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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

小児拡張型心筋症の心筋修復を目的とした心筋細胞由来エキソソームマイクロRNAの開発査読

Science Translational Medicine 2020年12月

failing Fontan症例に対するfenestration作成術

馬場健児, 近藤麻衣子, 栄徳隆裕, 今井祐喜, 福嶋遥佑, 重光祐輔, 平井健太, 大月審一, 笠原真悟, 岩崎達雄

日本小児循環器学会雑誌 36 ( Suppl.2 ) s2 - 236 2020年11月

新生児心嚢穿刺後の緊張性気腹に対して陽圧換気が奏功した1症例査読

JA Clinical Reports 6 ( 1 ) 2020年10月

成人先天性心疾患の現況と今後の展望成人先天性心疾患に対する非心臓手術招待

金澤伴幸, 岩崎達雄

臨床麻酔 44 ( 9 ) 1183 - 1188 2020年9月

担当区分：最終著者記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：真興交易(株)医書出版部

先天性心疾患の予後向上に伴い、成人先天性心疾患患者が増加している。成人先天性心疾患患者は、高血圧・高脂血症などの代謝疾患に罹患するリスクが高く、また癌罹患のリスクが上がるという報告もあり心臓手術以外の手術を受ける患者が増えている。非心臓手術の場合、一般的な病院でも手術手技自体は可能であるが、特殊な病態であるため周術期管理に難渋することが多い。ヨーロッパのガイドラインでは、専門機関での術前評価を推奨しており、手術も専門機関で行うことが望ましいとしている。特に気をつける病態は、単心室患者、肺高血圧症患者、妊婦の麻酔であり、麻酔科医はそれぞれの病態の基礎的な知識を有し、専門家との連携を取る必要がある。(著者抄録)

グレン循環の小児における大量無気肺に対する一側肺リクルートメントが有効でった1症例査読国際誌

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

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査読

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

日本小児麻酔学会誌 25 ( 1 ) 29 - 32 2019年11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：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)

成人先天性心疾患に対する非心臓手術の麻酔管理招待査読

岩崎達雄, 金澤伴幸, 川瀬宏和, 清水一好

麻酔 68 ( 増刊 ) S47 - S55 2019年11月

小児心臓病患者におけるポイントオブケア血清クレアチニン測定装置の評価と急性腎不全診断への影響。単一施設のレトロスペクティブ研究査読

Health Sci Rep 2019年11月

小児低侵襲心臓手術における心膜牽引による脳虚血の脳内酸素濃度測定により早期発見できた1症例査読

JA Clinical Reports 2019年8月

小児における鎮静薬「小児検査における麻酔法 (麻酔薬，鎮静薬，周術期関連薬)」招待

2) 安河内聰, 鮎澤衛, 小山耕太郎, 須田憲治, 建部俊介, 中川雅生, 三浦大, 石川友一, 島本裕子, 伊藤秀一, 小垣滋豊, 住友直方, 土井庄三郎, 福嶌教偉, 山岸敬幸, 伊藤直樹, 鈴木嗣敏, 岩崎達雄, 坂本喜三郎, 先崎秀明, 土橋一重, 堀米仁志, 岩本眞理, 白石公, 瀧聞浄宏, 豊島勝昭, 前田美穂, 与田仁志, 神山浩, 高橋健, 山岸正明, 大崎真樹, 髙井千夏, 武井黄太, 松裏裕行, 芳本潤, 赤阪隆史, 富田英, 深澤隆治, 村上智明, 石川司朗, 前田恵理子, 村島温子, 増谷聡, 森善樹, 小野稔, 木村剛

先天性心疾患並びに小児期心疾患の診断検査と薬物療法ガイドライン 2019年8月

先天性心疾患における肺静脈狭窄症に対する血管内治療後の臨床的転帰について査読

Cardiology in the Young 29 ( 8 ) 1057 - 1065 2019年8月

小児心臓病患者における高クロル血症は術後急性腎臓障害の独立した危険因子ではない査読国際誌

J Cardiothorac Vasc Anesth 33 ( 7 ) 1939 - 1945 2019年7月

小児心臓麻酔のいま

金澤伴幸, 清水一好, 岩崎達雄

臨床麻酔 43 ( 6 ) 844 - 851 2019年6月

担当区分：最終著者記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：真興交易(株)医書出版部

小児心臓手術の麻酔は、その複雑な病態を理解し、適切な麻酔薬の選択や人工呼吸器設定を行うことが必要である。大量麻薬麻酔から、フェンタニルに加え少量の吸入麻酔薬などを使用したバランス麻酔へと移行し、早期覚醒を目指した全静脈麻酔も行われている。特徴的な単心室の並列循環では、以前から提唱されている肺血管抵抗の調節に加え、血管拡張薬を使用した体血管抵抗の積極的な調節がより重要視されている。また、SvO2や脳組織rSO2などの新たなモニタリングにより心拍出量の推定や、中枢神経障害などの重度合併症を予防する積極的な取り組みなど、小児心臓麻酔は、より良い生存率と成績の質の向上を目指した管理へと移行している。(著者抄録)

胎児期から当院で管理した抗SS-A抗体による先天性完全房室ブロック症例の臨床経過

近藤麻衣子, 馬場健児, 栄徳隆裕, 今井祐喜, 重光祐輔, 福嶋遥佑, 平井健太, 原真佑子, 大月審一, 笠原真悟, 岩崎達雄

日本小児循環器学会雑誌 35 ( Suppl.1 ) s1 - 198 2019年6月

小児心臓手術の麻酔管理招待査読

岩崎達雄

Pediatric Cardiology and Cardiac Surgery 2019年5月

狭窄性心房中隔を有する左心不全症候群に対するバルーン心房中隔形成術査読

Pediatr International 61 ( 4 ) 339 - 344 2019年4月

小児複雑心奇形の周術期におけるECMO治療招待査読

岩崎達雄, 金澤伴幸, 清水一好, 川瀬宏和, 森松博史, 笠原真悟

日本臨麻麻酔学会雑誌 39 ( 2 ) 148 - 154 2019年3月

担当区分：筆頭著者記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：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)

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小児心臓手術後の抜管後急性呼吸不全に対する高流量鼻カニューレと非侵襲的換気の比較査読

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

小児麻酔におけるデクスメデトミジン招待査読

清水一好, 金澤伴幸, 岩崎達雄

小児外科 51 ( 2 ) 167 - 169 2019年2月

ECMO中の輸血需要に関連した臨床的特徴と凝固管理査読

青景聡之, 平山隆浩, 塚原紘平, 高寛, 清水一好, 中川晃志, 岩崎達雄, 笠原真悟, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 26 ( Suppl. ) [O27 - 6] 2019年2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。

High Ionized Calcium Concentration Is Associated With Prolonged Length of Stay in the Intensive Care Unit for Postoperative Pediatric Cardiac Patients. 査読国際誌

Kimura S, Iwasaki T, Oe K, Shimizu K, Suemori T, Kanazawa T, Shioji N, Kuroe Y, Matsuoka Y, Morimatsu H.

Journal of Cardiothoracic and Vascular Anesthesia 32 ( 4 ) 1667 - 1675 2018年8月

心室中隔のない肺動脈閉鎖症における巨大心室瘻の出生前診断．査読

Pediatric Cardiology and Cardiac Surgery 2018年5月

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

Shioji N, Kanazawa T, Iwasaki T, Shimizu K, Suemori T, Kawase H, Kimura S, Kuroe Y, Morimatsu H.:

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

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

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

Cardiovasc Anesth 2018年3月

小児の麻酔中における人工呼吸器設定査読

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：日本語掲載種別：研究論文（学術雑誌）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

狭小な心房間交通を有する左心低形成症候群に対するBalloon Atrial Septostomyの検討査読

福島遙祐, 馬場健児, 近藤麻衣子, 栗田佳彦, 栄徳隆裕, 重光祐輔, 平井健太, 塚原宏一, 岩崎達雄, 佐野俊二, 笠原真悟, 小谷恭弘, 大月審一

日本小児循環器学会雑誌 33 ( 6 ) 423 - 430 2017年11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：(NPO)日本小児循環器学会

背景:左心低形成症候群(HLHS)では左房容積が小さく、心房中隔の形態や心房中隔欠損(ASD)の大きさによってRashkind Balloon Atrial Septostomy(BAS)を行うことが困難な場合もある。目的:当院におけるHLHSに対するBASの有効性について検討した。対象と方法:2006年1月から2015年12月までの10年間にHLHSに対してカテーテル治療・手術を施行した患者におけるBASの有効性について検討した。またcatheter BASを施行した群についてASDの形態別に分けて有効性について両群比較検討した。結果:全HLHS70例中のGlenn手術到達は57例(81%)であり、BAS未施行群では86%(44/51)、catheter BAS群では91%(10/11)、open BAS群では25%(2/8)と統計学的有意差を認めたが(p=0.0002)、BAS未施行群とcatheter BAS群では同等の結果であった。(p=1.0)Glenn手術後にカテーテル検査を施行した56例について検討すると、BAS未施行群、catheter BAS施行群、open BAS施行群の平均肺動脈圧、肺血管抵抗、PAIいずれも3群間に差は認めなかった。次にCatheter BAS施行群をASDの位置・大きさ・atrial septumの厚さからstandard ASD(n=5)、complex ASD(n=5)に分類し、ASDの形態別にBAS施行方法を検討すると、standard ASD群では全例Rashkind BAS単独施行で効果を得たが、complex ASD群ではRashkind BAS単独施行症例は1例のみで、Static BASを先行させRashkind BASに到達した症例が4例であった(p=0.048)。BAS後のASD size、ASD flow、SpO2は2群間で統計学的有意差を認めなかった。結論:catheter BASは有効で、Glenn後のカテーテルデータではBAS未施行群と有意差は認めなかった。またcomplex ASD群の場合には、Static BASを先行し、Rashkind BASを追加することで、standard ASD群と同等の効果を得ることができた。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02003&link_issn=&doc_id=20180418180002&doc_link_id=%2Fee7shoni%2F2017%2F003306%2F003%2F0423-0430%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fee7shoni%2F2017%2F003306%2F003%2F0423-0430%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

周術期におけるECMO 小児複雑心奇形におけるECMO 査読

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

成人フォンタン手術後カテーテル治療

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

日本心臓病学会学術集会抄録 65回 ACHD - 4 2017年9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

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

総肺静脈還流異常症、大血管転位症の麻酔管理査読

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：日本語掲載種別：研究論文（学術雑誌）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)

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胎児期より管理したEbstein奇形の治療経過

近藤麻衣子, 馬場健児, 栗田佳彦, 栄徳隆裕, 重光祐輔, 平井健太, 大月審一, 佐野俊二, 笠原真悟, 岩崎達雄

日本小児循環器学会雑誌 33 ( Suppl.1 ) s1 - 281 2017年7月

重篤な低酸素血症のため緊急避難的に冠動脈用stentを留置した肺動脈低形成を伴うPA/VSD、MAPCAの2例

馬場健児, 近藤麻衣子, 栗田佳彦, 栄徳隆裕, 重光祐輔, 平井健太, 福嶋遙佑, 岩崎達雄, 笠原真悟, 佐野俊二, 大月審一

日本小児循環器学会雑誌 33 ( Suppl.1 ) s1 - 348 2017年7月

小児心臓手術後の抜管後の急性呼吸不全に対する高流量鼻カニューレ療法の生理的影響：前向き観察研究査読国際誌

J Intensive Care 5 35 - 35 2017年6月

Fontan手術後に発症する蛋白漏出性胃腸症の予後に関する検討査読

栗田佳彦, 馬場健児, 近藤麻衣子, 栄徳隆裕, 塚原宏一, 佐野俊二, 笠原真悟, 岩崎達雄, 佐藤修平, 大月審

日本小児循環器学会雑誌 33 ( 3 ) 202 - 210 2017年5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：特定非営利活動法人日本小児循環器学会

<p>背景：複雑先天性心疾患におけるFontan手術後に発症する蛋白漏出性胃腸症は発症すると難治・治療困難な病態であり生命予後を規定する．本研究の目的は当院でのPLE症例の予後と治療方針の検討である．</p><p>方法：1991～2014年に岡山大学病院でFontan手術後PLEの診断・治療を行った23例を対象にし，転帰の調査と死亡症例の傾向について検討を行った．</p><p>結果：Fontan手術施行401例中の23例（5.7％）に発症．フォローアップ期間は0.8～13年（中央値4.7年）．生存率は5年68％，10年54％．死亡原因は敗血症（2例），PLE増悪による多臓器不全（2例），心不全（1例），頭蓋内出血（1例）．死亡症例はPLE診断年齢が高くFontan手術から診断までの期間が長期であった．血行動態評価では治療前後の心係数（CI）と主心室駆出率（vEF），治療後の中心静脈圧（mCVP）に有意差を認めた．治療後CI＜2.8 L/min/mm, vEF＜50％，mCVP≧15 mmHgの症例は死亡率が高かった．</p><p>結論：PLEに対する治療は一定の有用性を認めたが，予後は満足できるものではない．血行動態的な治療の目標はCI，vEFの改善とCVPを低下させることと思われる．</p>

DOI： 10.9794/jspccs.33.202

【小児集中治療の新しい話題】循環管理成人期に達した先天性心疾患の周術期管理査読

1) 黒江泰利, 杉本健太郎, 金澤伴幸, 森松博史, 岩崎達雄

ICUとCCU 41 ( 4 ) 235 - 242 2017年4月

小児心臓手術患者における周術期の脳性ナトリウム利尿ペプチド。術後成績との関連性査読国際誌

J Cardiothorac Vasc Anesth 31 ( 2 ) 537 - 542 2017年4月

Intracoronary Cardiac Progenitor Cells in Single Ventricle Physiology: The PERSEUS (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) Randomized Phase 2 Trial. 査読

Circ Res. 120 ( 7 ) 1162 - + 2017年3月

複雑心奇形を有する成人先天性心疾患患者に対するCatheter Intervention

馬場健児, 大月審一, 近藤麻衣子, 栗田佳彦, 栄徳隆裕, 重光祐輔, 平井健太, 福嶋遙佑, 岩崎達雄, 笠原真悟

日本成人先天性心疾患学会雑誌 6 ( 1 ) 118 - 118 2017年1月

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

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査読

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

日集中医誌 2016年3月

Storage duration of transfused red blood cells is not significantly associated with postoperative adverse events in pediatric cardiac surgery patients 査読国際誌

Hirokazu Kawase,Moritoki Egi,Tomoyuki Kanazawa*,Kazuyoshi Shimizu*,Yuichiro Toda,Tatsuo Iwasaki*,Kiyoshi Morita

Transfusion and Apheresis Science, Transfusion Science, Plasma Therapy and Transfusion Technology 54 ( 1 ) 111 - 116 2016年2月

Effect of the Pulsatile Extracorporeal Membrane Oxygenation on Hemodynamic Energy and Systemic Microcirculation in a Piglet Model of Acute Cardiac Failure 査読

Hideshi Itoh,Shingo Ichiba,Yoshihito Ujike,Takuma Douguchi,Hideaki Obata,Syuji Inamori, Tatsuo Iwasaki, Shingo Kasahara, Shunji Sano, Akif Undar

Artificial Organs 40 ( 1 ) 19 - 26 2016年1月

小児心臓手術後の急性腎不全の発症を尿中アルブミン値で予測する：前向き観察研究査読国際誌

J Cardiothorac Vasc Anest 30 ( 1 ) 64 - 8 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

左心低形成症候群患者における冠動脈内自家心筋前駆細胞移植：TICAP前向き第1相対照試験査読

Circulation Research 2015年9月

小児心臓手術患者における術中乳酸値変化と術後転帰の関連性：レトロスペクティブ観察研究査読国際誌

BMC Anesthesiol 15 29 - 29 2015年7月

成人先天性疾患に対するカテーテル治療成人期のSingle Ventricle PhysiologyにおけるCatheter Interventionの役割

馬場健児, 大月審一, 近藤麻衣子, 栗田佳彦, 栄徳隆裕, 重光祐輔, 福嶋遙佑, 平井健太, 佐野俊二, 笠原真悟, 岩崎達雄

日本小児循環器学会雑誌 31 ( Suppl.1 ) s1 - 130 2015年7月

筋弛緩薬投与を契機に呼吸循環不全が劇的に改善した肺高血圧症合併のFallot四徴症の一例査読

石井南穗子, 金澤伴幸, 清水一好, 戸田雄一郎, 川瀬宏和, 武藤典子, 杉本健太郎, 岩崎達雄, 森松博史, 森田潔

日本小児麻酔学会誌 20 ( 1 ) 260 - 263 2014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：日本小児麻酔学会

1歳6ヵ月男児。生下時にFallot四徴症と診断され、Blalock-Taussigシャント術、狭窄に対する頻回のバルーン拡張術、狭窄解除術が施行されていた。今回、左肺動脈(PA)狭窄に対しカテーテルによるバルーン拡張術が施行された。術中にPA損傷による肺出血を来たし、術前からの低酸素血症もあるため、術後ICUで筋弛緩薬を用いた完全鎮静・抜管管理を行うこととした。ICU入室後に肺出血は消失したが、低酸素血症は遷延した。PAの著明狭窄に伴う肺高血圧症と肺出血による肺のコンプライアンス低下が問題であったため、人工呼吸器のモードは鎮静下に自発呼吸を温存することが有利と考え、ICU入室2日目に筋弛緩薬の投与を中止したところ、呼吸循環不全を生じた。ICU入室5日目に筋弛緩薬投与を再開したところ、呼吸循環動態は著明に改善し、11日目に抜管に至り、18日目には一般病棟に転棟することができた。

チームで実践するECMO管理査読

伊藤英史, 市場晋吾, 氏家良人, 岩崎達雄, 大藤剛宏, 笠原真悟, 佐野俊二

日本小児循環器学会雑誌 30 ( Suppl. ) s392 - s392 2014年6月

胎児診断に基く周産期治療左心低形成症候群high risk症例の周産期、周術期計画胎児診断からのアプローチ

近藤麻衣子, 大月審一, 馬場健児, 大野直幹, 栗田佳彦, 栄徳隆裕, 佐野俊二, 篠原真悟, 岩崎達雄, 戸田雄一郎, 清水一好

日本小児循環器学会雑誌 30 ( Suppl. ) s154 - s154 2014年6月

複雑心奇形の周術期管理並列循環症例の管理

岩崎達雄, 戸田雄一郎, 清水一好, 金澤伴幸, 森松博史, 森田潔

日本臨床麻酔学会誌 34 ( 2 ) 169 - 176 2014年3月

記述言語：日本語出版者・発行元：日本臨床麻酔学会

先天性心疾患で最もその生理が成人と異なり管理が困難な症例は,並列循環を伴う単心室症である.これらの患児は,まず第一期姑息術を受けるが,術後にも並列循環が残存するため周術期管理ではこの並列循環の管理が大切になる.理想的な並列循環を達成するために動脈血酸素飽和度のみならず体静脈血酸素飽和度をモニタリングして循環動態を正確に把握する.また体静脈血酸素飽和度は患児の予後予測,目標指向型治療の指標としても有用である.体・肺血流のバランスをとるために心拍出量,体・肺血管抵抗を調節するが,第一期姑息術後では体血管抵抗を調節する方がより効果的で,積極的な後負荷軽減療法は並列循環を安定させ,術後合併症を低減する.(著者抄録)

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01620&link_issn=&doc_id=20140319200001&doc_link_id=%2Fci4jjsca%2F2014%2F003402%2F001%2F0169-0176%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2014%2F003402%2F001%2F0169-0176%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

[Increase in serum vecuronium concentration following sugammadex administration in a pediatric patient after prolonged sedation].

Tatsuhiko Shimizu, Yuichiro Toda, Kazuyoshi Shimizu, Tatsuo Iwasaki, Tomoyuki Kanazawa, Noriko Ishii, Kentaro Sugimoto, Hirokazu Kawase, Kiyoshi Morita

Masui. The Japanese journal of anesthesiology 62 ( 10 ) 1225 - 9 2013年10月

記述言語：日本語掲載種別：研究論文（学術雑誌）

It is known that blood concentration of rocuronium increases after administration of sugammadex, but this is not clear in the case of vecuronium. We report a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. A 19-month-old girl weighing 7.8 kg had a history of aortic valvuloplasty at 4 months of age due to truncus arteriosus. She presented again to our hospital due to aortic regurgitation. She underwent aortic valvuloplasty and then aortic valve replacement. The postoperative course was complicated with severe heart failure and acute kidney injury requiring peritoneal dialysis. For that reason she required long-term sedation including administration of a large amount of muscle relaxant due to severe low cardiac output syndrome after aortic valvuloplasty. A total of 615 mg (79 mg x kg(-1)) of vecuronium was administered over a period of 24 days. On weaning from mechanical ventilation, 125 mg (16 mg x kg(-1)) of sugammadex was given. Vecuronium concentration measured by high-performance liquid chromatography (HPLC) was 5.03 ng x ml(-1) before sugammadex administration and increase to 13.98 ng x ml(-1) after that. However, blood concentration of metabolic products of vecuronium did not exceed the lower limits of measurement in each sample. She was successfully weaned from mechanical ventilation without recurarizarion. Serum concentration of vecuronium increased after administration of sugammadex because extravascular vecuronium was redistributed to intravascular space according to the concentration gradient induced by binding and clathration of vecuronium. The measured values of vecuronium after sugammadex administration on HPLC represented the total amount of free vecuronium and vecuronium combined with sugammadex. Recurarization might occur after sugammadex reversal in patients after long-term administration of vecuronium, especially if relatively smaller doses of sugammadex were given. We experienced a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. There is a risk of recurarization after sugammadex reversal in patients after long-term administration of vecuronium.

新生児・乳児心臓手術の周術期管理総肺静脈還流異常(TAPVC)

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, 石井典子, 森田潔

Cardiovascular Anesthesia 17 ( 1 ) 61 - 63 2013年8月

LVOTOを伴うTGAに対するPulmonary root translocationの有用性について

栄徳隆裕, 大月審一, 馬場健児, 大野直幹, 近藤麻衣子, 栗田佳彦, 小寺亜矢, 佐野俊二, 笠原真悟, 岩崎達雄, 戸田雄一郎

日本小児循環器学会雑誌 29 ( Suppl. ) s284 - s284 2013年6月

General anesthesia for pediatric cardiac catheterization - Effects of anesthetics on blood pressure, heart rate, oxygen saturation, and carbon dioxide 査読

Yuichiro Toda, Mamoru Takeuchi, Naoyuki Taga, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomohiko Suemori, Kiyoshi Morita

Japanese Journal of Anesthesiology 61 ( 12 ) 1312 - 1315 2012年12月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Background : There are limited data about the correlations between amount of anesthetics and variations in vital signs during pediatric cardiac catheterization. Methods : Data in 80 children with congenital heart disease undergoing cardiac catheterization with/without interventional cardiology in 2004 were examined in this retrospective cohort study. Data on blood pressure, heart rate, oxygen saturation, partial tension in end tidal carbon dioxide (PETCO2), and total amount of anesthetics given during general anesthesia were obtained from anesthetic charts. The correlations between amount of anesthetics and those vital signs were analyzed. Results : Median age of the patients was 14 months and median body weight was 8.8 kg. Median rates of variation in heart rate, blood pressure, oxygen saturation and PETCO2 were 22.8%, 29.3%, 5.9% and 10.8%, respectively. Although there were no statistical correlations between those vital signs and amounts of anesthetics such as fentanyl, vecuronium and sevoflurane, rates of variation in heart rate was smaller in patients for whom the amount of fentanyl given was more than 4 μg·kg-1·hr-1. Conclusions : There were no associations between amount of anesthetics and variations in vital signs in pediatric cardiac catheterization.

Pacing lead extraction using an excimer laser sheath under general anesthesia 査読

Satoshi Kimura, Yuichiro Toda, Kentaro Sugimoto, Noriko Ishii, Kazuyoshi Shimizu, Tomohiko Suemori, Tatsuo Iwasaki, Kiyoshi Morita

Japanese Journal of Anesthesiology 61 ( 11 ) 1277 - 1280 2012年11月

記述言語：日本語掲載種別：研究論文（学術雑誌）

An excimer laser sheath has recently been used for extraction of pacing and ICD leads. By using this technique, leads are removed more easily and it has to take a shorter time to extract leads. Although lead extraction with this method can cause fatal complications such as large vessel injury, little has been reported regarding anesthetic management during the lead extraction. We experienced two cases of pacing lead extraction using an excimer laser sheath under general anesthesia. The procedures were mainly performed by cardiologists in the operating theater. A wide area was prepared with sterile drapes as for cardiac surgery with cardiovascular surgeons standing by. Vascular access catheters were placed in the right femoral artery as well as vein, and in the right internal jugular vein so that immediate PCPS introduction could be performed in case of sudden hemodynamic collapse by massive bleeding. In the first case, lead extraction was completed without any complication, but in the second case sternotomy was performed by cardiac surgeons for safe separation of leads from vessels. There were also no bleeding episodes in the second case. Preparation for bleeding and cooperation among cardiologists, cardiovascular surgeons, medical engineers and anesthesiologists are necessary from the safety point of view of this procedure under general anesthesia.

先天性心疾患に対する姑息手術中に発生しうる危険な出来事

清水一好, 戸田雄一郎, 金澤伴幸, 石井典子, 杉本健太郎, 川瀬宏和, 岩崎達雄, 森田潔

Cardiovascular Anesthesia 16 ( 1 ) 131 - 136 2012年8月

成人先天性心疾患患者の麻酔管理非心臓手術麻酔

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, 石井典子, 森田潔

Cardiovascular Anesthesia 16 ( 1 ) 59 - 62 2012年8月

小児心臓手術後の急性腎障害(AKI)におけるpRIFLE criteriaの予測クレアチニンクリアランスを用いた診断と尿量を用いた診断の比較

杉本健太郎, 戸田雄一郎, 岩崎達雄, 清水一好, 金澤伴幸, 石井典子, 森田潔, 笠原真悟, 佐野俊二, 馬場健児, 大月審一

日本小児循環器学会雑誌 28 ( Suppl. ) s257 - s257 2012年6月

小児における経カテーテル的ASD閉鎖術(ASO)に対するリアルタイム3次元経食道エコー(Realtime3DTEE)の限界について

岡本吉生, 大月審一, 馬場健児, 栗田佳彦, 近藤麻衣子, 栄徳隆裕, 中本祐樹, 小寺亜矢, 佐野俊二, 岩崎達雄, 戸田雄一郎

日本小児循環器学会雑誌 28 ( Suppl. ) s178 - s178 2012年6月

左心低形成症候群に対するNorwood手術術式の違いによる術後遠隔期評価の比較検討

馬場健児, 大月審一, 岡本吉生, 近藤麻衣子, 栗田佳彦, 栄徳隆裕, 森島恒雄, 佐野俊二, 岩崎達雄, 新垣義夫, 脇研自

日本小児循環器学会雑誌 28 ( Suppl. ) s268 - s268 2012年6月

心臓手術の実際外科医が語る術式、麻酔科医が語る心臓麻酔、臨床工学技士が語る体外循環法(第22回) 大動脈縮窄症・大動脈弓離断症に対する手術と体外循環法岡山大学病院

佐野俊二, 笠原真悟, 新井禎彦, 岩崎達雄, 森田潔, 伊藤英史

Clinical Engineering 23 ( 2 ) 151 - 159 2012年1月

新生児緊急手術麻酔TAPVD、TGA、Arch anomaly 新生児緊急手術麻酔TAPVD

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

Cardiovascular Anesthesia 15 ( 1 ) 63 - 66 2011年9月

LONG TERM OUTOCOME IN CHILDREN WITH CONGENITAL HEART DISEASE WHO SUFFERED FROM ACUTE KIDNEY INJURY DURING POSTOPERATIVE ICU STAY

Yuichiro Toda, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomohiko Suemori, Noriko Ishii, Hirokazu Kawase, Kentaro Sugimoto, Moritoki Egi, Hiroshi Morimatsu, Kiyoshi Morita

CRITICAL CARE MEDICINE 38 ( 12 ) U188 - U188 2010年12月

Postoperative coil embolization of residual MAPCAs greatly improved left heart failure in a patient after corrective surgery for pulmonary atresia, ventricular septal defect and MAPCAs 査読

Masako Kinoshita, Kazuyoshi Shimizu, Yuichiro Toda, Satoshi Suzuki, Tomohiko Suemori, Tatsuo Iwasaki, Toru Takahashi, Kiyoshi Morita

Japanese Journal of Anesthesiology 59 ( 11 ) 1441 - 1445 2010年11月

記述言語：日本語掲載種別：研究論文（学術雑誌）

A male child, aged 1 year, with pulmonary atresia, ventricular septal defect and major aorto-pulmonary collateral arteries (PA, VSD, MAPCA) underwent corrective surgery including MAPCA ligation uneventfully. A few hours after admission to the ICU, severe heart failure, refractory to aggressive cardiac support including epinephrine infusion, became worse. Emergent cardiac catheterization on postoperative day 5 demonstrated the residual MAPCA and its occlusion by coil embolization dramatically resolved heart failure, indicating that the primary cause of this hemodynamic instability was likely excessive left-to-right shunt due to MAPCA. Residual LR shunt should be kept in mind to be a rare but significant cause of postoperative serious heart failure.

大動脈弁置換術中の大動脈遮断解除直後に発生した難治性心室細動に対して塩酸アミオダロン静脈内投与が奏効した1症例

鈴木聡, 岩崎達雄, 森松博史, 横井渚, 松岡舞夕子, 末盛智彦, 金澤伴幸, 清水一好, 戸田雄一郎, 森田潔

麻酔 59 ( 10 ) 1266 - 1270 2010年10月

記述言語：日本語出版者・発行元：克誠堂出版(株)

66歳男。労作時呼吸困難が持続し、高度大動脈弁狭窄症の診断で大動脈弁置換術が予定された。手術開始から大きな問題なく人工心肺開始、大動脈遮断となり、術操作も問題なく終了し、大動脈遮断時間は95分であった。遮断解除後に心室細動(VF)を認め、計3回の直流除細動器による電気ショックを行ったが改善せず、更に塩酸リドカインと硫酸マグネシウム液の静脈内投与後に計7回、次いで塩酸ニフェカラント投与後に計5回の電気ショックを行ったがVFは継続した。そこで、塩酸アミオダロンを静脈投与した後に電気ショックを行ったところ、1回で除細動に成功した。VFの持続時間は60分で、この間血液ガス分析では電解質や酸塩基平衡の異常はなかった。その後は心室ペーシング下で人工心肺を離脱し、手術終了となった。術後は塩酸アミオダロン、塩酸ランジオロールの静脈内持続投与を行い、VFの再発はなく、4日目に中止した。術後13日目にICUを退室し、63日目に退院した。

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01397&link_issn=&doc_id=20101005180011&doc_link_id=1520853833824188416&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520853833824188416&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

小児心臓手術における凝固検査の特徴トラネキサム酸の影響

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

Cardiovascular Anesthesia 14 ( Suppl. ) 157 - 157 2010年10月

フォンタン術後に長期人工呼吸を必要とした1症例

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

Cardiovascular Anesthesia 14 ( Suppl. ) 182 - 182 2010年10月

心疾患麻酔 Fontan術後の重症肺静脈狭窄症に対して緊急カテーテル検査から緊急狭窄解除手術に移行した一症例

池村志緒理, 清水一好, 戸田雄一郎, 末盛智彦, 杉本健太郎, 岩崎達雄, 森田潔

日本小児麻酔学会誌 16 ( 1 ) 113 - 113 2010年8月

術前・術後管理小児心臓カテーテル検査後の予定外人工呼吸の危険因子

戸田雄一郎, 清水一好, 岩崎達雄, 末盛智彦, 杉本健太郎, 森田潔

日本小児麻酔学会誌 16 ( 1 ) 110 - 110 2010年8月

麻酔法・術中管理右房内腫瘍浸潤を伴う小児腎腫瘍摘出術の麻酔経験

佐野美奈子, 末盛智彦, 清水一好, 戸田雄一郎, 岩崎達雄, 森田潔

日本小児麻酔学会誌 16 ( 1 ) 82 - 82 2010年8月

RACHS-1 CATEGORYは小児心臓手術において術後経過の予測因子となる

末盛智彦, 戸田雄一郎, 岩崎達雄, 清水一好, 鈴木聡, 森田潔, 笠原真悟, 佐野俊二, 岡本吉生, 大野直幹, 大月審一

日本小児循環器学会雑誌 26 ( Suppl. ) s282 - s282 2010年6月

The benefits of high-flow management in children with pulmonary atresia. 国際誌

Yasuhiro Fujii, Yasuhiro Kotani, Takuya Kawabata, Shinya Ugaki, Shigeru Sakurai, Hironori Ebishima, Hideshi Itoh, Mahito Nakakura, Sadahiko Arai, Shingo Kasahara, Shunji Sano, Tatsuo Iwasaki, Yuichiro Toda

Artificial organs 33 ( 11 ) 888 - 95 2009年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

The high-flow management of cardiopulmonary bypass (CPB; >or=2.4 L/min/m(2)) is a standard strategy used at this institute for children with pulmonary atresia (PA) due to a fear that the blood flow may be diverted by the major/minor aortopulmonary-collateral-arteries and hypervascularization due to long-term hypoxia. The purpose of this study was to describe the validity of high-flow management in children with PA. The CPB records of 23 children with PA who underwent a definitive biventricular repair between Feb 2006 and Nov 2008 were retrospectively reviewed. The mean age at the operation was 33 +/- 22 months. The blood-pressure during bypass was controlled with the same protocol. The mean cooling-temperature was 28.4 +/- 3.7 degrees C. The mean minimum hematocrit was 25.0 +/- 3.4%. The mean maximum bypass flow index at the initiation, the mean maximum flow index during aortic cross-clamping, the mean minimum flow index during aortic cross-clamping, and the mean maximum flow index after rewarming were 3.1 +/- 0.5, 3.1 +/- 0.5, 2.6 +/- 0.4, and 3.2 +/- 0.4 L/min/m(2), respectively. The higher bypass flow indexes significantly correlated with the lower serum lactate levels. The lowest oxygen delivery during CPB had significant influences on the urine output during bypass (R = 0.547, P = 0.007), the serum lactate levels at the end of CPB (R = -0.442, P = 0.035), and the postoperative thoracic effusion (R = -0.459, P = 0.028). A bypass flow index of 2.4 L/min/m(2) may not be sufficient and the maximum requirement of bypass flow index may be 3.2 L/min/m(2) or more in this patient population.

DOI： 10.1111/j.1525-1594.2009.00895.x

ASDの麻酔・術後管理

岩崎達雄, 戸田雄一郎, 清水一好, 末盛智彦, 鈴木聡, 森田潔

Cardiovascular Anesthesia 13 ( 1 ) 43 - 48 2009年5月

Non-overt disseminated intravascular coagulation scoring for critically ill patients: the impact of antithrombin levels. 国際誌

Moritoki Egi, Hiroshi Morimatsu, Christian J Wiedermann, Makiko Tani, Tomoyuki Kanazawa, Satoshi Suzuki, Takashi Matsusaki, Kazuyoshi Shimizu, Yuichiro Toda, Tatsuo Iwasaki, Kiyoshi Morita

Thrombosis and haemostasis 101 ( 4 ) 696 - 705 2009年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Validation of a scoring algorithm for non-overt disseminated intravascular coagulation (DIC) proposed by the International Society on Thrombosis and Haemostasis (ISTH) is still incomplete. It was the objective of this study to assess the impact of including AT to non-overt DIC scoring on the predictability for intensive care unit (ICU) death and the later development of overt-DIC defined by the Japanese Ministry of Health and Welfare (JMHW) or the ISTH. We performed a retrospective observational study conducted in 364 patients in critical care. Coagulation parameters obtained daily for DIC screening were utilised for scoring. There were 194 and 196 patients scored as positive non-overt DIC with and without AT, respectively; diagnostic agreement between the two was 78%. As compared with patients without non-overt DIC, these non-overt DIC patients had significantly higher mortality. In 37 ICU non-survivors, positive non-overt DIC scoring with AT preceded ICU death by a median of 6.8 days, which was significantly earlier as compared with a median of 5.4 days for non-overt DIC without AT (p = 0.022). In patients who developed overt-DIC after admission, the time period from positive non-overt DIC to positive overt-DIC was significantly longer when AT was utilised (overt-DIC ISTH; 1.3 days vs. 0.1 days, p = 0.004, overt-DIC JMHW; 2.5 days vs. 2.0 days, p = 0.04, with AT vs. without AT, respectively). Non-overt DIC scoring predicted a high risk of death in critically ill patients. When information on AT levels was included, non-overt DIC scoring was found to predict development of overt-DIC significantly earlier than non-overt DIC scoring without AT.

経皮的ASD閉鎖術におけるリアルタイム3D経食道エコー(RT3D-TEE)の有用性について

岡本吉生, 大月審一, 大野直幹, 美野陽一, 近藤麻衣子, 森島恒雄, 赤木禎治, 佐野俊二, 岩崎達雄, 戸田雄一郎, 清水一好

日本小児循環器学会雑誌 24 ( 3 ) 297 - 297 2008年5月

高肺血流型先天性心疾患を合併したDown症候群の術前検査および治療時期についての検討

美野陽一, 大月審一, 岡本吉生, 大野直幹, 近藤麻衣子, 森島恒雄, 佐野俊二, 笠原真悟, 吉積功, 岩崎達雄, 戸田雄一郎

日本小児循環器学会雑誌 24 ( 3 ) 355 - 355 2008年5月

大動脈弓狭窄病変を伴うTaussig-Bing奇形に対する大動脈弓形成

河田政明, 佐野俊二, 石野幸三, 神吉和重, 笠原真悟, 小泉淳一, 末澤孝徳, 立石篤史, 大崎悟, 小谷恭弘, 大月審一, 岡本吉生, 竹内護, 岩崎達雄, 戸田雄一郎

The Japanese Journal of THORACIC AND CARDIOVASCULAR SURGERY 53 ( Suppl.II ) 350 - 350 2005年9月

RV-PAシャントを用いたNorwood手術の術後経過 BTシャントを用いたNorwood手術との比較

岩崎達雄, 竹内護, 多賀直行, 大江克憲, 清水一好, 森田潔

麻酔 53 ( 9 ) 1008 - 1013 2004年9月

記述言語：日本語出版者・発行元：克誠堂出版(株)

Norwood手術施行時に鎖骨下動脈-肺動脈シャント(BTシャント)を用いた6症例(BT群)と右室-肺動脈シャント(RV-PAシャント)を用いた6症例(RV-PA群)について,術後循環動態を比較・検討した.両群間で日齢,体重,体外循環時間,循環停止時間,下半身虚血時間,脳虚血時間に有意差はなかったが,心筋虚血時間はRV-PA群において有意に長かった.心拍数は収縮期血圧に群間差はなかった.拡張期血圧はRV-PA群で有意に高かった.しかし心房圧,catecholamine indexには2群間に有意差を認めなかった.乳酸値はRV-P群が低い値で推移し2群間に有意差が見られたが,塩基過剰(BE)の推移には有意差がなかった.Pao2,Fio2には2群間に有意差はなかった.modified Norwood手術後症例は,従来のBTシャントを用いた症例に比し拡張期血圧が高く,安定した冠循環を維持できた上,術後乳酸値も低く推移し末梢循環が良く保たれていた

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2004&ichushi_jid=J01397&link_issn=&doc_id=20040910300006&doc_link_id=1520009409162371584&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520009409162371584&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

新生児・乳児に対する術中経食道心エコーの経験

小谷恭弘, 河田政明, 藤田康文, 徳永宣之, 末澤孝徳, 本浄修己, 大崎悟, 岩崎達雄, 石野幸三, 佐野俊二

日本小児循環器学会雑誌 20 ( 3 ) 295 - 295 2004年5月

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