Methadone: applications in pediatric anesthesiology and critical care medicine
AbstractLike morphine, methadone is a pure agonist at the µ opioid receptor. However, in distinction to morphine which has an elimination half-life of 2–3 h, methadone has an elimination half-life of 24–36 h. In addition to its effects at the µ opioid receptor, methadone is an antagonist at then-methyl-d-aspartate (NMDA) receptor and also inhibits the reuptake of the neurotransmitters, serotonin and norepinephrine, in the central nervous system. Given its long half-life and high oral bioavailability, methadone has had a primary role in the outpatient treatment of patients with a history of...
Source: Journal of Anesthesia - January 12, 2021 Category: Anesthesiology Source Type: research

Error grid analysis for risk management in the difference between invasive and noninvasive blood pressure measurements
ConclusionsThe error grid analysis indicated that the differences between IAP and NIBP for mean blood pressure were not clinically acceptable and had the risk of leading to unnecessary treatments. Continuous phenylephrine administration and age were the significant factors of an increased clinical risk of the discrepancies between IAP and NIBP. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - January 11, 2021 Category: Anesthesiology Source Type: research

Generic rocuronium reduces withdrawal movements compared to original rocuronium under target-controlled infusion induction with propofol
This study was carried out to compare the injection pain caused by generic rocuronium and that caused by original rocuronium in patients anesthetized by propofol with a target-controlled infusion system.MethodsForty patients were randomly assigned to two groups in this single-center, prospective, randomized, double-blind study. One group was administered generic rocuronium after sedation with propofol with a target-controlled infusion system. The other group was administered original rocuronium after anesthesia with propofol. Patient ’s withdrawal movements were assessed with the scale. The primary outcome was the to...
Source: Journal of Anesthesia - January 9, 2021 Category: Anesthesiology Source Type: research

Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study
AbstractSince perioperative anaphylaxis occurs suddenly, and it can be life-threatening, anesthesiologists need to have sufficient knowledge of the epidemiology of perioperative anaphylaxis and appropriate coping strategies to deal with it. Recent studies conducted in Western countries reported the characteristics of perioperative anaphylaxis in each country. However, there are few studies of perioperative anaphylaxis in Japan. To bridge the gap between Japan and other countries, the data of 46 anaphylaxis patients at Gunma University Hospital and 13 neighboring hospitals between 2012 and 2018 were collected and analyzed. ...
Source: Journal of Anesthesia - January 9, 2021 Category: Anesthesiology Source Type: research

Incidence and effects of postoperative migration of interscalene catheter tips placed using ultrasound-guided anterior and posterior approaches
We examined to see if catheter tip migration would occur with no catheter-at-skin change after anterior and posterior approaches to CISB in patients undergoing shoulder surgery, and compared the incidence rate and pain scores between approaches and between catheters with and without tip migration, respectively.MethodsPatients were randomly assigned to receive CISB using either anterior or posterior approach. Catheter tip was observed using a cross-sectional view. The rates of catheter tip migration with no catheter-at-skin change at 24  h after the two approaches were calculated and compared, and pain scores were comp...
Source: Journal of Anesthesia - January 8, 2021 Category: Anesthesiology Source Type: research

Reply to the letter
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - January 8, 2021 Category: Anesthesiology Source Type: research

Cardiopulmonary bypass and halogenated agents
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - January 7, 2021 Category: Anesthesiology Source Type: research

The impact of total intravenous anesthesia versus inhalation anesthesia on acute kidney injury after major abdominal surgery: a propensity score analysis
AbstractPurposeThe effect of anesthetic types on postoperative acute kidney injury (AKI) remains unclear particularly in patients undergoing non-cardiac surgery. The purpose of this retrospective study was to compare total intravenous anesthesia (TIVA) and inhalation anesthesia in terms of the risk of AKI after open major abdominal surgery (MAS).MethodsAdult patients who underwent open MAS (gastrectomy, hepatectomy, colectomy, or pancreatectomy) at our institute from  2016 to 2018 were included. Using the multivariable logistic regression, the risk of postoperative AKI was compared among patients who underwent TI...
Source: Journal of Anesthesia - January 2, 2021 Category: Anesthesiology Source Type: research

Steroid-induced rapid recovery from respiratory dysfunction in a patient with myasthenia gravis after spinal anesthesia
We report an 83-year-old man with myasthenia gravis (MG) who developed respiratory depression after spinal anesthesia for transurethral laser enucleation of the prostate. He became less responsive after complained of dyspnea, with a decrease of SpO2 to 83% approximately 13  min after intrathecal administration of 0.5% isobaric bupivacaine 3 ml. With a diagnosis of exacerbation of MG, hydrocortisone 100 mg was administered, following which both consciousness and spontaneous respiration rapidly improved. Cold sense was observed below the C4 dermatome. We provided gen eral anesthesia without using muscle relaxa...
Source: Journal of Anesthesia - January 2, 2021 Category: Anesthesiology Source Type: research

Pharmacokinetics of intraperitoneal and subcutaneous levobupivacaine in anesthetized rats
ConclusionLevobupivacaine is rapidly absorbed following IP administration, but its maximum plasma concentration within 2  h following IP administration is no statistical difference as that following SC administration. On the other hand, when levobupivacaine is given subcutaneously,Tmax can exceed 1  h, so we need to be aware of local anesthetic toxicity during this period. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - January 1, 2021 Category: Anesthesiology Source Type: research

Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study
ConclusionsThe anterior pathway of dye diffusion from the site of injection within the erector spinae muscle group during an ESP block seems to follow the blood vessels and dorsal rami of spinal nerves, suggesting the passing through the costotransverse foramen to reach the anterior paravertebral space and the intercostal nerves. These findings display an anterior histotopographic diffusion of dye resembling a paravertebral block. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - December 19, 2020 Category: Anesthesiology Source Type: research

Update to the handling of “Preprints” by the Journal of Anesthesia
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - December 15, 2020 Category: Anesthesiology Source Type: research

COVID-19: accurate interpretation of diagnostic tests — a statistical point of view
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - December 11, 2020 Category: Anesthesiology Source Type: research

Comparison of colloid and crystalloid using goal-directed fluid therapy protocol in non-cardiac surgery: a meta-analysis of randomized controlled trials
ConclusionColloids in goal-directed fluid therapy protocol does not offer any benefit over crystalloid-based goal-directed fluid therapy protocol in patients undergoing major non-cardiac surgical procedure. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - November 18, 2020 Category: Anesthesiology Source Type: research

High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
AbstractPurposeTo prevent coughing related to tracheal intubation and the resultant exposure of intubating staff to the patients ’ expiratory aerosols, the timing of tracheal intubation needs to be precisely predicted. The aim of this study was to evaluate the hypothesis that the timing for safe tracheal intubation in elderly patients can be determined by acceleromyographically monitoring paralysis of the adductor pollicis muscle when high-dose rocuronium, given to block the respiratory muscles, is administered.MethodsForty elderly (65 –92 years) patients were enrolled in this study and randomly assigned t...
Source: Journal of Anesthesia - November 18, 2020 Category: Anesthesiology Source Type: research

Interpretation of laboratory tests for prevention of the SARS-CoV-2 transmission
AbstractWith the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medical providers should take care to prevent the transmission of SARS-CoV-2 in hospitals including super-spreading. Understanding super-spreading would be useful to reduce future transmission. Some publications have shown clusters of SARS-CoV-2 such as at choir practice and in hospitals. Aerosol can be considered as a primary transmission route. As SARS-CoV-2 stability in aerosol is similar to SARS-CoV-1 with the higher reproductive number of SARS-CoV-2 than SARS-CoV-1, another factor causes rapidly spread-out, e.g. a higher discharge...
Source: Journal of Anesthesia - November 7, 2020 Category: Anesthesiology Source Type: research

Feasibility, reliability, and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 in patients attending the pain clinic
ConclusionsThe 12-item WHODAS 2.0 is a useful measurement tool to assess disability of pain patients with high reliability and validity. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - November 5, 2020 Category: Anesthesiology Source Type: research

Predicting cardiac risk in noncardiac surgery: a narrative review
The objective of this review is to summarize the current literature on the clinical diagnoses of perioperative myocardial injury in the setting of noncardiac surgery. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - November 3, 2020 Category: Anesthesiology Source Type: research

Retraction Note to: Functional analysis of newly identified RYR1 variants in patients susceptible to malignant hyperthermia
The authors have retracted this article because they did not have permission to use the data in Tables 1 and 2. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - November 2, 2020 Category: Anesthesiology Source Type: research

The pulmonary circuit dynamics in COVID-19!
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 31, 2020 Category: Anesthesiology Source Type: research

Reply to the letter
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 31, 2020 Category: Anesthesiology Source Type: research

Acknowledgment to reviewers
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 30, 2020 Category: Anesthesiology Source Type: research

Effects of anesthetic agents on contractions of the pregnant rat myometrium in vivo and in vitro
ConclusionsInhibition of myofilament calcium sensitivity may underlie the inhibition of myometrial contraction induced by sevoflurane. Arachidonic acid may play an important role in the enhancement of myometrial contraction induced by dexmedetomidine by increasing myofilament calcium sensitivity. Dexmedetomidine may be used as a sedative agent to promote uterine muscle contraction and suppress bleeding after fetal delivery. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 24, 2020 Category: Anesthesiology Source Type: research

Course of the thoracic nerves around the umbilicus within the posterior layer of the rectus sheath: a cadaver study
AbstractRectus sheath block is used to anesthetize thoracic nerves around the umbilicus. However, the appropriate point for anesthetic injection during rectus sheath block has not been determined anatomically. Here, we examined the course of thoracic nerve T10 at the posterior layer of the rectus sheath and the anatomical relationship between the nerve and the rectus abdominis and transversus abdominis muscles in formalin-fixed adult cadavers. The cranio-caudal distance from a horizontal line running through the umbilicus to where the thoracic nerve T10 passes through the posterior layer of the rectus sheath was 33.8 &thin...
Source: Journal of Anesthesia - October 16, 2020 Category: Anesthesiology Source Type: research

Evaluation of postoperative kidney function after administration of 6% hydroxyethyl starch during living-donor nephrectomy for transplantation
ConclusionSix percent HES 130/0.4 is not associated with postoperative renal dysfunction in donor patients undergoing nephrectomy for kidney transplantation. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 14, 2020 Category: Anesthesiology Source Type: research

How to administer remimazolam for anesthesia induction
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 13, 2020 Category: Anesthesiology Source Type: research

Evaluation of a new face mask concept for oxygen administration: a crossover study in healthy volunteers
In conclusion, the new mask was more comfortable and provided higher et-O2 than the conventional mask. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 8, 2020 Category: Anesthesiology Source Type: research

Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea
AbstractPurposePeripheral gangrene (PG) is a known complication requiring limb amputation among sepsis survivors; however, its incidence and associated risk factors remain controversial. We aimed to examine the incidence of limb amputation among sepsis survivors, and to investigate factors independently associated with limb amputation.MethodsIn this population-based cohort study, data obtained from the South Korean national health insurance service database between 2015 and 2016 were analyzed. A sepsis survivor was defined as someone having survived  >  90 days after initiation of treatment for sepsis...
Source: Journal of Anesthesia - October 5, 2020 Category: Anesthesiology Source Type: research

Training in pediatric anesthesia in Japan: how should we come along?
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - October 2, 2020 Category: Anesthesiology Source Type: research

Managing COVID-19 from the epicenter: adaptations and suggestions based on experience
This article describes how an anesthesiology department at a large urban academic hospital rapidly adapted and deployed to meet the threat head-on. Topics included are preparatory efforts, devel opment of a team-based staffing model, and a new strategy for resource management. While still maintaining a fully functioning operating theater, discrete teams were deployed to both COVID-19 and non-COVID-19 intensive care units, rapid response/airway management team, the difficult airway response team, and labor and delivery. Additional topics include the creation of a temporary ‘pop-up’ anesthesiology-run COVID-19 in...
Source: Journal of Anesthesia - September 30, 2020 Category: Anesthesiology Source Type: research

Effect of an aerosol box on tracheal intubation difficulty
AbstractThe aim of this study was to determine the effect of an aerosol box on tracheal intubation difficulty. Eighteen experienced anesthetists intubated the trachea of a manikin with a normal airway 6 times using a direct laryngoscope, a McGRATH ™ MAC videolaryngoscope, or an airway scope AWS-S200NK videolaryngoscope with or without an aerosol box. Although the aerosol box prolonged the time to successful intubation and decreased the percentage of glottic opening (POGO) score when using a direct laryngoscope, the statistically significant differences were clinically irrelevant. When a McGRATH™ MAC and an AWS-...
Source: Journal of Anesthesia - September 23, 2020 Category: Anesthesiology Source Type: research

Erector spinae plane block versus retrolaminar block for postoperative analgesia after breast surgery: a randomized controlled trial
ConclusionESPB is equivalent, and not superior, to RLB for postoperative analgesia after breast surgery when 20  mL of 0.375% levobupivacaine is injected at the fourth thoracic vertebra. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - September 10, 2020 Category: Anesthesiology Source Type: research

COVID-19: be aware of contaminated airway devices
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - September 10, 2020 Category: Anesthesiology Source Type: research

Validation of the Japanese version of the Bath CRPS Body Perception Disturbance Scale for CRPS
ConclusionsBPDS-J has good internal consistency and concurrent validity for assessing body perception disturbance in Japanese patients with CRPS. Disturbed body perception may be worth evaluating when managing patients with CRPS using BPDS. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - September 8, 2020 Category: Anesthesiology Source Type: research

Open randomized trial of the effects of 6% hydroxyethyl starch 130/0.4/9 and 5% albumin on safety profile, volume efficacy, and glycocalyx degradation in hepatic and pancreatic surgery
AbstractPurposeThe aim of this study was to evaluate the effects of hydroxyethyl starch (HES) 130/0.4/9 compared to 5% albumin on renal and coagulation safety profiles, volume efficacy and glycocalyx degradation in major abdominal surgery.MethodsThe study was approved by the institutional ethics committee as a single center, open-labeled randomized trial. Fifty patients undergoing hepatic or pancreatic surgery were randomly assigned to the HES group (n = 25), who received HES 130/0.4/9, or the Albumin group (n = 25), who received 5% albumin. Ringer’s acetate solution (3 ml/kg/h) and c...
Source: Journal of Anesthesia - September 7, 2020 Category: Anesthesiology Source Type: research

Intraoperative hyperglycemia in patients with an elevated preoperative C-reactive protein level may increase the risk of acute kidney injury after cardiac surgery
ConclusionsIntraoperative hyperglycemia in patients with an elevated preoperative CRP level was significantly related to an increased risk of AKI after cardiac surgery. Individualized perioperative glycemic control may therefore be necessary in these patients. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - September 3, 2020 Category: Anesthesiology Source Type: research

Effects of ultrasound-guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial
AbstractPurposeAlthough uniportal video-assisted thoracoscopic surgery (VATS) has been widely used, the associated postoperative pain is still severe. Currently, a variety of regional anesthesia methods have been used to relieve postoperative pain. In our study, we wanted to evaluate the effectiveness of ultrasound-guided erector spinae plane block (ESPB) as a postoperative analgesia after uniportal VATS.MethodsEighty patients scheduled to undergo uniportal VATS were randomly divided into Group ESP and Group C. In Group ESP, the patients underwent ultrasound-guided ESPB under general anesthesia before surgery, while Group ...
Source: Journal of Anesthesia - September 3, 2020 Category: Anesthesiology Source Type: research

Cardiovascular considerations for anesthesiologists during the COVID-19 pandemic
AbstractThe coronavirus disease (COVID-19) pandemic has brought critical challenges to anesthesiologists and perioperative practice. Whereas anesthesiologists may be primarily concerned with airway and respiratory management, the COVID-19 data accumulated to date indicate that primary and/or secondary cardiovascular complications are common. Previous studies have demonstrated that the mortality rate is significantly higher in patients with cardiovascular disease (CVD) than in patients without CVD. Dysregulation of immune function in patients with CVD may be involved in the prognosis of COVID-19 patients. Anesthesia and sur...
Source: Journal of Anesthesia - September 2, 2020 Category: Anesthesiology Source Type: research

Respiratory characteristics and related intraoperative ventilatory management for patients with COVID-19 pneumonia
AbstractA substantial proportion of patients with coronavirus disease 19 (COVID-19) develop severe respiratory failure. Although the exact pathophysiology of severe COVID-19 pneumonia remains unknown and the characteristics of these patients are heterogeneous, the acute respiratory failure often fulfills criteria for acute respiratory distress syndrome (ARDS) and the clinical characteristics are also consistent with what is previously known about ARDS. Cohort studies also report distinctively high association between perioperative COVID-19 and postoperative mortality. In this special article, we review several publications...
Source: Journal of Anesthesia - August 30, 2020 Category: Anesthesiology Source Type: research

Reply to the letter
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - August 29, 2020 Category: Anesthesiology Source Type: research

Supplemental oxygen in surgical patients with COVID-19
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - August 29, 2020 Category: Anesthesiology Source Type: research

Why the natural frequency and the damping coefficient do not evaluate the dynamic response of clinically used pressure monitoring circuits correctly
ConclusionsThe natural frequency and the damping coefficient are inadequate for the dynamic response evaluation. These parameters are primarily obtained from the phase spectrum curve and not from the amplitude spectrum curve. We strongly recommend an evaluation using the amplitude spectrum curve with our step response analysis method. It is crucial to maintain an amplitude gain of 1 (input amplitude  = output amplitude) in the pressure wave frequency range of 0–20 Hz. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - August 28, 2020 Category: Anesthesiology Source Type: research

Anesthesiologist behavior and anesthesia machine use in the operating room during the COVID-19 pandemic: awareness and changes to cope with the risk of infection transmission
AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease [coronavirus disease 2019 (COVID-19) infection] first appeared in December 2019 in China and is now spreading worldwide. Because SARS-CoV-2 can be transmitted via aerosols and surface contaminations of the environment, appropriate use of anesthesia machines and appropriate behavior in the operation room (OR) are required specifically in relation to this disease. The use of high-performance hydrophobic filters with a high rate of virus rejection is recommended as the type of viral filter, and surgical team behaviors that result in aerosol splas...
Source: Journal of Anesthesia - August 26, 2020 Category: Anesthesiology Source Type: research

Desflurane and sevoflurane concentrations in blood passing through the oxygenator during cardiopulmonary bypass: a randomized prospective pilot study
ConclusionOur results demonstrated that the blood concentrations of desflurane and sevoflurane passing through oxygenators used during CPB were similar to those in the human lung control. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - August 25, 2020 Category: Anesthesiology Source Type: research

Analogy between classical Yoga/Zen breathing and modern clinical respiratory therapy
AbstractAnesthesiologists and intensivists are modern-day professionals who provide appropriate respiratory care, vital for patient survival. Recently, anesthesiologists have increasingly focused their attention on the type of spontaneous breathing made by non-intubated patients with pulmonary disease cared for in an intensive care unit, and also patients with chronic pain receiving cognitive behavioral therapy. Prior to our modern understanding of respiratory physiology, Zen meditators recognized that breathing has a significant impact on a person ’s mental state and general physical well-being. Examples of this kno...
Source: Journal of Anesthesia - August 16, 2020 Category: Anesthesiology Source Type: research

Appropriate dosing of sugammadex and rocuronium for reversal of neuromuscular blockade and reparalysis
(Source: Journal of Anesthesia)
Source: Journal of Anesthesia - August 15, 2020 Category: Anesthesiology Source Type: research

Opioid-free anesthesia under single injection paravertebral block combined with sevoflurane for pediatric renal surgery: a prospective observational pilot study
AbstractEven though several studies have demonstrated the effectiveness of opioid free anesthesia (OFA) strategies in pediatric patients, OFA has not been studied in pediatric renal surgery. We, therefore, conducted a prospective observational pilot study on a total of 26 children to assess the feasibility and efficacy of using a single injection ultrasound-guided paravertebral block (PVB) at T10 level with 0.4  mL/kg bupivacaine 0.25% in combination with sevoflurane as an OFA technique in elective open renal surgery. A successful PVB (defined in terms of both hemodynamic change after the skin incision and the use of ...
Source: Journal of Anesthesia - August 13, 2020 Category: Anesthesiology Source Type: research

The incidence and reasons for canceled surgical cases in an academic medical center: a retrospective analysis before and after the development of a preoperative anesthesia clinic
ConclusionsThe total incidence of surgical case cancellations was 0.037%. Before and after the development of a PAC, cancellation rate was comparable. After the development of a PAC, none case were canceled due to insufficient preoperative anesthetic assessment. (Source: Journal of Anesthesia)
Source: Journal of Anesthesia - August 12, 2020 Category: Anesthesiology Source Type: research

Postoperative renal morbidity and mortality after volume replacement with hydroxyethyl starch 130/0.4 or albumin during surgery: a propensity score-matched study
AbstractPurposeWe aimed to compare retrospectively the rates of renal morbidity and mortality in surgical patients receiving 6% HES 130/0.4 to those receiving albumin.MethodsFrom a Japanese nationwide medical database between 2014 and 2016, we identified adults who received HES 130/0.4 (HES group) or albumin (albumin group) as a single colloid solution on the day of surgery. After propensity score matching, the two groups were analyzed withχ2 or Mann WhitneyU test. The primary outcome was the incidence of acute kidney injury (AKI). Secondary outcomes included the incidence of renal-replacement therapy, hospital length ...
Source: Journal of Anesthesia - August 10, 2020 Category: Anesthesiology Source Type: research

Unique challenges in pediatric anesthesia created by COVID-19
AbstractCoronavirus disease 2019 (COVID-19) has affected anesthetic care worldwide, including the provision of anesthesia for pediatric patients. Hospitals have balanced the risks associated with the potential surges of resource-intensive COVID-19 patients against the probable morbidity of delaying elective surgical procedures. These decisions are complicated by the unclear influence that COVID-19 has on the perioperative risk for disease-positive pediatric patients. We conducted a comprehensive literature search on MEDLINE for publications involving pediatric patients with COVID-19 who underwent general anesthesia. A tota...
Source: Journal of Anesthesia - August 6, 2020 Category: Anesthesiology Source Type: research