Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Benzodiazepines are used in pediatric patients with congenital heart disease (CHD) because of their mild hemodynamic depressant effects. A novel short-acting benzodiazepine, remimazolam, is expected to be suitable for these patients. We examined the characteristics of remimazolam anesthesia in pediatric patients with CHD undergoing cardiac catheterization. METHODS: This single-center retrospective study included pediatric patients undergoing cardiac catheterization for CHD. The primary outcome was the remimazolam dose for loss of consciousness. Secondary outcomes included the mean maintenance remimazolam dose, recovery time from anesthesia, predicted remimazolam concentration at emergence, decrease in blood pressure and heart rate, vasopressor administration during anesthesia, electroencephalogram index (bispectral index: BIS or patient state index: PSI), and life-threatening adverse events. RESULTS: Thirty-nine patients, aged 2 months to 16 years, were included. Thirty-three patients received a median [interquartile] midazolam dose of 0.10 [0.10-0.10] mg.kg-1 in the pre-anesthesia room. The remimazolam dose for loss of consciousness was 0.34 [0.26-0.45] mg.kg-1. The mean maintenance dose was 1.0 [0.8-1.4] mg.kg-1.h-1. The recovery time was 15 [12-17] min. The predicted remimazolam concentration at emergence was 0.4-1.2 µg.ml-1 in 3-6-year-old patients. Blood pressure and heart rate decreased by 30% in 15 and 6 patients, respectively. Vasopressors were administered as a bolus in 8 patients. The BIS or PSI did not fall ≤ 60 or ≤ 50, respectively, in 51% of patients before tracheal intubation. No life-threatening adverse events were reported. CONCLUSIONS: Remimazolam is a good alternative anesthetic agent for pediatric patients undergoing cardiac catheterization for CHD.

DOI： 10.1007/s00540-024-03395-5

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

Purpose of review

Remimazolam is a novel benzodiazepine anesthetic/sedative, designed as a rapidly metabolized carboxylic acid. Since its recent launch, the role of remimazolam in modern anesthesia and sedation practice is still evolving. This review aims to outline the clinical pharmacology and clinical utility of remimazolam to elucidate its potential advantages and limitations.

Recent findings

Remimazolam is “short-acting” but not ultra-short-acting compared with propofol based on context-sensitive decrement times. But compared to propofol, the availability of the benzodiazepine antagonist, flumazenil, is considered an advantage, particularly in certain emergency situations such as in patients with difficult airways. However, because flumazenil is shorter acting than remimazolam when remimazolam accumulates or is present in a high concentration, the reappearance of remimazolam sedation may occur after the initial reversal of anesthesia/sedation from flumazenil administration. Although it is beneficial that remimazolam causes less respiratory depression and hypotension than propofol, serious respiratory depression and hypotension can still occur. Remimazolam administration causes minimal or no pain on injection. Remimazolam is associated with less postoperative nausea and vomiting than inhaled anesthetics, but propofol is clearly superior in this regard. The anesthetic/sedative effects may be prolonged by severe hepatic impairment; remimazolam tolerance can occur in long-term benzodiazepine users.

Summary

Remimazolam may be beneficial to use in procedural sedation and general anesthesia for patients with difficult airways or hemodynamic instability. Further clinical studies with remimazolam are warranted to identify the potential benefits in other settings and patient populations.

DOI： 10.1097/ACO.0000000000001384

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BACKGROUND: The occurrence of hypotension after induction of general anaesthesia is common in geriatric patients, and should be prevented to minimise perioperative complications. Compared with propofol, remimazolam potentially has a lower incidence of hypotension. This study aimed to compare the incidence of hypotension after general anaesthesia induction with remimazolam or propofol in geriatric patients. METHODS: This single-centre, double-blind, randomised trial enrolled 90 patients aged ≥80 yr who received general anaesthesia for scheduled surgery. Patients were randomised to receive remimazolam (12 mg kg-1 h-1) or propofol (0.025 mg kg-1 s-1) for anaesthesia induction, with remifentanil and sevoflurane. The presence or absence of hypertension on the ward served as the stratification factor. The incidence of hypotension after the induction of general anaesthesia, defined as a noninvasive mean arterial pressure of <65 mm Hg measured every minute from initiation of drug administration to 3 min after tracheal intubation, was the primary outcome. Subgroup analysis was performed for the primary outcome using preoperative ward hypertension, clinical frailty scale, Charlson Comorbidity Index, and age. RESULTS: Three subjects were excluded before drug administration, and 87 subjects were included in the analysis. The incidence of hypotension was 72.1% (31/43) and 72.7% (32/44) with remimazolam or propofol, respectively. No statistically significant differences (adjusted odds ratio, 0.96; 95% confidence interval, 0.37-2.46; P=0.93) were observed between groups. Subgroup analysis revealed no significant differences between groups. CONCLUSIONS: Compared with propofol, remimazolam did not reduce the incidence of hypotension after general anaesthesia induction in patients aged ≥80 yr. CLINICAL TRIAL REGISTRATION: UMIN000042587.

DOI： 10.1016/j.bja.2024.04.013

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Monitoring the patient's physiological functions is critical in clinical anesthesia. The latest version of the Japanese Society of Anesthesiologists' Guidelines for Safe Anesthesia Monitoring, revised in 2019, covers various factors, including electroencephalogram monitoring, oxygenation, ventilation, circulation, and muscle relaxation. However, with recent advances in monitoring technologies, the information provided has become more detailed, requiring practitioners to update their knowledge. At a symposium organized by the Journal of Anesthesia in 2023, experts across five fields discussed their respective topics: anesthesiologists need to interpret not only the values displayed on processed electroencephalogram monitors but also raw electroencephalogram data in the foreseeable future. In addition to the traditional concern of preventing hypoxemia, monitoring for potential hyperoxemia and the effects of mechanical ventilation itself will become increasingly important. The importance of using AI analytics to predict hypotension, assess nociception, and evaluate microcirculation may increase. With the recent increase in the availability of neuromuscular monitoring devices in Japan, it is important for anesthesiologists to become thoroughly familiar with the features of each device to ensure its effective use. There is a growing desire to develop and introduce a well-organized, integrated "single screen" monitor.

DOI： 10.1007/s00540-024-03347-z

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BACKGROUND: Diagnosed intrathoracic meningocele is an uncommon complication of neurofibromatosis type 1. We report an anesthesia management for a rare case undergoing thoracoscopic resection of a huge intrathoracic meningocele. CASE PRESENTATION: A 51-year-old woman was scheduled for thoracoscopic meningectomy under general anesthesia. We monitored intrathecal pressure during anesthesia to prevent a decrease in intrathecal pressure. During surgery, the intrathecal pressure occasionally increased by around 5 cmH2O immediately after the insertion of the drainage tube and occasionally decreased by up to 10 cmH2O during the careful slow aspiration of the cerebrospinal fluid (CSF). The pressure rapidly recovered after the interruption of the procedures. She was discharged on postoperative day 4 without major complications. CONCLUSIONS: The CSF pressure was fluctuated by procedures during thoracoscopic resection of a huge meningocele. A CSF pressure monitoring was useful to detect the sudden change of CSF pressure immediately, which can cause intracranial hemorrhage.

DOI： 10.1186/s40981-024-00697-1

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.46728

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00540-022-03123-x

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Other Link： https://link.springer.com/article/10.1007/s00540-022-03123-x/fulltext.html

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Effect-site concentration is widely used to determine drug dosage in anesthesia practice. To obtain effect-site concentration, a pharmacokinetic model with a corresponding equilibration rate constant between plasma and effect-site, ke0, is necessary. Remimazolam, a novel short-acting benzodiazepine, has been approved as anesthetic/sedative. Recently, a remimazolam pharmacokinetic model has been published using a large dataset including wide range of subject characteristics (416 males and 246 females, age 18-93 years, total body weight 34-149 kg, height 133-204 cm, body mass index 14-61 kg m-2, ASA physical status: I-IV, and Asian, White, American African, and 2 other races). This Masui model can be applicable to various patients, but a pharmacodynamic model including ke0 was not developed simultaneously. A previous article has indicated that the time to peak effect of drug after its bolus should be used to determine ke0 for a pharmacokinetic model without simultaneous development of corresponding pharmacodynamic model. The ke0 value can be calculated using numerical analysis but not algebraic solution. We provide the detail method of the numerical analysis and a tool to have ke0 value easily for the Masui remimazolam PK model. Additionally, we provide a multiple regression model to have ke0 value for the PK model.

DOI： 10.1007/s00540-022-03099-8

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Authorship：Lead author,　Corresponding author   Language：English  

DOI： 10.1007/s00540-022-03107-x

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: In geriatric patients, hypotension is often reported after general anesthesia induction using propofol. Remimazolam is a novel short-acting sedative. However, the incidence of hypotension after general anesthesia induction using remimazolam in geriatric patients remains unclear. This study aims to compare the incidence of hypotension associated with remimazolam and propofol in patients aged ≥80 years. METHODS: This single-center, double-blind, randomized, two-arm parallel group, standard treatment-controlled, interventional clinical trial will include 90 patients aged ≥80 years undergoing elective surgery under general anesthesia who will be randomized to receive remimazolam or propofol for induction. The primary outcome is the incidence of hypotension after general anesthesia induction, occurring between the start of drug administration and 3 min after intubation. We define hypotension as mean blood pressure <65 mmHg. The primary outcome will be analyzed using the full analysis set. The incidence of hypotension in the two groups will be compared using the Mantel-Haenszel χ2 test. Subgroup analysis of the primary outcome will be performed based on the Charlson comorbidity index, clinical frailty scale, hypertension in the ward, and age. Secondary outcomes will be analyzed using the Fisher's exact test, Student's t test, and Mann-Whitney U test, as appropriate. Logistic regression analysis will be performed to explore the factors associated with the incidence of hypotension after anesthesia induction. DISCUSSION: Our trial will determine the efficacy of remimazolam in preventing hypotension and provide evidence on the usefulness of remimazolam for ensuring hemodynamic stability during general anesthesia induction in geriatric patients. TRIAL REGISTRATION: The study has been registered with UMIN Clinical Trials Registry (UMIN000042587), on June 30, 2021.

DOI： 10.1371/journal.pone.0275451

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Remimazolam besylate is a novel short-acting benzodiazepine. An appropriate pharmacokinetic model of remimazolam is desirable in anesthesia practice. The aim of the study was to develop a pharmacokinetic model using plasma samples from patients anesthetized with remimazolam. Influence of patient characteristics, context-sensitive decrement-times, and dose regimens were also examined. METHODS: Data were obtained from four trials on patients, and seven trials on healthy volunteers. The characteristics of 416 male and 246 female subjects were as follows: age, 18-93 years; body weight, 34-149 kg; and American Society of Anesthesiologists physical status (ASA-PS), I-IV. 2231 arterial and 3200 venous samples were used for the final model. The equilibration rate constant between arterial plasma and effect-site was estimated using the concept of time to peak effect. The final model was used to generate context-sensitive decrement times and dose regimens for general anesthesia. RESULTS: A three-compartment model plus virtual venous compartment with allometric scaling of adjusted body weight (ABW), age, sex, and ASA-PS as covariates were selected as the final model. Elimination clearance was lower in males, and in subjects with higher ABW and ASA-PS scores. Approximately 10% or 20% higher dose rate was necessary in females than in males or ASA-PS I/II than III/IV patient. The context-sensitive half-time for effect-site concentration in a 55-year-old, 70-kg, 170-cm male or female ASA-PS I/II patient after > 6-h infusion was 16.7 or 15.9 min. CONCLUSION: Remimazolam pharmacokinetic model for general anesthesia was successfully developed. ABW, ASA-PS, and sex has a considerable impact on the remimazolam concentration.

DOI： 10.1007/s00540-022-03079-y

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Frontiers Media SA  

Objective

To stratify patients with polymyositis/dermatomyositis-associated interstitial lung disease (ILD) who were initially treated with an intensive regimen consisting of high-dose corticosteroids, a calcineurin inhibitor, and intravenous cyclophosphamide (triple-combo therapy) into subgroups based on mortality outcomes by a cluster analysis using a large-scale multicenter retrospective cohort of Japanese patients with myositis-associated ILD (JAMI).

Methods

Two-step cluster analysis of preclustering and subsequent hierarchical clustering was conducted in 185 patients who received triple-combo therapy in an unbiased manner. Initial predictors for mortality previously reported in patients with myositis-associated ILD were used as variables and included age, sex, disease duration, classification of myositis, requirement of supplemental oxygen, anti-aminoacyl tRNA synthetase (ARS) antibody, anti-melanoma differentiation-associated gene 5 (MDA5) antibody, and serum levels of C-reactive protein (CRP) and Krebs von den Lungen-6 (KL-6). The cluster model was further applied to 283 patients who received conventional regimens consisting of corticosteroids with or without a single immunosuppressive agent (dual-combo therapy or monotherapy). Cumulative survival rates were compared using Kaplan-Meier analysis, and the log-rank test was used to test for significant differences between two groups.

Results

We developed a cluster model consisting of 6 clusters, which were categorized by age at onset, clinically amyopathic dermatomyositis, CRP, KL-6, requirement of supplemental oxygen, anti-ARS antibody, and anti-MDA5 antibody. This model was judged to be of good quality based on the silhouette measure of cohesion and separation of 0.6. These clusters were regrouped into three subsets based on low (&amp;lt;10%), moderate (10-50%), and high (&amp;gt;50%) mortality rates. The performance of the clustering was generally replicated in patients who received initial dual-combo therapy or monotherapy. Survival benefits of triple-combo therapy over dual-combo therapy or monotherapy were not observed in any of the clusters.

Conclusion

We successfully developed a cluster model that stratified patients with myositis-associated ILD who were treated with initial triple-combo therapy into subgroups with different prognoses, although this model failed to identify a patient subgroup that showed survival benefits from triple-combo therapy over dual-combo therapy or monotherapy.

DOI： 10.3389/fmed.2022.883699

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Authorship：Last author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Reconstructive head and neck surgery can alter upper airway anatomy. We report a difficult intubation in a patient with a history of hemiglossectomy and reconstruction. CASE PRESENTATION: A 65-year-old female patient, who had undergone hemiglossectomy with the flap reconstruction, underwent video-assisted thoracoscopic esophagectomy for esophageal cancer. After the loss of consciousness during anesthesia induction, we failed to perform direct and oral fiberoptic intubation using a video laryngoscope and nasal fiberoptic intubation without or with video laryngoscope assistance in the supine position. Finally, shifting the patient to the left-lateral position allowed successful nasal fiberoptic intubation. Postoperatively, we were informed that she was unable to sleep in the supine position because of airway obstruction and therefore always slept on her side. CONCLUSION: Preanesthetic evaluation of the influence of body position on the airway patency during sleep or sedation may aid in airway management.

DOI： 10.1186/s40981-022-00509-4

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A 60-year-old woman with a 5-year history of anxiolytic use, a diazepam-equivalent daily dose of 15 mg, was scheduled for esophageal stent removal. She was given remimazolam (0.5 mg/kg) but remained fully alert. She only lost consciousness with propofol (40 mg). A 61-year-old man with a 1-year history of anxiolytic use, diazepam-equivalent daily dose of 20 mg, was scheduled for hand tumor resection. He was given remimazolam (0.3 mg/kg) but remained fully alert. He only lost consciousness after desflurane inhalation. In a patient with a history of long-term benzodiazepine use, anesthetic or sedative agents aside from remimazolam should be considered.

DOI： 10.1213/XAA.0000000000001460

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Authorship：Last author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Chimpanzees are genetically and physiologically similar to humans. Several pharmacokinetic models of propofol are available and target controlled infusion (TCI) of propofol is established in humans, but not in chimpanzees. The purpose of this study was to investigate if human pharmacokinetic models can accurately predict propofol plasma concentration (Cp) in chimpanzees and if it is feasible to perform TCI in chimpanzees. Ten chimpanzees were anaesthetized for regular veterinary examinations. Propofol was used as an induction or maintenance agent. Blood samples were collected from a catheter in a cephalic vein at 3-7 time points between 1 and 100 min following the propofol bolus and/or infusion in five chimpanzees, or TCI in six chimpanzees. Cp was measured using high-performance liquid chromatography. The Marsh, Schnider and Eleveld human pharmacokinetic models were used to predict Cp for each case and we examined the predictive performances of these models using the Varvel criteria Median PE and Median APE. Median PE and Median APE for Marsh, Schnider and Eleveld models were within or close to the acceptable range. A human TCI pump was successfully maintained propofol Cp during general anesthesia in six chimpanzees. Human propofol pharmacokinetic models and TCI pumps can be applied in chimpanzees.

DOI： 10.1038/s41598-020-79914-7

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The objectives of this study were (a) to establish a population pharmacokinetic model and (b) to investigate the clinical and physiological effects of a single bolus dose of propofol in common marmosets. In Study 1, pharmacokinetic analysis was performed in six marmosets under sevoflurane anaesthesia. 8 mg/kg of propofol was administrated at a rate of 4 mg kg-1  min-1 . Blood samples were collected 2, 5, 15, 30, 60, 90, 120 or 180 min after starting propofol administration. Plasma concentration was measured, and population pharmacokinetic modelling was performed. A two-compartment model was selected as the final model. The population pharmacokinetic parameters were as follows: V1  = 1.14 L, V2  = 77.6 L, CL1  = 0.00182 L/min, CL2  = 0.0461 L/min. In Study 2, clinical and physiological parameters were assessed and recorded every 2 min after 12 mg/kg of propofol was administrated at a rate of 4 mg kg-1  min-1 . Immobilization was sustained for 5 min following propofol administration without apparent bradycardia. While combination of propofol and sevoflurane caused apnoea in Study 1, apnoea was not observed following single administration of propofol in Study 2. These data provide bases for further investigation on intravenous anaesthesia using propofol in common marmosets.

DOI： 10.1111/jvp.12905

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With 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 ratio from infected people or a higher viral intake ratio to human body. A basic research suggests higher infectivity of SARS-CoV-2 in the nose than the peripheral lung. Universal masking would be important to prevent the exposure of SARS-CoV-2 droplet to uninfected people. To detect SARS-CoV-2 infection, laboratory tests such as reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assays are applied. Although sensitivity and specificity are provided for the ability of the test, positive or negative prediction values are useful to indicate the possiblity of infection or non-infection in clinical practice. We have to realize that the positive and negative prediction values depend on the sensitivity, specificity, and infection probability of the patient.

DOI： 10.1007/s00540-020-02872-x

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OBJECTIVE: To establish predictive models for mortality in patients with polymyositis/dermatomyositis (PM/DM)-associated interstitial lung disease (ILD) using a combination of initial serum biomarkers. METHODS: A multicenter JAMI cohort database of 497 incident cases of PM/DM-ILD was used as a derivation cohort, and 111 cases were additionally collected as a validation cohort. Risks for predicting all-cause mortality were identified by univariate and multivariable Cox regression analyses using candidate serum biomarkers as explanatory variables. The predictive models for mortality were generated in patients with and without anti-melanoma differentiation-associated gene 5 (MDA5) antibody, using a combination of risk factors. Cumulative survival rates were assessed using Kaplan-Meier analysis, and were compared between the subgroups with Breslow test. RESULTS: In a derivation cohort, C-reactive protein (CRP) and Krebs von den Lungen-6 (KL-6) were identified as independent risk factors for mortality in both anti-MDA5-positive and negative patients. We then developed a prediction model termed MCK (MDA5, CRP, and KL-6) model, identifying patients at low (<15%), moderate (15-50%), or high risk (≥50%) of mortality, based on the number of risk factors. The MCK model successfully differentiated cumulative survival rates in anti-MDA5-positive patients (P < 0.01 between low and moderate risk and P = 0.03 between moderate and high risk) and in anti-MDA5-negative patients (P < 0.001 between low and moderate risk). Utility of the MCK model was replicated in the validation cohort. CONCLUSION: The evidence-based risk prediction model using CRP and KL-6 combined with anti-MDA5 antibody might be useful for predicting prognosis in patients with PM/DM-ILD.

DOI： 10.1002/art.41566

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WHAT IS KNOWN AND OBJECTIVE: Propofol is the most commonly used intravenous anaesthetic worldwide and is considered to be safe for all ages. However, there have been some reports that propofol induces severe atrioventricular (AV) blocks in humans and some studies demonstrated that propofol suppressed the cardiac conduction system in animals. A precise mechanism by which the block is induced has not been elucidated yet in humans. The objective of this study was to investigate the effects of propofol on the cardiac conduction system and the cardiac autonomic nervous balance in children. METHODS: We enrolled 23 paediatric patients (age: 6-15 years; males: 16, females: 7) who were scheduled to undergo radiofrequency catheter ablation (RFCA) under general anaesthesia. Anaesthesia was induced with 2 mg/kg propofol and 0.5 µg/kg/min remifentanil, and tracheal intubation was performed with the aid of 1 mg/kg rocuronium. Anaesthesia was maintained with 5-7 mg/kg/h propofol and 0.2 µg/kg/min remifentanil during the RFCA. After the completion of the RFCA, anaesthesia was further maintained with 5 mg/kg/h propofol and 0.2 µg/kg/min remifentanil for at least 10 min (LC: low propofol concentration state), followed by the injection of 2 mg/kg propofol and the infusion of 10 mg/kg/h propofol for 10 min (HC: high propofol concentration state). The sinus node recovery time (SNRT), sinoatrial conduction time (SACT), atrial-His (AH) interval and the His-ventricular (HV) interval were measured at the end of both the LC and HC. Cardiac autonomic regulation was simultaneously assessed based on heart rate variability. RESULTS AND DISCUSSION: Propofol significantly suppressed intrinsic cardiac HV conduction, but did not affect the SNRT, SACT or the AH interval. As HV blocks, which occur below the His bundle, are often life-threatening, the HV conduction delay may be a cause of severe AV blocks induced by propofol. Propofol directly suppressed parasympathetic nerve activity, and sympathetic nerve activity was also suppressed. WHAT IS NEW AND CONCLUSION: These results indicate that propofol suppresses the HV conduction and might help to elucidate the mechanism by which propofol causes lethal AV blocks.

DOI： 10.1111/jcpt.13302

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Hyponatremia can be developed during hysteroscopic surgery with electrolyte-free irrigation fluid. We experienced severe hyponatremia with postoperative seizures and confirmed mild brain edema. CASE PRESENTATION: A quadragenarian female patient underwent a 2-h hysteroscopic myomectomy with electrolyte-free fluid for uterine distension under general anesthesia. Plasma sodium level of 84.1 mmol/L 100 min after the start of surgery indicated excessive absorption of the irrigation fluid. Acute severe hyponatremia was diagnosed with significant edema in the conjunctiva, lip, and extremities. She was treated with a continuous infusion of hypertonic saline. However, seizures and cerebral edema developed 7 h later. The patient recovered without neurological deficits at postoperative day 2. CONCLUSION: The electrolyte-free irrigation fluid can be absorbed rapidly during hysteroscopic surgery. Its interruption with hyponatremia should be considered against prolonged surgery. Especially under general anesthesia, caution should be exercised because the typical symptoms of hyponatremia such as nausea and confusion are blinded.

DOI： 10.1186/s40981-020-00381-0

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Language：Japanese   Publisher：日本小児麻酔学会  

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To this day, the pathophysiology and risk factors of propofol infusion syndrome (PRIS) remain unknown. Moreover, there is no widely accepted definition of PRIS, even though it is a potentially fatal condition. While many suspected cases of PRIS have been reported in both pediatric and adult populations, the actual propofol plasma concentration (Cp) has never been clarified. In this clinical report, we described the first suspected PRIS case in which the propofol Cp was measured 25 min after 226 min of propofol infusion (7.2 µg/mL), which was 12 times higher than the predicted value (0.6 µg/mL). In the presented case, we observed gradually progressive uncontrollable hypercapnia and tachycardia, followed by severe lactic acidosis during surgical anesthesia based on the target-controlled infusion of propofol. Levels of liver enzymes were slightly elevated which suggests little or no liver damage though propofol is mainly metabolized by the liver. Meanwhile, renal impairment, a common secondary feature of PRIS, occurred concomitantly when hypercapnia and metabolic acidosis were manifested. In this case, low or delayed propofol clearance might have been a triggering factor causing severe lactic acidosis.

DOI： 10.1007/s00540-020-02773-z

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Sugammadex is an innovative reversal agent for neuromuscular blockade (NMB) induced by rocuronium. Although there is a case that re-paralysis is necessary after sugammadex administration, limited reports can be found on the sugammadex dosage for reversal from profound paralysis after induction and immediate re-paralysis following such reversal in detail. We experienced a case in which NMB reversal was required in a short period after paralysis for induction due to the discovery of anisocoria. We successfully re-induced general anesthesia with tracheal intubation soon after. To examine the validity of the dosing, we performed a pharmacometric analysis. A pharmacokinetic-pharmacodynamic model was developed for the patient based on a published pharmacokinetic-pharmacodynamic model for rocuronium and sugammadex. The developed model appropriately describes the train of four ratio observed. In this case, the dose of approximately 8 mg/kg sugammadex but not the conventional dose of 16 mg/kg would be enough for immediate reversal after induction. For the re-paralysis 30 min after NMB reversal, not 1.4 mg/kg but 2.2 mg/kg rocuronium was an adequate dose. Taking individual differences including given dose and time intervals in consideration, NMB monitoring should be used to determine the necessary dose of rocuronium and sugammadex in such situations.

DOI： 10.1007/s00540-020-02824-5

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OBJECTIVES: To investigate whether the onset of polymyositis (PM)/dermatomyositis (DM)-associated interstitial lung disease (ILD) is influenced by season and residence in the context of myositis-specific autoantibodies. METHODS: For patients with PM/DM-associated ILD enrolled in a multicentre cohort, 365 and 481 patients were eligible for seasonal and geographical analysis, respectively, based on the availability of reliable clinical information. The patients were divided into three groups: (1) anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive patients, (2) anti-aminoacyl tRNA synthetase (anti-ARS) antibody-positive patients and (3) patients negative for those antibodies. Seasonality was assessed by the Rayleigh test. Distance from residence to the nearest waterfront was measured on Google Map and was compared between groups by the exact Wilcoxon rank-sum test. RESULTS: In anti-MDA5-positive patients, the disease developed more frequently in October-March (p=0.03), whereas a seasonal relationship was not found in the remaining two patient groups. Residence at disease onset in anti-MDA5-positive patients was significantly closer to the waterfront, especially to freshwater, compared with that in anti-ARS-positive or anti-MDA5-/ARS-negative patients (p=0.003 and 0.006, respectively). CONCLUSIONS: Anti-MDA5-associated ILD occurred predominantly from October to March in individuals residing near freshwater, suggesting an environmental influence on the onset of this disease subset.

DOI： 10.1136/rmdopen-2020-001202

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Authorship：Lead author,　Corresponding author   Language：English  

DOI： 10.1007/s00540-020-02755-1

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Authorship：Lead author   Language：English  

DOI： 10.1016/j.jclinane.2019.08.025

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OBJECTIVE: To clarify the incidence, risk factors, and impact of malignancy in patients with PM/DM-associated interstitial lung disease (ILD). METHODS: This study used data from 497 patients with PM/DM-associated ILD enrolled in a multicentre, retrospective and prospective cohort of incident cases. Cancer-associated myositis (CAM) was defined as malignancy diagnosed within 3 years before or after PM/DM diagnosis. Demographic and clinical information was recorded at the time of diagnosis, and data about the occurrence of mortality and malignancy was collected. RESULTS: CAM was identified in 32 patients with PM/DM-associated ILD (6.4%). Patients with CAM were older (64 vs 55 years, P < 0.001), presented with arthritis less frequently (24% vs 49%, P = 0.01), and showed a lower level of serum Krebs von den Lungen-6 (687 vs 820 IU/l, P = 0.03) than those without CAM. The distribution of myositis-specific autoantibodies, including anti-melanoma differentiation-associated gene 5, anti-aminoacyl tRNA synthetase, and anti-transcriptional intermediary factor 1-γ antibodies, did not differ between the groups. Survival analysis demonstrated that CAM patients had a poorer survival than non-CAM patients (P = 0.006), primarily due to excess deaths by concomitant malignancy, while mortality due to ILD-related respiratory failure was similar between the groups (P = 0.51). CONCLUSION: Concomitant malignancy can occur in patients with PM/DM-associated ILD, and has significant impact on mortality. Older age, lack of arthritis, and a lower level of serum Krebs von den Lungen-6 at diagnosis are predictors of concomitant malignancy.

DOI： 10.1093/rheumatology/kez238

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OBJECTIVE: Surfactant protein D (SP-D) is considered a serum biomarker of various forms of interstitial lung disease (ILD). In this study, we examined the utility of SP-D as a predictive biomarker for mortality in patients with ILD associated with polymyositis/dermatomyositis (PM/DM) using large-scale multicentre cohort data. METHODS: We enrolled 381 patients with incident PM/DM-associated ILD in a multicentre retrospective cohort based on the availability of serum SP-D at the baseline. Demographic and clinical characteristics as well as the presence of autoantibodies to melanoma differentiation-associated gene 5 (MDA5) and aminoacyl tRNA synthetase were measured at the time of diagnosis, and follow-up survival data were collected prospectively. RESULTS: Seventy-eight patients died during the median observation period of 18 months, and the majority of patients died of ILD. The SP-D levels at baseline were significantly lower (P = 0.02) in a non-survivor subset than in a survivor subset among the entire enrolled patients. However, the SP-D levels were higher in the non-survivor subset than in the survivor subset based on the stratification by anti-MDA5-positive, anti-ARS-positive and, double-negativity, although there was an only statistically significant difference (P = 0.01) in the double-negative group. Surprisingly, the SP-D levels were within the upper limit of normal, 110 ng/mL, in 54 (87%) of 62 anti-MDA5-positive patients who died. In the double-negative group, the mortality rates were significantly higher (P = 0.002) in a subset with SP-D ≥127.6 ng/mL, the cut-off value for mortality calculated by the receiver operating characteristic curve, than the other subset. All of patients with SP-D <127.6 ng/mL survived. CONCLUSION: Serum SP-D levels behave differently among patients with stratified by anti-MDA5 antibody, anti-ARS antibody and both negativity in PM/DM-associated ILD. Its use in clinical practice should be applied with caution on the basis of the presence or absence of anti-MDA5 antibody or anti-ARS antibody.

DOI： 10.1371/journal.pone.0234523

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DOI： 10.1007/s00540-018-2543-3

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The relationships between propofol plasma concentrations and the pharmacodynamic endpoints may differ according to a type of airway device. To clarify these relationships in different airway devices would be useful to avoid the complication such as apnea and intraoperative awareness. The aim of this study was to investigate the influence of difference of airway device on propofol requirement during maintenance of anesthesia in dogs. We compared the influence of airway devices on the plasma propofol concentrations for apnea, response to mechanical ventilation, and response to airway device between endotracheal tube (ETT) and supraglottic airway device (SGAD) in Beagles. The pharmacodynamic effects were repeatedly assessed at varying propofol concentrations. The plasma concentrations (mean ± SD) of propofol in the ETT and SGAD groups were 10.2 ± 1.8 and 10.9 ± 2.4 µg/ml for apnea (P=0.438), 7.9 ± 1.2 and 7.4 ± 1.5 µg/ml for response to mechanical ventilation (P=0.268), and 5.2 ± 0.7 and 5.4 ± 1.5 µg/ml for response to airway device (P=0.580), respectively. Required propofol concentration during maintenance of anesthesia may be similar between ETT and SGAD. Without moderate to strong stimuli such as airway device insertion or painful stimulation during surgery, the type of airway device may have little impact on required propofol concentration during maintenance of anesthesia in dogs.

DOI： 10.1292/jvms.17-0468

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DOI： 10.1093/rheumatology/key060

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DOI： 10.1016/j.ejogrb.2018.02.014

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DOI： 10.1213/ANE.0000000000002749

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DOI： 10.1016/j.rvsc.2017.01.021

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DOI： 10.1007/s00540-017-2332-4

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DOI： 10.1097/ALN.0000000000001578

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DOI： 10.1213/ANE.0000000000001735

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DOI： 10.1097/EJA.0000000000000526

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DOI： 10.1007/s00540-016-2242-x

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DOI： 10.1007/s00540-016-2174-5

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/ALN.0000000000001184

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1213/ANE.0000000000001317

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1213/ANE.0000000000001094

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DOI： 10.1213/ANE.0b013e3182a44c87

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DOI： 10.1111/j.1365-2885.2012.01404.x

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DOI： 10.1097/ALN.0b013e318234228b

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DOI： 10.1007/s00540-011-1143-2

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DOI： 10.1007/s00540-010-1050-y

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DOI： 10.1111/j.1467-2995.2010.00564.x

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DOI： 10.1213/ANE.0b013e3181bdcf5b

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DOI： 10.1097/ANA.0b013e3181d0c2e4

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DOI： 10.1097/ALN.0b013e3181b799c1

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Remifentanil has short half-lives: the values of alpha and beta decay are about 2 and 15 min, respectively. Therefore, the time for remifentanil concentration to reach its steady state concentration (Css) is shorter than those of other anesthetic drugs such as propofol and fentanyl. The Css and the time course of plasma concentration as well as effect-site concentration (Ce) during the continuous infusion of remifentanil could be helpful in our clinical practice. Css is strongly affected by weight and age with Minto's pharmacokinetic parameters of remifentanil. Css increases by a factor of 1.8 when the weight doubles, and Css in a 75-year-old is 1.5 times higher than Css in a 25-year-old. We tried to simulate the time courses of remifentanil Ce and fentanyl Ce during induction, maintenance, and emergence phases of anesthesia. Because of the short half-lives, remifentanil concentration could be well-controlled. However, remifentanil concentration does not reach the Css immediately with constant rate infusion. For example, it will take about 5 min for remifentanil effect-site concentration to decrease from Css to a half of Css. It is considered that anesthetic management with remifentanil is superior to that without it.

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DOI： 10.1097/01.anes.0000264745.63275.59

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BACKGROUND: Pentazocine may be an alternative for fentanyl during total intravenous anesthesia (TIVA) using propofol. The authors compared the efficacy and safety of pentazocine for analgesics in TIVA using propofol. METHODS: Eighty-nine patients scheduled for mastectomy were analyzed retrospectively. Patients were classified into two groups by used analgesics; pentazocine (Group P, n = 34) and fentanyl (Group F, n = 55). Anesthesia was induced with propofol, using target controlled infusion method, and ketamine 20-50 mg, and was maintained with propofol infusion and increments of fentanyl or single dose of pentazocine with 40% oxygen in air. Postoperative pain was assessed using a visual analogue pain scale (VAS). RESULTS: There were no differences in the patient background between both groups. Systolic as well as diastolic blood pressure and heart rate were not different between both groups during surgery. The maintenance dose of propofol was not different between the two groups. Awakening time in about 80% of patients was within 15 minutes and is not different between the two groups. There were no differences between the two groups regarding VAS. There are no severe complications. Incidence of nausea and vomiting was not different between the two groups. CONCLUSIONS: The results suggest that pentazocine would provide a stable hemodynamic state, rapid recovery and an effective postoperative pain relief to the same degree as with fentanyl in TIVA with propofol.

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DOI： 10.1017/S0265021505002024

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Propofol has been used to treat convulsions, while the drug is known to induce convulsions. We described a case of generalized convulsions during brain tumor resection under propofol anesthesia. A 24-year-old man was scheduled to undergo brain tumor resection. He had no history of epilepsy. Anesthesia was induced and maintained with propofol and fentanyl. During the craniotomy, the patient developed generalized convulsions. Diazepam, thiamylal, and phenytoin were given intravenously and the seizure activity resolved. Generalized convulsions recurred three times during the operation. Postoperative course was uneventful. On the 16 th postoperative day, the patient underwent ventriculoperitoneal shunt under general anesthesia using sevoflurane, nitrous oxide and oxygen. Convulsions were not noted intra- and postoperatively. Because convulsions did not occur during sevoflurane anesthesia and the patient had no history of epilepsy, propofol may have induced a generalized convulsions on the first operation.

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DOI： 10.1007/s005400170047

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Total pages：359p   Language：Japanese  

CiNii Books

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Other Link： https://mol.medicalonline.jp/library/ebooks/detail?id=11083

Total pages：xii, 379p   Language：Japanese  

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ASIN

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Total pages：xiv, 469 p.   Language：English  

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Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：真興交易(株)医書出版部  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01620&link_issn=&doc_id=20210720270009&doc_link_id=%2Fci4jjsca%2F2021%2F004104%2F010%2F0352-0358%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2021%2F004104%2F010%2F0352-0358%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J02927&link_issn=&doc_id=20210604240013&doc_link_id=10.11477%2Fmf.3101202004&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.3101202004&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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Language：Japanese   Publisher：日本小児麻酔学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01397&link_issn=&doc_id=20200410030020&doc_link_id=%2Fad3msuie%2F2020%2F006904%2F021%2F0443b0449%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2020%2F006904%2F021%2F0443b0449%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

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Language：Japanese   Publisher：日本小児麻酔学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01397&link_issn=&doc_id=20191107120001&doc_link_id=%2Fad3msuie%2F2019%2F006811%2F003%2F1168-1175%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2019%2F006811%2F003%2F1168-1175%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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筋弛緩薬による筋弛緩効果を適切にコントロールするには、筋弛緩モニターが必須である。また薬物動態力学モデルによる予測濃度はそれを単独で使うのではなく、脳波モニターなどによって効果の評価を行ったうえで、濃度と効果の関係を把握して使うことが肝要である。ロクロニウムとスガマデクスの薬物動態力学モデルの知見など、筋弛緩でもファーマコメトリクスが活用できる知見を紹介した。

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Language：Japanese   Publisher：昭和大学学士会  

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&lt;p&gt;In 2016, there were many news reports concerning artificial intelligence learning by itself. For example, AlphaGo（Google DeepMind）won a Go match against a professional high-level player, and an automatic driving bus ran for a test on public road. In the area of anesthesiology, automated anesthesia is associated with artificial intelligence. There are currently a number of automated systems which maintain drug concentrations of anesthetics. Another automated anesthesia system, which administers an anesthetic drug to maintain these pharmacodynamic effects, requires appropriate electroencephalographic monitoring and continuous measurement of the actual drug concentration. Computer-assisted anesthetic management can compensate for shortcomings of anesthesiologists and improve medical quality in daily practice.&lt;/p&gt;

DOI： 10.2199/jjsca.38.410

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&amp;nbsp;&amp;nbsp;The effect site concentration of fentanyl during postoperative day 1 was simulated with a linear 3-compartment model, and an IV-PCA (intravenous patient-controlled analgesia) menu was created on the basis of the simulation result. The relation between postoperative effect site concentration and analgesic effect was then reviewed. The simulation indicates that the intravenous administration of 300 &amp;mu;g fentanyl accompanied with basal administration of 25 &amp;mu;g/h fentanyl, at 2h before the emergence, maintains a stable effect site concentration of 1.0 ng/m&lt;I&gt;l&lt;/I&gt; in a 50-kg patient. The effect site concentrations of fentanyl, 1.4 ng/m&lt;I&gt;l&lt;/I&gt; in the emergent period and 1.0 ng/m&lt;I&gt;l&lt;/I&gt; in postoperative period, are useful in postoperative analgesia in non-abdominal surgery.

DOI： 10.2199/jjsca.32.814

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DOI： 10.1111/j.1467-2995.2012.00762.x

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Gauss曲線を元にした薬物動態モデルと、Transitモデル(連続した複数のコンパートメントによるモデルで、なだらかな濃度上昇を表現できる)を比較し、NONMEMでモデリングが可能なコンパートメントモデルでの濃度変化曲線の表現の可能性を検討した。Lag+Transitモデル、TransitモデルともNONMEMで扱えるため、population pharmacokinetics modelに組み込むことができるが、Transitモデルは曲線の形状の表現に大きな制約があり、Lag+Transitモデルの方が濃度の表現に向いていることが示唆された。しかし、lagモデルを組み込むかどうかに関わりなく、Transitモデルを表す式には、Gauss曲線を元にしたモデルの式よりも制約があることが示唆された。

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Language：Japanese   Publisher：日鉄技術情報センタ-  

Multi compartment model is one of pharmacokinetic models. The model is widely used for calculating predicted blood concentration of intravenous anesthetics in clinical practice. The model provides anesthesiologists not only to see the time course of drug concentration but also one technique for continuous drug infusion, target-controlled infusion (TCI). When an intravenous drug is infused to patient constantly, the concentration of the drug will increase gradually. Effect of drug is determined by the drug concentration and its sensitivity to patient. TCI for intravenous drugs can maintain predicted blood concentration to be constant. Today, Diprifusor[○!R], that is infusion pump for TCI, is used for clinical anesthesia.

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

2003〜2004年にプロポフォールを用いた全静脈麻酔法で管理した乳癌手術患者89例を対象とし,併用する鎮痛薬ペンタゾシンとフェンタニルを比較検討した.対象はペンタゾシン34例,フェンタニル55例であり,麻酔記録と回診記録から薬物投与量,循環動態,覚醒状況,術後鎮痛,合併症を調査した.その結果,麻酔時中のプロポフォールの目標血中濃度は両群間で有意差はなく,術後の循環動態,覚醒の状況,術後疼痛の程度,悪心・嘔吐の頻度に両群間で有意差はなかった.プロポフォールを用いた全静脈麻酔法に併用する鎮痛薬として,ペンダゾシンとフェンタニルは同程度に有用であることが示唆された

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Language：Japanese   Publisher：(一社)日本防衛衛生学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本臨床麻酔学会  

&amp;nbsp; Incident reports provide information about the things that went wrong, and have the potential to improve the quality of patient&#039;s care. We compared incident reporting identified in 1999 and 2004 to elucidate how it works. Our evaluation mainly concerned the incidental total number, anesthesia machine, and drugs. There were 59 and 33 incidents reported in 1999 and 2004, respectively. Critical incidents were markedly decreased in 2004. Incidents related to the anesthesia machine decreased from 10 to 5, however, the same incidents occurred repeatedly. On the other hand, incidents associated with drugs increased from 7 to 10. Decrease of critical incidents may have resulted from awareness of mishaps and thus infomation sharing that have been highlighted by incident reporting. Nevertheless, incidents involving anesthesia machine occurred repeatedly and incidents of drugs increased. Because human factors should be closely involved in incidents associated with the anesthesia machine and drugs, and incidents are mainly caused by human error, some mechanical preventive strategies should be provided to lessen the risk in anesthetic practice.

DOI： 10.2199/jjsca.25.684

J-GLOBAL

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

24歳男.脳室内腫瘍に対して全身麻酔下での腫瘍摘出術を施行した.酸素6l・min-1マスク下にプロポフォール90mgとフェンタニル150μgで急速導入し,ベクロニウム6mgで気管挿管を行った.空気-酸素混合で吸入酸素濃度を33%とし,麻酔維持はプロポフォール7mg・kg-1・h-1とフェンタニル125μg・h-1による全静脈麻酔で行い,ベクロニウム1mg・h-1を投与した.手術開始50分後,開頭操作中に血圧の低下と心拍数の増加を認め,その直後に全身性痙攣が出現した.プロポフォール100mg,ジアゼパム10mg,チアミラール200mgの投与を行い,痙攣はいったん消失したが,手術開始10時間後,11時間30分後,17時間後に再発した.手術後に痙攣は認めなかった.16日後に脳室-腹腔短絡術が行われた際には導入薬にチアミラールを用いて亜酸化窒素-酸素-セボフルランで維持し,術中・術後を通して痙攣は発生しなかった

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Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

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Language：Japanese  

J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

麻酔科医は血行動態の変化により鎮静レベルの判断を行ってきたが,Aspect社製BISモニタA-1050の登場により,血行動態のみでは鎮静レベルの判断を行い難いことが明確になった.しかし,Aspect社製BISセンサー(既製BISセンサー)は高価かつディスポーザブルであるため,BISモニタを全身麻酔症例全例に使用すると病院の経営を圧迫してしまう.そこで,再使用可能なA-1050用BISセンサーを試作した.再利用可能なBISセンサーを,心電図電極,心電図誘導コード,シリアルオスコネクタを用い試作した.BISモニタのインピーダンスチェックを通過し使用可能であった

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(公社)日本小児科学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

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Language：Japanese   Publisher：日本麻酔・集中治療テクノロジー学会  

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Language：Japanese   Publisher：真興交易(株)医書出版部  

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Language：Japanese   Publisher：山梨県医師会  

山梨医科大学付属病院において1999年に施行された小児心臓外科手術は43例(開心術37例,非開心術6例)で,在院死亡は2例,遠隔死亡なしであった.この間のトピックスとして,遠心ポンプ脱血小型人工心肺回路modified ultrafiltration(MUF)の導入,minimally invasive cardiac surgery(MICS)の適応拡大,経右房経肺動脈アプローチによるファロー四徴症根治術,fenestrated one &amp; a half repair,extracardiac TCPC(total cavopulmonary connection)の導入,低体重の左心低形成症候群症例に対する両側肺動脈絞扼術と右室肺動脈間人工血管間置法によるmodified Norwood手術,乳児期早期の人工弁置換術,等があり,医療の質的な向上がもたらされた

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本蘇生学会  

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Language：Japanese   Publisher：日本蘇生学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：日本蘇生学会  

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Country：Japan

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Country：Japan

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