Shinichiro Kira

Olprinone reduces ischemia/reperfusion-induced acute renal injury in rats through enhancement of cAMP.

Activated leukocytes are implicated in development of ischemia/reperfusion (I/R)-induced organ injuries. Phosphodiesterase 3 inhibitors have anti-inflammatory effects by preventing cyclic adenosine monophosphate (cAMP) degradation. We examined the effects of olprinone, a specific phosphodiesterase 3 inhibitor, on I/R-induced acute renal injury model in rats. Forty-five minute renal I/R was induced in uni-nephrectomized rats. Rats were divided into a vehicle group, an olprinone group, and a dibutyril (DB) cAMP group. Olprinone (0.2 μg/kg/minute) infusion began 30 min after reperfusion and continued for 3 h. DBcAMP (5 mg/kg), a stable analog of cAMP, was intraperitoneally administered 5 min after reperfusion to clarify the effect of cAMP in our model. Olprinone reduced the I/R-induced increases in serum levels of blood urea nitrogen and creatinine, and improved histological changes, including acute tubular necrosis in the outer medulla. Hemodynamic status was not affected by olprinone. I/R-induced a decrease in renal tissue blood flow, an increase in renal vascular permeability, and an enhancement of leukocyte activation, reflected by renal tissue levels of myeloperoxidase activity, and the tissue levels of cytokine-induced neutrophil chemoattractant (an equivalent of human interleukin 8) and tumor necrosis factor-α were all significantly decreased by olprinone. Olprinone also increased the renal tissue and plasma levels of cAMP in rats subjected to renal I/R. DBcAMP showed similar effects. Our results indicated that olprinone reduced the I/R-induced acute renal injury, probably by inhibiting leukocyte activation. The effects of olprinone could be explained through its action on cAMP levels.

Olprinone decreases elevated concentrations of cytokine-induced neutrophil chemoattractant-1 in septic rats

PurposeThe diaphragm is one of the organs directly affected by abdominal sepsis. Evidence suggests that sepsis induces diaphragmatic fatigability and that activated neutrophils play a crucial role in the development of diaphragmatic fatigability. In the present study, we investigated whether olprinone, a phosphodiesterase inhibitor, influenced the kinetics of cytokine-induced neutrophil chemoattractant-1 (CINC-1) in the diaphragm under abdominal septic conditions.MethodsMale Wistar rats were randomly assigned to a sham group, a cecal ligation and perforation group, and a phosphodiesterase inhibitor-pretreated group. To measure serial changes in CINC-1 concentrations, the right hemidiaphragm was removed at 4, 8, and 16 h after the surgical procedure in each group.ResultIn the cecal ligation and perforation group, CINC-1 concentrations in the diaphragm were significantly elevated compared with those in the sham group at both 4 and 8 h after the cecal ligation and perforation procedure. In the phosphodiesterase inhibitor-pretreated group, olprinone significantly attenuated the elevated CINC-1 concentrations at both 4 and 8 h after the surgical procedure. However, we observed no statistically significant differences in CINC-1 concentrations between the cecal ligation and perforation group and the phosphodiesterase inhibitor-pretreated groups at 16 h after the surgical procedure.ConclusionOlprinone decreases elevated CINC-1 concentration in the diaphragm under septic conditions. This suggests that olprinone may inhibit neutrophil recruitment to the diaphragm.

Anesthetic management of laparoscopic adjustable gastric banding in Japanese patients with morbid obesity

Laparoscopic adjustable gastric banding (LAGB) is a common type of bariatric surgery worldwide, though not so in Japan. Here we report the anesthetic management of LAGB in ten Japanese patients with morbid obesity. General anesthesia was induced with propofol, fentanyl, and vecuronium bromide and maintained with sevoflurane in oxygen and air (or nitrous oxide in some cases). In a limited number of patients, perioperative epidural analgesia was performed, with fentanyl injected intravenously for analgesia in the remaining patients. Although some special considerations were needed, in perioperative management, including thromboprophylaxis, there were no severe complications in any of the patients.

Suspected reexpansion pulmonary edema during emergence from general anesthesia in a child with developmental dysplasia of the hip

1 Golz A, Netzer A, Gordin A et al. Safe extraction of an impacted open safety pin from the esophagus: report of 9 cases. Am J Otolaryngol 2006; 27: 413–417. 2 Shinhar SY, Strabbing RJ, Madgy DN. Esophagoscopy for removal of foreign bodies in the pediatric population. Int J Pediatr Otorhinolaryngol 2003; 67: 977–979. 3 Gun F, Salman T, Abbasoglu L et al. Safetypin ingestion in children: a cultural fact. Pediatr Surg Int 2003; 19: 482–484. 4 Virgilis D, Weinberger JM, Fisher D et al. Vocalcord paralysis secondary to impacted esophageal foreign bodies in young children. Pediatrics 2001; 107: E101. 5 Tomaske M, Gerber AC, Weiss M. Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal. Pediatr Anesth 2006; 16: 123–129.

Effects of high peak airway pressure on the expression of heat shock protein 70 in rat lungs: a preliminary study

Background:  Heat shock protein 70 (HSP70) is induced by a wide variety of stresses in addition to hyperthermia. Recent studies have clarified that mechanical stretching and pressure overload can induce HSP70 in some tissues and cells. However, it remains unclear whether HSP70 is induced in stretch‐subjected lungs, such as those under mechanical ventilation. This study was designed to investigate the effects of high peak airway pressure (PAP) ventilation on HSP70 expression in intact rat lungs.

Reexpansion pulmonary edema: review of pediatric cases

Reexpansion pulmonary edema (RPE) is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. This condition is recognized to occur more frequently in patients under the age of 40 years, but there has been no detailed analysis of reported pediatric cases of RPE to date. For this review, PubMed literature searches were performed using the following terms: ‘re(‐)expansion pulmonary (o)edema’ AND (‘child’ OR ‘children’ OR ‘infant’ OR ‘boy’ OR ‘girl’ OR ‘adolescent’). The 22 pediatric cases of RPE identified were included in this review. RPE was reported in almost the entire pediatric age range, and as in adult cases, the severity ranged from subclinical to lethal. No specific treatment for RPE was identified, and treatment was administered according to the clinical features of each patient. Of the 22 reported cases, 10 occurred during the perioperative period, but were not related to any specific surgical procedures or anesthetic techniques, or to the duration of lung collapse. Pediatric anesthesiologists should be aware that pediatric RPE can occur after reexpansion of any collapsed lung and that some invasive therapies can be useful in severe cases.

Difficult tracheal intubation in a child born small for gestational age and receiving growth hormone therapy for short stature.

laryngoscope offers an expanded view of the airway and does not require alignment of the oral, pharyngeal, and laryngeal axes for visualization of the glottic structures. The intrinsic antifogging system of the Airtraq scores an advantage even over the fiberoptic bronchoscope. Since the introduction of pediatric sized Airtraq laryngoscopes in 2009, there are few reports describing its use in difficult pediatric airway (4,5). To the best of our knowledge, this is the first report describing the usefulness of Airtraq laryngoscope in an infant with Hallermann–Streiff syndrome and difficult intubation. Except for one report that described the utility of Airtraq laryngoscope in difficult airway management in an infant, we could not find reports or studies on its use for difficult intubation in infant age group (5). One anatomical airway abnormality that we noticed in this case, not described in the literature on this syndrome, is the thick stout epiglottis that could not be lifted away from the field of vision despite attempting to use the Airtraq laryngoscope both as Macintosh (tip going into the vallecula) and Miller blade (epiglottis included in the blade). To conclude, a high index of suspicion for difficult airway is required in children presenting with bilateral cataract and dyscephalic features. Airtraq laryngoscope can be useful for tracheal intubation in infants with Hallermann–Streiff syndrome.

Removal of central venous catheter fibrin sheath under cardiopulmonary bypass in a patient with juvenile dermatomyositis

SIR—Thrombosis is a common problem, and the use of central venous catheters (CVCs) can fail for many reasons. Over 50% of venous thromboses in the upper venous system in children are reported to occur secondary to the use of CVCs (1). We report the successful removal of a CVC fibrin sheath (one type of CVCs related thrombosis) utilizing cardiopulmonary bypass (CPB) in a patient with juvenile dermatomyositis (JDM). An 11-yearold girl diagnosed JDM was transferred to our hospital with continuous tachycardia. The previous hospital had inserted a CVC via the right internal jugular vein for chemotherapy (cyclosporin) and total parental nutrition (TPN). Blood cultures were carried out several times when the patient developed a fever; however, no infection was found. Transthoracic echocardiography revealed the presence of a right atrial mass, which was removed as an emergency. Anesthesia was induced with propofol, fentanyl, and vecuronium bromide, and maintained with sevoflurane in oxygen/air, fentanyl, and midazolam. Before the start of surgery, another transesophageal echocardiography was performed, which showed the right atrial mass not adhering to the atrial wall. As catheter thrombosis was suspected, percutaneous removal of the catheter was avoided, not to cause a pulmonary embolus. A new central venous double-lumen catheter was inserted via the left internal jugular vein to measure central venous pressure and to restart the TPN postoperatively. After CPB was started, incision of the right atrium disclosed a yellowish fibrin-like mass surrounding the tip of catheter, which was then cut and removed from the right atrium. The mass was about 1.0 cm in diameter and hard but friable (Figure 1). It represented the so-called fibrin sheath. The mass and catheter tip were sent for culture, but no infection was found. After removal of the mass, cardiac function started immediately without inotropes and CPB was easily withdrawn. The patient was extubated 6 h after the end of surgery in the intensive care unit. Juvenile dermatomyositis is a rare disorder and its common manifestations are skin rash and proximal muscle weakness (1). Other organ systems, including the gastrointestinal tract, lungs, heart, joints, eyes and nervous system can be involved. Patients with JDM often need placement of a CVC because of gastrointestinal involvement or immunosuppression therapy. Central venous catheter-related thrombosis has been reported, but its incidence varies reflecting different underlying conditions, diagnostic tests, and index of suspicion. For example, the incidence of related thrombosis in CVC placed children receiving long-term TPN is 1–75% (2). Approximately 35% of CVC placed children with acute lymphatic leukemia or receiving TPN may have CVC-related thrombosis (3,4). central venous catheterrelated thrombosis is classified three types: (i) clots at the tips of CVCs, which impair infusion or the withdrawal of blood, (ii) fibrin sheaths, which are not adherent to vessel walls but may occlude CVCs, (iii) CVC-related thrombosis that adheres to vessel walls, partially or completely obstructing vessels at the site of the CVC (2). In our case, as the tip of the catheter was not impaired and thrombosis was not adherent to vessel walls, the fibrin sheath type was suspected. Several mechanisms might play important roles in the development of a fibrin sheath, including substances infused through the CVC (TPN, chemotherapy), duration of CVC, position of the catheter tip, catheter materials, and the characteristics of the underlying disease. Ozimek et al. (5) reported that up to 12.5% of all children with CVCs receiving chemotherapy or long-term administration of Figure 1 Central venous catheter fibrin sheath. The catheter is surrounded by a so-called fibrin sheath without occlusion of the tip.