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DOI： 10.1186/s40981-022-00551-2

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

File： Unexpected difficult airway due to an undiagnosed congenital lingual thyroglossal＠Clinical Case Reports.pdf

DOI： 10.1002/ccr3.5475

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：{MDPI} {AG}  

File： Ideal Depth of Endotracheal Intubation at the Vocal Cord Level in Pediatric Patients Considering Racial Differences in Tracheal Length.pdf

DOI： 10.3390/jcm11030864

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1213/xaa.0000000000001493

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Georg Thieme Verlag KG  

<title>Abstract</title>Near-infrared spectroscopy (NIRS) does not provide information about changes in oxygenation in whole-brain areas. Although the branching vessels of the aortic arch are not always easy to identify using transesophageal echocardiography (TEE), the blood flow status of cervical arteries can always be assessed by applying an ultrasound probe via the “ultrasound window” on the patient's neck, which can be ensured by devising alternative insertion approaches of the central venous catheter. This method is very simple but compensates for the limitations of the combination of NIRS and TEE, especially during cardiac surgery with cardiopulmonary bypass management using selective cerebral perfusion.

DOI： 10.1055/s-0041-1725181

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00540-021-02930-y

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00540-021-02915-x

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： Precautions with right supraclavicular approach@AIT.pdf

DOI： 10.5114/ait.2021.104098

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Termedia Sp. z.o.o.  

File： A real-time ultrasound-guided supraclavicular@AIT.pdf

DOI： 10.5114/ait.2020.103511

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

Systemic intravenous administration of opioids is the main treatment strategy for intraoperative and postoperative pain management in patients undergoing cardiac surgery with sternotomy. However, using lower doses of opioids may achieve the well-established benefits of the fast-track approach, with minimal opioid-related side effects. Postoperative pain is coupled with a long stay in the intensive care unit. Although neuraxial anesthesia has some benefits, its use remains controversial due to the potential development of epidural hematoma after anticoagulation for cardiopulmonary bypass and coagulopathy after cardiac surgery. Therefore, there is a need for other effective postoperative analgesic strategies, such as peripheral nerve blocks other than neuraxial anesthesia, for cardiac surgery with sternotomy. The effects of real-time ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain after sternotomy have been reported; however, the pain and discomfort in the epigastric area caused by chest drainage tubes placed through the rectus abdominis muscle also are major postoperative problems after cardiac surgery. Herein, the authors report on a preoperative combination of TTP block and rectus sheath block (RSB) for postoperative pain management after cardiac surgery with sternotomy that addresses pain in both the chest and epigastric areas. Considering previous studies, it is presumed that preemptive analgesic effects can be expected via a combination of the TTP block and RSB, and indeed, the preemptive effect was observed in the present study's patients. In this article, the procedure and tips for combining the TTP block and RSB are introduced.

DOI： 10.1053/j.jvca.2020.07.041

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Termedia Sp. z.o.o.  

his letter discusses precautions regarding the waterproof structure of the oximetry central venous catheter (CVC) shaft and the risk of blood reflux and leakage that can occur when the catheter shaft is cut. To assess oxygen supply-demand balance [1] and haemodynamics [2], the Swan-Ganz pulmonary artery catheter has been used for perioperative and postoperative management and treatment of critically ill patients for a half a century. In current clinical practice, haemodynamic parameters such as stroke volume (SV) and cardiac output (CO), as well as central venous oxygen saturation (ScvO2), can be measured continuously using a combination of FloTrac Sensor (Edwards Lifesciences Japan Ltd., Tokyo, Japan) [3], Edwards PreSep Oximetry Catheter (Edwards Lifesciences Japan Ltd., Tokyo, Japan) [4], and EV1000 Clinical Platform (Edwards Lifesciences Japan Ltd., Tokyo, Japan) or Vigileo Monitor (Edwards Lifesciences Japan Ltd., Tokyo, Japan) [5, 6]. These methods are less invasive than the Swan-Ganz pulmonary artery catheter, and the changes in the parameter values can be used as an index for perioperative management in both cardiovascular and non-cardiovascular surgeries. In addition, they can be used for the treatment of critically ill patients in the intensive care unit, enabling proactive determination of an appropriate therapy [7]. Compared to intermittent sampling and traditional vital signs alone, continuous ScvO2 monitoring is a more sensitive indicator of tissue perfusion because it reveals the true adequacy of tissue oxygenation, enabling early detection and assessment of clinical response to intervention [7, 8].

File： Precaution Oximetry central venous catheter shaft@AIT.pdf

DOI： 10.5114/ait.2020.100300

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Authorship：Lead author,　Corresponding author   Language：Japanese  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Georg Thieme Verlag KG  

<title>Abstract</title>We previously presented a cardiopulmonary bypass (CPB) method with blood delivery via femoral artery cannulation for pediatric aortic arch repair operations using the Radifocus Introducer sheath. However, the flow rate with the Radifocus Introducer sheath is limited by accessory parts with the same structure having a smaller inner diameter among different sizes, rather than the sheath body. Therefore, we further devised a combination of the JELCO IV catheter, an extension tube, and a three-way stopcock with a larger opening to obtain more flow rate keeping the CPB circuit pressure significantly lower than when using the Radifocus Introducer sheath successfully.

DOI： 10.1055/s-0040-1715604

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Authorship：Lead author,　Corresponding author   Language：Japanese  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

This case report describes a neonate with tracheal aplasia first diagnosed after birth due to the presentation of respiratory distress, absence of crying, and unsuccessful tracheal intubation. The most common finding with tracheal aplasia is polyhydramnios. However, diagnosis remains challenging in the prenatal period. In this case, maternal obesity and gestational diabetes made diagnosis more difficult. The only lifesaving treatment available is ventilation through esophageal intubation or tracheostomy. However, in some cases, tracheostomy is not an option.

DOI： 10.1213/xaa.0000000000001200

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Termedia Sp. z.o.o.  

File： AIT_Art_39991-10.pdf

DOI： 10.5114/ait.2020.93317

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Termedia Sp. z.o.o.  

File： Be on the alert again for the risk of pulmonary air embolisation in paediatric patients during the insertion of a central venous catheter under general anaesthesia with spontaneous respiration.pdf

DOI： 10.5114/ait.2019.89225

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/pan.13681

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (conference, symposium, etc.)  

File： ドイツの麻酔科医＠日本臨床麻酔学会誌.pdf

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/pan.13614

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： AIT_Art_37726-10.pdf

DOI： 10.5603/AIT.a2019.0002

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/PCC.0000000000001559

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1213/ANE.0000000000002182

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (other academic)  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1213/XAA.0000000000000451

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Authorship：Lead author,　Corresponding author   Language：German   Publishing type：Research paper (scientific journal)  

DOI： 10.1055/s-0042-104853

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： Where and how do anaesthetics act Mechanisms of action in the central nervous system.pdf

DOI： 10.5603/AIT.a2017.0046

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

We report a rare case of acute upper airway obstruction caused by spontaneous retropharyngeal hemorrhage as a result of hemophilia A in a 16-year-old pediatric patient who routinely received factor VIII replacement. Initial diagnosis was delayed because the patient presented with symptoms, such as throat pain and odynophagia, similar to those of common benign upper airway infections. Within 2 days of the initial presentation of symptoms, the patient went into respiratory failure as a result of retropharyngeal hemorrhage. The possibility of spontaneous retropharyngeal or epiglottic hemorrhage or hematoma should be considered as a cause of rapidly progressing odynophagia and dyspnea by hemophilia patients.

DOI： 10.1016/j.annemergmed.2015.08.028

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Authorship：Lead author,　Corresponding author   Language：German   Publishing type：Research paper (scientific journal)   Publisher：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0041-103909

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.5603/AIT.a2016.0050

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/pan.12734

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：GEORG THIEME VERLAG KG  

Background In open heart surgery, heparinization is commonly neutralized using an empirical heparin:protamine ratio ranging between 1:1 and 1:1.5. However, these ratios may result in protamine overdose that should be avoided for its negative side effects on the coagulation system. This study aimed to indicate the appropriate treatment for prolonged activated clotting time (ACT) after protamine administration following cardiopulmonary bypass (CPB) in pediatric open heart surgery by investigating the underlying reasons for it.
Methods Twenty-seven children (&lt;10 kg) undergoing open heart surgery were included. Heparin was administered only before CPB (400 IU/kg) and in the pump priming volume for CPB (2,000 IU) and was neutralized by 1:1 protamine after CPB. The blood heparin concentration was measured using anti-Xa assay. ACT and blood concentrations of heparin, coagulation factors, thrombin-antithrombin complex, and prothrombin fragment 1 + 2 were assessed. A rotational thromboelastometry (ROTEM; Tem International GmbH, Munchen, Bayern, Germany) was used to confirm the coagulation status and residual heparin after protamine administration.
Results Anti-Xa assay showed that there is no residual heparin in the blood after 1:1 protamine administration. Nevertheless, ACT (128.89 +/- 3.09 seconds before heparin administration) remained prolonged (177.14 +/- 5.43 seconds at 10 minutes after protamine, 182.00 +/- 5.90 seconds at 30 minutes after protamine). The blood concentrations of coagulation factors were significantly lower than those before heparin administration (p &lt; 0.01). The low FIBTEM MCF of ROTEM (4.43 +/- 0.32 mm) at 10 minutes after protamine indicated low fibrinogen concentration.
Conclusion Prolonged ACT after heparin neutralization by 1:1 protamine administration does not necessarily indicate residual heparin, but low blood concentrations of coagulation factors should be considered as a reason as well. Accordingly, supply of coagulation factors instead of additional protamine should be considered.

DOI： 10.1055/s-0035-1554998

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER HEIDELBERG  

The perioperative transesophageal echocardiography (TEE) is a very useful and minimal invasive monitoring not only for the cardiac anesthesia management, but also for the anesthesia management of the non-cardiac operations of the heart high risk patients. In this case report, we report a case of the urgent Blalock-Taussig shunt (BT shunt) operation for a small patient of Fallot's tetralogy with anoxic spell, which showed an atypical change of hemodynamics and SpO(2) with the shunt opening. After the BT shunt anastomosis, the diastolic blood pressure decreased with the shunt opening, however, the expected rise of SpO(2) was not provided. By the perioperative TEE monitoring with the single plane TEE transducer for neonate; UST-52110S (Hitachi Aloka Medical, Tokyo, Japan) with 4.5 mm in diameter, the cause of this atypical change of hemodynamics and SpO(2) was diagnosed to be an accidental anastomosis malposition of the BT shunt to the right pulmonary vein and reported to the operator during the operation, and the operation was performed correctly.

DOI： 10.1007/s10877-013-9509-7

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

DOI： 10.1007/s00540-013-1606-8

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Objectives In pediatric patients vascular access is often more difficult than in adults because of the smaller size of the vessels and the inability of the patient to cooperate without deep sedation or general anesthesia. Therefore Ultrasound has already become an invaluable tool for vascular access, but the full potential of ultrasound has yet to be fully realized. Improvements in image quality and a better understanding of optimal insertion techniques continue to help clinicians safely and efficiently place catheters with fewer complications. Methods and Technique The probes used for the vascular access are mainly linear and convex type. Higher- frequency ultrasound provides a vivid image; however, the signals are remarkably attenuated. Therefore, the choice of the probe with appropriate frequency is essential. As blood vessels are relatively easily identified with ultrasound, ultrasound-guided vascular access does not require as sharp images as ultrasound-guided nerve block. For pediatric vascular access, the linear probe with 515 MHz, 25 cm depth is ideal and adequate for almost all cases. Ultrasound-guided vascular access has two main approaches: long-axis or in-plane approach and short-axis or transverse approach. The long-axis approach visualizes the vessel along the insertion pathway and is commonly used to monitor the entire approach of the needle into the vessel. The short-axis approach is easier to show the positional relationship and depth of target vessels, but it is much harder to follow the needle tip within the tissues. Conclusion The use of real-time ultrasound has been shown to increase first insertion success, reduce access time, have a higher overall success, and reduce arterial puncture. As the technology continues to improve the use of ultrasound will become as ubiquitous as the lines themselves.

DOI： 10.1111/pan.12005

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: The minimum alveolar concentration is determined in the spinal cord rather than in the brain. Xenon inhibits glutamatergic excitatory synaptic transmission in the dorsal horn neurons. However, its actions in the ventral horn neurons have not been investigated.
Methods: The effects of 50 or 75% xenon on excitatory and inhibitory synaptic transmission were examined in the spinal lamina IX neurons of neonatal rats by using a whole cell patch clamp technique.
Results: Fifty percent xenon inhibited the alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid-induced currents (amplitudes = 72 +/- 9% and integrated area = 73 +/- 13% of the control values), and alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid receptor-mediated electrically evoked excitatory postsynaptic currents (amplitudes = 69 +/- 13% of the control values). Seventy-five percent xenon similarly inhibited alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid-induced currents. However, xenon had no effect on the N-methyl-D-aspartate-induced currents or N-methyl-D-aspartate receptor-mediated electrically evoked excitatory postsynaptic currents. Xenon decreased the amplitude, but not the frequency, of miniature excitatory postsynaptic currents. There were no discernible effects on the currents induced by gamma-aminobutyric acid or glycine or on miniature inhibitory postsynaptic currents.
Conclusions: Xenon inhibits alpha-amino-3-hydroxy-5-methyl-4-isoxazole-4-propionic acid receptor-mediated glutamatergic excitatory transmission in the spinal lamina IX neurons via a postsynaptic mechanism. In contrast, there are no substantial effects on N-methyl-D-aspartate receptor-mediated or inhibitory synaptic transmission. The suppressive effects on excitatory synaptic transmission in the ventral horn neurons partly account for the mechanism behind xenon's ability to produce immobility in response to noxious stimuli and to determine the minimum alveolar concentration.

DOI： 10.1097/ALN.0b013e31825037a1

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Authorship：Lead author   Language：Japanese  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J01397&link_issn=&doc_id=20110513160006&doc_link_id=%2Fad3msuie%2F2011%2F006005%2F008%2F0582-0589%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2011%2F006005%2F008%2F0582-0589%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Lead author,　Corresponding author   Language：Japanese  

We report a case of airway management by laryngeal mask airway (LMA) for a 4-year-old boy with laryngeal web undergoing adenotonsillectomy. Although the patient had no symptoms of airway stenosis, we detected a subglottic laryngeal web during the preoperative examination. The opening orifice of the laryngeal web was estimated to be too small for intubation, and we chose to manage the airway with LMA and spontaneous respiration. Using the LMA and DavisCrowe mouth gag, we were able to provide the surgeon with the same exposure as with intubation while effectively managing the airway.

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Authorship：Lead author,　Corresponding author   Language：Japanese  

We present a case of profound bradycardia and cardiac arrest in a 61-year-old man, which occurred during left upper lobectomy and lymph node dissection for the ligamentum arteriosum. General anesthesia was maintained by propofol TIVA combined with epidural anesthesia. During the electrocautery dissection of the lymph node of the ligamentum arteriosum the patient became extremely bradycardic for 10 min. Subsequent traction with forceps further aggravated the bradycardia leading to cardiac arrest. In order to continue the procedure, we initiated epicardial pacing and switched to isoflurane anesthesia. Given the close proximity of the lymph node of the ligamentum arteriosum to the thoracic cardiac branch of the vagus nerve and the cardiac plexus, we believe that the observed bradycardia and cardiac arrest are likely attributable to vasovagal stimulation.

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Event date： 2022.9 - 2022.10

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2022.9 - 2022.10

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2021.11

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Event date： 2021.10

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Event date： 2021.4

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File： 10th ASPA FLEX Webinar Poster.jpg

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Event date： 2020.9

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2019.11

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Language：Japanese   Presentation type：Oral presentation (general)  

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