Hemodynamic impact of ephedrine on hypotension during general anesthesia : a prospective cohort study on middle-aged and older patients

Background Ephedrine is a mixed α- and β-agonist vasopressor that is frequently used for the correction of hypotension during general anesthesia. β-responsiveness has been shown to decrease with age; therefore, this study aimed to determine whether aging would reduce the pressor effect of ephedrine on hypotension during general anesthesia. Methods Seventy-five patients aged ≥ 45 years were included in this study, with 25 patients allocated to each of the three age groups: 45–64 years, 65–74 years, and ≥ 75 years. All patients received propofol, remifentanil, and rocuronium for the induction of general anesthesia, followed by desflurane and remifentanil. Cardiac output (CO) was estimated using esCCO technology. Ephedrine (0.1 mg/kg) was administered for the correction of hypotension. The primary and secondary outcome measures were changes in the mean arterial pressure (MAP) and CO, respectively, at 5 min after the administration of ephedrine. Results The administration of ephedrine significantly increased MAP (p < 0.001, mean difference: 8.34 [95% confidence interval (CI), 5.95–10.75] mmHg) and CO (p < 0.001, mean difference: 7.43 [95% CI, 5.20–9.65] %) across all groups. However, analysis of variance revealed that the degree of elevation of MAP (F [2, 72] = 0.546, p = 0.581, η2 = 0.015 [95% CI, 0.000–0.089]) and CO (F [2, 72] = 2.023, p = 0.140, η2 = 0.053 [95% CI, 0.000–0.162]) did not differ significantly among the groups. Similarly, Spearman’s rank correlation and multiple regression analysis revealed no significant relation between age and the changes in MAP or CO after the administration of ephedrine. Conclusion The administration of ephedrine significantly increased MAP and CO; however, no significant correlation with age was observed in patients aged > 45 years. These findings suggest that ephedrine is effective for the correction of hypotension during general anesthesia, even in elderly patients

Clinical Evaluation of Adenosine Triphosphate Disodium Hydrate (ATP-2Na) for Asthenopia

To investigate the effect and the safety of Adenosine triphosphate disodium hydrate (ATP-2Na) for asthenopia. 40 subjects [35 females and 5 males, 25~87 years old (average: 62.5 years old)] with asthenopia ingested 200~300 mg/day ATP-2Na for 3 months. Before and after 1 and 3 months ingestion, subjects completed a questionnaire to determine their asthenopia symptom and fatigue symptom by visual analog scale (VAS). The scores were compared between before and after ingestion. 31 subjects completed a questionnaire for 1 month. The scores of asthenopia symptom before ingestion, 1 and 3 months were 4.05 ± 3.22, 2.67 ± 2.19 and 2.41 ± 2.16, respectively. The scores of fatigue symptom were 4.76 ± 3.05, 3.08 ± 2.93 and 3.10 ± 3.19, respectively. Both scores were significantly decreased (p < 0.005) at 1 month compared before ingestion. Three subjects had side effects (diarrhea for two, nausea for one), and all subjects improved by oral discontinuation. These results suggest that ATP-2Na is relatively early effective in improving asthenopia and accompanying fatigue symptoms

University Entrance Exams Renewal - From Translation to Communication -

本論文は日本の私立大学における大学入試問題改正プロジェクトの経過報告である。入試問題の更新は、コミュニカティブ英語教育と実際の言語使用状況に基づいた教材活用の促進を推薦する文部科学省の新学習指導要領の実施に合わせている。本プロジェクトの第一段階として開発チームは試験背景にある多数の実用的制約を配慮しながら、試験目的に最も適合させるべく実行可能な一連の試験仕様を作成した。 それに続き、実地試験済みの二種類の試験形式見本に対し試験課題と項目を開発した。試験結果の記述統計量では試験項目の作成は大部分において成功したことを示したが、試験の信頼性、妥当性をさらに高めるにはまだ多くの取り組みが必要であることも示した。This paper is an interim report on a project to revise the English entrance examinations for a private university in Japan. The exam renewal coincides with the implementation of MEXTs revised high school curriculum guidelines which endorse communicative language teaching and promote the use of materials based on actual language use situations. During the first stage of the project the development team attempted to establish a workable set of test specifications in order to best meet the objectives of the examinations within the considerable constraints of the testing context. Subsequently, the team developed tasks and items for two prototype exam forms which were piloted and then field-tested. Descriptive statistics of the trial results suggested that the team had been largely successful in generating items but that considerable work still needs to be done in order to further enhance the reliability and validity of th

Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients : a single-center, randomized, controlled trial

Background Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia. Methods Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 μg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV). Results MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (− 41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: − 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP < 65 mmHg over 2.5 min), without significant differences between the groups (p = 0.341). Conclusions Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, not only the choice but also the dose and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol

Transition in eye gaze as a predictor of emergence from general anesthesia in children and adults : a prospective observational study

Background: It is useful to monitor eye movements during general anesthesia, but few studies have examined neurological finding of the eyes during emergence from general anesthesia maintained with short-acting opioids and volatile anesthetics. Methods: Thirty children aged 1–6 years and 30 adults aged 20–79 years were enrolled. Patients received general anesthesia maintained with sevoflurane and remifentanil. The timing of three physical-behavioral responses—eye-gaze transition (the cycle from conjugate to disconjugate and back to conjugate), resumption of somatic movement (limbs or body), and resumption of respiration—were recorded until spontaneous awakening. The primary outcome measure was the timing of the physical-behavioral responses. Secondary outcome measures were the incidence of eye-gaze transition, and the bispectral index, concentration of end-tidal sevoflurane, and heart rate at the timing of eye-gaze transition. Results: Eye-gaze transition was evident in 29 children (96.7%; 95% confidence interval, 82.8–99.9). After the end of surgery, eye-gaze transition was observed significantly earlier than resumption of somatic movement or respiration (472 [standard deviation 219] s, 723 [235] s, and 754 [232] s, respectively; p < 0.001). In adults, 3 cases (10%; 95% CI, 0.2–26.5) showed eye-gaze transition during emergence from anesthesia. The incidence of eye-gaze transition was significantly lower in adults than in children (p < 0.001). Conclusion: In children, eye-gaze transition was observed significantly earlier than other physical-behavioral responses during emergence from general anesthesia and seemed to reflect emergence from anesthesia. In contrast, observation of eye gaze was not a useful indicator of emergence from anesthesia in adults

A Case of Acquired Leucoderma, Associated with Hashimoto's Thyroiditis

A 67-year-old female diagnosed as Hashimoto's thyroiditis in company with acquired leucoderma was reported. She first noticed the enlarged thyroid at the age of 36, and thereafter leucoderma made its appearance 30 years later. Though a significant association between these two diseases has been found in the literature thus far and they are considered to be of autoimmune origin, their coexistence is not so common clinically. In spite of PUVA treatment, a benefit effect was not obtained completely

Risk factors for unsuccessful removal of central venous access ports implanted in the forearm of adult oncologic patients

Purpose: To evaluate the risk factors for unsuccessful removal of a central venous access port (CV port) implanted in the forearm of adult oncologic patients. Materials and methods: This study included 97 adult oncologic patients (51 males, 46 females; age range, 30–88 years; mean age, 63.7 years) in whom removal of a CV port implanted in the forearm was attempted at our hospital between January 2015 and May 2021. Gender, age at removal, body mass index, and diagnosis were examined as patient characteristics; and indwelling period, indwelling side, and indication for removal were examined as factors associated with removal of a CV port. These variables were compared between successful and unsuccessful cases using univariate analysis. Then, multivariate analysis was performed to identify independent risk factors for unsuccessful removal of a CV port using variables with a significant difference in the univariate analysis. A receiver-operating characteristics (ROC) curve was drawn for significant risk factors in the multivariate analysis and the Youden index was used to determine the optimum cut-off value for predicting unsuccessful removal of a CV port. Results: Removal of CV ports was successful in 79 cases (81.4%), but unsuccessful in 18 cases (18.6%) due to fixation of the catheter to the vessel wall. Multivariate logistic regression analysis showed that the indwelling period (odds ratio 1.048; 95% confidence interval 1.026–1.070; P  60 months had unsuccessful removal. Conclusion: The indwelling period is an independent risk factor for unsuccessful removal of a CV port implanted in the forearm of adult oncologic patients, with a cut-off of 41 months