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Biomedical subjects

K Kinouchi

Publications and source records attributed to K Kinouchi.

At least 19 recordsLinked to original sources
PubMed2005

[Off-pump coronary artery bypasssurgery in patients with mitral regurgitation].

Introduction of off-pump coronary artery bypass grafting (off-pump CABG : OPCAB) makes it possible to shorten the bypass time and cardiac arrest time in patients with both ischemic heart disease and valvular disease. This may be beneficial in patients with poor cardiac function and renal dysfunction. However, it is unclear whether such patients can tolerate the changes of hemodynamics during vertical displacement of the heart. In 3 patients who had ischemic heart disease with non-ischemic mitral regurgitation, we performed OPCAB prior to mitral valve plasty. The changes of mitral regurgitation observed by transesophageal echocardiography and several hemodynamic parameters were monitored as the heart was moved to various positions during OPCAB. When a heart positioner (Starfish) was used, hemodynamic deterioration was not observed, and there was also no aggravation of mitral regurgitation. Based on these results, we conclude that it may be possible to carry out OPCAB safely in patients with associated mitral regurgitation.

Adult↗
PubMed2001

Respiratory system compliance and postoperative ventilator dependence in neonates with left-sided congenital diaphragmatic hernia.

PURPOSE: The purpose of this prospective consecutive patient study was to test if perioperative respiratory system compliance of patients undergoing surgical repair of congenital diaphragmatic hernia (CDH) can predict the need for prolonged postoperative mechanical ventilation. METHODS: All neonates over 35 weeks of gestation who had surgical repair of left-sided CDH between July 1994 and December 1996 ( n = 10) were included in this study. Static respiratory system compliance (C(rs)) was measured by the passive occlusion method with muscle relaxation before (C(pre)) and after (C(post)) surgical repair of left-sided CDH. We examined the relationship between respiratory system compliance and postoperative ventilator-dependent duration. RESULTS: The mean birthweight-corrected C(post) was lower than that of birthweight-corrected C(pre) (0.41 +/- 0.18 vs 0.54 +/- 0.18 ml.cm H(2)O(-1).kg(-1), P = 0.04). One neonate died on postoperative day 31 from intraventricular hemorrhage, and the other nine neonates survived. The patient who died was excluded from the rest of our calculations. The ventilator-dependent duration was 16.7 +/- 12.3 days. The postoperative ventilator-dependent duration was longer when the birthweight-corrected C(post) was smaller, with a significant correlation between these parameters ( P = 0.006). CONCLUSION: C(post), but not C(pre), may be useful to predict the need for prolonged postoperative mechanical ventilation in neonates with left-sided CDH.

Journal Article↗
PubMed2001

[Anesthetic management for the correction of pectus excavatum using pectus bar under video-assistance].

We report anesthetic management for a child undergoing Nuss operation, a minimally invasive operation which requires neither cartilage incision nor its resection for correction of pectus excavatum. The patient was a 7-year-old boy with the funnel index 5 and the mediastinal shift to the left. General anesthesia with endotracheal intubation was induced and maintained with nitrous oxide, sevoflurane and fentanyl. Thoracic epidural anesthesia was used with 0.125% bupivacaine to supplement analgesia. When the curved bar was passed under the sternum with the aid of an endoscope, sinus tachycardia occurred and continued for 5 minutes but subsided without medication. Otherwise operative course was uneventful with negligible blood loss. After surgery, the patient was kept at bed rest for 2 days, receiving epidural patient-controlled analgesia combined with sedation with midazolam with good results. He was allowed to sit 3 days, to walk 5 days and discharged 10 days postoperatively.

Analgesia, Patient-Controlled↗
PubMed2001

[Perioperative management of a child with congenital nephrogenic diabetes insipidus].

The key point in perioperative management of a patient with congenital nephrogenic diabetes insipidus is fluid and electrolytes management. Since the urine of these patients consists mainly of solute free water, replacement fluids should be fluids which provide free water. A 2-year-old girl with congenital nephrogenic diabetes insipidus was scheduled for dental extraction. Her daily fluid intake was 10 liter. She had a history of recurrent fever, polyuria and polydipsia since 2 months of age. Her previous perioperative course for gastric volvulus at another hospital was complicated with postoperative hyponatremia and convulsion. A venous line was secured the day before surgery and 5% dextrose in water was infused at a rate of 12 ml.kg-1.hr-1. Intraoperative infusion was mainly with 5% dextrose in water combined with maintenance fluid. Five hours after surgery oral intake was started. Her intraoperative electrolytes levels were low (Na 133 mEq.l-1, K 2.8 mEq.l-1), but otherwise her perioperative course was uneventful.

Anesthesia, Inhalation↗
PubMed2001

[Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia].

We compared recovery characteristics of propofol anesthesia with those of sevoflurane anesthesia in pediatric outpatients. One hundred and four children, 3 months to 6 years of age, ASA physical status 1 or 2, were randomly assigned to following four groups; sevoflurane (group S), propofol (group P), sevoflurane with premedication (group MS), or propofol with premedication (group MP). Midazolam 0.5 mg.kg-1 and famotidine 1 mg.kg-1 were administered orally 30 min before the induction in the MS and MP group. Recovery from anesthesia, agitation, and postoperative pain were evaluated. The time intervals from the end of surgery to extubation and to discharge from the hospital were recorded. The incidence of vomiting and use of analgesic drugs were also checked. The emergence from anesthesia was slower with propofol anesthesia than with sevoflurane anesthesia, but the time to discharge from the hospital was not significantly different among the four groups. Incidence of agitation was higher in S group compared with P group, but there were no differences between MS and MP. Postoperative pain was similar among the four groups. There were no differences in the incidence of vomiting. Propofol anesthesia provided slower emergence and less agitation compared with sevoflurane anesthesia.

Anesthesia Recovery Period↗
PubMed2001

[Perioperative management of twins with prenatally diagnosed congenital diaphragmatic hernia].

Congenital Diaphragmatic Hernia (CDH) occurs in one of every 2000-3000 births, and most of them are sporadic, and therefore recognized as a circumstantial event. But its occurrence in 85 children among the 40 families is also reported, and some reports suggest that an autosomal recessive gene may be responsible for this disease. We experienced identical twins (babies A and B) both with prenatally diagnosed CDH. They were delivered by emergent cesarean section at 33 weeks of gestation with birth weight of 1857 g and 1561 g, respectively. They were intubated immediately after birth, and ventilated with high frequency oscillation. Baby A presented persistent pulmonary hypertension of newborn, and received nitric oxide inhalation. At the age of 2 days, both of them were stabilized and underwent repair of CDH. After the repair, baby A developed perforation of ileum, airway bleeding and retinopathy of prematurity (ROP), and needed 28 days before extubation. Baby B also developed ROP, but had no other problem, and the trachea was extubated at the age of 12 days. They are the seventh pair reported in the world literature.

Diseases in Twins↗
PubMed2001

[Perioperative management of a neonate with aglossia-adactylia syndrome].

Aglossia-adactylia syndrome is a rare disorder characterized by aglossia and deformity of the limbs of variable degree. We managed a 2-day-old neonate with ileojejunal atresia with aglossia-adactylia syndrome. He was scheduled for the repair of the intestinal atresia, gastrostomy and palatal impression taking, under general anesthesia with sevoflurane supplemented with fentanyl. In this case we could achieve tracheal intubation by direct laryngoscopy with cricoid pressure applied, and could manage without any complications. But many of the patients with this syndrome are complicated with cleft palate and micrognathia, and we should be careful of the difficult airway at the induction of general anesthesia and aspiration during perioperative period.

Abnormalities, Multiple↗
PubMed2001

[An extremely low birth weight infant with pulmonary atresia complicated with necrotizing enterocolitis].

We experienced an extremely low birth weight (ELBW) infant complicated with pulmonary atresia and necrotizing enterocolitis. She was born at 25 weeks of gestation with a birth weight of 752 g. Five hours after birth, she manifested cyanosis and was diagnosed as having pulmonary atresia with intact ventricular septum (PAIVS). Infusion of lipo-prostaglandin E1 (PGE1) was started to keep the ductus open along with infusion of dopamine and dobutamine. At 8 days of life she developed hypotension and metabolic acidosis, and the diagnosis of intestinal perforation was made by free air in the abdomen. The excessive shunt flow to the pulmonary vasculature via the ductus was suspected to have caused an inadequate systemic flow leading to the intestinal ischemia and necrotizing enterocolitis. Lipo-PGE1 was discontinued to decrease the shunt flow through the ductus. Brock's operation (closed transventricular pulmonary valvotomy) was performed at the age of 8 and 11 days and the ligation of the ductus arteriosus was performed at the age of 13 days. Propranolol was administered to inhibit the pulmonary outflow tract constriction along with catecholamines to stabilize hemodynamics. She recovered slowly and her trachea was extubated at 58 days of life.

Anesthesia↗
PubMed2001

[Two pediatric cases of malignant hyperthermia caused by sevoflurane].

We experienced two cases of malignant hyperthermia (MH) triggered by sevoflurane. Case 1 was a six-year-old girl, 15.8 kg, undergoing strabismus repair. She had flat back, elevated diaphragm and high arched palate. Anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Her trachea was intubated without the use of muscle relaxant. Thirty minutes after the induction of anesthesia, ETco2 was over 60 mmHg despite hyperventilation. Muscle rigidity of legs and the rise in temperature were noted. MH was diagnosed and dantrolene i.v. was administered. Her maximum esophageal temperature was 40.2 degrees C. ETco2 and temperature returned to baseline values after dantrolene administration. Creatine phosphokinase (CK) level was 252 U.l-1 preoperatively, and 1690 U.l-1 next day. Case 2 was a year-and-9-month-old boy undergoing accessory ear resection. Anesthesia was induced with sevoflurane and nitrous oxide in oxygen. His trachea was intubated with an aid of vecuronium. Forty minutes after administration of sevoflurane his temperature rose to 38.6 degrees C with heart rate 191 bpm and Spo2 93%, and muscle rigidity of legs. MH was diagnosed and dantrolene was administered. His highest temperature was 39.3 degrees C and was reduced promptly after dantrolene. Postoperatively he was noted to have downslanting palpebral fissures, micrognathia, low set ears, and a single crease of the fifth finger and diagnosed as King syndrome which is reported to have association with MH. Both patients had no history of anesthesia nor abnormal family history. Both of them were rescued with dantrolene and recovered without sequelae.

Anesthetics, Inhalation↗
PubMed2001

[Evaluation of the new pump for home parenteral nutrition Terumo Cafty].

This study was undertaken to evaluate the usefulness of 'Cafty' which is a new infusion pump system for administering home parenteral nutrition (HPN), recently launched by Terumo Corporation. We used 'Cafty' in two patients and found it has more advantages than the existing pump with regard to the following points: 1. Cafty is provided with a display and alarms that indicate pump troubles such as emptiness, occlusion or mis-operation. 2. It is easier to carry because of its smaller size (width 80 mm x length 132 mm x thickness 33 mm) and its lighter weight (320 g). 3. While Cafty operation using a cassette-type tubing and plain control panel to simpler the flow rate accuracy is not reduced. In conclusion, Cafty is better than the existing HPN pump from the viewpoint of safety, portability and easiness.

Adolescent↗
PubMed2000

Platelet function in pregnant women receiving aspirin and dipyridamole.

PURPOSE: This study was undertaken to evaluate the hemostasis and coagulation profile of pregnant women receiving antiplatelet therapy with low-dose aspirin and dipyridamole for prevention of preeclampsia, intrauterine growth retardation, or pregnancy losses. METHODS: Twenty-three pregnant women who received antiplatelet therapy with combined aspirin (40 mg.day(-1)) and dipyridamole (150 mg.day(-1)) were enrolled in the study. Platelet aggregation and coagulation tests were performed before the start of aspirin and dipyridamole, during medication, and at 3 days and 6 days after cessation of medication. RESULTS: Collagen-induced platelet aggregation was decreased during medication (25 +/- 26%, P < 0.001) and at 3 days after cessation of medication (46 +/- 35%, P < 0.001) compared with that before the start of medication (89 +/- 7%). ADP-induced platelet aggregation was decreased during medication compared with that before medication (66 +/- 18% vs 92 +/- 7%, P < 0.001). The platelet count, prothrombin time, activated partial thromboplastin time, bleeding time, and levels of fibrinogen and antithrombin III did not change over time. The blood loss of these patients during vaginal delivery and cesarean section did not differ from that of normal women during vaginal delivery and repeat cesarean section, respectively. CONCLUSION: At the doses used in this study, aspirin and dipyridamole inhibited platelet aggregation for up to 3 days after cessation of medication. This abnormality of aggregation was not detected by the bleeding time and was not associated with clinically abnormal bleeding.

Journal Article↗
PubMed2000

Postbypass pulmonary artery pressure influences respiratory system compliance after ventricular septal defect closure.

It is reported that surgical correction of left-to-right shunt improves respiratory function in paediatric cardiac patients. However, such correction sometimes does not result in an improvement of respiratory compliance. The purpose of this study was to look for factors determining changes in respiratory system compliance (Crs) in patients who underwent closure of ventricular septal defect (VSD closure). In a prospective study, 17 children (< 10 kg) who underwent VSD closure were enrolled. They were divided into two groups, according to postbypass mean pulmonary artery pressure (mPAP). The patients were allocated to Group C if mPAP was < or = 18 mmHg (n=12) and to Group PH if > 18 mmHg (n=5). We compared the ratio of postoperative Crs to preoperative Crs (Cpost/Cpre) between the groups. A multiple occlusion technique was used to measure Crs. The Cpost/Cpre in group C was larger than that in group PH (1.11+/-0.17 vs. 0.81+/-0.12, P<0.01). There was a correlation between postbypass mPAP and Cpost/Cpre (r(s)=0.49, P<0.05), but no correlation was noted between preoperative mPAP, Qp/Qs or Rp/Rs and Cpost/Cpre. We concluded that high postbypass mPAP was associated with a perioperative decrease in Crs after VSD closure.

Blood Pressure↗
PubMed2000

[Cesarean section in a pregnant patient with placenta percreta involving the urinary bladder].

Placenta percreta involving adjacent structures is serious complication of pregnancy with a high mortality rate. A 32-year-old woman, gravida 4, para 3, who had previously undergone a cesarean section, was admitted to our hospital at 31 weeks' gestation for placenta previa. At 33 weeks' gestation, the diagnosis of placenta percreta with involvement of the urinary bladder was made by ultrasonography and magnetic resonance imaging. At 34 weeks' gestation, an elective cesarean section was scheduled. Anesthesia was maintained with sevoflurane in oxygen before delivery, and with nitrous oxide in oxygen, fentanyl and midazolam after delivery. During the operation, attempts to remove the placenta resulted in massive hemorrhage. Blood loss for the procedure was 13,800 g. Because of the extreme hemorrhage, we encountered hemorrhagic shock and postoperative complications despite the preoperative preparation. In case of placenta percreta, it is essential to prepare adequate volume of blood for transfusion at the start of surgery and secure large bore intravenous lines. A rapid transfusion device may be recommended. Regarding the anesthetic management, general anesthesia is preferable in consideration of the risk of hemorrhagic shock and the length of operation time. Furthermore, we need team approach and preoperative management to prevent the uncontrolled hemorrhage in such a severe case.

Adult↗
PubMed2000

[Perioperative management of two neonates with severe Ebstein's anomaly with pulmonary atresia].

Ebstein's anomaly appearing during the neonatal period carries a high mortality rate. We report the perioperative management of two neonates with severe Ebstein's anomaly associated with pulmonary atresia. Their chest radiography revealed massive cardiomegaly, with cardiothoracic ratio of 90% and 100%, respectively. Their tracheas were intubated immediately after birth because of severe respiratory distress. The babies were laid in the prone position and one of them was managed with high frequency oscillatory ventilation (HFO) for prevention of pulmonary barotrauma and extensive atelectasis in the preoperative period. On the 4th and 3rd day after birth, respectively, they underwent Starnes procedure which consists of closure of tricuspid valve, enlargement of atrial septal defect, reduction of right atrium and creation of aortopulmonary shunt reported to be a useful palliative treatment for critically ill neonates with Ebstein's anomaly. Case 1 baby could not be weaned from cardiopulmonary bypass because of low cardiac output. Case 2 could not be weaned from extracorporeal membrane oxygenation due to hypoxia. We consider, however, treatment of respiratory failure and lung protection after birth are important for the prognosis. Perioperative use of HFO may be advantageous for the neonate with severe Ebstein's anomaly with pulmonary atresia.

Cardiovascular Surgical Procedures↗
PubMed1999

Improved oxygen delivery to the fetus during cesarean section under sevoflurane anesthesia with 100% oxygen.

PURPOSE: To assess the potential benefits of sevoflurane with 100% oxygen in cesarean section in terms of oxygen delivery to the fetus, neonatal depression, and uterine contractility. METHODS: Thirty-six patients undergoing elective cesarean section were enrolled. After thiamylal induction, 0.7% sevoflurane-60% nitrous oxide-40% oxygen anesthesia was administered in group G1 (n = 9), and 1.7% sevoflurane-100% oxygen anesthesia was administered in group G2 (n = 9). Spinal anesthesia under oxygen nasal prong was used in group SP (n = 18). RESULTS: At delivery, the PO(2) values in the maternal artery and the umbilical vein and artery (MA, UV, UA) of group G2 (474 +/- 50, 43 +/- 9, 32 +/- 9 mmHg, respectively) were significantly greater than those in groups G1 (228 +/- 46, 31 +/- 4, 23 +/- 5 mmHg, respectively) and SP (147 +/- 21, 30 +/- 7, 18 +/- 7 mmHg, respectively). The SO(2) in the UA of group G2 (56 +/- 17 %) was also greater than that in groups G1 (34 +/- 10 %) and SP (32 +/- 10 %). The sevoflurane concentrations at delivery in the MA, UV, and UA in group G2 were almost threefold higher than those in group G1, whereas all the newborns in the three groups had Apgar scores of 8 or more at 5 min, and the intraoperative blood loss did not differ among the groups. CONCLUSION: Sevoflurane anesthesia with 100% oxygen in elective cesarean delivery improves oxygen delivery to the fetus without severe neonatal depression, prolonged uterine relaxation, or increased blood loss.

Journal Article↗
PubMed1999

Brachial plexus birth injuries: anaesthesia for surgical nerve reconstruction and preoperative myelography and computed tomographic myelography.

Surgical nerve reconstruction for brachial plexus birth injuries and preoperative myelography and computed tomographic (CT) myelography require special anaesthetic considerations. Anaesthesia and medical records were retrospectively reviewed for the infants who underwent myelography, CT myelography (n=37) and microsurgical nerve reconstruction (n=34) at our institution from January 1993 to August 1996. Anaesthetic considerations include long duration of operation, perioperative respiratory complications and plaster application which makes reintubation difficult. Myelography for diagnosis requires a specific positioning of the patient with the head fixed in a midline and prone position.

Anesthesia, Inhalation↗
PubMed1999

A new modification of anaesthesia mask for fibreoptic intubation in children.

We made a paediatric anaesthesia mask suitable for fibreoptic intubation by modifying a commercially available disposable mask with a ventilation port (Vent port) on a side. We added a large fibreoptic port (FO port, 22 mm in ID) in the middle of the mask to allow the passage of all sizes of paediatric tracheal tubes. This FO port was covered with an elastic rubber membrane to allow air-tight fibrescopic manipulation Fibreoptic intubation was performed safely through the FO port under continuous manual ventilation with anaesthetic gases via a Vent port connected to the breathing circuit. We succeeded in tracheal intubation in several infants and children with difficult airway in less than ten min, mainly via the nasotracheal route. This fibreoptic mask provides a safer technique for fibreoptic intubation in patients with difficult airways, especially in infants and small children.

Anesthesia, Inhalation↗