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Biomedical subjects

Kazuo Higa

Publications and source records attributed to Kazuo Higa.

At least 19 recordsLinked to original sources
PubMed2006

Vecuronium in a patient with late cerebellar cortical atrophy.

Little information is available regarding the sensitivity to neuromuscular blocking drugs in patients with spinocerebellar degeneration and associated diseases. We report the response to vecuronium in a patient with late cerebellar cortical atrophy, a nonhereditary type of cerebellar ataxia. Onset time and time to 25% recovery of T1/T0 after vecuronium 0.1 mg.kg(-1) under sevoflurane anesthesia were 156 seconds and 43 minutes, respectively. Recovery index was 27 minutes. We believe this is the first report describing a response to neuromuscular blocking drugs in this disease.

Aged↗
PubMed2006

Retropharyngeal hematoma after stellate ganglion block: Analysis of 27 patients reported in the literature.

BACKGROUND: Retropharyngeal hematoma (RPH) is rare; however, it causes airway obstruction and can be fatal. Stellate ganglion block (SGB) can cause RPH. The authors analyzed reports of patients with RPH after SGB to clarify the initial symptoms and signs, and the urgency of airway management. METHODS: MEDLINE and Japana Centra Revuo Medicina were searched for reports of RPH after SGB using the following terms and key words: stellate ganglion block, complication, hematoma, and retropharyngeal hematoma. RESULTS: The authors found 27 patients with RPH after SGB in the past 40 yr. The initial symptoms included neck pain (n = 10), dyspnea (n = 10), neck swelling (n = 8), and hoarseness (n = 5). The symptoms occurred 2 h or more after SGB in 14 patients (52%). Emergency airway management was needed in 21 patients (78%) because of airway obstruction. Among the 21 patients, orotracheal intubation was attempted first in 17 patients; however, it was unsuccessful in 5 patients who immediately needed emergency tracheostomy. Tracheal intubation was impossible by distortion of the anatomy of the markedly edematous pharyngolarynx. Failed airway management caused one death. There were no statistically significant predictors of the initial symptoms or signs for later emergency airway management. CONCLUSIONS: RPH after SGB necessitates emergency airway management. Because airway obstruction cannot be predicted by the initial symptoms or signs, emergency airway management tools should be at hand, and the patency of the airway should be continuously evaluated after onset of RPH after SGB.

Adult↗
PubMed2006

Anesthetic management of a child with chromosome 22q11 deletion syndrome.

Chromosome 22q11 deletion syndrome (22q11DS) is a congenital anomaly characterized by cardiovascular, oropharyngeal, immunologic, endocrine, and neurodevelopmental abnormalities. We successfully managed a 6-year-old girl with 22q11DS with general anesthesia. Potential problems in anesthetic management of patients with 22q11DS are reviewed.

Anesthesia, General↗
PubMed2006

[Anesthetic management of an infant with Cornelia de Lange syndrome].

We report anesthetic management of an infant with Cornelia de Lange syndrome. A 12-month-old girl with Cornelia de Lange syndrome was scheduled for ureterocystoneostomy because of vesicoureteral reflux. Preoperative physical examination suggested difficult tracheal intubation. After induction of anesthesia with sevoflurane (5%) in nitrous oxide (70%) and oxygen, a laryngeal mask airway (# 1.5) was inserted. A guide wire was inserted in the trachea through a laryngeal mask airway under direct vision of a fiberoptic bronchoscope. A tube-exchanger stylet was inserted around the guide wire after the laryngeal mask airway and fiberoptic bronchoscope had been removed. An endotracheal tube (ID 4.0 mm) was easily intubated around the tube-exchanger stylet. During the surgery, anesthesia was maintained with sevoflurane (2-3%) in nitrous oxide (50%) and oxygen. There was no perioperative pulmonary complication.

Anesthesia↗
PubMed2006

[Anesthetic management of a patient with hepatocellular carcinoma with tumor thrombosis extending into the right atrium].

We report a patient with hepatocellular carcinoma whose tumor thrombus was extending into the right atrium. A 55-year-old man underwent extended anterior segmental hepatectomy and removal of the tumor thrombus in the right atrium under cardiopulmonary bypass and general anesthesia using sevoflurane, nitrous oxide and oxygen. End-tidal carbon dioxide was closely monitored to detect pulmonary tumor emboli during the surgery. Intravenous fluid and blood transfusion in large volumes were necessary to avoid circulatory derangement.

Anesthesia, General↗
PubMed2006

[Pulmonary edema due to upper airway obstruction after extubation].

We report a patient who developed pulmonary edema due to airway obstruction after extubation. A 22-year-old man underwent removal of the nails for thoracoplasty under general anesthesia combined with epidural anesthesia. Upper airway obstruction occurred after extubation. SpO2 decreased to 70%. Insertion of an oral airway relieved the airway obstruction. However, inspiratory wheezing was heard over both lung fields. Chest X-ray taken 90 minutes after the event revealed pulmonary edema. Pulmonary edema gradually resolved after intravenous furosemide and oxygen inhalation by mask.

Adult↗
PubMed2006

[Lymphangioleiomyomatosis: a case report].

We report anesthetic management of a patient with lymphangioleiomyomatosis. A 41-year-old woman underwent lung biopsy under video-assisted thoracoscopic surgery to confirm the presence of lymphangioleiomyomatosis. She had hypoxemia due to obstructive lung disorder. Anesthesia was maintained with epidural block and general anesthesia with sevoflurane. During the operation, there were repeated episodes of hypoxemia, which required manual ventilation of the independent lung. After the operation, the tracheal tube was replaced with a laryngeal mask airway to minimize the risk of pneumothorax. There was no postoperative anesthesia-related complication.

Adult↗
PubMed2006

[Bradycardia and cardiac asystole immediately after abdominal incision for removal of a huge pyometra].

We report a patient who developed cardiac asystole, which may have been caused by Bezold-Jarisch reflex as a result of hypovolemia and compression of the inferior vena cava by a huge pyometra. A 61-year-old woman with a huge pyometra with occasional supine hypotension, tachycardia, and oliguria was scheduled for removal of the tumor. The systolic blood pressure decreased from 80 mmHg to 55 mmHg with simultaneous development of bradycardia 5 minutes after incision of the abdominal wall. Atropine was given but cardiac asystole occurred. Intravenous epinephrine restored systemic blood pressure and heart beats. There was no postoperative cardiorespiratory complication.

Bradycardia↗
PubMed2005

Reversal of neuromuscular effects of adenosine by specific adenosine A1-receptor antagonist in live rats.

Intravenous adenosine in-vivo was shown to potentiate the effects of non-depolarizing neuromuscular blocking agents. This study aimed to determine whether adenosine A1-receptors mediated this potentiation. The authors investigated the effects of intravenous adenosine, N6-cyclopentyladenosine, specific A1-receptor agonist, and 8-cyclopentyl-1,3-dipropylxanthine, specific A1-receptor antagonist, on neuromuscular block by vecuronium, in in-vivo rat sciatic nerve-tibialis anterior preparations. In the presence of 50% steady state block by vecuronium, adenosine, and N6-cyclopentyladenosine caused similar degree of depressions of twitch tension. Twitch tension returned to its pre-injection value more rapidly when 8-cyclopentyl-1,3-dipropylxanthine was given at the maximal block than when it was allowed to recover spontaneously. It was concluded that in in-vivo adenosine potentiated the neuromuscular effects of vecuronium through adenosine A1-receptors in rats.

Adenosine↗
PubMed2005

The effect of adenosine triphosphate on vecuronium-induced neuromuscular block.

Continuous IV adenosine triphosphate administration has been used during surgery in the expectation of analgesic and vasodilative effects. Because adenosine triphosphate inhibits neuromuscular transmission, we investigated whether the neuromuscular effect of vecuronium was enhanced by IV adenosine triphosphate in 29 patients randomly given either continuous IV adenosine triphosphate 0.1 mg.kg(-1).min(-1) or 0.9% NaCl when undergoing elective minor surgery. Anesthesia was induced and maintained with propofol. Neuromuscular monitoring was recorded from the adductor pollicis muscle using electromyography with train-of-four stimulation of the ulnar nerve. Vecuronium 25, 30, or 40 microg/kg was given and lag time, onset time, and maximum block were recorded. ED50 and ED95 values for each group were derived from least squares linear regression analysis. ED50 and ED95 values were 29 microg/kg and 44 microg/kg, respectively, for the adenosine triphosphate group and 26 microg/kg and 46 microg/kg, respectively, for the controls. Differences in lag time, onset time, and neuromuscular responses between the two groups were not statistically significant. A significantly larger number of patients in the adenosine triphosphate group showed hypotension (systolic blood pressure <80 mm Hg). Our results demonstrated that adenosine triphosphate 0.1 mg.kg(-1).min(-1) did not enhance the neuromuscular block induced by vecuronium.

Adenosine Triphosphate↗
PubMed2005

[Emergency microlaryngosurgery for a huge post-intubation laryngeal granuloma].

A 55-year-old woman who had undergone esophagectomy 3 months earlier developed a huge post-intubation laryngeal granuloma. She was scheduled for emergency microlaryngosurgery. Anesthesia was induced with 8% sevoflurane in oxygen under spontaneous respiration. After confirming no airway compromise, the spontaneous respiration was obtunded by forced manual ventilation without using a muscle relaxant. The trachea was intubated easily with an endotracheal tube. Anesthesia was maintained with sevoflurane and nitrous oxide supplemented with intravenous fentanyl. The granuloma removed was 11 x 8 mm in diameter. There were no respiratory complications during and after anesthesia and surgery.

Anesthetics, Inhalation↗
PubMed2005

[Severe hyponatremia during transurethral resection of prostate].

We report a case of severe hyponatremia (Na 82 mEq x l(-1)) during transurethral resection of the prostate for benign prostatic hypertrophy. A 61-year-old man was managed with epidural anesthesia and intravenous propofol. Three percent sorbitol (Uromatic S) solution was used for irrigation fluid. The serum sodium level 1 and 3 hours after the start of operation was 103 mEq x l(-1) and 82 mEq x l(-1), respectively. One hour after cessation of propofol administration he did not wake up, although he responded to mechanical stimulation. Saline (1.7%) and sodium bicarbonate (8.4%) were infused. Thirteen hours after the operation, serum sodium level rose to 114 mEq x l(-1), and he opened the eyes on verbal commands. Twenty-eight hours after the operation, serum sodium level was 132 mEq x l(-1). Postoperative neurological deficit did not occur.

Humans↗
PubMed2005

[Severe hypotension after induction of general anesthesia in a patient receiving an angiotensin II receptor antagonist and an alpha-blocker].

We report severe hypotension after induction of general anesthesia in a patient receiving an angiotensin II receptor antagonist and an alpha-blocker. A 50-year-old man with diabetes mellitus who had been treated with candesartan cilexetil and doxazosin was scheduled for vitreous surgery. He was operated on for vitreous surgery three times. He developed severe hypotension after induction of anesthesia with propofol and fentanyl on two occasions, when he was taking candesartan cilexetil and doxazosin. Repeated injections of intravenous ephedrine could not raise the blood pressure. After discontinuation of both drugs, although he developed hypotension after induction of anesthesia with propofol and fentanyl, hypotension was mild and responded promptly to intravenous ephedrine.

Adrenergic alpha-Antagonists↗
PubMed2005

[Anesthetic management for nephrectomy in a 2-year-old girl with abdominal aortic aneurysm].

We report anesthetic management for nephrectomy in an infant with aortic aneurysm. A 2-year-old girl with renovascular hypertension and abdominal aortic aneurysm, who had shown repeated episodes of heart failure, was scheduled for nephrectomy. Anesthesia was induced with sevoflurane in nitrous oxide (70%) and oxygen. During the surgery, anesthesia was maintained with sevoflurane (1.5%) in nitrous oxide (50%) and oxygen, supplemented with intermittent epidural block. The blood pressure did not show marked changes during the surgery. There was no perioperative cardiovascular complication.

Anesthesia, Epidural↗
PubMed2005

[A patient with Shy-Drager syndrome managed under general anesthesia with thoracic epidural anesthesia].

A 61-year-old man with Shy-Drager Syndrome underwent partial pulmonary lobectomy under general anesthesia combined with thoracic epidural anesthesia. The blood pressure decreased from 140/ 100 mmHg to 80/50 mmHg after thoracic epidural anesthesia. It increased after intravenous ephedrine. The blood pressure decreased when he was returned to the supine position postoperatively. It did not increase as expected with intravenous ephedrine. Intravenous etilefrine promptly raised the blood pressure. There was no postoperative cardiorespiratory complications.

Anesthesia, Epidural↗
PubMed2005

[Transfusion-related acute lung injury: a case report].

We report a patient who was suspected of transfusion-related acute lung injury. A 60-year-old man underwent emergency thoracotomy and hemostasis after pneumonectomy. The SpO2, decreased abruptly to 66% 90 minutes after transfusion of packed red blood cells and fresh frozen plasma. He was ventilated with 100% oxygen. The SPO2 returned to 100% in 3 minutes. Postoperative chest radiography showed diffuse pulmonary infiltrates. The pulmonary edema improved in 12 hours with mechanical ventilation.

Acute Disease↗
PubMed2005

[Anesthetic management for gastrectomy of a patient after coronary artery bypass graft with gastroepiploic artery].

We report anesthetic management of an 80-year-old man who had received coronary artery bypass graft with the gastroepiploic artery 5 years before the present gastrectomy. Preoperative angiography did not show patency of the grafted gastroepiploic artery. He underwent partial distal gastrectomy under general anesthesia with isoflurane in oxygen-enriched air combined with epidural block. The gastroepiploic artery was severed after temporary clamping which did not produce evidence of myocardial ischemia. There was no postoperative cardiovascular event after the surgery.

Adenocarcinoma↗