研究者詳細 - 森松　博史

論文 - 森松　博史

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Clinical predictors of extubation failure in postoperative critically ill patients: a post-hoc analysis of a multicenter prospective observational study. 国際誌

Jun Hattori, Aiko Tanaka, Junko Kosaka, Osamu Hirao, Nana Furushima, Yuichi Maki, Daijiro Kabata, Akinori Uchiyama, Moritoki Egi, Hiroshi Morimatsu, Satoshi Mizobuchi, Yoshifumi Kotake, Ayumi Shintani, Yukiko Koyama, Takeshi Yoshida, Yuji Fujino

BMC anesthesiology 25 ( 1 ) 127 - 127 2025年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Postoperative patients constitute majority of critically ill patients, although factors predicting extubation failure in this group of patients remain unidentified. Aiming to propose clinical predictors of reintubation in postoperative patients, we conducted a post-hoc analysis of a multicenter prospective observational study. METHODS: This study included postoperative critically ill patients who underwent mechanical ventilation for > 24 h and were extubated after a successful 30-min spontaneous breathing trial. The primary outcome was reintubation within 48 h after extubation, and clinical predictors for reintubation were investigated using logistic regression analyses. RESULTS: Among the 355 included patients, 10.7% required reintubation. Multivariable logistic regression identified that the number of endotracheal suctioning episodes during the 24 h before extubation and underlying respiratory disease or pneumonia occurrence were significantly associated with reintubation (adjusted odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05-1.18, p < 0.001; adjusted OR 2.58, 95%CI 1.30-5.13, p = 0.007). The probability of reintubation was increased significantly with the higher frequency of endotracheal suctioning, as indicated by restricted cubic splines. Subgroup analysis showed that these predictors were consistently associated with reintubation regardless of the use of noninvasive respiratory support after extubation. CONCLUSIONS: Endotracheal suctioning frequency and respiratory complications were identified as independent predictors of reintubation. These readily obtainable predictors may aid in decision-making regarding the extubation of postoperative patients.

DOI： 10.1186/s12871-025-02996-1

Preoperative Nutritional Status Influences Enteral Nutrition Weaning 6 Months Post-Surgery in Patients with Esophageal Cancer. 国際誌

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

Asian Pacific journal of cancer prevention : APJCP 26 ( 1 ) 263 - 267 2025年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: This study aimed to clarify whether nutritional status at admission affects enteral nutrition weaning 6 months after surgery in patients with esophageal cancer. METHODS: This was a retrospective study of 81 patients who underwent subtotal esophageal cancer resection between April 2014 and February 2016. The survey items were as follows: 1) sex, 2) age, 3) presence or absence of family members living together, 4) clinical stage, 5) surgical procedure, 6) reconstructed organs, 7) nutritional status at admission, 8) presence or absence of postoperative complications (anastomotic leakage, chylothorax, and recurrent laryngeal nerve paralysis), and 9) presence or absence of treatment other than surgery (chemo- or radiotherapy). RESULTS: The enteral nutrition withdrawal rate after 6 months was 15.5% in the malnutrition group and 84.5% in the normal nutrition group (p = 0.007). In a comparison between groups with and without enteral nutrition after 6 months, a significant association was observed with surgical procedure, nutritional status at admission, and postoperative complications (p < 0.05). Logistic regression analysis showed that the odds of discontinuing enteral nutrition 6 months later were 5.692 (hazard ratio: 1.545-20.962) for malnutrition on admission and 11.921 (hazard ratio: 3.449-41.207) for complications. CONCLUSION: Regardless of the presence or absence of treatment other than surgery, preoperative nutritional improvement is beneficial for increasing postoperative oral intake.

DOI： 10.31557/APJCP.2025.26.1.263

Association between plasma-free haemoglobin and postoperative acute kidney injury in paediatric cardiac surgery: a prospective observational study 査読

Takanobu Sakura, Tomoyuki Kanazawa, Tatsuhiko Shimizu, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

BJA Open 12 100348 - 100348 2024年12月

Subjective global assessment for nutritional screening and its impact on surgical outcomes: A prospective study in older patients with colorectal cancer. 国際誌

Fuminori Teraishi, Yusuke Yoshida, Ryohei Shoji, Nobuhiko Kanaya, Yuki Matsumi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Shunsuke Kagawa, Rie Tamura, Yoshikazu Matsuoka, Hiroshi Morimatsu, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara

Langenbeck's archives of surgery 409 ( 1 ) 356 - 356 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: Our perioperative management center provides preoperative intervention and functional and nutritional assessments for colorectal cancer patients aged over 75 years. This study evaluated the associations of preoperative nutritional status with postoperative outcomes and prognosis in colorectal cancer patients aged 75 years or older. METHODS: This was a prospective, observational study of 71 colorectal cancer patients aged 75 years or older who underwent surgery between July 2020 and September 2022. The Subjective Global Assessment (SGA) was evaluated as a nutritional index. The patients were classified into three groups: SGA-A (well nourished), B (moderately malnourished), and C (severely malnourished), and the correlations with postoperative outcomes and prognosis were examined. RESULTS: The median age of the 71 patients (34 males, 37 females) was 78 (75-92) years, and their median body mass index (BMI) was 22.3 (13.4-31.9) kg/m2. Forty-eight patients had colon cancer, and 23 had rectal cancer. On the SGA, 28 patients were SGA-A, 25 SGA-B, and 18 SGA-C. The SGA-B/C group had significantly higher BMI (p < 0.01) and more ICU admissions (p = 0.02). The G8 score was significantly lower (p = 0.03) in the SGA-B/C group, suggesting coexisting functional decline. In terms of postoperative outcomes, the SGA-B/C group had a significantly longer postoperative hospital stay (p = 0.04). The 3-year OS rates for all stages were 100% in the SGA-A group and 49.7% in the SGA-B/C group (p = 0.03), while the 3-year OS rates for patients excluding Stage IV were 100% in the SGA-A group and 68.5% in the SGA-B/C group, not significantly different (p = 0.14). The 3-year RFS rate was 95.5% in the SGA-A group and 65.3% in the SGA-B/C group (p = 0.15). CONCLUSION: The SGA is a promising nutritional index associated with short-term outcomes in older patients undergoing colorectal cancer surgery. The SGA can be assessed in a few minutes during an outpatient visit, making it useful for routine clinical use.

DOI： 10.1007/s00423-024-03548-w

Oxygen Delivery During Cardiopulmonary Bypass in Pediatric Patients With Congenital Heart Disease: Association With Postoperative Acute Kidney Injury. 国際誌

Hiroshi Taka, Takuma Douguchi, Ayako Miyamoto, Kazuyoshi Shimizu, Tatsuo Iwasaki, Tomoyuki Kanazawa, Satoshi Kimura, Hiroshi Morimatsu

Journal of cardiothoracic and vascular anesthesia 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: This study was designed to investigate the distribution of nadir oxygen delivery (DO2), mean DO2, and area under ideal DO2 (AUiDO2) among categorized age groups of pediatric patients and their associations with postoperative cardiac surgery-associated (CSA) acute kidney injury (AKI) and clinical outcomes. DESIGN: Retrospective cohort study. SETTING: A tertiary teaching hospital. PARTICIPANTS: Patients aged <15 years with congenital heart disease who underwent cardiac surgery between May 2018 and May 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nadir DO2, mean DO2, and AUiDO2 were defined as the lowest DO2, average DO2, and dose of decrement combining the intensity and duration of DO2 less than the calculated ideal DO2, respectively. The primary outcome was CSA-AKI occurrence within 48 hours postoperatively. Secondary outcomes included maximum serum lactate levels (Lacmax) for the first 24 hours after pediatric cardiac intensive care unit admission. Of 479 patients, 147 (30.7%) developed AKI. Nadir DO2 and AUiDO2 were not significantly different between patients with CSA-AKI and those without CSA-AKI (p = 0.115 and p = 0.12, respectively). However, the mean DO2 was significantly higher in patients with CSA-AKI (p = 0.025). After adjusting for potential confounders, no significant differences were observed in the odds for CSA-AKI based on increments in nadir DO2, mean DO2, or AUiDO2. In contrast, nadir DO2 and mean DO2 were significantly associated with Lacmax in both univariate and multivariable regression analyses. CONCLUSION: DO2-related values during cardiopulmonary bypass were not associated with CSA-AKI in pediatric patients with congenital heart disease. However, nadir DO2 and mean DO2 were significantly associated with postoperative serum lactate levels.

DOI： 10.1053/j.jvca.2024.11.017

A Retrospective Comparative Study of the Frequency of Hypotension in Pediatric Cardiac Catheterization under General Anesthesia: Remimazolam versus Sevoflurane. 査読国際誌

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

Journal of cardiothoracic and vascular anesthesia 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: To compare the incidence of hypotension between remimazolam and sevoflurane under general anesthesia for cardiac catheterization in patients with congenital heart disease. DESIGN: Retrospective observational study. SETTING: A single university hospital with 300 pediatric cardiac catheterizations by general anesthesia performed annually. PARTICIPANTS: Patients younger than 15 years who underwent cardiac catheterization under general anesthesia between March 1, 2021, and December 31, 2022. Exclusion criteria were general anesthesia maintained with other than remimazolam or sevoflurane, receipt of remifentanil, American Society of Anesthesiologists score 4 or 5, emergency procedures, and no direct arterial pressure measurement. INTERVENTIONS: General anesthesia was maintained with remimazolam or sevoflurane. MEASUREMENTS AND MAIN RESULTS: A total of 309 patients were analyzed, including 28 in the remimazolam group and 281 in the sevoflurane group. Propensity score matching adjusted for confounding factors resulted in 28 patients in each arm, with no apparent differences in background factors. Hypotension was defined as a time-averaged area > 1, in which systolic arterial pressure fell below 80% of the baseline from the start of anesthesia to the end of procedure. The significance level was set at P < .05. The incidence of hypotension was 39.3% in the remimazolam arm and 46.4% in the sevoflurane arm, with no significant difference (P = .79), although the ratio of the median systolic arterial pressure to the baseline value was significantly higher in the remimazolam arm (91.4 ± 15.2% vs 83.2 ± 11.4% in the sevoflurane arm; P = .03). CONCLUSIONS: Remimazolam was not associated with a lower incidence of hypotension compared to sevoflurane during pediatric cardiac catheterization for congenital heart disease while maintaining significantly higher blood pressure overall.

DOI： 10.1053/j.jvca.2024.08.038

Comprehensive geriatric assessment as an indicator of postoperative recovery in older patients with colorectal cancer. 国際誌

Fuminori Teraishi, Ryohei Shoji, Yoshitaka Kondo, Shunsuke Kagawa, Rie Tamura, Yoshikazu Matsuoka, Hiroshi Morimatsu, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara

Journal of geriatric oncology 101837 - 101837 2024年7月

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年7月

記述言語：日本語出版者・発行元：(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)

その他リンク： 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

リドカイン静注が肢端紅痛症診断の一助となった1例

荒川恭佑, 坂本里沙, 武藤典子, 森松博史

日本ペインクリニック学会誌 31 ( プログラム号 ) 169 - 169 2024年6月

難治性神経障害性疼痛に対するつぶつぶセラピーの有効性の検討

妹尾悠祐, 荒川恭佑, 森松博史

日本ペインクリニック学会誌 31 ( プログラム号 ) 227 - 227 2024年6月

Sensitivity and specificity of the question "do you have any concerns regarding your mouth related to undergoing surgery?" for predicting perioperative oral health problems in patients with primary esophageal and lung cancer: a retrospective observational study. 国際誌

Aiko Yoshitomi, Yoshihiko Soga, Reiko Yamanaka-Kohno, Hiroshi Morimatsu

Perioperative medicine (London, England) 13 ( 1 ) 36 - 36 2024年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Perioperative oral management contributes to the prevention of dental/systemic complications. However, a professional dental checkup before surgery is generally not performed and relies on the patient's answer to a simple question by medical professionals other than dentists: "Do you have any concerns regarding your mouth related to undergoing surgery?" Here, we evaluated the sensitivity and specificity of this question for predicting perioperative oral health problems in patients with primary esophageal and primary lung cancer. METHODS: We performed an oral cavity check in all patients before scheduled surgery for primary esophageal and lung cancer. A total of 183 patients were enrolled (M, 112; F, 71; 24-88 years, median, 69 years), consisting of 61 with primary esophageal cancer (M, 46; F, 15; 24-85 years, median, 69 years) and 122 with primary lung cancer (M, 66; F; 56; 33-88 years, median, 69 years). All subjects provided a response to this question, and an oral cavity check was performed by dentists. The sensitivity and specificity of this question for detecting oral health problems were evaluated retrospectively. RESULTS: Overall sensitivity and specificity for detecting oral health problems were 0.263 and 0.898, respectively. There were no significant differences by sex or disease (primary esophageal or lung cancer). CONCLUSION: This simple question has low sensitivity but high specificity for detecting oral health problems. Although challenging to detect surgical patients with oral health problems by simply asking questions, the results indicated that patients with oral complaints are more likely to have problems during surgery.

DOI： 10.1186/s13741-024-00394-8

レミフェンタニル投与時のシリンジポンプへの自動体重送信機能追加の評価

小坂順子, 松岡義和, 森松博史

医工学治療 36 ( Suppl. ) 204 - 204 2024年5月

Modified del Nido cardioplegia is associated with low incidence of low main strong ion difference and hyperchloremia in pediatric patients after cardiac surgery.

Hiroshi Taka, Takuma Douguchi, Ayako Miyamoto, Kazuyoshi Shimizu, Satoshi Kimura, Tatsuo Iwasaki, Tomoyuki Kanazawa, Hiroshi Morimatsu

Journal of anesthesia 38 ( 2 ) 244 - 253 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The aims of this study were (1) to determine the associations of cardioplegic solutions with postoperative main strong ion difference (mSID), which is the difference between sodium ion concentration and chloride ion concentration ([Cl-]) and (2) to determine the associations of cardioplegic solutions with markers of organ dysfunction. METHODS: In this retrospective cohort study, patients aged <5 years who underwent cardiac surgery in a tertiary teaching hospital were included. Patients were classified on the basis of the type of cardioplegic solution: modified del Nido cardioplegia (mDNC) and conventional cardioplegia (CC). The effects of mDNC on postoperative mSID and markers of organ functions were examined using propensity-matched analysis. RESULTS: A total of 500 cases were included. mDNC solution was used in 163 patients (32.6%). After propensity score matching, patients in the mDNC group (n = 152) had significantly higher minimum mSID [28 (26, 30) mEq/L vs. 27 (25, 29) mEq/L, p = 0.02] and lower maximum [Cl-] [112 (109, 114) mEq/L vs. 113 (111, 117) mEq/L, p < 0.001] than patients in the CC group (n = 304). The incidences of low mSID and hyperchloremia in the mDNC group were significantly lower than those in the CC group (63.8 vs. 75.7%, p = 0.01 and 63.2 vs. 79.3%, p < 0.001, respectively). There was no significant difference in the incidence of postoperative acute kidney injury and B-type natriuretic peptide level between the two groups. CONCLUSION: The use of modified del Nido cardioplegia may reduce the incidence of abnormal mSID and hyperchloremia compared with the use of a chloride-rich cardioplegic solution.

DOI： 10.1007/s00540-023-03306-0

A Pilot Study of Urine Oxytocin as an Objective Biomarker for Chronic Pain 査読

Daisuke Ono, Takashi Matsusaki, Yoshikazu Matsuoka, Ryuji Kaku, Hiroshi Morimatsu

Annals of Neurosciences 2024年3月

Power suppression in EEG after the onset of SAH is a significant marker of early brain injury in rat models. 国際誌

Yuji Takasugi, Tomohito Hishikawa, Tomohisa Shimizu, Satoshi Murai, Jun Haruma, Masafumi Hiramatsu, Koji Tokunaga, Yoshimasa Takeda, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Scientific reports 14 ( 1 ) 2277 - 2277 2024年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

We analyzed the correlation between the duration of electroencephalogram (EEG) recovery and histological outcome in rats in the acute stage of subarachnoid hemorrhage (SAH) to find a new predictor of the subsequent outcome. SAH was induced in eight rats by cisternal blood injection, and the duration of cortical depolarization was measured. EEG power spectrums were given by time frequency analysis, and histology was evaluated. The appropriate frequency band and recovery percentage of EEG (defined as EEG recovery time) to predict the neuronal damage were determined from 25 patterns (5 bands × 5 recovery rates) of receiver operating characteristic (ROC) curves. Probit regression curves were depicted to evaluate the relationships between neuronal injury and duration of depolarization and EEG recovery. The optimal values of the EEG band and the EEG recovery time to predict neuronal damage were 10-15 Hz and 40%, respectively (area under the curve [AUC]: 0.97). There was a close relationship between the percentage of damaged neurons and the duration of depolarization or EEG recovery time. These results suggest that EEG recovery time, under the above frequency band and recovery rate, may be a novel marker to predict the outcome after SAH.

DOI： 10.1038/s41598-024-52527-0

Epidural versus patient-controlled intravenous analgesia on pain relief and recovery after laparoscopic gastrectomy for gastric cancer: randomized clinical trial. 国際誌

Satoru Kikuchi, Takashi Matsusaki, Toshiharu Mitsuhashi, Shinji Kuroda, Hajime Kashima, Nobuo Takata, Ema Mitsui, Yoshihiko Kakiuchi, Kazuhiro Noma, Yuzo Umeda, Hiroshi Morimatsu, Toshiyoshi Fujiwara

BJS open 8 ( 1 ) 2024年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Epidural analgesia (EDA) is a main modality for postoperative pain relief in major open abdominal surgery within the Enhanced Recovery After Surgery protocol. However, it remains unclear whether EDA is an imperative modality in laparoscopic gastrectomy (LG). This study examined non-inferiority of patient-controlled intravenous analgesia (PCIA) to EDA in terms of postoperative pain and recovery in patients who underwent LG. METHODS: In this open-label, non-inferiority, parallel, individually randomized clinical trial, patients who underwent elective LG for gastric cancer were randomized 1:1 to receive either EDA or PCIA after surgery. The primary endpoint was pain score using the Numerical Rating Scale at rest 24 h after surgery, analysed both according to the intention-to-treat (ITT) principle and per protocol. The non-inferiority margin for pain score was set at 1. Secondary outcomes were postoperative parameters related to recovery and adverse events related to analgesia. RESULTS: Between 3 July 2017 and 29 September 2020, 132 patients were randomized to receive either EDA (n = 66) or PCIA (n = 66). After exclusions, 64 patients were included in the EDA group and 65 patients in the PCIA group for the ITT analysis. Pain score at rest 24 h after surgery was 1.94 (s.d. 2.07) in the EDA group and 2.63 (s.d. 1.76) in the PCIA group (P = 0.043). PCIA was not non-inferior to EDA for the primary endpoint (difference 0.69, one side 95% c.i. 1.25, P = 0.184) in ITT analysis. Postoperative parameters related to recovery were similar between groups. More EDA patients (21 (32.8%) versus 1 (1.5%), P < 0.001) developed postoperative hypotension as an adverse event. CONCLUSIONS: PCIA was not non-inferior to EDA in terms of early-phase pain relief after LG.Registration number: UMIN000027643 (https://www.umin.ac.jp/ctr/index-j.htm).

DOI： 10.1093/bjsopen/zrad161

General Anesthesia With Remimazolam During Minimally Invasive Cardiac Surgery for Atrial Septal Defect: A Pediatric Case Report. 国際誌

Tatsuhiko Shimizu, Tomoyuki Kanazawa, Yuto Matsuoka, Tsubasa Yoshida, Takanobu Sakura, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

A&A practice 18 ( 1 ) e01735 2024年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

Remimazolam is a new ultrashort-acting benzodiazepine sedative, the use of which has not been reported for pediatric cardiac surgery. This case report describes the use of remimazolam in a 6-year-old girl who underwent minimally invasive cardiac surgery with right-sided thoracotomy for an atrial septal defect. Under electroencephalographic monitoring, remimazolam (2-4 mg kg-1 h-1) and remifentanil (0.05 μg kg-1 min-1) were administered with an intercostal nerve block during the procedure. The patient awoke and was extubated promptly after surgery, without any serious adverse events, including intraoperative awareness. Remimazolam may be a viable option for general anesthesia during pediatric cardiac surgery.

DOI： 10.1213/XAA.0000000000001735

Clinical Impact of Prehabilitation on Elective Laparoscopic Surgery in Frail Octogenarians With Colorectal Cancer. 査読国際誌

Fuminori Teraishi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Shunsuke Kagawa, Rie Tamura, Yoshikazu Matsuoka, Hiroshi Morimatsu, Toshiyoshi Fujiwara

Anticancer research 43 ( 12 ) 5597 - 5604 2023年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND/AIM: The aim of the present study was to clarify the clinical impact of prehabilitation by the perioperative management center (PERIO) at our hospital in severely frail octogenarians with colorectal cancer. PATIENTS AND METHODS: We compared the clinicopathological characteristics of octogenarians who underwent surgery for colorectal cancer before the establishment of PERIO intervention (Control group) with those who received prehabilitation (PERIO group). All patients were classified as American Society of Anesthesiologists (ASA) class 3 or higher. The primary outcome was the incidence of postoperative complications. RESULTS: There were 21 patients in the Control group and 19 patients in the PERIO group. Operative time was significantly longer in the PERIO group (Control group, 200 min vs. PERIO group, 230 min; p=0.03) and blood loss was significantly higher in the PERIO group (Control group, 5 ml vs. PERIO group, 30 ml; p=0.02). Postoperative complications occurred in 10 patients (47.6%) in the Control group and 3 patients (15.8%) in the PERIO group and were significantly lower in the PERIO group (p=0.03). Postoperative hospital stay was 13 days (range=7-31 days) in the Control group and 11 days (range=8-70 days) in the PERIO group (p=0.39). The rate of discharge directly to home was 81% in the Control group and 93.3% in the PERIO group (p=0.29). CONCLUSION: In frail octogenarians with colorectal cancer of ASA class 3 or higher, the incidence of postoperative complications was significantly lower after PERIO intervention.

DOI： 10.21873/anticanres.16762

がん摘出手術を受けた患者における術後の長期的生活の質(QOL)調査

松岡義和, 小坂順子, 森松博史

日本臨床麻酔学会誌 43 ( 6 ) S187 - S187 2023年11月

Retraction Note: 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 ) 354 - 354 2023年10月

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

【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

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

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

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

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

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

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

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

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

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

Consistently low levels of histidine-rich glycoprotein as a new prognostic biomarker for sepsis: A multicenter prospective observational study 査読

Naoya Kawanoue, Kosuke Kuroda, Hiroko Yasuda, Masahiko Oiwa, Satoshi Suzuki, Hidenori Wake, Hiroki Hosoi, Masahiro Nishibori, Hiroshi Morimatsu

PLOS ONE 18 ( 3 ) e0283426 - e0283426 2023年3月

掲載種別：研究論文（学術雑誌）出版者・発行元：Public Library of Science (PLoS)

Background

Few sepsis biomarkers accurately predict severity and mortality. Previously, we had reported that first-day histidine-rich glycoprotein (HRG) levels were significantly lower in patients with sepsis and were associated with mortality. Since the time trends of HRG are unknown, this study focused on the time course of HRG in patients with sepsis and evaluated the differences between survivors and non-survivors.

Methods

A multicenter prospective observational study was conducted involving 200 patients with sepsis in 16 Japanese hospitals. Blood samples were collected on days 1, 3, 5, and 7, and 28-day mortality was used for survival analysis. Plasma HRG levels were determined using a modified quantitative sandwich enzyme-linked immunosorbent assay.

Results

First-day HRG levels in non-survivors were significantly lower than those in survivors (mean, 15.7 [95% confidence interval (CI), 13.4–18.1] vs 20.7 [19.5–21.9] μg/mL; P = 0.006). Although there was no time × survivors/non-survivors interaction in the time courses of HRG (P = 0.34), the main effect of generalized linear mixed models was significant (P < 0.001). In a univariate Cox proportional hazards model with each variable as a time-dependent covariate, higher HRG levels were significantly associated with a lower risk of mortality (hazard ratio, 0.85 [95% CI, 0.78–0.92]; P < 0.001). Furthermore, presepsin levels (P = 0.02) and Sequential Organ Function Assessment scores (P < 0.001) were significantly associated with mortality. Harrell’s C-index values for the 28-day mortality effect of HRG, presepsin, procalcitonin, and C-reactive protein were 0.72, 0.70, 0.63, and 0.59, respectively.

Conclusions

HRG levels in non-survivors were consistently lower than those in survivors during the first seven days of sepsis. Repeatedly measured HRG levels were significantly associated with mortality. Furthermore, the predictive power of HRG for mortality may be superior to that of other singular biomarkers, including presepsin, procalcitonin, and C-reactive protein.

DOI： 10.1371/journal.pone.0283426

Outcomes associated with unrecognized acute kidney injury in postoperative pediatric cardiac patients. 国際誌

Satoshi Kimura, Kazuyoshi Shimizu, Tatsuo Iwasaki, Tomoyuki Kanazawa, Takashi Morimatsu, Takeru Hatano, Hiroshi Morimatsu

Pediatric nephrology (Berlin, Germany) 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The present retrospective study was carried out to determine the incidence of unrecognized cardiac surgery-associated acute kidney injury (CSA-AKI) due to infrequency of serum creatinine (SCr) measurements in pediatric cardiac patients and to assess the association between unrecognized CSA-AKI and clinical outcomes. METHODS: This study was a single-center, retrospective study of pediatric patients who underwent cardiac surgery. Patients were diagnosed with CSA-AKI based on SCr measurements, and unrecognized CSA-AKI was defined under the assumptions that there had been only one or two SCr measurements within 48 h after surgery: CSA-AKI unrecognized by one SCr measurement (AKI-URone), CSA-AKI unrecognized by two SCr measurements (AKI-URtwo), and CSA-AKI recognized by one and two SCr measurements (AKI-R). The change of SCr from baseline to postoperative day 30 (delta SCr30d) was assessed as a surrogate of kidney recovery. RESULTS: In a total of 557 cases, 313 patients (56.2%) were diagnosed with CSA-AKI, 188 (33.8%) of whom had unrecognized CSA-AKI. Delta SCr30d in the AKI-URtwo group and delta SCr30d in the AKI-URone group was not significantly different from delta SCr30d in the non-AKI group (p = 0.67 and p = 0.79, respectively). There were significant differences in the durations of mechanical ventilation, serum B-type natriuretic peptide levels, and lengths of stay in hospital between the non-AKI group and the AKI-URtwo group and between the non-AKI group and the AKI-URtwo group. CONCLUSIONS: Unrecognized CSA-AKI due to infrequent SCr measurements is not rare and is associated with prolonged mechanical ventilation, high postoperative BNP level, and prolonged length of stay in hospital. A higher resolution version of the Graphical abstract is available as Supplementary information.

DOI： 10.1007/s00467-023-05925-x

Dexmedetomidine improves acute lung injury by activating autophagy in a rat hemorrhagic shock and resuscitation model. 国際誌

Yifu Lu, Hiroko Shimizu, Ryu Nakamura, Yaqiang Li, Risa Sakamoto, Emiko Omori, Toru Takahashi, Hiroshi Morimatsu

Scientific reports 13 ( 1 ) 4374 - 4374 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

Dexmedetomidine (DEX) can reduce lung injury in a hemorrhagic shock (HS) resuscitation (HSR) model in rats by inhibiting inflammation. Here, we aimed to investigate if these effects of DEX are due to autophagy activation. Therefore, we established HSR rat models and divided them into four groups. HS was induced using a blood draw. The rats were then resuscitated by reinjecting the drawn blood and saline. The rats were sacrificed 24 h after resuscitation. Lung tissues were harvested for histopathological examination, determination of wet/dry lung weight ratio, and detection of the levels of autophagy-related marker proteins LC3, P62, Beclin-1, and the ATG12-ATG5 conjugate. The morphological findings of hematoxylin and eosin staining in lung tissues and the pulmonary wet/dry weight ratio showed that lung injury improved in HSR + DEX rats. However, chloroquine (CQ), an autophagy inhibitor, abolished this effect. Detecting the concentration of autophagy-related proteins showed that DEX administration increased LC3, ATG12-ATG5, and Beclin-1 expression and decreased P62 expression. The expression levels of these proteins were similar to those in the HSR group after CQ + DEX administration. In summary, DEX induced autophagic activation in an HSR model. These findings suggest that DEX administration partially ameliorates HSR-induced lung injury via autophagic activation.

DOI： 10.1038/s41598-023-31483-1

Therapeutic plasma exchange in postpartum HELLP syndrome: a case report. 国際誌

Nana Kojima, Kosuke Kuroda, Makiko Tani, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Jota Maki, Hisashi Masuyama, Hiroshi Morimatsu

JA clinical reports 9 ( 1 ) 9 - 9 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Postpartum hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is more difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to plasma exchange (PE) therapy. CASE PRESENTATION: A 30-year-old primipara woman was hospitalized for gestational hypertension at 33 weeks of gestation and underwent an emergent cesarean section at 36 weeks and 6 days of gestation due to rapidly progressing pulmonary edema. After delivery, liver dysfunction and a rapid decrease in platelet count were observed, and the patient was diagnosed with severe HELLP syndrome. She experienced multiple organ failure despite intensive care, and PE therapy was initiated. Her general condition dramatically stabilized within a few hours of PE therapy. CONCLUSION: It is controversial whether PE therapy should be used primarily in the management of HELLP syndrome, but early initiation of PE therapy could be effective for severe HELLP syndrome.

DOI： 10.1186/s40981-023-00602-2

Anesthetic management of a patient with Osler-Weber-Rendu syndrome with multiple pulmonary arteriovenous malformations and pheochromocytoma for femoral artificial bone replacement: a case report. 国際誌

Toshiharu Hiyoshi, Kazuyoshi Shimizu, Satoshi Kimura, Toshiki Naritani, Hiroshi Morimatsu

JA clinical reports 9 ( 1 ) 6 - 6 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Osler-Weber-Rendu syndrome is characterized by mucocutaneous telangiectasia and arteriovenous malformations in organs. Anesthesia for patients with Osler-Weber-Rendu syndrome is challenging due to complications and physiological changes. CASE PRESENTATION: The case was a 49-year-old female with Osler-Weber-Rendu syndrome, multiple pulmonary arteriovenous malformations and pheochromocytoma who presented for femoral bone head fracture with metastatic adenocarcinoma. The patient was scheduled to undergo bone tumor resection and artificial bone replacement, being positioned laterally with a planned operation duration of 5 h. Anesthesia was managed with spinal and epidural anesthesia, combined with sedation by sevoflurane using a supraglottic airway (SGA) device under spontaneous breathing. Her intraoperative and postoperative courses were uneventful. CONCLUSION: Neuraxial anesthesia combined with general anesthesia using an SGA device to maintain spontaneous ventilation in order to minimize the risk of rupture of pulmonary arteriovenous malformations could be an option.

DOI： 10.1186/s40981-023-00600-4

合併増大号今月の臨床最善で最新の産科麻酔診療をめざして妊産婦急変対応妊産婦の心肺蘇生

木村貴一, 金澤伴幸, 森松博史

臨床婦人科産科 77 ( 1 ) 193 - 199 2023年1月

Decreased expression of hyaluronan synthase and loss of hyaluronan-rich cells in the anterior tibial fascia of the rat model of chemotherapy-induced peripheral neuropathy. 査読国際誌

Ruilin Wang, Yoshikazu Matsuoka, Nobutaka Sue, Kosuke Nakatsuka, Chika Tsuboi, Hiroshi Morimatsu

Pain reports 8 ( 4 ) e1088 2023年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Previous studies on chemotherapy-induced peripheral neuropathy (CIPN) have focused on neuronal damage. Although some studies have revealed that the fascia is an important sensory organ, currently, we do not know about chemotherapy drug-induced fascial dysfunction. OBJECTIVES: This study aimed to explore the fascia as a nonneural cause of mechanical hypersensitivity in CIPN by investigating the expression of hyaluronic acid synthase (HAS) and histology of the fascia in an animal model of CIPN. METHODS: Rats were intraperitoneally administered with vincristine (VCR). Mechanical hypersensitivities of the hind paw and the anterior tibial muscle were assessed. The expression of HAS mRNA in the fascia of the anterior tibial muscles was quantitated using reverse transcription polymerase chain reaction. Immunohistochemistry was also performed for HAS2, hyaluronic acid-binding protein, and S100A4 in the fascia. RESULTS: Vincristine administration significantly decreased mechanical withdrawal thresholds in the hind paw and the anterior tibial muscle after day 3. Quantitative polymerase chain reaction showed significant downregulation of HAS mRNAs in the fascia of VCR-treated rats. Immunohistochemical analysis showed that the number of cells with strong HAS2 immunoreactivity, classified as fasciacytes by morphology and colocalized marker S100A4, decreased significantly in the VCR group. CONCLUSION: Hyaluronic acid plays a critical role in somatic pain sensation. Damaged fascia could be a possible cause of musculoskeletal pain in patients with CIPN. This study suggests that fascia is a nonneural cause and novel therapeutic target for chemotherapy-induced "peripheral neuropathy."

DOI： 10.1097/PR9.0000000000001088

Depolarization time and extracellular glutamate levels aggravate ultraearly brain injury after subarachnoid hemorrhage 査読

Satoshi Murai, Tomohito Hishikawa, Yoshimasa Takeda, Yasuko Okura, Miki Fushimi, Hirokazu Kawase, Yu Takahashi, Naoya Kidani, Jun Haruma, Masafumi Hiramatsu, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Scientific Reports 12 ( 1 ) 2022年12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

Early brain injury after aneurysmal subarachnoid hemorrhage (SAH) worsens the neurological outcome. We hypothesize that a longer duration of depolarization and excessive release of glutamate aggravate neurological outcomes after SAH, and that brain hypothermia can accelerate repolarization and inhibit the excessive release of extracellular glutamate and subsequent neuronal damage. So, we investigated the influence of depolarization time and extracellular glutamate levels on the neurological outcome in the ultra-early phase of SAH using a rat injection model as Experiment 1 and then evaluated the efficacy of brain hypothermia targeting ultra-early brain injury as Experiment 2. Dynamic changes in membrane potentials, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and extracellular glutamate levels were observed within 30 min after SAH. A prolonged duration of depolarization correlated with peak extracellular glutamate levels, and these two factors worsened the neuronal injury. Under brain hypothermia using pharyngeal cooling after SAH, cerebral perfusion pressure in the hypothermia group recovered earlier than that in the normothermia group. Extracellular glutamate levels in the hypothermia group were significantly lower than those in the normothermia group. The early induction of brain hypothermia could facilitate faster recovery of cerebral perfusion pressure, repolarization, and the inhibition of excessive glutamate release, which would prevent ultra-early brain injury following SAH.

DOI： 10.1038/s41598-022-14360-1

その他リンク： https://www.nature.com/articles/s41598-022-14360-1

小児の全身麻酔下におけるPatient State indexと呼気終末セボフルラン濃度の関連性単施設後ろ向き研究

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

日本小児麻酔学会誌 27 ( Suppl. ) 172 - 172 2022年10月

小児の全身麻酔下におけるPatient State indexと呼気終末セボフルラン濃度の関連性単施設後ろ向き研究

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

日本小児麻酔学会誌 27 ( Suppl. ) 172 - 172 2022年10月

Correlation between Mean Arterial Pressure and Regional Cerebral Oxygen Saturation on Cardiopulmonary Bypass in Pediatric Cardiac Surgery.

Yu Pan, Qingqing Song, Tomoyuki Kanazawa, Hiroshi Morimatsu

Acta medica Okayama 76 ( 5 ) 557 - 564 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Some pediatric cardiac patients might experience low regional cerebral oxygen saturation (rSO2) during surgery. We investigated whether a pediatric patient's mean arterial pressure (MAP) can affect the rSO2 value during cardiopulmonary bypass (CPB). We retrospectively analyzed the cases of the pediatric patients who underwentcardiac surgery at our hospital (Jan. -Dec. 2019; n=141). At each MAP stage, we constructed line charts through the mean of the rSO2 values corresponding to each MAP and then calculated the correlation coefficients. We next divided the patients into age subgroups (neonates, infants, children) and into cyanotic congenital heart disease (CHD) and acyanotic CHD groups and analyzed these groups in the same way. The analyses of all 141 patients revealed that during CPB the rSO2 value increased with an increase in MAP (r=0.1626). There was a correlation between rSO2 and MAP in the children (r=0.2720) but not in the neonates (r=0.06626) or infants (r=0.05260). Cyanotic CHD or acyanotic CHD did not have a significant effect on the rSO2/MAP correlation. Our analysis demonstrated different patterns of a correlation between MAP and rSO2 in pediatric cardiac surgery patients, depending on age. MAP was positively correlated with rSO2 typically in children but not in neonate or infant patients.

DOI： 10.18926/AMO/64037

高齢者に対する大腸がん治療の個別化を考える周術期管理チーム介入により高齢Frail大腸癌患者に対する手術の安全性は向上したか

寺石文則, 庄司良平, 賀島肇, 松三雄騎, 重安邦俊, 近藤喜太, 黒田新士, 香川俊輔, 松岡義和, 森松博史, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OWS9 - 3 2022年10月

Opioid free anesthesiaは必要か? Opioid-Free Anesthesiaのウィークポイント OFAは必要ない!

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

日本小児麻酔学会誌 27 ( Suppl. ) 77 - 77 2022年10月

小児心臓手術の人工心肺中の急激なCO2貯留を脳波モニターで早期に検出できた1症例

米澤みほこ, 金澤伴幸, 吉田翼, 佐倉孝信, 清水達彦, 木村聡, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 27 ( Suppl. ) 172 - 172 2022年10月

高齢者に対する大腸がん治療の個別化を考える周術期管理チーム介入により高齢Frail大腸癌患者に対する手術の安全性は向上したか

寺石文則, 庄司良平, 賀島肇, 松三雄騎, 重安邦俊, 近藤喜太, 黒田新士, 香川俊輔, 松岡義和, 森松博史, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OWS9 - 3 2022年10月

くも膜下出血の病態ラットSAH single injection modelにおける脳波抑制時間がearly brain injuryに及ぼす影響

高杉祐二, 菱川朋人, 清水智久, 村井智, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 34 ( 1 ) 84 - 84 2022年10月

【周術期における免疫学:基礎と臨床】周術期管理における免疫関連薬剤

吉田翼, 松岡義和, 森松博史

麻酔 71 ( 9 ) 976 - 979 2022年9月

【一般の麻酔科医が知っておくべき産科麻酔の知識】無痛分娩

松岡勇斗, 金澤伴幸, 森松博史

臨床麻酔 46 ( 9 ) 1153 - 1158 2022年9月

記述言語：日本語出版者・発行元：真興交易(株)医書出版部

無痛分娩に関連した母児の死亡、後遺障害の個別案件が続いたことを受けて、無痛分娩の安全な提供体制の構築が求められている。本邦における無痛分娩普及率は、欧米と比較すると低いが、その割合は着実に増してきている。今後、麻酔科医による無痛分娩の需要は高まっていく可能性があり、産科麻酔を専門としない麻酔科医にとっても無痛分娩に関する最低限の知識は持っておく必要があると思われる。(著者抄録)

【周術期における免疫学:基礎と臨床】周術期管理における免疫関連薬剤招待

吉田翼, 松岡義和, 森松博史

麻酔 71 ( 9 ) 976 - 979 2022年9月

Histidine-rich glycoprotein as a novel predictive biomarker of postoperative complications in intensive care unit patients: a prospective observational study. 査読国際誌

Masahiko Oiwa, Kosuke Kuroda, Naoya Kawanoue, Hiroshi Morimatsu

BMC anesthesiology 22 ( 1 ) 232 - 232 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Decrease in histidine-rich glycoprotein (HRG) was reported as a cause of dysregulation of the coagulation-fibrinolysis and immune systems, leading to multi-organ failure, and it may be a biomarker for sepsis, ventilator-associated pneumonia, preeclampsia, and coronavirus disease 2019. However, the usefulness of HRG in perioperative management remains unclear. This study aimed to assess the usefulness of HRG as a biomarker for predicting postoperative complications. METHODS: This was a single-center, prospective, observational study of 150 adult patients who were admitted to the intensive care unit after surgery. Postoperative complications were defined as those having a grade II or higher in the Clavien-Dindo classification, occurring within 7 days after surgery. The primary outcome was HRG levels in the patients with and without postoperative complications. The secondary outcome was the ability of HRG, white blood cell, C-reactive protein, procalcitonin, and presepsin to predict postoperative complications. Data are presented as number and median (interquartile range). RESULTS: The incidence of postoperative complications was 40%. The HRG levels on postoperative day 1 were significantly lower in patients who developed postoperative complications (n = 60; 21.50 [18.12-25.74] µg/mL) than in those who did not develop postoperative complications (n = 90; 25.46 [21.05-31.63] µg/mL). The Harrell C-index scores for postoperative complications were HRG, 0.65; white blood cell, 0.50; C-reactive protein, 0.59; procalcitonin, 0.73; and presepsin, 0.73. HRG was independent predictor of postoperative complications when adjusted for age, the presence of preoperative cardiovascular comorbidities, American Society of Anesthesiologists Physical Status Classification, operative time, and the volume of intraoperative bleeding (adjusted hazard ratio = 0.94; 95% confidence interval, 0.90-0.99). CONCLUSIONS: The HRG levels on postoperative day 1 could predict postoperative complications. Hence, HRG may be a useful biomarker for predicting postoperative complications.

DOI： 10.1186/s12871-022-01774-7

Temporary hypotension and ventilation difficulty during endoscopic injection sclerotherapy for esophageal varices in a child with Fontan circulation: a case report. 査読国際誌

Nanako Yasutomi, Tatsuhiko Shimizu, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

JA clinical reports 8 ( 1 ) 48 - 48 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Endoscopic procedures are rarely performed in children with congenital heart disease (CHD); therefore, the associated complications are unknown. We report an abrupt change in circulatory and respiratory condition during endoscopic injection sclerotherapy for esophageal varices. CASE PRESENTATION: A 9-year-old boy with a history of total anomalous pulmonary venous connection (TAPVC) repair and Fontan procedure for asplenia and a single ventricle with TAPVC underwent endoscopic injection sclerotherapy under general anesthesia for esophageal varices. Systolic blood pressure decreased from 70 to 50 mmHg following a sclerosant injection; a second injection reduced his peripheral oxygen saturation from 93 to 79% secondary to ventilation difficulty. Although we suspected anaphylaxis intraoperatively, postoperative imaging suggested that balloon dilation performed to prevent sclerosing agent leakage caused compression of the pulmonary venous chamber and trachea owing to the anomalous intrathoracic organ anatomy. CONCLUSION: Thorough understanding of the complex anatomy is important before performing endoscopic procedures in children with CHD to preoperatively anticipate possible intraoperative complications and select the optimal therapeutic approach and anesthesia management.

DOI： 10.1186/s40981-022-00538-z

投稿論文症例報告インヒビター保有血友病A患者に対する肝切除術後に出血を来した1症例

佐藤航貴, 松崎孝, 佐倉考信, 森松博史

麻酔 71 ( 6 ) 623 - 626 2022年6月

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年6月

Intrathecal Administration of the α1 Adrenergic Antagonist Phentolamine Upregulates Spinal GLT-1 and Improves Mirror Image Pain in SNI Model Rats. 査読

Kosuke Nakatsuka, Yoshikazu Matsuoka, Masako Kurita, Ruilin Wang, Chika Tsuboi, Nobutaka Sue, Ryuji Kaku, Hiroshi Morimatsu

Acta medica Okayama 76 ( 3 ) 255 - 263 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Mirror image pain (MIP) is a type of extraterritorial pain that results in contralateral pain or allodynia. Glutamate transporter-1 (GLT-1) is expressed in astrocytes and plays a role in maintaining low glutamate levels in the synaptic cleft. Previous studies have shown that GLT-1 dysfunction induces neuropathic pain. Our previous study revealed bilateral GLT-1 downregulation in the spinal cord of a spared nerve injury (SNI) rat. We hypothesized that spinal GLT-1 is involved in the mechanism of MIP. We also previously demonstrated noradrenergic GLT-1 regulation. Therefore, this study aimed to investigate the effect of an α1 adrenergic antagonist on the development of MIP. Rats were subjected to SNI. Changes in pain behavior and GLT-1 protein levels in the SNI rat spinal cords were then examined by intrathecal administration of the α1 adrenergic antagonist phentolamine, followed by von Frey test and western blotting. SNI resulted in the development of MIP and bilateral downregulation of GLT-1 protein in the rat spinal cord. Intrathecal phentolamine increased contralateral GLT-1 protein levels and partially ameliorated the 50% paw withdrawal threshold in the contralateral hind paw. Spinal GLT-1 upregulation by intrathecal phentolamine ameliorates MIP. GLT-1 plays a role in the development of MIPs.

DOI： 10.18926/AMO/63719

Prediction Model of Extubation Outcomes in Critically Ill Patients: A Multicenter Prospective Cohort Study. 査読国際誌

Aiko Tanaka, Daijiro Kabata, Osamu Hirao, Junko Kosaka, Nana Furushima, Yuichi Maki, Akinori Uchiyama, Moritoki Egi, Ayumi Shintani, Hiroshi Morimatsu, Satoshi Mizobuchi, Yoshifumi Kotake, Yuji Fujino

Journal of clinical medicine 11 ( 9 ) 2022年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Liberation from mechanical ventilation is of great importance owing to related complications from extended ventilation time. In this prospective multicenter study, we aimed to construct a versatile model for predicting extubation outcomes in critical care settings using obtainable physiological predictors. The study included patients who had been extubated after a successful 30 min spontaneous breathing trial (SBT). A multivariable logistic regression model was constructed to predict extubation outcomes (successful extubation without reintubation and uneventful extubation without reintubation or noninvasive respiratory support) using eight parameters: age, heart failure, respiratory disease, rapid shallow breathing index (RSBI), PaO2/FIO2, Glasgow Coma Scale score, fluid balance, and endotracheal suctioning episodes. Of 499 patients, 453 (90.8%) and 328 (65.7%) achieved successful and uneventful extubation, respectively. The areas under the curve for successful and uneventful extubation in the novel prediction model were 0.69 (95% confidence interval (CI), 0.62-0.77) and 0.70 (95% CI, 0.65-0.74), respectively, which were significantly higher than those in the conventional model solely using RSBI (0.58 (95% CI, 0.50-0.66) and 0.54 (95% CI, 0.49-0.60), p = 0.004 and <0.001, respectively). The model was validated using a bootstrap method, and an online application was developed for automatic calculation. Our model, which is based on a combination of generally obtainable parameters, established an accessible method for predicting extubation outcomes after a successful SBT.

DOI： 10.3390/jcm11092520

Patients scheduled to undergo esophageal surgery should have the highest priority for perioperative oral management triage: a cross-sectional study.

Reiko Yamanaka-Kohno, Yasuhiro Shirakawa, Aya Yokoi, Mami Inoue-Minakuchi, Motomu Kobayashi, Kazuhiro Noma, Manabu Morita, Takuo Kuboki, Hiroshi Morimatsu, Yoshihiko Soga

General thoracic and cardiovascular surgery 70 ( 4 ) 378 - 385 2022年4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：Springer Science and Business Media LLC

OBJECTIVES: An increasing number of patients visiting the dental office have a growing need for perioperative oral management (POM) to prevent postoperative complications. Therefore, it is necessary to determine which patients should receive preferential POM. This study investigated the dental status of patients scheduled to undergo surgery and addressed the priority for POM. METHODS: This retrospective study included a total of 150 patients who were scheduled to undergo surgery at the Department of Respiratory Surgery (DRS), Department of Neurological Surgery (DNS), Department of Gynecological Surgery (DGS), Department of Breast and Endocrine Surgery (DBES), and Department of Esophageal Surgery (DES) managed by the Perioperative Management Center of Okayama University Hospital. We compared the general and dental status of patients among the five groups. RESULTS: The DES group had significantly fewer teeth than the DBES group (p = 0.012), more severe periodontitis than both the DBES (p = 0.005) and DNS groups (p = 0.020), and poorer molar occlusal support status than both the DBES (p = 0.002) and DGS groups (p = 0.041). The DES group exhibited a significantly higher median age (p = 0.002), a higher ratio of males (p < 0.001), a higher prevalence of malignant tumors (p < 0.001), and higher proportions of smokers (p < 0.001) and drinkers (p < 0.001) than the other groups. CONCLUSION: Patients who underwent surgery at the DES had more dental problems than other surgery patients. Accordingly, these patients should be given the highest priority for POM triage.

DOI： 10.1007/s11748-021-01757-4

その他リンク： https://link.springer.com/article/10.1007/s11748-021-01757-4/fulltext.html

Ketamine Improves Desensitization of µ-Opioid Receptors Induced by Repeated Treatment with Fentanyl but Not with Morphine. 査読国際誌

Yusuke Mizobuchi, Kanako Miyano, Sei Manabe, Eiko Uezono, Akane Komatsu, Yui Kuroda, Miki Nonaka, Yoshikazu Matsuoka, Tetsufumi Sato, Yasuhito Uezono, Hiroshi Morimatsu

Biomolecules 12 ( 3 ) 426 2022年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

The issue of tolerance to continuous or repeated administration of opioids should be addressed. The ability of ketamine to improve opioid tolerance has been reported in clinical studies, and its mechanism of tolerance may involve improved desensitization of μ-opioid receptors (MORs). We measured changes in MOR activity and intracellular signaling induced by repeated fentanyl and morphine administration and investigated the effects of ketamine on these changes with human embryonic kidney 293 cells expressing MOR using the CellKey™, cADDis cyclic adenosine monophosphate, and PathHunter® β-arrestin recruitment assays. Repeated administration of fentanyl or morphine suppressed the second MOR responses. Administration of ketamine before a second application of opioids within clinical concentrations improved acute desensitization and enhanced β-arrestin recruitment elicited by fentanyl but not by morphine. The effects of ketamine on fentanyl were suppressed by co-treatment with an inhibitor of G-protein-coupled receptor kinase (GRK). Ketamine may potentially reduce fentanyl tolerance but not that of morphine through modulation of GRK-mediated pathways, possibly changing the conformational changes of β-arrestin to MOR.

DOI： 10.3390/biom12030426

Current status of delirium assessment tools in the intensive care unit: a prospective multicenter observational survey. 査読国際誌

Kenzo Ishii, Kosuke Kuroda, Chika Tokura, Masaaki Michida, Kentaro Sugimoto, Tetsufumi Sato, Tomoki Ishikawa, Shingo Hagioka, Nobuki Manabe, Toshiaki Kurasako, Takashi Goto, Masakazu Kimura, Kazuharu Sunami, Kazuyoshi Inoue, Takashi Tsukiji, Takeshi Yasukawa, Satoshi Nogami, Mitsunori Tsukioki, Daisuke Okabe, Masaaki Tanino, Hiroshi Morimatsu

Scientific reports 12 ( 1 ) 2185 - 2185 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

Delirium is a critical challenge in the intensive care unit (ICU) or high care unit (HCU) setting and is associated with poor outcomes. There is not much literature on how many patients in this setting are assessed for delirium and what tools are used. This study investigated the status of delirium assessment tools of patients in the ICU/HCU. We conducted a multicenter prospective observational study among 20 institutions. Data for patients who were admitted to and discharged from the ICU/HCU during a 1-month study period were collected from each institution using a survey sheet. The primary outcome was the usage rate of delirium assessment tools on an institution- and patient-basis. Secondary outcomes were the delirium prevalence assessed by each institution's assessment tool, comparison of delirium prevalence between delirium assessment tools, delirium prevalence at the end of ICH/HCU stay, and the relationship between potential factors related to delirium and the development of delirium. Result showed that 95% of institutions used the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU) to assess delirium in their ICU/HCU, and the remaining one used another assessment scale. The usage rate (at least once during the ICU/HCU stay) of the ICDSC and the CAM-ICU among individual patients were 64.5% and 25.1%, and only 8.2% of enrolled patients were not assessed by any delirium assessment tool. The prevalence of delirium during ICU/HCU stay was 17.9%, and the prevalence of delirium at the end of the ICU/HCU stay was 5.9%. In conclusion, all institutions used delirium assessment tools in the ICU/HCU, and most patients received delirium assessment. The prevalence of delirium was 17.9%, and two-thirds of patients had recovered at discharge from ICU/HCU.Trial registration number: UMIN000037834.

DOI： 10.1038/s41598-022-06106-w

肺切除術中の気管支出血肺静脈閉塞に伴う区域性肺うっ血から持続的な肺胞出血を来した1症例査読

照屋洋武, 松岡義和, 角森雅樹, 西本れい, 谷口新, 森松博史

麻酔 71 ( 1 ) 82 - 86 2022年1月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：克誠堂出版(株)

気管支出血は、肺切除術中にしばしば見られる合併症である。本症例では、術中の胸膜縫合閉鎖に伴う肺区域静脈の圧排により生じた肺うっ血によって、持続的な肺胞出血を認めた。泡沫状出血や区域性の気管支粘膜発赤といった特徴的な気管支鏡所見から、原因や部位を特定した。術中に介入することで止血でき、良好な転帰を得た。(著者抄録)

Preventative effects of bisoprolol transdermal patches on postoperative atrial fibrillation in high-risk patients undergoing non-cardiac surgery: A subanalysis of the MAMACARI study. 国際誌

Takayuki Iwano, Hironobu Toda, Kazufumi Nakamura, Kazuyoshi Shimizu, Kentaro Ejiri, Yoichiro Naito, Hisatoshi Mori, Takuro Masuda, Toru Miyoshi, Masashi Yoshida, Yukiko Hikasa, Hiroshi Morimatsu, Hiroshi Ito

Journal of cardiology 78 ( 5 ) 349 - 354 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Perioperative atrial fibrillation (POAF) after non-cardiac surgery is a risk factor for cardiovascular events including stroke and death. The aim of this subanalysis of the MAMACARI study, a multicenter randomized control study on the effectiveness of a bisoprolol transdermal patch for prevention of perioperative myocardial injury in high-risk patients undergoing non-cardiac surgery, was to identify the predictors of POAF after non-cardiac surgery in high-risk patients and to determine changes in blood pressure and heart rate during bisoprolol patch administration in the perioperative period. METHODS AND RESULTS: Patients aged over 60 years with hypertension and a high revised cardiac risk index (≥2) who were scheduled to undergo non-cardiac surgery were randomly assigned to a bisoprolol patch group (n = 120) or a control group (n = 120). We divided the patients into two groups: patients with POAF (POAF group; n = 16) and patients without POAF (non-POAF group; n = 206). Multivariate analysis showed that bisoprolol patch therapy (OR: 0.30, 95% CI: 0.092-0.978) and surgery time of 250 min or more (OR: 4.99, 95% CI: 1.37-18.2) were independently associated with POAF. Although systolic blood pressure did not differ significantly between the two groups throughout the perioperative period, treatment with a bisoprolol patch significantly reduced heart rate throughout the perioperative period compared with that in the control group. CONCLUSIONS: Low dose of a bisoprolol patch in the perioperative period was effective for prevention of POAF after non-cardiac surgery in high-risk patients, while long surgery time was an independent risk factor for POAF. It is expected that low dose of a bisoprolol patch can prevent POAF without causing hypotension.

DOI： 10.1016/j.jjcc.2021.05.001

脊椎・脊髄、外傷 80歳以上の超高齢者脊椎脊髄症例に対する手術をいかに安全に行うか周術期管理センターの有用性

安原隆雄, 佐々田晋, 金恭平, 菱川朋人, 藤井謙太郎, 森松博史, 伊達勲

Geriatric Neurosurgery 34 67 - 70 2021年11月

記述言語：日本語出版者・発行元：日本老年脳神経外科学会

過去2年間の80歳以上の超高齢者脊椎脊髄に対する外科治療症例18例(男性11例、女性7例、80～89歳、中央値86歳)を対象に、患者背景、症状、治療、周術期の問題点、対策について検討を行った。初診時は全例が生活に重大な問題を生じており、8例は独歩不能であった。治療は頸椎病変11例全例に頸椎椎弓形成術、胸髄腫瘍1例に腫瘍摘出術、腰椎変性疾患は5例に片側進入両側開窓術、1例に後方腰椎椎体間固定術を行った。譫妄には抑肝散、食欲不振には六君子湯を用いた。術後、重篤な合併症なく17例で症状改善が得られた。

Extracellular Glutamate Concentration Increases Linearly in Proportion to Decreases in Residual Cerebral Blood Flow after the Loss of Membrane Potential in a Rat Model of Ischemia

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

Journal of Neurosurgical Anesthesiology 33 ( 4 ) 356 - 362 2021年10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：Lippincott Williams and Wilkins

Background: Brain ischemia due to disruption of cerebral blood flow (CBF) results in increases in extracellular glutamate concentration and neuronal cell damage. However, the impact of CBF on glutamate dynamics after the loss of the membrane potential remains unknown. Materials and Methods: To determine this impact, we measured extracellular potential, CBF, and extracellular glutamate concentration in the parietal cortex in male Sprague-Dawley rats (n=21). CBF was reduced by bilateral occlusion of the common carotid arteries and exsanguination until loss of extracellular membrane potential was observed (low-flow group), or until CBF was further reduced by 5% to 10% of preischemia levels (severe-low-flow group). CBF was promptly restored 10 minutes after the loss of membrane potential. Histologic outcomes were evaluated 5 days later. Results: Extracellular glutamate concentration in the low-flow group was significantly lower than that in the severe-low-flow group. Moreover, increases in extracellular glutamate concentration exhibited a linear relationship with decreases in CBF after the loss of membrane potential in the severe-low-flow group, and the percentage of damaged neurons exhibited a dose-response relationship with the extracellular glutamate concentration. The extracellular glutamate concentration required to cause 50% neuronal damage was estimated to be 387 μmol/L, at 8.7% of preischemia CBF. Regression analyses revealed that extracellular glutamate concentration increased by 21 μmol/L with each 1% decrease in residual CBF and that the percentage of damaged neurons increased by 2.6%. Conclusion: Our results indicate that residual CBF is an important factor that determines the extracellular glutamate concentration after the loss of membrane potential, and residual CBF would be one of the important determinants of neuronal cell prognosis.

DOI： 10.1097/ANA.0000000000000666

An Evaluation of the Safety and Feasibility of Adenosine-assisted Clipping Surgery for Unruptured Cerebral Aneurysms: Study Protocol.

Tomohito Hishikawa, Satoshi Murai, Masafumi Hiramatsu, Jun Haruma, Kazuhiko Nishi, Yuki Ebisudani, Yu Sato, Takao Yasuhara, Kenji Sugiu, Kazuyoshi Shimizu, Motomu Kobayashi, Koji Nakagawa, Aya Kimura-Ono, Katsuyuki Hotta, Hiroshi Morimatsu, Isao Date

Neurologia medico-chirurgica 61 ( 7 ) 393 - 396 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

The effectiveness of adenosine-induced flow arrest in surgical clipping for the cerebral aneurysms with difficulties in temporary clip placement to the proximal main trunk has been reported. This is the first clinical trial to evaluate the safety and feasibility of adenosine-assisted clipping surgery for unruptured cerebral aneurysms (UCAs) in Japan. The inclusion criteria are as follows: patients over 20 years old, patients who agree to be enrolled in this study after providing informed consent, patients who undergo clipping surgery for UCA in our institute, and patients in whom the surgeons (T.H. or I.D.) judge that decompression of the aneurysm is effective. The primary endpoint is a modified Rankin Scale (mRS) score 30 days after surgery. We plan to enroll 10 patients in this study. The original protocol of adenosine administration was established in this trial. Herein, we present the study protocol.

DOI： 10.2176/nmc.st.2021-0018

Higher preoperative Qp/Qs ratio is associated with lower preoperative regional cerebral oxygen saturation in children with ventricular septal defect 査読

Aya Banno, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Tatsuo Iwasaki, Kenji Baba, Shinichi Otsuki, Hiroshi Morimatsu

Journal of Anesthesia 35 ( 3 ) 442 - 445 2021年6月

Prognosis of patients with severe left ventricular dysfunction after transvenous lead extraction and the need for additional hemodynamic support in the perioperative period. 国際誌

Nobuhiro Nishii, Takashi Nishimoto, Tomofumi Mizuno, Takuro Masuda, Saori Asada, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Morimatsu, Shingo Kasahara, Hiroshi Ito

Heart rhythm 18 ( 6 ) 962 - 969 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Transvenous lead extraction (TLE) is necessary because of system infection, lead malfunction, or system upgrade. Patients with severe left ventricular dysfunction (SLVD) undergoing TLE may be at a higher risk because hemodynamic parameters may change unfavorably during or after TLE; however, this has not yet been clarified. OBJECTIVE: The purpose of this study was to examine whether patients with SLVD undergoing TLE have higher mortality. METHODS: All patients who underwent TLE were stratified as follows: patients with ejection fraction ≤ 35% (SLVD group) and those with ejection fraction > 35% (non-SLVD group). RESULTS: We assessed the data of 200 patients (SLVD group, 36; non-SLVD group, 164). Brain natriuretic peptide level and cardiac resynchronization therapy rate were higher in the SLVD group than in the non-SLVD group. There were no significant between-group differences in major complications and clinical success rates. Patients with SLVD were more likely to require additional hemodynamic support, such as catecholamine infusion, temporary atrial-ventricle sequential pacing, and temporary cardiac resynchronization therapy pacing (27.8% vs 1.2%; P < .001). The survival rate was not significantly different between the groups at 30 days and 1 year after TLE (SLVD vs non-SLVD: 30 days: 97.2% vs 99.4%; P = .215; 1 year: 80.6% vs 91.5%; P = .053). Multivariate Cox regression analysis revealed log brain natriuretic peptide and serum hemoglobin levels as predictors for 1-year mortality. CONCLUSION: The prognosis after TLE was comparable between patients with and without SLVD. However, additional hemodynamic support was often necessary for patients with SLVD.

DOI： 10.1016/j.hrthm.2021.01.026

Histidine-rich glycoprotein as a prognostic biomarker for sepsis. 国際誌

Kosuke Kuroda, Kenzo Ishii, Yuko Mihara, Naoya Kawanoue, Hidenori Wake, Shuji Mori, Michihiro Yoshida, Masahiro Nishibori, Hiroshi Morimatsu

Scientific reports 11 ( 1 ) 10223 - 10223 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Various biomarkers have been proposed for sepsis; however, only a few become the standard. We previously reported that plasma histidine-rich glycoprotein (HRG) levels decreased in septic mice, and supplemental infusion of HRG improved survival in mice model of sepsis. Moreover, our previous clinical study demonstrated that HRG levels in septic patients were lower than those in noninfective systemic inflammatory response syndrome patients, and it could be a biomarker for sepsis. In this study, we focused on septic patients and assessed the differences in HRG levels between the non-survivors and survivors. We studied ICU patients newly diagnosed with sepsis. Blood samples were collected within 24 h of ICU admission, and HRG levels were determined using an enzyme-linked immunosorbent assay. Ninety-nine septic patients from 11 institutes in Japan were included. HRG levels were significantly lower in non-survivors (n = 16) than in survivors (n = 83) (median, 15.1 [interquartile ranges, 12.7-16.6] vs. 30.6 [22.1-39.6] µg/ml; p < 0.01). Survival analysis revealed that HRG levels were associated with mortality (hazard ratio 0.79, p < 0.01), and the Harrell C-index (predictive power) for HRG was 0.90. These results suggested that HRG could be a novel prognostic biomarker for sepsis.

DOI： 10.1038/s41598-021-89555-z

頭蓋咽頭腫摘出後の血清ナトリウム濃度変動により橋外性髄鞘崩壊症を生じた一小児例

松岡勇斗, 谷真規子, 清水一好, 金澤伴幸, 市川智継, 佐々木達也, 長谷川高誠, 森松博史

日本集中治療医学会雑誌 28 ( 3 ) 227 - 229 2021年5月

記述言語：日本語出版者・発行元：(一社)日本集中治療医学会

6歳男児。1年前に頭蓋咽頭腫に対して開頭腫瘍摘出術を施行された。今回、頭蓋咽頭腫の再発に対して再度摘出術を施行され、術後2日目に意識障害が出現し、血清Na値が182mmol/Lまで上昇した。中枢性尿崩症と考え、生理食塩水とバソプレシンの持続静注を開始した。術後3日目以降は意識レベルが回復していたが、7日目に意識障害が再度出現し、血清Na値が142mmol/Lまで低下していたため、浸透圧性脱髄症候群を鑑別に挙げて頭部MRIを施行し、橋外性髄鞘崩壊症と診断した。本例は頭蓋咽頭腫が視床下部に強く癒着しており、腫瘍摘出に伴い視床下部機能障害が生じたことで高Na血症が急速に進行したものと考えられた。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J02874&link_issn=&doc_id=20210611380012&doc_link_id=10.3918%2Fjsicm.28_227&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.28_227&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

腹臥位胸腔鏡食道切除術後の同側肩の痛みと離床について

岩井賢司, 森松博史, 築山尚司, 太田晴之, 福田智美, 堅山佳美, 伊勢真人, 濱田全紀, 千田益生

The Japanese Journal of Rehabilitation Medicine 58 ( 特別号 ) 2 - 11 2021年5月

腹臥位胸腔鏡食道切除術後の同側肩の痛みと離床について

岩井賢司, 森松博史, 築山尚司, 太田晴之, 福田智美, 堅山佳美, 伊勢真人, 濱田全紀, 千田益生

The Japanese Journal of Rehabilitation Medicine 58 ( 特別号 ) 2 - 11 2021年5月

Thermosensitive TRPV4 channels mediate temperature-dependent microglia movement 査読国際誌

Rei Nishimoto, Sandra Derouiche, Kei Eto, Aykut Deveci, Makiko Kashio, Yoshitaka Kimori, Yoshikazu Matsuoka, Hiroshi Morimatsu, Junichi Nabekura, Makoto Tominaga

Proceedings of the National Academy of Sciences 118 ( 17 ) e201289411 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

ミクログリアの遊走は温度により調整されることが示唆されている．これまで，いくつかのイオンチャネルおよびトランスポータが遊走に関与することが知られているが，温度依存性による遊走の制御機構はまだ不明である．本研究は，実験を通じて，マウスのミクログリアがTRPPV4チャネルを介して温度依存性の運動を示すことを示したものである．
ミクログリアの動画像の自動トラッキング手法を開発し，ミクログリアの挙動解析を行った．

DOI： 10.1073/pnas.2012894118

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

くも膜下出血超急性期における皮質脱分極と細胞外グルタミン酸濃度が脳障害に与える影響

村井智, 菱川朋人, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 35 97 - 97 2020年2月

術後の肺血栓塞栓症発生率と重症化に対する加齢の影響

松岡義和, 中塚洸輔, 倉迫直子, 青江尚美, 森松博史

日本老年麻酔学会プログラム・抄録集 32回 68 - 68 2020年1月

Relationship between partial carbon dioxide pressure and strong ions in humans: A retrospective study

Satoshi Isoyama, Satoshi Kimura, Hiroshi Morimatsu

Acta Medica Okayama 74 ( 4 ) 319 - 325 2020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

Little is known about the role of a strong ions in humans with respiratory abnormalities. In this study, we investigated the associations between partial carbon dioxide pressure (pCO2) and each of sodium ion (Na+) concentrations, chloride ion (Cl-) concentrations and their difference (SIDNa-Cl). Blood gas data were obtained from patients in a teaching hospital intensive care unit between August 2013 and January 2017. The association between pCO2 and SIDNa-Cl was defined as the primary outcome. The associations between pCO2 and [Cl-], [Na+] and other strong ions were secondary outcomes. pCO2 was stratified into 10 mmHg-wide bands and treated as a categorical variable for comparison. As a result, we reviewed 115,936 blood gas data points from 3,840 different ICU stays. There were significant differences in SIDNa-Cl, [Cl-], and [Na+] among all categorized pCO2 bands. The respective pCO2 SIDNa-Cl, [Cl-], and [Na+] correlation coefficients were 0.48,-0.31, and 0.08. SIDNa-Cl increased and [Cl-] decreased with pCO2, with little relationship between pCO2 and [Na+] across subsets. In conclusion, we found relatively strong correlations between pCO2 and SIDNa-Cl in the multiple blood gas datasets examined. Correlations between pCO2 and chloride concentrations, but not sodium concentrations, were further found to be moderate in these ICU data.

Histidine-rich glycoprotein: A novel biomarker for assessing the severity of sepsis

Masahiko Oiwa, Naoya Kawanoue, Kosuke Kuroda, Hiroshi Morimatsu

Japanese Journal of Clinical Chemistry 49 ( 4 ) 251 - 257 2020年

Relationship between a High-inspired Oxygen Concentration and Dorsal Atelectasis in High-energy Trauma Patients

Kenzo Ishii, Hiroshi Morimatsu, Kazumi Ono, Koji Miyasho

Acta Medica Okayama 74 ( 1 ) 17 - 26 2020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

We performed a retrospective cohort study of 911 high-energy trauma patients who underwent chest CT scans at least twice after admission. We hypothesized that in high-energy trauma patients, a high-inspired oxygen concentration delivered after admission results in dorsal atelectasis. The study’s primary outcome was dorsal atelectasis formation diagnosed based on CT images. We defined dorsal atelectasis as the presence of atelectasis at ≥ 10 mm thick on CT images. We defined high-inspired oxygen concentration as &gt
60% oxygen delivered between two CT scans. Four hundred sixty-five patients (51.0%) developed atelectasis according to the second CT scan, and 338 (37.1%) received a high-inspired oxygen concentration. A univariate analysis showed that the rate of the high-inspired oxygen concentration in the atelectasis group was significantly higher than that in the non-atelectasis group (43.4% vs. 30.1%, p&lt
0.001). However, a logistic regression analysis showed that there was no significant relationship between the oxygen concentration and the formation of dorsal atelectasis (OR: 1.197, 95%CI: 0.852-1.683, p=0.30). Age, the Injury Severity Score, BMI, and smoking were found to be risk factors of dorsal atelectasis formation in high-energy trauma patients. There was no relationship between the oxygen concentration and atelectasis formation in our series of high-energy trauma patients.

Unilateral Lung Recruitment Maneuver for Massive Atelectasis in a Child With Glenn Circulation: A Case Report. 国際誌

Yoshikazu Kimura, Tomoyuki Kanazawa, Yasutoshi Kuroe, Makiko Tani, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

A&A practice 13 ( 11 ) 430 - 432 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

A 9-year-old girl with Glenn circulation suffered from massive atelectasis of the left lung caused by bleeding during cardiac catheterization. The atelectasis resulted in frequent hypoxia leading to oxygen saturation (SpO2) of 40%-50%. In the intensive care unit, we performed a unilateral lung recruitment maneuver (ULRM) for 2 days. The ULRM involved placement of a bronchial blocker in the right main bronchus and application of continuous positive airway pressure to the left lung without hemodynamic deterioration. Eventually, SpO2 improved to 80%-85%. ULRM can be a treatment option for unilateral atelectasis in a child with Glenn circulation.

DOI： 10.1213/XAA.0000000000001101

Local Anesthetic Systemic Toxicity Following General and Epidural Anesthesia in A patient with a History of Muscle Relaxant-induced Anaphylaxis.

Asuka Kubo, Kazuyoshi Shimizu, Kosuke Kuroda, Tomoyuki Kanazawa, Motomu Kobayashi, Hiroshi Morimatsu

Acta medica Okayama 73 ( 6 ) 543 - 546 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

We here report that a 71-year-old Japanese woman with a history of anaphylaxis induced by muscle relaxants had local anesthetic systemic toxicity (LAST) following an abdominal surgery under general anesthesia with combined spinal-epidural anesthesia without muscle relaxants. The total dosages of local anesthetics reached 0.67 mg/kg of ropivacaine and 11.5 mg/kg of lidocaine over 12.5 h to obtain sufficient muscle relaxation for surgery. Regional anesthesia is useful in cases in which muscle relaxants are to be avoided during a surgery. However, especially for a patient with risk factors and prolonged surgery, precautions should be taken to prevent LAST.

DOI： 10.18926/AMO/57721

Anesthetic management of a patient with sodium-channel myotonia: a case report. 国際誌

Naohisa Matsumoto, Rei Nishimoto, Yoshikazu Matsuoka, Yoshimasa Takeda, Hiroshi Morimatsu

JA clinical reports 5 ( 1 ) 77 - 77 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Sodium-channel myotonia (SCM) is a nondystrophic myotonia, characterized by pure myotonia without muscle weakness or paramyotonia. The prevalence of skeletal muscle channelopathies is approximately 1 in 100,000, and the prevalence of SCM is much lower. To our knowledge, this is the first report on anesthetic management of a patient with SCM. CASE PRESENTATION: A 23-year-old woman with congenital nasal dysplasia and SCM was scheduled to undergo rhinoplasty with autologous costal cartilage. Total intravenous anesthesia without muscle relaxants was administered followed by continuous intercostal nerve block. Although transient elevation of potassium level in the blood was observed during surgery, the patient did not show exacerbation of myotonic or paralytic symptoms in the postoperative period. CONCLUSION: Total intravenous anesthesia and peripheral nerve block can be administered safely to a patient with SCM. However, careful monitoring of the symptoms and electrolytes is recommended.

DOI： 10.1186/s40981-019-0300-8

Tチューブ挿入中の術中人工呼吸管理にFogartyカテーテルを使用した一症例

根ヶ山諒, 岡原修司, 熊代美香, 塩路直弘, 金澤伴幸, 松岡義和, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 25 ( 1 ) 29 - 32 2019年11月

記述言語：日本語出版者・発行元：日本小児麻酔学会

症例は1歳11ヵ月の男児、声門下狭窄に対して輪状軟骨前方切開術が予定された。術中管理の問題点として、Tチューブ挿入後の陽圧換気中のTチューブ口側断端からのエアリークが挙げられたため、Tチューブ内にTチューブ径より小径の挿管チューブを経鼻的に留置し、挿管チューブをクランプすることで口側断端を塞ぐ方法を計画した。しかしスペースが小さく留置困難だったため、経鼻的にFogartyカテーテルをTチューブ内に留置し、バルーン拡張にて口側断端からのエアリークを軽減し、確実に換気することができた。Tチューブ挿入下での呼吸管理において、位置調整など慎重な管理は必要となるが、小児症例ではFogartyカテーテルを用いた換気方法は有用性が高いと考える。(著者抄録)

Cortical spreading depolarizationがくも膜下出血後のearly brain injuryに与える影響

村井智, 菱川朋人, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 31 ( 1 ) 111 - 111 2019年11月

Comparison of the Effects of Epidural Analgesia and Patient-controlled Intravenous Analgesia on Postoperative Pain Relief and Recovery After Laparoscopic Gastrectomy for Gastric Cancer. 国際誌

Satoru Kikuchi, Shinji Kuroda, Masahiko Nishizaki, Takashi Matsusaki, Kazuya Kuwada, Yoshikazu Kimura, Shunsuke Kagawa, Hiroshi Morimatsu, Toshiyoshi Fujiwara

Surgical laparoscopy, endoscopy & percutaneous techniques 29 ( 5 ) 405 - 408 2019年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: Epidural analgesia (EDA) is an imperative modality for postoperative pain relief after major open abdominal surgery. However, whether EDA has benefits in laparoscopic surgery has not been clear. In this study, the effects of EDA and patient-controlled intravenous analgesia (PCIA) after laparoscopic distal gastrectomy (LDG) were compared. METHODS: This was a retrospective study that included 82 patients undergoing LDG for gastric cancer. Patients received either EDA (n=67) or PCIA (n=15) for postoperative pain relief. Postoperative outcomes and analgesia-related adverse events were compared between the two modalities. RESULTS: EDA and PCIA patients showed no differences in the incidence of complications [9 (13%) vs. 2 (13%); P=0.99] and the length of postoperative hospital stay (9.6±4.5 d vs. 9.7±4.0 d; P=0.90), although the PCIA included poorer preoperative physical status (PS) patients. The number of additional doses of analgesics was higher in the EDA than in the PCIA (1.8±2.4 vs. 0.9±1.0; P=0.01), although postoperative pain scores were similar in the 2 groups. Though the time to first passage of flatus was shorter in the EDA (P<0.05), more EDA patients developed postoperative hypotension as an adverse event (P<0.01). The full mobilization day and the day of oral intake tolerance were not significantly different between the 2 groups after surgery. CONCLUSIONS: After LDG, EDA may not be indispensable, while PCIA may be the optimal modality for providing safe and effective postoperative analgesia and recovery.

DOI： 10.1097/SLE.0000000000000605

食道胃接合部癌に対する観音開き法鏡視下再建中、心臓圧排を誘因として心室頻拍とST上昇が生じた1症例

藤井彩加, 清水達彦, 角森雅樹, 谷真規子, 松岡義和, 森松博史

日本臨床麻酔学会誌 39 ( 6 ) S313 - S313 2019年10月

Propofolにketamineを併用した麻酔による電気けいれん療法で有効かつ安全に治療し得た難治性統合失調症の2例査読

山田裕士, 藤原雅樹, 酒本真次, 冨永悟, 稲垣正俊, 松崎孝, 森松博史, 山田了士

総合病院精神医学 31 ( 4 ) 448 - 454 2019年10月

記述言語：日本語出版者・発行元：(一社)日本総合病院精神医学会

電気けいれん療法(ECT)は、統合失調症患者においても緊張病状態や薬物治療抵抗例に対して考慮される重要な治療法である。ECTにおいて本邦で頻用される麻酔薬のpropofolは、強い抗けいれん作用を有するため、高い発作閾値が問題になるケースでは麻酔に工夫を要する。発作閾値上昇効果がないとされるketamineへの切り替え、または併用によるpropofolの減量は有効な方法の1つで、うつ病患者では抗うつ効果の増強も期待したketamineによるECTの報告が多い。一方でketamineは、その作用機序から統合失調症の精神症状を悪化させる懸念もある。今回、高い発作閾値が問題化したが、ketamineの併用によりpropofolを減量したECTで有効な発作が得られ、精神病症状の悪化を認めることなく有効かつ安全に治療し得た統合失調症の2例を経験したため報告する。(著者抄録)

Postoperative Course of Serum Albumin Levels and Organ Dysfunction After Liver Transplantation. 国際誌

Kazumasa Hiroi, Takashi Matsusaki, Ryuji Kaku, Yuzo Umeda, Takahito Yagi, Hiroshi Morimatsu

Transplantation proceedings 51 ( 8 ) 2750 - 2754 2019年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: Postoperative hypoalbuminemia, especially following liver transplantation, can lead to adverse multisystem effects and even death. We investigated the relationship between postoperative albumin levels and organ failure (assessed using Sequential Organ Failure Assessment [SOFA] scores). METHODS: Sixty liver transplant recipients admitted to the intensive care unit (ICU) from 2012 to 2015 were retrospectively divided into 2 groups: lower albumin (LA) (n=28) and higher albumin (HA) (n=32), using whether serum albumin level fell below 3.0 g/dL during the first postoperative week as the stratifying factor. The SOFA scores (primary endpoint) and associated complications (ascites amount, rejection, re-intubation, abdominal re-operation, thrombosis), additional treatment (dialysis, pleural effusion drainage), and duration of ICU stay (secondary endpoints) of the 2 groups were compared. RESULTS: Average serum albumin levels were significantly different between HA and LA groups (3.6 [3.4-3.8] vs 3.1 [2.9-3.3], respectively, P<.05), although the amounts of albumin infused in the 2 groups during the first postoperative week were not different (HA vs LA: 42 [30-71] vs 40 [30-58], respectively, P=.37). Mean daily SOFA scores were not significantly different between the HA and LA groups (8.3 [6.6-9.0] vs 7.2 [6.3-8.6], P=.73), although the HA group had lower mean cardiovascular SOFA sub-scores than the LA group (0.1 [0-0.4] vs 0.4 [0-1.3], P=.032). There were no significant differences between the groups with regard to complication rates and duration of ICU and hospital stays. CONCLUSIONS: Serum albumin level might not influence cumulative organ function, but it decreases the amount of hemodynamic support required in liver transplant recipients.

DOI： 10.1016/j.transproceed.2019.01.199

Propofolにketamineを併用した麻酔による電気けいれん療法で有効かつ安全に治療し得た難治性統合失調症の2例査読

山田裕士, 藤原雅樹, 酒本真次, 冨永悟, 稲垣正俊, 松崎孝, 森松博史, 山田了士

総合病院精神医学 31 ( 4 ) 448 - 454 2019年10月

記述言語：日本語出版者・発行元：(一社)日本総合病院精神医学会

電気けいれん療法(ECT)は、統合失調症患者においても緊張病状態や薬物治療抵抗例に対して考慮される重要な治療法である。ECTにおいて本邦で頻用される麻酔薬のpropofolは、強い抗けいれん作用を有するため、高い発作閾値が問題になるケースでは麻酔に工夫を要する。発作閾値上昇効果がないとされるketamineへの切り替え、または併用によるpropofolの減量は有効な方法の1つで、うつ病患者では抗うつ効果の増強も期待したketamineによるECTの報告が多い。一方でketamineは、その作用機序から統合失調症の精神症状を悪化させる懸念もある。今回、高い発作閾値が問題化したが、ketamineの併用によりpropofolを減量したECTで有効な発作が得られ、精神病症状の悪化を認めることなく有効かつ安全に治療し得た統合失調症の2例を経験したため報告する。(著者抄録)

大学病院における専攻医臨床能力評価システム導入後の現状

谷真規子, 金澤伴幸, 清水一好, 森松博史

日本臨床麻酔学会誌 39 ( 6 ) S272 - S272 2019年10月

血小板無力症合併妊婦の帝王切開の周術期管理経験

鄭芳毅, 小野大輔, 谷口新, 松崎孝, 清水一好, 森松博史

日本臨床麻酔学会誌 39 ( 6 ) S300 - S300 2019年10月

ラット心室細動モデルにおける胸骨圧迫が脳内グルタミン酸濃度に及ぼす影響

伏見美紀, 武田吉正, 川瀬宏和, 森松博史

蘇生 38 ( 3 ) 193 - 193 2019年10月

大動脈弓離断症根治術後に左反回神経麻痺による吸気努力増大が誘因となり生じた心嚢気腫の一例

谷真規子, 金澤伴幸, 清水一好, 岩崎達雄, 森松博史

Cardiovascular Anesthesia 23 ( Suppl. ) [DP3 - 01] 2019年9月

非心臓手術周術期の心血管イベント成人期のFontan手術後患者の周術期管理

清水一好, 金澤伴幸, 岩崎達雄, 森松博史

日本心臓病学会学術集会抄録 67回 S - 4 2019年9月

Early detection of cerebral ischemia due to pericardium traction using cerebral oximetry in pediatric minimally invasive cardiac surgery: a case report. 国際誌

Fumiaki Hayashi, Rei Nishimoto, Kazuyoshi Shimizu, Tomoyuki Kanazawa, Tatsuo Iwasaki, Hiroshi Morimatsu

JA clinical reports 5 ( 1 ) 53 - 53 2019年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Minimally invasive cardiac surgery (MICS) for simple congenital heart defects has become popular, and monitoring of regional cerebral oxygen saturation (rSO2) is crucial for preventing cerebral ischemia during pediatric MICS. We describe a pediatric case with a sudden decrease in rSO2 during MICS. CASE PRESENTATION: An 8-month-old male underwent minimally invasive ventricular septal defect closure. He developed a sudden decrease in rSO2 and right radial artery blood pressure (RRBP) without changes in other parameters following pericardium traction. The rSO2 and RRBP immediately recovered after removal of pericardium fixation. Obstruction of the right innominate artery secondary to the pericardium traction would have been responsible for it. CONCLUSIONS: Pericardium traction, one of the common procedures during MICS, triggered rSO2 depression alerting us to the risk of cerebral ischemia. We should be aware that pericardium traction during MICS can lead to cerebral ischemia, which is preventable by cautious observation of the patient.

DOI： 10.1186/s40981-019-0273-7

訂正：小児心臓手術後のNasal high flow therapyの現在と将来への展望

塩路直弘, 岩崎達雄, 清水一好, 金澤伴幸, 川瀬宏和, 木村聡, 黒江泰利, 佐藤明, 森松博史, 大月審一, 笠原真悟

Cardiovascular Anesthesia 23 ( 1 ) xli - xli 2019年8月

記述言語：日本語出版者・発行元：一般社団法人日本心臓血管麻酔学会

機関誌『Cardiovascular Anesthesia Vol. 22 No. 1 2018』におきまして，一部誤りがございましたので，下記の通り訂正いたします。

P45 著者名

正：塩路直弘，岩崎達雄，清水一好，金澤伴幸，川瀬宏和，木村聡

黒江泰利，佐藤明，森松博史，大月審一，笠原真悟

誤：塩路直弘，岩崎達雄，清水一好，金澤伴幸，川瀬宏和，木村聡

黒江泰利，佐藤明，森松博史，大月審一，笠原慎吾

DOI： 10.11478/jscva.2018-9-001

Prognosis after lead extraction in patients with cardiac implantable electronic devices infection: Comparison of lead-related infective endocarditis with pocket infection in a Japanese single-center experience.

Nobuhiro Nishii, Yoshimasa Morimoto, Akihito Miyoshi, Saori Tsukuda, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Morimatsu, Nobuchika Kusano, Shingo Kasahara, Morio Shoda, Hiroshi Ito

Journal of arrhythmia 35 ( 4 ) 654 - 663 2019年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background: The increase in the use of cardiac implantable electronic devices (CIEDs) has been associated with an increase in CIED-related infections. Transvenous lead extraction is safe and effective for patients with CIED-related infections; however, the mortality rate in these patients is high. The prognosis after transvenous lead extraction in Japanese patients, especially those with lead-related infective endocarditis, has not been evaluated. Then, the purpose of this study is to clarify the prognosis after transvenous lead extraction in Japanese patients with CIED-related infections at a single Japanese center. Methods: A total of 107 patients who underwent transvenous lead extraction were retrospectively reviewed. The patients were divided into a lead-related infective endocarditis group (n = 32) and a pocket infection group (n = 75). Procedure success rate and prognosis after lead extraction were evaluated between the two groups. Results: Procedure success rate was not significantly different between the groups. There were no deaths associated with the procedure or with infection. The survival rate was not significantly different at 1 year or at a median of 816 days (lead-related infective endocarditis vs pocket infection; 93.7% vs 94.7%, P = 1.000; 78.1% vs 81.3%, P = 0.791) Time to reimplantation and duration of hospital stay and antibiotics therapy were significantly longer for patients with lead-related infective endocarditis. Conclusion: In this study, the prognosis for patients with lead-related infective endocarditis after transvenous lead extraction was favorable. Thus, extraction should be strongly recommended, even if the general condition of the patient is poor.

DOI： 10.1002/joa3.12164

某大学病院における周術期認定歯科衛生士育成への取り組みと課題について

花岡愛弓, 三浦留美, 山中玲子, 曽我賢彦, 森松博史

日本歯科衛生学会雑誌 14 ( 1 ) 179 - 179 2019年8月

食道癌術前化学療法中の口腔衛生管理が口腔粘膜炎の重症化を防ぎ歯科治療遂行に貢献した一症例

高坂由紀奈, 花岡愛弓, 三浦留美, 山中玲子, 吉冨愛子, 曽我賢彦, 白川靖博, 森松博史

日本歯科衛生学会雑誌 14 ( 1 ) 180 - 180 2019年8月

食道癌術前補助化学療法中のセルフケアの確立に難渋した一症例

小倉早妃, 花岡愛弓, 高坂由紀奈, 三浦留美, 吉富愛子, 山中玲子, 曽我賢彦, 白川靖博, 森松博史

日本歯科衛生学会雑誌 14 ( 1 ) 180 - 180 2019年8月

食道癌周術期患者の口腔衛生状態を改善させ術後肺炎予防に貢献した一症例

大森裕子, 花岡愛弓, 高坂由紀奈, 三浦留美, 佐藤あやめ, 吉冨愛子, 山中玲子, 曽我賢彦, 白川靖博, 森松博史

日本歯科衛生学会雑誌 14 ( 1 ) 181 - 181 2019年8月

Hyperchloremia Is Not an Independent Risk Factor for Postoperative Acute Kidney Injury in Pediatric Cardiac Patients. 国際誌

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

Journal of cardiothoracic and vascular anesthesia 33 ( 7 ) 1939 - 1945 2019年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Hyperchloremia recently has been shown to have an association with the development of acute kidney injury (AKI) in critically ill patients. However, there is little information about the prevalence of an abnormal chloride concentration after pediatric cardiac surgery and its association with postoperative AKI. The aim of this study was to determine the prevalence of hyperchloremia and its association with AKI in pediatric patients after cardiac surgery. DESIGN: A retrospective single-center study. SETTING: Referral high-volume pediatric cardiac center in a tertiary teaching hospital. PARTICIPANTS: Patients under 72 months of age with congenital heart disease who underwent cardiac surgery with the use of cardiopulmonary bypass. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was development of AKI diagnosed by Kidney Disease Improving Global Outcomes consensus criteria. The associations of outcomes with the highest serum chloride concentration ([Cl-]max) and time-weighted average chloride concentration ([Cl-]ave) within the first 48 hours after surgery were investigated. Of 521 patients included in the study, 463 patients (88.9%) had hyperchloremia at least 1 time within the first 48 hours after surgery. Postoperative AKI occurred in 205 patients (39.3%). [Cl-]ave and [Cl-]max in the AKI group were significantly higher than those in the non-AKI group (112 [110-114] mEq/L v 111 [109-113] mEq/L, p = 0.001 and 116 [113, 119] mEq/L v 114 [112-118] mEq/L, p = 0.002, respectively). After adjustment for other predictors of AKI by multivariable analyses, neither [Cl-]ave nor [Cl-]max was associated independently with the development of AKI (odds ratio [OR] = 1.040, 95% confidence interval [CI]: 0.885-1.220, p = 0.63; OR = 0.992, 95% CI: 0.874-1.130. p = 0.90). CONCLUSION: Postoperative hyperchloremia was common and was associated with the development of AKI in pediatric patients after congenital cardiac surgery in univariate analysis. After adjustment for predictors of AKI by multivariate analyses, there was no significant relationship between postoperative chloride concentration and AKI.

DOI： 10.1053/j.jvca.2018.12.009

Possible biased analgesic of hydromorphone through the G protein-over β-arrestin-mediated pathway: cAMP, CellKey™, and receptor internalization analyses.

Sei Manabe, Kanako Miyano, Yuriko Fujii, Kaori Ohshima, Yuki Yoshida, Miki Nonaka, Miaki Uzu, Yoshikazu Matsuoka, Tetsufumi Sato, Yasuhito Uezono, Hiroshi Morimatsu

Journal of pharmacological sciences 140 ( 2 ) 171 - 177 2019年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Morphine, fentanyl, and oxycodone are widely used as analgesics, and recently hydromorphone has been approved in Japan. Although all of these are selective for μ-opioid receptors (MORs) and have similar structures, their analgesic potencies and adverse effects (AEs) are diverse. Recent molecular analyses of MOR signaling revealed that the G protein-mediated signaling pathway causes analgesic effects and the β-arrestin-mediated signaling pathway is responsible for AEs. We used several cell-based analyses that selectively measure cellular responses activated by either G protein- or β-arrestin-mediated pathways. GloSensor™ cAMP, CellKey™, and receptor internalization assays were performed with four different types of cells stably expressing differentially labelled MOR. EC50 values measured by cAMP and CellKey™ assays had potencies in the order fentanyl ≤ hydromorphone < morphine ≤ oxycodone, all also exhibiting full agonist responses. However, in the internalization assay, only fentanyl elicited a full agonist response. Hydromorphone had the strongest potency next to fentanyl; however, contribution of the β-arrestin-mediated pathway was small, suggesting that its effect could be biased toward the G protein-mediated pathway. Based on these properties, hydromorphone could be chosen as an effective analgesic.

DOI： 10.1016/j.jphs.2019.06.005

Recent Changes and Improvements in Multidisciplinary Perioperative Management From a Nutritional Perspective: Dental Specialty Should Be Considered Important 査読

Yoshihiko Soga, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Takako Ashiwa, Hiroshi Morimatsu

Current Oral Health Reports 6 ( 2 ) 70 - 75 2019年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Purpose of Review: Recently, multidisciplinary strategies on accelerated recovery postoperatively have been provided, and management of the perioperative period has changed and improved dramatically. We summarize the enhanced recovery after surgery (ERAS®) protocol and its outcomes from a nutritional perspective. We established the perioperative management center (PERiO), much of whose work contents conform to ERAS®, but intensive dental staff involvement is characteristic. We also summarize its outcomes. Recent Findings: ERAS® is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. Nutrition is a key pillar for patient care. Throughout the perioperative period, oral nutrition is suggested as well as possible. Good outcomes have been reported by a meta-analysis of randomized controlled trials. However, the dental staff are not regarded as part of the professional team. PERiO reported good outcomes of care bundles and suggested the importance of dental staff contribution. The Japanese social insurance system began to cover involvements of the dental staff for perioperative oral management since 2012. Analysis of the nationwide administrative claims database in Japan concluded that preoperative oral care by a dentist significantly reduced postoperative complications in patients undergoing cancer surgery. Summary: Currently, the dental staff are not regarded as key professionals of ERAS®, although the dental staff can contribute to good outcomes in the perioperative period and PERiO, and consequently, the Japanese universal health insurance coverage system covering involvements of the dental staff for perioperative oral management showed good outcomes. Therefore, further clinical studies involving dental specialty should be considered important for perioperative management from nutritional perspectives.

DOI： 10.1007/s40496-019-0217-3

Therapeutic effect of carbon monoxide-releasing molecule-3 on acute lung injury after hemorrhagic shock and resuscitation. 国際誌

Yuta Kumada, Toru Takahashi, Hiroko Shimizu, Ryu Nakamura, Emiko Omori, Kazuyoshi Inoue, Hiroshi Morimatsu

Experimental and therapeutic medicine 17 ( 5 ) 3429 - 3440 2019年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Hemorrhagic shock and resuscitation (HSR) induces a pulmonary inflammatory response and frequently causes acute lung injury. Carbon monoxide-releasing molecule-3 (CORM-3) has been reported to liberate and deliver CO under physiological conditions, which exerts organ-protective effects during systemic insults. The present study aimed to determine whether the administration of CORM-3 following HSR exerts a therapeutic effect against HSR-induced lung injury without any detrimental effects on oxygenation and hemodynamics. To induce hemorrhagic shock, rats were bled to a mean arterial blood pressure of 30 mmHg for 45 min and then resuscitated with the shed blood. CORM-3 or a vehicle was intravenously administered immediately following the completion of resuscitation. The rats were divided into four groups, including sham, HSR, HSR/CORM-3 and HSR/inactive CORM-3 groups. Arterial blood gas parameters and vital signs were recorded during HSR. The histopathological changes to the lungs were evaluated using a lung injury score, while pulmonary edema was evaluated on the basis of the protein concentration in bronchoalveolar lavage fluid and the lung wet/dry ratio. We also investigated the pulmonary expression levels of inflammatory mediators and apoptotic markers such as cleaved caspase-3 and transferase-mediated dUTP-fluorescein isothiocyanate nick-end labeling (TUNEL) staining. Although HSR caused significant lung histopathological damage and pulmonary edema, CORM-3 significantly ameliorated this damage. CORM-3 also attenuated the HSR-induced upregulation of tumor necrosis factor-α, inducible nitric oxide synthase and interleukin-1β genes, and the expression of interleukin-1β and macrophage inflammatory protein-2. In addition, the expression of interleukin-10, an anti-inflammatory cytokine, was inversely enhanced by CORM-3, which also reduced the number of TUNEL-positive cells and the expression of cleaved caspase-3 following HSR. Although CORM-3 was administered during the acute phase of HSR, it did not exert any influence on arterial blood gas analysis data and vital signs during HSR. Therefore, treatment with CORM-3 ameliorated HSR-induced lung injury, at least partially, through anti-inflammatory and anti-apoptotic effects, without any detrimental effects on oxygenation and hemodynamics.

DOI： 10.3892/etm.2019.7390

Prolonged Tachycardia with Higher Heart Rate Is Associated with Higher ICU and In-hospital Mortality. 査読

Hayashi M, Taniguchi A, Kaku R, Fujimoto S, Isoyama S, Manabe S, Yoshida T, Suzuki S, Shimizu K, Morimatsu H, Momota R

Acta medica Okayama 73 ( 2 ) 147 - 153 2019年4月

周術期におけるECMO 小児複雑心奇形の周術期におけるECMO治療

岩崎達雄, 金澤伴幸, 清水一好, 川瀬宏和, 森松博史, 笠原真悟

日本臨床麻酔学会誌 39 ( 2 ) 148 - 154 2019年3月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

小児におけるECMO(Extracorporeal Membrane Oxygenation)治療は、先天性心疾患に対しても重要な適応がある。小児複雑心奇形周術期におけるECMO導入のコンセンサスの得られた明確な基準はないが、循環破綻による多臓器障害を合併した状態での導入より、計画的早期の導入の方が離脱率の向上につながると考えられる。出血性合併症が問題となりやすいが、病態を把握し補充療法に努める。心機能の回復には心室の十分な減圧が必要である。小児複雑心奇形の特徴的な疾患である単心室症例のECMO管理では循環生理および解剖学的特徴をよく理解し、各々の状態に応じた管理が肝要である。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01620&link_issn=&doc_id=20190319280006&doc_link_id=%2Fci4jjsca%2F2019%2F003902%2F007%2F0148-0154%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2019%2F003902%2F007%2F0148-0154%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

High-flow Nasal Cannula Versus Noninvasive ventilation for Postextubation Acute Respiratory Failure after Pediatric Cardiac Surgery.

Naohiro Shioji, Tomoyuki Kanazawa, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomohiko Suemori, Yasutoshi Kuroe, Hiroshi Morimatsu

Acta medica Okayama 73 ( 1 ) 15 - 20 2019年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

We compared the reintubation rate in children who received high-flow nasal cannula (HFNC) therapy to the rate in children who received noninvasive ventilation (NIV) therapy for acute respiratory failure (ARF) after cardiac surgery. This was a retrospective analysis of 35 children who received HFNC therapy for ARF after cardiac surgery in 2014-2015 (the HFNC group). We selected 35 children who had received NIV therapy for ARF after cardiac surgery in 2009-2012 as a control group. The matching parameters were body weight and risk adjustment for congenital heart surgery category 1. The reintubation rate within 48 h in the HFNC group tended to be lower than that in the NIV group (3% vs. 17%, p=0.06). The reintubation rate within 28 days was significantly lower in the HFNC group compared to the NIV group (3% vs. 26%, p=0.04). The HFNC group's ICU stays were significantly shorter than those of the NIV group: 10 (IQR: 7-17) days vs. 17 (11-32) days, p=0.009. HFNC therapy might be associated with a reduced reintubation rate in children with ARF after cardiac surgery.

DOI： 10.18926/AMO/56454

Hemi-clamshell開胸法により片側の脳局所組織酸素飽和度が低下した1例

部村公香, 清水一好, 金澤伴幸, 廣井一正, 小林求, 森松博史

日本臨床麻酔学会誌 39 ( 1 ) 21 - 25 2019年1月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

55歳、男性。左房浸潤を伴う肺癌に対し、右上葉切除、S6切除および人工心肺を用いた左房部分切除術が予定された。人工心肺使用症例であることから、両側の脳局所組織酸素飽和度(rSO2)をモニターした。胸壁への癒着剥離の際、hemi-clamshell開胸開始後から右rSO2値のみ低下を認めた。胸壁のつり上げに伴い腕頭動脈が狭窄し右脳血流が著明に低下したことが原因と考えた。つり上げ程度の調整により右rSO2値は速やかに改善した。術後は神経学的後遺症なく経過した。本症例ではrSO2測定により術操作に伴う脳血流異常を検知・対応でき、神経学的後遺症を回避できた。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01620&link_issn=&doc_id=20190123360004&doc_link_id=130007592686&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007592686&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Histidine-Rich Glycoprotein As a Prognostic Biomarker for Sepsis: A Multicenter Prospective Observational Cohort Study

Kosuke Kuroda, Kenzo Ishii, Yuko Mihara, Naoya Kawanoue, Hidenori Wake, Shuji Mori, Michihiro Yoshida, Masahiro Nishibori, Hiroshi Morimatsu, Okayama Research Investigation Orga Investigators

SSRN Electronic Journal 2019年

Incidence rates of postoperative pulmonary embolisms in symptomatic and asymptomatic patients, detected by diagnostic images: A single-center retrospective study

Yoshikazu Matsuoka, Hiroshi Morimatsu

Circulation Journal 83 ( 2 ) 432 - 440 2019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：Japanese Circulation Society

Background: Pulmonary embolism (PE) is a serious complication during the perioperative period. However, because most previous studies on the incidence of postoperative PE are based on symptoms, asymptomatic occurrences of PE have been overlooked, and the absolute incidence of postoperative PE remains unknown. The aim of this study was to investigate the incidence of perioperative PE, regardless of its symptoms, by reviewing the clinical interpretations of the diagnostic images obtained during the postoperative period. Methods and Results: This study included all patients aged at least 18 years who underwent operations under general and/or neuraxial anesthesia in our institution from 2013 to 2016. We reviewed all interpretations of the diagnostic imaging performed in the postoperative period. We analyzed the 90-day cumulative incidence of postoperative PE and the characteristics, risk factors, and symptoms of patients with and without postoperative PE. Among 21,763 operations, postoperative diagnostic imaging was performed in 1,168 patients, which found PE in 217 patients. Symptoms appeared in 11.1% (24/217) of the PE patients, and 66.7% of these symptoms were decreased levels of SpO 2 alone. Mortality from PE was 0.5% (1/217). Conclusions: Diagnostic imaging found a number of postoperative PE cases, regardless of the presence of symptoms. Although symptomatic PE was not a frequent occurrence, these findings suggest that clinicians should be aware of postoperative PE even under current prophylaxis.

DOI： 10.1253/circj.CJ-18-0729

Radio contrast imaging for continuous epidural infusion in humans: a report of three cases. 国際誌

Takashi Matsusaki, Ryuji Kaku, Daisuke Ono, Arata Taniguchi, Hiroshi Morimatsu

Journal of pain research 12 1077 - 1082 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）

There are no reports of human research on continuous epidural contrast injection, and there are no definite methods to investigate the spread of drugs injected continuously into the epidural space. We investigated the feasibility of continuous epidural contrast injection in patients undergoing computed tomography (CT)-guided therapy. In this study, a combination of a contrast agent mixed with 0.75% ropivacaine was used as the test drug. The main outcome evaluated was the feasibility of continuous epidural contrast imaging by CT scan following epidural injection of a contrast agent with 0.75% ropivacaine. We studied three patients who underwent CT-guided procedures and found that continuous epidural contrast injection was possible without any deleterious effects, such as an allergic reaction. The spread of the contrast agent was not consistent with the level of the clinical analgesic effect. Continuous epidural contrast injection is a feasible procedure. The results of our study might contribute to future research on continuous epidural contrast administration, as well as provide patients with superior analgesia.

DOI： 10.2147/JPR.S193500

Long-term outcomes in patients treated in the intensive care unit after hematopoietic stem cell transplantation. 査読

Nakamura M, Fujii N, Shimizu K, Ikegawa S, Seike K, Inomata T, Sando Y, Fujii K, Nishimori H, Matsuoka KI, Morimatsu H, Maeda Y

International journal of hematology 108 ( 6 ) 622 - 629 2018年12月

刺激神経の選択が可能な筋弛緩モニターの開発

岡久雄, 岸本俊夫, 木村聡, 川瀬宏和, 岩崎達雄, 青木梨奈, 有路未彩, 鴨川晴香, 森松博史

バイオメカニズム学術講演会予稿集 39回 48 - 51 2018年11月

記述言語：日本語出版者・発行元：バイオメカニズム学会

適切な神経刺激と誘発筋収縮の正確なモニタリングを行うことができる筋弛緩モニターを開発するために、機器の試作および刺激実験を行って性能を確認した。被験者は健常な50～60代男性2名とした。筋弛緩モニターシステムは、母指の筋振動を検出する軸加速度センサ、尺骨神経の選択的神経刺激が可能なアレイ電極、電極の自動探索を行う電極選択インタフェース、および電気刺激や四連刺激比を表示する筋弛緩モニターから構成された。まず、臨床でよく用いられ尺骨神経の支配を受ける母指内転筋を対象とし、筋弛緩モニタリングを行った。次に、試作したアレイ電極の神経刺激選択性を確認するために、正中神経を刺激して実験を行った。また、正中神経よりも細い尺骨神経を選択的に電気刺激して、正確に母指内転筋の筋振動を誘発できるかを確認した。本実験で得られた結果から、製作したアレイ電極は筋弛緩モニタリングに適した尺骨神経刺激部位を探索することが可能であり、また本実験で用いた加速度センサによって精度良く対象筋の動きを測定でき、当初の問題点を解決できたと考える。

Tチューブ挿入中の術中人工呼吸管理にForgatyカテーテルを使用した一症例

根ヶ山諒, 岡原修司, 松岡義和, 塩路直弘, 熊代美香, 金澤伴幸, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 24 ( Suppl. ) 161 - 161 2018年10月

A-line穿刺は貫通法で行う Pro: Proの立場から

金澤伴幸, 清水一好, 岩崎達雄, 森松博史

日本臨床麻酔学会誌 38 ( 6 ) S158 - S158 2018年10月

術後呼吸管理が予定される小児手術では,経鼻挿管とする Pro: 術後呼吸管理が予定される小児手術では,絶対経鼻挿管が有用である

川瀬宏和, 岩崎達雄, 清水一好, 金澤伴幸, 塩路直弘, 黒江泰利, 森松博史

日本臨床麻酔学会誌 38 ( 6 ) S159 - S159 2018年10月

The Incidence of Desaturation during Anesthesia in Adult and Pediatric Patients: A Retrospective Study.

Vika Fatafehi Hala'ufia Lemoto, Kentaro Sugimoto, Tomoyuki Kanazawa, Takashi Matsusaki, Hiroshi Morimatsu

Acta medica Okayama 72 ( 5 ) 467 - 478 2018年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

We investigated the incidence of desaturation during general anesthesia in preoperatively hypoxic (< 92%), and nonhypoxic (≥ 92%) pediatric (n=1,090) and adult (n=5,138) patients. We plotted the patients' SpO2 value time-courses and assessed desaturation in 6,228 patients. The crude overall incidence (95%CI) for desaturation was 11.1% (9.4-13.1) in the pediatric patients and 0.9% (0.6-1.2) in the adults. The crude incidence of desaturation in the hypoxic pediatric patients was 2.5 times the risk in the nonhypoxic patients: risk ratio (RR) 2.5 (1.8-3.5), p<0.001. The risk of desaturation in the hypoxic adult patients was 20.1 times the risk in the nonhypoxic adult patients: RR 20.1 (10.3-39.2), p<0.001. When the patients were separately stratified by American Society of Anesthesiologists Physical Status (ASA-PS) and by age, the directly adjusted risk-ratio (RRS) showed that the hypoxic pediatric patients had 1.8 and 1.6 times the risk in the nonhypoxic pediatric patients: ASA-PS adjusted RRS 1.6 (1.8-2.2), p<0.001; age-adjusted RRS 1.8 (1.3-2.5), p<0.001, and the hypoxic adult patients had 13.8 times the risk in the nonhypoxic adult patients: RRS 13.8 (6.9-27.6), p<0.001. A pulse-oximeter check before the start of general anesthesia could ensure timely preparation to avoid intraoperative desaturation.

DOI： 10.18926/AMO/56244

超音波ガイド下動脈ライン穿刺と末梢静脈ライン確保のコツ

金澤伴幸, 岩崎達雄, 清水一好, 塩路直弘, 黒江泰利, 森松博史

日本小児麻酔学会誌 24 ( Suppl. ) 72 - 72 2018年10月

硬膜外麻酔下血腫減量術が有効であった巨大慢性拡張性胸腔内血腫の一症例

五反田倫子, 小林求, 松岡勇斗, 廣井一正, 松岡義和, 森松博史

日本臨床麻酔学会誌 38 ( 6 ) S340 - S340 2018年10月

Norepinephrine-induced downregulation of GLT-1 mRNA in rat astrocytes

Masako Kurita, Yoshikazu Matsuoka, Kosuke Nakatsuka, Daisuke Ono, Noriko Muto, Ryuji Kaku, Hiroshi Morimatsu

Biochemical and Biophysical Research Communications 504 ( 1 ) 103 - 108 2018年9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：Elsevier B.V.

Aim of the research: Glutamate transporter-1 (GLT-1
also known as excitatory amino acid transporter 2) plays an important role in the maintenance of glutamate homeostasis in the synaptic cleft. Downregulation of GLT-1 in the spinal cord has been reported in chronic pain models, which suggests that GLT-1 is involved in the development of chronic pain. However, the mechanism by which GLT-1 is downregulated in the spinal cord is still unknown. We hypothesized that norepinephrine is involved in the regulation of GLT-1. The aim of this study was to investigate the effect of norepinephrine on GLT-1 expression in cultured astrocytes. Methods: This study involved both in vivo and in vitro experiments. We first validated changes in GLT-1 mRNA expression in the spinal cord of rats with spared nerve injury (SNI) using real-time RT-PCR. Next, cultured primary astrocytes from the rat spinal cord were stimulated with norepinephrine, and GLT-1 mRNA was subsequently quantitated. RNB cells, an astrocytic cell line, were also stimulated with norepinephrine and other α-adrenoceptor agonists. Results: SNI resulted in bilateral downregulation of GLT-1 in rat spinal cord. The in vitro study showed that norepinephrine and phenylephrine dose-dependently downregulated GLT-1 in primary astrocytes and RNB cells. Furthermore, the effect of norepinephrine was reversed by an α-adrenoceptor antagonist. Conclusion: Norepinephrine downregulates GLT-1 mRNA expression in astrocytes via the α 1 -adrenoceptor. Our results provide new insight into the mechanisms involved in downregulation of GLT-1 in the chronic pain models.

DOI： 10.1016/j.bbrc.2018.08.137

急性血液浄化法の開始基準・離脱基準-我々はこうしている- 当院におけるCRRT導入のタイミングと生存率の関係

末永健二, 清水一好, 中尾篤典, 森松博史

日本急性血液浄化学会雑誌 9 ( Suppl. ) 96 - 96 2018年9月

当院での小児血漿交換初期血圧低下予防への取り組み

落葉佑昌, 清水一好, 上野秀則, 岩藤晋, 森松博史

日本急性血液浄化学会雑誌 9 ( Suppl. ) 125 - 125 2018年9月

当院におけるECMO回路へのCRRT回路組み込み方法の現状

西村まどか, 堂口琢磨, 高寛, 宮本綾子, 高浪大地, 清水一好, 森松博史

日本急性血液浄化学会雑誌 9 ( Suppl. ) 127 - 127 2018年9月

肺動脈閉鎖、右室・冠動脈瘻、巨大冠動脈に対し、出生直後に右室・冠動脈瘻閉鎖術を施行した一症例

林真雄, 金澤伴幸, 谷真規子, 黒江泰利, 岩崎達雄, 森松博史

Cardiovascular Anesthesia 22 ( Suppl. ) 196 - 196 2018年9月

小児心臓手術後のNasal high flow therapyの現在と将来への展望

塩路直弘, 岩崎達雄, 清水一好, 金澤伴幸, 川瀬宏和, 木村聡, 黒江泰利, 佐藤明, 森松博史, 大月審一, 笠原慎吾

Cardiovascular Anesthesia 22 ( 1 ) 45 - 48 2018年8月

記述言語：日本語出版者・発行元：一般社団法人日本心臓血管麻酔学会

Nasal high flow therapy (NHFT)は，死腔の二酸化炭素洗い流し効果，規定された吸入酸素濃度の供給，持続陽圧効果などの特徴を有する呼吸補助デバイスである。成人では，NHFTは従来の酸素療法に比べて再挿管率の改善で有利な結果が得られており，小児心臓術後でもその役割が期待される。小児心臓手術後症例には並列循環やフォンタン循環といった特殊な循環動態の症例が含まれる。このような症例では投与酸素濃度や持続陽圧が循環動態に影響を与えるため，小児心臓手術後症例にNHFTを使用する際は病態やデバイスの特徴をよく理解して使用することが望ましい。また，NHFTの応用的な使用方法に，一酸化窒素（NO）とNHFTを併用したNO療法，窒素とNHFTを併用した低酸素療法がある。このようにNHFTは可能性がある呼吸補助デバイスであるが，現時点で小児心臓手術後のNHFTに関するエビデンスは限定されている。今後，小児心臓手術後の呼吸管理に関する新たな臨床研究が行われることが嘱望される。

DOI： 10.11478/jscva.2018-1-004

その他リンク： https://search.jamas.or.jp/link/ui/2019006587

Perioperative management of complete robotic renal autotransplantation: The first case in Japan

Yuriko Okazaki, Hideki Taninishi, Tsubasa Yoshida, Motoo Araki, Hiroshi Morimatsu

Japanese Journal of Anesthesiology 67 ( 8 ) 862 - 865 2018年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Kokuseido Publishing Co. Ltd

We report perioperative management of the first case in Japan of complete robotic renal autotransplan-tatioa This procedure was applied to a 38-year-old woman with ureteral stenosis. Anesthesia was induced by propofol and rocuronium with oxygen, and maintained by sevoflurane with remifentanil in 40% oxygen balanced with air. We gave dopamine for keeping renal perfusion pressure and steroid for avoiding ischemia-reperfusion injury. Longer procedure could be expected because of vascular and ureteral anastomosis by totally robot assistance, we had to pay special attention to posture related complicatioa Although past report showed that no position change was performed throughout nephrectomy and autotransplantation, we decided to switch from right-side lateral to head-down dorsosacral position at the end of nephrectomy. Layout of surgical table, anesthetic machine and biomonitor had to be adjusted following postural change in order to keep robot surgical system sterilized. Preoperative precise discussion and simulation of surgical procedure among surgeons, anesthesiologists and nursing staff was important factor for the success of this procedure without any major complicatioa.

A Multidisciplinary Approach to the Management of Chronic Pain through a Self-managed Behavioral Exercise Program : A Pilot Study in Japan. 査読

Nishie H, Tetsunaga T, Kanzaki H, Oda K, Inoue S, Ryuo Y, Ota H, Miyawaki T, Arakawa K, Tetsunaga T, Kitamura Y, Sendo T, Morimatsu H, Ozaki T, Nishida K

Acta medica Okayama 72 ( 4 ) 343 - 350 2018年8月

New oral hygiene care regimen reduces postoperative oral bacteria count and number of days with elevated fever in ICU patients with esophageal cancer. 査読

Mizuno H, Mizutani S, Ekuni D, Tabata-Taniguchi A, Maruyama T, Yokoi A, Omori C, Shimizu K, Morimatsu H, Shirakawa Y, Morita M

Journal of oral science 2018年8月

某大学病院の周術期口腔機能管理における患者満足度調査報告

高坂由紀奈, 花岡愛弓, 三浦留美, 山中玲子, 吉冨愛子, 曽我賢彦, 森松博史, 佐々木朗

日本歯科衛生学会雑誌 13 ( 1 ) 174 - 174 2018年8月

Perioperative Management of a Child With Glucose Transporter Type 1 Deficiency Syndrome: A Case Report. 国際誌

Tsubasa Yoshida, Kazuyoshi Shimizu, Satoshi Suzuki, Yoshikazu Matsuoka, Hiroshi Morimatsu

A&A practice 11 ( 2 ) 35 - 37 2018年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Glucose transporter type 1 deficiency syndrome (GLUT1DS) causes central nervous system dysfunction including intractable epilepsy caused by impaired glucose transport to the brain. To prevent convulsions and maintain an energy source for the brain in patients with GLUT1DS, the maintenance of adequate ketone body concentrations, compensation of metabolic acidosis, and reduction of surgical stress are essential. We here report the perioperative management of a child with GLUT1DS.

DOI： 10.1213/XAA.0000000000000727

Current Ventilator and Oxygen Management during General Anesthesia: A Multicenter, Cross-sectional Observational Study. 査読

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, Okayama Research, Investigation Organizing Network (ORION, investigators

Anesthesiology 129 ( 1 ) 67 - 76 2018年7月

ラット心室細動モデルにおける胸骨圧迫や脳低温療法が脳内グルタミン酸濃度に及ぼす影響

伏見美紀, 武田吉正, 川瀬宏和, 森松博史

日本脳低温療法・体温管理学会プログラム・抄録集 21回 45 - 45 2018年7月

Determination of the target temperature required to block increases in extracellular glutamate levels during intraischemic hypothermia

Sachiko Sato, Yoshimasa Takeda, Ryoichi Mizoue, Hirokazu Kawase, Miki Fushimi, Tomohisa Shimizu, Hiroshi Morimatsu

Therapeutic Hypothermia and Temperature Management 8 ( 2 ) 83 - 89 2018年6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：Mary Ann Liebert Inc.

This study aimed to determine a target temperature for intraischemic hypothermia that can block increases in extracellular glutamate levels. Two groups of 10 rats each formed the normothermia and intraischemic hypothermia groups. Extracellular glutamate levels, the extracellular potential, and the cerebral blood flow were measured at the adjacent site in the right parietal cerebral cortex. Cerebral ischemia was induced by occlusion of the bilateral common carotid arteries and hypotension. In the intraischemic hypothermia group, brain hypothermia was initiated immediately after the onset of membrane potential loss. In the normothermia group, extracellular glutamate levels began to increase simultaneously with the onset of membrane potential loss and reached a maximum level of 341.8 ± 153.1 μmol·L-1. A decrease in extracellular glutamate levels was observed simultaneously with the onset of membrane potential recovery. In the intraischemic hypothermia group, extracellular glutamate levels initially began to increase, similarly to those in the normothermia group, but subsequently plateaued at 140.5 ± 105.4 μmol·L-1, when the brain temperature had decreased to &lt
32.6°C ± 0.9°C. A decrease in extracellular glutamate levels was observed simultaneously with the onset of membrane potential recovery, similarly to the findings in the normothermia group. The rate of decrease in extracellular glutamate levels was the same in both groups (-36.6 and-36.0 μmol·L-1 in the normothermia and intraischemic hypothermia groups, respectively). In conclusion, the target temperature for blocking glutamate release during intraischemic hypothermia was found to be 32.6°C ± 0.9°C. Our results suggest that the induction of intraischemic hypothermia can maintain low glutamate levels without disrupting glutamate reuptake. Institutional protocol number: OKU-2016146.

DOI： 10.1089/ther.2017.0041

神経麻酔の多職種連携岡山大学病院における脳外科症例に対する周術期管理センターの取り組み

松崎孝, 松岡義和, 谷西秀紀, 賀来隆治, 小林求, 田村利枝, 足羽孝子, 安原隆雄, 伊達勲, 森松博史

日本神経麻酔集中治療学会プログラム・抄録集 22回 25 - 26 2018年6月

A subclinical high tricuspid regurgitation pressure gradient independent of the mean pulmonary artery pressure is a risk factor for the survival after living donor liver transplantation 査読

Yosuke Saragai, Akinobu Takaki, Yuzo Umeda, Takashi Matsusaki, Tetsuya Yasunaka, Atsushi Oyama, Ryuji Kaku, Kazufumi Nakamura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Takuya Adachi, Nozomu Wada, Yasuto Takeuchi, Kazuko Koike, Fusao Ikeda, Hideki Onishi, Hidenori Shiraha, Shinichiro Nakamura, Hiroshi Morimatsu, Hiroshi Ito, Toshiyoshi Fujiwara, Takahito Yagi, Hiroyuki Okada

BMC Gastroenterology 18 ( 1 ) 62 2018年5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：BioMed Central Ltd.

Background: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). Methods: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG
n=34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2&lt
80 mmHg and an alveolar-arterial oxygen gradient (AaDO2)≥15 mmHg were categorized as potentially having HPS (subclinical HPS
n=29). The clinical course after LDLT was investigated according to subclinical high TRPG. Results: A subclinical high TRPG (p=0.012) and older donor age (p=0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. Conclusion: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

DOI： 10.1186/s12876-018-0793-z

【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年5月

Decrease in Histidine-Rich Glycoprotein as a Novel Biomarker to Predict Sepsis Among Systemic Inflammatory Response Syndrome. 査読

Kuroda K, Wake H, Mori S, Hinotsu S, Nishibori M, Morimatsu H

Critical care medicine 46 ( 4 ) 570 - 576 2018年4月

Incidence of Pulmonary Complications with the Prophylactic Use of High-flow Nasal Cannula after Pediatric Cardiac Surgery: Prophylactic HFNC Study Protocol.

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

Acta medica Okayama 72 ( 2 ) 193 - 196 2018年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

We will investigate the incidence of postoperative pulmonary complications (PPCs) with the prophylactic use of a high-flow nasal cannula (HFNC) after pediatric cardiac surgery. Children < 48 months old with congenital heart disease for whom cardiac surgery is planned will be included. The HFNC procedure will be commenced just after extubation, at a flow rate of 2 L/kg/min with adequate oxygen concentration to achieve target oxygen saturation ≥ 94%. This study will reveal the prevalence of PPCs after pediatric cardiac surgery with the prophylactic use of HFNC.

DOI： 10.18926/AMO/55862

小児の麻酔中における人工呼吸器設定

金澤伴幸, 岩崎達雄, 清水一好, 末盛智彦, 森松博史

日本臨床麻酔学会誌 38 ( 2 ) 250 - 255 2018年3月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

小児患者は、年齢・体重・身長がさまざまであり、麻酔中の人工呼吸器設定は一定の条件下ですべての患者を管理することはできない。成長発達に伴い体格が変化するため、それぞれに合わせた設定が必要である。また、小児患者は成人に比べ呼吸数が多い、気道が狭いなどの特徴を持ち、それら呼吸生理学・解剖学に基づいた呼吸器設定や気管チューブ選択が必要である。すなわち小児の人工呼吸器設定を適切に行うには、まず小児の呼吸生理学を理解する必要がある。全身麻酔下の呼吸生理学は自発呼吸下のそれとは異なるため、本稿では、まず小児の自発呼吸下での呼吸生理学を正しく理解しそれを全身麻酔下人工呼吸に応用する方法を解説する。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01620&link_issn=&doc_id=20180319160017&doc_link_id=%2Fci4jjsca%2F2018%2F003802%2F020%2F0250-0255%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2018%2F003802%2F020%2F0250-0255%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

胸腺腫摘出術後の抜管時に冠動脈攣縮から心停止に至った1例

吹田晃享, 清水一好, 金澤伴幸, 松岡義和, 森松博史

日本臨床麻酔学会誌 38 ( 2 ) 142 - 147 2018年3月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

胸腺腫摘出術術後の抜管時に冠動脈攣縮から心停止に至ったと考えられる1例を経験した。症例は60歳、男性。術前評価で冠動脈器質的異常を認めなかったが、喫煙など複数の冠攣縮危険因子を有していた。腫瘍の浸潤性や術中循環動態の不安定性から、胸骨正中切開、静脈バイパス併用下胸腺腫摘出手術を行った。手術終了後にST上昇先行の心停止を発症したが、蘇生後の心機能回復は良好で、後遺症なく独歩退院した。術後の冠動脈攣縮誘発試験陽性から、心停止の原因は冠攣縮が強く疑われた。高侵襲手術などの手術因子、麻酔覚醒や薬剤投与などの術中因子が合わさり、冠攣縮に伴う心停止に至ったと考えられた。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01620&link_issn=&doc_id=20180319160002&doc_link_id=%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery. 査読

Hironobu Toda, Kazufumi Nakamura, Koji Nakagawa, Atsuyuki Watanabe, Toru Miyoshi, Nobuhiro Nishii, Kazuyoshi Shimizu, Masao Hayashi, Hiroshi Morita, Hiroshi Morimatsu, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 82 ( 3 ) 775 - 782 2018年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery.Methods and Results:In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

DOI： 10.1253/circj.CJ-17-0747

Randomized Controlled Trial of Epidural versus Patient-controlled Intravenous Analgesia for Postoperative Pain Control after Laparoscopic Gastrectomy. 査読

Kikuchi S, Kuroda S, Nishizaki M, Matsusaki T, Mitsuhashi T, Kuwada K, Kagawa S, Morimatsu H, Fujiwara T

Acta medica Okayama 72 ( 1 ) 95 - 98 2018年2月

人工呼吸器離脱時の吸入酸素濃度に関する研究単施設前向き無作為化比較試験

石井賢造, 森松博史, 兵頭剛, 日高秀邦, 藤重有紀, 佐倉考信, 横尾千加子, 矢島悠太, 木村貴一, 大村浩之

日本集中治療医学会雑誌 25 ( Suppl. ) [O65 - 4] 2018年2月

試作Tele ICUシステムの病院間使用

清水一好, 木村雅一, 鈴木聡, 林真雄, 森松博史

日本集中治療医学会雑誌 25 ( Suppl. ) [O76 - 7] 2018年2月

ラットくも膜下出血モデルにおける皮質脱分極、脳波、脳組織障害の評価

高杉祐二, 菱川朋人, 清水智久, 新治有径, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 33 56 - 56 2018年2月

NADH fluorescence imaging and the histological impact of cortical spreading depolarization during the acute phase of subarachnoid hemorrhage in rats 査読国際誌

Tomohisa Shimizu, Tomohito Hishikawa, Shingo Nishihiro, Yukei Shinji, Yuji Takasugi, Jun Haruma, Masafumi Hiramatsu, Hirokazu Kawase, Sachiko Sato, Ryoichi Mizoue, Yoshimasa Takeda, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Journal of Neurosurgery 128 ( 1 ) 137 - 143 2018年1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：American Association of Neurological Surgeons

OBJECTIVE Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH. METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites. RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 ± 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P50) was estimated to be 22.4 minutes (95% confdence intervals 17.0-30.3 minutes). CSD was observed in 3 rats at 6 sites in the Type 1 group 5.1 ± 2.2 minutes after initiation of SAH. On NADH?uorescence images CSD was initially observed in the anterior cortex∗it propagated through the entire hemisphere in the direction of the occipital cortex at a rate of 3 mm/minute, with repolarization in 2.3 ± 1.2 minutes. DC potential recording sites that had undergone CSD were found to have intact tissue 24 hours later. Compared with depolarization that caused 50% neuronal damage, the duration of CSD was too short to cause histological damage. CONCLUSIONS CSD was successfully visualized using NADH?uorescence. It propagated from the anterior to the posterior cortex along with an increase in CBF. The duration of depolarization in CSD (2.3 ± 1.2 minutes) was far shorter than that causing 50% neuronal damage (22.4 minutes) and was not associated with histological damage in the current experimental setting.

DOI： 10.3171/2016.9.JNS161385

Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: A randomized controlled trial. 査読

Takagi K, Yoshida R, Yagi T, Umeda Y, Nobuoka D, Kuise T, Hinotsu S, Matsusaki T, Morimatsu H, Eguchi J, Wada J, Senda M, Fujiwara T

Clinical nutrition (Edinburgh, Scotland) 2018年1月

Histidine-rich glycoprotein as an excellent biomarker for sepsis and beyond. 査読国際誌

Nishibori M, Wake H, Morimatsu H

Crit Care 22 ( 1 ) 209 - 209 2018年

Is supplemental oxygen necessary for intraoperative lung protective ventilation?

Shuji Okahara, Satoshi Suzuki, Hiroshi Morimatsu

Pulmonary and Critical Care Medicine 3 ( 1 ) 2018年

A Case of Cardiac Arrest Due to Coronary Vasospasm on Extubation Following Thymectomy

Koukyou SUITA, Kazuyoshi SHIMIZU, Tomoyuki KANAZAWA, Yoshikazu MATSUOKA, Hiroshi MORIMATSU

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 38 ( 2 ) 142 - 147 2018年

Perioperative respiratory management in high risk patients

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

Japanese Journal of Anesthesiology 67 ( 5 ) 2018年

Quercetin attenuates neuropathic pain in rats with spared nerve injury

Noriko Muto, Yoshikazu Matsuoka, Kyosuke Arakawa, Masako Kurita, Hiroki Omiya, Arata Taniguchi, Ryuji Kaku, Hiroshi Morimatsu

Acta Medica Okayama 72 ( 5 ) 457 - 465 2018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

Quercetin is a flavonoid widely found in plants and marketed to the public as a supplement. Several studies have reported its effect on glial cells. This study aimed to examine the effect of quercetin on the development of neuropathic pain and the underlying mechanism in a spared nerve injury (SNI) rat model. Male Sprague- Dawley rats randomly assigned to the control or the quercetin group were subjected to SNI of the sciatic nerve. We measured pain behaviors on the hind paw and glial fibrillary acidic protein (GFAP) in the dorsal root ganglion (DRG) and spinal cord. Oral administration of 1% quercetin, begun before surgery, attenuated mechanical allodynia compared to the control group at days 7 and 10 after SNI. On the other hand, established pain was not attenuated in a post-dose group in which quercetin was begun 7 days after SNI. Quercetin inhibited GFAP in the satellite glial cells of the ipsilateral L5 DRG on day 7 compared to the control group. Quercetin suppressed the development of neuropathic pain through a mechanism partly involving the inhibition of satellite glial cells. As its safety is well established, quercetin has great potential for clinical use in pain treatment.

Prolonged-duration pulsed radiofrequency is associated with increased neuronal damage without further antiallodynic effects in neuropathic pain model rats

Kyosuke Arakawa, Ryuji Kaku, Masako Kurita, Yoshikazu Matsuoka, Hiroshi Morimatsu

Journal of Pain Research 11 2645 - 2651 2018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：Dove Medical Press Ltd.

Aim of investigation: Pulsed radiofrequency (PRF) is a safe and effective approach for treating neuropathic pain. However, the optimal treatment conditions and analgesic mechanisms of PRF remain unclear. The aim of our study was to assess the beneficial and adverse effects of prolonged-duration PRF and the analgesic mechanisms of PRF treatment with neuropathic pain rats. Methods: Male Sprague Dawley rats received L5 spinal nerve ligation (SNL) for developing neuropathic pain. Fourteen days after L5 SNL surgery, they were divided into three groups according to duration of PRF current for 6 minutes, 12 minutes, and none. PRF current was delivered via direct visualization adjacent to the L5 dorsal root ganglion (DRG). Pain behavior was evaluated every week after L5 SNL surgery, until day 28. Seven days after PRF treatment, L5 DRG tissue was harvested to detect levels of activating translation factor 3 (ATF3
a marker of neuronal damage) and hyperpolarization-activated cyclic nucleotide (HCN)-gated cation channels (key factors in neuropathic pain) using quantitative PCR. Results: Before PRF application, withdrawal thresholds were significantly lower than at baseline and did not differ significantly between the three groups. After PRF application, withdrawal thresholds in the PRF6 and PRF12 groups were significantly increased compared to those in the sham group. However, those in the PRF6 and PRF12 groups did not differ significantly. The expression level of ATF3 mRNA in the PRF12 group was significantly higher than that in the sham group (P&lt
0.01), but the expression of HCN1 and HCN2 channels did not differ significantly between the three groups. Conclusion: Prolonged PRF exposure, from 6 to 12 minutes, was not only ineffective but also associated with increased neuronal damage. These findings do not support prolonged PRF exposure as a helpful treatment for neuropathic pain. In this study, the involvement of HCN channels in the antiallodynic effects of PRF was uncertain.

DOI： 10.2147/JPR.S168064

ラット心室細動モデルにおける胸骨圧迫が脳内グルタミン酸濃度に及ぼす影響

伏見美紀, 武田吉正, 川瀬宏和, 森松博史

蘇生 36 ( 3 ) 161 - 161 2017年11月

膜電位消失後のグルタミン酸放出は脳血流量に依存する

川瀬宏和, 武田吉正, 伏見美紀, 森松博史

蘇生 36 ( 3 ) 161 - 161 2017年11月

Hemi-clamshellによる開胸によって脳局所組織酸素飽和度が低下した1例

部村公香, 森松博史, 小林求, 清水一好, 金澤伴幸, 廣井一正

日本臨床麻酔学会誌 37 ( 6 ) S340 - S340 2017年10月

周術期におけるECMO 小児複雑心奇形におけるECMO

岩崎達雄, 金澤伴幸, 清水一好, 森松博史, 笠原真悟

日本臨床麻酔学会誌 37 ( 6 ) S104 - S104 2017年10月

多発性翼状片症候群に伴う困難気道に対してCT画像による気道評価を元に気道確保戦略を立てた1症例

前田明倫, 小林求, 日笠友起子, 岡原修司, 森松博史

日本臨床麻酔学会誌 37 ( 6 ) S298 - S298 2017年10月

心臓麻酔におけるNIRS

末盛智彦, 岩崎達雄, 清水一好, 黒江泰利, 塩路直弘, 木村聡, 金澤伴幸, 森松博史

Cardiovascular Anesthesia 21 ( Suppl. ) 148 - 148 2017年9月

胸骨正中切開時に心膜の牽引により上肢・脳血流の低下をきたした一症例

林文昭, 金澤伴幸, 岩崎達雄, 清水一好, 末盛智彦, 木村聡, 塩路直弘, 黒江泰利, 森松博史

Cardiovascular Anesthesia 21 ( Suppl. ) 361 - 361 2017年9月

BNPの臨床的意義の変遷と小児心臓手術周術期における役割慢性期から周術期へ

金澤伴幸, 黒江泰利, 塩路直弘, 木村聡, 末盛智彦, 清水一好, 岩崎達雄, 森松博史

Cardiovascular Anesthesia 21 ( Suppl. ) 153 - 153 2017年9月

小児心臓術後のHigh-flow nasal cannulaの現在と未来

塩路直弘, 岩崎達雄, 清水一好, 末盛智彦, 金澤伴幸, 木村聡, 黒江泰利, 森松博史

Cardiovascular Anesthesia 21 ( Suppl. ) 165 - 165 2017年9月

小児心臓麻酔のキーポイント肺循環を制御する呼吸管理による体・肺循環のバランス管理

末盛智彦, 岩崎達雄, 清水一好, 黒江泰利, 塩路直弘, 木村聡, 金澤伴幸, 森松博史

Cardiovascular Anesthesia 21 ( Suppl. ) 208 - 208 2017年9月

小児心臓手術後血清カルシウムイオン濃度とICU滞在日数との関連

木村聡, 岩崎達雄, 清水一好, 末盛智彦, 金澤伴幸, 塩路直弘, 黒江泰利, 松岡勇斗, 森松博史

Cardiovascular Anesthesia 21 ( Suppl. ) 310 - 310 2017年9月

食道癌DCF療法開始前から口腔衛生管理による口腔粘膜炎予防の有効性

花岡愛弓, 佐々木禎子, 三浦留美, 山中玲子, 曽我賢彦, 飯田征二, 森松博史

日本歯科衛生学会雑誌 12 ( 1 ) 83 - 83 2017年8月

小児循環器集中治療の未来小児循環器・心臓血管外科・麻酔集中治療とのコラボレーション小児循環器集中治療の未来麻酔集中治療医から見たこれからの集中治療体制のあり方

岩崎達雄, 清水一好, 末盛智彦, 金澤伴幸, 木村聡, 塩路直弘, 黒江泰利, 森松博史

日本小児循環器学会雑誌 33 ( Suppl.1 ) s1 - 124 2017年7月

新生児の麻酔ぜよ!! 総肺静脈還流異常症、大血管転位症の麻酔管理

末盛智彦, 岩崎達雄, 清水一好, 金澤伴幸, 杉本健太郎, 森松博史

日本臨床麻酔学会誌 37 ( 4 ) 491 - 497 2017年7月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

総肺静脈還流異常症と大血管転位症はともに新生児期に根治的手術が必要となりうる先天性心疾患である.新生児の心臓は構造的,機能的に未熟であるため術後心不全に陥りやすい.加えて総肺静脈還流異常症,大血管転位症の患者は疾患特有の血行動態により左心不全や肺高血圧のリスクが高く注意が必要である.両疾患の新生児期の根治的手術を成功に導くためには,前負荷,後負荷,心筋収縮力,心拍数を適切に調節し限られた心機能を無理なく発揮できる環境を作ることが重要である.(著者抄録)

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01620&link_issn=&doc_id=20170727200014&doc_link_id=%2Fci4jjsca%2F2017%2F003704%2F016%2F0491-0497%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2017%2F003704%2F016%2F0491-0497%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

ガムエラスティックブジー使用下気管切開チューブ挿入時に気管膜様部裂創に至った症例

内藤真由, 伊加真士, 黒江泰利, 清水一好, 武田吉正, 森松博史

日本臨床麻酔学会誌 37 ( 2 ) 156 - 161 2017年3月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

89歳,女性.口腔癌に対し全身麻酔下に切除術が予定された.気管挿管後,気管切開を施行し,気切孔よりガムエラスティックブジー(GEB)に沿ってスパイラルチューブを挿入した.両者とも抵抗なく挿入できたが,ETCO2は検出されなかった.気管支鏡で確認したところ,気管膜様部裂創を認めた.直ちに右片肺挿管とし,次いで左片肺挿管にした後に,開胸による気管修復術が施行された.この間,SpO2は100%を維持でき,循環動態も安定していた.術後は挿管のまま集中治療室へ入室,術後5日目に人工呼吸器から離脱,7日目にICU退室となった.気管切開手技のチューブ挿入時のGEBのルーチン使用を見直し,症例ごとの必要性などを術者と検討するべきである.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01620&link_issn=&doc_id=20170321180003&doc_link_id=%2Fci4jjsca%2F2017%2F003702%2F003%2F0156-0161%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2017%2F003702%2F003%2F0156-0161%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

集中治療領域におけるTele ICUシステムの試作・検討

清水一好, 林真雄, 鈴木聡, 森松博史

日本集中治療医学会雑誌 24 ( Suppl. ) DP74 - 5 2017年2月

ラットSAH single injection modelにおいて超急性期の頭蓋内圧が皮質電位と脳波に及ぼす影響

高杉祐二, 菱川朋人, 西廣真吾, 新治有径, 春間純, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 32 77 - 77 2017年2月

高トリグリセリド血症起因性急性膵炎にLDL（low density lipoprotein）吸着療法が奏功した妊婦の1例

佐倉考信, 清水一好, 廣井一正, 鈴木聡, 林真雄, 賀来隆治, 森松博史

日本集中治療医学会雑誌 24 ( 1 ) 26 - 30 2017年

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

妊娠中の急性膵炎は稀な疾患であるが，発症すると母体，胎児ともに予後が悪い。著明な高トリグリセリド（triglyceride, TG）血症による急性膵炎を発症した妊婦に対して，LDL（low density lipoprotein）吸着療法を施行し良好な経過をたどった症例を経験した。症例は35歳，妊娠39週の女性。TG 11,936 mg/dlの著明な高TG血症を認め，造影CTにて重症急性膵炎を疑う所見を認めた。帝王切開にて妊娠を中断の後，ICU入室となり急性膵炎，高TG血症に対する治療を開始した。高TG血症に対してLDL吸着療法を3回施行し，TG値は1,764 mg/dlまで低下した。その後，膵炎に対する保存加療が継続され，第15病日に退院した。高TG血症起因性急性膵炎において，高TG血症の治療併用は重要である。本疾患を合併した妊婦に対して，血漿交換と比較して合併症頻度の低いLDL吸着療法を選択し，安全に施行できた。

DOI： 10.3918/jsicm.24_26

脊髄腫瘍摘出術後に頭蓋内出血、気脳症を発症した1症例

合田慶介, 小畑ダニエル, 金澤伴幸, 三好亜希子, 佐々木俊弘, 末盛智彦, 清水一好, 森松博史

麻酔 65 ( 12 ) 1271 - 1275 2016年12月

記述言語：日本語出版者・発行元：克誠堂出版(株)

75歳女性。第3・4腰椎レベルの硬膜内髄外腫瘍に対し腫瘍摘出術が予定された。レミフェンタニル、プロポフォールによる麻酔管理を行い、術中の血圧変動にはフェニレフリン、ニカルジピンを使用し、手術は終了した。麻酔終了後の覚醒遅延を契機に頭蓋内出血、気脳症を発症したが、対症療法を主体とした全身管理を行ったところ、術後1日目のCTで気脳症や頭蓋内出血の改善が確認された。その後、徐々に意識レベルは改善し、軽度の認知機能障害が残存したものの、術後22日目に転院となった。

大手術後の重篤な有害事象を評価・予測するための観察研究査読

Shiozaki Kyoko, Morimatsu Hiroshi, Matsusaki Takashi, Iwasaki Tatsuo

Acta Med Okayama 70 ( 6 ) 461 - 467 2016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：Okayama University Medical School

Many patients suffer from postoperative serious adverse events (SAEs). Here we sought to determine the incidence of SAEs, assess the accuracy of currently used scoring systems in predicting postoperative SAEs, and determine whether a combination of scoring systems would better predict postoperative SAEs. We prospectively evaluated patients who underwent major surgery. We calculated 4 scores: American Society of Anesthesiologists physical status (ASA-PS) score, the Charlson Score, the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score, and the Surgical Apgar Score (SAS). We assessed the occurrence of SAEs. We assessed the association between each score and SAEs. We combined these scoring systems to find the best combination to predict the occurrence of SAEs. Among 284 patients, 43 suffered SAEs. All scoring systems could predict SAEs. However, their predictive power was not high (the area under the receiver operating characteristic curves [AUROC] 0.6-0.7). A combination of the ASA-PS score and the SAS was the most predictive of postoperative SAEs (AUROC 0.714). The incidence of postoperative SAEs was 15.1 . The combination of the ASA-PS score and the SAS may be a useful tool for predicting postoperative serious adverse events after major surgery.

DOI： 10.18926/AMO/54809

その他リンク： http://search.jamas.or.jp/link/ui/2017326186

浸潤性胸腺腫摘出術後の抜管時に冠動脈攣縮から心停止に至った一例

吹田晃享, 松岡義和, 金澤伴幸, 清水一好, 森松博史

日本臨床麻酔学会誌 36 ( 6 ) S354 - S354 2016年10月

2時間で学ぶ!小児呼吸管理の臨床最前線小児の麻酔中における人工呼吸器設定

金澤伴幸, 黒江泰人, 塩路直弘, 杉本健太郎, 末盛智彦, 清水一好, 岩崎達雄, 森松博史

日本臨床麻酔学会誌 36 ( 6 ) S191 - S191 2016年10月

【消化器・一般外科医のための-救急・集中治療のすべて】(I章)周術期の集中治療循環管理集中治療室における心血管作動薬と抗不整脈薬の使用法

金澤伴幸, 杉本健太郎, 森松博史

臨床外科 71 ( 11 ) 55 - 59 2016年10月

記述言語：日本語出版者・発行元：(株)医学書院

＜POINT＞集中治療室で用いる心血管作動薬はカテコールアミンと非カテコールアミンに分かれる.心血管作動薬にはそれぞれの特性があり,それを理解して使用する必要がある.集中治療室で用いる抗不整脈薬はβブロッカーとアミオダロンが多くなってきている.抗不整脈薬の作用機序・副作用を理解して使用する必要がある.(著者抄録)

ラットくも膜下出血injection modelでは脱分極時間、脳波抑制時間、脳組織障害に密接な関係がある

高杉祐二, 武田吉正, 菱川朋人, 清水智久, 新治有径, 森松博史, 伊達勲

蘇生 35 ( 3 ) 222 - 222 2016年10月

小児心臓術後呼吸不全に対するHigh flow nasal cannulaとNasal continuous positive airway pressureの比較

塩路直弘, 黒江泰利, 金澤伴幸, 野々村智子, 杉本健太郎, 末盛智彦, 清水一好, 岩崎達雄, 森松博史

Cardiovascular Anesthesia 20 ( Suppl. ) 191 - 191 2016年9月

血液浄化と酸塩基平衡

清水一好, 森松博史

日本急性血液浄化学会雑誌 7 ( Suppl. ) 67 - 67 2016年9月

歯科衛生士による専門的口腔衛生指導が食道がん術後肺炎予防に及ぼす効果

花岡愛弓, 山中玲子, 住吉由季子, 三浦留美, 曽我賢彦, 飯田征二, 佐々木朗, 森松博史

日本歯科衛生学会雑誌 11 ( 1 ) 90 - 90 2016年8月

コントロール不良の肺動脈性肺高血圧症に合併した急性肺動脈解離の一例

川出健嗣, 清水一好, 林真雄, 谷真規子, 鈴木聡, 金澤伴幸, 岩崎達雄, 森松博史

日本集中治療医学会雑誌 23 ( 3 ) 318 - 323 2016年5月

記述言語：日本語出版者・発行元：(一社)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、POD21に抜管、POD29にICUを退室、POD101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。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02874&link_issn=&doc_id=20160610390006&doc_link_id=10.3918%2Fjsicm.23.318&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.23.318&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

スガマデクス投与後ロクロニウムの再クラーレ化が疑われた1症例

伊加真士, 清水一好, 川出健嗣, 金澤伴幸, 西谷恭子, 森松博史

日本臨床麻酔学会誌 36 ( 1 ) 1 - 6 2016年1月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

スガマデクスは安全・迅速にロクロニウムを拮抗できる薬剤として広く使用されている.今回われわれは筋弛緩モニターを使用し,投与基準どおりにスガマデクスを使用したにもかかわらず,術後に再クラーレ化が疑われた症例を経験した.症例は78歳の男性で,胃癌に対し腹腔鏡下幽門側胃切除術が施行された.術中およびスガマデクス投与前にTOFウォッチを使用し,TOFカウント2を確認後,スガマデクスを3.6mg/kg投与し抜管した.その約70分後に著明な酸素化の悪化と四肢の体動低下を認め,ネオスチグミン投与により酸素化・体動の改善を得た.投与基準どおりのスガマデクス使用でも再クラーレ化の可能性は否定できないため,抜管後の厳重な呼吸の観察が重要である.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01620&link_issn=&doc_id=20160128310001&doc_link_id=%2Fci4jjsca%2F2016%2F003601%2F001%2F0001-0006%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2016%2F003601%2F001%2F0001-0006%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

拡張障害型心不全治療に対して横隔膜電位(Edi)モニタリングを活用した一症例

吉鷹志保, 清水一好, 岡原修司, 落葉佑昌, 日笠友起子, 廣井一正, 鈴木聡, 林真雄, 森松博史

日本集中治療医学会雑誌 23 ( Suppl. ) 551 - 551 2016年1月

238

Yasutoshi Kuroe, Tomoyuki Kanazawa, Naohiro Shioji, Kentaro Sugimoto, Tomohiko Suemori, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

Critical Care Medicine 44 136 - 136 2016年

Intraoperative Oxygen Consumption during Liver Transplantation 査読

M. Shibata, T. Matsusaki, R. Kaku, Yuzo Umeda, T. Yagi, H. Morimatsu

Transplantation Proceedings 47 ( 10 ) 2902 - 2906 2015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：Elsevier USA

Background The aim of this study was to investigate the changes in oxygen consumption during liver transplantation and to examine the relationship between intraoperatively elevated systemic oxygen consumption and postoperative liver function. Methods This study was performed in 33 adult patients undergoing liver transplantation between September 2011 and March 2014. We measured intraoperative oxygen consumption through the use of indirect calorimetry, preoperative and intraoperative data, liver function tests, and postoperative complications and outcomes. Results The mean age of patients was 52 ± 9.7 years
14 (42%) of them were women. Average Model for End-Stage Liver Disease scores were 20 ± 8.9. Oxygen consumption significantly increased after reperfusion from 172 ± 30 mL/min during the anhepatic phase to 209 ± 30 mL/min (P &lt
.0001). We divided patients into 2 groups according to the increase in oxygen consumption after reperfusion (oxygen consumption after reperfusion minus anhepatic phase oxygen consumption: 40 mL/min increase as cutoff). The higher consumption group had a longer cold ischemia time and higher postoperative aspartate aminotransferase and alanine aminotransferase levels as compared with the lower oxygen consumption group. There were no statistically significant differences in major postoperative complications, but the higher oxygen consumption group tended to have shorter hospital stays than the lower consumption group (58 versus 95 days). Conclusions We have demonstrated that oxygen consumption significantly increased after reperfusion. Furthermore, this increased oxygen consumption was associated with a longer cold ischemia time and shorter hospital stays.

DOI： 10.1016/j.transproceed.2015.10.057

The urinary levels of prostanoid metabolites predict acute kidney injury in heterogeneous adult Japanese ICU patients: a prospective observational study. 査読

Ujike-Omori H, Maeshima Y, Kinomura M, Tanabe K, Mori K, Watatani H, Hinamoto N, Sugiyama H, Sakai Y, Morimatsu H, Makino H

Clinical and experimental nephrology 19 ( 6 ) 1024 - 1036 2015年12月

【小児臓器移植の現状と展望】小児肺移植の麻酔および術後ICU管理

日笠友起子, 岡原修司, 清水一好, 小林求, 森松博史

移植 50 ( 6 ) 582 - 588 2015年12月

小児重症筋無力症の麻酔経験

西田静香, 小林求, 日笠友起子, 金澤伴幸, 森松博史

日本臨床麻酔学会誌 35 ( 7 ) 715 - 718 2015年11月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

小児の重症筋無力症(myasthenia gravis:MG)に対する胸腺摘出術の適応は限られており,その麻酔管理の報告は少なく,安全性は確立されていない.症例は9歳の男児.症状の増悪を認める全身型小児MGに対して胸腔鏡下胸腺摘出術が施行された.術後の呼吸不全を避けるため,筋弛緩薬を用いずに全身麻酔で管理した.麻酔導入時はセボフルランとレミフェンタニルにて麻酔深度を深め,スムーズに気管挿管を行えた.術中も体動を認めることなく安定して経過し,手術室にて抜管した.術後経過は良好であった.全身型小児MG患者の胸腺摘出術の周術期管理において筋弛緩薬を用いることなく麻酔を行い,安全に管理することができた.(著者抄録)

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01620&link_issn=&doc_id=20151126250004&doc_link_id=%2Fci4jjsca%2F2015%2F003507%2F004%2F0715-0718%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2015%2F003507%2F004%2F0715-0718%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

筋萎縮性側索硬化症患者に対する肺葉切除術の麻酔経験

大岩雅彦, 小林求, 金澤伴幸, 森松博史

日本臨床麻酔学会誌 35 ( 7 ) 711 - 714 2015年11月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

筋萎縮性側索硬化症は,麻酔や手術侵襲により術後呼吸器機能が低下した場合には,人工呼吸器管理を余儀なくされる可能性がある.そのため,肺葉切除術のような呼吸機能を低下させる手術の麻酔管理はほとんど報告がない.今回われわれは,76歳女性の筋萎縮性側索硬化症患者の肺葉切除術に対して,プロポフォール,レミフェンタニルを用いた全静脈麻酔と胸部硬膜外麻酔を併用し安全に管理しえた.短時間作用型の麻酔薬や術後鎮痛の進歩,低侵襲手術の普及により筋萎縮性側索硬化症患者でも以前より安全に手術が行えるようになった.しかし将来的な人工呼吸までの期間を短縮する可能性はあるため,手術適応には慎重な評価が必要である.(著者抄録)

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01620&link_issn=&doc_id=20151126250003&doc_link_id=%2Fci4jjsca%2F2015%2F003507%2F003%2F0711-0714%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2015%2F003507%2F003%2F0711-0714%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

The inhibitory effect of locally injected dexmedetomidine on carrageenan-induced nociception in rats 査読

Yuka Honda, Hitoshi Higuchi, Yoshikazu Matsuoka, Akiko Yabuki-Kawase, Minako Ishii-Maruhama, Yumiko Tomoyasu, Shigeru Maeda, Hiroshi Morimatsu, Takuya Miyawaki

EUROPEAN JOURNAL OF PHARMACOLOGY 764 215 - 219 2015年10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：ELSEVIER SCIENCE BV

Recent studies showed that the administration of dexmedetomidine relieved hyperalgesia in the presence of neuropathic pain. These findings have led to the hypothesis that the local administration of dexmedetomidine is useful for relieving acute inflammatory nociception, such as postoperative pain. Thus, we evaluated the inhibitory effect of locally injected dexmedetomidine on acute inflammatory nociception. Acute inflammatory nociception was induced by an intraplantar injection of 1% carrageenan into the hindpaws of rats, and dexmedetomidine was also injected combined with carrageenan. The paw withdrawal threshold based on von Frey filament stimulation was measured until 12 h after injection. We compared the area under the Lime-curve (AUC) between carrageenan and carrageenan with dexmedetomidine. To clarify that the action of dexmedetomidine was via alpha(2)-adrenoceptors, we evaluated the effect of yohimbine, a selective antagonist of alpha(2)-adrenoceptors, on the anti-nociception of dexmedetomidine. As the results, the intraplantar injection of carrageenan with over 10 mu M dexmedetomidine significantly increased AUC, compared to that with only carrageenan injection. This effect of dexmedetomidine was reversed by the addition of yohimbine to carrageenan and dexmedetomidine. These results demonstrated that the locally injected dexmedetomidine was effective against carrageenan-induced inflammatory nociception via alpha(2)-adrenoceptors. The findings suggest that the local injection of dexmedetomidine is useful for relieving local acute inflammatory nociception. (C) 2015 Elsevier B.V. All rights reserved,

DOI： 10.1016/j.ejphar.2015.06.054

小児心臓手術後の呼吸不全に対するHigh Flow Nasal Cannulaの効果

塩路直弘, 金澤伴幸, 岩崎達雄, 清水一好, 杉本健太郎, 黒江泰利, 森松博史

Cardiovascular Anesthesia 19 ( Suppl. ) 201 - 201 2015年10月

最先端心臓血管外科手術の麻酔管理成人先天性心疾患手術の麻酔管理

岩崎達雄, 清水一好, 末盛智彦, 金澤伴幸, 杉本健太郎, 野々村智子, 塩路直弘, 森松博史

日本臨床麻酔学会誌 35 ( 6 ) S196 - S196 2015年10月

脊髄腫瘍摘出術後に気脳症・頭蓋内出血を認めた一例

合田慶介, 小畑ダニエル, 金澤伴幸, 末盛智彦, 松岡義和, 佐々木俊弘, 清水一好, 森松博史

日本臨床麻酔学会誌 35 ( 6 ) S265 - S265 2015年10月

肝不全岡山大学病院ICUにおける肝不全に対する血漿交換について

賀来隆治, 松崎孝, 廣井一正, 林真雄, 清水一好, 森松博史

日本アフェレシス学会雑誌 34 ( Suppl. ) 63 - 63 2015年10月

小児心臓手術後患者におけるカロリーメトリーによる酸素消費量測定値とLaFarge法の比較

川出健嗣, 戸田雄一郎, 名原功, 杉本健太郎, 金澤伴幸, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 21 ( 1 ) 132 - 132 2015年8月

上顎癌術直後にAeromonas属による治療抵抗性の敗血症性ショックをきたし、急激な経過をたどった症例

塩路直弘, 清水一好, 林真雄, 金澤伴幸, 鈴木聡, 岡原修司, 日笠友起子, 森松博史

ICUとCCU 39 ( 7 ) 431 - 435 2015年7月

記述言語：日本語出版者・発行元：医学図書出版(株)

症例は71歳、男性。上顎癌に対して放射線、化学療法を先行した後、根治術を施行した。術後ICUに予定入室したが、入室約6時間後から血圧低下、代謝性アシドーシスが出現した。輸液負荷とノルアドレナリン持続投与にも抵抗性で敗血症性ショックを疑い、抗菌薬を変更、バソプレシン、アドレナリン、ハイドロコルチゾンを追加、CHDFを開始した。入室2日目に血液培養でグラム陰性桿菌が陽性となった。循環・呼吸不全と肝不全が進行したため、血漿交換、VA ECMOを導入した。その後も左心不全が急速に進行しIABPも挿入した。経過中2度、開創し皮弁を確認したが皮弁の血流は保たれていた。あらゆる治療に反応なく入室4日目に永眠した。後日、血液培養の結果がAeromonas属であることが判明した。免疫抑制の背景をもつ患者の場合、Aeromonas属による敗血症性ショックは重篤化し、急激に進行する可能性がある。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00001&link_issn=&doc_id=20150811310006&doc_link_id=%2Faa6icutc%2F2015%2F003907%2F007%2F0431-0435%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2015%2F003907%2F007%2F0431-0435%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Extra Corporeal Membrane Oxygenation(ECMO)の早期導入により救命できた、薬剤抵抗性心房頻拍を呈した1症例

金澤伴幸, 清水一好, 岩崎達雄, 森松博史

日本小児救急医学会雑誌 14 ( 2 ) 250 - 250 2015年6月

【Critical Care Nephrology】AKIに対する急性血液浄化療法

黒江泰利, 清水一好, 森松博史

日本腎臓学会誌 57 ( 2 ) 308 - 312 2015年3月

NADH蛍光によるラットくも膜下出血急性期におけるspreading depressionの可視化及びその組織学的検討

清水智久, 菱川朋人, 高杉祐二, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 30 54 - 54 2015年3月

ラットsingle injection modelを用いたくも膜下出血急性期におけるspreading depressionの可視化の試み

高杉祐二, 菱川朋人, 清水智久, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 30 50 - 50 2015年3月

小児心臓手術における周術期トロポニンTと術後予後との関係

金澤伴幸, 岩崎達雄, 戸田雄一郎, 清水一好, 森松博史

日本集中治療医学会雑誌 22 ( Suppl. ) [DO20 - 1] 2015年1月

先天性心疾患術後出血量の予測としてROTEMの有用性の検討

片山望, 戸田雄一郎, 岩崎達雄, 清水一好, 金澤伴幸, 杉本健太郎, 武藤典子, 川出健嗣, 名原功, 森松博史

日本集中治療医学会雑誌 22 ( Suppl. ) [DP115 - 5] 2015年1月

先天性心疾患肺体血流比の周術期管理重症単心室疾患の姑息術後の呼吸循環管理

清水一好, 戸田雄一郎, 金澤伴幸, 杉本健太郎, 川出健嗣, 武藤典子, 岩崎達雄, 森松博史

日本集中治療医学会雑誌 22 ( Suppl. ) [DPDp - 4] 2015年1月

Changes in the incidence, case fatality rate, and characteristics of symptomatic perioperative pulmonary thromboembolism in Japan: Results of the 2002-2011 Japanese Society of Anesthesiologists Perioperative Pulmonary Thromboembolism (JSA-PTE) Study. 査読

Kuroiwa M, Morimatsu H, Tsuzaki K, Irita K, Sanuki M, Nakatsuka H, Nakamura M

Journal of anesthesia 2014年11月

ADH蛍光によるラットくも膜下出血急性期におけるspreading depressionの可視化及びその組織学的検討

清水智久, 菱川朋人, 高杉祐二, 新治有径, 西廣真吾, 春間純, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 26 ( 1 ) 183 - 183 2014年11月

治療薬内服中断による著明な甲状腺腫大に気管狭窄を合併した一症例

名原功, 清水一好, 片山明, 林真雄, 松岡義和, 森松博史

日本臨床麻酔学会誌 34 ( 6 ) S343 - S343 2014年10月

小児全身型重症筋無力症の麻酔経験

西田静香, 小林求, 日笠友起子, 金澤伴幸, 松岡義和, 森松博史

日本臨床麻酔学会誌 34 ( 6 ) S294 - S294 2014年10月

カルニチン欠乏症の小児に対する全身麻酔の経験

木田好美, 小林求, 清水一好, 依田智美, 菊地佳枝, 西江宏行, 森松博史

日本臨床麻酔学会誌 34 ( 6 ) S279 - S279 2014年10月

小児心臓手術における周術期BNPと術後Serious Adverse Events(SAEs)の関係

金澤伴幸, 戸田雄一郎, 江木盛時, 清水一好, 岩崎達雄, 森松博史

Cardiovascular Anesthesia 18 ( Suppl. ) 174 - 174 2014年9月

成人先天性心疾患の周術期管理

岩崎達雄, 戸田雄一郎, 清水一好, 杉本健太郎, 金澤伴幸, 森松博史

Cardiovascular Anesthesia 18 ( Suppl. ) 139 - 139 2014年9月

重症インフルエンザ肺炎に対して膜型人工肺と横隔膜電位測定を併用し救命した1症例

岡原修司, 清水一好, 森松博史

日本救急医学会雑誌 25 ( 8 ) 606 - 606 2014年8月

食道癌手術における歯科の役割査読

山中玲子, 曽我賢彦, 前田直見, 大原利章, 田辺俊介, 野間和広, 白川靖博, 森松博史, 藤原俊義

日本食道学会学術集会プログラム・抄録集 68回 145 - 145 2014年7月

小児心臓手術後の急性腎傷害と血清ナトリウムの関連性

名原功, 戸田雄一郎, 岩崎達雄, 清水一好, 金澤伴幸, 杉本健太郎, 川出健嗣, 石井南穂子, 川瀬宏和, 森松博史

日本集中治療医学会雑誌 21 ( Suppl. ) [DP - 5] 2014年1月

小児心臓手術後出血量と術中Thromboelastgram(ROTEM)との関連

森英明, 戸田雄一郎, 岩崎達雄, 清水一好, 金澤伴幸, 杉本健太郎, 川出健嗣, 名原功, 石井南穂子, 森松博史

日本集中治療医学会雑誌 21 ( Suppl. ) [DP - 2] 2014年1月

新生児先天性心疾患患者における術前ICU入室の意義

川出健嗣, 戸田雄一郎, 名原功, 川瀬宏和, 石井典子, 杉本健太郎, 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 21 ( Suppl. ) [DP - 1] 2014年1月

Histidine-rich glycoprotein prevents septic lethality through neutrophil regulation 査読

Nishibori M, Wake H, Mori S, Liu K, Morioka Y, Teshigawara K, Sakaguchi M, Kuroda K, Takahashi H, Ohtsuka A, Yoshino T, Morimatsu H

Critical Care 1 - 53 2014年

Acoustic respiratory rate monitoring in a patient with a tracheostomy: A case report 査読

Yuichiro Toda, Hiroshi Morimatsu, Masao Hayashi, Kazuyoshi Shimizu, Kiyoshi Morita

Japanese Journal of Anesthesiology 63 ( 2 ) 161 - 163 2014年

記述言語：日本語掲載種別：研究論文（学術雑誌）

Acoustic respiratory rate (RRa) monitoring has been validated for patients after general anesthesia and has been shown to be a useful technique. However, its feasibility in patients with a tracheostomy has not been assessed yet. Successful monitoring of RRa in a patient with a tracheostomy is described in this case report. A 56-year-old male patient was scheduled for cranioplasty after severe subarachnoidal hemorrhage under general anesthesia. A tracheostomy tube had been placed in the patient because of airway obstruction and altered spontaneous breathing. The acoustic sensor was placed at the usual position and RRa was successfully monitored by Rad 87® (Masimo Corp., Irvine). Statistical analysis was made for comparison of respiratory rate determined by RRa monitoring with respiratory rate visually counted by intensive care nurses. There was no statistically significant difference between the two respiratory rates (P=0.82). RRa monitoring is useful even in patients with a tracheostomy.

Association between renal replacement therapy in critically ill patients with severe acute kidney injury and mortality

Sean M. Bagshaw, Shigehiko Uchino, John A. Kellum, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Etienne Macedo, Noel Gibney, Ashita Tolwani, Heleen M. Oudemans-van Straaten, Claudio Ronco, Rinaldo Bellomo

Journal of Critical Care 28 ( 6 ) 1011 - 1018 2013年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Purpose: To evaluate the characteristics and outcomes of critically ill patients with severe acute kidney injury (AKI) treated and not treated with renal replacement therapy (RRT). Methods: Secondary analysis of a multi-centre cohort study. Primary exposure was RRT. Primary outcome was propensity and multi-variable adjusted-hospital mortality. Results: We studied 1250 patients (71.3%) who received and 502 (28.7%) who did not receive RRT. Reasons for not starting RRT (not mutually exclusive) were limitations of support (33.6%, n = 169), adequate urine output (46.2%
n = 232), plan to observe (56.4%
n = 283), and advanced age (12.6%
n = 63). Mortality was higher in those not receiving RRT due to limitations and advanced age but lower for adequate urine output and plan to observe. Propensity and multi-variable adjusted analysis showed no statistical difference in hospital mortality (adj-OR 1.47
95% CI, 0.93-2.24) in patients receiving RRT. Results were similar in a sensitivity analysis restricted to patients fulfilling risk, injury, failure, loss, end-stage kidney disease-FAILURE criteria (37.0%
n = 446) (adj-OR 1.36
95% CI, 0.70-2.66). Conclusion: In this cohort, reasons for not starting RRT included limitations of support and perception of impending renal recovery. Despite similar risk of mortality after adjusting for selection bias and confounders, RRT-treated patients were fundamentally different from non-treated patients across a spectrum of variables that precludes valid comparison in observational data. © 2013 Elsevier Inc.

DOI： 10.1016/j.jcrc.2013.08.002

ラットくも膜下出血急性期におけるspreading depressionの新しい観察方法

清水智久, 菱川朋人, 高杉祐二, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 25 ( 1 ) 184 - 184 2013年11月

食道癌患者のより良い周術期医療のために歯科はどのような貢献ができるのか? 周術期管理センター(PERIO) 査読

山中玲子, 曽我賢彦, 前田直見, 田辺俊介, 大原利章, 野間和広, 白川靖博, 森田学, 佐藤健治, 森松博史, 藤原俊義

日本臨床外科学会雑誌 74 ( 増刊 ) 478 - 478 2013年10月

デスフルラン麻酔肝移植麻酔管理におけるデスフルランの役割術後早期抜管を目指して

賀来隆治, 小幡典彦, 柴田麻理, 松崎孝, 森松博史

日本臨床麻酔学会誌 33 ( 6 ) S158 - S158 2013年10月

新生児先天性心疾患患者における術前ICU入室の意義

川出健嗣, 戸田雄一郎, 山岡正和, 石井典子, 川瀬宏和, 金澤伴幸, 杉本健太郎, 清水一好, 岩崎達雄, 森松博史, 森田潔

日本小児循環器学会雑誌 29 ( Suppl. ) s311 - s311 2013年6月

Total cavopulmonary connection(TCPC)患者の手術室抜管に関する検討

山岡正和, 戸田雄一郎, 岩崎達雄, 清水一好, 金澤伴幸, 杉本健太郎, 川瀬宏和, 石井南穂子, 川出健嗣, 森松博史, 森田潔

日本小児循環器学会雑誌 29 ( Suppl. ) s311 - s311 2013年6月

ラット出血性ショック後急性肺障害に対するビリベルジン投与の抗酸化作用

小坂順子, 森松博史, 黒田浩佐, 谷岡野人, 川西進, 清水裕子, 高橋徹, 森田潔

日本集中治療医学会雑誌 20 ( Suppl. ) 300 - 300 2013年1月

肝移植及び食道亜全摘術後における白血球(WBC)、C-reactive protein(CRP)とプロカルシトニン(PCT)値の検討

東南杏香, 林真雄, 森松博史, 西江宏行, 賀来隆治, 清水一好, 松崎孝, 小幡典彦, 柴田麻理, 森田潔

日本集中治療医学会雑誌 20 ( Suppl. ) 356 - 356 2013年1月

マシモRad-87 RRa(アコースティック呼吸数)センサーの気管切開患者での使用経験

戸田雄一郎, 森松博史, 林真雄, 清水一好, 森田潔

日本臨床麻酔学会誌 32 ( 6 ) S253 - S253 2012年10月

肝性脳症4度の評価に頭部MRIを用いた使用経験

大矢紗弥子, 松崎孝, 柴田麻理, 杉本健太郎, 小幡典彦, 賀来隆治, 森松博史, 森田潔

日本臨床麻酔学会誌 32 ( 6 ) S241 - S241 2012年10月

岡山大学麻酔科におけるiPadを用いた医学生選択実習の紹介

松崎孝, 小林求, 谷真規子, 小幡典彦, 森松博史, 森田潔

日本臨床麻酔学会誌 32 ( 6 ) S302 - S302 2012年10月

血液悪性疾患由来の肝中心静脈閉塞症に緊急生体肝移植が施行され周術期管理を行った1症例

鳩崎綾子, 松崎孝, 柴田麻里, 小幡典彦, 賀来隆治, 森松博史, 森田潔

日本小児麻酔学会誌 18 ( 1 ) 136 - 136 2012年8月

TBX21遺伝子コドン33SNPはARDSに対するステロイド効果を予測できるか

西江宏行, 永坂岳司, 孫冬生, 森松博史, 溝渕知司, 片山浩, 林真雄, 谷真規子, 森田潔

日本集中治療医学会雑誌 19 ( Suppl. ) 345 - 345 2012年1月

出血性ショック後急性肺障害におけるビリベルジン投与の抗炎症効果について

小坂順子, 森松博史, 川西進, 清水裕子, 高橋徹, 森田潔

日本集中治療医学会雑誌 19 ( Suppl. ) 243 - 243 2012年1月

血漿交換が奏功した重症毛細血管漏出症候群(SCLS)の一症例

日笠友起子, 林真雄, 鈴木聡, 江木盛時, 小幡典彦, 森松博史, 森田潔

日本集中治療医学会雑誌 19 ( Suppl. ) 245 - 245 2012年1月

術後集中治療患者の早期せん妄発生と血清メラトニン値の関係

吉鷹志保, 江木盛時, 森松博史, 戸田雄一郎, 清水一好, 森田潔

日本臨床麻酔学会誌 31 ( 6 ) S315 - S315 2011年10月

食道癌術後患者の周術期血糖変動と酸化ストレスの関係

江木盛時, 森松博史, 戸田雄一郎, 竹野内志保, 末盛智彦, 清水一好, 森田潔

日本集中治療医学会雑誌 18 ( Suppl. ) 260 - 260 2011年1月

小児心臓術後腎傷害(acute kidney injury;AKI)患者の遠隔予後

戸田雄一郎, 岩崎達雄, 清水一好, 末盛智彦, 杉本健太郎, 石井典子, 川瀬宏和, 森松博史, 江木盛時, 森田潔

日本集中治療医学会雑誌 18 ( Suppl. ) 269 - 269 2011年1月

ラット出血性ショック後急性肺障害に対するCO吸入の治療効果のメカニズム

川西進, 森松博史, 清水裕子, 小坂順子, 有森豊, 高橋徹, 森田潔

日本集中治療医学会雑誌 18 ( Suppl. ) 238 - 238 2011年1月

ICU患者において不整脈が発生する因子の検討

今川憲太郎, 戸田雄一郎, 森松博史, 江木盛時, 守屋佳恵, 清水一好, 谷真規子, 片山浩, 森田潔

日本集中治療医学会雑誌 18 ( Suppl. ) 245 - 245 2011年1月

Successful use of intravenous amiodarone for refractory ventricular fibrillation just after releasing aortic cross-clamp 査読

Satoshi Suzuki, Tatsuo Iwasaki, Hiroshi Morimatsu, Nagisa Yokoi, Mayuko Matsuoka, Tomohiko Suemori, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Yuichiro Toda, Kiyoshi Morita

Japanese Journal of Anesthesiology 59 ( 10 ) 1266 - 1270 2010年10月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Amiodarone is widely used in Europe and the United States for refractory ventricular fibrillation (VF) in various situations, such as VF after myocardial infarction or out-of-hospital cardiac arrest. We report a case of successful treatment with amiodarone of refractory VF immediately after releasing aortic cross-clamp in cardiac surgery. A 66-year-old man suffering from severe aortic stenosis underwent aortic valve replacement (AVR). General anesthesia was induced with propofol and remifentanil, and subsequently AVR was performed under cardiopulmonary bypass. Just after releasing aortic cross-clamp, VF occurred, and it continued despite multiple trials of cardioversion with direct current (DC) shocks of 20 J or 30 J. Furthermore, some DC shocks of 30 J or 50 J after administering lidocaine 60 mg and 0.5 mol·l-1 magnesium sulfate 20 ml were also ineffective. Then, nifekalant 20 mg was administered and DC shocks of 50 J were repeated intermittently, but VF still persisted. Eventually, VF disappeared after a final DC shock of 50 J with intravenous amiodarone 125 mg. Overall duration of VF was 60 minutes. The patient's trachea was extubated three days after the surgery without any complications. Intravenous amiodarone may be one of the most useful remedies for some types of arrhythmias including persistent VF.

腫瘍随伴性ネフローゼ症候群のため著しい低アルブミン血症を合併した患者の周術期管理

守屋佳恵, 森松博史, 熊田雄太, 小坂順子, 松三絢弥, 谷真規子, 賀来隆治, 森田潔

日本臨床麻酔学会誌 30 ( 6 ) S347 - S347 2010年10月

小児心疾患集中治療室における鎮静薬の人工呼吸・ICU滞在への影響

戸田雄一郎, 清水一好, 岩崎達雄, 末盛智彦, 鈴木聡, 森松博史, 江木盛時, 森田潔

日本集中治療医学会雑誌 17 ( Suppl. ) 291 - 291 2010年1月

重症患者における低AT3血症と患者死亡の関係

竹野内志保, 江木盛時, 森松博史, 戸田雄一郎, 清水一好, 松崎孝, 鈴木聡, 森田潔

日本集中治療医学会雑誌 17 ( Suppl. ) 312 - 312 2010年1月

食道癌術後患者に対する栄養プロトコール導入の効果

濱田暁, 江木盛時, 竹野内志保, 鈴木聡, 清水一好, 松崎孝, 戸田雄一郎, 森松博史, 佐藤健治, 森田潔

日本集中治療医学会雑誌 17 ( Suppl. ) 369 - 369 2010年1月

集中治療領域における厳格血糖管理を考える心臓手術周術期の血糖変動と酸化ストレスの関係持続血糖測定を用いた検討

江木盛時, 清水一好, 戸田雄一郎, 岩崎達雄, 森松博史, 森田潔

日本集中治療医学会雑誌 17 ( Suppl. ) 233 - 233 2010年1月

小児心臓手術における下垂体ホルモンの変動年齢による相違

清水一好, 森松博史, 戸田雄一郎, 江木盛時, 末盛智彦, 鈴木聡, 岩崎達雄, 森田潔

日本集中治療医学会雑誌 17 ( Suppl. ) 279 - 279 2010年1月

A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury

Sean M. Bagshaw, Shigehiko Uchino, Dinna Cruz, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Etienne MacEdo, Noel Gibney, Ashita Tolwani, Heleen M. Oudemans-Van Straaten, Claudio Ronco, John A. Kellum

Nephrology Dialysis Transplantation 24 ( 9 ) 2739 - 2744 2009年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background. The RIFLE classification scheme for acute kidney injury (AKI) is based on relative changes in serum creatinine (SCr) and on urine output. The SCr criteria, therefore, require a pre-morbid baseline value. When unknown, current recommendations are to estimate a baseline SCr by the MDRD equation. However, the MDRD approach assumes a glomerular filtration rate of ∼75 mLmin1.73 m2. This method has not been validated.Methods. Data from the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study, a prospective observational study from 54 ICUs in 23 countries of critically ill patients with severe AKI, were analysed. The RIFLE class was determined by using observed (o) pre-morbid and estimated (e) baseline SCr values. Agreement was evaluated by correlation coefficients and Bland-Altman plots. Sensitivity analysis by chronic kidney disease (CKD) status was performed.Results. Seventy-six percent of patients (n = 1327) had a pre-morbid baseline SCr, and 1314 had complete data for evaluation. Forty-six percent had CKD. The median (IQR) values were 97 μmolL (79-150) for oSCr and 88 μmolL (71-97) for eSCr. The oSCr and eSCr determined at ICU admission and at study enrolment showed only a modest correlation (r = 0.49, r = 0.39). At ICU admission and study enrolment, eSCr misclassified 18.8 and 11.7 of patients as having AKI compared with oSCr. Exclusion of CKD patients improved the correlation between oSCr and eSCr at ICU admission and study enrolment (r = 0.90, r = 0.84) resulting in 6.6 and 4.0 being misclassified, respectively.Conclusions. While limited, estimating baseline SCr by the MDRD equation when pre-morbid SCr is unavailable would appear to perform reasonably well for determining the RIFLE categories only if and when pre-morbid GFR was near normal. However, in patients with suspected CKD, the use of MDRD to estimate baseline SCr overestimates the incidence of AKI and should not likely be used. Improved methods to estimate baseline SCr are needed.

DOI： 10.1093/ndt/gfp159

Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit 査読

Hiroshi Morimatsu, Yuichiro Toda, Moritoki Egi, Kazuyoshi Shimizu, Takashi Matsusaki, Satoshi Suzuki, Tatsuo Iwasaki, Kiyoshi Morita

JOURNAL OF ANESTHESIA 23 ( 3 ) 334 - 340 2009年8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：SPRINGER TOKYO

We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units.
A retrospective observational study was conducted in a pediatric cardiac care unit in a tertiary care university hospital. The subjects were 40 patients with AKI requiring PD between 2003 and 2005, and controls matched by type of surgery and body weight. Acid-base variables, including blood gas data and electrolytes, were assessed. The Stewart-Figge variables, including strong ion difference apparent (SIDa), strong ion difference effective (SIDe), and strong ion gap (SIG), were calculated.
Blood gas analyses showed that the PD group was more acidemic, with a lower mean bicarbonate and a lower mean base excess, typical features of metabolic acidosis. The strong ion analyses revealed that the PD group had lower mean sodium and albumin concentrations. Based on the Stewart-Figge methodology, SIDa was smaller in the PD group than in the control group, but SIG was similar in the two groups. Receiver-operating characteristic curve analyses showed that serum albumin was the only prognostic factor associated with PCCU mortality, even after adjustment for PD treatment.
Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.

DOI： 10.1007/s00540-009-0747-2

Site-specific induction of intestinal hypoxia-inducible factor-1α after hemorrhagic shock. 査読

Nishie H, Takahashi T, Inoue K, Shimizu H, Morimatsu H, Toda Y, Omori E, Akagi R, Katayama H, Morita K

Molecular medicine reports 2 ( 2 ) 149 - 152 2009年3月

先天性心疾患の筋弛緩持続投与症例における挿管時間に関係する因子

清水一好, 森松博史, 戸田雄一郎, 鈴木聡, 金澤伴幸, 末盛智彦, 江木盛時, 岩崎達雄, 森田潔

日本集中治療医学会雑誌 16 ( Suppl. ) 247 - 247 2009年1月

侵襲期の輸液栄養管理周術期急性高血糖に対するパラチノース含有糖質調節流動食 Randomized Cross-Over Trial

江木盛時, 鈴木聡, 松崎孝, 清水一好, 森松博史, 戸田雄一郎, 溝渕知司, 片山浩, 横山正尚, 森田潔

日本集中治療医学会雑誌 16 ( Suppl. ) 186 - 186 2009年1月

小児先天性心疾患術後における急性腎障害(Acute Kidney Injury)の影響 pediatric RIFLEの応用

戸田雄一郎, 岩崎達雄, 清水一好, 末盛智彦, 鈴木聡, 金澤伴幸, 森松博史, 江木盛時, 森田潔

日本集中治療医学会雑誌 16 ( Suppl. ) 247 - 247 2009年1月

小児心臓手術におけるトラネキサム酸投与は術中及び術後の出血量を減少させる

清水一好, 岩崎達雄, 森松博史, 鈴木聡, 金澤伴幸, 江木盛時, 戸田雄一郎, 森田潔

Cardiovascular Anesthesia 12 ( Suppl. ) 162 - 162 2008年11月

遺伝性コプロポルフィリン症患者に対する精巣固定術の麻酔経験

小野大輔, 松崎孝, 江木盛時, 清水一好, 森松博史, 戸田雄一郎, 松三昌樹, 森田潔

麻酔 57 ( 6 ) 786 - 786 2008年6月

血糖持続測定を用いた小児インスリノーマの麻酔経験

真鍋素子, 森松博史, 江木盛時, 賀来隆治, 松三昌樹, 森田潔

麻酔 57 ( 6 ) 784 - 784 2008年6月

小児ICUのスコアリングシステムの心疾患患者でのvalidation PIM,PRISM,PELODを用いて

戸田雄一郎, 森松博史, 岩崎達雄, 清水一好, 江木盛時, 鈴木聡, 金澤伴幸, 森田潔

日本集中治療医学会雑誌 15 ( Suppl. ) 179 - 179 2008年1月

岡山大学病院における新生児心臓手術後のステロイド使用の検討

清水一好, 竹内護, 岩崎達雄, 森松博史, 戸田雄一郎, 江木盛時, 金澤伴幸, 鈴木聡, 森田潔

日本集中治療医学会雑誌 15 ( Suppl. ) 179 - 179 2008年1月

先天性心疾患の術後呼吸不全におけるN-CPAPの有用性の検討

金澤伴幸, 清水一好, 戸田雄一郎, 岩崎達雄, 江木盛時, 森松博史, 森田潔

日本集中治療医学会雑誌 15 ( Suppl. ) 180 - 180 2008年1月

食道癌術後の発作性心房細動の発生とその危険因子

鈴木聡, 森松博史, 江木盛時, 清水一好, 金澤伴幸, 谷真規子, 戸田雄一郎, 岩崎達雄, 片山浩, 森田潔

日本集中治療医学会雑誌 15 ( Suppl. ) 182 - 182 2008年1月

危篤患者に対する非顕性DICスコアの妥当性検証(A validation of non-overt disseminated intravascular coagulation score for critically ill patients)

江木盛時, 森松博史, Wiedermann Christian J., 谷真規子, 金澤伴幸, 鈴木聡, 松崎孝, 清水一好, 戸田雄一郎, 岩崎達雄, 森田潔

日本集中治療医学会雑誌 15 ( Suppl. ) 223 - 223 2008年1月

腹膜透析中の血糖コントロールは予後を改善する?

戸田雄一郎, 江木盛時, 森松博史, 岩崎達雄, 清水一好, 竹内護, 森田潔, 笠原真悟, 佐野俊二, 大月審一, 岡本吉生

日本小児循環器学会雑誌 23 ( 3 ) 315 - 315 2007年5月

小児心臓手術後急性腎不全患者の酸塩基異常の特徴

森松博史, 戸田雄一郎, 江木盛時, 清水一好, 岩崎達雄, 竹内護, 森田潔

日本集中治療医学会雑誌 14 ( Suppl. ) 239 - 239 2007年1月

生体肝移植術後タクロリムス脳症の検討

松崎孝, 森松博史, 賀来隆治, 佐藤哲文, 松三昌樹, 森田潔

日本集中治療医学会雑誌 14 ( Suppl. ) 244 - 244 2007年1月

高血糖と予後 Hyperglycemia in Pediatric Cardiac Surgery Patients Requiring Peritoneal Dialysis

江木盛時, 森松博史, 戸田雄一郎, 岩崎達雄, 清水一好, 竹内護, 松崎孝, 鈴木聡, 横山正尚, 森田潔

日本集中治療医学会雑誌 14 ( Suppl. ) 211 - 211 2007年1月

小児先天性心疾患患者における腹膜透析の予後と予測因子

戸田雄一郎, 森松博史, 江木盛時, 清水一好, 鈴木聡, 岩崎達雄, 竹内護, 横山正尚, 森田潔

日本集中治療医学会雑誌 14 ( Suppl. ) 222 - 222 2007年1月

[Anesthetic management in a child with epidermolysis bullosa undergoing esophageal dilatation]. 査読

Matsumi J, Morimatsu H, Matsusaki T, Toda Y, Nakatsuka H, Morita K

Masui. The Japanese journal of anesthesiology 55 362 - 364 2006年3月

非閉塞性腸間膜虚血症に続発した敗血症性多臓器不全の2症例

岡部悠吾, 森松博史, 西江宏行, 花崎元彦, 岩崎達雄, 佐藤哲文, 武田吉正, 竹内護, 片山浩, 森田潔

日本集中治療医学会雑誌 13 ( Suppl. ) 235 - 235 2006年1月

[General anesthesia outside the operating room in patients with Pierre-Robin syndrome]. 査読

Kamitani J, Toda Y, Nakatsuka H, Sato K, Morimatsu H, Taga N, Takeuchi M, Morita K

Masui. The Japanese journal of anesthesiology 54 687 - 689 2005年6月

我が国の小児集中治療の現状と問題点岡山大学CCUにおける小児集中治療の現況と問題点

竹内護, 多賀直行, 岩崎達雄, 戸田雄一郎, 清水一好, 森松博史, 森田潔

日本集中治療医学会雑誌 11 ( Suppl. ) 138 - 138 2004年1月

An adult with ARDS managed with high-frequency oscillatory ventilation and prone position

Osamu Nagano, Hiromi Fujii, Hiroshi Morimatsu, Satoshi Mizobuchi, Keiji Goto, Hiroshi Katayama, Masahisa Hirakawa, Yoshitsugu Yamada

Journal of Anesthesia 16 ( 1 ) 75 - 78 2002年

MRSA敗血症に対してエンドトキシン(ET)吸着療法が有効であった2症例

賀来隆治, 森松博史, 奥格, 長野修, 片山浩, 森田潔, 平川方久

日本集中治療医学会雑誌 8 ( Suppl. ) 205 - 205 2001年1月

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