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Imafuku K, Iwata H, Natsuga K, Okumura M, Kobayashi Y, Kitahata H, Kubo A, Nagayama M, Ujiie H. 197 Tissue proliferation and turnover spatially regulates tight junctions in squamous epithelia. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Takaishi K, Takata M, Aoki R, Fujiwara SJL, Kawahito S, Kitahata H. Total Intravenous Anesthesia Using Remimazolam and Continuous Cardiac Output Monitoring for Dental Anesthesia in a Patient With Takayasu’s Arteritis: A Case Report. A A Pract 2022; 16:e01599. [DOI: 10.1213/xaa.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Takaishi K, Kawahito S, Kitahata H. Management of a Patient With Tracheal Stenosis After Previous Tracheotomy. Anesth Prog 2021; 68:224-229. [PMID: 34911067 DOI: 10.2344/anpr-68-03-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/11/2022] Open
Abstract
Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.
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Affiliation(s)
- Kazumi Takaishi
- Associate Professor, Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Kawahito
- Designated Professor, Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroshi Kitahata
- Professor, Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Takaishi K, Otsuka R, Fujiwara SJ, Eguchi S, Kawahito S, Kitahata H. A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts. Anesth Prog 2021; 68:168-177. [PMID: 34606575 PMCID: PMC8500314 DOI: 10.2344/anpr-68-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 09/04/2020] [Indexed: 11/11/2022] Open
Abstract
Previously undiagnosed or asymptomatic epiglottic cysts may be coincidentally detected during intubation. This retrospective case series identified undiagnosed epiglottic cysts that were discovered during intubation in 4 patients who underwent oral surgery under general anesthesia at our hospital during a 6-year period. Including 2 additional cases, 1 previously diagnosed and 1 detected during preoperative imaging, epiglottic cysts were observed in 6 of 1112 cases (0.54%) total. Among the undiagnosed epiglottic cyst cases, mild dyspnea on effort or snoring was reported in 2 patients, but all others were asymptomatic. Upon discovering previously undiagnosed epiglottic cysts during intubation, it is essential to proceed cautiously, remain alert for potential airway management difficulties, and avoid injuring or rupturing the cysts. In addition, any available preoperative imaging should be reviewed as information pertinent to the airway and any abnormalities may be useful. This report discusses the anesthetic care of 6 patients with epiglottic cysts that were previously known or initially discovered during intubation.
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Affiliation(s)
| | | | | | - Satoru Eguchi
- Assistant Professor, Department of Dental Anesthesiology,
Tokushima University Hospital, Tokushima, Japan
| | - Shinji Kawahito
- Designated Professor, Department of Community Medicine and
Human Resource, Tokushima University Graduate School of Biomedical Sciences,
Tokushima, Japan
| | - Hiroshi Kitahata
- Professor and Chairman, Department of Dental Anesthesiology,
Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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5
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Takaishi K, Kudo Y, Kawahito S, Kitahata H. Clinically relevant concentration of propofol and benzodiazepines did not affect in vitro angiogenesis. J Anesth 2021; 35:870-878. [PMID: 34460008 DOI: 10.1007/s00540-021-02993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Angiogenesis, one of regenerative medicine, is essential in the process of wound healing. The detailed effects of intravenous anesthetics and sedatives used during perioperative period have not yet been clarified. We investigated the effects of benzodiazepines and propofol on in vitro capillary tube formation. METHODS The effects of midazolam, diazepam and propofol (1, 10, 50 µM each) on proliferation of human umbilical vein endothelial cells (HUVEC) and normal human diploid fibroblasts (NHDF) were determined. Quantitation of migration was achieved by measuring the fluorescence of migrating HUVEC using angiogenesis system. The effects of midazolam, diazepam and propofol on in vitro angiogenesis were investigated in co-cultured HUVEC and NHDF incubated. The effects of midazolam on activation of p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinases were examined by Western blot analysis using phospho-specific antibodies. Parametric data were analyzed with one-way repeated measures analysis of variance followed by the Scheffé test. A value of P < 0.05 was considered statistically significant. RESULTS Fifty µM of midazolam significantly impaired endothelial cell proliferation, migration, and in vitro capillary tube formation. Propofol, diazepam or lower dose midazolam did not show any enhancing or suppressive effects on in vitro angiogenesis. Fifty µM of midazolam remarkably activated ERK, but not p38 MAPK in HUVEC. CONCLUSION Propofol and benzodiazepines except high-dose midazolam did not affect in vitro angiogenesis. High-dose midazolam may impair in vitro capillary tube formation due to by suppressing proliferation and migration of endothelial cells via activation of ERK.
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Affiliation(s)
- Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan.
| | - Yasusei Kudo
- Department of Oral Bioscience, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan
| | - Shinji Kawahito
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8504, Japan
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Kawahito S, Soga T, Yagi S, Mita N, Takaishi K, Kinoshita H, Kitagawa T, Kitahata H. Pathophysiology and Complications during Extracorporeal Circulation. J Med Invest 2020; 67:229-235. [PMID: 33148893 DOI: 10.2152/jmi.67.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shinji Kawahito
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomohiro Soga
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shusuke Yagi
- Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Naoji Mita
- Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroyuki Kinoshita
- Department of Anesthesiology, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Tetsuya Kitagawa
- Department of Cardiovascular Surgery, Shikoku Central Hospital of the Mutual Aid Association of Public School Teachers, Ehime, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Takaishi K, Kinoshita H, Feng GG, Azma T, Kawahito S, Kitahata H. Cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle. J Pharmacol Sci 2020; 144:197-203. [PMID: 33070838 DOI: 10.1016/j.jphs.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/01/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
The role of cytoskeleton dynamics in the oxidative stress toward human vasculature has been unclear. The current study examined whether the cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle. All experiments in the human omental arteries without endothelium or the cultured human coronary artery smooth muscle cells were performed in d-glucose (5.5 mmol/L). The exposure toward d-glucose (20 mmol/L) for 60 min reduced the relaxation or hyperpolarization to an ATP sensitive K+ channel (KATP) opener levcromakalim (10-8 to 3 × 10-6 mol/L and 3 × 10-6 mol/L, respectively). Cytochalasin B and a superoxide inhibitor Tiron, restored them similarly. Cytochalasin B reduced the NADPH oxidase activity, leading to a decrease in superoxide levels of the arteries treated with high d-glucose. Also, cytochalasin B impaired the F-actin constitution and the membrane translocation of an NADPH oxidase subunit p47phox in artery smooth muscle cells treated with high d-glucose. A clinical concentration of cytochalasin B prevented human vascular smooth muscle malfunction via the oxidative stress caused by high glucose. Regulation of the cytoskeleton may be essential to keep the normal vascular function in patients with hyperglycemia.
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Affiliation(s)
- Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Hiroyuki Kinoshita
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan; Department of Anesthesiology, Aichi Medical University School of Medicine, Aichi, Japan.
| | - Guo-Gang Feng
- Department of Anesthesiology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Toshiharu Azma
- Department of Anesthesiology & Pain Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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Takaishi K, Kitahata H. Electrons released from both flavins of NADPH-P450 reductase contribute to the reductive mobilization of iron from ferritin. J Med Invest 2019; 66:230-232. [PMID: 31656279 DOI: 10.2152/jmi.66.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Ferritin, an iron storage protein, plays an important role in iron homeostasis. The mechanism of reductive mobilization of iron from ferritin has not been clarified yet despite many studies. The aim of this study was to assess the mechanisms of the mobilization of iron from ferritin by NADPH P-450 reductase. Nucleotide-dependent flavoenzymes generated significant mobilization of iron from ferritin. The possibility of reductive mobilization of iron from ferritin by electrons released from flavin sites or heme site of two flavoenzymes was investigated to elucidate the mediator-independent mechanisms of such reductive mobilization. The mobilization by NADPH-P450 reductase in the presence of ferricyanide increased threefold, while in the presence of cytochrome C increased thirteen-fold. These results indicate that electrons released from both flavins of NADPH-P450 reductase contribute to the reductive mobilization of iron from ferritin. The mechanism of the mobilization of iron from ferritin is discussed. J. Med. Invest. 66 : 230-232, August, 2019.
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Affiliation(s)
- Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Kinoshita H, Akahori T, Nakamura E, Okawa H, Kawahito S, Kitahata H, Fujiwara Y. Tissue oxygenation index reflects changes in forearm blood flow after brief ischemia. J Med Invest 2017; 64:228-232. [PMID: 28954987 DOI: 10.2152/jmi.64.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Whether the near-infrared spectroscopy (NIRS) technology correctly detects the changes in oxygenation related to ischemia and reperfusion of organs and tissues other than brain remains unclear. The present study examined how different tissue oxygenation parameters derived from NIRS reflect the changes in the forearm blood flow (FBF) according to the brief ischemia and the subsequent reperfusion, and whether values of these parameters move in parallel with the medial and lateral sides of FBF. Thirteen volunteers underwent the prospective observational study. The tissue oxygenation index (TOI), regional saturation of oxygen (rSO2), skin tissue oxygenation (StO2), and FBF values were evaluated in the forearm. Medial rSO2 values at 1 to 3 minutes after the termination of brief ischemia were higher than lateral rSO2 and respective TOI values. FBF and StO2 values quickly increased according to the cessation of brief ischemia, whereas the medial and lateral values did not differ during and after the brief ischemia. TOI and StO2, but not rSO2, reflected changes in FBF of both medial and lateral sides simultaneously in response to the reperfusion after brief ischemia. The muscle tissue oxygenation during reperfusion favors the use of TOI and StO2, but not rSO2, as the surrogate parameter. J. Med. Invest. 64: 228-232, August, 2017.
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Affiliation(s)
- Hiroyuki Kinoshita
- Department of Anesthesiology, Aichi Medical University School of Medicine.,Departments of Anesthesiology, Tokushima University Hospital
| | - Takahiko Akahori
- Department of Anesthesiology, Aichi Medical University School of Medicine
| | - Emi Nakamura
- Department of Anesthesiology, Aichi Medical University School of Medicine
| | - Hazuki Okawa
- Department of Anesthesiology, Aichi Medical University School of Medicine
| | - Shinji Kawahito
- Departments of Anesthesiology, Tokushima University Hospital
| | - Hiroshi Kitahata
- Departments of Dental Anesthesiology, Tokushima University Hospital
| | - Yoshihiro Fujiwara
- Department of Anesthesiology, Aichi Medical University School of Medicine
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Kawahito S, Soga T, Mita N, Satomi S, Kinoshita H, Arase T, Kondo A, Miki H, Takaishi K, Kitahata H. Successful treatment of mixed (mainly cancer) pain by tramadol preparations. J Med Invest 2017; 64:311-312. [PMID: 28955004 DOI: 10.2152/jmi.64.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache. Because this pain could not be controlled by an increase to eight combination tablets per day, we switched her medication to a tramadol capsule. At 11 months post-surgery, we then switched her medication to an orally disintegrating tramadol tablet to improve medication adherence of the drug. From 14 months post-surgery, the patient also used a sustained-release tramadol preparation, and she was then able to sleep well. Her current regimen is an orally disintegrating sustained-release tablet combination (total 300 mg tramadol) per day, and she achieved sufficient pain relief. Because tramadol is not classified as a medical narcotic drug, it widely available and was shown here to be extremely useful for the treatment of our patient's mixed (mainly cancer) pain. J. Med. Invest. 64: 311-312, August, 2017.
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Affiliation(s)
| | - Tomohiro Soga
- Department of Anesthesiology, Tokushima University Hospital
| | - Naoji Mita
- Department of Anesthesiology, Tokushima University Hospital
| | - Shiho Satomi
- Department of Anesthesiology, Tokushima University Hospital
| | | | | | - Akira Kondo
- Division of Palliative Medicine, Kondo Hospital
| | | | - Kazumi Takaishi
- Department of Dental Anesthesiology, Tokushima University Hospital
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Hospital
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Kambe N, Kawahito S, Mita N, Takaishi K, Katayama T, Sakai Y, Soga T, Kawano H, Matsuhisa M, Shimada M, Kitagawa T, Kitahata H. Impact of newly developed, next-generation artificial endocrine pancreas. J Med Invest 2016; 62:41-4. [PMID: 25817282 DOI: 10.2152/jmi.62.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Recent studies have shown that strict perioperative blood glucose management may reduce mortality and morbidity in critically ill adult patients. The purpose of this study was to assess the accuracy and efficacy of the intraoperative application of a newly developed, next-generation artificial endocrine pancreas (STG-55, Nikkiso Co., Ltd., Tokyo, Japan). METHODS Twenty patients scheduled to undergo surgery were enrolled in this study. The STG-55 is designed to be more user-friendly than its conventional counterpart (STG-22) while maintaining the latter's fundamental functions, such as a closed-loop system using algorithms for insulin and glucose infusion. After anesthetic induction, a 20G intravenous catheter was inserted into a peripheral forearm vein and connected to a continuous blood glucose monitor. The resultant 105 scores for paired blood glucose values were compared by Bland-Altman analysis. RESULTS Stable blood glucose values were maintained automatically, and there were no complications related to use of the STG-55. A close correlation (r=0.96) was observed between continuous glucose measurements using the STG-55 and conventional intermittent glucose measurements. The difficulty of manipulation using this system was decreased by improved preparation procedures. CONCLUSION The glycemic control system using the STG-55 could provide an alternative way to achieve effective and safe perioperative glycemic control.
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Affiliation(s)
- Noriko Kambe
- Department of Anesthesiology, Tokushima University Hospital
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Otsuka R, Harada N, Aoki S, Shirai K, Nishitsuji K, Nozaki A, Hatakeyama A, Shono M, Mizusawa N, Yoshimoto K, Nakaya Y, Kitahata H, Sakaue H. C-terminal region of GADD34 regulates eIF2α dephosphorylation and cell proliferation in CHO-K1 cells. Cell Stress Chaperones 2016; 21:29-40. [PMID: 26318739 PMCID: PMC4679745 DOI: 10.1007/s12192-015-0633-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022] Open
Abstract
GADD34 is a member of a growth arrest and DNA damage (GADD)-inducible gene family. Here, we established a novel Chinese hamster ovary (CHO)-K1-derived cell line, CHO-K1-G34M, which carries a nonsense mutation (termed the Q525X mutation) in the GADD34 gene. The Q525X mutant protein lacks the C-terminal 66 amino acids required for GADD34 to bind to and activate protein phosphatase 1 (PP1). We investigated the effects of GADD34 with or without the Q525X mutation on the phosphorylation status of PP1 target proteins, including the α subunit of eukaryotic initiation factor 2 (eIF2α) and glycogen synthase kinase 3β (GSK3β). CHO-K1-G34M cells had higher levels of eIF2α phosphorylation compared to the control CHO-K1-normal cells both in the presence and absence of endoplasmic reticulum stress. Overexpression of the wild-type GADD34 protein in CHO-K1-normal cells largely reduced eIF2α phosphorylation, while overexpression of the Q525X mutant did not produce similar reductions. Meanwhile, neither wild type nor Q525X mutation of GADD34 affected the GSK3β phosphorylation status. GADD34 also did not affect the canonical Wnt signaling pathway downstream of GSK3β. Cell proliferation rates were higher, while expression levels of the cyclin-dependent kinase inhibitor p21 were lower in CHO-K1-G34M cells compared to the CHO-K1-normal cells. The GADD34 Q525X mutant had a reduced ability to inhibit cell proliferation and enhance p21 expression of the CHO-K1-normal cells compared to the wild-type GADD34 protein. These results suggest that the GADD34 protein C-terminal plays important roles in regulating not only eIF2α dephosphorylation but also cell proliferation in CHO-K1 cells.
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Affiliation(s)
- Ryo Otsuka
- Department of Dental Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8504, Japan
| | - Nagakatsu Harada
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan.
| | - Shouhei Aoki
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
| | - Kanna Shirai
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
| | - Kazuchika Nishitsuji
- Department of Molecular Pathology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
| | - Ayane Nozaki
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
| | - Adzumi Hatakeyama
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
| | - Masayuki Shono
- Support Center for Advanced Medical Sciences, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
| | - Noriko Mizusawa
- Department of Medical Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8504, Japan
| | - Katsuhiko Yoshimoto
- Department of Medical Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8504, Japan
| | - Yutaka Nakaya
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
| | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8504, Japan
| | - Hiroshi Sakaue
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, 770-8503, Japan
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Tsutsumi M, Kitahata H, Fukuda M, Kumamoto J, Goto M, Denda S, Yamasaki K, Aiba S, Nagayama M, Denda M. Numerical and comparative three‐dimensional structural analysis of peripheral nerve fibres in epidermis of patients with atopic dermatitis. Br J Dermatol 2015; 174:191-4. [DOI: 10.1111/bjd.13974] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Tsutsumi
- Japan Science and Technology Agency, CREST Kawaguchi Japan
- Shiseido Research Center 2‐2‐1 Hayabuchi Tsuzuki‐ku Yokohama 224‐8558 Japan
| | - H. Kitahata
- Japan Science and Technology Agency, CREST Kawaguchi Japan
- Department of Physics Graduate School of Science Chiba University Chiba Japan
| | - M. Fukuda
- Shiseido Research Center 2‐2‐1 Hayabuchi Tsuzuki‐ku Yokohama 224‐8558 Japan
| | - J. Kumamoto
- Japan Science and Technology Agency, CREST Kawaguchi Japan
- Research Institute for Electronic Science Hokkaido University Sapporo Japan
| | - M. Goto
- Japan Science and Technology Agency, CREST Kawaguchi Japan
- Shiseido Research Center 2‐2‐1 Hayabuchi Tsuzuki‐ku Yokohama 224‐8558 Japan
| | - S. Denda
- Japan Science and Technology Agency, CREST Kawaguchi Japan
- Shiseido Research Center 2‐2‐1 Hayabuchi Tsuzuki‐ku Yokohama 224‐8558 Japan
| | - K. Yamasaki
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - S. Aiba
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - M. Nagayama
- Japan Science and Technology Agency, CREST Kawaguchi Japan
- Research Institute for Electronic Science Hokkaido University Sapporo Japan
| | - M. Denda
- Japan Science and Technology Agency, CREST Kawaguchi Japan
- Shiseido Research Center 2‐2‐1 Hayabuchi Tsuzuki‐ku Yokohama 224‐8558 Japan
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Mio Y, Uezono S, Kitahata H. Anesthetic cardioprotection in relation to mitochondria: basic science. Curr Pharm Des 2015; 20:5673-80. [PMID: 24502577 DOI: 10.2174/1381612820666140204110101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/03/2014] [Indexed: 11/22/2022]
Abstract
Anesthetic pre- and postconditioning pharmacologically reduces ischemia/reperfusion injury. Mitochondria play a central role in these myocardial protective salvage effects. In the preconditioning, low levels of reactive oxygen species, which are produced by anesthetics in the mitochondria, act as a trigger to prevent cardiomyocytes death and modify intracellular signaling mechanisms. In the postconditioning, decreased mitochondrial matrix pH, which was caused by anesthetics, triggers the onset of a rapid protective effect. The mitochondrial membranes have several ion channels that act as major determining factors of cellular life and death under pathophysiological conditions. In these channels, the mitochondrial adenosine triphosphate-sensitive K(+) channels, the mitochondrial Ca(2+)-activated K(+) channels and mitochondrial permeability transition pores play critical roles in cardioprotection against ischemia/reperfusion injury. Mitochondrial permeability transition pores are end effectors, which contribute to myocardial preconditioning and postconditioning. Activation of intracellular signaling and acidification of mitochondrial matrix pH prevent the mitochondrial permeability transition pore opening, and therefore, preserve the mitochondrial function to supply adenosine triphosphate, resulting in myocardial protection due to the maintenance of intracellular homeostasis.
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Affiliation(s)
| | | | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima 770-8504, Japan.
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Sakai Y, Kawahito S, Takaishi K, Mita N, Kinoshita H, Hatakeyama N, Azma T, Nakaya Y, Kitahata H. Propofol-induced relaxation of rat aorta is altered by aging. J Med Invest 2014; 61:278-84. [PMID: 25264045 DOI: 10.2152/jmi.61.278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Propofol causes vasodilation via endothelium-dependent and -independent mechanisms. Because endothelial function is impaired with aging, the effects of propofol on endothelium-dependent vasodilation might be altered by aging. The aim of this study was thus to determine the effects of aging on vascular responses to propofol. METHODS Young (4-6 weeks old) or adult (16-25 weeks old) rats were anesthetized with sevoflurane. The thoracic aorta was dissected and cut into pieces 3-4 mm in length. In some rings, the endothelium was deliberately removed. The ring segment of the aorta was mounted for isometric force recording at a resting tension of 0.5-1.0 g in a 2 ml organ bath, containing Krebs-Ringer bicarbonate buffer. Arteries were precontracted with phenylephrine, and the function of endothelium was confirmed with acetylcholine. Then, we studied the concentration-dependent effects of propofol in endothelium-intact (control group) and -denuded aortic rings (denuded group), as well as those treated with N(ω)-nitro-L-arginine methylester (L-NAME group). RESULTS Relaxation due to propofol was observed in the control groups of both young and adult rats in a concentration-dependent manner, but the magnitude of relaxation was significantly greater in young rats. In addition, in young rats, relaxation due to propofol was significantly and equally reduced in both L-NAME and denuded groups at all propofol concentrations that we studied (10(-6)-10(-3) M). In adult rats, relaxation due to propofol was quite similar between control and L-NAME groups at all propofol concentrations, whereas it was significantly reduced in the denuded group. CONCLUSION These results suggest that endothelium-derived nitric oxide plays an important role in propofol-induced vasodilation in young rats, but not in adult rats.
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Affiliation(s)
- Yoko Sakai
- Department of Anesthesiology, Tokushima University Hospital
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16
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Abstract
Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.
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Affiliation(s)
- Kazumi Takaishi
- Assistant Professor, The University of Tokushima Graduate School, Tokushima, Japan
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Hirose K, Kawahito S, Mita N, Takaishi K, Kawahara T, Soga T, Katayama T, Imura S, Morine Y, Ikemoto T, Shimada M, Matsuhisa M, Kitahata H. Usefulness of artificial endocrine pancreas during resection of insulinoma. J Med Invest 2014; 61:421-5. [DOI: 10.2152/jmi.61.421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kayo Hirose
- Department of Pharmacology, Institute of Health Biosciences, the University of Tokushima Graduate School
- Department of Anesthesiology, Tokyo University Graduate School of Medicine
| | | | - Naoji Mita
- Department of Anesthesiology, Tokushima University Hospital
| | - Kazumi Takaishi
- Department of Dental Anesthesiology, Institute of Health Biosciences, the University of Tokushima Graduate School
| | | | - Tomohiro Soga
- Department of Anesthesiology, Tokushima University Hospital
| | | | - Satoru Imura
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Yuji Morine
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Tetsuya Ikemoto
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Mitsuo Shimada
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | | | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Institute of Health Biosciences, the University of Tokushima Graduate School
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18
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Kakuta N, Kawahito S, Mita N, Kambe N, Kasai A, Wakamatsu N, Katayama T, Soga T, Tada F, Kitaichi T, Kitagawa T, Kitahata H. Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt. J Med Invest 2013; 60:272-5. [PMID: 24190047 DOI: 10.2152/jmi.60.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A PediaSat™ oximetry catheter (PediaSat: Edwards Lifesciences Co., Ltd., Irvine, CA, U. S. A.), which facilitates continuous measurement of central venous oxygen saturation (ScvO2), may be useful for surgery for pediatric congenital heart disease. We used PediaSat during a bidirectional Glenn shunt. The patient was a 13-month-old boy. Under a diagnosis of left single ventricle (pulmonary atresia, right ventricular hypoplasia, atrial septal defect) and residual left aortic arch/left superior vena cava, a modified right Blalock-Taussig shunt was performed. Cyanosis deteriorated, so a bidirectional Glenn shunt was scheduled. After anesthesia induction, a 4.5 Fr double-lumen (8 cm) PediaSat was inserted through the right internal jugular vein for continuous ScvO2 monitoring. Furthermore, the probe of a near-infrared, mixed blood oxygen saturation-measuring monitor was attached to the forehead for continuous monitoring of the regional brain tissue mixed blood oxygen saturation (rSO2) (INVOS™ 5100C, Covidien; Boulder, CO, U. S. A.). Blockage of the right pulmonary artery and right superior vena cava decreased the oxygen saturation, ScvO2, and rSO2, but increased the central venous pressure. Although changes in ScvO2 were parallel to those in rSO2, the former showed more marked changes. A combination of ScvO2 and rSO2 for monitoring during Glenn shunt may be safer.
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Affiliation(s)
- Nami Kakuta
- Department of Anesthesiology, Tokushima University Hospital
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Takaishi K, Kawahito S, Yamada H, Soeki T, Sata M, Kitahata H. Increase in prominence of electrocardiographic J waves after a single dose of propofol in a patient with early ventricular repolarisation. Anaesthesia 2013; 69:170-5. [DOI: 10.1111/anae.12448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 11/26/2022]
Affiliation(s)
- K. Takaishi
- Department of Dental Anaesthesiology; The University of Tokushima Graduate School; Tokushima Japan
| | - S. Kawahito
- Department of Anaesthesiology; Tokushima University Hospital; Tokushima Japan
| | - H. Yamada
- Department of Cardiovascular Medicine; Tokushima University Hospital; Tokushima Japan
| | - T. Soeki
- Department of Cardiovascular Medicine; Tokushima University Hospital; Tokushima Japan
| | - M. Sata
- Department of Cardiovascular Medicine; The University of Tokushima Graduate School; Tokushima Japan
| | - H. Kitahata
- Department of Dental Anaesthesiology; The University of Tokushima Graduate School; Tokushima Japan
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20
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Kawahito S, Higuchi S, Mita N, Kitagawa T, Kitahata H. Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit. J Artif Organs 2013; 16:508-9. [DOI: 10.1007/s10047-013-0725-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
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21
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Soga T, Kawahito S, Oi R, Kakuta N, Katayama T, Wakamatsu N, Takaishi K, Yamaguchi K, Izaki H, Kanayama HO, Kitahata H, Oshita S. Recent less-invasive circulatory monitoring during renal transplantation. J Med Invest 2013; 60:159-63. [PMID: 23614926 DOI: 10.2152/jmi.60.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
For anesthetic management during renal transplantation, it is necessary to maintain the blood flow and function of the transplanted kidney by performing massive fluid management and stabilizing blood pressure. We report anesthetic management for renal transplantation with a less-invasive circulatory monitoring system (Edwards Life Sciences Co., Ltd., Irvine, California, U.S.A.). In November 2010, renal transplantation was started in our hospital, and performed in 6 patients. In the first patient, fluid/circulatory management was conducted by connecting a standard arterial line and a standard central venous (CV) line. In the second patient, a FloTrac(TM) system and a standard CV line were used. In the third patient, a standard arterial line and a PreSep(TM) CV Oximetry Catheter were used. In the fourth and fifth patients, a FloTrac(TM) and a PreSep(TM) were used. In the latest patient, FloTrac(TM) and PreSep(TM) were connected to an EV1000(TM) Clinical Platform for fluid/circulatory management. The establishment of high-visibility monitors was useful for evaluating the condition and confirming the effects. As there are marked changes in hemodynamics, the CV pressure, which has been used as a parameter of fluid management, is not reliable in renal failure patients with a high incidence of cardiovascular complications. Advances in noninvasive circulatory monitoring with dynamic indices may improve the safety of anesthetic management during renal transplantation.
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Affiliation(s)
- Tomohiro Soga
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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22
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Takaishi K, Kitahata H, Kawahito S. Local anesthetics inhibit nitric oxide production and l-arginine uptake in cultured bovine aortic endothelial cells. Eur J Pharmacol 2013; 704:58-63. [DOI: 10.1016/j.ejphar.2013.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 11/15/2022]
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Okada T, Kawahito S, Mita N, Matsuhisa M, Kitahata H, Shimada M, Oshita S. Usefulness of continuous blood glucose monitoring and control for patients undergoing liver transplantation. J Med Invest 2013; 60:205-12. [DOI: 10.2152/jmi.60.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Naoji Mita
- Department of Anesthesiology, Tokushima University Hospital
| | | | - Hiroshi Kitahata
- Department of Dental Anesthesiology, Tokushima University Hospital
| | - Mitsuo Shimada
- Department of Digestive and Pediatric Surgery, Tokushima University Hospital
| | - Shuzo Oshita
- Department of Anesthesiology, Tokushima University Hospital
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Kawahito S, Kitahata H. [Principles, usefulness, and limitations of recent circulatory monitoring]. Masui 2012; 61:25-34. [PMID: 22338857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Less invasive measuring procedures for hemodynamic status and function are increasingly being used. Surgical patients are frequently undifferentiated, need accurate risk assessment and stratification, while their need for diagnosis and therapy is often time-critical. Valid, less invasive hemodynamic monitoring modalities are essential to differentiate high- from low-risk patients, and for goal-directed management. Pulmonary artery catheters, transesophageal echocardiography, pressure pulse waveform analysis, and other less invasive monitoring techniques all are potentially effective for diagnosis and hemodynamic monitoring. This article provides information on the usefulness and limitations of recent circulatory monitoring procedures.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima 770-8503
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25
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Kawahito S, Kawano T, Kitahata H, Oto J, Takahashi A, Takaishi K, Harada N, Nakagawa T, Kinoshita H, Azma T, Nakaya Y, Oshita S. Molecular Mechanisms of the Inhibitory Effects of Clonidine on Vascular Adenosine Triphosphate–Sensitive Potassium Channels. Anesth Analg 2011; 113:1374-80. [DOI: 10.1213/ane.0b013e3182321142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Hamaguchi E, Kawano H, Kawahito S, Kitahata H, Oshita S. [Torsade de pointes associated with severe bradycardia after induction of general anesthesia]. Masui 2011; 60:1097-1100. [PMID: 21950046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An 80-year-old woman with chronic atrial flutter/fibrillation, and chronic renal failure underwent ileocecal resection. The preoperative electrocadiogram showed normal QT interval. Temporary pacemaker catheter was inserted for sinus arrest (5-6 sec) the day before operation. Anesthesia was induced with remifentanil 0.5 micro x kg(-1) min(-1), thiamylal 125 mg, and rocuronium 30 mg after intravenous atropine sulfate 0.5 mg. Because the heart rate was increased with atropine sulfate, the pacemaker was not started. Anesthesia was then maintained with intravenous remifentanil and sevoflurane-air-oxygen. Just after induction of anesthesia, sinus bradycardia occurred, and 9 minutes after tracheal intubation, ECG suddenly showed torsade de pointes (TdP) and the arterial blood pressure decreased leading to asystole. We immediately started cardiopulmonary resuscitation, and TdP stopped spontaneously within 1 minute. We started pacemaker (VVI, 60 beats x min(-1)) and intravenous injection of lidocaine, and TdP did not recur. In this case, TdP seemed to have occurred because of bradycardia-induced abnormal QT prolongation. This should be considered the risk of lethal arrhythmia in patients with severe bradycardia including TdP.
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Affiliation(s)
- Eisuke Hamaguchi
- Department of Anesthesiology, Tokushima University Hospital, Tokushima 770-8503
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27
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Kawano H, Hamaguchi E, Kawahito S, Tsutsumi YM, Tanaka K, Kitahata H, Oshita S. Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-D-aspartate receptor antibodies. Anaesthesia 2011; 66:515-8. [PMID: 21457154 DOI: 10.1111/j.1365-2044.2011.06707.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Paraneoplastic limbic encephalitis associated with ovarian teratoma has recently been related to the development of antibodies to specific heteromers of the N-methyl-d-aspartate receptor and exhibits various manifestations including psychiatric symptoms, hypoventilation, seizures and derangement of autonomic nervous system function. Although recovery can sometimes occur spontaneously, early tumour resection with immunotherapy facilitates earlier recovery. Herein, we describe anaesthetic management of a 20-year-old woman who developed general convulsions and decreased level of consciousness, whom we suspected of having paraneoplastic limbic encephalitis and was scheduled for left ovarian tumour resection. Anaesthetic management was successful with no complications but the case acts as focus of discussion for the potential interaction of N-methyl-D-aspartate receptors and anaesthetic sensitivity.
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Affiliation(s)
- H Kawano
- Department of Anesthesiology and Clinical Research, National Hospital Organization Zentsuji Hospital, Zentsuji, Japan.
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Abstract
Recent evidence in the fields of surgery, emergency and critical care medicine indicates that strict glycemic control results in lower mortality. Hyperglycemia occurs frequently in patients with and without diabetes during cardiovascular surgery, especially during cardiopulmonary bypass. However, strict glucose control is difficult to achieve during cardiovascular procedures. To establish effective intensive insulin therapy during cardiovascular surgery, we conduct continuous blood glucose monitoring and employ automatic control by using an artificial endocrine pancreas (the STG-22, Nikkiso, Tokyo, Japan). In this review, we will outline the present status and problems of conventional glycemic control for perioperative cardiovascular surgery and introduce the new perioperative blood glucose management method that we are testing now. We will also discuss the importance of perioperative glycemic control for cardiovascular surgery as well as future prospects.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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29
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Abstract
Glucose homeostasis deficiency leads to a chronic increase in blood glucose concentration. In contrast to physiological glucose concentration, chronic superphysiological glucose concentration negatively affects a large number of organs and tissues. Glucose toxicity means a decrease in insulin secretion and an increase in insulin resistance due to chronic hyperglycemia. It is now generally accepted that glucose toxicity is involved in the worsening of diabetes by affecting the secretion of β-cells. Several mechanisms have been proposed to explain the adverse effects of hyperglycemia. It was found that persistent hyperglycemia caused the functional decline of neutrophils. Infection is thus the main problem resulting from glucose toxicity in the acute phase. In other words, continued hyperglycemia is a life-threatening risk factor, not only in the chronic but also the acute phase, and it becomes a risk factor for infection, particularly in the perioperative period.
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Nakamura T, Kawahito S, Kawano H, Okada T, Kitahata H, Oshita S. [Anesthetic management for repair of Ebstein's anomaly with WPW syndrome]. Masui 2009; 58:438-441. [PMID: 19364004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with Wolff-Parkinson-White (WPW) syndrome. We report the perioperative management of 3 patients (a 34-year-old man, a 5-month-old boy and a 5-year-old girl) with Ebstein's anomaly associated with WPW syndrome. Anesthetic managements for valvuloplasty of the tricuspid valve and ablation of accessory pathway in 3 patients were successfully accomplished with a combination of fentanyl, sevoflurane, and midazolam. The management of Ebstein's anomaly is based on its severity. The major concerns with anesthesia for children with Ebstein's anomaly include decreased cardiac output, right-to-left atrial level shunting with cyanosis, and the propensity for atrial tachyarrhythmias. We conclude that perioperative management of arrhythmia and evaluation of residual tricuspid regurgitation using transesophageal echocardiography are essential.
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Affiliation(s)
- Tomoka Nakamura
- Department of Anesthesiology, Tokushima University Medical and Dental Hospital, Tokushima 770-8503
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31
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Kitahata H, Nozaki J, Kawahito S, Tomino T, Oshita S. Low-Dose Sevoflurane Inhalation Enhances Late Cardioprotection from the Anti-Ulcer Drug Geranylgeranylacetone. Anesth Analg 2008; 107:755-61. [DOI: 10.1213/ane.0b013e31817f0e61] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kitahata H. [Intraoperative application of transesophageal echocardiography]. Rinsho Byori 2008; 56:508-516. [PMID: 18646636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Transesophageal echocardiography (TEE) has become a routine monitor in the operating room for cardiac surgery because it provides instantaneous and continuous assessment of cardiac function and anatomy. TEE aids intraoperative management and improves outcome in patients undergoing cardiac valve repairs, complex congenital heart corrections, and high-risk patients undergoing coronary artery bypass graft surgery. Especially in mitral valve repair surgery, it is mandatory to evaluate the results of the surgical procedure after cardiopulmonary bypass during surgery. Multiple investigations have also documented the improved sensitivity of TEE for the detection of myocardial ischemia compared with ECG or pulmonary capillary wedge pressure measurements. Intraoperative TEE is, however, not without risks, so emerging evidence demonstrating the utility of TEE as a diagnostic monitor or to alter the management of patients is required, especially in non-cardiac surgery. TEE is less frequently used in non-cardiac surgery; however, the emergent use of intraoperative or perioperative TEE to determine the cause of an acute, persistent, and life-threatening hemodynamic abnormality is well indicated. A task force of the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists developed guidelines for the appropriate use of TEE, which were evidence-based and focused on the effectiveness of perioperative TEE in improving clinical outcomes. Compliance with the guidelines for basic intraoperative TEE resulted in a marked improvement in intraoperative TEE practice. Technical progress of echocardiographic equipment and the TEE probe will increase the application of intraoperative and perioperative TEE in the future.
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Affiliation(s)
- Hiroshi Kitahata
- Department of Anesthesiology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima, Japan
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Nitta K, Kawahito S, Kitahata H, Nozaki J, Katayama T, Oshita S. Two unusual complications associated with cardiopulmonary bypass for pediatric cardiac surgery detected by transesophageal echocardiography after decannulation. Paediatr Anaesth 2008; 18:325-9. [PMID: 18315639 DOI: 10.1111/j.1460-9592.2008.02437.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe two rare cases of complications associated with cannulation for cardiopulmonary bypass during pediatric cardiac surgery detected by transesophageal echocardiography (TEE). The first patient (a 20-month-old boy, 11 kg) was scheduled for complete repair of an atrial septal defect and partial anomalous pulmonary venous connection. After decannulation of the superior vena cava, a mosaic jet was observed by means of TEE. The second patient (an 11-month-old boy, 6.4 kg), with a double outlet right ventricle, was scheduled for a hemi-Fontan procedure. After decannulation of the ascending aorta, high blood flow velocity of 4 m x s(-1) was detected by TEE. Intraoperative TEE was useful for early detection of complications associated with cardiopulmonary bypass cannulation during pediatric cardiac surgery.
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Affiliation(s)
- Kazuhito Nitta
- Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Yamanaka A, Kitahata H, Tanaka K, Kawahito S, Oshita S. Intraoperative transesophageal ventricular pacing in pediatric patients. J Cardiothorac Vasc Anesth 2008; 22:92-4. [PMID: 18249338 DOI: 10.1053/j.jvca.2006.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Akemi Yamanaka
- Department of Anesthesiology, Tokushima University School of Medicine, Tokushima, Japan.
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Abstract
Although the efficacy of extracorporeal circulation (ECC) is well established for open-heart surgery, application of ECC in other surgical areas has not been given much attention. Advances in the related surgical technique and anesthetic management combined with refinements in the ECC procedure itself have encouraged several institutions to use ECC for complex non-cardiac surgeries. ECC is beginning to be used for circulatory support or tissue oxygenation during surgery on the lung, brain, liver, and kidney as well as in emergency situations. With ECC, difficult and complex surgeries can be performed more safely, and the success rate of certain surgeries has been positively affected. It is important that the surgeon, anesthesiologist, and perfusionist are trained in non-cardiac surgery applications of ECC. Thus, we review here non-cardiac uses that have emerged and summarize the related procedures.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, The University of Tokushima Graduate School, Tokushima, Japan
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36
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Nakamura A, Kawahito S, Kawano T, Nazari H, Takahashi A, Kitahata H, Nakaya Y, Oshita S. Differential effects of etomidate and midazolam on vascular adenosine triphosphate-sensitive potassium channels: isometric tension and patch clamp studies. Anesthesiology 2007; 106:515-22. [PMID: 17325510 DOI: 10.1097/00000542-200703000-00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effects of two imidazoline-derived intravenous anesthetics, etomidate and midazolam, on vascular adenosine triphosphate-sensitive potassium (KATP) channel activity. METHODS In isolated rat aorta, isometric tension was recorded to examine the anesthetic effects on vasodilator response to levcromakalim, a selective KATP channel opener. Using the patch clamp method, the anesthetic effects were also examined on the currents through (1) native vascular KATP channels, (2) recombinant KATP channels with different combinations of various types of inwardly rectifying potassium channel (Kir6.0 family: Kir6.1, 6.2) and sulfonylurea receptor (SUR1, 2A, 2B) subunits, (3) SUR-deficient channels derived from a truncated isoform of Kir6.2 subunit (Kir6.2DeltaC36 channels), and (4) mutant Kir6.2DeltaC36 channels with reduced sensitivity to adenosine triphosphate (Kir6.2DeltaC36-K185Q channels). RESULTS Etomidate (> or = 10 m), but not midazolam (up to 10 m), inhibited the levcromakalim-induced vasodilation, which was sensitive to glibenclamide (IC50: 7.21 x 10 m; maximum inhibitory concentration: 1.22 x 10 m). Etomidate (> or = 3 x 10 m), but not midazolam (up to 10 m), inhibited the native KATP channel activity in both cell-attached and inside-out configurations with IC50 values of 1.68 x 10 m and 1.52 x 10 m, respectively. Etomidate (10 m) also inhibited the activity of various types of recombinant SUR/Kir6.0KATP channels, Kir6.2DeltaC36 channels, and Kir6.2DeltaC36-K185Q channels with equivalent potency. CONCLUSIONS Clinical concentrations of etomidate, but not midazolam, inhibit the KATP channel activity in vascular smooth muscle cells. The inhibition is presumably through its effects on the Kir6.0 subunit, but not on the SUR subunit, with the binding site different from adenosine triphosphate at the amino acid level.
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Affiliation(s)
- Akiyo Nakamura
- Department of Anesthesiology, University of Tokushima Graduate School, Tokushima, Japan
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Katayama T, Nitta K, Kawahito S, Tanaka K, Matsumoto Y, Doi T, Kitahata H, Oshita S. [Usefulness of intraoperative transesophageal echocardiography in stent graft implantation for thoracic descending aorta]. Masui 2006; 55:886-91. [PMID: 16856550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Stent graft implantation for thoracic descending aorta is a promising alternative to open repair. Transesophageal echocardiography (TEE) is a sensitive imaging modality for aortic disease. We reviewed our experience with TEE in stent graft implantation for thoracic descending aorta. METHOD Five patients underwent stent graft implantation for thoracic descending aorta under general anesthesia. Intraoperative angiography and TEE were used to identify the extent of the aneurysm and the placement of the stent. RESULTS TEE showed stent graft configuration and presence of leakage in all cases. In three cases, additional stent graft placement or bypass was performed. CONCLUSIONS Useful information was obtained by TEE in enhancing the accuracy of stent graft positioning potentially improving outcomes. TEE may facilitate repair by confirming aortic pathology, identifying endograft placement, and assessing the adequacy of aneurysm sack isolation, presence of leakage, as well as dynamic intraoperative cardiac performance.
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Affiliation(s)
- Toshiko Katayama
- Department of Anesthesiology, Takamatsu Red Cross Hospital, Takamatsu 760-0017
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Nakamura A, Kawahito S, Katayama T, Kawano T, Nitta K, Inui D, Kitahata H, Oshita S. [Bronchospasm during anesthesia in a patient with Pena-Shokeir syndrome]. Masui 2005; 54:1146-8. [PMID: 16231771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A 3-month-old boy with Pena-Shokeir syndrome underwent tracheotomy under general anesthesia. Patients with this syndrome may present anesthetic problems involving difficulties in tracheal intubation, possibilities of malignant hyperthermia, as well as perioperative respiratory complications related to hypoplasia of the lung. General anesthesia was induced and maintained with sevoflurane (2-3%) and nitrous oxide (0-50%) in oxygen (50-100%). The patient developed bronchospasm during tracheotomy. Atropine and epinephrine were administered intravenously and 5% sevoflurane was inhaled. The bronchospasm was improved gradually and surgery was successfully finished. Pena-Shokeir syndrome is an uncommon disease first reported by Pena & Shokeir in 1974 and characterized by congenital multiple arthrogryposis, characteristic facies, camptodactyly and pulmonary hypoplasia. In the perioperative management for a patient with Pena-Shokeir syndrome, special attention should be paid to abnormalities in the upper and lower respiratory systems, especially bronchospasm.
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Affiliation(s)
- Akiyo Nakamura
- Department of Anesthesiology, Tokushima University School of Medicine, Tokushima
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Inatsugi M, Tanaka K, Kitahata H, Nozaki J, Kawahito S, Oshita S. Minute distance obtained from pulmonary venous flow velocity using transesophageal pulsed Doppler echocardiography is related to cardiac output during cardiovascular surgery. J Med Invest 2005; 52:178-85. [PMID: 16167536 DOI: 10.2152/jmi.52.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE We studied the relationship between minute distance calculated from pulmonary venous flow (PVF) velocity tracing and cardiac output (CO) measured with thermodilution method in patients undergoing cardiovascular surgery. METHODS In 32 patients undergoing cardiovascular surgery, simultaneous measurements of hemodynamics including CO and transesophageal pulsed Doppler signals of PVF velocity were performed before and after surgical repair. Minute distance was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF. RESULTS The minute distance after surgical intervention increased from 1121 +/- 347 cm x sec(-1) to 1764 +/- 538 cm x sec(-1) (p < 0.001; mean +/- SD), while CO increased after surgical intervention from 3.5 +/- 0.9 L x min(-1) to 5.3 +/- 1.1 L x min(-1). Simple linear regression analysis showed that minute distance was related with CO before and after surgical intervention (r = 0.81 and r = 0.76, respectively). The changes in minute distance were also related with those in CO (r = 0.80). CONCLUSION The present study demonstrated that minute distance obtained from the pulsed Doppler tracings of PVF velocity was related with CO during cardiovascular surgery in adults. These results suggest that the changes in CO could be estimated from minute distance in pulmonary vein.
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Affiliation(s)
- Mikiko Inatsugi
- Department of Anesthesiology, Institute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho, Tokushima 770-8503, Japan
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Kawano T, Oshita S, Takahashi A, Tsutsumi Y, Tanaka K, Tomiyama Y, Kitahata H, Nakaya Y. Molecular mechanisms underlying ketamine-mediated inhibition of sarcolemmal adenosine triphosphate-sensitive potassium channels. Anesthesiology 2005; 102:93-101. [PMID: 15618792 DOI: 10.1097/00000542-200501000-00017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ketamine inhibits adenosine triphosphate-sensitive potassium (KATP) channels, which results in the blocking of ischemic preconditioning in the heart and inhibition of vasorelaxation induced by KATP channel openers. In the current study, the authors investigated the molecular mechanisms of ketamine's actions on sarcolemmal KATP channels that are reassociated by expressed subunits, inwardly rectifying potassium channels (Kir6.1 or Kir6.2) and sulfonylurea receptors (SUR1, SUR2A, or SUR2B). METHODS The authors used inside-out patch clamp configurations to investigate the effects of ketamine on the activities of reassociated Kir6.0/SUR channels containing wild-type, mutant, or chimeric SURs expressed in COS-7 cells. RESULTS Ketamine racemate inhibited the activities of the reassociated KATP channels in a SUR subtype-dependent manner: SUR2A/Kir6.2 (IC50 = 83 microM), SUR2B/Kir6.1 (IC50 = 77 microM), SUR2B/Kir6.2 (IC50 = 89 microM), and SUR1/Kir6.2 (IC50 = 1487 microM). S-(+)-ketamine was significantly less potent than ketamine racemate in blocking all types of reassociated KATP channels. The ketamine racemate and S-(+)-ketamine both inhibited channel currents of the truncated isoform of Kir6.2 (Kir6.2DeltaC36) with very low affinity. Application of 100 mum magnesium adenosine diphosphate significantly enhanced the inhibitory potency of ketamine racemate. The last transmembrane domain of SUR2 was essential for the full inhibitory effect of ketamine racemate. CONCLUSIONS These results suggest that ketamine-induced inhibition of sarcolemmal KATP channels is mediated by the SUR subunit. These inhibitory effects of ketamine exhibit specificity for cardiovascular KATP channels, at least some degree of stereoselectivity, and interaction with intracellular magnesium adenosine diphosphate.
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Affiliation(s)
- Takashi Kawano
- Department of Anesthesiology, Tokushima University School of Medicine, Tokushima, Japan.
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Yamaguchi M, Tomiyama Y, Katayama T, Kitahata H, Oshita S. Involvement of Adenosine Triphosphate-Sensitive Potassium Channels in the Response of Membrane Potential to Hyperosmolality in Cultured Human Aorta Endothelial Cells. Anesth Analg 2005; 100:419-426. [PMID: 15673869 DOI: 10.1213/01.ane.0000143350.82645.5b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The membrane potential of endothelial cells is an important determinant of endothelial functions, including regulation of vascular tone. We investigated whether adenosine triphosphate-sensitive potassium (K(ATP)) channels were involved in the response of membrane potential to hyperosmolality in cultured human aorta endothelial cells. The voltage-sensitive fluorescent dye, bis-(1,3-diethylthiobarbiturate)trimethine oxonol, was used to assess relative changes in membrane potential semiquantitatively. To investigate the effect of mannitol-, sucrose-, and NaCl-induced hyperosmolality on membrane potential, cells were continuously perfused with Earle's balanced salt solution (285 mOsm/kg H(2)O) containing 200 nM bis-(1,3-diethylthiobarbiturate)trimethine oxonol and exposed to 315 and 345 mOsm/kg H(2)O hyperosmotic medium sequentially in the presence and absence of 1 muM glibenclamide, a well-known K(ATP) channel blocker. Hyperosmotic mannitol significantly induced hyperpolarization of the endothelial cells, which was prevented by 1 microM glibenclamide (n = 6). Estimated changes of membrane potential at 315 and 345 mOsm/kg H(2)O were 13 +/- 8 and 21 +/- 8 mV, respectively. Hypertonic sucrose induced similar changes. However, although hypertonic saline also significantly induced hyperpolarization of the endothelial cells (n = 6), the hyperpolarization was not prevented by 1 muM glibenclamide. In conclusion, K(ATP) channels may participate in hyperosmotic mannitol- and sucrose-induced hyperpolarization, but not in hypertonic saline-induced hyperpolarization in cultured human aorta endothelial cells.
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Affiliation(s)
- Mikiyo Yamaguchi
- Department of Anesthesiology, Tokushima University School of Medicine, Tokushima, Japan
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Jinnouchi Y, Kawahito S, Kitahata H, Tanaka K, Nozaki J, Oshita S. Anesthetic management of a patient undergoing cardioverter defibrillator implantation: usefulness of transesophageal echocardiography and near infrared spectroscopy. J Anesth 2004; 18:220-3. [PMID: 15290423 DOI: 10.1007/s00540-004-0243-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Accepted: 03/18/2004] [Indexed: 10/26/2022]
Abstract
A case of a patient with sustained ventricular tachycardia (VT) undergoing implantable cardiovertor defibrillator (ICD) implantation, using transesophageal echocardiography (TEE) and near infrared spectroscopy (NIR) is described. A 67-year-old man with sustained VT associated with old myocardial infarction underwent ICD implantation. Anesthesia was induced with fentanyl and propofol and maintained with nitrous oxide, oxygen, sevoflurane, and fentanyl. Global hypokinesis of the left ventricle was observed in the short-axis view provided by TEE. Intraoperative systolic blood pressure was maintained between 100 and 120 mmHg, and cerebral oxygenated hemoglobin (HbO2) was between 63% and 65%. During periods of induced ventricular fibrillation, systolic blood pressure decreased to 60 mmHg, HbO2 decreased to 59%, and TEE revealed cardiac arrest. These changes were transient; HbO2 returned to baseline values immediately after the restoration of normal rhythm. TEE confirmed no remarkable change in cardiac function after defibrillation testing. TEE and NIR were found to be beneficial for the anesthetic management of a patient with sustained VT who was underdoing ICD implantation.
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Affiliation(s)
- Yuka Jinnouchi
- Department of Anesthesiology, Tokushima University School of Medicine, 3-18-15 Kuramoto, 770-8503, Tokushima, Japan
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Kawano T, Oshita S, Takahashi A, Tsutsumi Y, Tomiyama Y, Kitahata H, Kuroda Y, Nakaya Y. Molecular Mechanisms of the Inhibitory Effects of Bupivacaine, Levobupivacaine, and Ropivacaine on Sarcolemmal Adenosine Triphosphate–sensitive Potassium Channels in the Cardiovascular System. Anesthesiology 2004; 101:390-8. [PMID: 15277922 DOI: 10.1097/00000542-200408000-00020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background
Sarcolemmal adenosine triphosphate-sensitive potassium (KATP) channels in the cardiovascular system may be involved in bupivacaine-induced cardiovascular toxicity. The authors investigated the effects of local anesthetics on the activity of reconstituted KATP channels encoded by inwardly rectifying potassium channel (Kir6.0) and sulfonylurea receptor (SUR) subunits.
Methods
The authors used an inside-out patch clamp configuration to investigate the effects of bupivacaine, levobupivacaine, and ropivacaine on the activity of reconstituted KATP channels expressed in COS-7 cells and containing wild-type, mutant, or chimeric SURs.
Results
Bupivacaine inhibited the activities of cardiac KATP channels (IC50 = 52 microm) stereoselectively (levobupivacaine, IC50 = 168 microm; ropivacaine, IC50 = 249 microm). Local anesthetics also inhibited the activities of channels formed by the truncated isoform of Kir6.2 (Kir6.2 delta C36) stereoselectively. Mutations in the cytosolic end of the second transmembrane domain of Kir6.2 markedly decreased both the local anesthetics' affinity and stereoselectivity. The local anesthetics blocked cardiac KATP channels with approximately eightfold higher potency than vascular KATP channels; the potency depended on the SUR subtype. The 42 amino acid residues at the C-terminal tail of SUR2A, but not SUR1 or SUR2B, enhanced the inhibitory effect of bupivacaine on the Kir6.0 subunit.
Conclusions
Inhibitory effects of local anesthetics on KATP channels in the cardiovascular system are (1) stereoselective: bupivacaine was more potent than levobupivacaine and ropivacaine; and (2) tissue specific: local anesthetics blocked cardiac KATP channels more potently than vascular KATP channels, via the intracellular pore mouth of the Kir6.0 subunit and the 42 amino acids at the C-terminal tail of the SUR2A subunit, respectively.
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Affiliation(s)
- Takashi Kawano
- Department of Anesthesiology, Tokushima University School of Medicine, Kuramoto, Tokushima, 770-8503, Japan.
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Abstract
OBJECTIVE To identify variables associated with perioperative myocardial ischemia in patients undergoing carotid artery endarterectomy (CEA). DESIGN Prospective, observational study. SETTING University-affiliated hospital operating room and intensive care unit. PARTICIPANTS One hundred twenty-eight consecutive patients who underwent CEA during a 7-year period. INTERVENTIONS Patients had general anesthesia with sevoflurane or isoflurane. CEA was performed by standard methods with shunting if clinically indicated. Holter electrocardiogram (ECG) monitoring was performed during surgery and 24 hours after surgery. MEASUREMENTS AND MAIN RESULTS The incidence of perioperative myocardial ischemia was examined, and perioperative risk factors were analyzed. Nineteen patients (15%) showed significant perioperative ECG abnormalities indicative of myocardial ischemia (10 patients during surgery, 12 patients after surgery, and 3 patients both during and after surgery). Multivariate analysis showed perioperative myocardial ischemia to be significantly associated with a history of angina (odds ratio, 11.68; 95% confidence interval, 2.64-51.70) and a history of hypertension (odds ratio, 14.08; 95% confidence interval, 1.51-131.04). CONCLUSION The data indicate that perioperative myocardial ischemia defined as an ECG abnormality does not often occur in patients undergoing CEA. However, angina and hypertension may be important risk factors warranting further investigation.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, Tojushima University School of Medicine, Kuramoto, Tokushima, Japan.
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Masuda T, Tomiyama Y, Kitahata H, Kuroda Y, Oshita S. Effect of Propofol on Hypotonic Swelling-induced Membrane Depolarization in Human Coronary Artery Smooth Muscle Cells. Anesthesiology 2004; 100:648-56. [PMID: 15108981 DOI: 10.1097/00000542-200403000-00027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background
Stretch (mechanical stress)-induced membrane depolarization of smooth muscle may contribute to basal vascular tone and myogenic control. Propofol induces vasodilation and inhibits myogenic control. Hypotonic swelling was used as a model of mechanical stress. The authors investigated the effects of propofol and 5-nitro-2-(3-phenylpropylamino)benzoic acid, a chloride channel and nonselective cation channel blocker, on hypotonicity-induced membrane depolarization in cultured human coronary artery smooth muscle cells.
Methods
A voltage-sensitive fluorescent dye, bis-(1,3-diethylthiobarbiturate)trimethine oxonol, was used to assess relative changes in membrane potential semiquantitatively. The cells were continuously perfused with Earle's balanced salt solution containing 200 nM bis-(1,3-diethylthiobarbiturate)trimethine oxonol and exposed sequentially to isotonic and hypotonic medium. In a second series of experiments, the cells were exposed to hypotonic media in the presence and absence of 5-nitro-2-(3-phenylpropylamino)benzoic acid or propofol.
Results
The relative fluorescence values at 10, 20, and 30% hypotonicity were 147 +/- 29, 214 +/- 74, and 335 +/- 102% of baseline, respectively. The changes were all significantly different from the isotonic time control group. In the presence of 200 microM 5-nitro-2-(3-phenylpropylamino)benzoic acid or 0.1, 1, 10, or 100 microg/ml propofol, the relative fluorescence values at 30% hypotonicity were 87 +/- 17, 194 +/- 27, 160 +/- 18, 130 +/- 18, and 84 +/- 15%, respectively. These changes were significantly less than the 30% for the hypotonic control (246 +/- 23%).
Conclusion
These results suggest that volume-sensitive chloride channels and nonselective cation channels may participate in hypotonicity-induced membrane depolarization and that propofol inhibits hypotonicity-induced membrane depolarization in coronary artery smooth muscle.
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Affiliation(s)
- Takako Masuda
- Department of Anesthesiology, Tokushima University School of Medicine, Japan
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Kawano T, Oshita S, Takahashi A, Tsutsumi Y, Tomiyama Y, Kitahata H, Kuroda Y, Nakaya Y. Molecular Mechanisms of the Inhibitory Effects of Propofol and Thiamylal on Sarcolemmal Adenosine Triphosphate–sensitive Potassium Channels. Anesthesiology 2004; 100:338-46. [PMID: 14739809 DOI: 10.1097/00000542-200402000-00024] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background
Both propofol and thiamylal inhibit adenosine triphosphate-sensitive potassium (KATP) channels. In the current study, the authors investigated the effects of these anesthetics on the activity of recombinant sarcolemmal KATP channels encoded by inwardly rectifying potassium channel (Kir6.1 or Kir6.2) genes and sulfonylurea receptor (SUR1, SUR2A, or SUR2B) genes.
Methods
The authors used inside-out patch clamp configurations to investigate the effects of propofol and thiamylal on the activity of recombinant KATP channels using COS-7 cells transfected with various types of KATP channel subunits.
Results
Propofol inhibited the activities of the SUR1/Kir6.2 (EC50 = 77 microm), SUR2A/Kir6.2 (EC50 = 72 microm), and SUR2B/Kir6.2 (EC50 = 71 microm) channels but had no significant effects on the SUR2B/Kir6.1 channels. Propofol inhibited the truncated isoform of Kir6.2 (Kir6.2DeltaC36) channels (EC50 = 78 microm) that can form functional KATP channels in the absence of SUR molecules. Furthermore, the authors identified two distinct mutations R31E (arginine residue at position 31 to glutamic acid) and K185Q (lysine residue at position 185 to glutamine) of the Kir6.2DeltaC36 channel that significantly reduce the inhibition of propofol. In contrast, thiamylal inhibited the SUR1/Kir6.2 (EC50 = 541 microm), SUR2A/Kir6.2 (EC50 = 248 microm), SUR2B/Kir6.2 (EC50 = 183 microm), SUR2B/Kir6.1 (EC50 = 170 microm), and Kir6.2DeltaC36 channels (EC50 = 719 microm). None of the mutants significantly affects the sensitivity of thiamylal.
Conclusions
These results suggest that the major effects of both propofol and thiamylal on KATP channel activity are mediated via the Kir6.2 subunit. Site-directed mutagenesis study suggests that propofol and thiamylal may influence Kir6.2 activity by different molecular mechanisms; in thiamylal, the SUR subunit seems to modulate anesthetic sensitivity.
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Affiliation(s)
- Takashi Kawano
- Department of Anesthesiology, Tokushima University School of Medicine, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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Tanaka K, Kitahata H, Kawahito S, Nozaki J, Tomiyama Y, Oshita S. Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot. Can J Anaesth 2003; 50:926-9. [PMID: 14617591 DOI: 10.1007/bf03018741] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Although it has been reported that the increase in blood pressure improves arterial oxygen saturation (SaO(2)) in children with tetralogy of Fallot, no prospective study has demonstrated that an increase in blood pressure induces an increase in pulmonary blood flow in these patients. The purpose of this study was to see whether a phenylephrine-induced increase in systemic blood pressure increased pulmonary blood flow, resulting in improved arterial oxygenation in tetralogy of Fallot. METHODS In 14 consecutive children with tetralogy of Fallot (2-32 months old), transesophageal pulsed Doppler signals of left upper pulmonary venous flow (PVF) velocity were recorded before and four minutes after 10 micro g x kg(-1) of phenylephrine i.v. Simultaneously, arterial blood gas analysis and hemodynamic measurements were performed. The minute distance (MD) was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF. RESULTS Phenylephrine iv increased mean arterial blood pressure from 54 +/- 8 mmHg to 73 +/- 10 mmHg. This phenylephrine-induced hypertension significantly increased SaO(2) and MD (92.0 +/- 7.5 vs 95.0 +/- 5.0% and 1318 +/- 344 vs 1533 +/- 425 cm x min(-1), respectively). There was a significant correlation (r = 0.72) between the change in MD and the change in SaO(2). CONCLUSION Our results suggest that the phenylephrine-induced increase in systemic blood pressure produces an increase in pulmonary blood flow in tetralogy of Fallot. Our results further suggest that this increase in pulmonary blood flow is involved in the mechanism of phenylephrine-induced improvement of arterial oxygenation in tetralogy of Fallot.
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Affiliation(s)
- Katsuya Tanaka
- Department of Anaesthesiology, Tokushima University School of Medicine, Tokushima, Japan.
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Kawahito S, Kitahata H, Tanaka K, Nozaki J, Oshita S. Intraoperative transoesophageal echocardiography in a low birth weight neonate with atrioventricular septal defect. Paediatr Anaesth 2003; 13:735-8. [PMID: 14535917 DOI: 10.1046/j.1460-9592.2003.01121.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An 18-day-old male neonate (45 cm, 1.8 kg) with a history of cyanosis and congestive heart failure from an atrioventricular septal defect (AVSD) with a large left-to-right shunt was scheduled for surgical repair of the AVSD. After routine induction of anaesthesia with fentanyl and vecuronium, a 4.5-mm diameter transoesophageal echocardiography (TOE) probe was inserted into the oesophagus, and systematic echocardiographic evaluation was performed during surgery. After cardiopulmonary bypass was stopped, intraoperative TOE revealed mild residual mitral valve regurgitation. Because good left ventricular wall motion was confirmed and haemodynamic parameters were stable, cardiopulmonary bypass was not reinitiated. The patient's cardiac output was low in the postoperative intensive care unit. TOE was performed the next day to detect the source of this problem, revealed severe regurgitation compared with that observed intraoperatively. TOE was useful for evaluation of the residual mitral valve regurgitation, and we reconfirmed the importance of continuous monitoring even in a low birthweight neonate undergoing repair of a complete AVSD.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, Tokushima University School of Medicine, Tokushima, Japan.
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Abstract
Volume-sensitive chloride channels (VSCC) play an important role in regulation of cell volume and electrical activity. Activation of vascular smooth muscle VSCC causes smooth muscle depolarization and contraction. We investigated the effects of propofol on VSCC in cultured human coronary artery smooth muscle cells by using the chloride-sensitive dye 6-methoxy-N-ethylquinolinium (MEQ). To activate VSCC, cells were superfused for 2 min with hypotonic gluconate solutions and then potassium thiocyanate solution. The percentage reduction in MEQ fluorescence during 60 s in the presence of potassium thiocyanate was measured and used as an index of VSCC activity. 5-Nitro-2-(3-phenylpropylamino) benzoic acid (NPPB), a well characterized chloride channel blocker, and propofol were dissolved in hypotonic gluconate solution to test their effect on VSCC activity. The reduction in fluorescence was inversely related to osmolality, indicating that activation of VSCC is osmolality dependent. Hypotonic gluconate solution (210 mOsm/kg H(2)O) reduced fluorescence by 38.9% +/- 2.6% of the baseline value. The reduction in fluorescence was dose-dependently inhibited by NPPB. Propofol at 0.3, 1, 3, 10, 30, and 100 micro g/mL significantly inhibited the reduction in fluorescence to 23.6% +/- 4.8%, 19.7% +/- 7.4%, 18.2% +/- 3.5%, 17.6% +/- 5.0%, 15.8% +/- 3.1%, and 10.3% +/- 3.9% of the baseline value, respectively. Our results indicate that propofol inhibits VSCC in a dose-dependent manner in human coronary artery smooth muscle cells.
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Affiliation(s)
- Takako Masuda
- *Department of Anesthesiology and †Division of Intensive Care and Critical Care Medicine, Tokushima University School of Medicine, Tokushima, Japan
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Kawahito S, Kitahata H, Tanaka K, Nozaki J, Oshita S. Dynamic QRS-complex and ST-segment monitoring by continuous vectorcardiography during carotid endarterectomy. Br J Anaesth 2003; 90:142-7. [PMID: 12538368 DOI: 10.1093/bja/aeg031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many authors report a high incidence of cardiac events during carotid endarterectomy. The aim of the present study was to evaluate the usefulness of dynamic continuous on-line vectorcardiography for monitoring the occurrence of myocardial ischaemia during carotid endarterectomy. METHODS We studied 21 patients undergoing carotid endarterectomy. Patients underwent general anaesthesia with isoflurane or sevoflurane. The vectorcardiogram was monitored continuously during carotid endarterectomy. Electrodes were placed according to the previously described lead system and connected to a computerized system for on-line vectorcardiography. Two trend variables were recorded: the QRS vector difference, which reflects changes in the shape of the QRS complex; and the ST vector magnitude, which represents deflection of the ST segment from the isoelectric level. The ST segment deflection was measured 60 ms after termination of the QRS complex. RESULTS Vectorcardiography was successfully recorded in all 21 patients. Three patients showed intraoperative vectorcardiogram abnormalities. In one of these three patients, both ST vector magnitude and QRS vector difference increased after induction of anaesthesia and ST vector magnitude returned to baseline after administration of nitroglycerin. In the other two patients, both ST vector magnitude and QRS vector difference gradually increased after cross-clamping of the internal carotid artery and ST vector magnitude returned to baseline after unclamping. QRS vector difference remained elevated for several hours in all three patients. CONCLUSIONS Monitoring ST vector magnitude and QRS vector difference by vectorcardiography may be useful for identifying myocardial ischaemia during carotid endarterectomy.
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Affiliation(s)
- S Kawahito
- Department of Anesthesiology, Tokushima University School of Medicine, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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