Papillary muscle sandwich plasty for the treatment of functional mitral valve regurgitation.

We evaluated the availability of original "sandwich plasty" for the treatment of functional mitral regurgitation (FMR) associated with ischemic heart disease (IHD) and aortic valve disease (AVD). Forty-three patients were reviewed, including 27 IHD patients and 16 AVD patients. Preoperatively severe FMR was detected in 14 patients, moderate FMR in 26, and mild FMR in 3.

[Choice of induction with, or standby of, extracorporeal lung assist (ECLA) in anesthetic management of bronchoscopic yttrium-aluminium-garnet (YAG) laser treatment of airway tumor].

Bronchoscopy with an yttrium-aluminium-garnet (YAG) laser is often used to resect benign and malignant airway tumors and for relief of associated airway stenosis. Complications of this procedure include airway obstruction and hemorrhage. Partial extracorporeal circulation for YAG laser resection in the airway may be helpful in minimizing these complications.

[Experience of participating in the 14th Nepal Cleft Lip and Palate Surgery Project].

Adventist Development and Relief Agency (ADRA) Japan, a non governmental organization (NGO), following an official request of Federal Democratic Republic of Nepal Government has organized Nepal Cleft Lip and Palate Surgery Project since 1995. We participated in the 14th Project as one of the anesthesiologists from 7th to 22nd November 2009 and performed general anesthesia with a Nepalese anesthetist without a medical license in Sheer Memorial Hospital. Use of unfamiliar anesthetic medications and limited medical devices made us understand the difficulty of anesthetic management.

[Femoral and sciatic nerve blocks for open reduction and internal fixation of a femoral condylar fracture in a patient with post-polio syndrome].

The post polio symdrome (PPS) refers to the development of delayed neuromuscular symptoms among survivors, years after the initial presentation of acute poliomyelitis. The symptoms of PPS vary widely and include flaccid palsy, muscle weakness, scoliosis, osteoarthritis, gait disturbance, sleep apnea syndrome (SAS), dysphagia, chronic lung dysfunction, and others. We report the successful combination of peripheral nerve blocks, femoral and sciatic nerve blocks, for surgery on the lower extremity in a patient with PPS.

[Intravenous patient-controlled analgesia (IV-PCA) for relief of postoperative pain].

Intravenous patient-controlled analgesia (IV-PCA) using opioids such as morphine and fentanyl can be an effective analgesic method for post-operative pain that is resistant to conventional administration of narcotic analgesics and nonsteroidal anti-inflammatory drugs, and where epidural block and peripheral nerve block are not feasible. In addition to post-operative pain relief, IV-PCA can facilitate early ambulation, reduce respiratory complications, and increase patient satis-faction. However, respiratory and circulatory depression, and post-operative nausea and vomiting (PONV) often occur as side effects of IV-PCA with opioids.

[Effect sites of anesthetics in the central nervous system network--looking into the mechanisms for natural sleep and anesthesia].

We showed the effect sites of anesthetics in the central nervous system (CNS) network. The thalamus is a key factor for loss of consciousness during natural sleep and anesthesia. Although the linkages among neurons within the CNS network in natural sleep are complicated, but sophisticated, the sleep mechanism has been gradually unraveled.

[Predisposing factors and prevention of emergence agitation].

Agitation during the emergence from general anesthesia is a great post-operative problem that often injures the patients themselves and requires the medical staff to restrain and calm the patients. The predisposing factors for emergence agitation include anesthesia, operation, and patient. Sevoflurane anesthesia results in higher incidence of emergence agitation than halothane, because of the rapid emergence, and its effects on central nervous system inducing convulsion and post-operative behavioral changes.

Efficacy of amiodarone on refractory ventricular fibrillation resistant to lidocaine and cardioversion during weaning from cardiopulmonary bypass in aortic valve replacement for severe aortic stenosis with left ventricular hypertrophy.

Intravenous injection of amiodarone, a class III anti-arrhythmic is widely used for persistent refractory arrhythmias. We present a case report suggesting the efficacy of amiodarone in refractory ventricular fibrillation (Vf) during weaning from cardiopulmonary bypass (CPB). A 66-year-old woman with hypertension had a medical examination as a result of an episode of palpitations and syncope.

[Awake fiberoptic intubation with Parker Flex-Tip tracheal tube in a patient with obesity, goiter, and laryngo-tracheal shift].

A 59-year-old woman with a body mass index of 30 and an edematous, tender goiter was scheduled for subtotal thyroidectomy. She had a history of dyspnea, cough, hoarseness, sleep disturbance in the supine position, difficulty in expelling sputum, and inability to rotate her neck to the left. Chest CT showed an adenomatous goiter, measuring 42 x 57 x 105 mm, with invasion into the mediastinal space, 17 mm right glottic shift, and 21 mm right tracheal shift.

Microinjection of propofol into the perifornical area induces sedation with decreasing cortical acetylcholine release in rats.

Background: Among many neurotransmitter systems in the central nervous system, the cholinergic system has been shown to contribute to propofol's sedative/anesthetic effects, because it has been shown that cholinesterase inhibitor reverses the level of propofol-induced unconsciousness in humans. It has been reported that intraperitoneal injection of propofol induced sedative/anesthetic actions and decreased the release of acetylcholine (Ach) from the rat cortex. However, the sites of action of propofol in the cholinergic pathway and its related pathways remain unresolved.

[Tracheal intubation in patients with Williams syndrome].

Williams syndrome is caused by the deletion of genetic material from chromosome 7, including the elastin gene. Affected individuals frequently have connective tissue disorders and skeletal hypoplasia, resulting in micrognathia and mandibular retrusion. These conditions hinder adequate visualization of the larynx and render intubation difficult.

[Tracheal intubation with Parker Flex-Tip tubes assisted by tube-guiding devices].

In tracheal intubation assisted by tube-guiding devices passing through the tube, such as fiberoptic scopes, bougies, tracheal tube exchange catheters, and light wands, passage of the tube-guiding device, by itself, is often easy. But advancing a tracheal tube with a conventional distal tip over these tube-guiding devices is frequently difficult or impossible, because its rigid, side-beveled tip frequently catches on anatomical features of the airway. A novel tracheal tube, the Parker Flex-Tip tube (Parker Medical, Colorado, USA) has a centered, curved, tapered and flexible distal tip that passes through the airway faster and easier than conventional tracheal tubes.

[Evaluation of cardiac and myocardial inotropism and lusitropism using half-logistic curve-fitting].

Half-logistic (h-L) function, which is half of the sigmoidal, logistic function with a boundary at the inflection point, curve-fits the isovolumic relaxation left ventricular (LV) pressure curve from the minimum of the first order time derivative of pressure (dP/dt(min)), and the myocardial isometric relaxation tension curve from the minimum of the first order time derivative of tension (dF/dt(min)) superior to the conventional mono-exponential function. Recently, we found that h-L function could curve-fit the other partial curves. The isovolumic LV pressure curve in the excised, cross-circulated canine heart, was divided into four distinct phases with boundaries set at the maximum of dP/dt (dP/dt(max)), peak LV pressure, dP/dt(min), and LV end-diastolic pressure (LVEDP) resulting in the first phase from the point corresponding to QR on the electrocardiogram to dP/dt(max); the second phase from dP/dt(max) to the peak LV pressure; the third phase from the peak LV pressure to dP/dt(min); and the fourth phase from dP/dt(min) to LVEDP.

[Clinical anesthetic training at St. Vincent's Hospital, Melbourne Australia].

Anesthesia training system and operation theater management at St Vincent's hospital Melbourne in Australia, are very well organized, including tutorials, invitation lecture, transesophageal echocardiography conference as well as working hour, operation room, organization of comedical staffs such as nursing and technician staff, and day surgery and anesthesia. Good anesthesia training system and efficient operation theater management are necessary to establish better quality of medical services.

[Paracervical block for dilatation and curettage in a parturient with Eisenmenger's syndrome].

Eisenmenger's syndrome is defined as the process in which a left-to-right shunt due to an atrial (ASD) or ventricular septal defect (VSD) in the heart causes increased pulmonary blood flow, leading to pulmonary hypertension, which in turn, ultimately results in increased pressure in the right side of the heart and reversal of the shunt to right-to-left. Therefore, anesthetic management of Eisenmenger's syndrome is often difficult. We described a case of paracervical block for dilatation and curettage in a parturient with Eisenmenger's syndrome in this report.

[Energy expenditure of anesthesiologists estimated from number of steps].

The physical activity can be mainly evaluated by the number of steps. We estimated the energy expenditure from the number of steps in the different job specifications of anesthesiologists using digital pedometer Walk Life CH-200 (Crecer Co, Tokyo, Japan). The average number of steps in the anesthesiologists (n = 41, 31 +/- 5 yr.

[Perioperative management for transurethral resection of bladder tumor (TUR-Bt) associated with congenital antithrombin III deficiency].

Congenital antithrombin III (ATIII) deficiency is a hereditary disease that predisposes to thromboembolic complications. We report perioperative management for twice in a patient with congenital ATIII deficiency. A 69-year-old man with congenital ATIII deficiency, with history of deep vein thrombosis (DVT) in his left popliteal vein, was scheduled for transurethral resection of bladder tumor (TUR-Bt).

[Perioperative management of a patient with Parkinson's disease with intravenous infusion of levodopa].

Parkinson's disease is a disorder of the extrapyramidal system resulting from the deficiency of dopamine in the basal ganglia. We experienced the perioperative management of a patient with Parkinson's disease with intravenous infusion of levodopa, precursor of which is dopamine. A 73-year-old woman with Parkinson's tremor in her bilateral fingers of Hoehn and Yahr stage II was scheduled for repair of bladder prolapse under general anesthesia.

[Anaesthesia training program in Australia].

We reviewed anaesthesia training program in Australia. Anaesthetists in Australia and New Zealand need to obtain the Diploma of Fellowship of the Australian and New Zealand College of Anaesthetists (FANZCA) to be recognised as specialists. The training sequence approved by ANZCA encompasses an initial two-year Prevocational Medical Education, Training (PMET) period, and the five-year period of ANZCA Approved Training, which included two-year Basic Training and three-year Advanced Training.

[Massive hemorrhage during abdominal total hysterectomy in a patient with placenta percreta].

A 33-year-old pregnant woman, who had undergone three previous cesarean sections and suspected of having placenta accrete, was scheduled for artificial abortion and abdominal total hysterectomy at 15 weeks gestation because of a probable high mortality rate. The general anesthesia was induced using fentanyl, propofol, and vecuronium and maintained with sevoflurane, fentanyl, and vecuronium, in combination with epidural anesthesia using ropivacaine. During the operation, we found that the placenta had penetrated into the posterior abdominal peritoneum and bladder wall.

[Intermittent bradycardia-dependent bundle branch block during sevoflurane and remifentanil anesthesia].

Cardiac arrhythmia and bradycardia occasionally occur from the effect of inhaled anesthetic agent and opioid on cardiac conduction. We experienced a case of intermittent bradycardia-dependent bundle branch block (IBDBBB) during sevoflurane and remifentanil anesthesia. A 17-year-old woman suffering from recurrent left ottitis media was scheduled for tympanoplasty under general anesthesia.

[Hyperventilation syndrome before induction of and after awakening from general anesthesia].

Hyperventilation syndrome has often occurred as a reaction to anxiety and stress. We experienced hyperventilation syndrome before induction of and after awakening from general anesthesia. A 53-year-old woman with no central nervous and psychiatric disease was scheduled for left total hip arthroplasty under general and epidural anesthesia.

Half-logistic time constants as inotropic and lusitropic indices for four sequential phases of isometric tension curves in isolated rabbit and mouse papillary muscles.

The waveforms of myocardial tension and left ventricular (LV) pressure curves are useful for evaluating myocardial and LV performance, and especially for inotropism and lusitropism. Recently, we found that half-logistic (h-L) functions provide better fits for the two partial rising and two partial falling phases of the isovolumic LV pressure curve compared to mono-exponential (m-E) functions, and that the h-L time constants for the four sequential phases are superior inotropic and lusitropic indices compared to the m-E time constants. In the present study, we tested the hypothesis that the four sequential phases of the isometric tension curves in mammalian cardiac muscles could be curve-fitted accurately using h-L functions.

[Isorhythmic dissociation during sevoflurane anesthesia].

Arrhythmia during general anesthesia occurrs occasionally as a result of the effect of inhalation anesthetic agent on cardiac conduction. We experienced a case of atrioventricular junctional rhythm (AVJR) during maintenance of general anesthesia with sevoflurane. A 61-year-old woman with normal preoperative electrocardiogram was scheduled for right total knee arthroplasty and autologous iliac crest bone graft under general and epidural anesthesia.

A new approach for observing cerebral cisterns and ventricles via a percutaneous lumbosacral route by using fine, flexible fiberscopes.

Object: To establish a new method for the diagnosis of central nervous system diseases, the authors visualized the cerebral cisterns and ventricles via a percutaneous lumbosacral route by using newly developed fine, flexible fiberscopes.

Methods: Fine, flexible fiberscopes, 0.9 and 1.