研究者詳細 - 岩崎　達雄

論文 - 岩崎　達雄

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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

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

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

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高齢の右室二腔症患者にロボット支援下膵頭十二指腸切除を施行した1症例

加藤光晴, 佐倉考信, 片山明, 清水達彦, 岩崎達雄

Cardiovascular Anesthesia 28 ( Suppl. ) 301 - 301 2024年9月

先天性心疾患患者の予後改善～麻酔科医が寄与できること～先天性心疾患における早期抜管の見極めと予後

清水達彦, 金澤伴幸, 岩崎達雄

日本小児麻酔学会大会プログラム 29回 6 - 6 2024年8月

Pulmonary Flow Management by Combination Therapy of Hemostatic Clipping and Balloon Angioplasty for Right Ventricular-Pulmonary Artery Shunt in Hypoplastic Left Heart Syndrome. 国際誌

Yusuke Shigemitsu, Maiko Kondo, Yoshihiko Kurita, Yosuke Fukushima, Yuya Kawamoto, Kenta Hirai, Mayuko Hara, Tomoyuki Kanazawa, Tatsuo Iwasaki, Shingo Kasahara, Koichi Kataoka, Hirokazu Tsukahara, Kenji Baba

Pediatric cardiology 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Controlling pulmonary blood flow in patients who have undergone Norwood palliation, especially early postoperatively, is challenging due to a change in the balance of systemic and pulmonary vascular resistance. We applied a combination therapy of clipping and balloon angioplasty for right ventricle-pulmonary artery (RV-PA) shunt to control pulmonary blood flow, but the influence of the combination therapy on the PA condition is uncertain. Retrospectively analysis was conducted of all infants with hypoplastic left heart syndrome who had undergone Norwood palliation with RV-PA shunt at Okayama University Hospital from January 2008 to September 2022. A total of 50 consecutive patients underwent Norwood palliation with RV-PA shunt in this study period. Of them, 29 patients underwent RV-PA shunt flow clipping, and the remaining 21 had unclipped RV-PA shunt. Twenty-three patients underwent balloon angioplasty for RV-PA shunt with clips. After balloon angioplasty, oxygen saturation significantly increased from 69 (59-76)% to 80 (72-86)% (p < 0.001), and the narrowest portion of the clipped conduit significantly improved from 2.8 (1.8-3.4) to 3.8 (2.9-4.6) mm (p < 0.001). In cardiac catheterizations prior to Bidirectional cavo-pulmonary shunt (BCPS), there were no significant differences in pulmonary-to-systemic flow ratio (Qp/Qs), ventricular end-diastolic pressure, Nakata index, arterial saturation, mean pulmonary artery pressure and pulmonary vascular resistance index. On the other hand, in Cardiac catheterizations prior to Fontan, Nakata index was larger in the clipped group (p = 0.02). There was no statistically significant difference in the 5-year survival between the two groups (clipped group 96%, unclipped group 74%, log-rank test: p = 0.13). At least, our combination therapy of clipping and balloon angioplasty for RV-PA shunt did not negatively impact PA growth. Although there is a trend toward better but not statistically significant difference in outcomes in the clipped group compared to the non-clipped group, this treatment strategy may play an important role in improving outcomes in hypoplastic left heart syndrome.

DOI： 10.1007/s00246-024-03579-6

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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)

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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

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

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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

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Carboxyhemoglobin and Methemoglobin Levels and Hemolysis in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass. 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

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1097/MAT.0000000000002044

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食道閉鎖根治術後の食道右上葉肺瘻に対して2本のFogarty catheterで分離肺換気を行った一例

吉田翼, 金澤伴幸, 佐倉考信, 清水達彦, 清水一好, 岩崎達雄

日本小児麻酔学会誌 29 ( Suppl. ) 178 - 178 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

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

食道閉鎖根治術後の食道右上葉肺瘻に対して2本のFogarty catheterで分離肺換気を行った一例

吉田翼, 金澤伴幸, 佐倉考信, 清水達彦, 清水一好, 岩崎達雄

日本小児麻酔学会誌 29 ( Suppl. ) 178 - 178 2023年10月

症例報告フォンタン手術後の肝切除術の麻酔経験

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

Challenging cases in interventional cardiology カテーテル的肺静脈ステント留置術の留意点

馬場健児, 栗田佳彦, 近藤麻衣子, 重光祐輔, 福嶋遥佑, 川本祐也, 原真祐子, 岩崎達雄, 金澤伴幸, 小谷泰弘, 笠原真悟

日本小児循環器学会総会・学術集会抄録集 59回 [I - 06] 2023年7月

大動脈離断/心室中隔欠損症の術後遠隔期の検討

福嶋遥佑, 大月審一, 馬場健児, 近藤麻衣子, 栗田佳彦, 重光祐輔, 平井健太, 原真祐子, 岩崎達雄, 笠原真悟, 小谷恭弘

日本小児循環器学会総会・学術集会抄録集 59回 [II - 06] 2023年7月

Challenging cases in interventional cardiology カテーテル的肺静脈ステント留置術の留意点

馬場健児, 栗田佳彦, 近藤麻衣子, 重光祐輔, 福嶋遥佑, 川本祐也, 原真祐子, 岩崎達雄, 金澤伴幸, 小谷泰弘, 笠原真悟

日本小児循環器学会総会・学術集会抄録集 59回 [I - 06] 2023年7月

大動脈離断/心室中隔欠損症の術後遠隔期の検討

福嶋遥佑, 大月審一, 馬場健児, 近藤麻衣子, 栗田佳彦, 重光祐輔, 平井健太, 原真祐子, 岩崎達雄, 笠原真悟, 小谷恭弘

日本小児循環器学会総会・学術集会抄録集 59回 [II - 06] 2023年7月

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

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

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

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1007/s00540-023-03187-3

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