Keiko Nakazato

The efficacy of dexmedetomidine in patients with noninvasive ventilation: a preliminary study.

BACKGROUND: Agitation is associated with failure of noninvasive ventilation (NIV). We investigated the effect of dexmedetomidine in patients with NIV. METHODS: This was a prospective clinical investigation in an intensive care unit. Dexmedetomidine was infused in 10 patients in whom NIV was difficult because of agitation. RESULTS: Ramsay and Richmond Agitation-Sedation Scale scores were maintained at 2.94 ± 0.94 and −1.23 ± 1.30, respectively. All patients were successfully weaned from NIV, and the respiratory state was not worsened. CONCLUSION: This study shows that dexmedetomidine is an effective sedative drug for patients with NIV.

The influences of propofol and dexmedetomidine on circadian gene expression in rat brain

INTRODUCTION There are circadian genes whose expressions were affected by sevoflurane. We hypothesized that propofol and dexmedetomidine also have influences on the expressions of circadian genes. MATERIALS AND METHODS Seven-week-old rats were cannulated and propofol (600 microg/kg/min, 1 ml/h, n=6: group P6H), dexmedetomidine (1 microg/kg/min, 1 ml/h, n=6: group D6H), 10% lipid (1 ml/h, n=6: group L) and normal saline (1 ml/h, n=6: group N) were infused intravenously for 6h; rats were decapitated soon or 24h after awakening from anesthesia (groups P24H n=6 and D24H n=6). Real time reverse transcription-polymerase chain reaction was performed using rat whole brain and the expressions of circadian genes were measured. RESULTS In the P6H group and the P24H group, the whole expressions of seven genes were changed significantly compared with the L group. In the D6H group, the whole expression of seven genes was changed significantly compared with the N group. In the P6H group, all gene expressions except for Tef (thyrotroph embryonic factor) were changed significantly compared with the L group. In this group, the expression of Dbp (D site albumin promoter binding protein) was increased, and the others were decreased. In the D6H group, all gene expressions except for Dbp and Tef were decreased significantly compared with the N group. For the two anesthetics, the expression patterns were different only in Dbp. CONCLUSION We showed that propofol and dexmedetomidine have influences on the circadian gene expressions.

Clinical evaluation of sivelestat for acute lung injury/acute respiratory distress syndrome following surgery for abdominal sepsis.

Background The efficacy of sivelestat in the treatment of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) has not been established. In part, this is due to the wide variety of factors involved in the etiology of ALI/ARDS. In this study, we examined the efficacy of sivelestat in patients with ALI/ARDS associated with abdominal sepsis. Methods The subjects were 49 patients with ALI/ARDS after surgery for abdominal sepsis. The efficacy of sivelestat was retrospectively assessed in two treatment groups, ie, a sivelestat group (n = 34) and a non-sivelestat group (n = 15). Results The sivelestat group showed significant improvements in oxygenation, thrombocytopenia, and multiple organ dysfunction score. The number of ventilator days (6.6 ± 6.1 versus 11.1 ± 8.4 days; P = 0.034) and length of stay in the intensive care unit (8.5 ± 6.2 versus 13.3 ± 9.5 days; P = 0.036) were significantly lower in the sivelestat group. The hospital mortality rate decreased by half in the sivelestat group, but was not significantly different between the two groups. Conclusion Administration of sivelestat to patients with ALI/ARDS following surgery for abdominal sepsis resulted in early improvements of oxygenation and multiple organ dysfunction score, early ventilator weaning, and early discharge from the intensive care unit.

Aggressive treatment with noninvasive ventilation for mild acute hypoxemic respiratory failure after cardiovascular surgery: Retrospective observational study

BackgroundAcute hypoxemic respiratory failure (AHRF) is one of the most serious complications after cardiovascular surgery. It remains unclear whether noninvasive ventilation (NIV) has potential as an effective therapy for AHRF after cardiovascular surgery, although many reports have described the use of NIV for AHRF after extubation. The aim of this study was to investigate the effectiveness of NIV in the early stage of mild AHRF after cardiovascular surgery.MethodsWe retrospectively analyzed all patients admitted to the intensive care unit after cardiovascular surgery, whose oxygenation transfer (PaO2/FIO2) deteriorated mildly after extubation, and in whom NIV was initiated. A two-way analysis of variance and the Bonferroni multiple comparisons procedure, the Mann–Whitney test, Fisher’s exact test or the χ2test was performed.ResultsA total of 94 patients with AHRF received NIV, of whom 89 patients (94%) successfully avoided endotracheal intubation (successful group) and five patients required reintubation (reintubation group). All patients, including the reintubated patients, were successfully weaned from mechanical ventilation and discharged from the intensive care unit. In the successful group, PaO2/FIO2 improved and the respiratory rate decreased significantly within 1 h after the start of NIV, and the improvement in PaO2/FIO2 remained during the whole NIV period.ConclusionWe conclude that NIV is beneficial for mild AHRF after cardiovascular surgery when it is started within 3 h after mild deterioration of PaO2/FIO2. We also think that it is important not to hesitate before performing reintubation when NIV is judged to be ineffective.

Inhaled nitric oxide therapy for secondary pulmonary hypertension with hypertrophic obstructive cardiomyopathy and severe kyphoscoliosis

Inhaled nitric oxide therapy for secondary pulmonary hypertension with hypertrophic obstructive cardiomyopathy and severe kyphoscoliosis☆ YusukeHosokawa ⁎, Takeshi Yamamoto , Yuto Yabuno , KeisukeHara , Toshiyuki Aokage , KeikoNakazato , Hiroomi Suzuki , Manabu Suzuki , Akira Ueno , Ryo Munakata , Yukichi Tokita , Eisei Yamamoto , Koichi Akutsu , Hitoshi Takano , Naoki Sato , Morimasa Takayama , Keiji Tanaka , Kyoichi Mizuno b

Severe respiratory depression and bradycardia before induction of anesthesia and onset of Takotsubo cardiomyopathy after cardiopulmonary resuscitation

A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. Approximately 2 minutes after an intravenous line was established by an anesthesia resident, severe hypoxia and bradycardia developed, and she lost consciousness. Cardiopulmonary resuscitation was initiated immediately, and after 1 minute, she regained consciousness, and her breathing and circulation recovered. After admission to the intensive care unit, emergency coronary angiography was performed. The blood flow in all the coronary arteries was normal. However, a decrease in the apical left ventricular wall motion and an increase in the basal wall motion were observed. Based on these findings, Takotsubo cardiomyopathy was diagnosed. The wall motion gradually improved and the patient was discharged from the hospital on postoperative day 15. The respiratory depression and bradycardia were thought to be due to an inadvertent bolus of remifentanil. We surmised that the patient had received a slight amount of retained medication when the anesthesia resident established the intravenous line, which caused severe respiratory depression. It is important to note that adverse effects such as severe respiratory depression and bradycardia can be caused by even small doses of remifentanil.

Use of Dexmedetomidine in Patients with Noninvasive Ventilation

Agitation and delirium are relative contraindications for noninvasive ventilation (NIV) in acute care [1]. These cause serious complications, and even if indicated, NIV sometimes fails with these complications. Although sedation therapy can play an important role in NIV success, it is also potentially dangerous because respiratory depression is a concern when using potent analgesics or sedatives. Routine use of sedatives such as opioids and benzodiazepines can lead to a fatal outcome when overdosed.