Biomedical subjects

Kiyoshi Morita

Publications and source records attributed to Kiyoshi Morita.

At least 19 recordsLinked to original sources

PubMed2005

Anesthetic management of a patient with severe dilated cardiomyopathy and an automatic implantable cardioverter-defibrillator (AICD) during total gastrectomy.

We report a case of severe dilated cardiomyopathy with an automatic implantable cardioverter-defibrillator (ICD) undergoing total gastrectomy. During the operation, the defibrillation function of the ICD was suspended and its pacing function was used solely in VOO mode. Electrodes of an external defibrillator were attached on the chest wall, and a pulmonary arterial (PA) catheter with a ventricle pacing port was inserted into the pulmonary artery. Proper perioperative management, including measures that the patient underwent the surgery uneventfully and could attain a rapid and successful discharge from the intensive care unit.

Anesthesia, General↗

PubMed2005

Measurement of GABA and glutamate in vivo levels with high sensitivity and frequency.

In the present protocol, we demonstrate a high-performance liquid chromatography (HPLC) system that enables detection of very low amounts of gamma-aminobutyric acid (GABA) (0.03 pmol) and glutamate (0.8 pmol). The HPLC system consists of two pumps, an electrochemical detector, a high-pressure six-way switching valve, a guard column, a microbore column, and a column oven. A microdialysis probe was implanted in the right parietal cortex in rats. Dialysates were collected every 5 min and were split into two equal aliquots for separate analysis of GABA and glutamate. After derivatization with o-phthalaldehyde (OPA), samples were isocratically separated and purified by the guard column. To make the peak of GABA or glutamate appear in an opportune place in a chromatogram, a six-way switching valve was used to control the eluate containing GABA or glutamate to be led to the microbore column and electrochemical detector. By the use of this system, decrease in extracellular concentration of GABA, which precedes the appearance of electrical discharge initiated by hyperbaric oxygen (HBO2) exposure, was detected by microdialysis at the time resolution of 5 min.

Animals↗

PubMed2005

The lower intestinal tract-specific induction of heme oxygenase-1 by glutamine protects against endotoxemic intestinal injury.

OBJECTIVE: The aim of the present study was to investigate whether glutamine pretreatment improves intestinal injury in rats with endotoxemia by its heme oxygenase-1 induction in the lower intestinal tract. DESIGN: Randomized, blinded, controlled animal study. SETTING: University-based animal research facility. SUBJECTS: Sprague-Dawley male rats, weighing 220-250 g (n = 201). INTERVENTIONS: Rats were treated with glutamine (0.75 g/kg) dissolved in lactated Ringer's solution via the tail vein. Endotoxemia was induced in rats by intraperitoneal injection of lipopolysaccharide (10 mg/kg or 20 mg/kg for survival study). Lipopolysaccharide-treated animals were pretreated with glutamine or lactated Ringer's solution 9 hrs before lipopolysaccharide treatment. Some of the glutamine-pretreated animals further received tin mesoporphyrin (1 micromol/kg), a specific inhibitor of heme oxygenase activity, 1 hr before lipopolysaccharide treatment. MEASUREMENTS AND MAIN RESULTS: Glutamine treatment markedly induced heme oxygenase-1 messenger RNA and protein in the mucosal epithelial cells as well as in the lamina propria cells in the ileum and the colon, whereas its expression in the duodenum and the jejunum was not influenced by the treatment. Glutamine treatment before lipopolysaccharide administration significantly ameliorated lipopolysaccharide-induced mucosal injury, inflammation, and apoptotic cell death in the ileum and the colon, as judged by significant decreases in tumor necrosis factor-alpha gene expression, histologic damage scores, and expression of activated caspase-3 and by an increase in gene expression of Bcl-2. In addition, glutamine treatment markedly decreased lipopolysaccharide-induced mortality. In contrast, treatment with tin mesoporphyrin abolished the beneficial effect of glutamine pretreatment. CONCLUSIONS: Glutamine pretreatment significantly ameliorated intestinal tissue injury of rats following lipopolysaccharide treatment. The same treatment also improved the survival of animals from endotoxemia. The protective effect of glutamine is mediated by its lower intestine-specific induction of heme oxygenase-1, since its inhibition by tin mesoporphyrin completely abolished the beneficial effect of glutamine.

Animals↗

PubMed2005

[Supplemental survey in 2003 concerning life-threatening hemorrhagic events in the operating room].

BACKGROUND: We previously showed that pre-operative hemorrhagic shock and surgical hemorrhage were the major causes of life-threatening events in the operating room and subsequent fatality. We investigated the background of these events. METHODS: The Subcommittee on Surveillance of Anesthesia-Related Critical Incidents, Japanese Society of Anesthesiologist (JSA) sent confidential questionnaires to all JSA-certified training hospitals (n=862). The questionnaires were composed of two parts: one for examining all life-threatening events in the operating room and the other for examining the background of massive hemorrhage in the operating room. The number of patients registered between January 1, 2003 and December 31, 2003 was 1,367,790 from 782 hospitals. Life-threatening hemorrhagic events were reported in 1,011 patients, of whom 876 patients were available for further analysis of the background of the events. Fatality within 7 postoperative days following these events was 45.4%. RESULTS: In patients who developed life-threatening events due to hemorrhage, 35.2% had blood loss of more than 12 l x 60 kg(-1) of body weight, 44.9% had a maximal hemorrhagic speed of more than 240 ml x min(-1) x 60 kg(-1) of body weight, and 39.1% had a minimal hemoglobin concentration of less than 5 g x dl(-1). The main sources of hemorrhage were as follows: the abdominal aorta, 15.4%; the thoracic aorta, 14.0%; the liver, 12.6%; intra-cranium, 8.2%; the pelvic organs, 8.0%; celiac or mesenteric artery, 7.8%; the lung, 7.1%. Of patients who developed life-threatening events due to preoperative hemorrhagic shock, 18.3% underwent cardiac massage preoperatively, 50.0% lost consciousness, 58.5% were intubated, and 16.4% were retrospectively judged to have had no operative indications. Human factors also affected the life-threatening events due to preoperative hemorrhagic shock: delayed decision making concerning indications for surgical treatment, 15.6%; delayed admission to the operating room, 16.6%; delayed supply of blood products, 25.5%; problems in surgical management, 16.3%; problems in anesthetic management, 28.1%. These problems in anesthetic management included shortage of supportive anesthesiologists. This was partly explained by the time of their admission to the operating room: 67.0% of the patients admitted during the week end or at night. Of the patients who developed life-threatening events due to surgical hemorrhage, 58.0% were predicted preoperatively to develop massive hemorrhage by anesthesiologists, and 66.7% were informed of the risks of massive hemorrhage and associated complications. The main causes of surgical hemorrhage were as follows: adhesion or invasion, 44.7%; and problems in surgical judgments or techniques, 43.7%. Anesthetic management affected the development of life-threatening events in these patients: lack of infusion prior to hemorrhage, shortage of supportive anesthesiologists, delay in ordering additional blood products, delayed judgment to start blood transfusion, and shortage of rapid infusion/transfusion apparatus. Delay for hospitals in obtaining blood supply from blood banks was reported in 13.0% of cases, and delayed supply from inhospital blood transfusion service to the operating room in 16.0%. Despite massive hemorrhage, ABO cross-matching was omitted only in 13.4% of patients, and transfusion of ABO-compatible, instead of ABO-identical red blood cells, was performed only in 1.3%. CONCLUSIONS: To reduce life-threatening hemorrhagic events in the operating theater, reorganization of emergency medical service and blood supply, improvement of surgical techniques, improved triage of patients with hemorrhagic shock, flexible application of compatible blood products in emergency situations, and improvement of the quality and number of anesthesiologists should be considered.

Anesthesiology↗

PubMed2004

Blood flow-dependent changes in intrarenal nitric oxide levels during anesthesia with halothane or sevoflurane.

We previously demonstrated that intrarenal nitric oxide (NO) levels and renal blood flow are reduced during halothane anesthesia. Studies were performed to determine if volatile anesthetics-induced reductions in renal NO levels are associated with blood flow changes. Halothane and sevoflurane at 0.8 and 2.4 Mac were administered by inhalation to dogs, and cGMP and NOx concentrations in the renal interstitial fluid were measured by a microdialysis method. Neither halothane nor sevoflurane at 0.8 Mac altered renal blood flow and renal interstitial cyclic guanosine monophosphate (cGMP) and NOx levels, but both anesthetics significantly decreased these values at 2.4 Mac. Using an adjustable aortic clamp, renal perfusion pressure was reduced in 2 steps without halothane and sevoflurane anesthesia. Renal blood flow as well as cGMP and NOx concentrations in the renal interstitial fluid were unchanged within the autoregulatory range, but significantly decreased below the autoregulatory range. Changes in cGMP and NOx concentrations in the renal interstitial fluid were highly correlated with renal blood flow changes during halothane or sevoflurane anesthesia, and during stepwise reductions in renal perfusion pressure. The results suggested that halothane- and sevoflurane-induced decreases in intrarenal NO levels result from reductions in blood flow.

Anesthetics, Inhalation↗

PubMed2004

Alcohols increase calmodulin affinity for Ca2+ and decrease target affinity for calmodulin.

It has been proposed that alcohols and anesthetics selectively inhibit proteins containing easily disrupted motifs, e.g., alpha-helices. In this study, the calcineurin/calmodulin/Ca(2+) enzyme system was used to examine the effects of alcohols on calmodulin, a protein with a predominantly alpha-helical structure. Calcineurin phosphatase activity and Ca(2+) binding were monitored as indicators of calmodulin function. Alcohols inhibited enzyme activity in a concentration-dependent manner, with two-, four- and five-carbon n-alcohols exhibiting similar leftward shifts in the inhibition curves for calmodulin-dependent and -independent activities; the former was slightly more sensitive than the latter. Ca(2+) binding was measured by flow dialysis as a direct measure of calmodulin function, whereas, with the addition of a binding domain peptide, measured calmodulin-target interactions. Ethanol increased the affinity of calmodulin for Ca(2+) in the presence and absence of the peptide, indicating that ethanol stabilizes the Ca(2+) bound form of calmodulin. An increase in Ca(2+) affinity was detected in a calmodulin binding assay, but the affinity of calmodulin for calcineurin decreased at saturating Ca(2+). These data demonstrate that although specific regions within proteins may be more sensitive to alcohols and anesthetics, the presence of alpha-helices is unlikely to be a reliable indicator of alcohol or anesthetic potency.

Alcohols↗

PubMed2004

Protective role of heme oxygenase-1 in renal ischemia.

Oxidative stress, which has been implicated in the pathogenesis of ischemic renal injury, degrades heme proteins, such as cytochrome P450, and causes the elevation in the level of cellular free heme, which can catalyze the formation of reactive oxygen species. Heme oxygenase-1 (HO-1), the rate-limiting enzyme in heme degradation, is induced not only by its substrate, heme, but also by oxidative stress. In various models of oxidative tissue injuries, the induction of HO-1 confers protection on tissues from further damages by removing the prooxidant heme, or by virtue of the antioxidative, antiinflammatory, and/or antiapoptotic actions of one or more of the three products, i.e., carbon monoxide, biliverdin IXalpha, and iron by HO reaction. In contrast, the abrogation of HO-1 induction, or chemical inhibition of HO activity, abolishes its beneficial effect on the protection of tissues from oxidative damages. In this article, we review the protective role of HO-1 in renal ischemic injury, and its potential therapeutic applications. In addition, we summarize recent findings in the regulatory mechanism of ho-1 gene expression.

Acute Kidney Injury↗

PubMed2004

Correlation between the distribution of contrast medium and the extent of blockade during epidural anesthesia.

BACKGROUND: If the epidural spread of contrast medium can be well correlated with the spread of local anesthetics, epidurography can predict the dermatomal distribution of the anesthetic block. The authors evaluated the relation between radiographic and analgesic spread. METHODS: An epidural catheter was inserted in 90 patients, and predicted catheter tip position was recorded. The analgesic area was determined by pinprick after a 5-ml injection of 1.5% lidocaine, and epidurography was performed after a 5-ml injection of 240 mg I/ml iotrolan. Patients were assigned to three groups according to catheter tip position (group C: C-T4; group T: T5-T10; group L: T11-L), and patterns of spread were compared. In 16 of 90 subjects, radiographic and analgesic spread was further investigated after an additional 5-ml injection of iotrolan and lidocaine. RESULTS: The total radiographic spread correlated well with analgesic spread (right side: Y = 0.84 X + 0.16, r = 0.92, P < 0.01; left side: Y = 0.78 X + 0.45, r = 0.91, P < 0.01). The mean radiographic spread in the cephalad and caudal directions from the catheter tip also correlated well with mean analgesic spread (r = 0.97, P < 0.01, each direction). The mean distance between the predicted catheter tip and radiographically determined positions was 1.0 +/- 0.8 segments: the value in group T was significantly larger than that in groups C (P < 0.05) and L (P < 0.01). Although the correlation of radiographic spread with age was statistically significantly (r = 0.39, P < 0.01), great individual variation in spreading pattern was seen. In 16 subjects, mean radiographic spread correlated well with analgesic spread after 5- and 10-ml injections of iotrolan and lidocaine. CONCLUSIONS: Epidurography is useful to indicate epidural catheter position and can help to predict the exact dermatomal distribution of analgesic block.

Adult↗

PubMed2004

A protective role of interleukin 11 on hepatic injury in acute endotoxemia.

The liver is one of the major target organs affected in sepsis, and its failure always results in critical consequences. It has been reported that recombinant human interleukin 11 (rhIL-11), a pleiotropic cytokine, may be useful in the treatment of sepsis. However, the effect of IL-11 specifically on the hepatic failure in sepsis has not been evaluated. In the present study, we examined the effect of rhIL-11 on the hepatic injury in a rat endotoxemia model. Acute endotoxemia was induced in male Sprague-Dawley rats by intraperitoneal injection (i.p.) of bacterial lipopolysaccharide (LPS, 20 mg/kg). Immediately after injection of LPS, rats were treated with rhIL-11 (150 microg/kg, i.p.) or the vehicle. LPS treatment induced severe hepatic injury as revealed by marked increases in serum alanine transaminase (ALT) and aspartate transaminase (AST) activities, extensive hepatocyte necrosis, tumor necrosis factor-alpha (TNF-alpha) mRNA, inducible nitric oxide synthase (iNOS) mRNA, and DNA-binding activity of nuclear factor-kappaB (NF-kappaB). In contrast, rhIL-11 treatment significantly ameliorated the LPS-induced hepatic injury, as judged by marked improvement in all these indices. In addition, rhIL-11 treatment markedly decreased LPS-induced mortality. These results indicate that rhIL-11 plays a significant protective role in LPS-induced hepatic injury in acute endotoxemia.

Acute Disease↗

PubMed2004

The effects of pretreatment with lidocaine or bupivacaine on the spatial and temporal expression of c-Fos protein in the spinal cord caused by plantar incision in the rat.

UNLABELLED: We investigated the spatial and temporal patterns of c-Fos protein (Fos) expression in the dorsal horn of the spinal cord caused by plantar incision in the rat and the effects of pretreatment with local anesthetics. Bupivacaine (0.5%), lidocaine (2%), or saline for control was injected for nerve block and local infiltration before the plantar incision was made under anesthesia. Pain behavior and Fos expression in the L4-L5 segments of the spinal cord were assessed at 1, 3, 6, 24, 48, 72, and 120 h after the incision. The withdrawal threshold to mechanical stimulation decreased significantly at 1 h until 120 h (1-72 h, P < 0.01;120 h, P < 0.05), and pretreatment with local anesthetics increased the threshold significantly at 1 h (both groups: P < 0.01), 3 h (both groups: P < 0.01), and 6 h (bupivacaine, P < 0.01; lidocaine, P < 0.05) in comparison with that in the saline group. In the saline group, Fos expression was detected predominantly in laminae I-II and V-VI, and the total Fos expression was maximal at 1 h and then decreased gradually. Pretreatment with local anesthetics suppressed Fos expression significantly in all layers, and this suppression continued for several days. This study provides evidence of spatial and temporal changes in Fos expression induced by plantar incision. Our results indicate that although pretreatment with local anesthetics suppresses Fos expression for several days in the postoperative period, the analgesic effect is observed only for the expected duration of the local anesthetic used. IMPLICATIONS: Prevention of early pain by pretreatment with local anesthetics provides little benefit for postoperative pain relief in the plantar incision model, although c-Fos expression is suppressed. The number of c-Fos-expressing neurons is not necessarily correlated with pain behavior.

Anesthetics, Local↗

PubMed2004

Comparison of percutaneous electrical nerve stimulation with transcutaneous electrical nerve stimulation for long-term pain relief in patients with chronic low back pain.

UNLABELLED: The long-term effect of percutaneous electrical nerve stimulation (PENS) on chronic low back pain (LBP) is unclear. We evaluated the number of sessions for which PENS should be performed to alleviate chronic LBP and how long analgesia is sustained. Patients underwent treatment on a twice-weekly schedule for 8 wk. Group A (n = 18) received PENS for 8 wk, group B (n = 17) received PENS for the first 4 wk and transcutaneous electrical nerve stimulation (TENS) for the second 4 wk, and group C (n = 18) received TENS for 8 wk. Pain level, degree of physical impairment, and the daily intake of nonsteroidal antiinflammatory drugs (NSAIDs) were assessed before the first treatment, 3 days after Week 2, Week 4, and Week 8 treatments, and at 1 and 2 mo after the sessions. During PENS therapy, the pain level decreased significantly from Week 2 in Groups A and B (P < 0.05 or 0.01), and physical impairment and required NSAIDs decreased significantly from Week 4 (P < 0.05 or 0.01) in Group A but only at Week 4 in Group B (P < 0.05 or 0.01). These effects were sustained until 1-mo follow-up (P < 0.01) in Group A but not in Group B; these effects were not observed at 2-mo follow-up even in Group A. In Group C, pain level decreased significantly only at Week 8 (P < 0.05). Our results indicate that repeated PENS is more effective than TENS for chronic LBP but must be continued to sustain the analgesic effect. IMPLICATIONS: A cumulative analgesic effect was observed in patients with chronic low back pain (LBP) after repeated percutaneous electrical nerve stimulation (PENS), but this effect gradually faded after the treatment was terminated. Results indicate that although PENS is effective for chronic LBP, treatments need to be continued to sustain analgesia.

Adult↗

PubMed2004

Increased carbon monoxide concentration in exhaled air after surgery and anesthesia.

Heme oxygenase-1 (HO-1) is induced by oxidative stress and is thought to confer protection against oxidative tissue injuries. HO-1 catalyzes the conversion of the heme moiety of hemeproteins, such as hemoglobin, myoglobin, and cytochrome P450, to biliverdin, liberating carbon monoxide (CO) in the process. CO reacts with hemoglobin to form carboxyhemoglobin. In this study, to examine the effect of anesthesia and/or surgery on endogenous CO production, we measured the amount of exhaled CO and the arterial carboxyhemoglobin concentration of patients who underwent surgery under general or spinal anesthesia. Both CO and carboxyhemoglobin concentrations were significantly larger on the day after surgery than during the preoperative period (P < 0.05) and in the recovery room (P < 0.05), regardless of anesthesia. However, neither index differed between general and spinal anesthesia. These results suggest that oxidative stress caused by anesthesia and/or surgery may induce HO-1, which catalyzes heme to produce CO, leading to increased exhaled CO concentration.

Adolescent↗

PubMed2004

Rapid development of severe interstitial pneumonia caused by epoprostenol in a patient with primary pulmonary hypertension.

A young woman with primary pulmonary hypertension developed severe interstitial pneumonia (IP) 5 days after induction of epoprostenol infusion. Although the pathogen involved was not identified, her IP was initially responsive to steroids, and discontinuation of steroid therapy caused the redevelopment of IP. After intensive treatment, including steroid therapy and inhaled nitric oxide, epoprostenol was successfully switched to prostaglandin E(1) infusion and she recovered. Epoprostenol infusion can cause a rapid severe IP, even soon after the induction of therapy. Clinicians should keep this syndrome in mind, especially when treating a severe case of IP.

Adult↗

PubMed2004

The close relationship between decreases in extracellular GABA concentrations and increases in the incidence of hyperbaric oxygen-induced electrical discharge.

To elucidate the mechanism by which hyperbaric oxygen (HBO2) induces electrical discharge, changes in the extracellular concentrations of GABA and glutamate were measured every 5 min using a microdialysis technique in rats during a period of exposure to HBO2 (5 atm abs). Electrical discharge was observed at 28 +/- 4 min after the onset of exposure. Though the extracellular concentrations of glutamate remained unchanged, the extracellular GABA concentrations (pre-exposure level, 0.026 +/- 0.005 microM in dialysate) began to decrease 15 min after the onset of exposure and reached their lowest level (74 +/- 14%, 0.019 +/- 0.004 microM) at the time of appearance of the discharge. There was a close logistic relationship between extracellular GABA concentrations and the discharge incidence, and the extracellular concentrations of GABA causing electrical discharge in 50% of the animals were estimated to be 80% of the pre-exposure level. These results suggest a possible mechanism that HBO2 exposure-induced discharge is caused by the decrease in extracellular concentration of GABA.

Animals↗

PubMed2004

[Usefulness of intraoperative transesophageal echocardiography for pediatric patients with congenital heart disease].

This report describes usefulness of intraoperative transesophageal echocardiograpy (TEE) based on 773 cases we experienced in 7 years. We assessed residual lesions, ventricular function and preload with TEE. We found a case with stenotic lesion in her lateral tunnel which TEE revealed after Fontan procedure. We also ensured that no micro air bubble was in the left ventricle and the left atrium before weaning from cardiopulmonary bypass. No patient suffered from convulsion during postoperative management after induction of intraoperative TEE examination though we had had some cases in the previous year. Respiratory compromise was observed in 3 cases (0.5%) and significant hemodynamic change occurred in 9 cases (1.3%). The conditions improved just after withdrawing TEE probe. Neither inadvertent tracheal extubation, nor serious complication occurred during TEE examinations. The incidence of complications during pediatric TEE is low and TEE examination is useful for pediatric patients with congenital heart disease.

Cardiac Surgical Procedures↗

PubMed2004

[Annual mortality and morbidity in operating rooms during 2002 and summary of morbidity and mortality between 1999 and 2002 in Japan: a brief review].

The Japanese Society of Anesthesiologists (JSA) conducts an annual survey of life-threatening events in operating rooms (OR) in JSA Certified Training Hospitals (JSACTH) by sending and collecting confidential questionnaires. Etiologies of the incidents were divided into four categories: those totally attributable to anesthetic management (AM), those resulting from preoperative complications (PC), those resulting from intraoperative pathological events (IP) and those related to surgical procedures (SP). IP resulted from coronary ischemia not suspected preoperatively, arrhythmias, pulmonary embolism, and other conditions. Outcomes were judged on the 7th post-operative day. In the year 2002, questionnaires were sent to 844 JSACTHs, and a total of 1,461,020 cases of anesthesia were documented from 773 JSACTHs. Of these, 1,277,045 cases of anesthesia from 712 JSACTHs were available for analysis. Seven hundred thirty nine cardiac arrests (5.79 per 10,000 anesthetics) and 806 deaths (6.31 per 10,000 anesthetics) due to life-threatening events in the OR were reported. The incidence of cardiac arrest and mortality totally attributable to AM was 0.38 and 0.11 per 10,000 anesthetics. These values tended to decrease after 1994, except the mortality totally attributable to AM, which were almost at constant level during recent years. The summary of the study between 1999 and 2002 was as follows. Among 3,855,384 anesthetics, 2,443 cardiac arrests (6.34 per 10,000 anesthetics) and 2,638 deaths (6.85 per 10,000 anesthetics) due to life-threatening events in the OR were reported. PC, SP, IP and AM were responsible for 64.7, 23.9, 9.4, and 1.5% of deaths, respectively. The major cause of PC related deaths was preoperative hemorrhagic shock, followed by cardiovascular diseases such as myocardial ischemia and congestive heart failure. Excessive surgical bleeding comprised 70.2% of SP-related deaths. The major causes of IP-related death were myocardial ischemia, pulmonary embolism, and severe arrhythmias. The incidence of cardiac arrest and death totally attributable to AM was 0.47 and 0.10/10,000 anesthetics, respectively. Among patients with ASA-PS 1(E) and 2(E), AM-related deaths occurred at a rate of 0.04/10,000 anesthetics. Half of AM-induced deaths were caused by airway or ventilatory problems. Other causes of AM-related death were medication accidents and infusion/transfusion accidents. Considerable effort is required to reduce intraoperative life-threatening events caused by human error, hemorrhage, and cardiovascular diseases.

Anesthesiology↗

PubMed2004

[Incidence and characteristics of perioperative pulmonary thromboembolism in Japan].

BACKGROUND: Perioperative pulmonary thromboembolism (preoperative PTE) is widely recognized as one of the life-threatening perioperative complications in Japan. However, incidence of perioperative PTE is not well surveyed. The Japanese Society of Anesthesiologist (JSA) mailed the questionnaire about incidence of perioperative PTE and its characteristics to the institutions registered in JSA. METHODS: The questionnaire was mailed to 844 institutions. The items of the survey included age, sex, type of surgery and risk factors of the cases performed in 2002. Data were analyzed using chi-square test and Fisher's test, and P < 0.05 was taken as significant. RESULTS: Four-hundred sixty-seven out of 844 institutions responded (55.3%) effectively. There were 369 cases of perioperative PTE in 208 institutions (44.5% of the institutions responded). The incidence of perioperative PTE was 4.4 per ten thousand cases. Massive PTE or cardiac arrest at the onset occurred in 57 cases (15.4%). Out of these patients, 117 patients (31.7%) had obesity, and bed-ridden rest (> 4 days) patients and cancer patients were each 105 (28.5%). Sixty-six patients died from perioperative PTE, out of which 5 patients (7.5%) died during operation, 31 patients (47.0%) died within 7 days after the operation, and 30 patients (45.5%) died 8 days after the operation. The commonest type of surgery among mortality cases was abdominal surgery (20 cases: 30.3%), and the commonest risk factor was being bedridden (34.5 cases: 51.5%). The patients who had developed PTE during surgery counted 64, among whom the major type of operation was lower limb/pelvic surgery (36 cases: 56.3%). Major risk factors were being bed-ridden in 25 cases (39.1%) and lower limb/pelvic fracture in 25 cases (39.1%). Despite having dangerous risk factors, 128 patients (57.7%) received the measures not recommended or did not receive any preventive measure for PTE. CONCLUSIONS: This survey revealed that the incidence of perioperative PTE in Japan is considerable. On the ground that most PTE could be prevented, it is suggested that by employing preventive measures for PTE, the incidence of perioperative PTE will decrease.

Adolescent↗

PubMed2004

[Critical incidents due to drug administration error in the operating room: an analysis of 4,291,925 anesthetics over a 4 year period].

BACKGROUND: Wrong drugs, overdose of drugs, and incorrect administration route remain unsolved problems in anesthetic practice. We determined the incidence and outcome of drug administration error in the operating room of Japanese Society of Anesthesiologists Certified Training Hospitals. METHODS: Data were obtained from annual surveys conducted by Japanese Society of Anesthesiologists between 1999 and 2002. There were 4,291,925 cases of anesthetic delivery for this analysis. RESULTS: Incidence of critical incidents due to drug administration error was 18.27/100,000 anesthetics. Cardiac arrest occurred in 2.21 patients per 100,000 anesthetics. Causes of these critical incidents were as follows: overdose or selection error involving non-anesthetic drugs, 42.1%; overdose of anesthetics, 28.7%; inadvertent high spinal anesthesia, 17.9%; local anesthetic intoxication, 6.4%; ampule or syringe swap, 4.3%; blood mismatch, 0.6%. Incidence of death following these incidents was 0.44/100,000. Causes of death were as follows: overdose or selection error involving non-anesthetic drugs, 47.4%; overdose of anesthetics, 26.3%; inadvertent high spinal anesthesia, 15.8%; local anesthetic intoxication, 5.3%. Ampule or syringe swap did not lead to any fatalities. Death following inadvertent high spinal anesthesia and local anesthetic intoxication was reported only in patients who had developed cardiac arrest. It should be noted that 88 percent of ampule or syringe swap occurred in patients with American Society of Anesthesiologists-Physical Status 1 or 2, who did not seem to require complex anesthetic management. CONCLUSIONS: We should increase awareness that drug administration is generally performed with limited objective monitoring, although "To error is human". Increased vigilance is required to avoid drug administration error in the operating room. Additional anesthesia resident education, adequate supervision, and improved organization are necessary. Bar-coding technology might be useful in preventing drug administration error.

Anesthetics↗