by 0.57 ml/kg/min in BT > = 36.5 °C and < 37 °C (p < 0.001), by 1.8 ml/kg/min in BT > = 37 °C and < 37.5 °C (p < 0.001), by 3.6 ml/kg/min in BT > = 37.5 °C and < 38 °C (p < 0.001), by 4.9 ml/kg/min in BT > = 38 °C and < 38.5 °C (p < 0.001), and by 5.7 ml/kg/min in BT > = 38.5 °C (p < 0.001). The associations between VO2 and BT were significantly different among categorized age groups (p = 0.03).<br>
Conclusions VO2 increases in parallel with increase in body temperature in a hyperthermic state but remains constant in a hypothermic state. Neonates and infants, who have high VO2, may have a large systemic organ response in VO2 to change in BT.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama2363-9024912023Therapeutic plasma exchange in postpartum HELLP syndrome: a case report9ENNanaKojimaDepartment of Anesthesiology and Resuscitology, Okayama University HospitalKosukeKurodaDepartment of Anesthesiology and Resuscitology, Okayama University HospitalMakikoTaniDepartment of Anesthesiology and Resuscitology, Okayama University HospitalTomoyukiKanazawaDepartment of Anesthesiology and Resuscitology, Okayama University HospitalKazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalJotaMakiDepartment of Obstetrics and Gynecology, Okayama University HospitalHisashiMasuyamaDepartment of Obstetrics and Gynecology, Okayama University HospitalHiroshiMorimatsuDepartment of Obstetrics and Gynecology, Okayama University HospitalBackgroundPostpartum hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is more difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to plasma exchange (PE) therapy.Case presentationA 30-year-old primipara woman was hospitalized for gestational hypertension at 33 weeks of gestation and underwent an emergent cesarean section at 36 weeks and 6 days of gestation due to rapidly progressing pulmonary edema. After delivery, liver dysfunction and a rapid decrease in platelet count were observed, and the patient was diagnosed with severe HELLP syndrome. She experienced multiple organ failure despite intensive care, and PE therapy was initiated. Her general condition dramatically stabilized within a few hours of PE therapy.ConclusionIt is controversial whether PE therapy should be used primarily in the management of HELLP syndrome, but early initiation of PE therapy could be effective for severe HELLP syndrome.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama2363-9024912023Anesthetic management of a patient with Osler-Weber-Rendu syndrome with multiple pulmonary arteriovenous malformations and pheochromocytoma for femoral artificial bone replacement: a case report6ENToshiharuHiyoshiDepartment of Anesthesiology and Resuscitology, Okayama University HospitalKazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalSatoshiKimuraDepartment of Anesthesiology and Resuscitology, Okayama University HospitalToshikiNaritaniDepartment of Anesthesiology and Resuscitology, Okayama University HospitalHiroshiMorimatsuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalBackground<br>
Osler-Weber-Rendu syndrome is characterized by mucocutaneous telangiectasia and arteriovenous malformations in organs. Anesthesia for patients with Osler-Weber-Rendu syndrome is challenging due to complications and physiological changes.<br><br>
Case presentation<br>
The case was a 49-year-old female with Osler-Weber-Rendu syndrome, multiple pulmonary arteriovenous malformations and pheochromocytoma who presented for femoral bone head fracture with metastatic adenocarcinoma. The patient was scheduled to undergo bone tumor resection and artificial bone replacement, being positioned laterally with a planned operation duration of 5 h. Anesthesia was managed with spinal and epidural anesthesia, combined with sedation by sevoflurane using a supraglottic airway (SGA) device under spontaneous breathing. Her intraoperative and postoperative courses were uneventful.<br><br>
Conclusion<br>
Neuraxial anesthesia combined with general anesthesia using an SGA device to maintain spontaneous ventilation in order to minimize the risk of rupture of pulmonary arteriovenous malformations could be an option.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama2363-9024812022Temporary hypotension and ventilation difficulty during endoscopic injection sclerotherapy for esophageal varices in a child with Fontan circulation: a case report48ENNanakoYasutomiDepartment of Anesthesiology, Japanese Red Cross Kobe HospitalTatsuhikoShimizuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalTomoyukiKanazawaDepartment of Anesthesiology and Resuscitology, Okayama University HospitalKazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalTatsuoIwasakiDepartment of Anesthesiology and Resuscitology, Okayama University HospitalHiroshiMorimatsuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalBackground : Endoscopic procedures are rarely performed in children with congenital heart disease (CHD); therefore, the associated complications are unknown. We report an abrupt change in circulatory and respiratory condition during endoscopic injection sclerotherapy for esophageal varices. <br>
Case presentation : A 9-year-old boy with a history of total anomalous pulmonary venous connection (TAPVC) repair and Fontan procedure for asplenia and a single ventricle with TAPVC underwent endoscopic injection sclerotherapy under general anesthesia for esophageal varices. Systolic blood pressure decreased from 70 to 50 mmHg following a sclerosant injection; a second injection reduced his peripheral oxygen saturation from 93 to 79% secondary to ventilation difficulty. Although we suspected anaphylaxis intraoperatively, postoperative imaging suggested that balloon dilation performed to prevent sclerosing agent leakage caused compression of the pulmonary venous chamber and trachea owing to the anomalous intrathoracic organ anatomy.<br>
Conclusion : Thorough understanding of the complex anatomy is important before performing endoscopic procedures in children with CHD to preoperatively anticipate possible intraoperative complications and select the optimal therapeutic approach and anesthesia management.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama2363-9024712021Intact survival from severe cardiogenic shock caused by the first attack of atrial tachycardia treated with extracorporeal membrane oxygenation and surgical left atrium appendage resection: a case report81ENTatsuhikoShimizuDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomoyukiKanazawaDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakanobuSakuraDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTatsuoIwasakiDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesBackground Atrial tachycardia (AT) is rare in children and can usually be reversed to sinus rhythm with pharmacotherapy and cardioversion. We report a rare case of severe left-sided heart failure due to refractory AT. Case presentation A 12-year-old boy had AT with a heart rate of 180 beats/minute, which was refractory to any medication and defibrillation despite the first attack. Due to rapid cardiorespiratory collapse shortly after arriving at our hospital, central extracorporeal membrane oxygenation (ECMO) with left arterial venting was started immediately. Although AT persisted after that, it stopped on the 3rd day after admission following surgical resection of the left atrial appendage thought to be the source of AT. He was weaned off ECMO on the 7th day and ventilator on the 14th day. Conclusions The appropriate timing of central ECMO and surgical ablation were effective in saving this child from a life-threatening situation caused by refractory AT.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2398-8835312019Evaluation of a point-of-care serum creatinine measurement device and the impact on diagnosis of acute kidney injury in pediatric cardiac patients: A retrospective, single center studye143ENSatoshiKimuraDepartment of Anesthesiology and Resuscitation, Okayama University HospitalTatsuoIwasakiDepartment of Anesthesiology and Resuscitation, Okayama University HospitalKazuyoshiShimizuDepartment of Anesthesiology and Resuscitation, Okayama University HospitalTomoyukiKanazawaDepartment of Anesthesiology and Resuscitation, Okayama University HospitalHirokazuKawaseDepartment of Anesthesiology and Resuscitation, Okayama University HospitalNaohiroShiojiDepartment of Anesthesiology and Resuscitation, Okayama University HospitalYasutoshiKuroeDepartment of Anesthesiology and Resuscitation, Okayama University HospitalSatoshiIsoyamaDepartment of Anesthesiology and Resuscitation, Okayama University HospitalHiroshiMorimatsuDepartment of Anesthesiology and Resuscitation, Okayama University HospitalBackground and aims: Agreement between measurements of creatinine concentrations using point-of-care (POC) devices and measurements conducted in a standard central laboratory is unclear for pediatric patients. Our objectives were (a) to assess the agreement for pediatric patients and (b) to compare the incidence of postoperative acute kidney injury (AKI) according to the two methods. <br>
Methods: This retrospective, single-center study included patients under 18 years of age who underwent cardiac surgery and who were admitted into the pediatric intensive care unit of a tertiary teaching hospital (Okayama University Hospital, Japan) from 2013 to 2017. The primary objective was to assess the correlation and the agreement between measurements of creatinine concentrations by a Radiometer blood gas analyzer (Cre(gas)) and those conducted in a central laboratory (Cre(lab)). The secondary objective was to compare the incidence of postoperative AKI between the two methods based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. <br>
Results: We analyzed the results of 1404 paired creatinine measurements from 498 patients, whose median age was 14 months old (interquartile range [IQR] 3, 49). The Pearson correlation coefficient of Cre(gas) vs Cre(lab) was 0.968 (95% confidence interval [CI], 0.965-0.972, P < 0.001). The median bias between Cre(gas) and Cre(lab) was 0.02 (IQR -0.02, 0.05) mg/dL. While 199 patients (40.0%) were diagnosed as having postoperative AKI based on Cre(lab), 357 patients (71.7%) were diagnosed as having postoperative AKI based on Cre(gas) (Kappa = 0.39, 95% CI, 0.33-0.46). In a subgroup analysis of patients whose Cre(gas) and Cre(lab) were measured within 1 hour, similar percentage of patients were diagnosed as having postoperative AKI based on Cre(gas) and Cre(lab) (42.8% vs 46.0%; Kappa = 0.76, 95% CI, 0.68-0.84). <br>
Conclusion: There was an excellent correlation between Cre(gas) and Cre(lab) in pediatric patients. Although more patients were diagnosed as having postoperative AKI based on Cre(gas) than based on Cre(lab), paired measurements with a short time gap showed good agreement on AKI diagnosis.No potential conflict of interest relevant to this article was reported.Japan Neurosurgical Soc.Acta Medica Okayama0470-81056172021An Evaluation of the Safety and Feasibility of Adenosine-assisted Clipping Surgery for Unruptured Cerebral Aneurysms: Study Protocol393396ENTomohitoHishikawaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoshiMuraiDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasafumiHiramatsuDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunHarumaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuhikoNishiDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiEbisudaniDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuSatoDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakaoYasuharaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKenjiSugiuDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotomuKobayashiDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKojiNakagawaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAyaKimura-OnoCenter for Innovative Clinical Medicine, Okayama University HospitalKatsuyukiHottaCenter for Innovative Clinical Medicine, Okayama University HospitalHiroshiMorimatsuDepartment of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesIsaoDateDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesThe effectiveness of adenosine-induced flow arrest in surgical clipping for the cerebral aneurysms with difficulties in temporary clip placement to the proximal main trunk has been reported. This is the first clinical trial to evaluate the safety and feasibility of adenosine-assisted clipping surgery for unruptured cerebral aneurysms (UCAs) in Japan. The inclusion criteria are as follows: patients over 20 years old, patients who agree to be enrolled in this study after providing informed consent, patients who undergo clipping surgery for UCA in our institute, and patients in whom the surgeons (T.H. or I.D.) judge that decompression of the aneurysm is effective. The primary endpoint is a modified Rankin Scale (mRS) score 30 days after surgery. We plan to enroll 10 patients in this study. The original protocol of adenosine administration was established in this trial. Herein, we present the study protocol.No potential conflict of interest relevant to this article was reported. SpringerActa Medica Okayama2363-9024612020Successful treatment with positive airway pressure ventilation for tension pneumopericardium after pericardiocentesis in a neonate: a case report79ENMakikoTaniDepartment of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical SciencesTomoyukiKanazawaDepartment of Anesthesiology and Resuscitology, Okayama University HospitalNaohiroShiojiDepartment of Anesthesiology and Resuscitology, Okayama University HospitalKazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical SciencesTatsuoIwasakiDepartment of Anesthesiology and Resuscitology, Okayama University HospitalHiroshiMorimatsuDepartment of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical SciencesBackground Pneumopericardium in neonates is often associated with respiratory diseases, of which positive pressure ventilation (PPV) is an exacerbating factor. Here, we present a neonate case of pneumopericardium after cardiac surgery which was resolved after applying PPV. Case presentation A 28-day-old neonate with left recurrent nerve palsy after aortic reconstruction for interrupted aortic arch developed pericardial effusion. Pericardiocentesis was performed under general anesthesia, and a drainage tube was left in the pericardium. After extubation, stridor gradually exacerbated, following hemodynamic deterioration. A chest X-ray demonstrated pneumopericardium. Upper airway stenosis due to recurrent nerve palsy developed excessive negative pleural pressure, and air was drawn into pericardium via the insertion site of the drainage tube. After tracheal intubation and applying PPV, the pneumopericardium improved. Conclusion PPV does not always exacerbate pneumopericardium. In a patient with pericardial-atmosphere communication, increased inspiration effort can cause pneumopericardium, and PPV is a therapeutic option to alleviate the pneumopericardium.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama2363-90245512019Early detection of cerebral ischemia due to pericardium traction using cerebral oximetry in pediatric minimally invasive cardiac surgery: a case report53ENFumiakiHayashiDepartment of Anesthesiology and Resuscitology, Okayama University Hospital,ReiNishimotoDepartment of Anesthesiology and Resuscitology, Okayama University Hospital,KazuyoshiShimizuDepartment of Anesthesiology and Resuscitology, Okayama University Hospital,TomoyukiKanazawaDepartment of Anesthesiology and Resuscitology, Okayama University Hospital,TatsuoIwasakiDepartment of Anesthesiology and Resuscitology, Okayama University Hospital,HiroshiMorimatsuDepartment of Anesthesiology and Resuscitology, Okayama University Hospital,Background<br/>
Minimally invasive cardiac surgery (MICS) for simple congenital heart defects has become popular, and monitoring of regional cerebral oxygen saturation (rSO2) is crucial for preventing cerebral ischemia during pediatric MICS. We describe a pediatric case with a sudden decrease in rSO2 during MICS.<br/>
Case presentation<br/>
An 8-month-old male underwent minimally invasive ventricular septal defect closure. He developed a sudden decrease in rSO2 and right radial artery blood pressure (RRBP) without changes in other parameters following pericardium traction. The rSO2 and RRBP immediately recovered after removal of pericardium fixation. Obstruction of the right innominate artery secondary to the pericardium traction would have been responsible for it.<br/>
Conclusions<br/>
Pericardium traction, one of the common procedures during MICS, triggered rSO2 depression alerting us to the risk of cerebral ischemia. We should be aware that pericardium traction during MICS can lead to cerebral ischemia, which is preventable by cautious observation of the patient.No potential conflict of interest relevant to this article was reported.