Language：English   Publishing type：Research paper (scientific journal)  

帝王切開術後の母体に対して，母乳中へのデクスメデトミジンの移行を液性クロマトグラフィーにて測定した研究

DOI： 10.1016/j.jchromb.2016.11.015

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Language：Japanese   Publishing type：Research paper (scientific journal)  

橈骨動脈穿刺に対して超音波ガイド下の有用性を検討した研究

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: We previously determined the pharmacokinetic (PK) parameters of landiolol in healthy male volunteers. In this study, we evaluated the usefulness of target-controlled infusion (TCI) of landiolol hydrochloride and determined PK parameters of landiolol in gynecologic patients. Methods: Nine patients who were scheduled to undergo gynecologic surgery were enrolled. After inducing anesthesia, landiolol hydrochloride was administered at the target plasma concentrations of 500 and 1,000 ng/mL for each 30 min. A total of 126 data points of plasma concentration were collected from the patients and used for the population PK analysis. Furthermore, a population PK model was developed using the nonlinear mixed-effect modeling software. Results: The patients had markedly decreased heart rates (HRs) at 2 min after the initiation of landiolol hydrochloride administration; however, their blood pressures did not markedly change from the baseline value. The concentration time course of landiolol was best described by a 2-compartment model with lag time. The estimate of PK parameters were total body clearance (CL) 34.0 mL/min/kg, distribution volume of the central compartment (V<inf>1</inf>) 74.9 mL/kg, inter-compartmental clearance (Q) 70.9 mL/min/kg, distribution volume of the peripheral compartment (V<inf>2</inf>) 38.9 mL/kg, and lag time (ALAG) 0.634 min. The predictive performance of this model was better than that of the previous model. Conclusion: TCI of landiolol hydrochloride is useful for controlling HR, and the PK parameters of landiolol in gynecologic patients were similar to those in healthy male volunteers and best described by a 2-compartment model with lag time. © 2014, Japanese Society of Anesthesiologists.

DOI： 10.1007/s00540-014-1908-5

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Olprinone decreases the cardiac preload and/or afterload because of its vasodilatory effect and increases myocardial contractility by inhibiting phosphodiesterase III. Purpose: The objective of this study was to characterize the population pharmacokinetics of olprinone after a single continuous infusion in healthy male volunteers. Methods: We used 500 plasma concentration data points collected from nine healthy male volunteers for the study. The population pharmacokinetic analysis was performed using the nonlinear mixed effect model (NONMEM®) software. Results: The time course of plasma concentration of olprinone was best described using a two-compartment model. The final pharmacokinetic parameters were total clearance (7.37 mL/minute/kg), distribution volume of the central compartment (134 mL/kg), intercompartmental clearance (7.75 mL/minute/kg), and distribution volume of the peripheral compartment (275 mL/kg). The interindividual variability in the total clearance was 12.4%, and the residual error variability (exponential and additive) were 22.2% and 0.129 (standard deviation). The final pharmacokinetic model was assessed using a bootstrap method and visual predictive check. Conclusion: We developed a population pharmacokinetic model of olprinone in healthy male adults. The bootstrap method and visual predictive check showed that this model was appropriate. Our results might be used to develop the population pharmacokinetic model in patients. © 2014 Kunisawa et al.

DOI： 10.2147/CPAA.S50626

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Language：English   Publishing type：Research paper (scientific journal)  

We report three cases with systolic anterior motion (SAM) after mitral valve plasty. Preoperative mitral valve morphology is a risk factor for SAM. The morphological characteristics of SAM have been revealed in several studies. We found a small distance between coaptation and the interventricular septum in all cases, and cases 2, and 3 had a low AL/PL ratio, whereas case 3 had a large PML, which was revealed by transesophageal echocardiography. With the use of 3D transesophageal echocardiography, when mitral valve prolapse was investigated, in all three cases, it was easy to specify lesions. The issue for the future is 3D analysis when SAM is occurring. © 2013 The Author(s).

DOI： 10.1007/s00540-013-1731-4

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: The general dexmedetomidine (DEX) concentration required for sedation of intensive care unit patients is considered to be approximately 0.7 ng/mL. However, higher DEX concentrations are considered to be required for sedation and/or pain management after major surgery using remifentanil. We determined the DEX concentration required after major surgery by using a target-controlled infusion (TCI) system for DEX. Methods: Fourteen patients undergoing surgery for abdominal aortic aneurysms (AAA) were randomly, double-blindly assigned to two groups and underwent fentanyl- or remifentanil-based anesthetic management. DEX TCI was started at the time of closing the peritoneum and continued for 12 hours after stopping propofol administration (M0); DEX TCI was adjusted according to the sedation score and complaints of pain. The doses and concentrations of all anesthetics and postoperative conditions were investigated. Results: Throughout the observation period, the predicted plasma concentration of DEX in the fentanyl group was stable at approximately 0.7 ng/mL. In contrast, the predicted plasma concentration of DEX in the remifentanil group rapidly increased and stabilized at approximately 2 ng/mL. The actual DEX concentration at 540 minutes after M0 showed a similar trend (0.54±0.14 [fentanyl] versus 1.57±0.39 ng/mL [remifentanil]). In the remifentanil group, the dopamine dose required and the duration of intubation decreased, and urine output increased; however, no other outcomes improved. Conclusion: The DEX concentration required after AAA surgery with remifentanil was three-fold higher than that required after AAA surgery with fentanyl or the conventional DEX concentration for sedation. High DEX concentration after remifentanil affords some benefits in anesthetic management. © 2014 Kunisawa et al.

DOI： 10.2147/TCRM.S67211

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Language：Japanese   Publishing type：Research paper (scientific journal)  

76歳男。肝・腸管虚血を伴うIIIb型急性大動脈解離に対して開腹による腹部大動脈開窓術を施行した。本術式は根治術に比べて侵襲が少なく、短時間で血行再建が行えるという利点がある一方で、「虚血改善の不確実性」という欠点があるため、術中に分枝動脈での虚血改善を評価することが重要となる。本例では経食道心エコー(TEE)法で術中評価を行い有用であった。さらに術後もTEEを施行し、血流改善を確認することができた。

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Language：Japanese   Publishing type：Research paper (scientific journal)  

コリン性蕁麻疹患者に対し、麻酔薬の薬物動態と薬物相互作用モニタリングを可能とするSmartPilot View(SPV)を用いて、全身麻酔管理を行った。コリン性蕁麻疹患者の全身麻酔管理では、過度な侵襲を避ける必要があるため、SPVを指標として鎮静薬と麻薬性鎮痛薬の投与量調節を行った。全身麻酔中に蕁麻疹が発生することはなく、良好に麻酔管理を施行することが可能であった。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

プレガバリンが奏功した硬膜穿刺後頭痛の症例を経験したので報告する.症例は57歳の女性で大腸癌に対して大腸切除術が予定された.硬膜外麻酔を施行した際,髄液の流出を認めたため,1椎間頭側から硬膜外麻酔を施行し直し,全身麻酔を導入した.術後,頭高位で悪化する頭痛,嘔吐が出現し硬膜穿刺後頭痛と診断した.フォンダパリヌクスを使用しており,硬膜外自己血パッチは施行できなかった.術後3日目よりプレガバリンの内服を開始して頭痛は改善した.術後8日目にプレガバリンを中断して頭痛が再発したため,内服を再開して鎮痛を得た.硬膜外自己血パッチが禁忌であってもプレガバリンは使用可能であり,保存的治療として推奨できる.(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

経胸壁肺超音波検査による気胸の診断は、簡便で有効な手法とされている。人工的気胸状態となる開胸患者を対象として、経胸壁肺超音波検査を施行し、正常肺と気胸肺の判別に有効とされる6所見を比較検討した。2所見(lung sliding、Mモード)は感度・特異度ともに高く、気胸判別に有効であった。1所見(多重反射)は特異度が高いが感度は低く、有効な所見ではなかった。気胸判別におけるMモードでの観察は、手技が簡単でまた判定効果が高く、気胸の有無を確かめるスクリーニング検査として有効な手法であり、中心静脈穿刺や体幹神経ブロックなどの麻酔関連医療手技に伴う気胸の検出に有用と考えられる。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

Dexmedetomidine (DEX) for sedation in diagnostic and interventional cardiac catheterization (DICC) has been reported to require other drugs or rescue drugs because of its insufficient sedative effect when used alone. We administered DEX and adjusted its dose according to the bispectral index (BIS) monitor™ for DICC in a toddler; consequently, a high dose of DEX had to be administered. The patient was a 1-year and 4-month-old boy who was scheduled to undergo DICC after intracardiac repair. We used DEX alone as the sedative because this was expected to avoid oxygen SUPPL.y and mechanical ventilation and to produce a safe situation for procedures around the neck. DEX was administered at the dose of 1-15 μg/kg/h according to BIS monitor™ ; administration of cardiovascular drugs or oxygen SUPPL.y or assist ventilation, except chin lift, were not needed. The maximum predicted plasma concentration (pCp) of DEX and mean pCp were calculated as 6.1 and 4.1 ng/mL, respectively. A high dose of DEX may be required for DICC sedation, as for MRI sedation, in many cases. Although further studies should be conducted to reveal the merits and demerits of DEX in cardiac catheterization, a high dose of DEX may be useful in some cases. © 2011 Japanese Society of Anesthesiologists.

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Language：English   Publishing type：Research paper (scientific journal)  

We report the clinical management of 2 adults with mental retardation because of trisomy 21 who were sedated with high-dose dexmedetomidine (DEX) alone during diagnostic cardiac catheterization (DCC). The first patient was a 25-year-old man with aortic regurgitation and ventricular septal defect. DEX increased his Ramsay sedation score; however, a high dose and bolus injection of DEX were required to perform an invasive procedure. Cardiovascular drugs were not administered and heart rate was maintained in the low 40s. The maximum predicted plasma concentration (pCp) of DEX was 2.3 ng/mL. The second patient was a 26-year-old woman who had developed hypoxia 20 years after palliative surgery for tetralogy of Fallot. High-dose DEX was administered to keep the bispectral index value below 70 and maintain an immobile state; her maximum pCp of DEX was 4.3 ng/mL. Percutaneous oxygen saturation was kept above 83%, because of the suspicion that DEX may increase the ratio of pulmonary artery flow to systemic artery flow. In both cases, no respiratory system complications occurred despite inspiration of room air, indicating the usefulness of DEX for DCC. However, because of DEX may affect DCC data, it is necessary to pay careful attention to the use of DEX during DCC. © 2011 Japanese Society of Anesthesiologists.

DOI： 10.1007/s00540-011-1174-8

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DOI： 10.1007/s00540-010-1003-5

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DOI： 10.1007/s00540-010-1024-0

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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We safely administered dexmedetomidine (DEX) for sedation during spinal anesthesia in a very elderly patient. The patient was a 98-year-old woman who had hypertension, renal failure, and first-grade atrioventricular block. She was scheduled to undergo internal fixation for fracture of the femoral neck. Initially, DEX (6.0 μg/kg/h) was administered over 10 min, followed by continuous infusion at a dose of 0.7 μg/kg/h. Consequently, her Ramsay sedation score (RSS) increased to 5, and the patient did not grimace in pain while being turned to the lateral position. Epidural catheterization and spinal anesthesia were performed under sedation without any problem. The DEX dose was adjusted to maintain the RSS within 3-4. The surgical operation was performed smoothly without any problem. Since the hemodynamic condition was stable, administration of ephedrine (5 mg) was required only once during surgery. Percutaneous oxygen saturation was maintained at 98% or more; respiratory rate was within 15-21 tpm, and no ventilatory assistance was required. The maximum predicted plasma concentration (pCp) of DEX was 1.56 ng/mL, and the mean pCp of DEX during surgery was approximately 0.45 ng/mL. We found that DEX can be safely used for sedation during spinal anesthesia in a very elderly patient. © 2010 Japanese Society of Anesthesiologists.

DOI： 10.1007/s00540-010-1025-z

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：日本手術医学会  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：真興交易(株)医書出版部  

抗凝固療法の継続が困難な心房細動(Af)患者に対し、抗凝固療法の代替として脳梗塞のリスクを減らす目的で開発された治療法がWatchmanを用いた経皮的左心耳閉鎖術(LAAC)である。本稿では、Watchmanデバイスを用いたLAACの現状とその麻酔管理の実際について紹介した。脳梗塞予防の観点から抗凝固療法の適応があるにもかかわらず、抗凝固薬内服の長期継続が困難なAf患者が多数存在している現状がある。そのため、今後増加が見込まれるAf患者に対し、生涯にわたり抗凝固薬を必要とせずに脳梗塞を予防することが可能となるLAACの臨床意義は大きい。麻酔法の選択には経食道心エコーの使用の有無が大きく関わる。

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Event date： 2006.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：札幌  

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Event date： 2006.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：旭川  

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Event date： 2023.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：神戸  

麻酔科管理手術前の休薬未実施率は経時的に減少し、SGLT2阻害薬とメトホルミンの術前休薬運用
に関する院内周知は進んでいる。周術期の患者安全向上のためには、引き続き各診療科・部門が協働して取り組んでいく必要がある

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Event date： 2023.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福井市（ザ・グランユアーズフクイ・福井県繊協ビル）  

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Event date： 2023.9

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2023.9

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2023.6

Language：Japanese   Presentation type：Oral presentation (general)  

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