研究者詳細 - 森松　博史

論文 - 森松　博史

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Integrated pulmonary index can predict respiratory compromise in high-risk patients in the post-anesthesia care unit: a prospective, observational study. 国際誌

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

BMC anesthesiology 21 ( 1 ) 123 - 123 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: 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 (SpO2), 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). METHODS: 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). RESULTS: 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 SpO2 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, p < 0.001 and 95.9 ± 4.2 % vs. 98.3 ± 1.9 %, p = 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 SpO2 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, p = 0.002). CONCLUSIONS: 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.

DOI： 10.1186/s12871-021-01338-1

Effectiveness of scheduled intravenous acetaminophen in the postoperative pain management of video-assisted thoracic surgery. 査読

Yoshinobu Shikatani, Junichi Soh, Kazuhiko Shien, Takeshi Kurosaki, Shinji Ohtani, Hiromasa Yamamoto, Arata Taniguchi, Mikio Okazaki, Seiichiro Sugimoto, Masaomi Yamane, Takahiro Oto, Hiroshi Morimatsu, Shinichi Toyooka

Surgery today 51 ( 4 ) 589 - 594 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The scheduled administration of intravenous acetaminophen (scheduled-IV-AcA) is one of the more effective multimodal analgesic approaches for postoperative pain in abdominal/orthopedic surgeries. However, there is little evidence concerning scheduled-IV-AcA after general thoracic surgery, especially when limited to video-assisted thoracoscopic surgery (VATS). We investigated the efficacy of scheduled-IV-AcA administration in patients after undergoing VATS. METHODS: Ninety-nine patients who underwent VATS lobectomy or segmentectomy via an 8-cm access window and 1 camera port were retrospectively reviewed by categorizing them into groups either with scheduled-IV-AcA (Group AcA: n = 29) or without it (Group non-AcA: n = 70). Group AcA received 1 g of IV-AcA every 6 h from the end of the operation until the end of POD2. Postoperative pain was measured using a numeric rating scale (NRS) three times per day until discharge. RESULTS: NRS scores were significantly lower in Group AcA with motion (on POD1 to the first point of POD2) than in Group non-AcA. Group non-AcA was also more likely to use additional analgesics than Group AcA (39% vs. 17%, p = 0.058). CONCLUSIONS: Scheduled-IV-AcA administration is a safe and effective multimodal analgesic approach in patients undergoing VATS pulmonary resection via an 8-cm access window.

DOI： 10.1007/s00595-020-02127-y

Two cases of intraoperative hemodynamic instability during combined thoracoscopic-laparoscopic surgery for esophagogastric junction carcinoma. 国際誌

Makiko Tani, Yoshikazu Matsuoka, Mayu Sugihara, Ayaka Fujii, Tomoyuki Kanazawa, Hiroshi Morimatsu

JA clinical reports 7 ( 1 ) 16 - 16 2021年2月

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

Perioperative Milrinone Infusion Improves One-Year Survival After the Norwood-Sano Procedure. 国際誌

Tomoyuki Kanazawa, Kazuyoshi Shimizu, Tatsuo Iwasaki, Kenji Baba, Shinichi Otsuki, Yasuhiro Kotani, Shingo Kasahara, Hiroshi Morimatsu

Journal of cardiothoracic and vascular anesthesia 2021年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: The aim of this study was to investigate whether milrinone infusion improved one-year survival in patients who underwent the Norwood-Sano procedure. DESIGN: A retrospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: Children who underwent the Norwood-Sano procedure from January 2008 to December 2014. INTERVENTIONS: Patients were categorized into two groups: group E+D, who received routine epinephrine and dopamine infusion, and group M, who received routine milrinone infusion for intra- and postoperative inotropic support. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study was one-year survival after the Norwood-Sano procedure. A total of 45 patients were included (group E+D, 22; group M, 23). One-year survival in group M was significantly higher than that in group E+D (95.7% [22/23] v 72.7% [16/22], p = 0.03). A Kaplan-Meier curve also showed that one-year survival in group M was significantly higher than that in group E+D (p = 0.04), from the result of the log-rank test. The number of patients who had any arrhythmias in the intensive care unit (ICU) was significantly lower in group M than in group E+D (21.7% [5/23] v 50% [11/22], p = 0.03). The duration of ICU stay did not have statistical difference between groups (group M 19; interquartile range [IQR], 15-28) v group E+D 19.5 (IQR, 16.3-35.5) days, p = 0.57). CONCLUSIONS: Perioperative milrinone infusion improved the mortality after the Norwood-Sano procedure. Potential advantages of milrinone compared with epinephrine are fewer arrhythmias and better systemic perfusion, which could decrease lethal cardiac events in the ICU.

DOI： 10.1053/j.jvca.2021.02.017

心不全症状を伴う胸腔内巨大慢性拡張性血腫に対して硬膜外麻酔下血腫減量術を先行した二期分割手術の麻酔経験

五反田倫子, 松岡義和, 廣井一正, 松岡勇斗, 小林求, 森松博史

日本臨床麻酔学会誌 41 ( 1 ) 36 - 41 2021年1月

Role of the Transcription Factor BTB and CNC Homology 1 in a Rat Model of Acute Liver Injury Induced by Experimental Endotoxemia

Nohito Tanioka, Hiroko Shimizu, Emiko Omori, Toru Takahashi, Masakazu Yamaoka, Hiroshi Morimatsu

Acta Medica Okayama 75 ( 3 ) 363 - 372 2021年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Okayama University

Hepatic oxidative stress plays an important role in the pathogenesis of several acute liver diseases, and free heme is thought to contribute to endotoxemia-induced acute liver injury. The heme oxygenase 1 (HO-1) gene is upregulated and the δ-aminolevulinate synthase (ALAS1) gene is downregulated in the rat liver following lipopolysaccharide (LPS) treatment. BTB and CNC homology 1 (Bach1) is a heme-responsive transcription factor that normally represses HO-1 expression. In this study, we evaluated the changes in HO-1, ALAS1, and Bach1 expression and nuclear Bach1 expression in rat livers following intravenous LPS administration (10 mg/kg body weight). LPS significantly upregulated HO-1 mRNA and downregulated ALAS1 mRNA in the rat livers, suggesting that hepatic free heme concentrations are increased after LPS treatment. Bach1 mRNA was strongly induced after LPS injection. In contrast, nuclear Bach1 was significantly but transiently decreased after LPS treatment. Rats were also administered hemin (50 mg/kg body weight) intravenously to elevate heme concentrations, which decreased nuclear Bach1 levels. Our results suggest that elevated hepatic free heme may be associated with a decline of nuclear Bach1, and induction of Bach1 mRNA may compensate for the decreased nuclear Bach1 after LPS treatment in the rat liver.

Association between intraoperative hyperglycemia and postoperative end-organ dysfunctions after cardiac surgery: a retrospective observational study

Shinsaku Matsumoto, Hiroki Omiya, Waso Fujinaka, Hiroshi Morimatsu

Journal of Anesthesia 2021年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Japan

Purpose: Hyperglycemia has been associated with postoperative morbidity in patients who undergo cardiac surgery. However, it remains unclear whether the duration of hyperglycemia is as important as its magnitude in the development of postoperative end-organ dysfunction (PEOD). This retrospective study investigated the hypothesis that the intraoperative blood glucose (BG) exposure index (GE index), calculated by the product of the magnitude and duration of BG concentration ≥ 180 mg/dL, which is an integration of the severity and duration of hyperglycemia, is associated with the incidence of PEOD in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: The primary outcome in this study was PEOD within 72 h of surgery, which was defined as a composite of postoperative acute kidney injury, delirium, myocardial injury, and prolonged mechanical ventilation. The GE index (the magnitude of BG concentration deviation ≥ 180 mg/dL × duration of BG concentration ≥ 180 mg/dL) of each patient was calculated based on the intraoperative BG concentration. The relationship between the GE index and the primary outcome was examined via logistic regression model with adjustment for potential confounders. Results: Within 72 h of surgery, 301 patients (54.5%) developed PEOD. PEOD was more common in patients with greater GE index quartiles (first versus third quartile
adjusted odds ratio, 5.65, 95% confidence interval (95% CI), 2.94–10.90
P &lt
0.001
first versus forth quartile, adjusted odds ratio, 20.80
95% CI, 8.01–54.00
P &lt
0.001). Conclusion: In patients undergoing cardiac surgery with cardiopulmonary bypass, the GE index was an independent predictor of PEOD.

DOI： 10.1007/s00540-021-03024-5

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

Hideki Taninishi, Takashi Matsusaki, Hiroshi Morimatsu

Scientific Reports 10 ( 1 ) 2020年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nature Research

Analgesic effect of transversus abdominis plane block (TAP block) in lower major abdominal laparoscopic surgery with about 5 cm of maximum surgical scar has been controversial. We hypothesized that TAP block has benefits, so the analgesic effect of TAP block after robot-assisted laparoscopic prostatectomy (RALP) was evaluated. One hundred patients were enrolled in this prospective, double-blinded, randomized study. Standardized general anesthesia with wound infiltration on camera port and fentanyl dose limit of 3 µg/kg was provided. Ultrasound-guided, single-shot subcostal TAP block with either 0.375% ropivacaine (Ropivacaine group, 48 patients) or normal saline (Control group, 52 patients) was performed by anesthesiologist in charge (34 anesthesiologists) after surgical procedure. Pain score using numerical rating scale (NRS) and postoperative intravenous fentanyl were evaluated for the first 24 postoperative hours. Median values (interquartile range) of NRS scores when the patients were transferred to post-anesthesia care unit (PACU) were 5 (2–7) in Ropivacaine group and 6 (4–8) in Control group at rest (P = 0.03), 5 (2–8) in Ropivacaine group and 7 (5–8) in Control group during movement (P &lt
0.01). These significant differences disappeared at the time of discharging PACU. Fentanyl doses for the first 24 postoperative hours were 210 µg (120–360) in Ropivacaine group and 200 µg (120–370) in Control group (P = 0.79). These results indicated that subcostal TAP block by anesthesiologists of varied level of training reduced postoperative pain immediate after RALP. TAP block had fundamental analgesic effect, but this benefit was too small to reduce postoperative 24-hour fentanyl consumption.

DOI： 10.1038/s41598-020-60687-y

Successful treatment with positive airway pressure ventilation for tension pneumopericardium after pericardiocentesis in a neonate: a case report. 国際誌

Makiko Tani, Tomoyuki Kanazawa, Naohiro Shioji, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

JA clinical reports 6 ( 1 ) 79 - 79 2020年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Pneumopericardium in neonates is often associated with respiratory diseases, of which positive pressure ventilation (PPV) is an exacerbating factor. Here, we present a neonate case of pneumopericardium after cardiac surgery which was resolved after applying PPV. CASE PRESENTATION: A 28-day-old neonate with left recurrent nerve palsy after aortic reconstruction for interrupted aortic arch developed pericardial effusion. Pericardiocentesis was performed under general anesthesia, and a drainage tube was left in the pericardium. After extubation, stridor gradually exacerbated, following hemodynamic deterioration. A chest X-ray demonstrated pneumopericardium. Upper airway stenosis due to recurrent nerve palsy developed excessive negative pleural pressure, and air was drawn into pericardium via the insertion site of the drainage tube. After tracheal intubation and applying PPV, the pneumopericardium improved. CONCLUSION: PPV does not always exacerbate pneumopericardium. In a patient with pericardial-atmosphere communication, increased inspiration effort can cause pneumopericardium, and PPV is a therapeutic option to alleviate the pneumopericardium.

DOI： 10.1186/s40981-020-00384-x

重度呼吸機能障害のあるハイリスク食道癌患者に対する多職種介入による長期術前管理

廣川万里子, 板垣栞, 田村利枝, 三宅裕高, 福田智美, 松岡義和, 小林求, 森松博史

日本臨床麻酔学会誌 40 ( 6 ) S275 - S275 2020年10月

【周術期管理】(PART5)周術期チーム医療のこれから PERIO 10年を振り返って

松岡義和, 森松博史

LiSA 別冊 27 ( 別冊'20秋号 ) 287 - 289 2020年9月

記述言語：日本語出版者・発行元：(株)メディカル・サイエンス・インターナショナル

＜文献概要＞岡山大学病院(以下,当院)は,2008年に周術期管理センターperioperative management center(PERIO)を開設し,多職種連携による周術期管理を目指してきた。2018年には10周年を迎え,2020年時点で12年目である。本稿では,これまでのPERIOの歴史を振り返りながら,これからの周術期管理について考えてみたい。

Treat and Repairを行った重度肺高血圧症を伴う成人心室中隔欠損症の一麻酔管理例

武藤典子, 岩崎達雄, 金澤伴幸, 清水達彦, 佐倉考信, 黒江泰利, 清水一好, 森松博史

Cardiovascular Anesthesia 24 ( Suppl. ) 150 - 150 2020年9月

穿通胎盤遺残の管理にThromboelastographyを使用した一例

西本れい, 廣井一正, 松岡義和, 日笠友起子, 白川拓, 坪井千佳, 小坂順子, 清水一好, 賀来隆治, 森松博史

日本集中治療医学会雑誌 27 ( Suppl. ) 580 - 580 2020年9月

Workplace-based assessment導入には、指導医の養成と積極参加を促す工夫が必要自施設での導入経験から

谷真規子, 清水一好, 金澤伴幸, 森松博史

医学教育 51 ( Suppl. ) 210 - 210 2020年7月

【急性血液浄化法2020-'21-ガイドライン、スタンダード、論点そして私見-】急性血液浄化療法の適応疾患・臨床場面頭蓋内病変合併例に対する血液浄化療法

大岩雅彦, 清水一好, 森松博史

救急・集中治療 32 ( 2 ) 513 - 520 2020年6月

記述言語：日本語出版者・発行元：(株)総合医学社

＜POINT＞頭蓋内病変を有している症例での血液浄化療法は、▼不均衡症候群に伴う脳浮腫増悪、血圧低下に伴う脳灌流圧低下、抗凝固薬使用に伴う出血増悪などのリスクが高く、頭蓋内圧(intracranial pressure:ICP)上昇をひき起こす危険性が高い。▼血流量と浄化量をゆっくりと、生体適合性に優れた表面積の小さい浄化膜を用い、重炭酸濃度を抑え、ナトリウム濃度を高くした透析液の使用などを考慮する。▼continuous renal replacement therapy(CRRT)のほうが、intermittent renal replacement therapy(IRRT)より推奨される。▼IRRTを選択する場合は血液濾過(hemofiltraion:HF)やsustained low efficiency dialysis(SLED)を検討する。▼抗凝固薬の選択や浸透圧療法の併用を考慮する。(著者抄録)

Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study.

Yukiko Hikasa, Satoshi Suzuki, Yuko Mihara, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Hiroshi Morimatsu

Journal of anesthesia 34 ( 3 ) 404 - 412 2020年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE. METHODS: This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications. RESULTS: In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001). CONCLUSIONS: In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.

DOI： 10.1007/s00540-020-02766-y

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年5月

記述言語：日本語出版者・発行元：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)

その他リンク： 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

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery - Multicenter Randomized Controlled Study. 査読

Hironobu Toda, Kazufumi Nakamura, Kazuyoshi Shimizu, Kentaro Ejiri, Takayuki Iwano, Toru Miyoshi, Koji Nakagawa, Masashi Yoshida, Atsuyuki Watanabe, Nobuhiro Nishii, Yukiko Hikasa, Masao Hayashi, Hiroshi Morita, Hiroshi Morimatsu, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 84 ( 4 ) 642 - 649 2020年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of transdermal β-blocker patches, which offer stable blood concentration and easy availability during operation, for prevention of perioperative myocardial injury (PMI) in high-risk patients.Methods and Results:In this randomized controlled trial, patients aged >60 years with hypertension and high revised cardiac risk index (≥2) undergoing non-cardiac surgery were randomly assigned to a bisoprolol patch or control group. Primary efficacy outcome was incidence of PMI, defined as postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL and relative hs-cTnT change ≥20%. Secondary efficacy outcomes were number of cardiovascular events and 30-day mortality. From November 2014 to February 2019, 240 patients from 5 hospitals were enrolled in this study. The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in the control group (P=0.18). Incidence of major adverse cardiac events including non-critical myocardial infarction, strokes, decompensated heart failure and tachyarrhythmia was similar between the 2 groups. Tachyarrhythmia tended to be higher in the control group. There were no significant differences in safety outcomes including significant hypotension and bradycardia requiring any treatment between the 2 groups. CONCLUSIONS: Bisoprolol patches do not influence the incidence of PMI and cardiovascular events in high-risk patients undergoing non-cardiac surgery, but perioperative use of these patches is safe.

DOI： 10.1253/circj.CJ-19-0871

Evaluation of a point-of-care serum creatinine measurement device and the impact on diagnosis of acute kidney injury in pediatric cardiac patients: A retrospective, single center study. 査読国際誌

Satoshi Kimura, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomoyuki Kanazawa, Hirokazu Kawase, Naohiro Shioji, Yasutoshi Kuroe, Satoshi Isoyama, Hiroshi Morimatsu

Health science reports 3 ( 1 ) e143 2020年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background and aims: Agreement between measurements of creatinine concentrations using point-of-care (POC) devices and measurements conducted in a standard central laboratory is unclear for pediatric patients. Our objectives were (a) to assess the agreement for pediatric patients and (b) to compare the incidence of postoperative acute kidney injury (AKI) according to the two methods. Methods: This retrospective, single-center study included patients under 18 years of age who underwent cardiac surgery and who were admitted into the pediatric intensive care unit of a tertiary teaching hospital (Okayama University Hospital, Japan) from 2013 to 2017. The primary objective was to assess the correlation and the agreement between measurements of creatinine concentrations by a Radiometer blood gas analyzer (Cregas) and those conducted in a central laboratory (Crelab). The secondary objective was to compare the incidence of postoperative AKI between the two methods based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results: We analyzed the results of 1404 paired creatinine measurements from 498 patients, whose median age was 14 months old (interquartile range [IQR] 3, 49). The Pearson correlation coefficient of Cregas vs Crelab was 0.968 (95% confidence interval [CI], 0.965-0.972, P < 0.001). The median bias between Cregas and Crelab was 0.02 (IQR -0.02, 0.05) mg/dL. While 199 patients (40.0%) were diagnosed as having postoperative AKI based on Crelab, 357 patients (71.7%) were diagnosed as having postoperative AKI based on Cregas (Kappa = 0.39, 95% CI, 0.33-0.46). In a subgroup analysis of patients whose Cregas and Crelab were measured within 1 hour, similar percentage of patients were diagnosed as having postoperative AKI based on Cregas and Crelab (42.8% vs 46.0%; Kappa = 0.76, 95% CI, 0.68-0.84). Conclusion: There was an excellent correlation between Cregas and Crelab in pediatric patients. Although more patients were diagnosed as having postoperative AKI based on Cregas than based on Crelab, paired measurements with a short time gap showed good agreement on AKI diagnosis.

DOI： 10.1002/hsr2.143

Pediatric Living Donor Liver Transplantation for Congenital Absence of the Portal Vein With Pulmonary Hypertension: A Case Report. 国際誌

Naohisa Matsumoto, Takashi Matsusaki, Kazumasa Hiroi, Ryuji Kaku, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi, Hiroshi Morimatsu

Transplantation proceedings 52 ( 2 ) 630 - 633 2020年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

Few reports of liver transplantation exist in patients with congenital absence of the portal vein and pulmonary hypertension. Living donor liver transplantation is usually performed before exacerbation of pulmonary hypertension. A 7-year-old girl (height: 131.5 cm; weight: 27.4 kg) with congenital absence of the portal vein was diagnosed with pulmonary hypertension (mean pulmonary artery pressure 35 mm Hg), and liver transplantation was planned before exacerbation of pulmonary hypertension. We successfully managed her hemodynamic parameters using low-dose dopamine and noradrenaline under monitoring of arterial blood pressure, central venous pressure, cardiac output, and stroke volume variation. Anesthesia was maintained using air-oxygen-sevoflurane and remifentanil 0.1 to 0.6 μg∙kg-1∙min-1. It is necessary to understand the potential perioperative complications in such cases and to adopt a multidisciplinary team approach in terms of the timing of transplantation and readiness to deal with exacerbation of pulmonary hypertension.

DOI： 10.1016/j.transproceed.2019.11.032

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