Takeshi Tateda

Novel mechanism of action hypothesized for stellate ganglion block related to melatonin

The mechanism of action of stellate ganglion block has generally been explained by vasodilation within its sphere of innervation. However, the success of treatment cannot always be explained by just one mechanism of action, because its clinical indications in Japan extend to many diseases, including systemic diseases. We propose a new mechanism of action for stellate ganglion block that is based on correction of melatonin rhythm disorder resulting from increased sympathetic nerve tone and does not involve vasodilation.

Comparison between a disposable and an electronic PCA device for labor epidural analgesia

PurposeThe aims of the present study were (1) to investigate if a disposable patient-controlled analgesia (PCA) device can be used for labor analgesia and (2) to evaluate the device by midwives and parturients.MethodsForty healthy parturients were divided into two groups and received combined spinal epidural analgesia for labor pain relief. Following intrathecal administration of 3 mg ropivacaine and 1.5 µg sufentanil, either a disposable PCA device (Coopdech Syrinjector; Daiken Medical, Osaka, Japan) or an electronic PCA device (IVAC PCAM PCA Syringe Pump; Alaris, Basingstoke, UK) was connected to the epidural catheter, and 0.15% ropivacaine with sufentanil 0.75 µg/ml was used for continuous infusion and PCA. For an electronic PCA device, continuous infusion rate, bolus dose, lockout time, and hourly limit were set at 4 ml/h, 3 ml, 15 min, and 16 ml, respectively. For a disposable PCA device, continuous infusion rate, bolus dose, and an hourly limit were set at 4 ml/h, 3 ml, and 16 ml, respectively, but lockout function was not available.ResultsNo differences were observed between the groups concerning demographic data, obstetric data, and outcome of labor. Anesthetic requirements (disposable, 9.7 ± 4.7 ml/h; electronic, 8.2 ± 4.0 ml/h) and VAS score during the delivery (disposable, 26 ± 25; electronic, 21 ± 22) were similar between the groups. Midwives praised the disposable PCA device as well as the electronic one.ConclusionThe present results imply that the disposable PCA device can be an alternative to the electronic PCA device for labor analgesia.

Thrombomodulin improves maternal and fetal conditions in an experimental pre-eclampsia rat model

The aim of this study was to investigate whether the consecutive administration of recombinant thrombomodulin (r‐TM) for 4 days improves maternal and fetal conditions and physiological outcomes in an N′‐nitro‐L‐arginine‐methyl ester hydrochloride‐induced and low‐dose endotoxin‐induced pre‐eclampsia (PE).

Inhibitory effect of alprostadil against sevoflurane-induced myometrial relaxation in rats.

PurposeFor anesthetic management of cesarean sections, regardless of the use of regional or general anesthesia, it is crucial to achieve sufficient uterine contraction immediately following the delivery of an infant in order to reduce excessive bleeding. No previous study has investigated the ability of alprostadil, a synthesized prostaglandin, to inhibit myometrial relaxation induced by volatile anesthetics. The aim of the present study was to investigate the inhibitory effects of alprostadil on sevoflurane-induced myometrial relaxation using myometrial strips isolated from pregnant rats.MethodsMyometrial strips were isolated from Sprague–Dawley rats (300–400 g) in the late stage of gestation (19–21 days). The time course of changes in spontaneous myometrium contraction was studied in the presence and absence of sevoflurane. Additionally, alprostadil was titrated at three different concentrations during continuous introduction of sevoflurane 2%, and myometrium contraction was studied. As an index of contraction, the area under the contraction curve was used, and data were analyzed by repeated measure one-way analysis of variance.ResultsWe have shown a significant decrease in myometrium contraction as a result of the use of sevoflurane (2%). Additionally, alprostadil has been shown to inhibit myometrial relaxation induced by sevoflurane in a dose-dependent manner. The areas under the contraction curve were 87%, 87%, 129%, and 172% of the baseline value for the control and at low, medium, and high concentrations of alprostadil, respectively.ConclusionThe ability of alprostadil to inhibit myometrial relaxation induced by sevoflurane suggests that the use of alprostadil during general anesthesia for cesarean section may be advantageous for the reduction of postpartum bleeding.

Hypothetical mechanism of prostaglandin E1-induced bronchoconstriction

In general, prostaglandin E1 (PGE1) is thought to relax smooth muscles in the airway and to inhibit muscle constriction. We hypothesized that, under the specific conditions, PGE1 induces bronchoconstriction, resulting in the promotion of inflammation. Examples of the specific conditions where this mechanism may occur include cases where patient who are susceptible to inflammation receive a continuous infusion of PGE1 during induced hypotension or during treatment for intraoperatively abnormal hypertension.