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Kunihisa Miura

Publications and source records attributed to Kunihisa Miura.

5 recordsLinked to original sources
PubMed2005

Clinical review: Tokyo - protecting the health care worker during a chemical mass casualty event: an important issue of continuing relevance.

Determine the effectiveness of decontamination, and perform thorough dry or wet decontamination, depending on the circumstances. Always remain cognizant of the fact that, even after decontamination has been completed, contamination may not have been completely eliminated. Perform periodic monitoring to determine whether secondary exposure has occurred in health care workers; if it appears that secondary exposure has occurred, then the PPE level must be increased and attempts must be made to identify and eliminate the source of the contamination. Finally, if the victims were exposed through ingestion, then consider the possibility that secondary exposure will occur during gastric lavage.

Chemical Terrorism↗
PubMed2004

[Perioperative heart rate control with landiolol for a patient with rapid atrial fibrillation complicated with low cardiac function].

A 62-year-old man complicated with old antero-septal wall myocardial infarction and atrial fibrillation suffered from lung and pancreas cancer. He underwent gastro-duodenum bypass surgery under epidural combined with general anesthesia. His ECG and echocardiogram revealed atrial fibrillation and his left ventricular ejection fraction was 35%. After the start of surgery under general anesthesia, EHR was stable between 80-100 beats x min(-1) but rapid atrial fibrillation developed with a rate of over 140 beats x min(-1) after epidural injection of 0.375% ropivacaine 3 ml. Treatment including continuous intravenous diltiazem and several bolus intravenous injections of verapamil failed to decrease the heart rate. Therefore we used landiolol, a short-acting beta blocker, to control heart rate. HR decreased without decreasing his blood pressure. Continuous landiolol infusion was maintained for 3 hours and 30 minutes in the ICU. After finishing infusion, his heart rhythm never became rapid atrial fibrillation. We conclude that landiolol is useful for heart rate control of rapid atrial fibrillation.

Anesthesia, Epidural↗
PubMed2003

[The accuracy of transcutaneous carbon dioxide monitoring during laparoscopic surgery].

BACKGROUND: Laparoscopic procedures are considered relatively low-invasive. However, there exists a small but important risk of developing complications related to carbon dioxide (CO2) insufflation. End-tidal CO2 (PetCO2) monitoring may not be a sufficient guide to adjust pulmonary ventilation during laparoscopic surgery, and arterial CO2 (PaCO2) monitoring is not always indicated. We evaluated the accuracy and feasibility of transcutaneous CO2 (PtcCO2) monitoring during laparoscopic surgery. METHODS: Thirty adult patients undergoing abdominal or gynecological laparoscopic surgery were studied. PtcCO2, PaCO2 and PetCO2 were measured before laparoscopy, and 30 and 60 minutes after beginning of CO2 insufflation. PtcCO2 and PaCO2 were also measured in the recovery room under spontaneous respiration. RESULTS: During operation, the PtcCO2 values demonstrated a high degree of correlation with PaCO2 (r = 0.92), and PetCO2 values also demonstrated generally a good correlation with PaCO2 (r = 0.85). The PtcCO2 PaCO2 gradient was -0.6 +/- 2.2 mmHg, while the PetCO2-PaCO2 gradient was -3.9 +/- 2.7 mmHg. In the recovery room, PtcCO2 values still demonstrated a high correlation with PaCO2 (r = 0.91). CONCLUSIONS: The transcutaneous devices provide an effective method for non-invasive monitoring of PCO2 in situations where continuous monitoring of CO2 levels is desired such as peri-operative period of laparoscopic surgery.

Adult↗
PubMed2002

[Transcutaneous carbon dioxide and oxygen measurement in patients undergoing microlaryngosurgery with high frequency jet ventilation].

BACKGROUND: High frequency jet ventilation (HFJV) via thin tracheal tube is a convenient method of ventilation in microlaryngosurgery, but the problem of the assessment of oxygen and carbon dioxide status during HFJV is yet to be studied. METHODS: Fifteen patients undergoing microlaryngosurgery under total intravenous anesthesia with HFJV were studied. The combined transcutaneous carbon dioxide (PtcCO2) and oxygen (PtcO2) levels were compared with arterial blood gas values (PaCO2, PaO2). RESULTS: The PtcCO2 values demonstrated a high degree of correlation with PaCO2 before intubation (r = 0.97), during HFJV (r = 0.96), and after anesthesia (r = 0.93). The PaO2 values demonstrated a generally good correlation with PaO2 before intubation (r = 0.78) and during HFJV (r = 0.83), but not after anesthesia (r = 0.54). CONCLUSION: Capnography values are invalid during HFJV, and an arterial catheter is not always indicated and feasible in microlaryngoscopy. The transcutaneous devices provide an effective method for non-invasive monitoring of PaCO2 in situations where continuous and precise control of CO2 levels is desired such as in perioperative period of microlaryngosurgery with HFJV.

Adult↗