Publications by authors named "Kenichi Takechi"

13 Publications

  • Page 1 of 1

One-lung ventilation using a laryngeal mask airway and bronchial blocker in a patient with vocal cord cancer: a case report.

JA Clin Rep 2022 Mar 17;8(1):22. Epub 2022 Mar 17.

Department of Anesthesia, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama City, Ehime, Japan.

Background: One-lung ventilation is a standard technique for thoracic anesthesia. Usually, one-lung ventilation requires a large-bore tracheal tube. Therefore, in patients with vocal cord morbidity, it is challenging to achieve one-lung ventilation while preventing the damage of vocal cord lesions.

Case Presentation: A 77-year-old man was diagnosed with vocal cord cancer and lung tumor. One-lung ventilation with a combination of a laryngeal mask airway and bronchial blocker was planned to avoid unexpected vocal cord injury. After securing the airway with a laryngeal mask airway, a bronchial blocker was placed under fiberscope guidance. The bronchial blocker passed through a position far enough from the vocal cord lesion. The bronchial blocker provided a clear view of the operative field. The patient's perioperative course was uneventful.

Conclusions: When one-lung ventilation is required for patients with vocal cord lesions, a combination of a laryngeal mask airway and bronchial blocker is considered a good option.
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http://dx.doi.org/10.1186/s40981-022-00513-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8931128PMC
March 2022

Delayed Ventricular Tachycardia After Prophylactic Doses of Droperidol in Patients With Mild QT Interval Prolongation Due to Preoperative Medication.

Cureus 2021 Jun 10;13(6):e15560. Epub 2021 Jun 10.

Anesthesia, Matsuyama Red Cross Hospital, Ehime, JPN.

Prophylactic doses of droperidol are effective in preventing postoperative nausea and vomiting (PONV). However, due to concerns of QT interval prolongation and ventricular arrhythmias, the safety of droperidol for PONV prophylaxis has been debated. A 70-year-old woman was scheduled for total knee arthroplasty. She had a history of aortic valve replacement. Oral aprindine (40 mg/day) was prescribed. Preoperative electrocardiogram showed mild QT interval prolongation (QTc = 475 ms). Anesthesia was induced using propofol, remifentanil, and rocuronium, and maintained using desflurane, remifentanil, and a bolus dose of rocuronium. The surgery was uneventful. At the time of skin closure, droperidol (1.25 mg) was administered intravenously for PONV prophylaxis. Twenty-three minutes after administration of droperidol, a sudden onset of premature cardiac contraction was observed, which progressed directly to ventricular tachycardia and atrioventricular block. Arrhythmia due to droperidol-induced QT interval prolongation was strongly suspected. Intravenous magnesium sulfate (2 g) and atropine (0.5 mg) were administered immediately. The ventricular tachycardia resolved quickly after the magnesium injection. Following the resolution of the arrhythmia, the patient was extubated. The patient experienced ventricular tachycardia after a prophylactic dose of droperidol that resulted from QT interval prolongation due to the preoperative medication. It may be prudent to avoid even low-dose droperidol in the background of already present QT prolongation, especially when multiple putative QT-prolonging drugs are used.
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http://dx.doi.org/10.7759/cureus.15560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270060PMC
June 2021

Anaphylactic reaction after pre-deposit autologous blood transfusion.

Transfus Med 2020 Dec 3;30(6):520-521. Epub 2020 Nov 3.

Department of Anaesthesia, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan.

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http://dx.doi.org/10.1111/tme.12735DOI Listing
December 2020

Laparoscopic image of carbon dioxide embolism during laparoscopic hepatectomy: a case report.

JA Clin Rep 2020 May 30;6(1):39. Epub 2020 May 30.

Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama City, Ehime, Japan.

Background: Carbon dioxide embolism is a life-threatening complication of laparoscopic hepatectomy.

Case Presentation: A 59-year-old man was admitted for laparoscopic hepatectomy. Approximately 5 h after commencing the operation, we observed a gradual decline in the SpO from 100 to 94%, reduction in the ETCO from 44 to 19 mmHg, reduction in the systolic blood pressure from 100 to 82 mmHg, and elevation of the heart rate from 82 to 120 beats/min. Intraoperatively, the image displayed on the laparoscopic monitor revealed a small tear in the vein. The inspired O fraction was raised to 1.0, intravenous phenylephrine (0.1 mg bolus) was administered, and the respiratory rate was increased. After the patient was stabilized, the injured vein was cut and sealed. After the embolic event, the entire operation was completed without complications.

Conclusions: Careful observation of the laparoscopic monitor is important, particularly during establishment of pneumoperitoneum in patients undergoing laparoscopic hepatectomy.
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http://dx.doi.org/10.1186/s40981-020-00345-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261313PMC
May 2020

Adverse events associated with continuous interscalene block administered using the catheter-over-needle method: a retrospective analysis.

BMC Anesthesiol 2019 10 28;19(1):195. Epub 2019 Oct 28.

Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime, Japan.

Background: Continuous interscalene block is widely used for pain management in shoulder surgery. However, continuous interscalene block performed using the catheter-through-needle method is reportedly associated with adverse events such as pericatheter leakage of the local anesthetic, phrenic nerve paralysis, and hoarseness. Because we expected that the catheter-over-needle method would reduce these adverse events, we examined cases in which continuous interscalene block was performed using the catheter-over-needle method to determine what adverse events occurred and when.

Methods: We retrospectively reviewed the anesthesia and medical records of adult patients who underwent catheter insertion to receive a continuous interscalene block performed using the catheter-over-needle method at our hospital from July 2015 to July 2017.

Results: During the surveillance period, 122 adult patients underwent catheter insertion to receive a continuous interscalene block administered using the catheter-over-needle method. No case of pericatheter local anesthetic leakage was observed. Adverse events, such as dyspnea, hoarseness, insufficient anesthetic effect, dizziness, cough reflex during drinking, or ptosis, were observed in 42 patients (34.4%; 95% confidence interval 26-42.7). Most of the adverse events occurred on postoperative day 2. The median time between surgery and the onset of adverse events was 28.5 h.

Conclusions: The catheter-over-needle method may prevent the pericatheter leakage of the local anesthetic. However, adverse events occurred in more than one-third of the patients. During continuous interscalene block, patients must be carefully observed for adverse events, especially on postoperative day 2.

Trial Registration: This study was registered at the UMIN Clinical Trials Registry on August 13th, 2019 ( UMIN000037673 ).
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http://dx.doi.org/10.1186/s12871-019-0873-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816201PMC
October 2019

Lower limb perfusion during robotic-assisted laparoscopic radical prostatectomy evaluated by near-infrared spectroscopy: an observational prospective study.

BMC Anesthesiol 2018 08 18;18(1):114. Epub 2018 Aug 18.

Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime, Japan.

Background: Decreased perfusion in the lower extremities is one of the several adverse effects of placing patients in a lithotomy or Trendelenburg position during surgery. This study aimed to evaluate the effects of patient positioning in lower limb perfusion patients undergoing robotic-assisted laparoscopic radical prostatectomy (RARP) using near-infrared spectroscopy (NIRS).

Methods: This observation study comprised 30 consenting males with American Society of Anaesthesiologists physical status classes I and II (age range, ≥20 to < 80 years). Regional saturation of oxygen measurements was obtained using an INVOS™ oximeter (Somanetics, Troy, MI, USA). A NIRS sensor was positioned on the surface of the skin at the mid-diaphyseal region of the calf muscles (the gastrocnemius and soleus), over the posterior compartment, in the right lower leg. Regional saturation of oxygen (rSO) was sampled during the following time points: before and 5 min after induction of anaesthesia (T0,T1); 5 min after establishment of pneumoperitoneum in a 0° lithotomy position (T2); 5 min after a 25° Trendelenburg position (T3); 30, 60, 90 and 120 min after pneumoperitoneum in a Trendelenburg position (T4, T5, T6 and T7, respectively); after desufflation in a supine position (T8); and after tracheal extubation (T9).

Results: Lower limb perfusion evaluated by NIRS was increased after induction of anaesthesia and maintained during steep Trendelenburg positions in RARP patients with no risk for lower limb compartment syndrome (LLCS) (T0:65 ± 7.2%, T1:69 ± 6.1%, T2:70±:6.1%, T3:68 ± 6.7%, T4:66 ± 7.5%, T5:67 ± 6.9%, T6:68 ± 7.2%, T8:73 ± 7.2%, T9:71 ± 7.9%, respectively).

Conclusions: Lower limb perfusion evaluated by NIRS was maintained during the RARP procedure. Correct patient positioning and careful assessment of risk factors such as vascular morbidity could be important for the prevention of LLCS during RARP.
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http://dx.doi.org/10.1186/s12871-018-0567-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098825PMC
August 2018

Real-time ultrasound-guided infraorbital nerve block to treat trigeminal neuralgia using a high concentration of tetracaine dissolved in bupivacaine.

Scand J Pain 2015 Jan 1;6(1):51-54. Epub 2015 Jan 1.

Ehime University Graduate School of Medicine, Department of Anesthesia and Perioperative Medicine, Ehime Japan.

Background Trigeminal neuralgia is a neuropathic disorder characterized by episodes of intense pain in the face. Drug therapy is the first choice of treatment. However, in cases where drug therapy are contraindicated due to side effects, patients can get pain relief from lengthy neurosurgical procedures. Alternatively, a peripheral trigeminal nerve block can be easily performed in an outpatient setting. Therefore it is a useful treatment option for the acute paroxysmal period of TN in patients who cannot use drug therapy. We performed real-time ultrasound guidance for infraorbital nerve blocks in TN patients using a high concentration of tetracaine dissolved in bupivacaine. In this report, we examine the efficacy of our methods. Patients As approved by the Institutional Review Board, the medical records in our hospital were queried retrospectively. Six patients with TN at the V2 area matched the study criteria. All patients could not continue drug therapy with carbamazepine due to side effects and they received an ultrasound-guided infraorbital nerve block with a high concentration of tetracaine dissolved in bupivacaine. Methods The patient was placed in the supine position and the patient's face was sterilized and draped. An ultrasound system with a 6-13 MHz linear probe was used with a sterile cover. The probe was inserted into the horizontal plane of the cheek just beside the nose and was slid in the cranial direction to find the dimple of the infraorbital foramen. The 25G 25 mm needle was inserted from the caudal side just across from the probe using an out-of-plane approach. To lead the needle tip to the foramen, needle direction was corrected with real-time ultrasound guidance. After the test block with lidocaine (2%, 0.5 ml), a solution of tetracaine (20 mg) dissolved in bupivacaine (0.5%, 0.5 ml) was injected. During each injection, the spread of the agent around the nerve was confirmed using ultrasound images. Results Ten blocks were performed for six patients. Immediately after the procedure, all 10 blocks produced analgesia and relieved the pain. In the three blocks, pain was experienced in a new trigger point outside of the infraorbital nerve region (around the back teeth) within a week after the block and pain were relieved using other treatment. Two patients developed small hematomas in the cheek but they disappeared in a week. All patients did not complain about other side effects including paraesthesia, hyperpathia, dysaesthesia, or double vision. Hypoaesthesia to touch and pain in the infraorbital region were observed in all blocks after 2 weeks. Conclusions We performed real-time ultrasound-guided infraorbital nerve block for TN with a high concentration of tetracaine dissolved in bupivacaine. Our method achieved a high success rate and there were only minor and transient side effects. Implications Real-time ultrasound-guided infraorbital nerve block is one of the useful options to treat the acute paroxysmal period of TN at the infraorbital nerve area. Ultrasound-guided injections may become the standard practice for injecting peripheral trigeminal nerves. Using this high concentration of tetracaine as a neurolytic agent is effective and appears to have only minor side effects.
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http://dx.doi.org/10.1016/j.sjpain.2014.10.003DOI Listing
January 2015

Effect of dexmedetomidine on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy under total intravenous anesthesia: A randomized, double blinded placebo controlled clinical trial.

J Clin Anesth 2018 Sep 5;49:30-35. Epub 2018 Jun 5.

Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime 790-0295, Japan. Electronic address:

Study Objective: To study the effects of intraoperative dexmedetomidine on the intraocular pressure (IOP) in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP) under propofol-remifentanil anesthesia.

Design: Double-blind, randomized controlled trial.

Setting: Operating room.

Patients: Forty consenting male patients aged ≥20 to <80 years with American Society of Anesthesiologists physical status classes I and II.

Interventions: The patients were randomly assigned to either dexmedetomidine (DEX) (n = 20) or control (n = 20) group. Anesthesia was induced and maintained using propofol, remifentanil, and rocuronium. In the dexmedetomidine group, dexmedetomidine was administered at 0.4 μg/kg/h immediately after anesthesia induction until the end of the surgery, whereas normal saline was administered as placebo in the control group.

Measurements: IOP was measured using a rebound tonometer. Time points of measuring IOP were as follows: T1: before anesthesia induction, T2: 5 min after intubation, T3: 60 min after placing patient in the Trendelenburg position, T4: 120 min after placing patient in the Trendelenburg position, T5: 180 min after placing patient in the Trendelenburg position, T6: 5 min after placing patient in a horizontal position, T7: 5 min after extubation, and T8: 30 min after extubation.

Main Results: A linear mixed model analysis demonstrated a significant intergroup difference in IOP over time and during pneumoperitoneum in the steep Trendelenburg position. IOP at T5 was significantly lower in the dexmedetomidine group than in the control group even after post-hoc analysis in the steep Trendelenburg position periods with Bonferroni correction.

Conclusions: Dexmedetomidine combined with propofol decreases IOP in the steep Trendelenburg position during RALRP.
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http://dx.doi.org/10.1016/j.jclinane.2018.06.006DOI Listing
September 2018

[The looks of Gendai Kamada].

Masui 2013 Jul;62(7):894-7

Intensive Care Division, Ehime University Hospital, Toon 791-0295.

We realized the looks of Gendai Kamada. At first, we found in a figure, in "Seishu Hanaoka and His Surgery" by Syuzo Kure, that the portrait described as that of Gendai is his father's. And we discovered the illustrations that illustrate the looks of Gendai in "Gekakihaizufu", which was a textbook of clinical anesthesia and surgery, printed in 1840. Using these illustrations, we realized the looks of Gendai Kamada.
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July 2013

The antinociceptive and antihyperalgesic effects of topical propofol on dorsal horn neurons in the rat.

Anesth Analg 2013 Apr 21;116(4):932-8. Epub 2013 Jan 21.

Department of Anesthesiology and Resuscitology, Ehime University Medical School, Matsuyama, Japan.

Background: Propofol (2,6-diisopropylphenol) is an IV anesthetic used for general anesthesia. Recent evidence suggests that propofol-anesthetized patients experience less postoperative pain, and that propofol has analgesic properties when applied topically. We presently investigated the antinociceptive effects of topical propofol using behavioral and single-unit electrophysiological methods in rats.

Methods: In behavioral experiments with rats, we assessed the effect of topical hindpaw application of propofol (1%-25%) on heat and mechanically evoked paw withdrawals. In electrophysiological experiments, we recorded from lumbar dorsal horn wide dynamic range (WDR)-type neurons in pentobarbital-anesthetized rats. We assessed the effect of topical application of propofol to the ipsilateral hindpaw on neuronal responses elicited by noxious heat, cold, and mechanical stimuli. We additionally tested whether propofol blocks heat sensitization of paw withdrawals and WDR neuronal responses induced by topical application of allyl isothiocyanate (AITC; mustard oil).

Results: Topical application of propofol (1%-25%) significantly increased the mean latency of the thermally evoked hindpaw withdrawal reflex on the treated (but not opposite) side in a concentration-dependent manner, with no effect on mechanically evoked hindpaw withdrawal thresholds. Propofol also prevented shortening of paw withdrawal latency induced by AITC. In electrophysiological experiments, topical application of 10% and 25% propofol, but not 1% propofol or vehicle (10% intralipid), to the ipsilateral hindpaw significantly attenuated the magnitude of responses of WDR neurons to noxious heating of glabrous hindpaw skin with no significant change in thermal thresholds. Maximal suppression of noxious heat-evoked responses was achieved 15 minutes after application followed by recovery to the pre-propofol baseline by 30 minutes. Responses to skin cooling or graded mechanical stimuli were not significantly affected by any concentration of propofol. Topical application of AITC enhanced the noxious heat-evoked response of dorsal horn neurons. This enhancement of heat-evoked responses was attenuated when 10% propofol was applied topically after application of AITC.

Conclusions: The results indicate that topical propofol inhibits responses of WDR neurons to noxious heat consistent with analgesia, and reduced AITC sensitization of WDR neurons consistent with an antihyperalgesic effect. These results are consistent with clinical studies demonstrating reduced postoperative pain in surgical patients anesthetized with propofol. The mechanism of analgesic action of topical propofol is not clear, but may involve desensitization of TRPV1 or TRPA1 receptors expressed in peripheral nociceptive nerve endings, engagement of endocannabinoids, or activation of peripheral γ-aminobutyric acid A receptors.
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http://dx.doi.org/10.1213/ANE.0b013e31827f560dDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3606650PMC
April 2013

Case reports: management of intractable upper extremity pain with continuous subarachnoid block at the low cervical level without impairment of upper extremity function.

Anesth Analg 2010 Jun 7;110(6):1721-4. Epub 2010 Apr 7.

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Shitukawa, Toon City, Ehime 791-0295, Japan.

We present a case of continuous subarachnoid block for the treatment of refractory cancer pain in the shoulder and upper extremity on the right side of the patient. The catheter tip was placed in the subarachnoid space close to the nerve roots on the right side at the height of C5 corresponding to the painful region. Until the patient died, his pain was controlled with infusions of bupivacaine (30-58.7 mg/d) and morphine (2-19.6 mg/d) for 120 days during which upper extremity function was not disturbed and respiratory function and performance status were improved. This case suggests continuous subarachnoid block at the low cervical level is useful for refractory cancer pain in the shoulder and upper extremity.
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http://dx.doi.org/10.1213/ANE.0b013e3181da8ee0DOI Listing
June 2010

[Nerve block for the treatment of chronic pain].

Masui 2008 Nov;57(11):1371-8

Department of Anesthesiology & Resuscitology, Ehime University Graduate School of Medicine, Ehime.

Nerve block is useful for the treatment of acute pain and cancer pain; however the treatment's effectiveness with regard to non-cancer chronic pain is controversial. Of the non-cancer diseases, trigeminal neuralgia and spinal facet joint pain, in which long-term pain relief can be obtained by the nerve block without serious complications in most of patients, are well suited for the nerve block. Systemic reviews for the treatment of radicular pain from spine disorders with the nerve block showed contradictory long-term results. In other chronic pains, the effectiveness of nerve blocks has not been proved, although anecdotal reports suggests that a small proportion of patients respond well to the nerve block. Further study is necessary to examine what kinds of pains and patients will be relieved with the nerve block.
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November 2008
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