Quality of life of caregivers supporting neurologically impaired patients who underwent surgery.

BACKGROUND: A questionnaire survey was conducted to clarify whether surgical treatments performed by a pediatric surgeon improve the quality of life (QOL) of caregivers (medical doctors, nurses, physical therapists, and nursery teachers) supporting neurologically impaired (NI) patients who work at specialized institutions. METHODS: The questionnaire survey was conducted with caregivers who cared for NI patients who underwent an operation at the Department of Pediatric Surgery, Kurume University Hospital. Quality-of-life related responses concerning the change of care after surgical procedures in NI patients were collected in addition to the background data related to caregivers and the surgical procedures performed for them. Degrees of difficulty in caring for NI patients and of the caregivers' own QOL postoperatively were also compared. RESULTS: There were 192 valid responses. The majority of responses were from females and nurses aged in their 40s and 50s. The surgical procedure performed most often in the NI patients was gastrostomy. Of the respondents, 77% answered that the postoperative care became easier. The degrees of difficulty in caring for NI patients and the caregivers' own QOL were significantly higher and lower, respectively, among physical therapists compared with caregivers in other occupations. Moreover, the QOL in respondents with factors related to a longstanding relationship with NI patients was significantly higher compared with the respondents without them. CONCLUSION: This survey indicated that surgical procedures for NI patients might contribute to improved QOL for the caregiver by reducing the difficulty of caring for NI patients.

[Anesthetic Management of Video-assisted Left Upper Lobectomy in a Patient with Ischemic Heart Disease Using an Intraaortic Balloon Pump].

We report the successful anesthetic management of video-assisted left upper lobectomy in a patient with ischemic heart disease using an intra-aortic balloon pump (IABP). An 81-year-old man with severe ischemic heart disease was scheduled for partial lobectomy for suspected lung cancer under general anesthesia. Although he had severe ischemic heart disease, coronary intervention such as percutaneous cardiac intervention or coronary artery bypass grafting was impossible due to severe coronary stenosis. IABP was instituted through the femoral artery before inducing anesthesia. Tracheal intubation was performed with the McGRATH MAC videolaryngoscope to minimize stress. Surgery was performed uneventfully and the patient was transferred to the intensive care unit under sedation. IABP was removed three hours postoperatively. After confirming no ischemic or vital sign changes, he was extubated the next day. No complications resulting from the IABP were observed.

[Successful Postoperative Management of a Pediatric Patient with Renal Failure by Ultrasound-guided Transversus Abdominis Plane and Rectus Sheath Block].

We report the successful postoperative pain man- agement of a pediatric patient with end-stage renal failure by ultrasound-guided peripheral nerve block following peritoneal dialysis catheter surgery. A 2-year-old boy with kidney hypoplasia was scheduled for peritoneal dialysis catheter implantation under gen- eral anesthesia. Anesthesia was induced with nitrous oxide and sevoflurane in a slow incremental manner. Airway management was performed with i-gelo to minimize stress and to protect the cervical spine. Maintenance of anesthesia was achieved with sevoflu- rane and remifentanil. For postoperative analgesia, opi- oids were not used in order to avoid respiratory sup- pression or CO2 accumulation. Recovery from anesthe- sia was uneventful and the boy did not experience pain until the next morning.

Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial.

The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP) and taper-shaped (taper) cuffs in a prospective randomized clinical trial. Methods. Forty patients were intubated using tracheal tubes with either HVLP (n = 20; HVLP group) or taper-shaped (n = 20; Taper group) cuffs. Initial cuff pressure was adjusted to 15, 20, or 25 cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation. Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure. Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered with UMIN000016119.

Evaluation of the efficacy of six supraglottic devices for airway management in dark conditions: a crossover randomized simulation trial.

PURPOSE: During out-of-hospital cardiopulmonary resuscitation, several factors can render tracheal intubation more difficult, such as when rescuers must secure the airway in complete darkness or with limited illumination. The purpose of this study was to evaluate the efficacy of six supraglottic devices (SGDs), ProSeal(®) (ProSeal), Classic(®) (Classic), Supreme(®) (Supreme), Laryngeal Tube(®) (LT), air-Q(®) (air-Q), and i-gel(®) (i-gel), for airway management under light and dark conditions using a manikin. METHODS: Seventeen novice doctors and 15 experienced doctors performed insertion of six SGDs under light and dark conditions using an adult manikin. Insertion time, successful ventilation rate, and subjective insertion difficulty on a visual analogue scale (VAS) were measured. RESULTS: Both novice and experienced doctors had a significantly lower ventilation success rate in the dark than in the light when ProSeal and Classic were used, but not with the other four SGDs. Novice doctors required a significantly longer insertion time in the dark than in the light with all SGDs. Experienced doctors required a significantly longer insertion time in the dark than in the light with ProSeal or Classic, but not with the other four SGDs. VAS was significantly higher for both novice and experienced doctors when ProSeal and Classic were used, as compared with the other four SGDs in the dark. CONCLUSIONS: Compared to ProSeal and Classic, Supreme, i-gel, LT, and air-Q are more effective for airway management in the dark. Our findings suggest that anatomically shaped SGDs may help novice doctors secure the airway under dark conditions.

Cardiomyocyte-driven gel network for bio mechano-informatic wet robotics.

This paper reports on a cellular mechano-informatics network gel robot which was powered by culturing cardiomyocytes in the micro gel structure. Contraction activities propagated through the cardiomyocyte gel network will transmit a spatial mechanical wave as information about the chemical and mechanical responses to environmental changes. The cardiomyocyte gel network robot transmits electrically excited potential and mechanical stretch-induced contractions as information carried on the gel network. The cardiomyocyte gel network robot was fabricated from a mixture of primary cardiomyocytes and collagen gel and molded in a PDMS casting mold, which could produce serial, parallel lattice, or radial pattern networks. Fluorescent calcium imaging showed that the calcium activity of the cardiomyocytes in the gel network was segmented in small domains in the gel network; however, the local contraction that started on one branch of the gel network was propagated to a neighboring branch, and the propagation velocity was increased with increasing concentration of adrenaline. This increase was limited to ~20 mm/s. This proposed mechano-informatics kineticism will provide not only mechano-informatics for cardiomyocyte powered wet robotics but will also help show how cardiac disease occurs in activity propagation systems.

Fabrication and evaluation of reconstructed cardiac tissue and its application to bio-actuated microdevices.

In this paper, we proposed to utilize a reconstructed cardiac tissue as microactuator with easy assembly. In a glucose solution, cardiomyocytes can contract autonomously using only chemical energy. However, a single cardiomyocyte is not enough to actuate a microrobot or a mechanical system. Though the output power will increase by using multiple cardiomyocyte, it is difficult to assemble those cardiomyocyte to predefined positions one-by-one using a micromanipulator. Reconstructed cardiac tissue not only will enable researchers to assemble the cells easily and but also has a potential to improve the contractile ability. To realize a bio-actuator in this paper, we reconstructed a microcardiac tissue using an extracellular matrix, and their displacements, displacement frequency, contractile force, and lifetime of the reconstructed cardiac tissue were evaluated. Electrical and pharmacological responses of the reconstructed cardiac tissue were also evaluated. Finally, a bioactuator, a primitive micropillar actuator, was fabricated and applicability of the reconstructed cardiac tissue for bioactuators was evaluated.