Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

緊張性気腹は閉塞性ショックを呈し心肺停止に至ることがある。腹腔穿刺による緊急脱気によって容易に改善が見込めるため,迅速な診断と処置が望まれる。原因の明確な医原性の緊張性気腹症例がしばしば報告されているが,消化管穿孔などの非医原性の機序でも緊張性気腹を来しうる。このような場合,予備情報がないため病態の把握に時間がかかる可能性がある。今回我々は,上部消化管穿孔から緊張性気腹を呈し,緊急腹腔穿刺で改善した症例を経験したので報告する。患者は60歳の女性。感冒症状の後に呼吸苦が出現,意識障害を呈したため当院に救急搬送された。当院受診時は心肺停止状態であったが,直ちに蘇生処置を行い4分程度で自己心拍が再開した。胸部X線写真で腹腔内遊離ガスと横隔膜の挙上ならびに右上肺野に空洞を伴う腫瘤影を認め,腹部CTでは腹部の膨隆と多量の腹腔内遊離ガスならびに胃穿孔を疑う所見がみられた。緊急手術を行う方針となったが,ショック状態が遷延した。緊張性気腹と判断し18G留置針で試験穿刺を行ったところ,速やかに循環動態は安定した。開腹手術を施行し,ICUに入室となった。手術後循環状態は安定し経過したが,肺アスペルギルス症によると思われる喀血が出現し,コントロールができず第24病日に死亡退院となった。(著者抄録)

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.5847/wjem.j.1920-8642.2020.03.009

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Intensive care unit-acquired weakness (ICU-AW) can be diagnosed using the Medical Research Council (MRC) score. However, such scoring may not be possible in ICU patients who may be sedated or delirious or have encephalopathy. Currently, a quantitative assessment of the cross-sectional area of the muscle is available to assess changes in skeletal muscle mass using computed tomography (CT) images. This assessment calculates the skeletal muscle index (SMI) (cm2/m2) by dividing the cross-sectional area (cm2) of the skeletal muscle at the level of the third lumbar vertebra by the square of the patient's height (m2) on CT. This study assessed the effectiveness of SMI, as measured by abdominal CT scans, in predicting the onset of ICU-AW in patients with sepsis admitted to the ICU. Methods: We examined septic ICU patients admitted to the Niigata University Hospital ICU during 2012 - 2017 under mechanical ventilation. Patients were retrospectively divided into two groups by MRC score at ICU discharge: group AW comprised patients with an MRC score < 48, and group non-AW (NAW) comprised the remaining patients. Clinicopathological factors at ICU admission such as age, gender, underlying disease, body mass index, and SMI were compared between the two groups. Statistical analyses were performed using the Mann-Whitney U test, Fisher's exact test, receiver operator characteristic (ROC) analysis and multivariate analysis. Results: A total of 31 septic patients were examined, and 23 patients met the criteria for ICU-AW. The prevalence of women was significantly higher in group AW (P < 0.05). All clinical factors, except for gender, were not significantly different between the two groups. SMI was significantly lower in group AW than in group NAW (P < 0.05). ROC analysis revealed that the cut-off value of SMI for predicting ICU-AW was 44.1, and the multivariate analysis revealed that only low SMI was a significant factor in predicting ICU-AW (P < 0.05). Conclusions: Our results show that SMI measurement at ICU admission is a valid predictive factor for ICU-AW progression in septic patients.

DOI： 10.14740/jocmr4027

PubMed

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Language：Japanese   Publisher：日本航空医療学会  

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

DOI： 10.1016/s0261-5614(19)32546-4

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Language：Japanese   Publisher：医歯薬出版(株)  

気道管理トレーナーの機能および活用方法について解説する。気道管理トレーナーで行えることは、気道確保、換気、気管挿管のそれぞれの手技の訓練・手順の理解と確認である。その点を踏まえて本トレーナーを活用すれば有用なシミュレータといえる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00060&link_issn=&doc_id=20190913050012&doc_link_id=%2Faa7ayuma%2F2019%2F027011%2F013%2F1081-1084%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2019%2F027011%2F013%2F1081-1084%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本口腔顎顔面外傷学会  

過去10年間に受診した顎顔面外傷835例を対象とし、救命センター開設前と開設後に分けた。内訳は、歯の損傷493例、軟組織損傷181例、顎顔面骨骨折112例、打撲症26例、歯槽骨骨折23例であった。開設前は10歳代が最も多く、開設後は60歳代が最も多かった。受傷原因は、いずれも転倒・転落が最も多かったが、開設後には、交通事故が3.1倍に、自殺企図が2.2倍となった。骨折部位では、開設後に顎顔面多発骨折が2.0倍となった。処置内容は、開設後に非観血的整復固定術が1.6倍に増加した。既往歴では、開設前は31.3%であったが、開設後は46.2%で、有病者の割合が1.5倍となった。既往歴の詳細についてみてみると、高血圧症や不整脈などの循環器疾患、消化器疾患、内分泌代謝疾患、神経筋疾患に加え、うつ病などの精神疾患が増加した。合併損傷の割合は、開設前は17.0%であったが、開設後は43.1%で2.5倍となった。2012年11月にドクターヘリが導入され、2013年は257件、2014年は330件の稼働があり、治療に関わった顎顔面骨骨折症例は2014年に3例であった。

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：日本航空医療学会  

地理情報システム(GIS)を用いて、平成25年10月から始まった山形県、福島県、新潟県ドクターヘリの相互応援により、重症外傷、脳卒中、急性心筋梗塞の重症救急患者のどれくらいに早期の医療投入が可能になるのか、さらに、新潟県が長野県および群馬県ドクターヘリと相互応援した場合について検討した。その結果、相互応援により、重症救急疾患の各県の年間発生数の8〜33%に対して要請から30分以内の早期の医療投入が可能となり、また、新潟県が長野県および群馬県と共同運航すると、さらに、新潟県の重症救急疾患の18%に対して早期の医療投入が可能となると予測された。以上から、県域が大きく、人口密度が小さい地域において、基地病院から100kmを適応範囲とした隣県ドクターヘリの相互応援や共同運航は、早期の医療投入の観点から有用であると考えられた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：東北救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：日本航空医療学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

DOI： 10.1155/2012/863163

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Subarachnoid haemorrhage (SAH) is known as one of the aetiologies of out-of-hospital cardiac arrest (OHCA). However, the mechanisms of circulatory collapse in these patients have remained unclear. METHODS AND RESULTS: We examined 244 consecutive OHCA patients transferred to our emergency department. Head computed tomography was performed on all patients and revealed the existence of SAH in 14 patients (5.9%, 10 females). Among these, sudden collapse was witnessed in 7 patients (50%). On their initial cardiac rhythm, all 14 patients showed asystole or pulseless electrical activity, but no ventricular fibrillation (VF). Return of spontaneous circulation (ROSC) was obtained in 10 of the 14 patients (14.9% of all ROSC patients) although all resuscitated patients died later. The ROSC rate in patients with SAH (71%) was significantly higher than that of patients with either other types of intracranial haemorrhage (25%, n=2/8) or presumed cardiovascular aetiologies (22%, n=23/101) (p<0.01). On electrocardiograms, ST-T abnormalities and/or QT prolongation were found in all 10 resuscitated patients. Despite their electrocardiographic abnormalities, only 3 patients showed echocardiographic abnormalities. CONCLUSIONS: The frequency of SAH in patients with all causes of OHCA was about 6%, and in resuscitated patients was about 15%. The initial cardiac rhythm revealed no VF even though half had a witnessed arrest. A high ROSC rate was observed in patients with SAH, although none survived to hospital discharge.

DOI： 10.1016/j.resuscitation.2011.05.019

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Language：English   Publishing type：Research paper (scientific journal)  

Subarachnoid hemorrhage (SAH) often accompanies cardiac abnormalities. Sudden cardiac arrest is also known to occur after SAH. A 32-year-old woman was admitted to our hospital because of cardiac arrest immediately after the onset of SAH. Return of spontaneous circulation was obtained by conventional advanced cardiovascular life support. After resuscitation, her echocardiogram showed left ventricular apical ballooning, which improved within 7 days. This is the first report presenting both sudden cardiac arrest and transient left ventricular apical ballooning after SAH.

DOI： 10.1016/j.jccase.2010.08.003

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Ventricular fibrillation (VF) is a common cardiac arrest rhythm that can be terminated by electrical defibrillation. During cardiopulmonary resuscitation, there is a strong need for a prompt and reliable predictor of successful defibrillation because myocardial damage can result from repeated futile defibrillation attempts. Continuous wavelet transform (CWT) provides excellent time and frequency resolution of signals. The purpose of this study was to evaluate whether features based on CWT could predict successful defibrillation. METHODS: VF electrocardiogram (ECG) waveforms stored in ambulance-located defibrillators were collected. Predefibrillation waveforms were divided into 1.0- or 5.12-s VF waveforms. Indices in frequency domain or nonlinear analysis were calculated on the 5.12-s waveform. Simultaneously, CWT was performed on the 1.0-s waveform, and total low-band (1-3 Hz), mid-band (3-10 Hz), and high-band (10-32 Hz) energy were calculated. RESULTS: In 152 patients with out-of-hospital cardiac arrest, a total of 233 ECG predefibrillation recordings, consisting of 164 unsuccessful and 69 successful episodes, were analyzed. Indices of frequency domain analysis (peak frequency, centroid frequency, and amplitude spectral area), nonlinear analysis (approximate entropy and Hurst exponent, detrended fluctuation analysis), and CWT analysis (mid-band and high-band energy) were significantly different between unsuccessful and successful episodes (P < 0.01 for all). However, logistic regression analysis showed that centroid frequency and total mid-band energy were effective predictors (P < 0.01 for both). CONCLUSIONS: Energy spectrum analysis based on CWT as short as a 1.0-s VF ECG waveform enables prompt and reliable prediction of successful defibrillation.

DOI： 10.1007/s00540-010-1043-x

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Language：Japanese   Publisher：Japanese Association for Acute Medicine  

<B><I>Background</I></B>: The majority of sudden cardiac arrests (SCA) occur in the home, an area not targeted by current public access defibrillation (PAD) programs.<BR><B><I>Objective</I></B>: The purpose of this study was to investigate effective deployment placement of AEDs against SCA in the home using a geographic information system (GIS).<BR><B><I>Methods</I></B>: A total of 848 in-home SCA were extracted from the Utstein data of Niigata city in 2008. Initially, distances between in-home SCAs and existing AEDs deployed as a part of a PAD program (568 places) were studied. Using GIS, 200m or 100m buffer zones were created around the locations of existing AEDs, and the number of in-home SCAs contained within the buffer zones was counted. Convenience stores and police facilities are frequently located in residential areas and are open 24 hours, which makes them particularly good locations for AED placement against in-home SCA. Therefore, deployment of AEDs in convenience stores and police facilities was studied using the same method.<BR><B><I>Results</I></B>: A total of 23.5% and 5.7% of in-home SCAs occurred within a distance of 200m and 100m, respectively, from an existing PAD program-deployed AED. However, nearly 65% of these placements were in schools, sport facilities, government office, and private company that are not generally accessible all 24 hours. If AEDs were deployed in convenience stores (232 places) and police facilities (93 places), 16.5% and 4.7% of in-home SCAs would have occurred within a distance of 200m and 100m, respectively. The number of in-home SCAs within a distance of 100m was enough to meet the recommendations for performing PAD program, and the number of SCAs per single AED placement was significantly higher than existing AEDs (0.12 versus 0.07, p<0.05). Although more than one witness may be required to perform both in-home CPR and retrieval of an AED, convenience stores and police facilities may be more effective locations because they provide 24 hour AED access.<BR><B><I>Conclusion</I></B>: In the provincial city, convenience stores and police facilities seem to be effective deployment places of AEDs against SCA in home.

DOI： 10.3893/jjaam.22.1

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Other Link： http://search.jamas.or.jp/link/ui/2011166901

Language：English   Publishing type：Research paper (scientific journal)  

A 54-year-old man was transferred to our ICU because of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). He died after 38 days of intensive care. During treatment, his serum calcium (Ca) levels continued to increase and reached 3.95 mmol/L, while the ionized Ca levels reached 2.30 mmol/L before his death. He presented with severe kidney injury, pancreatitis, and hemorrhagic gastric erosion that worsened his prognosis; these were possibly associated with the hypercalcemia. His circulating 1alpha,25-dihydroxyvitamin D [1,25(OH)(2)D] level was elevated (75.7 to 204 pg/mL), whereas the levels of 25-hydroxyvitamin D, parathyroid hormone, and parathyroid hormone-related peptide were not. Liver histology revealed immunoreactivity for 25-hydroxyvitamin D 1alpha-hydroxylase (CYP27B1) in some of the hepatocytes, in which the localization pattern was similar to that of lysozyme-positive hepatocytes. Our ICU has previously encountered 22 similar MODS patients who presented with hypercalcemia over the last 8 years. SIRS with severe kidney and liver injuries are common clinical findings in hypercalcemic patients with MODS. Of the 23 hypercalcemic MODS patients, including the present patient, 17 had circulating 1,25(OH)(2)D levels exceeding 70 pg/mL despite severe kidney injury. Extrarenal activation of CYP27B1 seems to play a role in the development of hypercalcemia in this disease condition. Clinicians need to be aware that severe hypercalcemia may occur in MODS patients.

DOI： 10.1002/jbmr.18

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Language：English  

DOI： 10.1007/s00540-010-0885-6

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1161/CIRCULATIONAHA.109.885137

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Language：Japanese   Publisher：Japanese Association for Acute Medicine  

Consecutive assessments of the anteroposterior distance (AP distance) of the epiglottis with ultrasonography may provide useful information regarding airway management in patients with inhalational burn or acute epiglottis. The AP distance of the epiglottis was ultrasonographically measured in 3 adult patients with inhalational burn. Two adult male patients had an AP distance of 0.35 and 0.25cm, respectively and both were intubated at ICU admission. The distance gradually decreased to<0.2cm by the sixth ICU day. One adult female had a low AP distance (0.08-0.14cm) and was not intubated. These results indicate that non-invasive consecutive ultrasonographic assessments of the AP distance of the epiglottis can assist with evaluation of laryngeal edema in patients with suspected inhalational burn.

DOI： 10.3893/jjaam.17.651

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Other Link： http://search.jamas.or.jp/link/ui/2007078068

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.12.31

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Other Link： http://search.jamas.or.jp/link/ui/2005110718

Language：Japanese   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.10.373

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Other Link： http://search.jamas.or.jp/link/ui/2004112190

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Although the prone position has been reported to improve arterial oxygenation in patients with acute respiratory distress syndrome, there have been no reports on its efficacy in patients with hypoxemia after transthoracic esophagectomy with three-field lymphadenectomy. This study was undertaken to assess the efficacy of the prone position on hypoxemia after three-field lymphadenectomy for thoracic esophageal carcinoma. DESIGN: Prospective randomized clinical study. SETTING: General intensive care unit at a university hospital. INTERVENTIONS AND MEASUREMENTS: Sixteen patients who underwent three-field lymphadenectomy and showed hypoxemia (PaO2/FiO2 ratios of <200 under positive end-expiratory pressure of >5 cm H2O) on the fifth postoperative day were randomly assigned to prone (eight patients) and nonprone (eight patients) groups. Prone position for 6 hrs was carried out for four consecutive days. The PaO2/FiO2 ratio, the duration of ventilatory support, and length of stay, were measured. RESULTS: Oxygenation: The PaO2/FiO2 ratio markedly increased by 32% +/- 22% in seven of eight patients (p <.05) when the patients were moved from the supine to the prone position. The PaO2/FiO2 ratio after the fourth prone position (238 +/- 55, p <.05) was significantly higher than that before the first trial of prone position (166 +/- 25) in these seven patients. Duration of ventilatory support and intensive care unit length of stay: Both the ventilation period (11.6 +/- 2.2 vs. 14.0 +/- 1.6 days, p =.0029) and the length of stay in the intensive care unit (12.8 +/- 4.4 vs. 17.2 +/- 3.4 days, p =.0032) were significantly shorter in the prone group compared with the nonprone group. The PaO2/FiO2 ratio at the time of cessation of prone positioning was significantly higher than the corresponding value in the nonprone group. CONCLUSION: In hypoxemic patients after three-field lymphadenectomy, the prone position improved arterial oxygenation without any deleterious effects. The beneficial effect of the prone position is possibly attributable to opening of the bronchi obstructed by secretions.

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Language：English   Publishing type：Research paper (scientific journal)  

UNLABELLED: We investigated the influence of drug-induced hypotension at a mean arterial pressure (MAP) of 60-70 mm Hg on cerebral pressure autoregulation in 45 adult patients during propofol-fentanyl anesthesia. Time-averaged mean blood flow velocity in the right middle cerebral artery (Vmca) was continuously measured at a PaCO(2) of 39-40 mm Hg by using transcranial Doppler ultrasonography. Hypotension was induced and maintained with a continuous infusion of nicardipine, nitroglycerin, or prostaglandin E(1). Cerebral autoregulation was tested by a slow continuous infusion of phenylephrine to induce an increase in MAP of 20-30 mm Hg. From the simultaneously recorded data of Vmca and MAP, cerebral vascular resistance (CVR) was calculated as MAP/Vmca. Furthermore, the index of autoregulation (IOR) was calculated as DeltaCVR/DeltaMAP, where DeltaCVR = change in CVR and DeltaMAP = change in MAP. The test was performed twice for each condition on each patient: baseline and hypotension. The IOR during baseline was similar among the groups. During nitroglycerin- and prostaglandin E(1)-induced hypotension, IOR was not different from baseline. In contrast, during nicardipine-induced hypotension, IOR significantly decreased compared with baseline (0.37 +/- 0.08 versus 0.83 +/- 0.07, P < 0.01). In conclusion, nicardipine, but not nitroglycerin or prostaglandin E(1), significantly attenuates cerebral pressure autoregulation during propofol-fentanyl anesthesia. IMPLICATIONS: Vasodilators may influence cerebral autoregulation by changing cerebral vascular tone. Nicardipine, but not nitroglycerin or prostaglandin E(1), attenuated cerebral pressure autoregulation in normal adult patients during propofol-fentanyl anesthesia.

PubMed

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Study Objective: To investigate the effects of nicardipine-, nitroglycerin-, and prostaglandine E1-induced hypotension on cerebrovascular carbon dioxide (CO2) reactivity over a wide range of arterial CO2 tension (PaCO2) (PaCO2
range 25 to 50 mmHg).Design: Prospective, randomized study.Setting: Operating room of a university-affiliated hospital.Patients: 36 ASA physical status I and II patients without cerebrovascular disease, hypertension, or diabetes mellitus, undergoing an elective abdominal surgery.Interventions: Patients were randomly allocated to one of three groups (nicardipine-, nitroglycerin-, or prostaglandin E1-induced hypotension group
12 in each group). Anesthesia was induced and maintained with a bolus dose, followed by a continuous infusion of propofol (6.7 ± 1.5 mg/kg/hr) and fentanyl (1.68 ± 0.4 μg/kg/hr). Deliberate hypotension of mean arterial pressure 55 to 60 mmHg was induced and maintained with a bolus dose, followed by a continuous infusion of nicardipine (6.80 ± 0.75 μg/kg/min), nitroglycerin (3.20 ± 1.10 μg/kg/min), or prostaglandin E1 (0.103 ± 0.052 μg/kg/min).Measurements and Main Results: Time-averaged mean red blood cell velocity in the right middle cerebral artery (Vmca) at PaCO2 ranging from 25 to 50 mmHg was measured with transcranial Doppler ultrasonography. A minimum of six simultaneous measurements of Vmca and PaCO2 were obtained during baseline and deliberate hypotension in each patient. Absolute slope between Vmca and PaCO2 during baseline and deliberate hypotension was determined individually by linear regression analysis. Absolute slope was treated as the variable, because it yielded a significant close correlation coefficient (r &gt
0.95
p &lt
0.05). Comparisons between baseline and deliberate hypotension were made by analysis of variance for repeated measures. Mean absolute slope was significantly reduced from 1.88 ± 0.57 cm/sec/mmHg (mean ± SD) to 1.21 ± 0.46 in the nicardipine group (p &lt
0.05), from 1.75 ± 0.69 to 1.35 ± 0.47 in the nitroglycerin group (p &lt
0.05), and from 1.95 ± 0.89 to 1.33 ± 0.70 (p &lt
0.05) in the prostaglandin E1 group, respectively.Conclusion: Nicardipine-, nitroglycerin-, and prostaglandin E1-induced hypotension attenuate the human cerebrovascular CO2 reactivity during propofol-fentanyl anesthesia. Copyright (C) 1999 Elsevier Science Inc.

DOI： 10.1016/S0952-8180(99)00051-3

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PubMed

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本救急医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本救急医学会  

J-GLOBAL

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00990&link_issn=&doc_id=20201223020011&doc_link_id=http%3A%2F%2Fhdl.handle.net%2F10191%2F00052018&url=http%3A%2F%2Fhdl.handle.net%2F10191%2F00052018&type=%90V%8A%83%91%E5%8Aw%81F%90V%8A%83%91%E5%8Aw%8Aw%8Fp%83%8A%83%7C%83W%83g%83%8A_Nuar&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80230_3.gif

Language：Japanese   Publisher：東北救急医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.ccm.0000439818.36331.58

Web of Science

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Language：Japanese   Publisher：(一社)日本内科学会  

57歳男性。患者は糖尿病(無治療)の既往があった。今回、自宅で意識朦朧となり倒れ、著者らの施設へ救急搬送された。体温は38.8℃、血圧は86/56mmHgで、検査にて高度の炎症反応、凝固系異常、腎機能障害が認められ、DIC score 7点、HbA1c 15.1%であった。尿検査では蛋白、潜血、糖がみられ、尿・血液培養でE.coliが検出された。一方、X線では腫大した左腎に一致してガス像が認められ、CTでは左後腹膜腔に実質臓器は認めず、肺野条件では左腎実質内、被膜下および腎盂にガスを内包し、左腎静脈内にもガスが確認された。以上、これらのことより、本症例は敗血症性ショックとDICを伴った気腫性腎盂腎炎と診断され、ICUで治療を開始した。抗生物質、昇圧薬、グロブリン製剤投与とエンドトキシン吸着療法を行い、インスリン持続静注で血糖をコントロールした。だが、発熱の遷延、呼吸状態が悪化し、第13病日目に左腎摘出術を行い、以後、呼吸状態の改善で人工呼吸器から離脱し、発熱も改善をみて、第23病日に患者はICUを退室となった。

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Language：Japanese  

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Language：Japanese   Publisher：医学図書出版  

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Other Link： http://search.jamas.or.jp/link/ui/2006218972

Language：Japanese  

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Language：Japanese   Publisher：一般社団法人 日本農村医学会  

DOI： 10.14879/nnigss.54.0.336.0

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Language：Japanese   Publisher：医学図書出版  

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Other Link： http://search.jamas.or.jp/link/ui/2002247396

Language：Japanese   Publisher：医学図書出版  

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Other Link： http://search.jamas.or.jp/link/ui/2002203602

Language：Japanese   Publisher：克誠堂出版  

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Other Link： http://search.jamas.or.jp/link/ui/2002136604

Language：Japanese   Publisher：The Japanese Society of Reanimatology  

Recent studies on the resuscitation of central nervous system (CNS) were reviewed from the standpoint of an anesthesiologist. Pathologic states with which the anesthesiologists face during the perioperative period might mostly be the acute CNS ischemia caused by hemodynamic disturbances or acute CNS hypoxia resulting from the respiratory failures. However, pathophysiology and recoverability of CNS ischemia/hypoxia still remain to be investigated. One of the most provocative recent topics regarding the pathophysiology of CNS ischemia/hypoxia might be the programmed cell death, apoptosis. We, anesthesiologists, must pay attention to this pathophysiology in terms of the prognosis after CNS resuscitation.<BR>In this context, it should be stressed that the anesthesiologists must not only make the most of CNS monitorings but care the patients intensively, always considering the prognosis if the incidence of CNS ischemia/hypoxia occurs.

DOI： 10.11414/jjreanimatology1983.19.93

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Language：Japanese   Publisher：へるす出版  

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Other Link： http://search.jamas.or.jp/link/ui/2000065733

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Language：English   Publisher：Niigata University  

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Other Link： http://search.jamas.or.jp/link/ui/1999173509