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Keiichi Nitahara

Publications and source records attributed to Keiichi Nitahara.

18 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

[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↗
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

[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 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↗
PubMed2005

[Anesthetic management for partial lobectomy in a postpneumonectomy patient].

We report a postpneumonectomy patient who underwent partial lobectomy. A 74-year-old man was scheduled for right partial lobectomy because of metastatic lung cancer. He had undergone left pneumonectomy 19 months before because of lung cancer. Anesthesia was maintained with intravenous propofol and thoracic epidural block. During surgery, respiration was maintained with mechanical and intermittent manual ventilation. Percutaneous cardiopulmonary support and high frequency jet ventilation were at hand but were not needed. There was no intraoperative hypoxia and the postoperative course was uneventful.

Aged↗
PubMed2005

[Pneumothorax revealed by postoperative computed tomography].

We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.

Accidents, Traffic↗
PubMed2005

[Anesthetic management of a cesarean section in a patient with schizophrenia receiving a large amount of antipsychotic agents].

We experienced perioperative management of a patient with schizophrenia who had been taking a large amount of antipsychotic agents until the cesarean section. A 31-year-old woman in 38th week gestation with schizophrenia underwent a cesarean section. Anesthesia was maintained with light plane of general anesthesia combined with epidural anesthesia. Perioperatively, the mother experienced no complications and the baby only developed slight generalized tremor and hypotonus for a short period after delivery.

Adult↗
PubMed2003

[Propofol anesthesia for a patient in the terminal stage of Fukuyama type congenital muscular dystrophy].

A 31-year-old tracheostomized woman weighing 32.5 kg with Fukuyama type congenital muscular dystrophy in terminal stage was scheduled for dilatation of the tracheostoma, removal of the tracheal granulomas and reconstruction of gastrostoma. Anesthesia was induced and maintained with continuous propofol infusion and intermittent fentanyl. Muscle relaxant was not necessary because of generalized severe muscular atrophy. There was no hemodynamic derangement during the surgery and emergence from the anesthesia was rapid. There were no postoperative complications related to anesthesia and surgery.

Adult↗
PubMed2003

[Anesthetic management for a patient with hyper-IgE syndrome].

Hyper-IgE syndrome is a rare immunodeficiency disorder characterized by recurrent skin and pulmonary infections and extremely elevated serum levels of IgE. A 6-year-old girl with hyper-IgE syndrome underwent appendectomy. Anesthesia was induced with sevoflurane. After insertion of a laryngeal mask, anesthesia was maintained with nitrous oxide, sevoflurane, and oxygen. There were no perioperative complications related to anesthesia and surgery.

Anesthesia, General↗
PubMed2003

[Anesthetic management of patients with Poland syndrome: report of two cases].

Poland syndrome is a rare anomaly characterized by unilateral absence of the pectoral muscles and ipsilateral syndactyly and microdactyly. Associated anomalies include defect of ipsilateral ribs and costal cartilages. We report two cases of Poland syndrome. The first case, 24 year old female patient underwent mammoplasty. Although her pectoral muscles were absent, there was no rib or costal cartilage defect. General anesthesia was maintained with assisted spontaneous respiration through laryngeal mask airway. The second case, 18 year old male patient had rib cage defect. Although the patient was asymptomatic when he was awake, paradoxical respiratory movement could have caused inadequate ventilation during general anesthesia. Anesthesia was maintained with intermittent positive pressure ventilation through endotracheal tube during skin flap plasty of latissimus dorsi muscle. In both cases, there was no respiratory complication during perioperative period.

Adolescent↗