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Biomedical subjects

K Kinouchi

Publications and source records attributed to K Kinouchi.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Congenital ventricular diverticulum in a neonate: anesthetic considerations].

Congenital diverticulum of the ventricle is a rare cardiac malformation and the reports of its surgical repair are scarce. We experienced anesthesia for a neonate with an isolated congenital left ventricular diverticulum diagnosed in utero. A male infant presented with ventricular arrhythmias and congestive heart failure. At 9 days of life the resection of the diverticulum was performed under moderately hypothermic cardio-pulmonary bypass (CPB) Major anesthetic considerations include the possible life-threatening arrhythmias, cardiac failure due to diverticulum and cardiac dysfunction after resection. Premature ventricular contractions were noted before CPB but greatly decreased under anesthesia. The operation was performed safely and arrhythmias disappeared completely after resection. Intra- and post-operative course was uneventful without any sign of cardiac dysfunction.

Anesthesia, Inhalation↗
PubMed1999

[Anesthetic management of parturients with cerebrovascular diseases].

From January 1992 to December 1997, 13 parturients with cerebrovascular diseases had childbirth at our institution. Among them, 8 patients received anesthesia for delivery. Five patients had a history of ruptured arteriovenous malformation (AVM), cerebral aneurysm, or intraventricular bleeding due to moyamoya disease, and they had radical operations. Of these 5 patients after radical operations, three had a repeat cesarean section under spinal anesthesia, and two had a vaginal delivery under epidural anesthesia to avoid excessive hypertension and hyperventilation. There were two patients with a history of cerebrovascular diseases but had no radical operations. Of these two, one patient who was diagnosed as having aneurysm underwent elective cesarean section under spinal anesthesia, and another patient with a history of cerebral bleeding underwent cesarean section under general anesthesia for abruptio placentae. These 7 patients did well during pregnancy and puerperium. The eighth patient experienced severe headache followed by loss of consciousness caused by ruptured AVM, and required an emergency operation. Simultaneous cesarean section and craniotomy were performed at another hospital. Intrauterine fetal death (IUFD) occurred, but mother survived.

Adult↗
PubMed1999

[Anesthetic management for newborn pharyngeal teratoma].

Epignathus (pharyngeal teratoma) is a rare disease of newborns associated with a high mortality secondary to airway obstruction in the neonatal period. We report anesthetic management of a newborn with epignathus who underwent tumor resection. He was delivered vaginally at 39 weeks of gestation and Apgar scores were 9 at 1 and 5 min. The tumor originated from the palate, almost filled the oral cavity and protruded through the mouth with its external part 6 x 7 cm in size. He could breathe with the head and mass turned to the left. The excision of the tumor was scheduled on the fifth day of life. Mask ventilation and laryngoscopy were considered impossible. Fiberoptic nasal intubation was successfully performed with topical anesthesia without sedation. Tumor was resected with blood loss of 103 gm. The trachea was extubated on the third postoperative day and the postoperative course was uneventful. For safe management of cases of pharyngeal teratoma, careful preoperative assessment of the airway is most important and sufficient preparation and careful intubation are mandatory to keep airway patent. The perioperative bleeding from the tumor and the airway obstruction by the tumor or its remnant after the excision could also be hazardous to the airway.

Anesthesia, Inhalation↗
PubMed1999

[A new bite block also serving as an endotracheal tube holder for infants].

We developed a new type of bite block with a combined function as an endotracheal tube (ETT) holder for infants and small children to prevent airway troubles caused by tube kinking, dislodging, extubation and oral membrane trauma. One mm thick plastic plate sized 3.5 x 2 cm was curved to make an open roll. The outer surface of the roll was covered and glued with soft plastic tube (5.0 mm ID endotracheal tube), cut in 3.5 cm length to give an elastic outer surface for the patient's comfort. The rolled ends were diagonally cut to make an oblique slit of 3 mm width. A t-shaped flange made of soft vinyl plate was fixed at a third of the length of the roll to maintain the block's position relative to the lips and to make the fixation of the tube easier. In practical use, after endotracheal intubation is performed as usual, this bite block is put into the mouth and positioned at the oral angle with the flange on the patient's skin. The ETT is fit into the slit of the roll. The skin-facing surface of the flange is pasted to the skin with the double stick material usually used for colostomy stoma. The ETT and the bite block are fixed en bloc with fixing tapes around the mouth. Our bite block has following advantages over other types of bite blocks and tube holders especially for children; 1) the volume of foreign bodies (ETT and bite block) occupying the oral cavity can be reduced and this attenuates the patient's discomfort, 2) good holding of the ETT can prevent its dislodging and decrease the incidence of accidental extubation and 3) suctioning is easier because of wide oral space. The four sizes of the bite block suitable for 4.0, 4.5, 5.0, 5.5 and 6.0 mm ID ETTs are manufactured. We applied this device to several ICU patients and found its use practical and safe.

Child, Preschool↗
PubMed1999

A rare case of upper airway obstruction in an infant caused by basal encephalocele complicating facial midline deformity.

A four-month-old male infant with basal encephalocele of the transsphenoidal type presented with upper airway obstruction and facial midline deformity, including cleft lip, cleft palate, hypertelorism and exophthalmos. Basal encephalocele is a rare disease, and usually not detectable from the outside. In this case, initially the cause of an upper airway obstruction was considered to be posterior rhinostenosis, and posterior rhinoplasty with inferior nasal conchectomy was scheduled. However, in preoperative examination, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a bony defect in the sphenoidal bone and a cystic mass in communication with cerebrospinal fluid, herniating into the nasal cavity through the bony defect. The mass was diagnosed as a transsphenoidal encephalocele, the scheduled operation cancelled, and tracheostomy performed for airway management. The possibility of basal encephalocele should be considered in the case of upper airway obstruction with facial midline deformity.

Cleft Lip↗
PubMed1998

[Anesthetic management involving difficult intubation in a child with Gaucher disease].

Gaucher disease is the most common of the glycolipid storage disorders caused by the deficiency of glucocerebrosidase, an enzyme which hydrolyzes glucocerebroside to glucose and ceramide. Accumulation of the substrate leads to multiorgan dysfunction involving the brain, spleen, liver, lymph node and bone marrow. In anesthetic management, gastroesophageal reflux leading to recurrent aspiration, pancytopenia and airway difficulties due to trismus, neck extension and upper airway infiltration with glucocerebroside must be considered. We report a case of a 9-year-old boy presenting developmental delay, mild pancytopenia, splenomegary gastroesophageal reflux. He was scheduled for measurement of intra-esophageal pressure, total splenectomy and Nissen fundoplication. Preoperative examination showed trismus and opisthotonic posturing. We predicted difficult airway maintenance and assessed his airway with airway radiograph. Airway narrowing was not shown. For this difficult airway, we made a special mask that has an introducer port for fiberbronchoscope. For the first time, we tried to insert a laryngeal mask, but the insertion was difficult due to trismus and narrowed oral cavity. Then, we used this special mask for the next time. Tracheal intubation was much safer by using this mask for fiberoptic intubation. In Gaucher disease, preoperative assessment of airway difficulties and preparation for this situation are necessary and anesthesiologist must be concerned about aspiration and airway difficulties.

Anesthesia, Inhalation↗
PubMed1998

[A case report: inhaled nitric oxide improves respiratory function in an infant with pulmonary hypertension].

Nitric oxide (NO) was administered to an infant in a near fatal crisis of pulmonary hypertension after total correction of double outlet right ventricle. Inhaled NO of 4 parts per million reduced pulmonary arterial pressure (PAP) and increased tidal volume during pressure limit ventilation. Both respiratory system compliance and resistance were improved with NO inhalation. There was a significant negative correlation between mean PAP and respiratory system compliance. We speculated that a reduction in PAP with NO inhalation resulted in the improvement of respiratory function. He was successfully weaned from mechanical ventilation.

Double Outlet Right Ventricle↗
PubMed1998

[Anesthesia and perioperative management in infants with Chiari type II malformation].

From July 1991 to June 1997. 15 neonates with Chiari type II malformation were treated at our institution. Four of them required posterior fossa decompression and cervical laminectomy for hindbrain decompression. We report anesthesia and postoperative management in these four patients. They had a fetal diagnosis of hydrocephalus and was delivered by caesarean section. They underwent Ommaya reservoir placement for drainage and repair of myelomeningocele in the neonatal period. They developed respiratory depression as apneic spells or retraction with or without swallowing difficulties and underwent posterior fossa decompression and cervical laminectomy at 20-87 days of life. One patient died of asthma at the age of 2 years and 8 days and others are doing well. Patients with this malformation may develop respiratory depression such as apneic spells and vocal cord paralysis even if the intracranial pressure is well controlled and they should be monitored carefully for the signs of apnea and the compromised airway.

Anesthesia, General↗
PubMed1998

[Perinatal and perianesthetic management of the sacrococcygeal teratoma in a neonate].

We report perinatal and perianesthetic management of a female infant with sacrococcygeal teratoma who underwent fetal bladder puncture and postnatal tumor resection. At 33 weeks' gestation, fetal ultrasonography revealed an intrapelvic mass, oligohydramnios and the dilatation of the bladder. At 34 weeks' gestation, bladder puncture was performed in utero to relieve urinary obstruction by the mass. And it served to reserve the renal function but caused remarkable ascites at birth due to urine leakage to the peritoneum through the puncture site. After the delivery by cesarean section, the patient underwent the tumor extirpation at 2 days of life. The operation and anesthesia proceeded uneventfully. In previous reports, several mortalities due to exsanguinating hemorrhage during surgery have been reported. In addition, sacrococcygeal teratoma is occasionally accompanied by coagulopathy and high output cardiac failure caused by arteriovenous fistulae. Therefore it is important for good patient outcomes to evaluate preoperatively the risks mentioned above.

Anesthesia, General↗
PubMed1997

Arterial oxygenation during one lung ventilation.

PURPOSE: To compare the effects of isoflurane and sevoflurane on arterial oxygenation and middle cerebral artery blood flow velocity during one lung ventilation. METHODS: This was a randomized, crossover study in 20 patients undergoing thoracotomy for oesophageal cancer and scheduled for long term one lung ventilation (OLV). They were randomized to one of two groups: group A, firstly isoflurane was administered followed by sevoflurane, and then isoflurane was resumed; group B, the order of the administration was reversed. Arterial blood gas samples were drawn at the start of OLV, 30 and 60 min after the initiation of OLV and the end of OLV (the change of volatile anesthetics was done 30 and 60 min after the start of OLV). Middle cerebral artery (MCA) was monitored continuously with the probe positioned over the temporal bone window. This probe transmitted 2 MHZ wave Doppler signals. Time-averaged MCA blood flow velocity was calculated from the signals. RESULTS: The PaO2 values decreased 30 min after the start of OLV (364.4 +/- 33.4 mmHg vs 179.0 +/- 19.5, and 338.7 +/- 24.8 mmHg vs 139.7-19.9 in groups A and B respectively), but there was no difference between the groups. Blood flow velocity of MCA did not change after the start of OLV (53.1 +/- 3.2, 55.9 +/- 3.0, 56.4 +/- 2.4, and 54.1 +/- 1.9 vs 50.8 +/- 2.1, 50.7 +/- 2.4, 53.7 +/- 1.5, 50.8 +/- 2.2 cm.sec-1 in groups A and B respectively): there was no difference between the groups. (P < 0.05). CONCLUSION: In clinical practice, the selection of either isoflurane and sevoflurane for OLV was of no difference in terms of the arterial blood oxygenation. With both agents MCA blood flow velocity was maintained during OLV.

Adult↗
PubMed1997

[A risk of pulmonary edema associated with G-CSF pretreatment].

We reported a case of severe pulmonary edema in the normal adult after bone marrow harvesting (BMH), who had received granular cell stimulating factor (G-CSF) pretreatment. The patient was 38 year old healthy man who was a donor to his son suffering from SCID (severe complicated immunodefficiency). He was administered total of G-CSF 750 mcg for three days before BMH. At the end of the BMH procedure, the patient was becoming dyspneic followed by severe pulmonary edema that continued about 8 hours. The levels of TNF alpha and IL-6 in his plasma and endotracheal exudate were abnormally as high as 10 and 130 pg.ml-1 of TNF alpha in plasma and exudate respectively and as 51.8 pg.ml-1 of IL-6 in plasma. We speculate that G-CSF activates white cells and induces leaking of cytokines from white cells, and the severity of pulmonary edema is associated with the cytokines.

Adult↗
PubMed1997

[Anesthetic and perioperative management of a neonatal vein of Galen malformation with multiple organ failure].

We treated a neonate in intractable cardiac failure due to a vein of Galen malformation. She manifested severe multiple organ failure. Perioperative problems are cardiac failure, respiratory failure, renal as well as hepatic dysfunction, and coagulopathy. Direct clipping of the feeding arteries improved her symptoms. Anesthetic problems encountered in this patient are massive bleeding and drastic circulatory changes while clipping the feeding arteries, increased intracranial pressure and brain ischemia, and other underlying complications; hepatic and renal dysfunction, respiratory failure and coagulopathy.

Anesthesia, General↗
PubMed1996

[Changes of respiratory system compliance by closure of congenital abdominal wall defects and postoperative complications].

We treated four neonates with congenital abdominal wall defects and performed pulmonary function testing before and after closure of abdominal wall defects. Pulmonary mechanics were measured by passive occlusion technique. Static respiratory system compliance (Crs) was 0.61 +/- 0.16 ml.cmH2O-1 .kg-1 (mean +/- SD) preoperatively and decreased to 0.31 +/- 0.03 ml.cmH2O-1.kg-1 postoperatively. Two cases with a marked decrease in Crs after the abdominal wall closure seemed to have longer intubation time and N.P.O period and to have more complications than with the other two cases. Our experience provides an evidence that Crs measurement could be a useful index in decision-making of the treatment of neonates with congenital abdominal wall defects.

Abdominal Muscles↗
PubMed1996

[HELP syndrome and anesthetic management].

From January 1990 to December 1994, 24 parturients were diagnosed as having HELLP syndrome alone or combined with preeclampsia/eclampsia among 8,224 patients who were delivered at our institution. They consisted of 14 primiparous and 10 multiparous patients. Mean maternal age was 28.9 +/- 3.3 and gestational age was 34.8 +/- 5.6 weeks. Of 24 parturients, 8 had vaginal delivery and the remaining 16 were delivered by caesarean section. Serious maternal morbidity included eclampsia (n = 3), preeclampsia (n = 18), renal failure (n = 5), hydrothorax (n = 4), and DIC (n = 1). There was no maternal death. There were 3 intrauterine fetal deaths and two neonatal deaths. Perinatal deaths were 2 (0.9%, 2/26). Three caesarean sections were performed under general anesthesia, and 13 under spinal anesthesia. In cases with apparent bleeding tendency, spinal and epidural anesthesia should be avoided. In providing general anesthesia, hypertension should be controlled, and the uterus is preferably dilated before the delivery and contracted there-after.

Adult↗
PubMed1995

Anesthetic management of a 656-g neonate undergoing pulmonary valvotomy.

We describe the successful management of a 656-g preterm infant of 29 weeks' postconceptional age undergoing closed transventricular pulmonary valvotomy. The patient had a critical pulmonary stenosis and was treated with an infusion of prostaglandin E1, which resulted in excessive pulmonary blood flow through the ductus arteriosus. The key points in anaesthetic management were maintaining an optimum balance between the systemic and pulmonary circulation and preparing for the abrupt haemodynamic change caused by valvotomy.

Anesthesia↗
PubMed1995

Duration of apnoea in anaesthetized children required for desaturation of haemoglobin to 95%: comparison of three different breathing gases.

In this study, we compared three gas compositions to determine if the duration of apnoea for SpO2 to decrease is proportionate to the oxygen fraction of the gas prior to apnoea. Twenty-five patients ASA physical status 1-2 aged two months to 12 years were included in the study. Anaesthesia was induced via a mask with 5% sevoflurane and 66% N2O in oxygen. After paralysis with vecuronium (0.12 mg.kg-1, i.v.) the trachea was intubated and anaesthesia was maintained with sevoflurane and N2O in oxygen. When cardiovascular stability was obtained, the patient was randomly set to breathe one of three gas compositions: 1. oxygen (FiO2 1.0), 2. N2O/O2 (FiO2 0.4), and 3. air/O2 (FiO2 0.4). All three gas compositions included 2-4% of sevoflurane to maintain anaesthesia. After more than eight min of each gas breathing, apnoea was begun by disconnecting the breathing circuit from the tracheal tube. The time from the start of apnoea (SpO2 100%) to SpO2 of 95% (T95) was measured. T95 measured after breathing N2O/O2 and air/O2 were 34.6 +/- 5.7 and 28.8 +/- 4.7% of that measured after oxygen breathing (P < 0.001 vs oxygen breathing, P < 0.001 vs oxygen and N2O/O2 breathing), respectively. Preoxygenation before intubation was validated to delay the haemoglobin desaturation brought about by apnoea. An induction technique using a low FiO2 will allow rapid haemoglobin desaturation.

Age Factors↗