Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

OBJECTIVES: The aims of the present study were to evaluate and compare the safety and feasibility, including hospitalization, intensive care unit (ICU) stay, frequency of conversion to general anesthesia (GA), pH, PaCO2, and PaO2, of selected patients who underwent minimally invasive mitral valve surgery (MIMVS) via a right minithoracotomy under conscious sedation (CS) to avoid GA. The authors also aimed to evaluate the perioperative management of spontaneous breathing. DESIGN: A retrospective, observational study. SETTING: Single-center. PARTICIPANTS: This study enrolled 101 patients who underwent MIMVS under CS or GA. INTERVENTIONS: The patients who underwent MIMVS were managed under CS or GA according to indication criteria. MEASUREMENTS AND MAIN RESULTS: ICU stay (p = 0.010), postoperative time until first fluid intake (p < 0.0001), and duration of mechanical ventilation (p = 0.004) were shorter in the CS group than in the GA group. No patients converted to GA from CS. PaCO2 during cardiopulmonary bypass (CPB) in the CS group was significantly lower than that in the GA group. However, PaCO2 at the termination of CPB in the CS group was significantly higher than that in the GA group. CONCLUSIONS: In the CS group, advanced-age patients with comorbidities underwent mitral surgery without postoperative complications. The authors' findings suggested that MIMVS under CS could be a potentially less-invasive method, providing a quicker recovery than MIMVS under GA.

DOI： 10.1053/j.jvca.2021.07.005

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGERNATURE  

Background Rocuronium consumption with or without intraoperative objective neuromuscular monitoring in clinical settings of unrestricted use of sugammadex and neuromuscular monitoring has not been reported earlier. The study aimed to investigate the association between the use of intraoperative objective neuromuscular monitoring and rocuronium consumption in patients undergoing laparoscopic abdominal surgery. Methods Data were collected by reviewing electronic medical records of patients who received laparoscopic abdominal surgery under general anesthesia with rocuronium and reversal with sugammadex at a university teaching hospital between May 2017 and April 2018. A multivariate linear regression model was developed to compare the amount of rocuronium consumption (mg) per weight (kg) per hour (mg/kg/h) between the group in which intraoperative objective neuromuscular monitoring was used (NMM+ group) and the group in which intraoperative neuromuscular monitoring was not used (NMM- group). Additionally, we performed an interaction test. Results A total of 429 patients were evaluated, with 371 patients (86%) included in the NMM+ group and 58 patients (14%) in the NMM- group. Log-transformed rocuronium consumption between the NMM+ group and NMM- group was not significantly different (back-transformed β coefficients [95% CI]: 1.080 [0.951-1.226]; P = 0.23). Male sex and body mass index (BMI) were independent factors associated with 15% (0.853 [0.788-0.924]; P < 0.001) and 3% (for every 1 kg/m2 increase in BMI) (0.971 [0.963-0.979]; P < 0.001) decrease in intraoperative rocuronium consumption, respectively. A significant interaction was detected only between the use of neuromuscular monitoring and age ≥65 years (β: 0.803 [0.662-0.974]; P = 0.026). Conclusions Although the use of intraoperative objective neuromuscular monitoring was not an individual factor influencing intraoperative rocuronium consumption, this retrospective study demonstrated that the use of intraoperative neuromuscular monitoring reduced rocuronium consumption for approximately 20% of elderly patients (age ≥65 years) undergoing laparoscopic abdominal surgery.

DOI： 10.7759/cureus.19245

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本麻酔・集中治療テクノロジー学会  

症例は20代男性で、左前頭葉腫瘍に対して覚醒下脳腫瘍摘出術が予定された。麻酔導入はプロポフォールの効果部位-TCIを初期標的濃度4μg/mLで行った。意識消失時のSmartPilot View(SPV)に表示されたプロポフォール効果部位濃度は5.07μg/mLであった。意識消失確認後、レミフェンタニルの効果部位-TCIを初期標的濃度4μg/mLで開始し、フェンタニル1μg/kgを単回投与した。術中はBIS値とSPVを参考にし、覚醒試験に合わせてプロポフォールとレミフェンタニルの効果部位濃度を適宜調節した。腫瘍切除後、プロポフォールの目標効果部位濃度を1.7μg/mLで再開し、SPVを参考にフェンタニルの単回投与と持続投与を行い、自発呼吸下で管理した。術中に呼吸抑制は認めなかった。覚醒下手術の麻酔管理において、覚醒試験に応じた覚醒度の把握や覚醒時間の予測が重要であるため、SPVと効果部位-TCIを併用することで薬物の投与量の調節が容易であった。

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

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J05198&link_issn=&doc_id=20200911160005&doc_link_id=%2Fca4crbam%2F2020%2F002401%2F005%2F0035-0040%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca4crbam%2F2020%2F002401%2F005%2F0035-0040%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本麻酔・集中治療テクノロジー学会  

症例は60歳男性で、急性大動脈解離術後の左反回神経麻痺に対して甲状軟骨形成術が予定された。術野での局所麻酔に加えて、術中鎮静はフェンタニルとデクスメデトミジンを使用した。投与開始時の単回投与量と持続投与量は事前にTivatrainerを利用して検討し、投与開始後は麻酔情報システム(ORSYS)に表示される予測血中濃度の未来予測と、シミュレーターを利用したマニュアルTarget-controlled infusionを行った。薬剤に応じて使用可能なシリンジポンプが規定されており、本症例ではプレセデックスとフェンタニルを使用するため、それぞれTE-371、TE-351を使用した。ORSYSと接続して認識された際、薬剤名の欄で「ポンプ取り込み(静注)」の段が表示されるようになり、TE-371の場合、送液中は緑回転点滅表示であるが、データ通信中は緑全点滅も追加表示される。シリンジポンプから該当薬剤投与後1分程度でORSYSヘデータが取り込まれ数値が表示される。また、シリンジポンプから自動取得した投与情報の予測血中濃度を表示させることが可能である。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jclinane.2019.01.025

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BACKGROUND: The duration of rocuronium in patients with BMI more than 30 kg m is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m is unclear. OBJECTIVE: The objective of this study was to investigate whether a BMI less than 25 kg m affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN: A prospective, observational, single-centre study. SETTING: The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS: Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI < 25 kg m, aged 23 to 74 years) maintained by 0.7 minimum alveolar concentration sevoflurane and remifentanil. MAIN OUTCOME MEASURES: Repetitive train-of-four stimulation was applied and contractions of the adductor pollicis muscle were recorded. Duration of the initial dose of rocuronium (D1) was defined as the time from injection of rocuronium 0.6 mg kg to return of first twitch height to 25% of the control. Duration of additional doses (D2) was the time from a supplement of 0.15 mg kg rocuronium to return of first twitch height to 25% of the control. The relationship between D1 or D2 and BMI was examined using linear regression analysis. RESULTS: Linear regression analysis revealed a significant correlation between duration of initial dose and BMI (R = 0.246; P = 0.00531). A significant correlation between the duration of the additional dose and BMI was also found (R = 0.316; P = 0.00122). CONCLUSION: The lower the BMI, the shorter the duration of rocuronium at initial and additional doses determined by the actual body weight in adult patients with a BMI less than 25 kg m. TRIAL REGISTRATION: www.umin.ac.jp/ctr/index/htm with registry number UMIN 00009337 and UMIN 000015407.

DOI： 10.1097/EJA.0000000000000823

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

We report the use of rocuronium to re-establish neuromuscular block after reversal with sugammadex. The aim of this study was to investigate the relationship between the dose of rocuronium needed to re-establish neuromuscular block and the time interval between sugammadex administration and re-administration of rocuronium. Patients who required re-establishment of neuromuscular block within 12 h after the reversal of rocuronium-induced neuromuscular block with sugammadex were included. After inducing general anesthesia and placing the neuromuscular monitor, the protocol to re-establish neuromuscular block was as follows. An initial rocuronium dose of 0.6 mg/kg was followed by additional 0.3 mg/kg doses every 2 min until train-of-four responses were abolished. A total of 11 patients were enrolled in this study. Intervals between sugammadex and second rocuronium were 12-465 min. Total dose of rocuronium needed to re-establish neuromuscular block was 0.6-1.2 mg/kg. 0.6 mg/kg rocuronium re-established neuromuscular block in all patients who received initial sugammadex more than 3 h previously. However, when the interval between sugammadex and second rocuronium was less than 2 h, more than 0.6 mg/kg rocuronium was necessary to re-establish neuromuscular block.

DOI： 10.1007/s00540-016-2159-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

We report a temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in our dose-finding study in pediatric patients. A 19-month-old female infant (9.6 kg, 80 cm) was scheduled for elective cheiloplasty surgery. Anesthesia was induced with nitrous oxide 50% and sevoflurane 5% and maintained with air, oxygen, sevoflurane 3%, and fentanyl (total, 3 μg/kg). Neuromuscular monitoring was performed at the adductor pollicis muscle after induction of anesthesia but before the administration of rocuronium. Total dose of rocuronium during the surgery was 0.9 mg/kg. Neuromuscular block was reversed with 0.5 mg/kg sugammadex when one response was observed with post-tetanic count stimulation. Twitch responses after sugammadex administration showed a temporary decrease after its initial recovery. Maximum decreases in twitch responses were observed 17 min after initial dose of sugammadex. Twitch responses recovered to their control values after additional doses of 3.5 mg/kg sugammadex (4 mg/kg in total). Time from sugammadex administration to maximum decreases in twitch responses is earlier than has been reported in adults (20-70 min). It is demonstrated that following neuromuscular block reversal with insufficient dose of sugammadex, there is a possibility of the recurrence of residual paralysis within less than 20 min in pediatric patients.

DOI： 10.1007/s00540-013-1688-3

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：HINDAWI LTD  

The objective of this study was to determine the point after sugammadex administration at which sufficient or insufficient dose could be determined, using first twitch height of train-of-four (T1 height) or train-of-four ratio (TOFR) as indicators. Groups A and B received 1 mg/kg and 0.5 mg/kg of sugammadex, respectively, as a first dose when the second twitch reappeared in train-of-four stimulation, and Groups C and D received 1 mg/kg and 0.5 mg/kg of sugammadex, respectively, as the first dose at posttetanic counts 1-3. Five minutes after the first dose, an additional 1 mg/kg of sugammadex was administered and changes in T1 height and TOFR were observed. Patients were divided into a recovered group and a partly recovered group, based on percentage changes in T1 height after additional dosing. T1 height and TOFR during the 5 min after first dose were then compared. In the recovered group, TOFR exceeded 90% in all patients at 3 min after sugammadex administration. In the partly recovered group, none of the patients had a TOFR above 90% at 3 min after sugammadex administration. An additional dose of sugammadex can be considered unnecessary if the train-of-four ratio is ≥90% at 3 min after sugammadex administration. This trial is registered with UMIN000007245.

DOI： 10.1155/2014/848051

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

Purpose. Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA) is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme. Clinical Features. A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4 LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60 cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%), and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months. Conclusion. Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery.

DOI： 10.1155/2014/369563

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

PURPOSE: We report on two patients with ocular myasthenia gravis who received rocuronium, followed later by sugammadex to reverse neuromuscular blockade. Recovery was monitored simultaneously at the adductor pollicis muscle (APM) and the corrugator supercilii muscle (CSM). CLINICAL FEATURES: Two patients with ocular myasthenia gravis (case 1: 74 yr-old female, 54 kg; case 2: 71 yr-old male, 72 kg) were scheduled for surgery under general anesthesia. Neuromuscular blockade was induced with rocuronium 0.3 mg·kg(-1) after placing two separate monitors at the APM and the CSM, respectively. Additional doses of rocuronium 0.1-0.2 mg·kg(-1) were given to maintain neuromuscular blockade at fewer than two twitches at the APM during surgery. Train-of-four response at the CSM did not show recovery of the twitch after its initial disappearance. At the end of surgery, sugammadex was administered. Twitch height at the APM recovered to the control value in 12 min (case 1) and 13 min (case 2) after sugammadex administration; however, twitch height at the CSM took 26 min (case 1) and 14 min (case 2) to recover to the control value. CONCLUSION: After rocuronium-induced paralysis in both patients with ocular myasthenia, spontaneous recovery and sugammadex-assisted recovery were slower at the CSM than at the APM. In patients without the disorder, CSM recovery is faster than APM recovery. Thus, in ocular myasthenia gravis, neuromuscular recovery at the APM may not reflect recovery of all muscles.

DOI： 10.1007/s12630-013-0042-4

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

BACKGROUND: Differences in the supramaximal current (STIM) and sensitivity of the transducer (SENS) after calibration using mode "CAL2" of the neuromuscular accelermyography (TOF-Watch SX, MSD, Japan) between type 2 diabetic and non-diabetic patients were evaluated undergoing general anesthesia. METHODS: Thirty four elective surgical patients (20-69 years) were enrolled in this study. We evaluated STIM, SENS, onset time of rocuronium (onset time), time from onset to first T1 appearance (T1 appearance) and time from T1 appearance to T2 appearance (T1-T2 time) by using TOF stimulation between type 2 diabetic patients and non-diabetic patients, retrospectively. RESULTS: Thirteen diabetic patients (DM group) and twenty one non-diabetic patients (non-DM group) were included in this analysis. The values of SENS in DM group were significantly higher compared to non-DM patients (207 +/- 59 vs 113 +/- 44). However, STIM did not differ significantly between the two groups. Anesthesia in the 6 patients in DM group (SEV-DM group) and 14 patients in the non-DM group (SEV-non DM group) were maintained with sevoflurane. The other 14 patients were maintained with desflurane (DES-DM: n = 7 and DES-non DM: n = 7). A significant difference in the SENS values only was observed between the two SEV groups. On the other hand, the onset time, T1 appearance and T1-T2 time were significantly longer in DES-DM patients than those in the DES-non DM group. CONCLUSIONS: It is demonstrated that the values in the SENS and the recovery speed (T1-T2 time) under measuring the degree of neuromuscular blockade by TOF stimulation were significantly higher in diabetic patients compared to non-diabetic patients. The present study provides additional confirmation of low neuromuscular response under peripheral electrical stimulation using TOF-Watch SX in type 2 diabetes patients, and attention should be paid to the evaluation of neuromuscular block using TOF-Watch SX in diabetic patients.

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J01397&link_issn=&doc_id=20130806040004&doc_link_id=1520572359223700480&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520572359223700480&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publishing type：Meeting report  

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Language：Japanese   Publishing type：Meeting report  

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Authorship：Last author   Language：Japanese   Publishing type：Meeting report  

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Language：Japanese   Publishing type：Meeting report   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：日本老年麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)メディカ出版  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J01964&link_issn=&doc_id=20190219110004&doc_link_id=%2Fao7opnui%2F2019%2F003403%2F006%2F0232-0241%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7opnui%2F2019%2F003403%2F006%2F0232-0241%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Meeting report   Publisher：日本神経麻酔集中治療学会  

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)日本救急医学会  

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Meeting report   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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