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Sugano K.,Jichi Medical University | Matsumoto Y.,Kohnan Hospital | Itabashi T.,Hokusetsu General Hospital | Abe S.,Koukan Clinic | And 10 more authors.
Journal of Gastroenterology | Year: 2011

Background The efficacy of low-dose lansoprazole has not been established for the prevention of recurrent gastric or duodenal ulcers in those receiving long-term low-dose aspirin (LDA) for cardiovascular and cerebrovascular protection. This study sought to examine the efficacy of low-dose lansoprazole (15 mg once daily) for the secondary prevention of LDA-associated gastric or duodenal ulcers. Methods Patients were randomized to receive lansoprazole 15 mg daily (n = 226) or gefarnate 50 mg twice daily (n = 235) for 12 months or longer in a prospective, multicenter, double-blind, randomized active-controlled trial, followed by a 6-month follow-up study with open-label lansoprazole treatment. The study utilized 94 sites in Japan and 461 Japanese patients with a history of gastric or duodenal ulcers who required long-term LDA therapy for cardiovascular and cerebrovascular disease. Results The primary endpoint was the development of gastric or duodenal ulcers. The cumulative incidence of gastric or duodenal ulcers on days 91, 181, and 361 from the start of the study was calculated by the Kaplan-Meier method as 1.5, 2.1, and 3.7%, respectively, in the lansoprazole group versus 15.2, 24.0, and 31.7%, respectively, in the gefarnate group. The risk of ulcer development was For the Lansoprazole Ulcer Prevention Study Group (Low-Dose Aspirin Therapy). significantly (log-rank test, P<0.001) lower in the lansoprazole group than in the gefarnate group, with the hazard ratio being 0.099 (95% confidence interval [CI] 0.042-0.230). Conclusion Lansoprazole was superior to gefarnate in reducing the risk of gastric or duodenal ulcer recurrence in patients with a definite history of gastric or duodenal ulcers who required long-term LDA therapy. Source

Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Minami T.,Osaka Medical College
Japanese Journal of Anesthesiology | Year: 2016

As Japan's population ages, the number of cases of emergency abdominal surgery at advanced ages is increasing. A 105-year-old man weighing 37 kg combined with aortic stenosis and regurgitation was scheduled for emergency surgery for incarcerated inguinofemoral hernia. General anesthesia was induced with short-acting analgesics and sedatives. The patient was extubated uneventfully in the operating room and discharged without any major complications. Anesthetic management of elderly patients requires appropriate preoperative evaluation of complicating diseases, degree of consciousness, and nutritional condition. For those aged 100 years and older in particular, their quality of life should be considered. Close and cooperative communication between surgeons and anesthesiologists are also an important aspect in treating these patients. Source

Fujiwara A.,Osaka Medical College | Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Miyazaki S.,Osaka Medical College | And 3 more authors.
Journal of Anesthesia | Year: 2015

Background: Anesthesiologists often encounter LMA-ProSeal® (ProSeal) insertion difficulty due to its large cuff size. We performed a randomized clinical trial to examine how insertion efficacy and sealing pressure of ProSeal are affected by muscle relaxant administration in anesthetized patients. Methods: Our adult patients were either administered rocuronium (0.9 mg kg−1) as a muscle relaxant (R group; 40 patients) or not (C group; 40 patients). Anesthesia was induced with propofol and fentanyl. We compared the two groups with regard to the number of attempts required for successful insertion, sealing pressure, and subjective difficulty for insertion. Results: Total insertion attempts required for successful ventilation in the two groups were one (R group, 38 patients; C group, 28 patients), two (R group, one patient; C group, seven patients), and three (R group, one patient; C group, five patients), revealing a significant difference between groups (p < 0.001). Sealing pressure was significantly higher in the R group than in the C group (R group, 27.4 ± 5.4 cmH2O; C group, 21.2 ± 5.2 cmH2O; p < 0.001). Leakage volume by mechanical ventilation was significantly smaller in the R group than in the C group (R group, 17.4 ± 29.1 ml; C group, 46.8 ± 45.5 ml; p < 0.001). Subjective difficulty of insertion was significantly lower in the R group than in the C group (R group, 12.3 ± 23.1 mm; C group, 39.4 ± 31.9 mm; p < 0.001). Conclusions: Muscle relaxation appears to facilitate ProSeal insertion efficacy by enabling higher successful insertion rates, higher sealing pressure, lower leakage volume, and lower subjective difficulty of insertion in anesthetized patients. © 2015, Japanese Society of Anesthesiologists. Source

Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Tatsumi S.,Osaka Medical College | Minami T.,Osaka Medical College
Journal of Clinical Anesthesia | Year: 2014

Study Objective: To determine if prewarming of the i-gel (Intersurgical, Wokingham, United Kingdom) improves insertion and ventilation efficacy with muscle relaxation in patients undergoing elective surgery. Design: Clinical randomized study. Setting: Operating room. Patients: Sixty-eight adult patients scheduled for elective surgery under general anesthesia with American Society of Anesthesiologists physical status 1-3. Interventions: The i-gel was warmed to 42°C for 30 minutes before insertion (W group; 34 patients) or kept at room temperature (approximately 23°C) (C group; 34 patients). Measurements: The number of attempts for a successful insertion and the sealing pressure and leak volume 30 seconds and 30 minutes after initiating mechanical ventilation. Main Results: The total insertion attempts were 1 (W group, 31 cases; C group, 24 cases) and 2 (W group, 3 cases; C group, 10 cases), which was significant (P = .001). Sealing pressure was significantly higher in the W group than the C group (W group, 21.8 ± 3.7 cm H2O; C group, 18.5 ± 3.4 cm H2O; P = .001). Leak volume was significantly smaller after 30 seconds in the W group than the C group (P = .002), but not after 30 minutes (P = .69). Conclusions: Prewarming the i-gel to 42°C demonstrated a higher successful ventilation initiation. © 2014 Elsevier Inc. All rights reserved. Source

Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Tatsumi S.,Osaka Medical College | Minami T.,Osaka Medical College
BMJ Open | Year: 2015

Objective: This study aimed to test the hypothesis that the i-gel supraglottic airway device would fit the larynx and provide better sealing pressure if prewarmed to 42°C relative to the device kept at room temperature in non-paralysed, sedated patients. Methods: A total of 74 adult patients were assigned to the warm (i-gel prewarmed to 42°C; W group; 37 patients) or the control (i-gel kept at room temperature; C group; 37 patients) groups. Anaesthesia was induced with propofol and fentanyl. The i-gel was prewarmed to 42°C for 30 min before insertion in the W group, but kept at room temperature (approximately 23°C) for the C group. The number of attempts made until successful insertion and sealing pressure were compared between the two groups. Results: Insertion was successful with one attempt in 35 cases each for the W and C groups. Two attempts were needed in two cases for the W group and one case for the C group. There was one failed attempt in the C group, but none in the W group. None of the differences between the two groups were significant (p=0.51). Sealing pressure was slightly, but not significantly, higher in the W group than in the C group (W group 22.6±6.1 cm H2O; C group 20.7 ±6.1 cm H2O; p=0.15). Conclusions: Prewarming of the i-gel to 42°C did not increase the success rate of insertion, nor did it significantly increase sealing pressure in anaesthetised, non-paralysed patients. Our data suggest that we can keep the i-gel at room temperature for emergency airway management for non-paralysed, sedated patients. Trial registration number: University Medical Information Network, Japan 000012287. © 2015, BMJ Publishing Group. All rights reserved. Source

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