PubMed Health⌕ Search

Biomedical subjects

Hidefumi Obara

Publications and source records attributed to Hidefumi Obara.

17 recordsLinked to original sources
PubMed2004

Efficacy of partial liquid ventilation in improving acute lung injury induced by intratracheal acidified infant formula: determination of optimal dose and positive end-expiratory pressure level.

OBJECTIVES: Partial liquid ventilation with fluorocarbon was successfully used for acute lung injury induced by oleic acid or lung lavage. Positive end-expiratory pressure (PEEP) during partial liquid ventilation enhances the efficacy of fluorocarbon. The aim of the current study was to assess whether partial liquid ventilation can repair lung damage induced by intratracheal acidified infant formula and to determine the optimal fluorocarbon dose and PEEP level. DESIGN: Prospective, randomized animal study. SETTING: University research laboratory. SETTING AND SUBJECTS: Seventy-six male anesthetized rabbits. INTERVENTIONS: For study 1, acute lung injury was induced by intratracheal acidified infant formula in four groups. Next, three groups received 10, 15, or 20 mL/kg fluorocarbon, and the fourth group was conventionally gas ventilated. For study 2, acute lung injury was induced in five groups. One group was gas ventilated at a PEEP of 5 cm H2O, whereas the other four groups received fluorocarbon (15 mL/kg) and were assigned to one of four PEEP levels (5, 7.5, 10, or 12.5 cm H2O). The lungs were ventilated with 100% oxygen for 4 hrs after acute lung injury. MEASUREMENTS AND MAIN RESULTS: In study 1, fluorocarbon at doses of 15 and 20 mL/kg attenuated lung leukosequestration and edema and superoxide production of neutrophils, resulting in similar improvements in oxygenation, lung mechanics, and pathologic changes. The highest fluorocarbon dose caused mortality from pneumothorax. In study 2, the combination of PEEP with partial liquid ventilation improved gas exchange, lung compliance, pulmonary edema, and histologically observed damage. The beneficial effects of PEEP at 10 and 12.5 cm H2O were similar. Adverse side effects of 12.5 cm H2O PEEP included pneumothorax and hemodynamic instability. CONCLUSIONS: The combination of fluorocarbon and PEEP improved the physiologic, biochemical, and histologic lung injury induced by acidified infant formula. The beneficial effects of partial liquid ventilation are due, in part, to inhibition of pulmonary neutrophil accumulation and activation with fluorocarbon. The optimal fluorocarbon dose and PEEP level in our model were 15 mL/kg and 10 cm H2O, respectively.

Analysis of Variance↗
PubMed2004

Reductive surgery plus percutaneous isolated hepatic perfusion for multiple advanced hepatocellular carcinoma.

OBJECTIVE: To evaluate the efficacy of a novel 2-stage treatment with reductive surgery plus percutaneous isolated hepatic perfusion (PIHP) for multiple hepatocellular carcinoma (HCC), which was previously unresectable. SUMMARY BACKGROUND DATA: Surgical resection is the treatment of choice for HCC, but the majority of patients with advanced HCC are not suitable candidates. PIHP is a minimally invasive surgery that allows high-dose regional chemotherapy of the liver, and our phase II studies have shown its profound efficacy for the local control of advanced HCC. METHODS: Twenty-five patients with multiple advanced HCC were enrolled in this prospective study. In the first stage, all patients underwent reductive hepatectomy: major hepatectomy in 13 patients and segmentectomy or less in 12. In 2 patients with subsegmentectomy, the retropancreatic and periportal metastatic lymph nodes were synchronously resected. Regardless of the type of hepatectomy, all patients routinely underwent cholecystectomy, and ligations of the right gastric artery and arterial collaterals of the remnant liver to increase the safety and efficacy of PIHP. In the second stage, PIHP with doxorubicin 60-120 mg/m2/treatment was planned for a period of 1 to 3 months after surgery. RESULTS: Of 25 enrolled patients, 22 successfully underwent PIHP an average of 1.8 times for the local control of residual liver tumors. In the remaining 3 patients, PIHP was abandoned because 2 had rapid disease progression and 1 had liver failure after surgery. In 22 patients with the 2-stage treatment, 19 (86%) had objective local tumor control (10 complete remissions and 9 partial responses with a median response duration of 16 months). The actuarial survival rate of all 25 patients was 42% at 5 years. CONCLUSIONS: Reductive surgery plus PIHP produced a strong antitumoral effect on multiple advanced HCC, when liver function allows this concentrated treatment approach, and offers long-term survival in a subset of patients who were previously deemed to have unresectable disease.

Adult↗
PubMed2003

The effects of enflurane, isoflurane, and intravenous anesthetics on rat diaphragmatic function and fatigability.

UNLABELLED: We examined the effect of isoflurane, enflurane, midazolam, ketamine, propofol, and thiopental on diaphragmatic functions under unfatigued and fatigued conditions in 228 rat isolated muscle strips. Diaphragmatic twitch characteristics and tetanic contractions were measured before and after muscle fatigue, which was induced by repetitive tetanic contraction with or without exposure to one of the anesthetics at clinically relevant plasma concentrations, and at 10 and 100 times this concentration, or at 1, 2, and 3 minimum alveolar anesthetic concentration (MAC). Isoflurane, midazolam, ketamine, propofol, and thiopental did not induce a direct inotropic or lusitropic effect under unfatigued and fatigued conditions. Enflurane did not change contraction or relaxation in fresh isolated diaphragm, but enflurane at 2-3 MAC enhanced diaphragmatic fatigability itself and fatigue-induced impairment of twitch characteristics and tetanic tensions. These effects were greater at 3 MAC than at 2 MAC. Our findings suggest that the reduction of diaphragm function previously reported in in vivo experiments using propofol, midazolam, and isoflurane is not related to a direct effect on intrinsic diaphragmatic contractility. Our results also indicate that large concentrations of enflurane may impair the diaphragmatic function at sites other than excitation-contraction coupling. IMPLICATIONS: Enflurane did not change contraction or relaxation in fresh isolated rat diaphragm, but enhanced diaphragmatic fatigability itself and fatigue-induced impairment of twitch characteristics and tetanic tensions. Isoflurane, midazolam, ketamine, propofol, and thiopental had no direct effects on diaphragmatic functions under unfatigued and fatigued conditions. Isoflurane and these i.v. anesthetics may be advantageous over enflurane to anesthetize and/or sedate patients who are predisposed to diaphragmatic fatigue.

Anesthetics, Inhalation↗
PubMed2003

ONO-1714, a nitric oxide synthase inhibitor, attenuates endotoxin-induced acute lung injury in rabbits.

UNLABELLED: Overproduction of nitric oxide by inducible nitric oxide synthase (iNOS) expressed in the lung is thought to play a crucial role in the pathogenesis of endotoxin-induced acute lung injury (ALI). In this two-part study, we determined whether ONO-1714, a new selective iNOS inhibitor, attenuates endotoxin-induced ALI in rabbits. For Part I of the study, a control group received IV saline and ALI was induced by IV infusion of endotoxin 5 mg/kg over 30 min in 4 groups. Three groups received either 0.1, 0.03, or 0.01 mg/kg of ONO-1714 10 min before the start of endotoxin and the fourth group received saline. For Part II of the study, ALI was induced by endotoxin infusion in all 6 groups. One group was treated with saline. The other 5 groups received ONO-1714 0.1 mg/kg at various timings (10 min before or 1, 2, 3, or 4 h after ALI induction). The lungs were mechanically ventilated with 40% oxygen for 6 h after induction of ALI. In Part I, pretreatment with 0.1 mg/kg ONO-1714 mitigated endotoxin-induced ALI. In Part II, early posttreatment (within 2 h after the insult) with ONO-1714 was as effective as pretreatment in improving oxygenation, lung mechanics, lung leukosequestration, pulmonary edema, and histological change. However, lung damage was not improved in rabbits receiving the drug 3 or 4 h after endotoxin. These data suggest that the current study is a basis for future clinical trials to elucidate whether ONO-1714 can be a promising therapeutic approach in patients with acute respiratory distress syndrome induced by endotoxin/sepsis. IMPLICATIONS: An excess of nitric oxide is thought to play a crucial role in the pathogenesis of acute organ injury in endotoxemia. Early posttreatment with ONO-1714, a nitric oxide synthase inhibitor, attenuated physiological, biochemical, and pathological changes in endotoxin-induced acute lung injury in rabbits.

Airway Resistance↗
PubMed2003

[Life-threatening coronary ischemia in the operating room: analysis of annual survey from 1999 to 2001 conducted by Japanese Society of Anesthesiologists].

In Japan, the incidence of cardiac morbidity among patients with ischemic heart diseases has been reported to be 13.2-16.4%, and that of perioperative myocardial infarction in these patients about 1%. We investigated the perioperative morbidity and mortality due to coronary ischemia by using data from an annual survey concerning anesthesia-related critical incidents, conducted by the Committee on Operating Room Safety, Japanese Society of Anesthesiologists. In this survey, coronary ischemia was divided into intraoperative pathological events (coronary ischemia as intraoperative event) and preoperative complication (coronary ischemia as preoperative complication). The former consists of coronary ischemia which developed in patients without preoperative diagnosis of ischemic heart diseases or which was induced by surgical and/or anesthetic procedures. The latter was coronary ischemia developed in patients with preoperative diagnosis of ischemic heart diseases. From January 1, 1999, to December 31, 2001, 3,020,021 patients were registered from certified training hospitals of Japanese Society of the Anesthesiologists in the survey. Among them 1,918 episodes of intraoperative cardiac arrest and 2,054 deaths (within 7th postoperative days) were reported. Of these 7.5% and 6.3% of cardiac arrests were due to coronary ischemia as intraoperative event and as preoperative complication, respectively. Death was due to coronary ischemia as intraoperative event in 4.0% and as preoperative complication in 5.1%. The occurrence of critical incidents (cardiac arrest and the other life-threatening events) due to both types of coronary ischemia depended on ASA-PS. The percentage of coronary ischemia as preoperative complication was higher in emergency patients than in elective patients. The percentage of coronary ischemia as intraoperative event was almost the same between emergency and elective patients. Both types of coronary ischemia developed most frequently in cardiac/aortic surgeries, followed by thoracotomy with or without laparotomy. The number of critical incidents due to coronary ischemia as preoperative complication was the largest in emergency cardiac/aortic surgeries, followed by elective non-cardiac surgeries. The number of critical incidents due to coronary ischemia as intraoperative event was the largest in elective non-cardiac, especially open abdominal, surgeries in patients with ASA-PS 1(E) + 2(E). Among the patients with ASA-PS 1(E) + 2(E) who underwent non-cardiac surgeries 13.9% of deaths were due to coronary ischemia as preoperative complication and 12.5% as intraoperative event. It should be noted that many critical incidents due to coronary ischemia as intraoperative event during laparotomy developed in patients anesthetized by inhalation anesthesia combined with epidural, spinal or conduction block. Prognosis of cardiac arrest due to coronary ischemia as preoperative complication was the worst: 47.1% of these patients died. The best prognosis was found in critical incidents other than cardiac arrest due to coronary ischemia as intraoperative event with mortality of 12.3%. The results show that quality improvement from the standpoint of intraoperative coronary ischemia is required.

Anesthesia↗
PubMed2003

[Annual study of anesthesia-related mortality and morbidity in the year 2001 in Japan: the outlines--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety].

We reported anesthesia-related mortality and morbidity in Japanese Society of Anesthesiologists Certified Training Hospitals (JSACTH) in the year 2001, as a part of the second series of annual studies in the identical questionnaires form started in 1999. JSA Committee on Operating Room Safety sent confidential questionnaires to 813 JSACTH and received effective answers from 87.9% of the hospitals. A total number of 1,284,957 anesthetics were documented. The respondents were asked to report all cases of cardiac arrests and other critical incidents (serious hypotension, serious hypoxemia and others) during anesthesia and surgery, and their outcomes (death in operating room, death within 7 days, transfer to vegetative state and rescue without sequelae) as well as one principal cause for each incident from the list of 52 items. Definition of serious hypotension, serious hypoxemia and others was those events suggesting the possibility of impending cardiac arrest or permanent disability of the central nervous system or myocardium. The respondents were also requested to submit the tabulation of patients by ASA physical status, age distribution, surgery sites and anesthetic methods. Analysis was made by total incidents under anesthesia/surgery, and also by incidents totally attributable to anesthetic management (AM), due to preoperative complications (PC), due to intraoperative pathological events (IP) and due to surgery (SG). This paper focused on analysis of entire patients, as other later papers will report analyses with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods. Total incidence of cardiac arrest under anesthesia/surgery was 6.12 per 10,000 anesthetics. PC, IP and SG occupied 47.2%, 21.1% and 24.2% of principal causes of total cardiac arrest, respectively. AM occupied only 6.4% of the principal causes and the incidence was 0.39 per 10,000. The most frequent cause of cardiac arrest in 52 more detailed classifications of principal causes was preoperative hemorrhagic shock that occupied 19.2% of all cardiac arrests. The second was massive hemorrhage due to surgical procedures (12.3%), and the third was surgery itself (9.7%). Prognosis of the cardiac arrest was worst in that due to PC, i.e. 86.1% of cardiac arrests died in the operating room or within 7 days after surgery and only 5.3% survived without sequelae. Very low survival rate of preoperative hemorrhagic shock (5.3%) and preoperative multiple organ failure/sepsis (7.1%) aggravated the prognosis. Pulmonary embolism was the worst single cause in prognosis of cardiac arrest due to IP. The best prognosis was found in cardiac arrest due to AM, 82.0% survived without sequelae and 10.0% died. The mortality rate after cardiac arrest was 3.04 per 10,000 anesthetics, of them 0.04 was due to AM, 0.43 due to IP, 1.89 due to PC and 0.67 due to SG. The mortality rate after critical incidents other than cardiac arrest such as severe hypotension and severe hypoxemia was 3.37, and of them 0.06 was due to AM, 0.23 due to IP, 2.25 due to PC and 0.82 due to SG. The final mortality rate attributable to anesthesia/surgery including deaths after cardiac arrest and after other critical incidents was 6.41 per 10,000 anesthetics. The final mortality rate totally attributable to AM was 0.10 per 10,000 anesthetics, which was significantly improved from 0.21 [0.15, 0.27], that of mean [95%C.I.] in 1994-1998. IP, PC and SG showed the final mortality rate of 0.65, 4.14 and 1.49, respectively. Three major causes of all critical incidents in 52 detailed classification of principal causes were preoperative hemorrhagic shock (31.4%), massive hemorrhage due to surgical procedures (16.9%), and preoperative multiple organ failure/sepsis (9.0%). In conclusion, the obtained incidences as to cardiac arrest and death, either in total number during anesthesia/surgery or in that due to anesthetic management, kept decreasing lineally through 8 years study in 1994-2001. We expect that this second series of annual studies for five-years should reveal precise and definite direction for us to reduce anesthesia-related mortality and morbidity by analyzing further detail with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods.

Anesthesia↗
PubMed2003

[The relationship between the yearly number of operations and mortality due to intraoperative critical incidents in patients for cardiac surgery: an analysis of annual survey 2001 conducted by the Japanese Society of Anesthesiologists].

BACKGROUND: The number of surgical operations performed has been reported to have a relation with surgical morbidity and mortality. In Japan, however, the relationship between surgical load and outcome has not been elucidated. METHODS: We investigated this relationship in patients for cardiac surgery using data from the 2001 annual survey concerning anesthesia-related critical incidents, conducted by the Committee on Operating Room Safety, Japanese Society of Anesthesiologists. Between January 1, 2001 and December 31, 2001, 43,411 patients for cardiac surgery patients were registered from 486 training hospitals certified by the Japanese Society of Anesthesiologists. Intraoperative critical incidents occurred in 632 of the patients. Of these, 289 patients died within 7 postoperative days. The overall mortality was 66.57 per 10,000 anesthetics. Hospitals were divided into 4 groups according to their annual numbers of cardiac operations: Group A, fewer than 50; Group B, 50-99; Group C, 100-199; Group D, more than 200. Mortality rate was expressed as a mean +/- SD (95% confidence interval). RESULTS: The mortality rates in Group A-D were 107.64 +/- 327.33 (63.47-151.81), 114.42 +/- 168.76 (83.02-145.87), 63.53 +/- 84.35 (48.04-79.01), and 36.97 +/- 52.83 (22.32-51.61) per 10,000 anesthetics, respectively. CONCLUSIONS: The yearly number of operations has been shown to affect mortality rate due to intraoperative critical incidents among patients for cardiac surgery in Japan. Hospitals with a small number operations should pay significant attention to improving surgical outcome. These results also suggest that centralization or regionalization of cardiac surgery should be discussed from the socio-economical points as well as patient safety.

Anesthesia↗
PubMed2003

[Incidence and clinical characteristics of perioperative pulmonary thromboembolism under the use of intermittent pneumatic compression as a preventive measure].

Pulmonary thromboembolism (PTE) is a crucial complication characterized by rapid onset and a high mortality rate. There are few reports concerning perioperative incidence of PTE and deep vein thrombosis (DVT) among Japanese population. All surgical patients excluding young patients for minor surgery were equipped with calf- or thigh-length intermittent pneumatic compression (IPC) device as a DVT preventive method during the period of immobility. Incidence and clinical characteristics of perioperative PTE and DVT under the use of IPC device were analyzed at Kobe University Hospital. One patient developed DVT and four patients developed PTE among the 6500 surgical cases. All patients with DVT or PTE were 66 years or older, and all patients were diagnosed by computer tomography, venography and pulmonary angiography between 7 to 14 days after each operation. One patient was surgically treated by embolectomy and removal of intraarterial thrombus, and others were treated with thrombolysis, anticoagulants and placement of vena cava filters. For prevention of DVT and PTE, other preventive methods such as anticoagulants and prolonged application of IPC should be necessary.

Age Factors↗
PubMed2002

The effects of intravenous anesthetics and lidocaine on proliferation of cultured type II pneumocytes and lung fibroblasts.

UNLABELLED: Type II pneumocytes synthesize surfactant and differentiate into type I pneumocytes to maintain the epithelium (1). Alveolar type II cell proliferation is required for reepithelization after acute lung injury (ALI) and is thought to minimize the subsequent fibrotic response (1). Keratinocyte growth factor (KGF) and hepatocyte growth factor (HGF) are among the most potent mitogen for type II epithelial cells, but not for fibroblasts in the lung (1). These growth factors attenuate several experimental ALI models by promoting epithelial repair (2,3). Thus, KGF and HGF may be a promising therapeutic approach to ALI. Critically ill patients with ALI often receive IV anesthetics or sedatives to facilitate mechanical ventilation. Furthermore, these patients sometimes undergo bronchoscopy under local anesthesia to obtain bronchoalveolar lavage fluid or to remove respiratory secretions. Several IV and local anesthetics inhibit proliferation of various cells including epithelium (4,5). If these anesthetics impede proliferation of type II pneumocytes, this suppressive effect may be a disadvantage for alveolar reepithelization in the course of recovery from ALI. In this study, we examined the effects of midazolam, propofol, ketamine, thiopental, and lidocaine on proliferation of type II alveolar epithelial cells using in vitro culture system. Because fibroblast proliferation is a key event in late phase of ALI, inhibition of this fibroproliferation is probably beneficial. Thus, we further determined whether these anesthetics could regulate proliferation of lung fibroblasts. In the current study, rolipram was used as a positive control. In our previous preliminary experiment, we found that rolipram, a phosphodiesterase inhibitor type IV, augments spontaneous or KGF-/HGF-promoted type II cell proliferation (6). IMPLICATIONS: Midazolam, ketamine, thiopental, propofol, or lidocaine did not inhibit proliferation of cultured rat type II pneumocytes. Our findings suggest that these anesthetics do not impede alveolar reepithelization after acute lung injury.

Anesthetics, Dissociative↗
PubMed2002

The efficacy of lafutidine in improving preoperative gastric fluid property: a comparison with ranitidine and rabeprazole.

IMPLICATIONS: Acid aspiration syndrome remains a potentially critical perioperative complication. We compared lafutidine, ranitidine, and rabeprazole for reduction of preoperative gastric fluid acidity and volume in elective surgery and found that these variables were minimized with a single morning dose of lafutidine 20 mg compared with ranitidine or rabeprazole. Preoperative oral lafutidine may be an alternative to ranitidine as a prophylaxis against aspiration pneumonia.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2002

Efficacy of clonidine for prevention of perioperative myocardial ischemia: a critical appraisal and meta-analysis of the literature.

BACKGROUND: There is a belief that clonidine may be effective in reducing perioperative myocardial ischemic events, although the results of several trials are conflicting. The aim of the current study was to provide a systematic review of randomized controlled trials that tested the efficacy of clonidine in this regard. METHODS: Data was collected from a MEDLINE search of English-language studies published from 1980 to 1999 and a manual search of bibliographies from retrieved articles. A total of 28 studies were assessed. According to the selection criteria (study design, population, intervention, and outcome) and a quality scoring system, seven studies were finally included in the meta-analysis. After homogeneity was established by Q value, the data were then combined using the fixed-effects model. The pooled odds ratio was calculated. A subgroup analysis based on the types of surgery and administration route was also performed to qualify the results. The results were expressed as odds ratio and 95% confidence interval. RESULTS: Heterogeneity of outcome data was negative in the trials. The pooled odds ratio was 0.49 (95% confidence interval 0.34-0.71). In the subgroup analysis, clonidine reduced the incidence of myocardial ischemia in patients undergoing cardiac and noncardiac surgery. Rates of bradycardia were similar in clonidine and placebo groups. CONCLUSION: The meta-analysis suggests that perioperative clonidine reduces cardiac ischemic episodes in patients with known, or at risk of, coronary arterial disease without increasing the incidence of bradycardia. Therefore, these findings strongly justify planning and execution of a definitive study seeking the benefits of clonidine.

Adrenergic alpha-Agonists↗
PubMed2002

[Perioperative mortality and morbidity in the year 2000 in 502 Japanese certified anesthesia-training hospitals: with a special reference to ASA-physical status--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety].

Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 certified training hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to ASA physical status (ASA-PS). The total number of anesthesia available for this analysis was 897,733. The percentages of patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E are 38.0, 40.3, 8.5, 0.4, 4.3, 5.3, 2.5, and 0.7%, respectively. Mortality and morbidity from all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and surgical problems were as follows. The incidences of cardiac arrest (per 10,000 cases of anesthesia) were 1.11, 3.26, 12.25, 54.60, 0.77, 4.46, 21.08 and 217.75 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 6.89, 20.22, 62.18, 148.21, 6.71, 20.38, 106.72 and 592.21 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7 postoperative days) after cardiac arrest were 0.26, 0.77, 3.69, 41.60, 0.00, 1.06, 9.42 and 163.31 per 10,000 cases of anesthesia in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.32, 1.38, 9.75, 70.20, 0.26, 2.12, 29.15 and 353.02 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthesia than in elective anesthesia. ASA-PS correlated well with overall mortality and morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.23, 0.50, 1.32, 0.00, 0.00, 0.85, 2.69 and 4.95 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 3.13, 5.56, 11.46, 5.20, 3.87, 5.94, 13.90 and 14.85 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.03, 0.03, 0.00, 0.00, 0.00, 0.21, 0.45 and 3.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.03, 0.06, 0.00, 0.00, 0.00, 0.21, 0.45 and 6.60 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rate totally attributable to anesthesia among patients with good physical status (ASA-PS of I, II, I E, II E) was 0.05. Anesthetic management was mainly responsible for critical events in patients with good physical status, while coexisting diseases were in those with poor physical status. Surgical problems including procedures and massive hemorrhage were the leading causes of mortality in patients with good physical status. We reconfirmed that ASA-PS is useful to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation in those with poor physical status. Reducing mortality and morbidity from surgical problems is also required for improving perioperative mortality.

Anesthesia↗
PubMed2002

[Anesthetic management for laryngotracheal separation and tracheoesophageal diversion].

Patients with severe neurological impairment may develop recurrent pneumonia due to aspiration. Laryngotracheal separation and tracheoesophageal diversion are one of the surgical treatments to prevent salivaly aspiration. We report anesthetic management for laryngotracheal separation and tracheoesophageal diversion of five pediatric patients with severe cerebral palsy. Anesthetic problem was that all patients was repeating intractable pneumonia. And when the trachea was resected from esophageal mucosa, we experienced temporary ventilatory disturbance. So airway management was most important during anesthesia. Perioperative complications were postanesthetic seizure and postoperative brief apnea. Recurrent fever and aspiration pneumonia subsided in all of them. Our impression is that laryngotracheal separation and tracheoesophageal diversion are not so invasive surgical treatment for intractable pneumonia. But perioperative management should be concerned about both respiratory and neurological problems.

Adolescent↗
PubMed2002

[Annual study of anesthesia-related mortality and morbidity in the year 2000 in Japan: the outlines--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety].

This report contains anesthesia-related mortality and morbidity in Japanese Society of Anesthesiologists Certified Training Hospitals (JSACTH) in the year 2000, as a part of the second series of annual studies started in 1999. JSA Committee on Operating Room Safety (CORS) sent confidential questionnaires to 794 JSACTH and received effective answers from 65.5% of hospitals. A total number of 941,217 anesthetics were documented. The respondents were asked to report all cases of cardiac arrests and other critical incidents (serious hypotension, serious hypoxemia and others), and their outcomes (death in operating room, death within 7 days, transfer to vegetative state and rescue without sequelae) as well as one principal cause for each incident from the list of 52 items. They were also requested to submit the tabulation of patients by ASA physical status, age distribution, surgery sites and anesthetic methods. Analysis was made by total incidents under anesthesia/surgery, and also by incidents totally attributable to anesthetic management (AM), due to preoperative complications (PC), due to intraoperative pathological events (IP) and due to surgery (SG). This paper focused analysis on entire patients, since analyses with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods were reported previously. Total incidence of cardiac arrest under anesthesia/surgery was 6.52 per 10,000 anesthetics. PC, IP and SG occupied 46.4%, 19.1% and 23.0% of principal causes of total cardiac arrest, respectively. AM occupied only 8.1% of the principal causes and the incidence was 0.53 per 10,000. The most frequent cause of cardiac arrest in 52 more detailed classification of principal causes was preoperative hemorrhagic shock that occupied 23.3% of all cardiac arrests. The second was massive hemorrhage and/or hypovolemia due to surgical procedures (10.6%), and the third was surgery itself (9.5%). Prognosis of the cardiac arrest was worst in that due to PC, 73.7% of cardiac arrests died in the operating room or within 7 days after surgery and only 20.4% survived without sequelae. The best prognosis was found in cardiac arrest due to AM, 76.0% survived without sequelae and 12.0% died. The mortality rate after cardiac arrest was 3.52 per 10,000 anesthetics, of them 0.06 was due to AM, 0.39 due to IP, 2.23 due to PC and 0.76 due to SG. The mortality rate after critical incidents other than cardiac arrest such as severe hypotension and severe hypoxemia was 3.48, and of them 0.03 was due to AM, 0.18 due to IP, 2.45 due to PC and 0.81 due to SG. The final mortality rate attributable to anesthesia/surgery including deaths after cardiac arrest and after other critical incidents was 7.00 per 10,000 anesthetics and very close to 7.18 [6.22, 8.13], that of mean [95%C.I.] in 1994-1998, and 7.19 in 1999. The final mortality rate totally attributable to AM was 0.10 per 10,000 anesthetics, which was significantly improved from 0.21 [0.15, 0.27], that of mean [95%C.I.] in 1994-1998, but not different from 0.13 in 1999. IP, PC and SG showed the final mortality rate of 0.56, 4.69 and 1.57, respectively. Five major causes of all critical incidents were massive hemorrhage due to surgical procedures (13.8%), preoperative hemorrhagic shock (13.1%), surgical technique (8.6%), inappropriate airway management (6.2%) and preoperative respiratory complication (5.7%). Drug overdose or wrong choice (2.7%) as a human error occupied the 10th. In conclusion, the obtained incidences as to death, other critical incidents and their outcomes as well as the occurrence of principal causes in 2000 study were remarkably close to those in 1999 study. We expect that this second series of annual studies for five-years should reveal precise and definite direction for us to reduce anesthesia-related mortality and morbidity.

Anesthesia↗