研究者詳細 - 森松　博史

論文 - 森松　博史

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Carboxyhemoglobin and Methemoglobin Levels and Hemolysis in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass. 査読国際誌

Tsubasa Yoshida, Takanobu Sakura, Kazuyoshi Shimizu, Satoshi Kimura, Tatsuo Iwasaki, Tomoyuki Kanazawa, Hiroshi Morimatsu

ASAIO journal (American Society for Artificial Internal Organs : 1992) 2023年10月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Hemolysis is a complication of cardiopulmonary bypass (CPB). Carboxyhemoglobin (COHb) and methemoglobin (MetHb) were suggested as potential hemolysis biomarkers. This retrospective study was based on a prospective registry aimed to determine the association of COHb and MetHb levels with hemolysis in pediatric patients <4 years old who underwent cardiac surgery with CPB. Plasma-free hemoglobin (PFH), COHb, and MetHb levels were measured before CPB; every 30 minutes during CPB; and on postoperative days 1, 2, and 3. Patients were classified into hemolysis and nonhemolysis groups based on the maximum PFH levels during CPB. A total of 193 patients were included. No significant difference was observed in the maximum COHb levels during CPB (COHbCPB) between the hemolysis and nonhemolysis groups (1.2% [interquartile range {IQR} 0.9-1.4%] vs. 1.1% [IQR: 0.9-1.4%]; p = 0.17). The maximum MetHb levels during CPB (MetHbCPB) were significantly higher in the hemolysis group than in the nonhemolysis group (1.3% [IQR: 1.1-1.5%] vs. 1.2% [IQR: 1.0-1.4%]; p = 0.007). Areas under the receiver operating curves of COHbCPB and MetHbCPB were 0.557 (95% confidence interval: 0.475-0.640) and 0.615 (95% confidence interval: 0.535-0.695), respectively. Therefore, the predictive ability of both hemolysis biomarkers during CPB is limited.

DOI： 10.1097/MAT.0000000000002044

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【効率化と質向上を目指した術前外来up-to-date】術前外来に関するエビデンスと現状招待

伊加真士, 清水達彦, 森松博史

日本手術医学会誌 44 ( 3 ) 261 - 266 2023年10月

全身麻酔下小児心臓カテーテルにおける低血圧発生率:レミマゾラムとセボフルランの後方視的比較検討査読

清水達彦, 金澤伴幸, 吉田翼, 佐倉考信, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 29 ( Suppl. ) 113 - 113 2023年10月

全身麻酔下小児心臓カテーテルにおける低血圧発生率:レミマゾラムとセボフルランの後方視的比較検討

清水達彦, 金澤伴幸, 吉田翼, 佐倉考信, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 29 ( Suppl. ) 113 - 113 2023年10月

Relationship of Intraoperative SpO2 and ETCO2 Values with Postoperative Hypoxemia in Elderly Patients after Non-Cardiac Surgery.

Qingqing Song, Yu Pan, Tomoyuki Kanazawa, Hiroshi Morimatsu

Acta medica Okayama 77 ( 5 ) 537 - 543 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Elderly patients are at higher risk of postoperative hypoxemia due to their decreased respiratory function. The aim of this study was to investigate the relationship of intraoperative oxygen saturation (SpO2) and end-expiratory carbon dioxide (ETCO2) values with postoperative hypoxemia in elderly patients. The inclusion criteria were: 1) patients aged≥75 years; 2) underwent general anesthesia in non-cardiac surgery; 3) operative time longer than two hours; and 4) admission to the intensive care unit (ICU) following surgery performed between January and December 2019. Intraoperative SpO2 and ETCO2 values were collected every minute for the first two hours during surgery. The 253 patients were divided into two groups: SpO2≥92% and SpO2<92%. The time-weighted averages of intraoperative SpO2 and ETCO2 were used to compare differences between the two groups. The incidence of postoperative hypoxemia was 22.5%. For similar ventilator settings, patients with postoperative hypoxemia had lower intraoperative SpO2 and higher ETCO2 values. Sex, ASA classification, and intraoperative SpO2 were independent risk factors for postoperative hypoxemia. In conclusion, postoperative SpO2<92% was a frequent occurrence (> 20%) in elderly patients who underwent major non-cardiac surgery. Postoperative hypoxemia was associated with low intraoperative SpO2 and relatively higher ETCO2.

DOI： 10.18926/AMO/65976

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Stroke volume variation and dynamic arterial elastance predict fluid responsiveness even in thoracoscopic esophagectomy: a prospective observational study 査読

Yukiko Hikasa, Satoshi Suzuki, Shunsuke Tanabe, Kazuhiro Noma, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Hiroshi Morimatsu

Journal of Anesthesia 37 ( 6 ) 930 - 937 2023年9月

持続くも膜下鎮痛を在宅で行った一経験例査読

武藤典子, 中村龍, 藤原典子, 片山英樹, 森松博史

Palliative Care Research 18 ( Suppl._Chugoku-Shikoku ) S635 - S635 2023年9月

症例報告フォンタン手術後の肝切除術の麻酔経験査読

道満啓, 佐倉考信, 藤井彩加, 松崎孝, 岩崎達雄, 森松博史

麻酔 72 ( 8 ) 769 - 773 2023年8月

【急性腎障害(AKI)新たな局面に向けて】臨床におけるAKI治療の考え方 AKI予防のための血圧管理招待

吉田翼, 清水達彦, 森松博史

Medical Practice 40 ( 8 ) 1250 - 1253 2023年8月

Cardiopulmonary Resuscitation May Not Stop Glutamate Release in the Cerebral Cortex. 査読国際誌

Miki Fushimi, Yoshimasa Takeda, Ryoichi Mizoue, Sachiko Sato, Hirokazu Kawase, Yuji Takasugi, Satoshi Murai, Hiroshi Morimatsu

Journal of neurosurgical anesthesiology 35 ( 3 ) 341 - 346 2023年7月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Cardiopulmonary resuscitation (CPR) may not be sufficient to halt the progression of brain damage. Using extracellular glutamate concentration as a marker for neuronal damage, we quantitatively evaluated the degree of brain damage during resuscitation without return of spontaneous circulation. MATERIALS AND METHODS: Extracellular cerebral glutamate concentration was measured with a microdialysis probe every 2 minutes for 40 minutes after electrical stimulation-induced cardiac arrest without return of spontaneous circulation in Sprague-Dawley rats. The rats were divided into 3 groups (7 per group) according to the treatment received during the 40 minutes observation period: mechanical ventilation without chest compression (group V); mechanical ventilation and chest compression (group VC) and; ventilation, chest compression and brain hypothermia (group VCH). Chest compression (20 min) and hypothermia (40 min) were initiated 6 minutes after the onset of cardiac arrest. RESULTS: Glutamate concentration increased in all groups after cardiac arrest. Although after the onset of chest compression, glutamate concentration showed a significant difference at 2 min and reached the maximum at 6 min (VC group; 284±48 μmol/L vs. V group 398±126 μmol/L, P =0.003), there was no difference toward the end of chest compression (513±61 μmol/L vs. 588±103 μmol/L, P =0.051). In the VCH group, the initial increase in glutamate concentration was suddenly suppressed 2 minutes after the onset of brain hypothermia. CONCLUSIONS: CPR alone reduced the progression of brain damage for a limited period but CPR in combination with brain cooling strongly suppressed increases in glutamate levels.

DOI： 10.1097/ANA.0000000000000838

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Associations of systemic oxygen consumption with age and body temperature under general anesthesia: retrospective cohort study. 国際誌

Satoshi Kimura, Kazuyoshi Shimizu, Hiroshi Morimatsu

BMC anesthesiology 23 ( 1 ) 216 - 216 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Body temperature (BT) is thought to have associations with oxygen consumption (VO2). However, there have been few studies in which the association between systemic VO2 and BT in humans was investigated in a wide range of BTs. The aims of this study were 1) to determine the association between VO2 and age and 2) to determine the association between VO2 and BT. METHODS: This study was a retrospective study of patients who underwent surgery under general anesthesia at a tertiary teaching hospital. VO2 was measured by the Dräger Perseus A500 anesthesia workstation (Dräger Medical, Lubeck, Germany). The associations of VO2 with age and BT were examined using spline regression and multivariable regression analysis with a random effect. RESULTS: A total of 7,567 cases were included in this study. A linear spline with one knot shows that VO2 was reduced by 2.1 ml/kg/min with one year of age (p < 0.001) among patients less than 18 years of age and that there was no significant change in VO2 among patients 18 years of age or older (estimate: 0.014 ml/kg/min, p = 0.08). VO2 in all bands of BT < 36.0 °C was not significantly different from VO2 in BT > = 36 °C and < 36.5 °C. Multivariable linear regression analysis showed that compared with VO2 in BT > = 36 °C and < 36.5 °C as a reference, VO2 levels were significantly higher by 0.57 ml/kg/min in BT > = 36.5 °C and < 37 °C (p < 0.001), by 1.8 ml/kg/min in BT > = 37 °C and < 37.5 °C (p < 0.001), by 3.6 ml/kg/min in BT > = 37.5 °C and < 38 °C (p < 0.001), by 4.9 ml/kg/min in BT > = 38 °C and < 38.5 °C (p < 0.001), and by 5.7 ml/kg/min in BT > = 38.5 °C (p < 0.001). The associations between VO2 and BT were significantly different among categorized age groups (p = 0.03). CONCLUSIONS: VO2 increases in parallel with increase in body temperature in a hyperthermic state but remains constant in a hypothermic state. Neonates and infants, who have high VO2, may have a large systemic organ response in VO2 to change in BT.

DOI： 10.1186/s12871-023-02182-1

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Assessing the Role of Perioperative Nutritional Education in Improving Oral Intake after Oesophagectomy: A Retrospective Study. 査読国際誌

Mika Sonoi, Kazuhiro Noma, Shunsuke Tanabe, Naoaki Maeda, Yasuhiro Shirakawa, Hiroshi Morimatsu

Asian Pacific journal of cancer prevention : APJCP 24 ( 6 ) 2037 - 2041 2023年6月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: This study aimed to determine whether nutritional education, from the preoperative to postoperative period, and nutritional management designed to improve nutritional status alone, could improve patients' health-related self-management and nutritional management skills during the postoperative period. METHODS: We evaluated 101 hospitalised patients with oesophageal cancer who underwent surgery between 2015 and 2016 and received perioperative nutritional education (PERIO-N). The control group included 52 patients who underwent surgery between 2014 and 2015 and were supported only by normal interventions according to the Enhanced Recovery After Surgery protocol. The PERIO-N group paid specific attention to nutrition risk screening, nutrition assessment, nutrition monitoring, and lifestyle education. RESULTS: The patients in the PERIO-N group were 1.8 times more likely to be able to consume food orally than the control group (p=0.010). In the PERIO-N group, 50.5% of the patients could orally consume food, 42.6% received a combination of oral and enteral nutrition, and 6.9% only underwent enteral nutrition. In comparison, in the control group, 28.8% of the patients could orally consume food, 53.8% received a combination of oral and enteral nutrition, and 17.3% were only administered enteral nutrition (p=0.004). In addition, patients in the PERIO-N group were discharged at a 1.5 times higher rate than those in the control group (p=0.027). The readmission rate for malnutrition within 3 months was 4% in the PERIO group (5.4% for home discharge only) and 5.8% in the control group (10.5% for home discharge only) (p=0.61). CONCLUSION: This study found that perioperative nutrition education in patients who underwent oesophageal cancer surgery led to increase in the amount of oral intake at discharge. Moreover, the group that received nutrition education did not have an increased probability of hospitalisation due to the risk of malnutrition within 3 months after discharge.

DOI： 10.31557/APJCP.2023.24.6.2037

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めざせLess is more(臓器別編) 人工呼吸管理離脱にhyperoxiaは有用か多施設前向きコホート研究におけるpost-hoc解析

田中愛子, 平尾収, 小坂順子, 古島夏奈, 牧裕一, 内山昭則, 森松博史, 溝渕知司, 小竹良文, 藤野裕士

日本集中治療医学会雑誌 30 ( Suppl.1 ) S382 - S382 2023年6月

Early Fluid Balance Is Associated with 90-Day Mortality in Patients Receiving Continuous Renal Replacement Therapy.

Yusheng Guo, Junko Kosaka, Hiroshi Morimatsu

Acta medica Okayama 77 ( 3 ) 263 - 272 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Continuous renal replacement therapy (CRRT) is widely used to control fluid balance, but the optimal fluid balance to improve the prognosis of patients remains debated. Appropriate fluid management may depend on hemodynamic status. We investigated the association between 90-day mortality and fluid balance/mean arterial pressure (MAP) in patients receiving CRRT. This single-center retrospective study was conducted between May 2018 and March 2021. Based on the cumulative fluid balance at 72 h after initiation of CRRT, the cases were divided into negative (< 0 mL) and positive (> 0 mL) fluid balance groups. Ninety-day mortality was higher in the positive fluid balance group (p=0.009). At 4 h before and after CRRT initiation, the mean MAP was lower in the positive fluid balance group (p<0.05). After multivariate cox adjustment, 72-h positive fluid balance was independently associated with 90-day mortality (p=0.004). In addition, the cumulative fluid balance was associated with 90-day mortality (p<0.05) in cases without shock, high APACHE II score, sepsis, dialysis dependence, or vasopressor use. A 72-h positive fluid balance was associated with 90-day mortality in patients receiving CRRT.

DOI： 10.18926/AMO/65491

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人工呼吸離脱時の平均肺動脈圧と再挿管率との関係多施設前向きコホート研究におけるpost-hoc解析

小坂順子, 田中愛子, 平尾収, 古島夏奈, 鈴木聡, 小竹良文, 江木盛時, 藤野裕士, 森松博史

日本集中治療医学会雑誌 30 ( Suppl.1 ) S416 - S416 2023年6月

Efficacy of prophylactic high-flow nasal cannula therapy for postoperative pulmonary complications after pediatric cardiac surgery: a prospective single-arm study.

Tatsuhiko Shimizu, Tomoyuki Kanazawa, Takanobu Sakura, Naohiro Shioji, Kazuyoshi Shimizu, Ryuichiro Fukuhara, Takayoshi Shinya, Tatsuo Iwasaki, Hiroshi Morimatsu

Journal of anesthesia 37 ( 3 ) 433 - 441 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: This study investigated the incidence of postoperative pulmonary complications (PPC) when high-flow nasal cannula therapy (HFNC) is used prophylactically after pediatric cardiac surgery, and evaluated its efficacy. METHODS: This was a single-arm prospective interventional study that was conducted in a tertiary teaching hospital with eight beds in the pediatric cardiac ICU after approval by the Ethics Committee. One-hundred children under the age of 48 months who were scheduled for cardiac surgery for congenital heart disease were recruited. HFNC was used for 24 h after extubation at a 2 L/kg/min flow rate. The primary outcome was the incidence of PPC within 48 h after extubation. PPC was defined as atelectasis and acute respiratory failure meeting certain criteria. We considered prophylactic HFNC as effective if the prevalence of PPC was < 10%, based on previous reports of reintubation rates of 6%-9% after pediatric cardiac surgery. RESULTS: A total of 91 patients were finally included in the analysis. The incidence of PPC within 48 h after extubation was 18.7%, whereas atelectasis was observed in 13.2%, and acute respiratory failure in 8.8%. Reintubation rate within 48 h after extubation was 0%. CONCLUSIONS: We found the incidence of PPC with prophylactic HFNC after planned extubation after pediatric cardiac surgery. However, the incidence was > 10%; therefore, we could not demonstrate its efficacy in this single-arm study. Further studies are needed to investigate whether the HFNC could be adapted as first-line oxygen therapy after pediatric cardiac surgery.

DOI： 10.1007/s00540-023-03187-3

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An Assessment of the Practice of Neuromuscular Blockade and the Association Between Its Prophylactic Use and Outcomes Among Postoperative Pediatric Cardiac Patients. 査読国際誌

Satoshi Kimura, Kazuyoshi Shimizu, Yoshikazu Matsuoka, Tatsuo Iwasaki, Tomoyuki Kanazawa, Hiroshi Morimatsu

Journal of cardiothoracic and vascular anesthesia 37 ( 6 ) 980 - 987 2023年6月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: The authors investigated the management of neuromuscular blocking agents (NMBAs) for pediatric patients after cardiac surgery, and compared the outcomes of patients who received prophylactic NMBA (pNMBA) infusions and patients without pNMBA infusions. DESIGN: A retrospective cohort study. SETTING: At a tertiary teaching hospital. PARTICIPANTS: Patients younger than 18, with congenital heart disease, who underwent cardiac surgery. INTERVENTIONS: Commencement of NMBA infusion in the first 2 hours after surgery MEASUREMENTS AND MAIN RESULTS: The primary endpoint was a composite of one or more of the following major adverse events (MAEs) that occurred within 7 days after surgery: death from any cause, a circulatory collapse that needed cardiopulmonary resuscitation, and requirement for extracorporeal membrane oxygenation. The secondary endpoints included the total duration of mechanical ventilation for the first 30 days after surgery. A total of 566 patients were included in this study. The MAEs occurred in 13 patients (2.3%). An NMBA was commenced within 2 hours after surgery in 207 patients (36.6%). There were significant differences in the incidence of postoperative MAEs between the pNMBA group and the non-pNMBA group (5.3% v 0.6%; p < 0.001). In multivariate regression models, pNMBA infusion was not significantly associated with the incidence of MAEs (odds ratio: 1.79, 95% CI: 0.23-13.93, p = 0.58), but was significantly associated with prolonged mechanical ventilation by 3.85 days (p < 0.001). CONCLUSIONS: Postoperative prophylactic neuromuscular blockade after cardiac surgery can be associated with prolonged mechanical ventilation, but has no association with MAEs among pediatric patients with congenital heart disease.

DOI： 10.1053/j.jvca.2023.02.030

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Delayed emergence from anesthesia caused by an intraoperative cerebral embolism of a malignant peripheral nerve sheath tumor in a neurofibromatosis type 1 patient: a case report

Keishi Kawano, Makiko Tani, Hiroshi Morimatsu

JA Clinical Reports 9 ( 1 ) 2023年5月

掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

Background

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas which commonly arise from neurofibromatosis type 1. Lung metastases of the tumors are well-known, but intraoperative cerebral tumor embolisms of MPNSTs have not been reported in literature.

Case presentation

A 52-year-old female patient with neurofibromatosis type 1 underwent a right lung partial resection for lung tumors. She was extubated after adequate recovery of spontaneous breathing; however, she could not respond to verbal commands. In the intensive care unit, her neurological examination revealed conjugate eye deviation, right hemiparalysis, and aphasia. Magnetic resonance imaging revealed acute cerebral ischemia, so she underwent an endovascular thrombectomy. The histopathological diagnosis of emboli was a MPNST, which was identical with that of the resected lung tumor.

Conclusion

We report the first case of delayed emergence caused by a cerebral tumor embolism of MPNST during partial lung resection.

DOI： 10.1186/s40981-023-00614-y

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その他リンク： https://link.springer.com/article/10.1186/s40981-023-00614-y/fulltext.html

Regional Cerebral Oxygen Saturation and Estimated Oxygen Extraction Ratio as Predictive Markers of Major Adverse Events in Infants with Congenital Heart Disease. 国際誌

Satoshi Kimura, Kazuyoshi Shimizu, Kaoru Izumi, Tomoyuki Kanazawa, Keiichiro Mizuno, Tatsuo Iwasaki, Hiroshi Morimatsu

Pediatric cardiology 2023年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Regional cerebral oxygen saturation (ScO2) determined by near-infrared spectroscopy, monitoring both arterial and venous blood oxygenation of the brain, could reflect the balance between oxygen delivery and consumption. The aim of this study was to determine the predictabilities of ScO2 and estimated oxygen extraction ratio (eO2ER) with outcomes in infants with congenital heart disease (CHD). This study was a two-center, retrospective study of patients at 12 months of age or younger with CHD who underwent cardiac surgery. The primary outcome was a composite of one or more major adverse events (MAEs) after surgery: death from any cause, circulatory collapse that needed cardiopulmonary resuscitation, and requirement for extracorporeal membrane oxygenation. Based on the assumptions of arterial to venous blood ratio, eO2ER was calculated. A total of 647 cases were included in this study. MAEs occurred in 16 patients (2.5%). There were significant differences in post-bypass ScO2 [46.61 (40.90, 52.05) vs. 58.52 (51.52, 66.08), p < 0.001] and post-bypass eO2ER [0.66 (0.60, 0.78) vs. 0.52 (0.43, 0.61), p < 0.001] between patients with MAEs and patients without MAEs. Area under the receiver operating curve (AUROC) of post-bypass ScO2 was 0.818 (95% confidence interval: 0.747-0.889), AUROC of post-bypass eO2ER was 0.783 (0.697-0.870) and AUROC of post-bypass maximum serum lactate level was 0.635 (0.525-0.746). Both ScO2 and eO2ER, especially after weaning off bypass, are acceptable predictive markers for predicting MAEs after cardiac surgery in infants.(227 words).

DOI： 10.1007/s00246-023-03158-1

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肺移植術後の気管支狭窄解除術において、Electrical Impedance Tomographyを治療効果判定に使用した一例

木村貴一, 岡原修司, 清水一好, 森松博史

臨床モニター 34 ( Suppl. ) 62 - 62 2023年4月

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