Publications by authors named "Takeshi Iritakenishi"

Background: Conjoined twins are an extremely rare congenital occurrence, and anesthetic management for surgical separation presents unique challenges for anesthesiologists.

Case Presentation: Five-month-old male pygopagus conjoined twins underwent separation surgery. We performed anesthesia induction in the supine position and surgery in the prone position.

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Background: Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency. Because the maternal mortality associated with AFE is very high, early recognition and prompt treatment are important for improving the prognosis. We report a case of amniotic fluid embolism successfully treated by multidisciplinary treatment.

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Purpose: This study aimed to reveal whether the occurrence of periprocedural myocardial damage (PMD) decreases in patients who received volatile anesthetics to maintain general anesthesia compared with those who received propofol during transcatheter aortic valve implantation (TAVI).

Methods: We included one hundred and forty adult patients who underwent transfemoral TAVI under general anesthesia from January 2015 to March 2017 in this single-center retrospective review. We compared the rate of patients who developed PMD between those who received desflurane (Group D, n = 72) and propofol (Group P, n = 68) for anesthetic maintenance.

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Background: Arytenoid cartilage dislocation/subluxation is one of the rare complications following tracheal intubation, and there have been no reports about risk factors leading this complication. From our clinical experience, we have an impression that patients undergoing cardiovascular operations tend to be associated with this complication.

Aims: We designed a large retrospective study to reveal the incidence and risk factors predicting the occurrence and to examine whether our impression is true.

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Purpose: Regional anesthesia is more favorable than general anesthesia in patients with severe comorbidity; however, data on the superiority of peripheral nerve blocks over general anesthesia in patients with severe cardiac dysfunction are lacking. We aimed to demonstrate that peripheral nerve blocks reduce perioperative analgesic requirements and promote faster recovery compared to general anesthesia.

Methods: We retrospectively evaluated intraoperative blood pressure, perioperative medications, and postoperative recovery in patients who underwent skeletal muscle harvesting for autologous myoblast sheet transplantation.

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Background: Vocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur.

Objective: To evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors.

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Background: The purpose of this study was to compare the perioperative management of aortic valve replacement combined with coronary artery bypass grafting (AVR+CABG) and transcatheter aortic valve implantation combined with off-pump coronary artery bypass grafting (TAVI+OPCAB).

Methods: A retrospective analysis was performed on patients who had undergone either AVR+CABG or TAVI+OPCAB for AS and CAD in Osaka Univer- sity Medical Hospital from January to October, 2014.

Results: AVR+CABG was performed in 11 pa- tients (group A) and TAVI+OPCAB was performed in 4 patients (group T) in this period.

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Rapid ventricular pacing (RVP) is used during transcatheter aortic valve implantation (TAVI). RVP disturbs myocardial oxygen balance, and when prolonged, it may cause procedure-related myocardial injury (PMI). This study investigated whether a longer duration of RVP increased the occurrence of PMI or worsened long-term mortality after TAVI.

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A 64-year-old male patient with pheochromocytoma underwent an off-pump coronary artery bypass graft- ing. Determination of order of surgeries, preoperative medical management and intraoperative hemodynamic management are important in these cases. Al- though bolus administration of phenylephrine showed poor response, the surgery was uneventful and the patient remained hemodynamically stable throughout the procedure and perioperative period.

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We describe a patient with biventricular assist devices who had systemic inflammation because of cholecystitis that required open cholecystectomy, and we discuss the anesthetics and monitors that should be used in unstable patients with ventricular assist devices (VADs) who are undergoing major surgery. The patient was a 40-year-old man in the dilated phase of hypertrophic obstructive cardiomyopathy, who was implanted with an internal left VAD and external right VAD. We anesthetized the patient with a combination of a low dose of sevoflurane and ketamine to minimize vasodilation.

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Heart and lung transplantation (HLT) is the surgical procedure for congenital heart disease and cardiomy- opathy with pulmonary hypertension. HLT is rare in the world and has been performed only twice until October, 2014 at our hospital in Japan. We report the anesthetic management for HLT.

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Objective: This study aimed to determine the risk of hematoma associated with thoracic paravertebral block (TPVB) in patients undergoing cardiovascular surgery.

Design: Retrospective analysis.

Setting: Single university hospital.

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Left ventricular assist device (LVAD) implantation is increasingly being used as a bridging therapy to heart transplantation. Infection is a major complication in patients with implanted LVADs, and it is associated with short- and long-term mortality. Surgical management for infection control is sometimes necessary; however, providing pain management during the surgical procedures is challenging.

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Paravertebral block (PVB) is feasible for postoperative analgesia in patients who undergo cardiac surgery with unilateral thoracotomy. Postoperative continuous PVB is as effective as thoracic epidural anesthesia and is less likely to cause hypotension. However, the intraoperative utility and safety of PVB remains unclear.

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Contralateral tension pneumothorax during 1-lung ventilation is rare but life threatening. We report the case of a patient who developed tension pneumothorax of the dependent lung during 1-lung ventilation while the surgeon was anastomosing the bronchi after sleeve lobectomy. Ventilation was not possible in either the dependent or nondependent lung, leading to severe desaturation and cardiac arrest.

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Objective: To identify the risk factors of prolonged hemodynamic compromise caused by rapid pacing for valve deployment during transcatheter aortic valve implantation.

Design: A retrospective study.

Setting: Academic hospital.

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Objective: Intraoperative two-dimensional echocardiography is technically challenging, given the unique geometry of the right ventricle (RV). It was hypothesized that the RV fractional area change (RVFAC) could be used as a simple method to evaluate RV function during surgery. Therefore, the correlation between the intraoperative RVFAC and the true right ventricular ejection fraction (RVEF), as measured using newly developed three-dimensional (3D) analysis software, was evaluated.

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Non-cardiac surgery should only be performed in patients with Eisenmenger's syndrome if absolutely mandatory because these patients are at high risk of perioperative mortality. Proper anesthetic and perioperative pain management in these patients remains a controversial topic. Transversus abdominis plane (TAP) block provides safe and beneficial perioperative analgesia in adults and children; however, no report has described the performance of TAP block in a child with Eisenmenger's syndrome.

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Moyamoya disease (MMD) is a rare disease characterized by occlusive intracranial arteriopathy with formation of abnormal cerebrovascular collateral networks. Conventional cardiovascular surgical procedures using cardiopulmonary bypass for patients with MMD is challenging because low cerebral perfusion pressure and nonpulsatile (continuous) flow during cardiopulmonary bypass can cause severe cerebral ischemia. We successfully performed transcatheter aortic valve replacement in 3 women with severe aortic valve stenosis complicated with MMD.

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Surgical aortic valve replacement (SAVR) which requires cardiopulmonary bypass (CPB) is still the gold standard for treatment of aortic stenosis (AS). But for elderly patients with severe AS and coexisting conditions, invasive surgery with CPB may lead to organ dysfunction and life-threatening complications. Transcatheter aortic valve replacement (TAVR) is a novel treatment for AS.

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We report a case of acute subdural hematoma which occurred following cerebrospinal fluid (CSF) drainage during thoracic endovascular aortic repair (TEVAR) surgery. A 63-year-old woman was scheduled to receive TEVAR for thoracic-abdominal aneurysm extending from the descending aorta (T10) to 15 mm above the celiac trunk. Before the TEVAR operation, a lumbar cerebrospinal drain was inserted at L4-5.

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Background: The incidence of perioperative pulmonary thromboembolism (PTE) has increased in Japan. As the mortality rate of PE is very high, its prophylaxis is important.

Methods: From January 1998 to December 1999 no prophylactic strategies were employed.

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