Mina Masuda

Impact of skin incision on the pleth variability index.

ObjectiveThe pleth variability index (PVI), which is calculated from respiratory variations in the perfusion index (PI), reportedly predicts fluid responsiveness. However, vasomotor tone fluctuations induced by nociceptive stimuli change the PI and may reduce the accuracy of PVI. The aim of this study was to confirm the effects of surgical stimuli on PVI.MethodsTwenty-four patients were examined after the induction of general anesthesia. Heart rate (HR), mean arterial blood pressure (MBP), PI, PVI, stroke volume variation (SVV), and cardiac index (CI) were recorded before and after the skin incision. PI and PVI were calculated using a Radical 7 pulse oximeter, and SVV and CI were calculated using the FloTrac/Vigileo system.ResultsAfter the skin incision, the PI decreased significantly from 5.3 (4.0–6.2%) to 3.6% (1.8–4.7%), whereas the PVI increased significantly from 9.5 (7.0–12.0%) to 13.5% (9.0–16.0%). A significant negative correlation was observed between the changes in PI and PVI before and after the skin incision. The skin incision did not affect the HR, CI, or SVV but increased the MBP.ConclusionThis study showed a significant increase in the PVI and a negative correlation between the changes in PVI and PI before and after the skin incision. The PVI can be calculated from the variations in the PI caused not by mechanical ventilation, but rather by fluctuations in vasomotor tone. When using the PVI as an indicator for fluid responsiveness, it is crucial to pay attention to fluctuations in vasomotor tone induced by nociceptive stimuli.

A novel gene suppressed in the ventricle of carnitine-deficient juvenile visceral steatosis mice

In order to clarify the pathogenesis and pathophysiology of cardiac hypertrophy in carnitine‐deficient juvenile visceral steatosis (JVS) mice, we performed mRNA differential display analysis with total RNA extracted from the ventricles of control and JVS mice at 14 days of age. We identified four up‐regulated genes, two known and two unknown, and a novel down‐regulated gene. Northern blot analysis with a novel cDNA probe derived from the down‐regulated gene fragment 8A2 revealed three mRNA species of 1.1‐, 1.3‐, and 2.6‐kb. The 1.1‐ and 1.3‐kb mRNA species were found only in the heart, and the 2.6‐kb species was found in the heart, kidney and brain, but not in skeletal muscle or liver. The 1.1‐ and 1.3‐kb species were down‐regulated in the ventricles of JVS mice, but not in the auricles, and increased to the control level with carnitine treatment. We isolated cDNA clones from ventricle RNA, termed CDV‐1 (carnitine deficiency‐associated gene expressed in ventricle) and from brain RNA, termed CDV‐1R (CDV‐1‐related gene) by 5′‐ and 3′‐RACE analyses. The entire nucleotide sequence except the 5′‐terminal 64 bp of CDV‐1 cDNA was completely identical to the 992 bp sequence from the 3′‐end of CDV‐1R cDNA. The CDV‐1 cDNA contained an open reading frame predicting a peptide of 107 amino acids, which composed the C‐terminal portion of CDV‐1R peptide consisting of 414 amino acids.

Novel mRNA molecules are induced in hypertrophied ventricles of carnitine-deficient mice and belong to a family of up-regulated gene in cells overexpressing c-erbB-2

To clarify the pathogenesis of cardiac hypertrophy in carnitine-deficient juvenile visceral steatosis (JVS) mice, we performed differential mRNA display analysis with the ventricles of control and JVS mice. We found a novel up-regulated gene, designated as carnitine deficiency-associated gene expressed in ventricle (CDV)-3. Northern blot analysis with a cDNA probe derived from the novel gene revealed two substantial mRNA species of prominent 4.1- and faint 3.5-kb in examined tissues of control and JVS mice. In spite of their widely expressed features, up-regulation of the gene was found predominantly in the ventricles and slightly in the auricles and skeletal muscles of JVS mice. The up-regulation of CDV-3 gene in the ventricles of JVS mice was significantly relieved by carnitine administration within 6 h. The entire cDNA nucleotide sequences showed that two kinds of cDNA, long and short versions (CDV-3A and -3B), corresponding to the detected mRNAs, are different in a 711 base fragment. Analysis of genomic DNA revealed that the two mRNAs were derived from a single CDV-3 gene with five exons by alternative splicing. The deduced amino acid sequences indicated that the isoforms consist of 236 and 281 residues, differing at regions near the carboxy-terminus but sharing 231 residues of the amino-terminal regions. A BLAST search revealed that they show a high similarity to a human predicted nuclear protein (H41), which has been reported to be up-regulated in breast cancer cells overexpressing cellular-erythroblastosis B-2 (c-erbB-2, a kind of tyrosine kinase).We report the identification and characterization of novel transcripts that may be involved in the development of cardiac hypertrophy caused by carnitine deficiency.

Effect of Pneumoperitoneum on Functional Residual Capacity

Background Pneumoperitoneum (PP) during laparoscopic surgery of the abdomen induces a mechanical compression of the diaphragm that reduces the functional residual capacity (FRC). The aim of this study was to evaluate the adverse effect of PP on FRC and the improvement of the degraded FRC using positive end-expiratory pressure (PEEP).

Difficult airway associated with bifid glottis and coexistent subglottic stenosis in a patient with Pallister–Hall syndrome: a case report

BackgroundPallister–Hall syndrome is a rare disorder characterized by hypothalamic hamartoma, hypopituitarism, bifid epiglottis, and micrognathia.Case presentationWe describe the airway management under general anesthesia of a 15-year-old female with Pallister–Hall syndrome whose airway was compromised with bifid epiglottis and acquired subglottic stenosis. The three options considered for airway management were tracheal intubation, a supraglottic device, and surgical tracheotomy. Tracheal intubation provides a secured airway, but extubation can be difficult. A supraglottic device minimizes airway injury, but it does not completely protect the airway from aspiration.ConclusionsThe patient’s airway was successfully managed using a supraglottic device with aspiration prophylaxis. Airway management devices should be selected according to each patients’ individual circumstances.

Management of general anesthesia in a child with Miller–Dieker syndrome: a case report

Miller–Dieker syndrome (MDS) is a rare disorder characterized by type I lissencephaly and a distinctive facial appearance that may include prominent forehead, bitemporal hollowing, and micrognathia. MDS is associated with epilepsy. We here report an 18-month-old girl with MDS who required general anesthesia. The child had an extremely low Bispectral Index (BIS) value prior to undergoing general anesthesia. Her perioperative course was uneventful. This case highlights some of the important anesthetic concerns in patients with MDS, which include potentially difficult airways and extremely low BIS values.