[Evaluation of supplemental and oral deglutition foods in bedridden elderly patients receiving parenteral nutrition].

BACKGROUND AND AIM: We examined oral dyskinesia (OD), wearing artificial tooth, food test findings and conducted a video - fluoroscopic swallowing study (VFSS) in bedridden elderly patients before they were received parenteral nutrition once daily. However, the validity and properties of these deglutition foods have not been evaluated. Therefore, in this study, we clarified four deglutition foods as four aspects. METHOD: Forty-five patients (23 males, mean age: 82.5 years) receiving deglutition foods were evaluated. The OD and food tests were performed at the bedside. The VFSS (dynamics of swallowing, oropharyngeal transit time, distance of hyoid bone displacement and difference in the oropharyngeal transit time) was conducted via X-rayunder administration of contrast medium mixed with food. Additionally, the physical properties of the deglutition foods were evaluated in accordance with thestandard methods for patients with dysphagia by the Ministry of Health, and Labour, Welfare and Consumer Affairs Agency. RESULTS: The mean duration receiving deglutition foods was 8 months. Although OD and wearing artificial tooth were observed in 42% of the patients, the rate of OD was significantly higher in patients receiving thick than in patients receiving jelly. The deglutition foods were classified into four types based on their physical properties (thick 1, n=18; thick 2, n=10; jelly 1, n=10; and jelly 2, n=7). The food test scores markedly differ among the four types of deglutition food. The mean score for swallowing dynamics was significantly different among the four types. Although the oropharyngeal transit time was similar for each type, the thick 1 group was divided into fast and slow transitors. The distance of hyoid bone displacement was significantly different among the four types. The oropharyngeal transit time was significantly correlated with the number of teaspoons ingested at a time. In the physical properties test, all four deglutition foods showed appropriate results; thick 1 and 2 were within the standardII category, while jelly 1 and 2 were within the standardIII category. CONCLUSION: The results of swallowing tests suggest that these four deglutition foods may be safe and reasonable for administration to bedridden elderly patients receiving parenteral nutrition.

Molecular epidemiological study of gammaherpesvirus in domestic cats in Japan.

Gammaherpesviruses (GHVs) are members of an emerging subfamily of the family Herpesviridae. A recent study identified a novel GHV in domestic cats (Felis catus GHV1, FcaGHV1), and epidemiological surveys have found that FcaGHV1 is distributed worldwide. In this study, we investigated the prevalence of GHVs in domestic cats in Japan with a molecular epidemiological survey. Blood samples were collected from 1,738 domestic cats and GHV-derived DNA was detected with PCR in 1.3% (23/1,738) of the Japanese domestic cats. The FcaGHV1 detected in this study was very similar to FcaGHV1 detected in a domestic cat in North America. Older age (>5 years old) and Feline immunodeficiency virus infection were identified as risk factors for GHV infection.

[Anesthetic management of intraoperative aortic dissection during cardiovascular surgery].

Despite considerable advances in anesthesia technique, intraoperative aortic dissection remains a potentially lethal complication during on-pump cardiovascular surgery. Intraoperative dissection has been described worldwide, ranging between 0.06% and 0.24%. Here we present 8 patients who had intraoperative dissection during 10-year period with 6,266 on-pump cases (0.13%, 95% confidence interval 0.12% to 0.14%). In-hospital mortality rate of intraoperative dissection was 12.5% (1/8) at our institution, which was exceptionally lower than that reported previously (24% to 43%). Therefore, we also show our treatment strategy for intraoperative dissection with the related-literature review. The original surgical procedures were descending aortic replacement in 3 patients, valve replacement in 4 patients, and aortic-root replacement in 1 patient. Dissection occurred during aortic cannulation in 6 patients and during manipulation of aortic cross-clamping/de-clamping in 2 patients. Three patients had retrograde dissection extending and beyond the arch. Trans-esophageal echocardiography was useful to confirm dissection and ensure proper perfusion of the aortic-branches. Immediately after its diagnosis, all patients were managed with hypotensive strategy and subsequently underwent deep hypothermic circulatory arrest for prevention of dissection propagation. Among patients with intraoperative aortic dissection undergoing on-pump cardiovascular surgery, not only earlier diagnosis but proper anesthetic management may be crucial for the successful outcome.

[Coronary artery bypass graft (CABG) in a patient with chronic obstructive pulmonary disease (COPD) who showed difficulty in respiratory control].

We experienced a patient with severe COPD undergoing OPCAB who showed difficult perioperative respiratory and circulatory management. Since patients with severe COPDs are often complicated with not only respiratory but also circulatory problems such as right heart failure, it is necessary to assess preoperatively the method of intraoperative management including operative procedure.

[Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia].

Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia was reviewed. Common crisis which is encountered during regional anesthesia includes toxic reaction to local anesthetic drugs, allergic reaction induced by local anesthetic drugs, reaction induced by epinephrine, nerve injury, hematoma etc. Concerning peripheral nerve block, crisis encountered during brachial plexus block, interscalene block and supraclavicular block used for surgical operation of upper extremity was discussed. On the other hands, there are various common crises encountered during epidural anesthesia and spinal anesthesia. These crises include hypotension, bradycardia, total spinal anesthesia, postspinal headache and infection, and hematoma in the spinal canal. Especially, epidural hematoma and epidural abcess have possibility to cause nerve defect symptoms such as motor paralysis and sensory disturbance if appropriate treatment was not started in early stage. Moreover crisis such as cauda equina syndrome and anterior spinal cord syndrome have possibility to remain permanent and hard to cure. We anesthesiologists should make efforts to prevent crisis, to detect crisis in early stage, and to treat it in early stage.

Effect of landiolol hydrochloride on suxamethonium-induced neuromuscular block.

PURPOSE: The aim of this study was to examine the effect of landiolol hydrochloride, an ultrashort-acting beta(1)-blocker, on suxamethonium-induced neuromuscular block. METHODS: Thirty patients were randomly allocated to receive a loading dose of landiolol, 0.125 mg x kg(-1) x min(-1) for 1 min, followed by an infusion at 0.04 mg x kg(-1) x min(-1), or placebo. Twenty minutes after the infusion of landiolol or placebo, suxamethonium 1 mg x kg(-1) was administered during propofolfentanyl-nitrous oxide anesthesia. Neuromuscular block was monitored by train-of-four (TOF) responses of the adductor pollicis muscle, applying acceleromyographic stimuli to the ulnar nerve. RESULTS: The onset of neuromuscular block did not differ between the groups. The time from administration of suxamethonium to spontaneous recovery to the first twitch of TOF (T1) of control was significantly longer in the landiolol group (mean [SD]; 12.2 [2.5] min), when compared with the control group (9.8 [2.6] min). However, the TOF ratios measured when the T1 had spontaneously recovered to 10%, 25%, 50%, 75%, 90%, and 100% of control was comparable between the groups. CONCLUSION: Landiolol delayed recovery from suxamethonium-induced paralysis. However, the interaction between the drugs seemed to be small in the clinical setting.

[Investigations into neostigmine-induced inhibition of neuromuscular transmission].

BACKGROUND: Fade of the muscle contraction evoked by indirect tetanic nerve stimulation shows residual neuromuscular block. Anticholinesterases can reverse the partial block; however, they may also inhibit normal neuromuscular transmission and can cause fading responses by misuse of these drugs. The aim of this study is to investigate how neostigmine acts on normal neuromuscular function. METHODS: In cats, we observed a series of 8 consecutive muscular compound action potentials (mCAPs; M1-8) of the gastrocnemius muscle evoked by repetitive sciatic nerve stimulation at 100 Hz and calculated the M8/M1 amplitude ratio as an index of fading phenomenon. Neostigmine 0.05 mg x kg(-1) repetitively every 5 minutes before neuromuscular blocking agent had been administered, or after the complete recovery from vecuronium-induced block had been obtained. RESULTS: Neostigmine caused dose-dependent fade in the mCAPs. The mean doses (SD) of neostigmine for depressing M8/M1 ratio to 50% of baseline were 0.087 (0.029) mg x kg(-1) before use of neuromuscular blocking agent and 0.161 (0.070) mg x kg(-1) after the recovery from neuromuscular block. The fading responses induced by neostigmine were paradoxically reversed by small doses of vecuronium. CONCLUSIONS: Therapeutic doses of neostigmine administered during normal neuromuscular function cause fade of the repetitive muscle contractions. Neuromuscular monitoring should be used before the reversal with neostigmine.