Biomedical subjects

Katsuyasu Kitaguchi

Publications and source records attributed to Katsuyasu Kitaguchi.

At least 19 recordsLinked to original sources

PubMed2005

[Difficult airway management during emergency tracheostomy in a patient with severe rheumatoid arthritis].

We experienced difficult airway management in a 65-year-old woman with acute dyspnea due to bilateral recurrent nerve palsy suffering from severe rheumatoid arthritis for fifty years. Her cervical spine was ankylosed and could not be extended at all. Tracheostomy was planned under local anesthesia because of difficulty of endotracheal intubation, possibility of airway obstruction and laryngeal edema. In this condition, the surgical area was narrow and difficult to approach. The surgical bleeding and blood-aspiration into the tracheostomy site occurred followed by airway obstruction. A rigid tracheal tube could not be inserted through the tracheal incision and SpO2 decreased to 81%. We inserted a percutaneous cricothyroidotomy cannula through the tracheal incision and superimposed HFJV on her spontaneous ventilation. Assisting the ventilation in this way finally, a spiral endtracheal tube was inserted and her oxygenation became stable.

Acute Disease↗

PubMed2005

[Prevalence and risk factors for latex sensitization among anesthesiologists].

BACKGROUND: Although powdered latex surgical gloves are predominantly used in Japanese healthcare facilities, the prevalence of latex sensitization among anesthesiologists has not been investigated. METHODS: The authors surveyed 60 anesthesiologists of 16 facilities with questionnaires and measurements of specific IgE antibodies against latex and other aeroallergens by AlaSTAT microplate immunoassay. Sensitization was defined as positive if the specific IgE concentration was not less than 0.70 IU x ml(-1). RESULTS: With surgical gloves 63.3% of anesthesiologists used powdered latex gloves, compared to 10.2% with examination gloves. The prevalence of latex sensitization was 33.3%, with a peak of 70% (7/10) in ages 45-49. In multivariate analysis, anesthesiologists of the facilities where more than 50% of them used powdered latex surgical gloves had a 6.0-fold risk of latex sensitization (95% CI 1.7-21.5; P=0.006). Histories of atopic dermatitis, asthma, or food allergy were also considered as risk factors (OR 3.8; 95% CI 1.1-13.7; P=0.038). The history of allergic rhinoconjunctivitis was not associated with latex allergen, but with Japanese cedar pollen. No relation was observed between latex and timothy pollen. CONCLUSIONS: Our results suggest that surgical powdered latex gloves were the major predisposing factor for latex sensitization measured by latex-specific IgE among anesthesiologists.

Adult↗

PubMed2005

[Four cases of diplopia following spinal anesthesia].

Many complications after spinal anesthesia have been reported, but diplopia is rare. We had four cases of diplopia in 794 cases of spinal anesthesia in three years at Nara Medical University Hospital. These 4 cases were not characterized by any major factors including gender, age, or anesthetic choice. However, two of them were accompanied with post-spinal headache. Diplopia in three cases improved spontaneously, but one finally required epidural blood patch for the persistent diplopia. Lack of concern regarding the possibility of post-spinal diplopia among medical staffs might be common because this incidence is really rare. However, we need to know the possibility of this neurological sequel after spinal anesthesia. We would like to propose that the informed consent regarding spinal anesthesia should include the possibility of this complication and anesthesiologists should perform intensive neurological examinations after spinal anesthesia concerning post-spinal diplopia.

Adult↗

PubMed2004

[Retrospective analysis of postoperative nausea and vomiting after craniotomy].

BACKGROUND: Postoperative nausea and vomiting are important complications after craniotomy. METHODS: One hundred and seventy eight patients who had undergone brain tumor resection at Nara Medical University were retrospectively divided to one of two groups; with or without PONV within 24 hours postoperatively. Variables compared between the groups include gender, age, weight, height, site of surgery (supratentorial versus infratentorial craniotomy), size of brain tumor, type of anesthesia (inhalation versus intravenous anesthesia with nitrous oxide), intraoperative fentanyl dose, duration of surgery as well as anesthesia, and intraoperative posture. RESULTS: PONV occurred in 87 patients (49%). The incidence of PONV in patients undergoing infratentorial craniotomy was significantly higher than that in patients undergoing supratentorial craniotomy (75% vs 45%, P = 0.0011). There were no significant associations between PONV and other variables analyzed. CONCLUSIONS: These results indicate that the incidence of PONV after brain tumor resection is high and infratentorial surgery is a risk factor for PONV. Strategies for the prevention of PONV after craniotomy are required.

Anesthesia, General↗

PubMed2004

[Present state of guidelines for perioperative management of deep vein thrombosis and pulmonary embolism in Japan].

To clarify the present state of local institutional guideline for perioperative deep thrombosis and pulmonary embolism in individual hospitals, a questionnaire was sent to anesthesia departments in Japan. According to the replies, 82 hospitals have original guidelines. Forty of them reported the contents of their guidelines. However, 37 hospitals have some problems regarding their guidelines. Cost for these perioperative managements and application of spinal or epidural anesthesia for heparinized patients appears to be commonly recognized as pending questions in their guideline. It seems to be difficult to make a stereotyped standard guideline in Japan because each local guideline has a specific strategy according to their situations. However, it is needless to say that a further nationwide survey and collaboration, and governmental support for these diseases would be required.

Anesthesia Department, Hospital↗

PubMed2004

[Patient dissatisfaction with anesthetic care].

BACKGROUND: The evaluation of services by patients is an essential component of quality improvement in anesthesiology. Therefore, it is important to identify the factors for patient dissatisfaction. METHODS: We retrospectively studied 9974 consecutive patients who had received spinal or general anesthesia for elective surgery between 1999 and 2002. Pre-anesthetic, intra-anesthetic and post-anesthetic variables were recorded and patient satisfaction was assessed using direct interviews at the post-anesthetic clinic. Qualitative data on dissatisfaction were obtained by asking patients' reasons for dissatisfaction. RESULTS: 348 of the 8843 respondents (3.9%) had dissatisfaction with anesthesia. The rates of dissatisfaction were higher in women than in men and in spinal anesthesia than in general anesthesia, and were observed mostly in the patients aged from 20 to 39 years. Qualitative data show that the common reasons for dissatisfaction with anesthesia were spinal anesthesia as the most dissatisfactory factor, followed by epidural anesthesia, postoperative pain, vomiting/nausea and memory of tracheal extubation. However, other various factors were associated with dissatisfaction. CONCLUSIONS: It is difficult for anesthesiologists to satisfy all patients, because patients' senses of values were varied. However, we conclude that anesthesiologists can improve the quality of anesthesia by enlightenment of the patient about anesthesia, and moreover, by better peri-anesthetic management for dissatisfactory factors with anesthesia.

Adult↗

PubMed2003

Noxious stimuli do not modify myogenic motor evoked potentials by electrical stimulation during anesthesia with propofol-based anesthesia.

PURPOSE: To investigate whether motor evoked potentials (MEP) to transcranial electrical stimulation under constant blood propofol concentration are affected by the arousing effect of surgical noxious stimuli. METHODS: Twenty patients who underwent elective spinal surgery were studied. Patients were anesthetized with 50% nitrous oxide in oxygen, fentanyl, and propofol to maintain the bispectral index (BIS) score around 50. MEP in response to a multipulse transcranial electrical stimulation at stimulus sites of C3-C4 were recorded over the right abductor pollicis brevis muscle. Changes of peak-to-peak amplitude and onset latency of MEP, BIS score before and after surgical stimuli were evaluated. Propofol plasma concentration was measured at the same time points. RESULTS: Both MEP amplitude and latency did not change significantly after surgical stimuli although BIS increased significantly (48 +/- 6 to 58 +/- 5; P < 0.05). Plasma propofol concentration was maintained at the same level between the two measurement points (3.3 +/- 0.7 to 3.3 +/- 0.7 micro g*mL(-1)). There was no relation between BIS change and changes of MEP amplitude and latency, and propofol plasma concentration. CONCLUSION: MEP to the transcranial electrical stimulation under a constant and clinically appropriate blood propofol concentration are not affected by surgical noxious stimuli.

Anesthesia, General↗

PubMed2003

The influence of induced hypothermia for hemostatic function on temperature-adjusted measurements in rabbits.

UNLABELLED: In hypothermic patients, a tendency to bleed may be observed even when hemostatic tests seem to be normal. Coagulation and platelet function tests are usually performed at 37 degrees C. We investigated the influence of induced hypothermia on temperature-adjusted hemostasis function testing using Sonoclot Analyzer (Sonoclot) and Thromboelastography (TEG). Anesthesia was induced and maintained with IV ketamine and fentanyl on 15 male New-Zealand White rabbits. A water blanket was used to induce hypothermia to 30 degrees C and to rewarm to 37 degrees C. Blood samples were obtained at four points: before hypothermia, at 34 degrees C, at 30 degrees C, and after rewarming. Standard coagulation tests were performed at 37 degrees C (C method), and simultaneously, real temperature hemostasis function tests (R method) were run. In Sonoclot(R), activated clotting time and time to peak increased and clot rate decreased significantly at 30 degrees C in the R method compared with those in the C method. In TEG(R), reaction time and clot formation time were prolonged and clot formation rate was diminished at 30 degrees C in the R method compared with those in the C method. Induced hypothermia delayed the coagulation cascade and reduced platelet function. During hypothermia, hemostatic measurements should be performed at real temperature to avoid overestimating patient hemostatic function based on results measured at the standard 37 degrees C. IMPLICATIONS: We investigated the influence of induced hypothermia on temperature-adjusted hemostasis function tests in rabbits using Sonoclot Analyzer and Thromboelastography. Induced hypothermia delayed the coagulation cascade and reduced platelet function. The conventional coagulation tests performed at 37 degrees C failed to detect these hypothermia-induced degradations in hemostasis performance.

Anesthesia↗

PubMed2003

[Effect of teeth protector on dental injuries during general anesthesia].

BACKGROUND: Dental injuries are the most common reason for complaints against anesthetists. The purpose of this study was to investigate the effect of teeth protector on dental injuries during general anesthesia. METHODS: Incidence of dental injuries was evaluated retrospectively in 5,946 consecutive patients between November 1998 and October 2001. All the patients were interviewed directly at a post-anesthetic clinic. RESULTS: Dental injuries were observed in 2.1% of the patients, and the injuries occurred more frequently in the patients undergoing difficult tracheal intubation. The teeth protector used in the present study was made of cellulose aceto-butylate and was produced using eruko-pressed disks molded from own teeth form. One hundred and eighty five patients (3.1%) requested teeth protectors, and none of them had their teeth injured during anesthesia. CONCLUSION: Our results showed that the teeth protector could protect the teeth from dental injuries and increased the satisfaction with anesthesia. Preoperatively anesthesiologists should know the characteristics of patients' teeth and inform the patients of the risk of injury. We conclude that the custom-made protector might be useful and necessary to preserve the teeth from dental injuries during anesthesia.

Adult↗

PubMed2003

[Anesthetic management of a patient with congenital plasminogen activator inhibitor-1 deficiency].

Congenital plasminogen activator inhibitor-1 (PAI-1) deficiency is an extremely rare disorder characterized by a bleeding diathesis due to hyperfibrinolysis as a result of decreased PAI-1 activity. A 21-year-old male with congenital PAI-1 deficiency underwent wisdom teeth extraction of the mandible under general anesthesia using propofol, nitrous oxide, sevoflurane, fentanyl, and vecuronium. No complications including prolonged bleeding and rebleeding after the operation were observed because hemostatic management was successful by using intravenous tranexamic acid.

Adult↗

PubMed2003

[Evaluation of the different doses of olprinone for continuous infusion after cardiopulmonary bypass for coronary artery bypass surgery].

BACKGROUND: We evaluated the hemodynamic efficacy of combined cathecholamine and three different continuous infusion doses of olprinone (0.05, 0.1, 0.3 microgram.kg-1.min-1) in 24 cases (0.05 group: 8 cases, 0.1 group: 8 cases, 0.3 group: 8 cases) undergoing coronary artery bypass grafting (CABG). METHODS: Olprinone was administered as a single dose (0.1 mg.kg-1) into the venous reservoir of the CPB circuit 15 min prior to the end of emergence from CPB, followed by continuous infusion. Hemodynamics were measured at the time of preCPB (M 0), just after the end of CPB (M 1), pre chest closure (M 2) and after chest closure (M 3). Cathecholamines were used to maintain mean arterial pressure (> 65 mmHg) and cardiac index (> 3.0 l.min-1.m-2). Hemodynamics (at M 0, M 1, M 2 and M 3) and the number of cases requiring combined cathecholamine were compared among the 3 doses. RESULTS: Three doses showed no significant difference on hemodynamics. In the number of cases requiring combined cathecholamine, group 0.3 were significantly lower than group 0.05 at dobutamine, and group 0.05 were significantly higher than group 0.1 and 0.3 at norepinephrine. CONCLUSIONS: The higher continuous infusion dose of olprinone (0.3 > 0.1 > 0.05 microgram.kg-1.min-1) can diminish the number of cases requiring combined cathecholamine administration during coronary artery bypass grafting.

Aged↗

PubMed2002

Intraoperative monitoring of myogenic motor-evoked potentials from the external anal sphincter muscle to transcranial electrical stimulation.

STUDY DESIGN: Motor-evoked potentials from the external anal sphincter were analyzed using transcranial electrical stimulation during spinal surgery in patients under general anesthesia. OBJECTIVE: To investigate whether motor-evoked potentials from the external anal sphincter could be elicited by transcranial electrical stimulation under general anesthesia. SUMMARY OF BACKGROUND DATA: Lumbosacral surgery often places nerve rootlets at risk for injury during operative dissection. Specifically, injury for sacral rootlets can result in bowel and bladder dysfunction, but the techniques for monitoring bowel and bladder function are limited. METHODS: Thirty patients who underwent elective spinal surgery were studied. Patients were anesthetized with 50% nitrous oxide in oxygen, fentanyl, and 4 mg/kg/h of propofol (n = 19) or 1 mg/kg/h of ketamine (n = 11). The level of neuromuscular blockade, assessed by recording the M-response from the right abductor pollicis brevis muscle, was maintained at an M-response amplitude of 40-50% of control. Motor-evoked potentials in response to a multipulse transcranial electrical stimulation at stimulus sites of C3-C4 or Fz-Cz were recorded from the skin over the subcutaneous part of the external anal sphincter using a plug-type electrode probe. The success rate of motor-evoked potentials' recording and peak-to-peak amplitude and the onset latency of motor-evoked potentials were evaluated. RESULTS: Success rates of motor-evoked potentials from the external anal sphincter were 73% and 53% after transcranial stimulation at stimulus sites of C3-C4 and Cz-Fz, respectively. Amplitudes of motor-evoked potentials after C3-C4 stimulation were significantly greater than those after Cz-Fz stimulation. Motor-evoked potential latency from the external anal sphincter was 18.6 +/- 1.5 and 19.0 +/- 2.7 msec after C3-C4 and Cz-Fz stimulation, respectively. CONCLUSIONS: The results suggest that, using a transcranial multipulse stimulation, monitoring of motor-evoked potentials from the external anal sphincter is feasible during ketamine- and propofol-based anesthesia. However, further improvement of techniques would be required for intraoperative elicitation of motor-evoked potentials from the external anal sphincter.

Adolescent↗

PubMed2002

A comparison of the INVOS 4100 and the NIRO 300 near-infrared spectrophotometers.

UNLABELLED: We determined whether two different devices for measuring near-infrared spectroscopy (NIRS)---the INVOS 4100 and the NIRO 300---produce similar cerebral oxygenation data during the CO(2) challenge test. Nineteen patients anesthetized with sevoflurane, 67% nitrous oxide in oxygen, and fentanyl were studied. A series of measurements of regional cerebral oxygen saturation (rSO(2)), measured by the INVOS 4100, and tissue oxygen index (TOI), measured by the NIRO 300, were performed in the following conditions: 1) normocapnia (PaCO(2), 35--45 mm Hg); 2) hypocapnia (PaCO(2), 25--35 mm Hg); 3) normocapnia; and 4) hypercapnia (PaCO(2), 45--55 mm Hg). Hemodynamic variables, including arterial blood gases and cerebral blood flow velocity, were measured at the same time with transcranial Doppler. The values and percentage changes of rSO(2) and TOI were compared by using regression analysis and Bland and Altman analysis. The rSO(2) showed a significant positive correlation with TOI (r = 0.58, P < 0.01). The percentage change of rSO(2) also showed a significant positive correlation with the percentage change of TOI during the CO(2) challenge (r = 0.85, P < 0.01). Bland and Altman analysis revealed a bias of -0.5% with 2 SD of 15.6% when comparing the rSO(2) value with the TOI value, and it showed a bias of -3.4% with 2 SD of 15.2% when comparing the percentage change of rSO(2) with the percentage change of TOI, indicating unacceptable disagreement of these data. These results indicate that cerebral oxygen saturation and its relative change during the CO(2) challenge may vary depending on the type of NIRS used. Because the measurement technique and algorithm were different in each device, we should carefully consider the clinical application of the values produced by NIRS. IMPLICATIONS: Near-infrared spectroscopy (NIRS) has been proposed as a noninvasive clinical method for assessing cerebral oxygenation. The acceptable reliability and validity of NIRS values have not been established despite their widespread use. The INVOS 4100 and the NIRO 300 can display cerebral oxygen saturation as regional cerebral oxygen saturation and tissue oxygenation index, but they produce differing results.

Adult↗

PubMed2002

High-dose amrinone is required to accelerate rewarming from deliberate mild intraoperative hypothermia for neurosurgical procedures.

BACKGROUND: Since the time available to provide the cooling and rewarming is limited during deliberate mild hypothermia, the technique to accelerate the cooling and rewarming rate of core temperature has been studied. Amrinone has been reported to accelerate the cooling rate but not the rewarming rate of core temperature during deliberate mild hypothermia. The failure of amrinone effect on the rewarming rate might be due to an insufficient dose of amrinone during hypothermic conditions. The authors therefore tested whether higher doses of amrinone can accelerate the rewarming rate of core temperature during deliberate mild hypothermia for neurosurgery. METHODS: After institutional approval and informed consent, 30 patients were randomly assigned to one of three groups. Patients in the control group (n = 10) did not receive amrinone; patients in the AMR 15 group (n = 10) received 15 microg x kg(-1) x min(-1) amrinone with a 1.0-mg/kg loading dose of amrinone at the beginning of cooling; and patients in the ReAMR group (n = 10) received 5 microg x kg(-1) x min(-1) amrinone with 1.0-mg/kg loading and reloading doses of amrinone at the beginning of cooling and rewarming, respectively. Administration of amrinone was started just after the induction of cooling and continued until the end of anesthesia. Anesthesia was maintained with nitrous oxide in oxygen, propofol, and fentanyl. After induction of anesthesia, patients were cooled, and tympanic membrane temperature was maintained at 34.5 degrees C. After completion of the main surgical procedures, patients were actively rewarmed and extubated in the operating room. RESULTS: The cooling and rewarming rates of core temperature were both significantly faster in both amrinone groups than in the control group. During the cooling and rewarming periods, forearm minus fingertip temperature gradient was significantly smaller in both amrinone groups than in the control group. During the rewarming period, heart rate and mean arterial pressure in the AMR 15 group were significantly faster and lower, respectively, than in the control group. Systemic vascular resistance in the AMR 15 group was smaller than in the control group throughout the study; on the other hand, only the value after the start of rewarming in the ReAMR group was smaller than in the control group. CONCLUSIONS: Amrinone at an infusion rate of 15 or 5 microg x kg(-1) x min(-1) with a reloading at the beginning of rewarming accelerated the rewarming rate of core temperature during deliberate mild hypothermia. This suggests that high-dose amrinone is required to accelerate rewarming from deliberate mild intraoperative hypothermia for neurosurgical procedures.

Adult↗

PubMed2002

Mild hypothermia can enhance pial arteriolar vasodilation induced by isoflurane and sevoflurane in cats.

OBJECTIVE: Volatile anesthetics have been shown to dilate cerebral vessels. Recent evidence suggests that mild hypothermia can alter vascular reactivity of the cerebral vessels. However, the effect of mild hypothermia on volatile anesthetic-induced vasodilation of cerebral vessels is unknown. In the present study, we investigated the effect of mild hypothermia on pial arteriolar vasodilation induced by isoflurane and sevoflurane in cats. DESIGN: Prospective, randomized, experimental study with repeated measures. SETTING: Investigational animal laboratory. SUBJECTS: Forty cats were used for the study of systemic administration of volatile anesthetics, and 22 cats were used for the study of topical administration of volatile anesthetics. INTERVENTIONS: This study was approved by the Animal Experiment Committee of Nara Medical University. Animals were anesthetized with pentobarbital to maintain suppressive electroencephalographic patterns, which were introduced to measure direct effects of anesthetic agents after removing metabolic effects. The cranial window technique, combined with microscopic video recording, was used for the measurement of small (50-100 microm) and large (100-200 microm) pial arteriolar diameter in an experiment. Animals were randomly assigned to either a normothermic (37 degrees C) or a hypothermic group (33 degrees C). Desired temperatures were maintained by using a water blanket. In the first phase of the study, the effect of hypothermia on pial arteriolar vasodilation induced by systemic administration of isoflurane or sevoflurane was assessed. Each cat received isoflurane or sevoflurane at 0.5, 1.0, 1.5, and 2.0 minimum alveolar anesthetic concentrations, and the diameter of pial arterioles was measured. In the second group of animals, the direct effect of isoflurane and sevoflurane on pial vessels was evaluated. The artificial cerebrospinal fluid bubbled with isoflurane or sevoflurane (minimum alveolar anesthetic concentrations of 1 or 3) was topically administered in the cranial window. MEASUREMENTS AND MAIN RESULTS: Systemic and topical administration of isoflurane and sevoflurane produced significant dilation of both small and large pial arterioles in a dose-dependent manner during normothermia. In the hypothermic group, vasodilation of small pial arterioles by systemic administration of isoflurane and sevoflurane at a high concentration was significantly larger than in the normothermic group (p <.05). Vasodilation of both small and large pial arterioles by topical administration of isoflurane and sevoflurane was significantly greater in the hypothermic group than in the normothermic group (p <.05). CONCLUSIONS: These results suggest that pial arteriolar vasodilation induced by isoflurane and sevoflurane can be enhanced by mild hypothermia in cats anesthetized with pentobarbital.

Anesthetics, Inhalation↗

PubMed2002

Effect of mild hypothermia on inodilator-induced vasodilation of pial arterioles in cats.

BACKGROUND: Mild hypothermia has been proposed as a means of providing cerebral protection after traumatic brain injury. However, hypothermia has been shown to alter not only physiologic but also pharmacologic responses. The purpose of this study was to investigate whether mild hypothermia (3-4 degrees C temperature reduction) could alter cerebral vasodilation induced by inodilators, which are characterized by having an inotropic effect in addition to a vasodilatory effect. Isoproterenol (a beta-adrenergic receptor agonist), colforsin dapropate (an adenylate cyclase stimulant), and amrinone (a phosphodiesterase inhibitor) were chosen as inodilators. METHODS: The cranial window technique, combined with microscopic video recording, was used. Forty-eight cats were randomly assigned to either a normothermic or a hypothermic group (33 degrees C). Isoproterenol, colforsin dapropate, or amrinone was topically applied in the cranial window and the diameter of pial arterioles was measured. RESULTS: Topical administration of isoproterenol, colforsin dapropate, and amrinone produced a significant dilation in a dose-dependent manner during normothermia. The vasodilation induced by these inodilators was not affected by mild hypothermia. CONCLUSION: The vasodilation induced by topical administration of isoproterenol, colforsin dapropate, and amrinone was not affected by mild hypothermia.

Administration, Topical↗

PubMed2002

Amplitudes and intrapatient variability of myogenic motor evoked potentials to transcranial electrical stimulation during ketamine/N2O- and propofol/N2O-based anesthesia.

The aim of the current study was to investigate whether there are differences in amplitudes and intrapatient variability of motor evoked potentials to five pulses of transcranial electrical stimulation between ketamine/N2O- and propofol/N2O-based anesthesia. Patients in the propofol group (n = 13) and the ketamine group (n = 13) were anesthetized with 50% N2O in oxygen, fentanyl, and 4 mg/kg/hr of propofol or 1 mg/kg/hr of ketamine, respectively. The level of neuromuscular blockade was maintained at an M-response amplitude of approximately 50% of control. Motor evoked potentials in response to multipulse transcranial electrical stimulation were recorded from the right adductor pollicis brevis muscle, and peak-to-peak amplitude and onset latency of motor evoked potentials were evaluated. To estimate intrapatient variability, the coefficient of variation (standard deviation/mean x 100%) of 24 consecutive responses was determined. Motor evoked potential amplitudes in the ketamine group were significantly larger than in the propofol group (mean, 10th-90th percentile: 380 microV, 129-953 microV; 135 microV, 38-658 microV, respectively; P <.05). There were no significant differences in motor evoked potential latency (mean +/- standard deviation: 20.9 +/- 2.2 msec and 21.4 +/- 2.2 msec, respectively) and coefficient of variation of amplitudes (median [range]: 32% [22-42%] and 26% [18-41%], respectively) and latencies (mean +/- standard deviation: 2.1 +/- 0.7% and 2.1 +/- 0.7%, respectively) between the ketamine and propofol groups. In conclusion, intrapatient variability of motor evoked potentials to multipulse transcranial stimulation is similar between ketamine/N2O- and propofol/N2O-based anesthesia, although motor evoked potential amplitudes are lower during propofol/N2O-based anesthesia than ketamine/N2O-based anesthesia.

Anesthesia↗

PubMed2002

[Sevoflurane can induce rhabdomyolysis in Duchenne's muscular dystrophy].

Rhabdomyolysis is one of the perioperative complications in patients with Duchenne's muscular dystrophy (DMD). It has been suggested that sevoflurane can be used safely for anesthesia in patients with DMD. In this report, we describe a case with DMD who received anesthesia with sevoflurane, in which rhabdomyolysis developed postoperatively. A 6-year-old boy diagnosed as DMD was scheduled for tonsillectomy under general anesthesia. Preoperative laboratory examination revealed a high level of creatine kinase (CK) (16,000-32,000 IU.l-1). An abnormality of the dystrophin gene was detected by DNA analysis. Anesthesia was induced with sevoflurane without muscle relaxant, and maintained with sevoflurane in nitrous oxide and oxygen under controlled ventilation. The course of anesthesia was uneventful and the patient recovered smoothly. Three hours postoperatively, dark red urine with a high concentration of myoglobin (1,390,000 ng.ml-1) was recognized with a high level of CK (63,500 IU.l-1). Body temperature was 37.6 degrees C, and electrocardiogram and serum potassium were within normal ranges. After the diuresis with mannitol and furosemide, the urine became clear. On the 4th postoperative day, he was discharged without any complication. This case suggested that rhabdomyolysis can develop after sevoflurane anesthesia in patients with DMD.

Anesthesia, Inhalation↗