Publications by authors named "Takumi Nagaro"

35 Publications

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

[Refractory Hypotension Induced by Continuous Phonation during Spinal Anesthesia in a Patient Suffering from Severe Aortic Stenosis.]

Masui 2016 Sep;65(8):847-849

An 85-year-old man suffering from severe aortic ste- nosis underwent transurethral resection of the prostate (TUR-P) under spinal anesthesia producing analgesia below T7. TUR-P was performed uneventfully with repeated injections of phenylephrine 0.05 to 0.1 mg which kept systolic blood pressure around 100 mmHg. Refractory hypotension occurred in the intensive care unit two hours after spinal anesthesia when the patient continued to speak ; systolic blood pressure fell to 60 mmHg from 100 mmHg, and discontinuance of speak- ing restored the blood pressure, although injections of phenylephrine had no effect Four episodes of hypoten- sion occurred before the movement of lower extremi- ties was restored, 5.5 hours after spinal anesthesia. Refractory hypotension might have been the result of a decrease in venous return caused by increased intra- thoracic pressure during speaking, and sympatholysis and decreased abdominal compression by spinal anes- thesia combined with complicating cardiac dysfunction.
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September 2016

The ameliorative effects of a hypnotic bromvalerylurea in sepsis.

Biochem Biophys Res Commun 2015 Apr 28;459(2):319-326. Epub 2015 Feb 28.

Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan. Electronic address:

Sepsis is a severe pathologic event, frequently causing death in critically ill patients. However, there are no approved drugs to treat sepsis, despite clinical trials of many agents that have distinct targets. Therefore, a novel effective treatment should be developed based on the pathogenesis of sepsis. We recently observed that an old hypnotic drug, bromvalerylurea (BU) suppressed expression of many kinds of pro- and anti-inflammatory mediators in LPS- or interferon-γ activated alveolar and peritoneal macrophages (AMs and PMs). Taken the anti-inflammatory effects of BU on macrophages, we challenged it to septic rats that had been subjected to cecum-ligation and puncture (CLP). BU was subcutaneously administered to septic rats twice per day. Seven days after CLP treatment, 85% of septic rats administrated vehicle had died, whereas administration of BU reduce the rate to 50%. Septic rats showed symptoms of multi-organ failure; respiratory, circulatory and renal system failures as revealed by histopathological analyses, blood gas test and others. BU ameliorated these symptoms. BU also prevented elevated serum-IL-6 level as well as IL-6 mRNA expression in septic rats. Collectively, BU might be a novel agent to ameliorate sepsis by preventing the onset of MOF.
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http://dx.doi.org/10.1016/j.bbrc.2015.02.111DOI Listing
April 2015

Changes in Energy Levels by Dexamethasone in Ischemic Hearts and Brains in Male Mice.

J Neurosurg Anesthesiol 2015 Oct;27(4):295-303

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

Background: Glucocorticoids have been shown to alleviate ischemia-induced myocardial injury, while aggravating neuronal damage caused by ischemia. As energy failure is a predominant factor in cellular viability, we examined the effects of glucocorticoids on energy utilization in the mouse heart and brain.

Methods: Seventy-two male ddY mice were assigned to 1 of 3 groups: saline (S), dexamethasone (a glucocorticoid without mineralocorticoid activity, 5 mg/kg) (D), and metyrapone (a potent inhibitor of the synthesis of glucocorticoids, 100 mg/kg) (M) groups (n=24 in each). Three hours after intraperitoneal administration, all animals were decapitated, and the heads were frozen in liquid nitrogen after 0, 0.5, 1, or 2 minutes (n=6 in each). The hearts were immediately removed and frozen in liquid nitrogen after 0, 5, 10, or 20 minutes of incubation at 37°C (n=6 in each). The concentrations of adenylates and monoamines were determined by high-performance liquid chromatography.

Results: In the heart, the adenosine 5'-triphosphate (ATP) concentration did not differ among the 3 groups at 0 minute of ischemia (3 h of S, D, or M treatment). Ischemia for 5 minutes decreased the ATP content to 21% of the basal level in the S group. The ATP decrease was suppressed by either the D or M treatment, such that after 5 minutes ATP levels were 63% and 64% of each basal level, respectively. In the brain, the ATP level in the M group was 62% of that in the S group at 0 minute of ischemia, and the 5'-monophosphate (AMP) level was 276% of that in the S group. Brain dopamine metabolism was facilitated by dexamethasone, and suppressed by metyrapone.

Conclusions: The relationship between effects of glucocorticoids on ischemia-induced changes in energy levels and cellular viability was not clearly elucidated.
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http://dx.doi.org/10.1097/ANA.0000000000000153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560271PMC
October 2015

Usefulness of cordotomy in patients with cancer who experience bilateral pain: implications of increased pain and new pain.

Neurosurgery 2015 Mar;76(3):249-56; discussion 256; quiz 256-7

*Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Ehime, Japan; ‡Department of Palliative Care Medicine, Matsuyama Bethel Hospital, Ehime, Japan; §Department of Anesthesiology, Uwajima City Hospital, Ehime, Japan; ¶Department of Palliative Care Medicine, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan; ‖Pain Clinic Unit, Nakatani Hospital, Hyogo, Japan.

Background: Although mirror pain occurs after cordotomy in patients experiencing unilateral pain via a referred pain mechanism, no studies have examined whether this pain mechanism operates in patients who have bilateral pain.

Objective: To assess the usefulness of cordotomy for bilateral pain from the viewpoint of increased pain or new pain caused by a referred pain mechanism.

Methods: Twenty-six patients who underwent percutaneous cordotomy through C1-C2 for severe bilateral cancer pain in the lumbosacral nerve region were enrolled. Pain was dominant on 1 side in 23 patients, and pain was equally severe on both sides in 3 patients. Unilateral cordotomy was performed for the dominant side of pain, and bilateral cordotomy was performed for 13 patients in whom pain on the nondominant side developed or remained severe after cordotomy.

Results: After unilateral cordotomy, 19 patients (73.1%) exhibited increased pain, which for 14 patients was as severe as the original dominant pain. After bilateral cordotomy, 7 patients (53.4%) exhibited new pain, which was located cephalad to the region rendered analgesic by cordotomy and was better controlled than the original pain. No pathological organic causes of new pain were found in any patient, and evidence of a referred pain mechanism was found in 3 patients after bilateral cordotomy.

Conclusion: These results show that a referred pain mechanism causes increased or new pain after cordotomy in patients with bilateral pain. Nevertheless, cordotomy can still be indicated for patients with bilateral pain because postoperative pain is better controlled than the original pain.
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http://dx.doi.org/10.1227/NEU.0000000000000593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337588PMC
March 2015

[Shortage of anesthesiologists in university hospitals].

Authors:
Takumi Nagaro

Masui 2014 Mar;63(3):243

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March 2014

[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

[Stricture of oxygen outlet of the central piping identified by a decrease in the oxygen supply pressure into the anesthesia machine].

Masui 2011 Apr;60(4):507-10

Department of Anesthesiology, Uwajima City Hospital, Uwajima 798-8510.

We experienced an incident of the stricture caused by the degradation of an O-ring in the oxygen outlet of the central piping. The event was identified by the intermittent decrease of the central piping oxygen supply pressure into the anesthesia machine. In this case, pressure was judged normal by periodical checking. But the malfunction became clear when the parts of outlet were replaced, because similar incidents frequently had occurred. The cyclical rhythm of the declining oxygen supply pressure means that oxygen supplies decreases with the increase of oxygen consumption, and it may be a sign of serious malfunction. Therefore, it is necessary to check the pressure deviations under use of high-flow oxygen.
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April 2011

[Incorrect descriptions about Seicho Kamata in "Seishu Hanaoka and his surgery"].

Masui 2010 Oct;59(10):1321-4

Intensive Care Division, Ehime University Hospital, Toon 791-0204.

"Seishu Hanaoka and his surgery" by Shuzo Kure is one of the most important books for the study of Seishu Hanaoka. However, several incorrect descriptions have been pointed out in the book. Therefore, we checked the content about Seicho Kamata, a distinguished disciple of Seishu Hanaoka (p.154-163) in the book, and found three incorrect descriptions. The figure being described as that of Seicho Kamata is his father's. His graveyard being described as "Nyohoji" is truly "Daizenji". Seicho Kamata is also described as the second distinguished disciple of Seishu Hanaoka ; however, authors think that he was the first distinguished disciple from his career. Further investigation into the content of the book is necessary.
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October 2010

[Importance of pain management to anesthesiologists].

Authors:
Takumi Nagaro

Masui 2010 Aug;59(8):953

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August 2010

Massive subcutaneous emphysema developing before surgery for mandibular fracture: a case report.

Dent Traumatol 2010 Aug 23;26(4):363-5. Epub 2010 Apr 23.

Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of Medicine, Japan.

Preoperative massive subcutaneous emphysema before intubation is extremely rare. However, this complication may be potentially lethal, depend on the condition of air spreading. Subcutaneous emphysema which occurs intra- or postoperative period is sometimes iatrogenic because the air is introduced into the tissue space through the hole injured by the operation. But the emphysema in this case occurred preoperatively by the pressure of the bag valve mask, because the patient had an intra-oral wound, which reaches the submental space. In this report, we describe an extremely rare case of preoperative massive emphysema of the patient with the mandibular fracture.
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http://dx.doi.org/10.1111/j.1600-9657.2010.00889.xDOI Listing
August 2010

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

[A case of neuropathic cancer pain in the lower extremities successfully treated with spinal cord stimulation].

Masui 2009 Nov;58(11):1460-1

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Touon 791-0295.

A 76-year-old man was referred to our pain clinic for the treatment of bilateral lower extremity pain due to metastasis of renal cell carcinoma to the sacrum. The pain could not be controlled with narcotics, antidepressant or the epidural block. The characteristics of pain were like those of benign disease, being spontaneous, not exacerbated by body movement, and having a dysesthetic nature with chill sensations. Therefore, spinal cord stimulation (SCS) was performed, relieving the pain until death, 6 months after its induction. This case shows the usefulness of SCS for neuropathic cancer pain that shows signs similar to those of benign disease.
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November 2009

[Successful oral fiberoptic intubation by a double-lumen tube under the ventilation only via nostrils with a child size mask in a patient with limited mouth opening].

Masui 2009 May;58(5):616-9

Department of Anesthesiology and Resuscitology, Ehime University Graduate School of Medicine, Touon 791-0295.

A 36-year-old woman was scheduled for the right lower lobe resection under the left one-lung ventilation with a double-lumen tube (DLT). Difficult intubation due to limited (1.5 cm) mouth opening was recognized following the induction of anesthesia. Fiberoptic oral intubation by the DLT was successfully performed under the ventilation via the nostrils using a small-size, child mask covering only the nose (nasal mask). Ventilation was well maintained using the nasal mask, and the gas leakage was coped with tightening the lips with the tube and using a high flow of oxygen. This nasal mask ventilation method is useful and safe in cases of difficult intubation by DLT in which no other proper methods are available.
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May 2009

[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

Alleviation of ischemia-induced brain edema by activation of the central histaminergic system in rats.

J Pharmacol Sci 2008 Sep 11;108(1):112-23. Epub 2008 Sep 11.

Department of Anesthesiology and Resuscitology, Ehime University Graduate School of Medicine, Shitsukawa, Touon, Ehime, Japan.

We have reported that facilitation of central histaminergic activity prevents the development of ischemia-induced brain injury. Since cerebral edema is a major cause of brain damage, we studied effects on brain edema of postischemic administration of L-histidine, a precursor of histamine, and thioperamide, a histamine H(3)-receptor antagonist, both of which enhance central histaminergic activity. Focal cerebral ischemia for 2 h was provoked by transient occlusion of the right middle cerebral artery in rats, and the water content and infarct size were determined 24 h after reperfusion. Changes in the extracellular concentration of histamine were examined in the striatum by a microdialysis procedure, and effects of these compounds were evaluated. Repeated administration of L-histidine (1000 mg/kg x 2, i.p.), immediately and 6 h after reperfusion, reduced the increase in the water contents in ischemic regions. Simultaneous administration of thioperamide (5 mg/kg, s.c.) with L-histidine (1000 mg/kg, i.p.) completely prevented edema formation and alleviated brain infarction, although a single dose of L-histidine, immediately after reperfusion, showed no benefits. The striatal histamine level was gradually increased after reperfusion as well as during ischemia. Simultaneous administration of thioperamide with L-histidine markedly increased the brain histamine concentration, and the value increased up to 230% of that in the saline group 5 - 6 h after reperfusion. L-Histidine alone did not affect the increase in the histamine output after ischemia. These findings suggest that further activation of the central histaminergic system after initiation of cerebral ischemia prevents development of ischemia-induced brain edema.
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http://dx.doi.org/10.1254/jphs.08114fpDOI Listing
September 2008

Bilateral brachial plexus injury after liver transplantation.

J Anesth 2008 7;22(3):308-11. Epub 2008 Aug 7.

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

We report a case of bilateral brachial plexus injury following living-donor liver transplantation. A 35-year-old man with hepatitis C cirrhosis underwent liver transplantation under general anesthesia, performed in the supine position with 90 degrees arm abduction. The surgery lasted for 14 h, and the anesthesia for 16 h. On postoperative day 1, it was noticed that he had brachial plexus injuries. We investigated the cause of the nerve injuries, in particular, the possible involvement of stretching, compression, or nerve ischemia, which can often result from excessive abduction, the use of shoulder braces, compression by the poles used in the operating theater or compression caused by surgeons leaning on the patient, or serious general status (e.g., hypotension or hypoxemia). Our findings were inconclusive, but we postulated that 90 degrees abduction of the arms per se may have resulted in excessive stretching of the brachial nerves, causing his injuries.
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http://dx.doi.org/10.1007/s00540-008-0636-0DOI Listing
January 2009

Suppression of ischaemia-induced cytokine release by dimaprit and amelioration of liver injury in rats.

Basic Clin Pharmacol Toxicol 2008 Apr 29;102(4):394-8. Epub 2008 Feb 29.

Department of Anaesthesiology and Resuscitology, Ehime University Graduate School of Medicine, Shitsukawa, Touon-shi, Ehime, Japan.

Inflammatory reactions play an important role in ischaemia/reperfusion injury in various organs. Since histamine H(4) action has been shown to prevent the development of ischaemia/reperfusion liver injury, we examined the effects of dimaprit, a histamine H(2)/H(4) receptor agonist, on ischaemia-induced cytokine release and liver damage. Male Wistar rats (300 g) were subjected to warm ischaemia for 30 min. by occlusion of the left portal vein and hepatic artery under halothane anaesthesia. Saline or dimaprit (20 mg/kg, subcutaneously) was injected immediately after reperfusion of blood flow. Transient ischaemia provoked severe liver damage 24 hr after reperfusion, and the plasma concentrations of alanine transaminase and aspartate transaminase were 4600 IU/l and 13,200 IU/l, respectively. The values in the dimaprit group were 55% and 46% of those in control animals, respectively. Dimaprit also reduced the infarct size to 50%. Liver ischaemia markedly increased interleukin-12 levels 2-24 hr after reperfusion. The dimaprit treatment depressed the values to 40-64% of those in the corresponding control group 4-24 hr after reperfusion. Since interleukin-12 facilitates cell-mediated cytotoxicity, the protective effect of dimaprit may be attributed to regulation of cytokine release during reperfusion.
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http://dx.doi.org/10.1111/j.1742-7843.2008.00219.xDOI Listing
April 2008

Recovery of brain dopamine metabolism by branched-chain amino acids in rats with acute hepatic failure.

J Neurosurg Anesthesiol 2007 Oct;19(4):243-8

Department of Internal Medicine, University of California-San Diego, San Diego, CA, USA.

A decrease in the serum ratio of branched-chain amino acids (BCAAs) to aromatic amino acids (Fischer ratio) reflects the severity of hepatic encephalopathy, and clinical improvement by dietary augmentation with BCAAs has been demonstrated. As behavioral alteration results from changes in central neurotransmission, we investigated the role of BCAA administration on changes in the levels of central neurotransmitters in acute liver injury. Male Wistar rats were subjected to liver ischemia by occluding the left portal vein and hepatic artery for 90 minutes. A 4% BCAA solution containing valine, leucine, and isoleucine was intraperitoneally administered 3 times (8 mL/kg, each) at 1 hour, 6 hours, and 24 hours after vascular reperfusion, and changes in the extracellular concentrations of neurotransmitter amino acids, monoamines, and their metabolites were evaluated in the striatum by a microdialysis procedure. Although the extracellular concentration of dopamine was affected by neither liver ischemia nor BCAA injections, the level of 3,4-dihydroxyphenylacetic acid, a metabolite of dopamine, decreased to 34% in the ischemic group 24 hours after reperfusion. The 3,4-dihydroxyphenylacetic acid level was normalized by treatments with BCAAs. The improvement of deranged cerebral dopaminergic activity may be a contributing factor in the improvement of hepatic encephalopathy by BCAAs.
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http://dx.doi.org/10.1097/ANA.0b013e31811ecdf6DOI Listing
October 2007

Histaminergic involvement in neuropathic pain produced by partial ligation of the sciatic nerve in rats.

Reg Anesth Pain Med 2007 Mar-Apr;32(2):124-9

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

Background And Objectives: Because the histaminergic system in the brain is involved in regulation of pain, the relationship between central histaminergic activity and neuropathic pain is of interest.

Methods: Neuropathic pain was induced in rats by partial ligation of the left sciatic nerve, and changes in the extracellular concentration of histamine in the right striatum were examined by a microdialysis procedure 2 weeks later. The nociceptive threshold was determined with von Frey tests, and effects of histaminergic ligands were examined.

Results: Although the extracellular concentration of histamine did not differ between the sham-operated and ligated groups, histaminergic activity assessed by metoprine-induced accumulation of histamine was facilitated in ligated animals. The metoprine treatment ameliorated neuropathic pain in ligated animals, although the agent did not affect the threshold in sham-operated rats. Either intracerebroventricular (ICV) administration of histamine (30 microg) or intraperitoneal (IP) administration of L-histidine (370 mg/kg) decreased the nociceptive threshold in ligated rats. However, a high dose of histamine (180 microg ICV) increased the nociceptive threshold. Ranitidine (100 microg ICV), an H2 antagonist, increased the threshold, whereas pyrilamine (15 microg ICV), an H1 antagonist, showed no remarkable change. Administration of thioperamide (30 microg ICV), an H3 antagonist, increased the threshold, although systemic administration of the agent (3.6 mg/kg IP) decreased it.

Conclusions: Blockade of supraspinal histamine H2 receptors or stimulation of spinal H3 receptors may contribute to alleviation of neuropathic pain.
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http://dx.doi.org/10.1016/j.rapm.2006.11.009DOI Listing
June 2007

[Cancer pain treatment with nerve blocks and neuroablative procedures].

Nihon Rinsho 2007 Jan;65(1):103-8

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

The management of opioid resistant cancer pain is a significant issue for palliative medicine. Certain types of pain can be relieved effectively using nerve blocks without exacerbating and sometimes improving daily activity as long as proper patient selection and technique are employed. Continuous epidural and subarachnoid block, celiac plexus block, superior hypogastric plexus block, subarachnoid phenol block and percutaneous cervical cordotomy are common pain treatment procedures. In our pain clinic, these procedures were performed on about 20% of cancer pain patients, most of whom experienced pain relief without serious complications. Proper use of nerve blocks and neuroablative procedures can undoubtedly improve the management of cancer pain and should be a significant component of the strategy for cancer pain relief.
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January 2007

Suppression of inflammatory cell recruitment by histamine receptor stimulation in ischemic rat brains.

Eur J Pharmacol 2007 Feb 14;557(2-3):236-44. Epub 2006 Nov 14.

Department of Anesthesiology and Resuscitology, Ehime University Graduate School of Medicine, Shitsukawa, Touon-shi, Ehime 791-0295, Japan.

Inflammation is a crucial factor in the development of ischemia-induced brain injury. Since facilitation of central histaminergic activity ameliorates reperfusion injury, effects of postischemic administration of L-histidine, a precursor of histamine, and thioperamide, a histamine H3 receptor antagonist, on inflammatory cell infiltration were evaluated in a rat model of transient occlusion of the middle cerebral artery. After reperfusion for 12, 24, or 72 h following 2 h of occlusion, brain slices were immunohistochemically stained with antibodies against myeloperoxidase and CD68, which were markers of polymorphonuclear leukocytes and macrophages/microglia, respectively. After reperfusion for 12-24 h, the number of neutrophils on the ischemic side increased markedly, whereas the increase was not observed on the contralateral side. Administration of L-histidine (1000 mg/kg x 2, i.p.), immediately and 6 h after reperfusion, reduced the number of neutrophils to 52%. Simultaneous administration of thioperamide (5 mg/kg, s.c.) further decreased the number of neutrophils to 32%. Likewise, the ischemia induced increase in the number of CD68-positive cells after 24 h was suppressed by L-histidine injections. The L-histidine administration decreased the number of CD4+ T lymphocytes on both ischemic and contralateral sides after 12 h, and concurrent administration of thioperamide prolonged the effect. Although administration of mepyramine (3 nmol, i.c.v.) did not affect suppression of leukocyte infiltration, ranitidine tended to reverse the effect of L-histidine. These data suggest that enhancement of central histaminergic activity suppresses inflammatory cell recruitment after ischemic events through histamine H2 receptors, which may be a mechanism underlying the protective effect of L-histidine.
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http://dx.doi.org/10.1016/j.ejphar.2006.11.020DOI Listing
February 2007

Fluoroscopically guided epidural block in the thoracic and lumbar regions.

Reg Anesth Pain Med 2006 Sep-Oct;31(5):409-16

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Toon City, Ehime, Japan.

Background And Objectives: Epidural block in the midthoracic region is difficult, even with fluoroscopically guided methods, because of the inability to view the interlaminar space on radiographs. We have, therefore, proposed fluoroscopically guided epidural block for the midthoracic region, as well as other thoracic and lumbar regions, by use of the pedicle as a landmark to show the height of the interlaminar space.

Methods: Twenty patients scheduled to receive an indwelling epidural catheter at Th6-7, Th9-10, Th12-L1, or L3-4 were studied. The skin insertion site was at the junction of a line parallel to the vertebral column that passed through the middle of the pedicle and the lower border of vertebral body, immediately inferior to the target interlaminar space on an anteroposterior radiograph. The needle was walked up the lamina, and the interlaminar space was sought near the midline of the vertebra at the height of the pedicle.

Results: Epidural block was easily performed in all cases. No difference was observed in the angulation of the epidural needle among the groups; the mean inward and upward angulation were 38 degrees and 63 degrees , respectively, although the skin insertion site relative to the spinous process was different among the groups.

Conclusions: This study showed the usefulness of our fluoroscopically guided method for the midthoracic region, and other thoracic and lumbar regions. We propose an alternative method for a blind epidural approach at Th6-7, Th9-10, Th12-L1, or L3-4.
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http://dx.doi.org/10.1016/j.rapm.2006.06.006DOI Listing
December 2006

Survey of patients whose lungs could not be ventilated and whose trachea could not be intubated in university hospitals in Japan.

J Anesth 2003 ;17(4):232-40

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Shigenobu, Onsen-gun, Ehime 791-0295, Japan.

Purpose: We conducted a survey to clarify the actual circumstances in which the lungs could not be ventilated and the trachea could not be intubated (CVCI).

Methods: A questionnaire was mailed to all the university hospitals in Japan, asking about CVCI they had experienced during induction of anesthesia in 1998, and before 1997.

Results: Answers were obtained from 60 of 83 institutes. CVCI occurred in 26 of 151 900 cases of general anesthesia (0.017%) in 1998. Eighteen cases occurred after induction of anesthesia by several induction methods. Five cases occurred after repeated attempts at tracheal intubation by laryngoscopy and fiberscopy in patients under awake or anesthetized conditions. In the remaining 3 cases, the situation of occurrence was not documented. Patients with CVCI had anatomical abnormalities around the upper airways, mostly from acquired diseases. CVCIs after induction of anesthesia were successfully treated by restoration of spontaneous respiration, blind intubation, laryngeal mask airway, and transtracheal approaches, and CVCIs after repeated attempts at intubation were treated mostly by transtracheal approaches. No serious consequences occurred in any patients in 1998. Twenty cases were reported before 1997, and 2 were specific, in which CVCI followed malplacement of a tracheal tube, and serious consequences, death and brain damage, respectively, followed. In other patients, no serious consequences occurred, although cardiac arrest occurred in 1 patient.

Conclusion: This survey demonstrates that CVCI can occur in any situation in which the airway is not established. Furthermore, effective treatments may be different depending on the situation, and delayed recognition of tracheal tube misplacement may lead to a serious outcome.
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http://dx.doi.org/10.1007/s00540-003-0187-3DOI Listing
February 2004

Facilitation of ischemia-induced release of dopamine and neuronal damage by dexamethasone in the rat striatum.

Eur J Pharmacol 2003 Apr;465(3):267-74

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime 791-0295, Japan.

Glucocorticoids have been reported to aggravate ischemia-induced neuronal damage in both humans and experimental animals. Because an excess release of neurotransmitters is closely related to the outcome of ischemic neuronal damage, we evaluated the effects of dexamethasone on monoaminergic release and histological outcome. Changes in the extracellular concentrations of monoamines and their metabolites in the striatum produced by occlusion of the middle cerebral artery for 20 min were measured using a microdialysis high-performance liquid chromatography procedure, and the effects of intracerebroventricular administration of dexamethasone (10 microg) were evaluated in halothane-anesthesized rats. The histological outcome was evaluated by light microscopy 7 days after ischemia. Additionally, the effects of lesioning of the substantia nigra were estimated. The extracellular concentrations of neither dopamine nor serotonin were affected by the administration of dexamethasone in the nonischemic state. The occlusion of the middle cerebral artery produced a marked increase in the extracellular concentration of dopamine in the striatum, the peak value being 240 times that before ischemia. The preischemic administration of dexamethasone enhanced the increase in dopamine level during ischemia, and the peak value in the dexamethasone group was 640% of that in the vehicle group. After 7 days, ischemic neuronal damage in the dexamethasone group was severe compared with that in the vehicle group. In rats receiving the substantia nigra lesion, the ischemic release of dopamine was abolished, and the aggravation of ischemic neuronal damage by dexamethasone was completely alleviated. Changes in the release of monoamines may be a contributing factor in the development of the ischemic neuronal damage induced by glucocorticoids.
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http://dx.doi.org/10.1016/s0014-2999(03)01534-6DOI Listing
April 2003

Misplacement of an epidural catheter via intervertebral foramen is not rare.

J Anesth 1995 Jun;9(2):209

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-Gun, 791-02, Ehime, Japan.

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http://dx.doi.org/10.1007/BF02479864DOI Listing
June 1995

Percutaneous cervical cordotomy and subarachnoid phenol block using fluoroscopy in pain control of costopleural syndrome.

Pain 1994 Sep;58(3):325-330

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Sigenobu-cho, Onsen-gun, Ehime-ken 791-02 Japan.

We examined the efficacy of percutaneous cervical cordotomy (PCC) and subarachnoid phenol block using fluoroscopy (SAPB-F) for control of chest and/or back pain from costopleural syndrome. The efficacy of each block was evaluated by changes in pain score (PS), analgesic dose and performance status 1 week after the block, as well as by the complications. Between 1980 and 1986, PCC was performed in 10 patients. SAPB-F was performed in 13 patients between 1987 and 1991. Pain was not well controlled by analgesics in any of these patients. For PCC the follow-up period was 94.7 +/- 71.1 days. PS (VAS, 0-10) reduced from 8.5 +/- 0.9 to 3.0 +/- 2.7. No analgesics were needed in 4 patients. Pain recurred in 1 patient. Hemiparesis occurred in 2 patients. General fatigue occurred in 6 patients. In 4 patients with these complications performance status deteriorated and did not recover during the follow-up period. For SAPB-F the follow-up period was 71.8 +/- 44.0 days. SAPB-F was designed to achieve selective phenol deposit at the targeted nerve root. PS decreased from 7.5 +/- 1.9 to 2.7 +/- 2.6. No analgesics were needed in 5 patients. Pain recurred in 3 patients. There were no complications and no changes in performance status. From this study we concluded that PCC is an effective method of pain control for costopleural syndrome, but a risk of serious complications is involved. SAPB-F is an effective and safe method and should be the first choice of nociceptive pathway block.
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http://dx.doi.org/10.1016/0304-3959(94)90126-0DOI Listing
September 1994

An analysis of CO elimination curves during artificial ventilation.

J Anesth 1994 Jun;8(2):172-177

Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Shitsukawa, Shigenobu-Town, Onsen-Gun, 791-02, Ehime, Japan.

We have developed some indices to evaluate the phase III slope in CO elimination curves. The indices were applied to 12 mechanically ventilated patients in ICU to determine their stability under various ventilator settings. F-sl[30-90] and[Formula: see text] expressed the mean incline of phase III slope in F-volume curves and[Formula: see text]-volume curves, respectively. F-SR and[Formula: see text]-SR expressed the ratio of the slopes in the first and second halves of the phase III portion in both curves. The indices were also applied to 108 elective surgery patients to determine their usefulness in predicting ventilatory efficiency during general anesthesia. In the first study, F-sl[30-90] and[Formula: see text][30-90] correlated with ET, V/V and the volume of CO expired, but F-SR and[Formula: see text]-SR were independent of these parameters.[Formula: see text]-SR did not show any significant changes under various ventilator settings except for application of PEEP. In the second study, those with impaired preoperative respiratory function had significantly larger values for[Formula: see text].[Formula: see text] was as sensitive as parameters such as V/V, arterial to end-tidal CO tension difference (a-ET·D), and volume pressure index (VPI) in prediting poor respiratory functions. We concluded that[Formula: see text] is a useful index for evaluating the phase III slope in CO elimination curves.
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http://dx.doi.org/10.1007/BF02514708DOI Listing
June 1994
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