Vascular Endothelial Glycocalyx Plays a Role in the Obesity Paradox According to Intravital Observation.

According to the "obesity paradox," for severe conditions, individuals with obesity may be associated with a higher survival rate than those who are lean. However, the physiological basis underlying the mechanism of the obesity paradox remains unknown. We hypothesize that the glycocalyx in obese mice is thicker and more resistant to inflammatory stress than that in non-obese mice.

Postoperative renal morbidity and mortality after volume replacement with hydroxyethyl starch 130/0.4 or albumin during surgery: a propensity score-matched study.

Purpose: We aimed to compare retrospectively the rates of renal morbidity and mortality in surgical patients receiving 6% HES 130/0.4 to those receiving albumin.

Methods: From a Japanese nationwide medical database between 2014 and 2016, we identified adults who received HES 130/0.

Renal Morbidity of 6% Hydroxyethyl Starch 130/0.4 in 9000 Propensity Score Matched Pairs of Surgical Patients.

Background: Several studies of critically ill patients reported that fluid resuscitation with hydroxyethyl starch (HES) solutions damages the kidneys, but their use for surgical patients is debated. Because different HES preparations have different safety profiles, we sought to determine whether 6% third-generation HES 130/0.4 was associated with renal morbidity when used for surgical patients.

The protective effect of hydroxyethyl starch solution on the glycocalyx layer in an acute hemorrhage mouse model.

Purpose: Fluid therapy focused on glycocalyx (GCX) protection in hemorrhagic shock is a current focus of research. Hydroxyethyl starch (HES) solution is commonly used for fluid resuscitation; however, its effects on the GCX remain unclear. The primary aim of this study was to explore the protective effect of HES130 in maintaining GCX thickness and reducing plasma syndecan-1 expression.

Blood transfusion, colloid therapy and the possible saving of albumin volumes during surgery: data analysis of the survey for certified hospitals of the Japanese Society of Anesthesiologists.

Purpose: Third-generation hydroxyethyl starch (HES) 130/0.4 has a larger dose limitation (up to 50 mL/kg/day) than HES 70/0.5 (up to 1000 mL/day) which has been used in Japan for 40 years.

The fentanyl concentration required for immobility under propofol anesthesia is reduced by pre-treatment with flurbiprofen axetil.

Purpose: We hypothesized that nonsteroidal anti-inflammatory drugs decrease the plasma fentanyl concentration required to produce immobility in 50% of patients in response to skin incision (Cp50incision) compared with placebo under target-controlled infusion (TCI) propofol anesthesia.

Methods: Sixty-two unpremedicated patients scheduled to undergo gynecologic laparoscopy were randomly assigned to receive placebo (control group) or flurbiprofen axetil 1 mg·kg(-1) (flurbiprofen group) preoperatively. General anesthesia was induced with fentanyl and propofol, and intubation was performed after succinylcholine 1 mg·kg(-1).

Pharmacokinetics and safety of 6 % hydroxyethyl starch 130/0.4 in healthy male volunteers of Japanese ethnicity after single infusion of 500 ml solution.

Purpose: This phase I study was performed in volunteers of Japanese ethnicity to compare pharmacokinetic data after infusion of 6 % hydroxyethyl starch (HES) 130/0.4 with historical data of Caucasians.

Methods: In an open-label, uncontrolled, single-center study, 12 healthy male Japanese volunteers received single intravenous infusions of 500 ml 6 % HES 130/0.

Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial.

Purpose: In many countries, patients are generally allowed to have clear fluids until 2-3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of oral rehydration therapy until 2 h before surgery.

[Excessive bleeding in the patients with past history of Hassab's operation].

We report two cases of massive perioperative bleeding and multiple organ failure with past history of Hassab's operation. Massive bleeding occurred during laparotomy and thoracocentesis in each case. After Hassab's operation, collateral circulation and coagulation disorders could develop, and unanticipated massive bleeding might occur.

[Use of StyletScope in a patient with airway injury].

A forty-year old man hanged himself and was transported to our hospital. On arrival his consciousness was clear but he showed dyspnea, dysphagia, and oral bleeding. Tracheal intubation was attempted but was failed and emergency tracheostomy was successfully accomplished.

Fluid therapy with hydroxyethyl starch for massive blood loss during surgery.

Purpose: This clinical trial reports the use of hydroxyethyl starch (HES70/0.55/4) at very high dosages during surgery. HES70/0.

Buccal administration of dexmedetomidine as a preanesthetic in children.

Purpose: The objective of this study was to evaluate the efficacy and safety of buccal dexmedetomidine as a preanesthetic in children, to compare it with diazepam, and to investigate the optimal dosage for buccal dexmedetomidine administration by measuring its serum concentration.

Methods: We performed a prospective study with 40 children who were assigned to two groups. The patients underwent an operation for inguinal or umbilical hernia.

[BONFILS retromolar intubation fiberscope VS styletscope for oro-tracheal intubation].

Background: Battery-powered BONFILS Retromolar Intubation Fiberscope (B-scope) is a nonflexible fiberscope having the same curvature as the Macintosh laryngoscope. Battery-powered StyletScope (S-scope) has a flexible apex whose direction was controlled by grasping a handle. We assessed the operational performance of the two scopes.

Does bilateral bispectral index monitoring (BIS) detect the discrepancy of cerebral reperfusion during carotid endarterectomy?

The case of a 70 year-old man undergoing bilateral carotid endarterectomy (CEA), for whom alterations in his bispectral index (BIS) values were noted during general anesthesia, is presented. Prior to bypass of the internal carotid artery (ICA), there were no significant differences in bilateral BIS values. After bypass of the left ICA, the left BIS increased to approximately 60, while the right BIS remained at 40.

[Effect of the music-therapy under spinal anesthesia].

Background: Since no pre-medication has been widely accepted especially in spinal anesthesia, anesthesiologists should manage the control of patient's anxiety during surgery. Instead of sedatives, we have been using music-therapy during spinal anesthesia. Bispectral index monitoring (BIS) is used as one of the sedation indices in spinal anesthesia.

Neonatal exposure to sevoflurane induces abnormal social behaviors and deficits in fear conditioning in mice.

Background: Neonatal exposure to anesthetics that block N-methyl-D-aspartate receptors and/or hyperactivate gamma-aminobutyric acid type A receptor has been shown to cause neuronal degeneration in the developing brain, leading to functional deficits later in adulthood. The authors investigated whether exposure of neonatal mice to inhaled sevoflurane causes deficits in social behavior as well as learning disabilities.

Methods: Six-day-old C57BL/6 mice were exposed to 3% sevoflurane for 6 h.

[Anesthetic management for cases of placenta accreta presented for cesarean section: a 7-year single-center experience].

Background: Anesthetic management of cesarean section for placenta accreta is very challenging. The aim of our retrospective study was to review past placenta accreta cases in our hospital to suggest a strategy for anesthetic management for placenta accreta.

Methods: Placenta accreta cases were identified in our obstetric anesthesia data base.

Delayed respiratory depression associated with 0.15 mg intrathecal morphine for cesarean section: a review of 1915 cases.

Purpose: A low dose of morphine, given intrathecally is an effective postoperative analgesic technique and is widely used in cesarean section. Delayed respiratory depression is the most feared side effect of this technique. However, this side effect has not been thoroughly reported in the obstetric population.

Evaluation of low-dose propofol preadministration to attenuate vascular pain during induction of anesthesia.

Study Objective: To determine whether a small dose of propofol before induction decreases pain with injection using two different formulas of propofol-10% long-chain triglycerides (LCT) and medium-chain triglycerides (MCT) and LCT.

Design: Prospective, randomized, comparative study.

Setting: University-affiliated hospital.

Gender differences between predicted and measured propofol C(P50) for loss of consciousness.

Objective: To investigate gender differences in the effective dose of 50% for loss of consciousness (C(P50LOC)) for propofol using Diprifusor, the most commonly used target-controlled infusion system.

Design: Prospective, randomized, comparative study.

Setting: University-affiliated hospital.

[Newly developed BONFILS Retromolar Intubation Fiberscope for difficult airway].

Battery powered BONFILS Retromolar Intubation Fiberscope (BRIF) is a nonflexible fiberscope having the same curvature as the Macintosh laryngoscope for difficult airway. We used this device in two patients; A 65-year-old man with small chin and a 35-year-old man with neck spinal cord injury. Two trials of orotracheal intubation were accomplished easily in 20 seconds.

Determination of the standard value of circulating blood volume during anesthesia using pulse dye-densitometry: a multicenter study in Japan.

Purpose: The standard value for circulating blood volume (BV) during anesthesia was determined by a multicenter study in Japan. The significance of BV on the reduction of blood pressure after the induction of anesthesia was also examined.

Methods: The study included 184 patients from eight university hospitals.

Electron microscopic evaluations of clot morphology during thrombelastography.

In this study, we characterized clot morphology with a scanning electron microscope (SEM) at time points corresponding to the commonly used thrombelastography (TEG) variables, illustrating the correlation of the physical clot formation with TEG(R) tracings. The first channel of the TEG analyzer was used to obtain the tracings of clot formation, while the sub-samples for the SEM were obtained from the second TEG channel. Different types of samples were examined, including whole blood, abciximab-treated whole blood, platelet-rich plasma (PRP), and abciximab-treated PRP.