担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Intraoperative complications during combined thoracoscopic-laparoscopic surgery for esophagogastric junction (EGJ) carcinoma have not been reported as compared to those during surgery for esophageal carcinoma. We present two cases which had surgery-related hemodynamic instability during laparoscopic proximal gastrectomy and intra-mediastinal valvuloplastic esophagogastrostomy (vEG) with thoracoscopic mediastinal lymphadenectomy for EGJ carcinoma. CASE PRESENTATION: In case 1, the patient fell into hypotension with hypoxemia during laparoscopic vEG due to pneumothorax caused by entry of intraabdominal carbon dioxide. In case 2, ventricular arrythmia and ST elevation occurred during laparoscopic vEG. Pericardium retraction to secure surgical field during reconstruction compressed the coronary artery, which caused coronary malperfusion. These two events were induced by the surgical procedure, characterized by the following: (1) connection of the thoracic and abdominal cavities and (2) cardiac displacement during vEG. CONCLUSION: These cases indicated tension pneumothorax and coronary ischemia are possible intraoperative complications specific to combined thoracoscopic-laparoscopic surgery for EGJ carcinoma.

DOI： 10.1186/s40981-021-00419-x

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40981-020-00384-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ctr.13996

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記述言語：日本語   出版者・発行元：(一社)日本医学教育学会  

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記述言語：日本語   出版者・発行元：日本臨床麻酔学会  

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記述言語：日本語   出版者・発行元：日本臨床麻酔学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓血管麻酔学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓血管麻酔学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

New anesthesiology residency education program requirements were launched in Japan. The main change was to specify which anesthesia cases a resi- dent must experience during the training period. We believe that comparing the educational requirements between anesthesiology specialty certification programs in Japan and the USA is a timely undertaking. This detailed comparison study is aimed to identify compo- nents to improve the current educational systems in each country. Three educational components are required in the USA, but not in Japan: daily clinical evaluations based on well-defined criteria, regular lectures and nation- wide annual achievement tests, and national board- accredited subspecialty fellowships. Conversely, in Japan, scholarly presentations at scientific meetings are mandatory for anesthesiology board certification, but the scholarly activity requirement in the USA is vaguely defined. These points identified through our comparison could help improve residency training programs in both Japan and in the USA.

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担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：一般社団法人 日本集中治療医学会  

症例は29歳，男性。5年前に肺動脈性肺高血圧症（pulmonary arterial hypertension, PAH）を指摘されたが，内科的治療は行われていなかった。今回，胸痛を主訴に近医を受診し，造影CTにて肺動脈解離（pulmonary artery dissection, PAD）を指摘されたため，当院へ転院となった。当院入院後，緊急で主肺動脈人工血管置換術および左右肺動脈縫縮術が施行された。術後， PAHに対して早期に治療を開始した。未治療であったためPAHのコントロールに難渋したが，PAH治療薬の多剤併用および厳重な鎮静・挿管・人工呼吸管理を行うことで，POD 21に抜管，POD 29にICUを退室，POD 101に退院となった。PADは非常に致死率の高い疾患であるが，早期の手術および厳重な術後管理により救命できた。

DOI： 10.3918/jsicm.23.318

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その他リンク： http://search.jamas.or.jp/link/ui/2016258189

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

An 87-year-old man with severe aortic stenosis developed torsade de pointes (TdP) during carotid endarterectomy before carotid artery stenosis. By prompt resuscitation and medication including lidocaine and magnesium, the patient recovered without complications in spite of high risk for refractory cardiac arrest or brain infarction. There was no other history or laboratory data suggesting arrhythmia except elongation on preoperative electrocardiogram. Inhaled anesthetics, catecholamine and sympathetic nerve stimulation were possible causes of QT elongation and induce TdP. Particularly in a patient with carotid and cardiac diseases, cardiac arrest is critical. Therefore we should avoid exacerbating factors of QT elongation or TdP even if patients have no particular history of arrhythmia.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Ultrasound-guided brachial plexus block (UGBB) makes it possible to block both lateral and medial aspects of the skin overlying the elbow, which are mainly innervated by C5 and T1 roots of brachial plexus, respectively. The effect of UGBB on perioperative pain relief in total elbow arthroplasty (TEA) was evaluated. METHODS: Twenty-one patients scheduled to undergo TEA with general anesthesia from January 2009 to December 2010 were assigned to a group receiving UGBB (Block group, n = 10) and a group receiving general anesthesia alone (General group, n = 11). Perioperative anesthetic dose and postoperative pain intensity were recorded. Statistical analysis was performed with Mann-Whitney's U-test, and P < 0.05 was considered to be significant. RESULTS: Median fentanyl doses during the operation in the Block group and General group were 100 microg and 250 microg, respectively (P < 0.05). Numerical rating scale (NRS) in the Block group was significantly lower than that in the General group immediately after the operation (median value: Block group = 0, General group = 4). Although NRS in the two groups was not different from the night of the day of operation, no patient in the Block group needed supplementary opioids. CONCLUSIONS: Ultrasound-guided brachial plexus block in patients undergoing TEA reduces perioperative opioid consumption and wound pain in the early postoperative period.

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Little is known on the clinical effects of chloride on critically ill patients. We conducted this retrospective, observational study in 488 critically ill patients to investigate the incidence of chloride abnormalities, effects of hypochloremia in acid-base disorders, and association between chloride and clinical outcome. The study involved retrieval of arterial blood gas analyses, biochemical and demographical data from electrical records as well as quantitative acid-base analyses. For statistical analysis, the patients were stratified into three groups according to their chloride level (normal range: 98-106 mEq/L). The distribution of chloride levels was hyperchloremia 16.6%, normochloremia 74.6%, and hypochloremia 8.8%. The hypochloremic group was significantly alkalemic (P < 0.0001) and has significantly higher apparent strong ion difference (SIDa) (P < 0.0001) compared to the two other groups. The hypochloremic group had significantly longer stays in the ICU and hospital (P < 0.0001) with higher mortality (P < 0.0001). However, multiple regression analysis showed that chloride was not an independent factor of poorer outcome. In conclusion, the acid-base characteristics of the hypochloremic patients were alkalemia coexisting with higher SIDa. And although it was not an independent prognostic factor, hypochloremia was related to poorer outcome in critically ill settings.

DOI： 10.1100/2012/474185

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記述言語：日本語   出版者・発行元：日本臨床麻酔学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Validation of a scoring algorithm for non-overt disseminated intravascular coagulation (DIC) proposed by the International Society on Thrombosis and Haemostasis (ISTH) is still incomplete. It was the objective of this study to assess the impact of including AT to non-overt DIC scoring on the predictability for intensive care unit (ICU) death and the later development of overt-DIC defined by the Japanese Ministry of Health and Welfare (JMHW) or the ISTH. We performed a retrospective observational study conducted in 364 patients in critical care. Coagulation parameters obtained daily for DIC screening were utilised for scoring. There were 194 and 196 patients scored as positive non-overt DIC with and without AT, respectively; diagnostic agreement between the two was 78%. As compared with patients without non-overt DIC, these non-overt DIC patients had significantly higher mortality. In 37 ICU non-survivors, positive non-overt DIC scoring with AT preceded ICU death by a median of 6.8 days, which was significantly earlier as compared with a median of 5.4 days for non-overt DIC without AT (p = 0.022). In patients who developed overt-DIC after admission, the time period from positive non-overt DIC to positive overt-DIC was significantly longer when AT was utilised (overt-DIC ISTH; 1.3 days vs. 0.1 days, p = 0.004, overt-DIC JMHW; 2.5 days vs. 2.0 days, p = 0.04, with AT vs. without AT, respectively). Non-overt DIC scoring predicted a high risk of death in critically ill patients. When information on AT levels was included, non-overt DIC scoring was found to predict development of overt-DIC significantly earlier than non-overt DIC scoring without AT.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Anesthesia for Jehovah's witnesses is sometimes problematic, especially when they have an open heart surgery. We could successfully manage two Jehovah's witnesses who underwent mitral valve replacement and thoracic aneurysm repair without transfusion. Prior to surgery, it is crucial for a operation to carefully assess the patient's cardiovascular reserve, estimated hemorrhage volume, permissive range of hemorrhage, alternative methods of blood transfusion, and risk of death.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Coronary artery bypass graft surgery in patients with immune thrombocytopenic purpura (ITP) refractory to preoperative medical therapy accompanies an increased risk of bleeding perioperatively. In the ITP patient without responding to intravenous immunoglobulin and corticosteroids, we performed combined off-pump coronary artery bypass grafting with splenectomy to minimize the risk of intraoperative bleeding and cardiac ischemia. Using platelets infusion, we successfully managed the patient without major bleeding and ischemic events.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A five-year-old boy with recurring tonsillitis and sleep apnea was admitted for tonsillectomy and tympanic membrane tubing. He presented with a history of bronchial asthma and hereditary spherocytosis without obvious cardiac failure symptoms. Anesthetic agents for induction included nitrous oxide, oxygen, and sevoflurane. Because oxygen saturation decreased immediately to 90%, tracheal intubation was performed. The patient began to wheeze. Sevoflurane concentration was increased but cardiac murmur (gallop), cold limbs and jugular vein distension were noted. Acute cardiac failure was diagnosed following a chest X-ray and cardiac echo showing an enlarged heart, CTR of 80%, left ventricular dilation, and contractile failure. Tympanic membrane tubing only was performed. Sevoflurane was discontinued and the patient was treated for the cardiac failure under an ICU oxygen tent. The patient was discharged when his general condition improved. He showed elevated levels of viral antibodies, suggesting myocarditis. Later he was treated for dilating cardiomyopathy before undergoing a heart transplant.

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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開催年月日： 2023年6月1日 - 2023年6月3日

記述言語：日本語   会議種別：ポスター発表  

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開催年月日： 2023年6月1日 - 2023年6月3日

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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開催年月日： 2022年9月11日

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開催年月日： 2022年5月26日 - 2022年5月27日

会議種別：シンポジウム・ワークショップ パネル（指名）  

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