[Observation of the lungs using ultrasonography].

The three ways to observe the lungs using ultrasonography are transthoracic echography, transesophageal echography and endobronchial ultrasonography. All methods have their own advantages. Consolidation and pleural effusion are evaluated with transthoracic echography and transesophageal echography.

Neither dynamic, static, nor volumetric variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy.

Background: Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), intrathoracic blood volume (ITBV), and initial distribution volume of glucose (IDVG) to predict fluid responsiveness soon after esophagectomy under mechanical ventilation (tidal volume >8 mL/kg) without spontaneous respiratory activity.

Methods: Forty-three consecutive non-arrhythmic patients undergoing abdominothoracic esophagectomy were studied.

Basic and clinical assessment of initial distribution volume of glucose in hemodynamically stable pediatric intensive care patients.

Background: Initial distribution volume of glucose (IDVG), which is not associated with significant modification of glucose metabolism, has been proposed as an indicator of the central extracellular fluid volume status in adults. However, data on IDVG in children are lacking. This study examined pharmacokinetic data on IDVG in children and compared IDVG with other clinical variables.

Corrected right ventricular end-diastolic volume and initial distribution volume of glucose correlate with cardiac output after cardiac surgery.

Purpose: Appropriate adjustment of cardiac preload is essential to maintain cardiac output (CO), especially in patients after cardiac surgery. This study was intended to determine whether index of right ventricular end-diastolic volume (RVEDVI), corrected RVEDVI using ejection fraction (cRVEDVI), index of initial distribution volume of glucose (IDVGI), or cardiac filling pressures are correlated with cardiac index (CI) following cardiac surgery in the presence or absence of arrhythmias.

Methods: Eighty-six consecutive cardiac surgical patients were studied.

[Case of fluminant myocarditis with fatal pulmonary edema even after introduction of bi-ventricular assist devices].

A 15-year-old man developed cardiopulmonary dysfunction 4 days after flu-like symptom, and was transfered to our hospital and diagnosed as a fulminant myocarditis (FM). Intraaortic ballon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) were immediately initiated. However, cardiac function did not recover until 7 days after admission to the ICU, and bilateral ventricular assist devices (BiVAD) were introduced with extracorporeal membrane oxygenation (ECMO).

[A case of hypernatremia treated with human atrial natriuretic peptide].

We describe a case of 65-year-old obese female patient with pulmonary embolism and life-threatening hypernatremia after removal of craniopharyngioma. On the 18th day after neurosurgical procedure, pulmonary embolism developed abruptly. Immediately after placement of inferior vena cava filter, surgical removal of the pulmonary thrombus was performed under cardiopulmonary bypass.

Combination of extracorporeal membrane oxygenation and high-frequency oscillatory ventilation saved a child with severe ARDS after pulmonary resection.

We report a case in which a 2-year-old girl who underwent a right middle and lower lung lobectomy for congenital cystic adenomatoid malformation suffered massive bleeding and developed acute respiratory distress syndrome (ARDS) during the operation. She was ventilated with a high level of F(I)O(2) (0.75-1.

[A case of asystole following povidone iodine administration].

We present a case of asystole due to anaphylactoid reaction after vaginal disinfection with povidone iodine under epidural anesthesia combined with general anesthesia. A 71-year-old woman was scheduled to undergo total cystectomy due to vesical cancer, invading into the wall of the vagina. After induction of anesthesia, epidural injection with 10 ml of 1% lidocaine and cleansing the vagina with povidone iodine solution were done at the same time.

Use of bispectral index monitoring for a patient with hepatic encephalopathy requiring living donor liver transplantation: a case report.

We report the use of perioperative bispectral index (BIS) monitoring in a patient who underwent living donor liver transplantation (LDLT). Hepatic encephalopathy featuring extreme excitement developed in a 42-year-old male and was diagnosed as acute hepatitis. Sedation with continuous infusion of midazolam was necessary.

Use of initial distribution volume of glucose to determine fluid volume loading in pulmonary thromboembolism and right ventricular myocardial infarction.

We report a case of acute right ventricular myocardial infarction (right AMI) following pulmonary thromboembolism (PTE). Following percutaneous coronary intervention, the patient was treated in our intensive care unit (ICU) with intraortic balloon pumping, anticoagulants, and plasma expansion. Fluid overload may cause a further leftward shift of the interventricular septum in patients with PTE, resulting in decreased cardiac output (CO).

A new method to estimate regional pulmonary blood flow using transesophageal echocardiography.

Background: We report a novel method to estimate regional blood flow in the atelectatic lung using transesophageal echocardiography in an experimental dog model. To verify the efficacy of the method, we investigated the ability of this experimental model to detect changes in regional pulmonary blood flow.

Methods: Fourteen anesthetized and ventilated mongrel dogs were randomized into an isoproterenol group (n = 7) or a dopamine group (n = 7).

Comparison of initial distribution volume of glucose and intrathoracic blood volume during hemodynamically unstable States early after esophagectomy.

Study Objective: We have reported that initial distribution volume of glucose (IDVG) measures the central extracellular fluid volume in the presence of fluid gain or loss without apparent modification of glucose metabolism. We hypothesized that IDVG has a close relationship with intrathoracic blood volume (ITBV). We examined whether IDVG can correlate with ITBV during hemodynamically unstable states early after esophagectomy.

A new non-invasive continuous cardiac output trend solely utilizing routine cardiovascular monitors.

Objective: Three of the us developed a new non-invasive continuous cardiac output (CCO) measurement method utilizing routine clinical monitors based on the pulse-contour analysis combined with pulse wave transit time (PWTT). Using pulmonary artery catheter (CCOpa), we compared this estimated CCO (esCO) with the thermodilution CCO early after cardiac surgery, and tested whether the esCO method has potential of being an alternative measure of CCO.

Methods: Thirty-six patients without continued arrhythmias were studied.

Initial distribution volume of glucose can be approximated using a conventional glucose analyzer in the intensive care unit.

Introduction: We previously reported that initial distribution volume of glucose (IDVG) reflects central extracellular fluid volume, and that IDVG may represent an indirect measure of cardiac preload that is independent of the plasma glucose values present before glucose injection or infusion of insulin and/or vasoactive drugs. The original IDVG measurement requires an accurate glucose analyzer and repeated arterial blood sampling over a period of 7 min after glucose injection. The purpose of the present study was to compare approximated IDVG, derived from just two blood samples, versus original IDVG, and to test whether approximated IDVG is an acceptable alternative measure of IDVG in the intensive care unit.

Evaluation of density area in dorsal lung region during prone position using transesophageal echocardiography.

Objective: To evaluate the changes of density area in the dorsal lung regions of acute respiratory distress syndrome patients during prone position using transesophageal echocardiography.

Design: Retrospective clinical study.

Setting: General intensive care unit in a university hospital.

[A clinical study of total intravenous anesthesia by using mainly propofol, fentanyl and ketamine--with special reference to its safety based on 26,079 cases].

During a period of five years from January 1996 through December 2000 total intravenous anesthesia with mainly propofol, fentanyl and ketamine was administered to 26,079 patients including cardiac and neurosurgical patients at the University of Hirosaki Hospital and five other affiliated hospitals. The patients studied ranged from 1 year 8 months to 93 years in age, 9.2 kg to 135.

Quantification and comparison of pulmonary emboli formation after pneumatic tourniquet release in patients undergoing reconstruction of anterior cruciate ligament and total knee arthroplasty.

Unlabelled: The amount of emboli formed (percentage of total emboli area to the right atrial area [%Ae]) after tourniquet release in invasive procedures of the medullary cavity is empirically much larger than that in noninvasive procedures, even if the tourniquet duration is similar. Thus, we compared %Ae between arthroscopic reconstruction of the anterior cruciate ligament (ACL, n = 20) and total knee arthroplasty (TKA, n = 20). The right atrium was continuously monitored by transesophageal echocardiography to assess %Ae.

Does indocyanine green accurately measure plasma volume early after cardiac surgery?

Unlabelled: Potential overestimation of plasma volume (PV) determination by the conventional indocyanine green (ICG) dilution method (PV-ICG) can occur when generalized capillary protein leakage is present, because ICG binds to proteins. We recently reported that this overestimation can be recognized by simultaneous measurement of the initial distribution volume of glucose (IDVG). We examined whether overestimation of PV-ICG and further ICG-pulse dye densitometry-derived plasma volume (PV-PDD) can occur early after cardiac surgery by using the PV-ICG/IDVG ratio as an indicator.