研究者詳細 - 岩崎　達雄

論文 - 岩崎　達雄

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

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1053/j.jvca.2023.02.030

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

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

Pediatric cardiology 2023年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1007/s00246-023-03158-1

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小児心臓麻酔の理論と実際査読

木村聡, 金澤伴幸, 清水一好, 岩崎達雄

臨床麻酔 47 ( 4 ) 542 - 553 2023年4月

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

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

Pediatric Nephrology 38 ( 8 ) 2861 - 2871 2023年3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

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

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その他リンク： https://link.springer.com/article/10.1007/s00467-023-05925-x/fulltext.html

重症大動脈弁狭窄症合併大腿骨骨折の周術期管理計画を麻酔科が中心となって立案した1症例査読

越智美咲, 谷真規子, 黒田浩佐, 岩崎達雄

麻酔 72 ( 5 ) 484 - 488 2023年

小児麻酔 up to date 小児心臓手術の麻酔招待査読

清水一好, 金澤伴幸, 岩崎達雄

麻酔 72 ( 11 ) 1024 - 1029 2023年

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

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

人工心肺離脱困難症例とその対応 HLHSに対するNorwood手術

佐倉考信, 金澤伴幸, 清水一好, 岩崎達雄

日本小児麻酔学会誌 27 ( Suppl. ) 68 - 68 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

小児心臓手術における人工心肺中のカルボキシヘモグロビンおよびメトヘモグロビンと溶血の関係性

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

Cardiovascular Anesthesia 26 ( Suppl. ) 175 - 175 2022年9月

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

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The frequency of postoperative BNP measurement and intervention threshold of BNP concentration in pediatric cardiac intensive care unit: a prospective multicenter observational study. 査読

Tomoyuki Kanazawa, Kazuyoshi Shimizu, Naoyuki Taga, Masaki Yamasaki, Hideaki Mori, Sonoko Fujii, Tatsuo Iwasaki

Journal of anesthesia 36 ( 3 ) 367 - 373 2022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）

PURPOSE: The purpose of this study is to investigate the current status of postoperative BNP measurement in the pediatric cardiac intensive care unit (PCICU). METHODS: This was a prospective multicenter observational study. Children under 15 years old who underwent pediatric cardiac surgery were included. Postoperatively, all BNP measurement was collected in PCICU. We checked whether each BNP measurement was used for the decision-making of intervention or not. We divided the BNP measurements into 4 groups: group A 0-299 pg/ml (reference), group B 300-999 pg/ml, group C 1000-1999 pg/ml, group D ≧ 2000 pg/ml. We performed logistic regression analysis to compare the intervention ratio between group A and B, C, D. We also did multiple comparison analyses to compare the intervention ratio in each group. RESULTS: Thirty-nine (15.8%) measurements were used as a criterion to intervene in all BNP measurements. There was no protocol for the measurement of BNP in all institutions. The number of BNP measurements in each group is as follows: group A 113 (45.9%), group B 81 (32.9%), group C 45 (18.3%), group D 7 (2.8%). The intervention ratio in each group was 6.2% (group A), 8.6% (group B), 44.4% (group C), and 71.4% (group D). The intervention ratio of group C and D were significantly higher than group A: (Odds ratio (95%CI): 12.1(4.8-33.9), p < 0.0001, 25.2(5.2-146.2), p < 0.0001). The result of multiple comparisons is similar to logistic regression analysis. CONCLUSION: High BNP concentration, especially more than 1000 pg/ml, was more often intervened upon compared to that of less than 1000 pg/ml.

DOI： 10.1007/s00540-022-03052-9

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Vascular occlusion with 0.035-inch hydrogel expandable coils in congenital heart diseases and vascular anomalies. 査読国際誌

Kenji Baba, Maiko Kondo, Takahiro Eitoku, Yusuke Shigemitsu, Kenta Hirai, Shinichi Otsuki, Tomoyuki Kanazawa, Tatsuo Iwasaki, Toshihiro Iguchi, Norihisa Toh, Yasuhiro Kotani, Shingo Kasahara

Journal of cardiology 80 ( 3 ) 249 - 254 2022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：Elsevier BV

BACKGROUND: We present our experience with transcatheter vascular occlusion using 0.035-inch hydrogel expandable coils, which has been reported only in a few cases in the pediatric cardiology fields. METHODS: This study is a retrospective analysis of all patients who underwent transcatheter embolization with 0.035-inch hydrogel coils at the Department of Pediatrics, Okayama University Hospital, between October 2018 and September 2020. RESULTS: Twenty patients with a median age of 5.1 years (0.05-26.0 years) and a median weight of 13.8 kg (3.0-56.8 kg) were included. A total of fifty-four 0.035-inch hydrogel coils, including 35 Azur 35 and nineteen Azur CX 35 coils (Terumo, Tokyo, Japan), were successfully deployed in 22 target vessels. The target vessels consisted of 10 aortopulmonary collaterals, 8 veno-venous collaterals, and 4 pulmonary arteriovenous malformations. We achieved technical success in all the target vessels. In total, the mean target vessel diameter was 4.4 mm, the mean number of 0.035-inch hydrogel coils was 2.5 per vessel. The mean device to vessel ratio was 1.6 for the anchor coil and 1.2 for the additional coil. Post-implantation angiograms revealed that the primary occlusion rate was 18/22 (82%). There were no periprocedural complications. CONCLUSIONS: The 0.035-inch hydrogel expandable coils are effective and safe in patients with congenital heart disease and vascular anomalies. These occlusion devices could be valuable options for interventional pediatric cardiologists.

DOI： 10.1016/j.jjcc.2022.04.005

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Stepwise Treatment for Heterotaxy Syndrome and Functional Single Ventricle Complicated by Infra-Cardiac Total Anomalous Pulmonary Venous Connection with Ductus Venosus Stent Placement and Subsequent Occlusion 査読

Yuki Imai, Kenji Baba, Shinichi Otsuki, Maiko Kondo, Takahiro Eitoku, Yusuke Shigemitsu, Yosuke Fukushima, Kenta Hirai, Tatsuo Iwasaki, Tomoyuki Kanazawa, Yasuhiro Kotani, Shingo Kasahara

Pediatric Cardiology 43 ( 4 ) 756 - 763 2022年4月

Intact survival from severe cardiogenic shock caused by the first attack of atrial tachycardia treated with extracorporeal membrane oxygenation and surgical left atrium appendage resection: a case report 査読国際誌

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

JA Clinical Reports 7 ( 1 ) 81 - 81 2021年12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）出版者・発行元：Springer Science and Business Media LLC

<title>Abstract</title><sec>
<title>Background</title>
Atrial tachycardia (AT) is rare in children and can usually be reversed to sinus rhythm with pharmacotherapy and cardioversion. We report a rare case of severe left-sided heart failure due to refractory AT.

</sec><sec>
<title>Case presentation</title>
A 12-year-old boy had AT with a heart rate of 180 beats/minute, which was refractory to any medication and defibrillation despite the first attack. Due to rapid cardiorespiratory collapse shortly after arriving at our hospital, central extracorporeal membrane oxygenation (ECMO) with left arterial venting was started immediately. Although AT persisted after that, it stopped on the 3rd day after admission following surgical resection of the left atrial appendage thought to be the source of AT. He was weaned off ECMO on the 7th day and ventilator on the 14th day.

</sec><sec>
<title>Conclusions</title>
The appropriate timing of central ECMO and surgical ablation were effective in saving this child from a life-threatening situation caused by refractory AT.

</sec>

DOI： 10.1186/s40981-021-00481-5

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その他リンク： https://link.springer.com/article/10.1186/s40981-021-00481-5/fulltext.html

小児心臓手術における術中トロンボエラストメトリーのA10と術後出血量との関連性査読

森英明, 戸田雄一郎, 清水一好, 金澤伴幸, 岩崎達雄

麻酔 70 ( 12 ) 1315 - 1321 2021年12月

Risk factors and outcomes of pediatric extracorporeal membrane oxygenation 査読国際誌

Hiroshi Taka, Yasuhiro Kotani, Yosuke Kuroko, Susumu Iwadou, Tatsuo Iwasaki, Shingo Kasahara

Asian Cardiovascular and Thoracic Annals 29 ( 9 ) 916 - 921 2021年11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：SAGE Publications

<sec><title>Background</title> Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD.

</sec><sec><title>Methods</title> We retrospectively reviewed the medical records of 37 patients (<16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38–53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge.

</sec><sec><title>Results</title> The median ECMO duration was 160 (91–286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration >1 week and urine output <1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min.

</sec><sec><title>Conclusions</title> Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.

</sec>

DOI： 10.1177/0218492321997379

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.1177/0218492321997379

肺循環の生理と肺動脈性肺高血圧症の病態生理からみたその治療. 査読

中村一文, 赤木達, 岩野貴之, 江尻健太郎, 杜徳尚, 伊藤浩, 清水一好, 岩崎達雄

Cardiovascular Anesthesia 25 ( 1 ) 7 - 12 2021年9月

Perioperative Milrinone Infusion Improves One-Year Survival After the Norwood-Sano Procedure 査読

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

Journal of Cardiothoracic and Vascular Anesthesia 35 ( 7 ) 2073 - 2078 2021年7月

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