Publications by authors named "Nagara Ohno"

13 Publications

  • Page 1 of 1

Perioperative Elevation in Cell-Free DNA Levels in Patients Undergoing Cardiac Surgery: Possible Contribution of Neutrophil Extracellular Traps to Perioperative Renal Dysfunction.

Anesthesiol Res Pract 2016 2;2016:2794364. Epub 2016 Nov 2.

Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

. This study aimed to determine the perioperative change in serum double-strand DNA (dsDNA) as a marker potentially reflecting neutrophil extracellular trap concentration in samples from patients undergoing cardiac surgery and to analyze a relationship between serum dsDNA concentrations and perioperative renal dysfunction. . Serum dsDNA concentrations in samples that were collected during a previously conducted, prospective, multicenter, observational study were measured. Eighty patients undergoing elective cardiac surgery were studied. Serum samples were collected at baseline, immediately after surgery, and the day after surgery (POD-1). . Serum dsDNA concentration was significantly increased from baseline (median, 398 ng/mL [interquartile range, 372-475 ng/mL]) to immediately after surgery (median, 540 ng/mL [437-682 ng/mL], < 0.001), and they were reduced by POD-1 (median, 323 ng/mL [256-436 ng/mL]). The difference in serum creatinine concentration between baseline and POD-1 was correlated with dsDNA concentration on POD-1 ( = 0.61, < 0.001). . In patients undergoing cardiac surgery, serum dsDNA concentration is elevated postoperatively. Prolonged elevation in dsDNA concentration is correlated with perioperative renal dysfunction. Further large-scale studies are needed to determine the relationship between serum concentration of circulating dsDNA and perioperative renal dysfunction.
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http://dx.doi.org/10.1155/2016/2794364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110877PMC
November 2016

Elevated levels of angiopoietin-2 as a biomarker for respiratory failure after cardiac surgery.

J Cardiothorac Vasc Anesth 2014 Oct 11;28(5):1293-301. Epub 2014 Jul 11.

Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Tokyo, Japan.

Objectives: Angiopoietin-1 and angiopoietin-2 are important factors in regulating endothelial vascular permeability. This study evaluated perioperative changes in serum levels of angiopoietin-1 and -2 in patients undergoing cardiac surgery.

Design: Measurement of serum levels of angiopoietin-1 and angiopoietin-2 in samples collected during a previously conducted prospective, multicenter, observational study.

Setting: Three university hospitals.

Participants: Eighty-four adult patients undergoing cardiac surgery.

Intervention: Serum levels of angiopoietins were measured at baseline, immediately after surgery, and the day after surgery (POD-1).

Measurements And Main Results: Serum levels of angiopoietin-2 were elevated by POD-1 (median 3.3 ng/mL, interquartile range [IQR] 2.5-4.6 ng/mL) compared with baseline (median 1.6 ng/mL, IQR 1.3-2.1 ng/mL, p < 0.0001), and angiopoietin-1 levels were decreased immediately after surgery (baseline median 23.2 ng/mL, IQR 10.2-32.8 ng/mL; postoperative median 8.0 ng/mL, IQR 1.5-13.2 ng/mL, p<0.0001). Angiopoietin-2 levels on POD-1 in patients undergoing off-pump coronary artery bypass grafting were significantly lower than those in patients undergoing aortic surgery (p = 0.0009) and valve surgery (p = 0.008). Angiopoietin-2 levels on POD-1 had a predictive performance of the area under the curve (AUC) of the receiver operating characteristic curve 0.74 for mechanical ventilation>3 days. Angiopoietin-1 levels and the angiopoietin-2/angiopoietin-1 ratio showed lower predictive performance (AUC values 0.58 and 0.68, respectively).

Conclusions: Angiopoietin-2 serum levels were elevated after cardiac surgery. Elevated angiopoietin-2 had a good predictive performance for respiratory failure after cardiac surgery, perhaps reflecting the severity of lung dysfunction related to postoperative increases in vascular permeability.
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http://dx.doi.org/10.1053/j.jvca.2014.03.004DOI Listing
October 2014

Soluble isoform of the receptor for advanced glycation end products as a biomarker for postoperative respiratory failure after cardiac surgery.

PLoS One 2013 23;8(7):e70200. Epub 2013 Jul 23.

Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan.

Purpose: Postoperative respiratory failure is a major problem which can prolong the stay in the intensive care unit in patients undergoing cardiac surgery. We measured the serum levels of the soluble isoform of the receptor for advanced glycation end products (sRAGE), and we studied its association with postoperative respiratory failure.

Methods: Eighty-seven patients undergoing elective cardiac surgery were enrolled in this multicenter observational study in three university hospitals. Serum biomarker levels were measured perioperatively, and clinical data were collected for 7 days postoperatively. The duration of mechanical ventilation was studied for 28 days.

Results: Serum levels of sRAGE elevated immediately after surgery (median, 1751 pg/mL; interquartile range (IQR) 1080-3034 pg/mL) compared with the level after anesthetic induction (median, 884 pg/mL; IQR, 568-1462 pg/mL). Postoperative sRAGE levels in patients undergoing off-pump coronary artery bypass grafting (median, 1193 pg/mL; IQR 737-1869 pg/mL) were significantly lower than in patients undergoing aortic surgery (median, 1883 pg/mL; IQR, 1406-4456 pg/mL; p=0.0024) and valve surgery (median, 2302 pg/mL; IQR, 1447-3585 pg/mL; p=0.0005), and postoperative sRAGE correlated moderately with duration of cardiopulmonary bypass (rs  =0.44, p<0.0001). Receiver operating characteristic curve analysis demonstrated that postoperative sRAGE had a predictive performance with area under the curve of 0.81 (95% confidence interval 0.71-0.88) for postoperative respiratory failure, defined as prolonged mechanical ventilation >3 days. The optimum cutoff value for prediction of respiratory failure was 3656 pg/mL, with sensitivity and specificity of 62% and 91%, respectively.

Conclusions: Serum sRAGE levels elevated immediately after cardiac surgery, and the range of elevation was associated with the morbidity of postoperative respiratory failure. Early postoperative sRAGE levels appear to be linked to cardiopulmonary bypass, and may have predictive performance for postoperative respiratory failure; however, large-scale validation studies are needed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070200PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720894PMC
March 2014

[Intraoperative coronary spasm during caesarean section under spinal anesthesia].

Masui 2010 May;59(5):648-51

Department of Anesthesiology, Faculty of Madicine, The University of Tokyo, Tokyo 113-8655.

A 37-year-old woman without history of ischemic heart disease or any coronary risk factors was scheduled for caesarean section. Under spinal anesthesia, the patient's blood pressure (BP) decreased to 93/72 mmHg. Although 6 mg of ephedrine was administered intravenously, BP continued to decrease to 75/40 mmHg and she complained of nausea. In addition to additional ephedrine (12 mg), phenylephrine (0.1 mg) and atropine (0.5 mg) were administered. BP increased to 170/100 mmHg, but electrocardiogram (ECG) showed ST elevation in I and aV(L), ST depression in II, III, aV(F), and frequent premature ventricular beats, and the patient complained of chest discomfort. Coronary dilators and lidocaine promptly reversed the ST elevation, premature ventricular beats and discomfort. The operation was started promptly and was uneventful. Although BP decreased again to 75/45 mmHg at the beginning of the operation, we did not use vasopressors to avoid the relapse of myocardial ischemia. The anesthetic course was uneventful thereafter. This cardiac event seemed to be derived from coronary spasm caused by acute sympathetic stimulation. The observations in this case suggest that the possibility of intraoperative coronary spasm should be considered even in a healthy patient.
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May 2010

[Case of bladder perforation due to the obturator nerve reflex during transurethral resection (TUR) of bladder tumor using the TUR in saline (Turis) system under spinal anesthesia].

Masui 2010 Mar;59(3):386-9

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.

Bladder perforation due to the obturator nerve reflex (ONR) is a serious complication during TUR of bladder tumor using the conventional TUR system; requiring monopolar electrocautery and non-conductive solution as perfusate. Recently, the TURis system, which employs bipolar electrocautery and physiological saline as perfusate, has been developed. Electrical resistance of physiological saline and human tissues are approximately 40 and 500 omega, respectively. Thus, theoretically, electrical current flows between the resection loop and the recovery electrode integrated in the outer sleeve of the endoscope, without forming electrical circuit in the patient's body; suggesting possible elimination of the ONR. Here we describe a case of bladder perforation during surgery using the TURis system; the ONR was exaggerated during the procedure to stop bleeding at the lateral wall using bipolar electrocautery. In addition to this case, there have been a few reports of the ONR during surgery using the TURis system, and it is reported that weak electrical current may pass through the patient's body in the TURis system. We consider that evaluation of the necessary precautions, such as the obturator nerve block, for the prevention of the ONR is important even in the surgery using the TURis system.
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March 2010

[Efficacy of acetated-Ringer containing 10% dextran: evaluation in a rat model of acute normovolemic hemodilution].

Masui 2010 Feb;59(2):164-8

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.

Background: In this study, we prepared acetated-Ringer containing 10% dextran, and evaluated its efficacy in a rat model of acute normovolemic hemodilution (ANH).

Methods: Under sevoflurane anesthesia, 21 rats (350-400 g) underwent ANH. In all rats 10 ml of blood was withdrawn, and they were infused with 10 ml of acetated-Ringer containing 10% dextran (Group-A, n = 11) or lactated-Ringer containing 10% dextran (Group-L, n = 10). For each rat, ANH procedure took 20 minutes. Hemodynamics and arterial blood gas data before and after ANH were compared.

Results: All results but for blood lactate level after ANH were comparable between the 2 groups. Blood lactate level was elevated in both groups after ANH; however, the elevation was significantly higher in Group-L.

Conclusions: No differences in hemodynamics after ANH reveal that 2 plasma substitutes used in this study have almost the same quality in maintaining intravascular volume. Blood lactate level is generally recognized as an indicator of tissue hypoxia. A possible explanation for the significantly higher blood lactate level in Group-L after ANH is that exogenous overload of lactate as well as tissue hypoxia might have elevated blood lactate levels after ANH in this study. These results suggest the efficacy of acetated-Ringer containing 10% dextran.
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February 2010

[Anesthetic management for emergency laparotomy in an adult patient with Eisenmenger syndrome: a case report].

Masui 2009 Aug;58(8):1021-4

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.

There are few clinical reports concerning anesthetic management for patients with Eisenmenger syndrome requiring non-cardiac surgery. The risk of morbidity and mortality associated with non-cardiac surgery in patients with Eisenmenger syndrome is considerable. During anesthetic management for these patients, careful circulatory and respiratory managements to avoid several factors related to surgery and anesthesia that can potentially increase right to left shunt flow are required. Therefore, it is very important to maintain cardiac output to prevent a decrease in systemic vascular resistance and an increase in pulmonary vascular resistance. For this purpose, combination of intravenous administration of inotropes such as milrinone and dobutamine, and vasopressors such as norepinephrine, might have clinical efficacy. Here we describe an anesthetic management for a 50-year-old woman with a ventricular septal defect and Eisenmenger syndrome undergoing emergency laparotomy. We considered that sufficient fluid therapy and adequate administration of inotropes and vasopressors, based on strict hemodynamic assessment using direct arterial and central venous pressure monitoring, arterial blood gas analysis, and transesophageal echocardiography during general anesthesia, might have contributed to the uneventful perioperative course of the patient.
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August 2009

[Effects of general anesthesia using ketamine and remifentanil on postoperative pain management for patients undergoing laparotomy].

Masui 2009 Jun;58(6):739-44

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo.

Background: Co-administration of ketamine and remifentanil may offer preemptive analgesia and prevention of opioid-induced hyperalgesia, resulting in reduction of postoperative pain.

Methods: We retrospectively analyzed data concerning anesthetic management and postoperative pain management in 19 adult patients undergoing elective laparotomy with general anesthesia using ketamine and remifentanil.

Results: Ketamine and remifentanil were co-administered for both induction and maintenance of general anesthesia. Preoperative and total doses of ketamine were 1.4+/-0.5 and 1.9+/-0.4 mg x kg(-1). Infusion rate of remifentanil at the beginning of surgery was 0.24+/-0.02 microg x kg(-1) x min(-1), and minimal and maximal rate were 0.06+/-0.03 and 0.26+/-0.03 microg x kg(-1) min(-1). Pentazocine and nonsteroidal anti-inflammatory drugs (NSAIDs) were used for postoperative pain management. Consumption of pentazocine was 0.51+/-0.33 mg x kg(-1) on 1st postoperative day (1POD), and NSAIDs were co-administered on 1POD for 3 patients. Most patients could stand up and walk on 1POD.

Conclusions: Results in this study suggest that anesthetic management using ketamine and remifentanil may be useful for postoperative pain management, probably by preemptive analgesic effects of both agents and preventive effects of ketamine against opioid-induced hyperalgesia.
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June 2009

[Second-degree atrioventricular block (Mobitz type II) probably exaggerated by dopamine during anesthetic management for a patient with ochronosis: a case report].

Masui 2008 Dec;57(12):1513-6

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.

Ochronosis is a rare disease. Usually symptoms appear in the third, fourth, or later decade of life. The most common symptom is arthropathy, but cardiovascular system can be involved in this disease. A 71-year-old man with ochronosis was scheduled for total hip arthroplasty. Preoperatively, echocardiogram revealed aortic valve stenosis, mitral valve stenosis, and hypokinesis on antero-septal, lateral and posterior walls. Coronary angiogram revealed 50-75% stenosis of the left anterior descending coronary artery (segment 7) and 100% stenosis of the left circumflex artery (segment 15). Before the induction of general anesthesia, electrocardiogram showed first-degree atrioventricular block. After the induction of general anesthesia, blood pressure decreased markedly. Phenylephrine administration and rapid infusion of extracellular fluid failed to increase blood pressure. Thus, we started to administer dopamine at an infusion rate of 10 microg x kg(-1) x min(-1) which increased blood pressure effectively, but electrocardiogram showed second-degree atrioventricular block (Mobitz type II). We started rapid infusion of a plasma substitute, and gradually decreased the infusion rate of dopamine to 4 microg x kg(-1) x min(-1). Then electrocardiogram returned to first-degree atrioventricular block. We estimated that second-degree atrioventricular block in this patient might have been exaggerated by dopamine at least in part.
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December 2008

[Multiple linear regression analysis for predictability of the extent of spinal anesthesia by plain bupivacaine].

Masui 2008 Dec;57(12):1494-7

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.

Background: Predictability of the extent of spinal anesthesia by plain bupivacaine has been controversial.

Methods: Two hundred and twenty-eight patients undergoing elective surgery with spinal anesthesia were enrolled in this retrospective study. Using gender, age, height, body mass index (BMI), chosen spinal interspace for spinal tap (L2-3 or L3-4), and dose of plain bupivacaine as independent variables, we performed stepwise multiple linear regression analysis to examine predictability of the extent of sensory blockade produced by spinal anesthesia using plain bupivacaine.

Results: Following equation was obtained. Extent of sensory blockade = 14.9 + (male : 0.540, female: -0.540) -0.0774 x height + 0.124 x BMI + (L2-3 : 0.345, L3-4: -0.345): r2 = 0.0604. P values of gender, height and BMI were less than 0.05; however, r2 of each variable was very low.

Conclusions: Results of this retrospective study imply the unpredictability of the extent of spinal anesthesia produced by plain bupivacaine.
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December 2008

[Comparison of the effects of sevoflurane and propofol on changes in leukocyte-count induced by surgical stress].

Masui 2008 Aug;57(8):968-72

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.

Background: It is well known that surgical stress causes granulocytosis and lymphopenia. However, effects of general anesthetics on changes in leukocyte-count induced by surgical stress are not still clear.

Methods: One hundred and sixteen patients undergoing elective surgery with general anesthesia were enrolled in this retrospective study. Patients were classified into two groups according to anesthetic agents used for maintenance of general anesthesia; sevoflurane group (n = 69) and propofol group (n = 47). Changes in leukocyte-count during surgery were compared between the two groups.

Results: In sevoflurane group, lymphocyte-count increased in the early period during surgery, but decreased later. However, lymphocyte-count continued to increase during surgery in propofol group. We found a significant difference in lymphocyte-count during surgery between sevoflurane group and propofol group. On the contrary, granulocyte- and monocyte-count increased during surgery in both groups. There were no significant differences in granulocyte- and monocyte-count during surgery between the two groups.

Conclusions: There were significant differences in effects of sevoflurane and propofol on changes in lymphocyte-count induced by surgical stress. Results of this study imply the efficiency of propofol to prevent lymphopenia, which may play an important role in postoperative immunosuppression caused by surgical stress.
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August 2008

[Effects of preoperative ketamine on postoperative pain in patients undergoing laparotomy].

Masui 2008 Aug;57(8):963-7

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.

Background: Effects of preoperative ketamine on postoperative pain in patients undergoing laparotomy have been controversial.

Methods: Fifty-two patients undergoing elective laparotomy were enrolled in this retrospective study. Patients were classified into 3 groups according to anesthetic management; patients received general anesthesia alone with preoperative ketamine (n = 20), patients received epidural blockade and general anesthesia with preoperative ketamine (n = 15), and patients received epidural blockade and general anesthesia without preoperative ketamine (n = 17). Among the three groups, we compared the parameters concerning postoperative pain managements; frequency of complaining about pain, opioid consumption, incidence of nausea and vomiting in the first 24 hours after laparotomy, and ability of ambulation on the first postoperative day.

Results: Among the three groups, there were no significant differences in all parameters concerning postoperative pain management described above.

Conclusions: Results of this study imply that preoperative ketamine may elicit preemptive analgesic effects, and can be an efficient adjuvant to postoperative pain management for patients undergoing laparotomy.
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August 2008
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