Heat stroke management during the COVID-19 pandemic: Recommendations from the experts in Japan (2nd edition).

Both coronavirus disease 2019 (COVID-19) and heat stroke have symptoms of fever or hyperthermia and the difficulty in distinguishing them could lead to a strain on emergency medical care. To mitigate the potential confusion that could arise from actions for preventing both COVID-19 spread and heat stroke, particularly in the context of record-breaking summer season temperatures, this work offers new knowledge and evidence that address concerns regarding indoor ventilation and indoor temperatures, mask wearing and heat stroke risk, and the isolation of older adults. Specifically, the current work is the second edition to the previously published guidance for handling heat stroke during the COVID-19 pandemic, prepared by the "Working group on heat stroke medical care during the COVID-19 epidemic," composed of members from four organizations in different medical and related fields. The group was established by the Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee. This second edition includes new knowledge, and conventional evidence gleaned from a primary selection of 60 articles from MEDLINE, one article from Cochrane, 13 articles from Ichushi, and a secondary/final selection of 56 articles. This work summarizes the contents that have been clarified in the prevention and treatment of infectious diseases and heat stroke to provide guidance for the prevention, diagnosis, and treatment of heat stroke during the COVID-19 pandemic.

[Perioperative Blood Pressure Changes in a Patient Undergoing One-stage Bilateral Nephrectomy for Treatment-resistant Hypertension].

We describe our experience with a 15-year-old girl receiving anesthesia during one-stage bilateral nephrectomy for treatment-resistant hypertension due to chronic renal failure. Approximately 10 minutes after removal of both kidneys, a reduction in blood pressure associated with decreased cardiac contractile force was observed and this necessitated catecholamine administration. However, blood pressure was sufficiently improved approximately 60 minutes later, and catecholamine administration was not necessary after she awoke from anesthesia. Although administration of an antihypertensive agent as required after surgery, as had been the case before surgery, the dose was gradually tapered and we were able to stop drug administration on postoperative day 31.

Nanoscale mechanical contacts mapped by ultrashort time-scale electron transport.

Mechanical contacts are crucial to systems in engineering, electronics and biology. The microscopic nature of the contacting surfaces determines how they mesh on the nanoscale. There is thus much interest in methods that can map the actual area of two surfaces in contact--the real contact area--during the loading or unloading phases. We address this problem using an ultrafast optical technique to generate non-equilibrium electrons that diffuse across a nanoscale mechanical contact between two thin gold films deposited on sapphire. We image this process in the contact and near-contact regions to micron resolution in situ using transient optical reflectivity changes on femtosecond time scales. By use of a model of the ultrashort-time electron dynamics, we account for an up to ~40% drop in the transient optical reflectivity change on contact. We thereby show how the real contact area of a nanoscale contact can be mapped. Applications include the probing of microelectronic mechanical devices.

[Air-Q® intubating laryngeal airway as a conduit for tracheal intubation in a patient with Apert syndrome: a case report].

We present a case of an 18-year-old male who underwent strabismus operation under general anesthesia. In his childhood, tracheostomy had been performed for the repair of cleft lip and palate. His Mallampati classification was IV and preoperative endoscopic examination revealed megaloglossia and severe airway narrowing. For possible difficult airway, intubating laryngeal airway (air-Q®, size 2.5) was used for tracheal intubation. Following insertion of air-Q®, trachea was intubated via air-Q® guided with fiberscope. The patient was ventilated via tracheal tube with the air-Q® remaining in place during the operation. air-Q® can be effectively utilized for airway management for an adult Apert syndrome patient

[Use of the air-Q laryngeal airway and tube exchanger in a case of difficult tracheal extubation after maxillectomy].

A 79-year-old man was diagnosed with maxillary cancer and underwent total maxillectomy under general anesthesia. The oropharyngeal airway was needed for efficient mask ventilation during anesthesia induction. The maxilla was totally resected and reconstructed with skin from a femoral flap. Tracheal extubation was considered to be difficult given that mask ventilation was contraindicated due to reconstruction of the maxilla. After inserting a tube exchanger (TE) into the trachea, the tracheal tube was exchanged with an air-Q laryngeal airway through the TE. After confirming effective ventilation with the air-Q mask, the patient was awakened from anesthesia. We confirmed sufficient spontaneous breathing and no active bleeding in the pharynx. After re-inserting the TE thorough air-Q, the air-Q was removed, followed by removal of the TE. These findings suggest that the air-Q and TE were effective in a case of difficult extubation after maxillectomy.

[Retrospective evaluation of dexmedetomidine for postoperative sedation in patients for cerebral aneurysm surgery].

BACKGROUND: Use of conventional sedatives is restricted in order to evaluate consciousness levels in patients undergoing intracranial surgery. However, patients can become agitated and delirious as a result of insufficient doses of sedatives, and as a consequence require physical restriction. Dexmedetomidine (DEX) provides a cooperative form of sedation, allowing patients easy transition from sleep to wakefulness. The clinical characteristics make it possible to perform neurological assessments. We evaluated the effect of DEX for sedation in patients undergoing cerebral aneurysm surgery. METHODS: Data were collected retrospectively from 49 patients admitted to the ICU after cerebral aneurysm surgery who were allocated into two groups: non-DEX(nDEX, n = 25) and DEX (n = 24). RESULTS: In the nDEX group, two patients were administered sedatives and 10 patients required physical restriction, as opposed to one in the DEX group (P < 0.05). Although the Ramsay scale was higher in the DEX group (2.7 +/- 0.6) than in the nDEX group (1.5 +/- 0.6) (P < 0.05), there were no significant differences on the Glasgow coma scale. CONCLUSIONS: DEX is beneficial for sedation in patients undergoing cerebral aneurysm surgery because it provides adequate sedation with less physical restriction.

Efficient and practical arene hydrogenation by heterogeneous catalysts under mild conditions.

An efficient and practical arene hydrogenation procedure based on the use of heterogeneous platinum group catalysts has been developed. Rh/C is the most effective catalyst for the hydrogenation of the aromatic ring, which can be conducted in iPrOH under neutral conditions and at ordinary to medium H(2) pressures (<10 atm). A variety of arenes such as alkylbenzenes, benzoic acids, pyridines, furans, are hydrogenated to the corresponding cyclohexyl and heterocyclic compounds in good to excellent yields. The use of Ru/C, less expensive than Rh/C, affords an effective and practical method for the hydrogenation of arenes including phenols. Both catalysts can be reused several times after simple filtration without any significant loss of catalytic activity.