Tatsushige Iwamoto

Three-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation

AbstractThe incidence of a tracheal bronchus—that is, a congenitally abnormal bronchus originating from the trachea or main bronchi–is 0.1%–2%. Serious hypoxia and atelectasis can develop in such patients with intubation and one-lung ventilation. We experienced a remarkable decrease in peripheral oxygen saturation (

Suppression of the descending inhibitory pathway by continuous thoracic intrathecal lidocaine infusion reduces the thermal threshold of the tail-flick response in rats

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Antinociceptive action of carbamazepine on thermal hypersensitive pain at spinal level in a rat model of adjuvant-induced chronic inflammation

) and a rise in airway pressure during placement of a double-lumen endobronchial tube in a patient with patent ductus arteriosus and tracheal bronchus. Substitution of the double-lumen tube with a bronchial blocker tube provided secure isolation of the lung intraoperatively. A type I tracheal bronchus and segmental tracheal stenosis were identified on postoperative three-dimensional (3D) computed tomographic (CT) images. Preoperative examination of chest X-rays, CT images, and preoperative tracheal 3D images should preempt such complications and assist in securing safe and optimal one-lung ventilation.

The effect of Sub-MAC anesthesia and the radiation setting on repeated tail flick testing in rats.

To the Editor: Stellate ganglion block (SGB) is widely used to treat upper-extremity and facial pain. Cervical hematoma is one of the most serious and sometimes life-threatening complications of SGB. Here, we report a case of life-threatening neck and mediastinal hematoma due to venous bleeding 2 h after SGB in a patient without hemostatic abnormalities or receiving anticoagulants and/or antiplatelet drugs. A 44-year-old man sensed a persistent pain and numbness of the lower left lip after treatment in a dental clinic. Under a diagnosis of neuropathic pain, we administered SGB and pregabalin at 150 mg/day. Two hours after SGB, however, he presented to our hospital complaining of severe dyspnea and pain in the neck and back and showed slight cervical swelling and hypoxemia. We tried to intubate but failed because of severe upper airway edema and performed an emergency tracheostomy in the operating room. Careful observation of the SGB puncture site revealed a massive cervical hematoma, and we removed it and ligated the vein responsible for the bleeding. Higa et al. [1] reviewed clinical reports on cervical hematomas after SGB and reported that the most frequent initial symptoms are neck pain, dyspnea, and neck swelling. In our case, although the patient also had neck pain and dyspnea, cervical swelling was not so marked, probably because bleeding was venous. We assume the reason bleeding was prolonged and aggravated was the possibility that we tore a vascular wall, especially when pulling out a needle, because the tip may have been bent like a hook while advancing it and pressing it hard on the bone surface. Ultrasound guidance for SGB seems to be a good choice to avoid hematoma formation.

Sudden Cardiac Arrest During General Anesthesia in an Undiagnosed Brugada Patient

PurposeFor the suppression of descending inhibitory pathways in animals, single-dose lidocaine blockade is reversible and causes less damage than chronic spinal cord injury, decerebration, and cold blockade of the spinal cord. However, single-dose blockade has a variable onset and is relatively short-lived. To surmount these disadvantages, we devised a continuous thoracic intrathecal lidocaine infusion and evaluated its effects in rats.MethodsRats were administered continuous intrathecal infusions of 0, 0.25%, 0.5%, and 1% lidocaine at 10 &gml·h−1 following a 10-&gml bolus. The effects of the continuous thoracic blockade on tail-flick (TF) latency (estimated by the percent maximum possible effect [%MPE]) and on the release of neurotransmitters in the cerebrospinal fluid (CSF) were evaluated.ResultsContinuous thoracic blockade with 0.5% and 1% lidocaine infusion reversibly shortened TF latency (%MPE, −22.0 ± 11.0 % and −21.2 ± 4.6 %, respectively, versus baseline; P < 0.05) during drug infusion. Compared with normal saline, thoracic intrathecal infusion of lidocaine significantly lowered norepinephrine and serotonin concentrations in the CSF at 1 h of infusion (P = 0.02 for both).ConclusionContinuous thoracic blockade by local anesthetic resulted in reversible suppression of descending inhibitory pathways for varying durations. Such blockade may provide further information regarding nociceptive transmission and the mechanisms of antinociception in animals.

Persistent isoflurane-induced hypotension causes hippocampal neuronal damage in a rat model of chronic cerebral hypoperfusion

OBJECTIVE To evaluate the preoperative prevalence of each type of J-wave syndrome electrocardiographic pattern and its association with perioperative cardiac events. DESIGN Retrospective study. SETTING Single hospital university study. PARTICIPANTS The study evaluated 930 patients who underwent gynecologic, abdominal, neurosurgical, orthopedic, and urologic surgeries. INTERVENTIONS Preoperative standard 12-lead electrocardiogram (ECG) monitoring was performed, and each type of J-wave syndrome ECG pattern-types 1, 2, and 3 and Brugada syndrome-type-was evaluated. Incidence of perioperative cardiac events was investigated up to 1 year postoperatively using an electronic medical record system. MEASUREMENTS AND MAIN RESULTS Data from 789 patients were included in the final study. Of these, 16 patients (2.0%) had J-wave syndrome: 7 patients (0.9%) had type-1 patterns; 5 patients (0.6%) had type-2 patterns; 2 patients (0.3%) had type-3 patterns; and 2 patients (0.3%) had Brugada syndrome-type ECG patterns. A J-point elevation≥0.2 mV, which is considered to be more dangerous, was found in only 2 patients with Brugada syndrome-type ECG patterns, both of whom suffered perioperative lethal arrhythmias. CONCLUSION Patients with J-wave syndrome ECG patterns, even dangerous patterns, are not necessarily associated with a higher risk of perioperative cardiac events. However, Brugada syndrome type ECG patterns should be carefully monitored.