Faculty Profiles - OKAHARA Shuji

Papers - OKAHARA Shuji

Division display 1 - 20 of about 31 ／ All the affair displays >>

イソフルラン,プロポフォールを投与し鎮静薬を計画的に減量しえた長期人工呼吸管理の小児重症心不全例

成谷俊輝, 黒田浩佐, 岡原修司, 鈴木聡, 金澤伴幸, 清水一好, 岩崎達雄, 森松博史

日本集中治療医学会雑誌 31 ( 4 ) 261 - 265 2024.7

Language：Japanese Publisher：(一社)日本集中治療医学会

小児の長期にわたる鎮静は,薬剤耐性や医原性離脱症候群(iatrogenic withdrawal syndrome,IWS)を引き起こし,管理に難渋する場合がある。患者は14歳,男児。劇症型心筋炎と診断され左心補助人工心臓を必要とし,鎮痛鎮静薬は高用量かつ長期間投与となった。抜管に向けてIWS発症回避のため薬剤漸減の必要があったが,その過程での安全な管理のために抜管までは鎮静度の維持が必要と考えた。ミダゾラムとフェンタニルは12時間ごとに5%ずつ減量し,その間は適応外使用としてケタミン,イソフルラン,プロポフォールを順に投与し,鎮静度を維持した。プロポフォール中止後は速やかに覚醒が得られたため抜管し,ミダゾラム,フェンタニル中止後にデクスメデトミジンを漸減終了した。経過中はプロポフォール注入症候群,IWS,悪性高熱症を疑う所見を認めなかった。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J02874&link_issn=&doc_id=20240719470006&doc_link_id=20240719470001&url=http%3A%2F%2Fsearch.jamas.or.jp%2Flink%2Fbc%2F20240719470001&type=jamaslink&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F99999_1.gif

Postoperative Complications in Living Donors for Lung Transplantation. International journal

Shin Tanaka, Kento Fujii, Megumi Ishihara, Haruki Choshi, Kei Matsubara, Kohei Hashimoto, Shuji Okahara, Kazuhiko Shien, Ken Suzawa, Kentaroh Miyoshi, Hiromasa Yamamoto, Mikio Okazaki, Seiichiro Sugimoto, Shinichi Toyooka

Transplantation direct 10 ( 5 ) e1617 2024.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Living donor lobar lung transplantation is a life-saving procedure for critically ill patients. This requires 2 healthy donors exposed to risks and without medical benefit. Therefore, the donor's safety and minimal postoperative complications are crucial. This study aimed to investigate the short-term outcomes and identify the risk factors affecting these outcomes. METHODS: The data of 175 living donors enrolled between 1998 and 2022 were analyzed. Donors were divided into era 1 (1998-2009) and era 2 (2010-2022). RESULTS: The overall incidence of postoperative complications was 39%, of which 7% were major complications. Donors who underwent surgery on the right side had a higher incidence of delayed pulmonary fistulae (P = 0.01) and elevated liver enzyme levels (P = 0.028). Living donor surgery on the right side (P = 0.01), era 2 (P = 0.01), and the need for plasty (P = 0.04) were predictors of postoperative complications. CONCLUSIONS: Updated data on complications and their correlation with postoperative quality of life from this study could aid in the selection of potential donors and facilitate informed consent.

DOI： 10.1097/TXD.0000000000001617

PubMed

researchmap

Donor's long-term quality of life following living-donor lobar lung transplantation. International journal

Kento Fujii, Shin Tanaka, Megumi Ishihara, Kei Matsubara, Kohei Hashimoto, Shuji Okahara, Kazuhiko Shien, Ken Suzawa, Kentaroh Miyoshi, Shinji Otani, Hiromasa Yamamoto, Mikio Okazaki, Seiichiro Sugimoto, Masaomi Yamane, Shinichi Toyooka

Clinical transplantation 37 ( 4 ) e14927 2023.2

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Living-donor lobar lung transplantation is an alternative procedure to deceased donation lung transplantation. It involves graft donation from healthy donors; however, only a few reports have discussed its long-term prognosis in living lung donors and their associated health-related quality of life. This study aimed to examine living lung donors' health-related quality of life. METHODS: In our cross-sectional survey of living lung donors, we assessed health-related quality of life based on three key aspects (physical, mental, and social health) using the 36-Item Short Form Health Survey. We also evaluated chronic postoperative pain and postoperative breathlessness using the numeric rating scale and the modified Medical Research Council Dyspnea scale, respectively. RESULTS: We obtained consent from 117 of 174 living lung donors. The average scores of the living lung donors on the 36-Item Short Form Health Survey were higher than the national average. However, some donors had poorer physical, mental, and social health, with lower summary scores than the national averages. Low mental component summary predictors included donor age (<40 years; odds ratio = 10.2; p<.001) and recipient age (<18 years; odds ratio = 2.73; p<.032). Low role-social component summary predictors included high lung allocation score (≥50; odds ratio = 3.94, p<.002) and recipient death (odds ratio = 3.64; p = .005). There were no predictors for physical component summary. Additionally, many donors did not complain of pain or dyspnea. CONCLUSIONS: Living lung donors maintained acceptable long-term health-related quality of life after surgery. Potential donors should be informed of relevant risk factors, and high-risk donors should receive appropriate support. This article is protected by copyright. All rights reserved.

DOI： 10.1111/ctr.14927

PubMed

researchmap

A prediction model to determine the untapped lung donor pool outside of the DonateLife network in Victoria International journal

Shuji Okahara, Gregory I Snell, Bronwyn J Levvey, Mark McDonald, Rohit D’Costa, Helen Opdam, David V Pilcher

Anaesthesia and Intensive Care 50 ( 5 ) 380 - 387 2022.9

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE Publications

Lung transplantation is limited by a lack of suitable lung donors. In Australia, the national donation organisation (DonateLife) has taken a major role in optimising organ donor identification. However, the potential outside the DonateLife network hospitals remains uncertain. We aimed to create a prediction model for lung donation within the DonateLife network and estimate the untapped lung donors outside of the DonateLife network. We reviewed all deaths in the state of Victoria’s intensive care units using a prospectively collected population-based intensive care unit database linked to organ donation records. A logistic regression model derived using patient-level data was developed to characterise the lung donors within DonateLife network hospitals. Consequently, we estimated the expected number of lung donors in Victorian hospitals outside the DonateLife network and compared the actual number. Between 2014 and 2018, 291 lung donations occurred from 8043 intensive care unit deaths in DonateLife hospitals, while only three lung donations occurred from 1373 ICU deaths in non-DonateLife hospitals. Age, sex, postoperative admission, sepsis, neurological disease, trauma, chronic respiratory disease, lung oxygenation and serum creatinine were factors independently associated with lung donation. A highly discriminatory prediction model with area under the receiver operator characteristic curve of 0.91 was developed and accurately estimated the number of lung donors. Applying the model to non-DonateLife hospital data predicted only an additional five lung donors. This prediction model revealed few additional lung donor opportunities outside the DonateLife network, and the necessity of alternative and novel strategies for lung donation. A donor prediction model could provide a useful benchmarking tool to explore organ donation potential across different jurisdictions, hospitals and transplanting centres.

DOI： 10.1177/0310057x211070011

PubMed

researchmap

Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/0310057X211070011

血液粘弾性検査によりヘパリン残存が術後止血困難の原因と特定できた心臓外科緊急手術の一症例

森松尭, 金澤伴幸, 岡原修司, 越智聡子, 佐倉考信, 清水一好, 森松博史

臨床モニター 33 ( Suppl. ) 117 - 117 2022.6

Integrated pulmonary index can predict respiratory compromise in high‐risk patients in the post‐anesthesia care unit: a prospective, observational study International journal

Yasutoshi Kuroe, Yuko Mihara, Shuji Okahara, Kenzo Ishii, Tomoyuki Kanazawa, Hiroshi Morimatsu

BMC Anesthesiology 21 ( 1 ) 123 - 123 2021.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media {LLC}

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>Respiratory compromise (RC) including hypoxia and hypoventilation is likely to be missed in the postoperative period. Integrated pulmonary index (IPI) is a comprehensive respiratory parameter evaluating ventilation and oxygenation. It is calculated from four parameters: end-tidal carbon dioxide, respiratory rate, oxygen saturation measured by pulse oximetry (SpO<jats:sub>2</jats:sub>), and pulse rate. We hypothesized that IPI monitoring can help predict the occurrence of RC in patients at high-risk of hypoventilation in post-anesthesia care units (PACUs).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>This prospective observational study was conducted in two centers and included older adults (≥ 75-year-old) or obese (body mass index ≥ 28) patients who were at high-risk of hypoventilation. Monitoring was started on admission to the PACU after elective surgery under general anesthesia. We investigated the onset of RC defined as respiratory events with prolonged stay in the PACU or transfer to the intensive care units; airway narrowing, hypoxemia, hypercapnia, wheezing, apnea, and any other events that were judged to require interventions. We evaluated the relationship between several initial parameters in the PACU and the occurrence of RC. Additionally, we analyzed the relationship between IPI fluctuation during PACU stay and the occurrences of RC using individual standard deviations of the IPI every five minutes (IPI-SDs).</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>In total, 288 patients were included (199 elderly, 66 obese, and 23 elderly and obese). Among them, 18 patients (6.3 %) developed RC. The initial IPI and SpO<jats:sub>2</jats:sub> values in the PACU in the RC group were significantly lower than those in the non-RC group (6.7 ± 2.5 vs. 9.0 ± 1.3, <jats:italic>p</jats:italic> < 0.001 and 95.9 ± 4.2 % vs. 98.3 ± 1.9 %, <jats:italic>p</jats:italic> = 0.040, respectively). We used the area under the receiver operating characteristic curves (AUC) to evaluate their ability to predict RC. The AUCs of the IPI and SpO<jats:sub>2</jats:sub> were 0.80 (0.69–0.91) and 0.64 (0.48–0.80), respectively. The IPI-SD, evaluating fluctuation, was significantly greater in the RC group than in the non-RC group (1.47 ± 0.74 vs. 0.93 ± 0.74, <jats:italic>p</jats:italic> = 0.002).</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Our study showed that low value of the initial IPI and the fluctuating IPI after admission to the PACU predict the occurrence of RC. The IPI might be useful for respiratory monitoring in PACUs and ICUs after general anesthesia.</jats:p>
</jats:sec>

DOI： 10.1186/s12871-021-01338-1

PubMed

researchmap

高用量ステロイド治療が奏功した重症COVID-19妊婦の1例

山本紘一郎, 萩谷英大, 牧尉太, 岡原修司, 長谷川功, 大塚文男

日本内分泌学会雑誌 97 ( 2 ) 568 - 568 2021.10

High-Dose Corticosteroids for a Pregnant Woman Critically Ill With Coronavirus Disease 2019 International journal

Koichiro Yamamoto, Hideharu Hagiya, Jota Maki, Shuji Okahara, Kou Hasegawa, Fumio Otsuka

Cureus 13 ( 8 ) e17398 2021.8

Language：English Publishing type：Research paper (scientific journal) Publisher：Cureus, Inc.

Pregnancy was reported to be a risk factor for coronavirus disease 2019 (COVID-19), with an increased risk for premature birth. Corticosteroids and remdesivir are used for patients with COVID-19; however, there is no established treatment for these patients. In particular, the effective management of pregnant, critically ill patients with COVID-19 remains unknown. We describe a 34-year-old, critically ill woman at 30 weeks of gestation with COVID-19, who was successfully treated with remdesivir and combined high-dose betamethasone (12 mg/day for two days) and methylprednisolone (125 mg/day for three days) followed by steroid tapering. During treatment, fetal biophysical profile scores on obstetric ultrasound were normal; her pregnancy course progressed well. Since high-dose corticosteroids improve fetal lung maturation and as well as cytokine storm due to COVID-19, this case provides an insight into the management of pregnant COVID-19 patients.

DOI： 10.7759/cureus.17398

PubMed

researchmap

A Retrospective Review of Declined Lung Donors: Estimating the Potential of Ex Vivo Lung Perfusion

Shuji Okahara, Bronwyn Levvey, Mark McDonald, Rohit D'Costa, Helen Opdam, David V. Pilcher, Gregory I. Snell

The Annals of Thoracic Surgery 112 ( 2 ) 443 - 449 2021.8

The Relationship between Frailty and Mechanical Ventilation: A Population-based Cohort Study

Shuji Okahara, Ashwin Subramaniam, Jai N. Darvall, Ryo Ueno, Michael Bailey, David V Pilcher

Annals of the American Thoracic Society 2021.7

An Audit of Lung Donor Pool: Optimal Current Donation Strategies and the Potential of Novel Time-Extended Donation After Circulatory Death Donation

Shuji Okahara, Bronwyn Levvey, Mark McDonald, Rohit D'Costa, Helen Opdam, David V. Pilcher, Gregory I. Snell

Heart, Lung and Circulation 2021.6

Improving the predictability of time to death in controlled donation after circulatory death lung donors

Shuji Okahara, Gregory I. Snell, Mark McDonald, Rohit D'Costa, Helen Opdam, David V. Pilcher, Bronwyn Levvey

Transplant International 34 ( 5 ) 906 - 915 2021.5

Infective Endocarditis Is a Risk Factor for Heparin Resistance in Adult Cardiovascular Surgical Procedures: A Retrospective Study

Yoshikazu Kimura, Shuji Okahara, Kanae Abo, Yusuke Koyama, Mitsuhito Kuriyama, Kazumi Ono, Hidekuni Hidaka

Journal of Cardiothoracic and Vascular Anesthesia 2021.5

Influence of the donor history of tobacco and marijuana smoking on early and intermediate lung transplant outcomes

Shuji Okahara, Bronwyn Levvey, Mark McDonald, Rohit D{\textquotesingle}Costa, Helen Opdam, David V. Pilcher, Eldho Paul, Gregory I. Snell

The Journal of Heart and Lung Transplantation 39 ( 9 ) 962 - 969 2020.9

Common Criteria for Ex-vivo Lung Perfusion Have No Significant Impact on Post-Transplant Outcomes

Shuji Okahara, Bronwyn Levvey, Mark McDonald, Rohit D'Costa, Helen Opdam, David V. Pilcher, Gregory I. Snell

The Annals of Thoracic Surgery 2020.9

全身麻酔中に気管支痙攣と肺高血圧を伴う薬剤性アナフィラキシーが疑われた肺リンパ脈管筋腫症の1例

明賀翔平, 日笠友起子, 岡原修司, 川瀬宏和, 小林求, 森松博史

日本臨床麻酔学会誌 40 ( 3 ) 221 - 226 2020.5

Language：Japanese Publisher：日本臨床麻酔学会

症例は49歳,女性.肺リンパ脈管筋腫症に対して脳死両肺移植が予定された.麻酔導入後にセフォチアムを投与したところ,突然換気困難となり,同時に肺動脈圧の上昇を認めた.アナフィラキシーによる気管支痙攣を疑いアドレナリンを投与すると,換気は改善し肺動脈圧も低下した.全身麻酔中のアナフィラキシーは皮膚症状,循環症状,呼吸症状を認めることが多いが,肺動脈圧の変化については知られていない.動物実験ではアナフィラキシー発症時の肺血管抵抗の上昇,肺高血圧が報告されているが,ヒトでの報告はこれまでにほとんどない.本症例では,アナフィラキシーによる気管支痙攣時に,急激に肺高血圧を呈している可能性が示唆された.(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01620&link_issn=&doc_id=20200529370003&doc_link_id=10.2199%2Fjjsca.40.221&url=https%3A%2F%2Fdoi.org%2F10.2199%2Fjjsca.40.221&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

【周術期の呼吸管理】術後合併症ハイリスク患者の周術期呼吸管理

岡原修司, 清水一好, 塩路直弘, 森松博史

麻酔 67 ( 5 ) 511 - 517 2018.5

Current ventilator and oxygen management during general anesthesia: A multicenter, cross-sectional observational study International journal

Suzuki, S., Mihara, Y., Hikasa, Y., Okahara, S., Ishihara, T., Shintani, A., Morimatsu, H., Sato, A., Kusume, S., Hidaka, H., Yatsuzuka, H., Okawa, M., Takatori, M., Saeki, S., Samuta, T., Tokioka, H., Kurasako, T., Maeda, M., Takeuchi, M., Hirasaki, A., Kitaura, M., Kajiki, H., Kobayashi, O., Katayama, H., Nakatsuka, H., Mizobuchi, S., Sugimoto, S., Yokoyama, M., Kusudo, K., Shiraishi, K., Iwaki, T., Komatsu, T., Hirai, Y., Sato, T., Kimura, M., Yasukawa, T., Kimura, M., Taniguchi, M., Shimoda, Y., Kobayashi, Y., Tsukioki, M., Manabe, N., Ando, E., Kosaka, M., Tsukiji, T., Tokura, C., Asao, Y., Sugiyama, M., Seto, K.

Anesthesiology 129 ( 1 ) 67 - 76 2018

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. METHODS: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%). RESULTS: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60). CONCLUSIONS: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.

DOI： 10.1097/ALN.0000000000002181

Scopus

PubMed

researchmap

Perioperative respiratory management in high risk patients

Okahara, S., Shimizu, K., Shioji, N., Morimatsu, H.

Japanese Journal of Anesthesiology 67 ( 5 ) 2018

Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: A prospective observational study International journal

Okahara, S., Shimizu, K., Suzuki, S., Ishii, K., Morimatsu, H.

BMC Anesthesiology 18 ( 1 ) 13 - 13 2018

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (VT) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (FIO2). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery. METHODS: We performed a prospective observational two-center study in Japan. Patients scheduled for thoracic surgery with OLV from April to October 2014 were eligible. We recorded ventilator settings (FIO2, VT, driving pressure (ΔP), and PEEP) and calculated the time-weighted average (TWA) of ventilator settings for the first 2 h of OLV. PPCs occurring within 7 days of thoracotomy were investigated. Associations between ventilator settings and the incidence of PPCs were examined by multivariate logistic regression. RESULTS: We analyzed perioperative information, including preoperative characteristics, ventilator settings, and details of surgery and anesthesia in 197 patients. Pressure control ventilation was utilized in most cases (92%). As an initial setting for OLV, an FIO2 of 1.0 was selected for more than 60% of all patients. Throughout OLV, the median TWA FIO2 of 0.8 (0.65-0.94), VT of 6.1 (5.3-7.0) ml/kg, ΔP of 17 (15-20) cm H2O, and PEEP of 4 (4-5) cm H2O was applied. Incidence rate of PPCs was 25.9%, and FIO2 was independently associated with the occurrence of PPCs in multivariate logistic regression. The adjusted odds ratio per FIO2 increase of 0.1 was 1.30 (95% confidence interval: 1.04-1.65, P = 0.0195). CONCLUSIONS: High FIO2 was applied to the majority of patients during OLV, whereas low VT and slight degree of PEEP were commonly used in our survey. Our findings suggested that a higher FIO2 during OLV could be associated with increased incidence of PPCs.

DOI： 10.1186/s12871-018-0476-x

Scopus

PubMed

researchmap

　 PREV - NEXT 　

< OKAHARA Shuji >

Papers - OKAHARA Shuji