基本情報
- 所属
- 自治医科大学 麻酔科 / 医学部総合医学第2講座 准教授
- 研究者番号
- 20650857
- ORCID ID
- https://orcid.org/0000-0002-2071-3898
- J-GLOBAL ID
- 202101016122264634
- researchmap会員ID
- R000018711
論文
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JA clinical reports 10(1) 65-65 2024年10月15日BACKGROUND: Interatrial right-to-left shunt flow through a patent foramen ovale (PFO) can be caused by changes in heart position for anastomosis during off-pump coronary artery bypass (OPCAB). We herein present a case in which the direction of PFO shunt flow changed with heart position during OPCAB and the ventilation settings after sternal closure. CASE PRESENTATION: A 66-year-old man with interstitial pneumonia underwent OPCAB. Preoperative transesophageal echocardiography revealed right-to-left shunt flow through a PFO induced by the Valsalva maneuver. During OPCAB, heart displacement resulted in right-to-left shunting and acute hypoxemia, which quickly improved with increase of inspired oxygen fraction. After chest closure, bidirectional shunt flow developed under increased airway pressure. CONCLUSIONS: Vigilant intraoperative monitoring with TEE and postoperative airway pressure management are important to address shunt flow and hypoxemia due to PFO.
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Cureus 16(8) e67801 2024年8月Introduction Remifentanil is an opioid with rapid onset and elimination. Theoretically, reducing sedation using high-dose remifentanil may contribute to early emergence and prevention of postanesthetic complications related to residual anesthesia. However, there have been few reports of high-dose remifentanil anesthesia in neonatal surgery. This study aims to describe the techniques of high-dose remifentanil anesthesia in neonates and their safety outcomes. Methods This is a single-center, retrospective observational study from January 2016 to February 2022. Medical records from neonatal surgical procedures performed using high-dose remifentanil anesthesia were reviewed. "High dose" was defined as 0.5 mcg/kg/min or more. Patient profiles, anesthetic drugs used, and intra- and post-operative adverse events, including cardiopulmonary complications, were abstracted. Results There were 15 neonatal abdominal operations performed under high-dose (>0.5 mcg/kg/min) remifentanil anesthesia during the study period. The average remifentanil infusion rate was 1.9 (0.68-3.1) mcg/kg/min. Hypotension occurred in two patients (13%). Bradycardia was not observed in any patients. The mean time for tracheal extubation was 16 minutes. Five patients (33%) received naloxone administration before extubation, and two patients (13%) experienced hypoxemia immediately after extubation. No patient had cardiorespiratory complications after leaving the operating room. Conclusions High-dose remifentanil can be used without impairing hemodynamic stability in neonatal surgery, although there is concern about respiratory depression. Further research is needed on its potential impact on long-term outcomes.
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General thoracic and cardiovascular surgery 2024年7月17日OBJECTIVE: Systemic heparinization during cardiopulmonary bypass (CPB) can significantly affect thromboelastography (TEG). This study investigated the feasibility of adding protamine in vitro to allow assessment of coagulation status using the TEG 6s system during CPB. METHODS: In this prospective observational study, 21 patients undergoing elective cardiac valve surgery were evaluated. During CPB, protamine was added in vitro to the heparinized blood of these patients at a concentration of 0.05 mg/mL and analyzed with the TEG 6s (Pre). The TEG parameters were compared to those analyzed after CPB withdrawal and systemic protamine administration (Post). RESULTS: The citrated kaolin maximal amplitude (CK-MA) and the citrated functional fibrinogen maximal amplitude (CFF-MA) exhibited strong correlations between Pre and Post measurements (r = 0.790 and 0.974, respectively, P < 0.001 for both), despite significant mean differences (-2.23 mm for CK-MA and -0.68 mm for CFF-MA). Bland-Altman analysis showed a clinically acceptable agreement between Pre and Post measurement of CK-MA and CFF-MA (the percentage error was 10.6% and 12.2%, respectively). In contrast, the citrated kaolin reaction time (CK-R) showed no significant correlation between Pre and Post measurements (r = 0.328, P = 0.146), with a mean difference of 1.42 min (95% CI: -0.45 to 3.29). CONCLUSIONS: In vitro protamine addition allows assessment of coagulation status during CPB using the TEG 6s system. CK-MA and CFF-MA measured during CPB using this method revealed a strong correlation and agreement with post-CPB measurements, suggesting that our method potentially facilitates early prediction of post-CPB coagulation status and decision-making on transfusion strategies. CLINICAL TRIAL REGISTRATION: The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, registration number: UMIN000041097, date of registration: July 13, 2020, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046925 ) before the recruitment of participants.
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Dialogues in health 4 100172-100172 2024年6月BACKGROUND: Masks are well accepted in Japan, where they were already part of daily life even before the COVID-19 pandemic. Unlike many other countries where mask mandates were lifted as soon as the pandemic was under control, Japan was one of the last countries to ease mask-wearing guidelines. Even after the formal announcement to allow masks-off in mid-March 2023, many Japanese still voluntarily wear masks. In this work, possible reasons for this extreme "mask-affinity" of Japanese people were studied by exploring various information sources including tweets (now known as X posts) and subsequent text-analysis, online news, and medical literature. METHODS: An observational study was conducted based on tweets prospectively collected during 5 months from June 26th, 2022 to November 26th, 2022. Tweets with the hashtag "mask (in Japanese)" were collected weekly via the Twitter application programming interface by using R version 4.0.3 to gauge public opinions. The word clouds to allow intuitive understanding of the key words were drawn from the tokenized text. RESULTS: The data collection period included the 7th flareups of the newly infected cases i.e. "the 7th surge". In total, 161,592 tweets were collected. Word clouds for 1) before the 7th surge based on 18,000 tweets on June 26th and 2) during/after the 7th surge based on 143,592 tweets between July-November were created with the R package "wordcloud2". The results indicated that the people wanted to take off masks due to the heat in summer, then shifted again toward mask-wearing along with the 7th surge but with a certainly growing "no-mask" sentiment. CONCLUSIONS: Subsequent review of domestic information sources suggested that various factors, not only well-known peer pressure, may have contributed the public's mask affinity in Japan. This work revealed an aspect of Japanese struggle toward adaptation to life in an unexpected pandemic by focusing on masks as our closest daily adjunct over the past 3 years of isolation.Trial registration: not applicable.
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Cureus 16(6) e62370 2024年6月Andexanet alfa neutralizes factor Xa inhibitors in critical bleeding situations. However, in cardiac surgery with cardiopulmonary bypass (CPB), heparin resistance induced by andexanet alfa should be a concern, and the lack of point-of-care monitoring of plasma concentration of factor Xa inhibitors makes it difficult to decide when to administer andexanet alfa. A 69-year-old man underwent emergency surgery for acute pulmonary thromboembolism. The patient had been on edoxaban until the day before the surgery. Withdrawal from CPB required venoarterial extracorporeal membrane oxygenation due to right heart failure, followed by severe bleeding that required massive transfusion. Despite adequate coagulation factor replacement, bleeding persisted and citrated kaolin-reaction time (CK-R) on thromboelastography (TEG) was prolonged. Administering andexanet alfa achieved excellent hemostasis without any thrombosis and normalized the prolonged CK-R of TEG. This is the first report of a change in TEG findings before and after administration of andexanet alfa in a cardiac surgery patient taking factor Xa inhibitor. Monitoring CK-R in TEG may help evaluate the anticoagulant effect of factor Xa inhibitors and the reversal effect of andexanet alfa.
MISC
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人工呼吸 39(2) 81-121 2022年11月日本集中治療医学会/日本呼吸器学会/日本呼吸療法医学会ARDS診療ガイドライン作成委員会は、今回、合同で『ARDS診療ガイドライン2021』を作成した。2016年版の診療ガイドラインでは、成人のみを対象とした臨床課題(clinical question:CQ)を取り上げたが、今回は成人の46のCQに加えて小児を対象とした15のCQも作成した。前回と同様、GRADE(Grading of Recommendations Assessment,Development and Evaluation)システムを用いた推奨度決定の手法を用いた。また、新たな手法として診断精度のメタ解析およびネットワークメタ解析を用いたシステマティックレビュー(systematic review:SR)も行った。これらにより、より充実した信頼性の高い実用的な診療ガイドラインを作成することができた。(著者抄録)
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日本集中治療医学会雑誌 29(4) 295-332 2022年7月日本集中治療医学会/日本呼吸器学会/日本呼吸療法医学会ARDS診療ガイドライン作成委員会は,今回,合同で『ARDS診療ガイドライン2021』を作成した。2016年版の診療ガイドラインでは,成人のみを対象とした臨床課題(clinical question:CQ)を取り上げたが,今回は成人の46のCQに加えて小児を対象とした15のCQも作成した。前回と同様,GRADE(Grading of Recommendations Assessment,Development and Evaluation)システムを用いた推奨度決定の手法を用いた。また,新たな手法として診断精度のメタ解析およびネットワークメタ解析を用いたシステマティックレビュー(systematic review:SR)も行った。これらにより,より充実した信頼性の高い実用的な診療ガイドラインを作成することができた。(著者抄録)
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レジデントノート 14(9) 1697-1704 2012年9月
講演・口頭発表等
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日本集中治療医学会雑誌 2017年11月 (一社)日本集中治療医学会2013年7月〜2014年2月にスケールベッドで体重測定を行う施設A 29名と懸架で体重測定を行う施設B 30名の2施設のICU医師・看護師59名(男性25名、女性34名)を対象に、体重測定値の測定誤差および立位とスケールベッド、立位と懸架の相関について検討した。スケールベッド、懸架ともに立位に対し相関係数0.99以上で高い相関がみられた。スケールベッド、懸架ともにライン類装着により測定誤差が1.0〜1.2kg上昇したが、ライン類保持により、ラインを装着せず測定したレベルまで低下した。スケールベッドの測定誤差は全ての測定状況において、懸架の測定誤差より小さい傾向がみられた。
共同研究・競争的資金等の研究課題
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日本学術振興会 科学研究費助成事業 若手研究 2020年4月 - 2023年3月