YAMAKAGE Michiaki

写真a

Affiliation

School of Medicine, Department of Anesthesiology

Job title

Professor
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Education 【 display / non-display 】

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    1993

    Sapporo Medical University Postgraduate School of Medicine  

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    1988

    Sapporo Medical University School of Medicine  

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Degree 【 display / non-display 】

  • Ph.D. (Medical)

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Professional Memberships 【 display / non-display 】

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    Japanese Society of Dental Anesthesia

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    日本手術医学会

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    日本循環制御医学会

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    Japan Medical Association

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    International Anesthesia and Research Society

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Research Areas 【 display / non-display 】

  • Life sciences   Anesthesiology  

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Affiliation 【 display / non-display 】

  • Sapporo Medical University   医学部 医学科学科目（臨床医学部門）   教授  

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Research Interests 【 display / non-display 】

  • 呼吸 吸入麻酔薬 血液凝固線溶 体温管理 統計 医学教育

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Papers 【 display / non-display 】

  • Comparison of the negative effect of remimazolam and propofol on cardiac contractility: Analysis of a randomised parallel-group trial and a preclinical ex vivo study.

    Yusuke Yoshikawa, Shunsuke Oura, Masatoshi Kanda, Tomohiro Chaki, Naoyuki Hirata, Mitsutaka Edanaga, Michiaki Yamakage

    Clinical and experimental pharmacology & physiology   51 ( 3 ) e13840  2024.03  [International journal]

    　View Summary

    Remimazolam is a newly developed ultra-short-acting benzodiazepine that exerts sedative effects. This study aimed to clarify the effects of remimazolam on cardiac contractility. In a randomised-parallel group trial, haemodynamic parameters were compared between propofol (n = 11) and remimazolam (n = 12) groups during the induction of general anaesthesia in patients undergoing non-cardiac surgery. In a preclinical study, the direct effects of remimazolam on cardiac contractility were also evaluated using isolated rat hearts. RNA sequence data obtained from rat and human hearts were analysed to assess the expression patterns of the cardiac γ-aminobutyric acid type A (GABAA ) receptor subunits. In a clinical study, the proportional change of the maximum rate of arterial pressure rise was milder during the study period in the remimazolam group (propofol: -52.6 [10.2] (mean [standard deviation])% vs. remimazolam: -39.7% [10.5%], p = 0.007). In a preclinical study, remimazolam did not exert a negative effect on left ventricle developed pressure, whereas propofol did exert a negative effect after bolus administration of a high dose (propofol: -26.9% [3.5%] vs. remimazolam: -1.1 [6.9%], p < 0.001). Analysis of the RNA sequence revealed a lack of γ subunits, which are part of the major benzodiazepine binding site of the GABAA receptor, in rat and human hearts. These results indicate that remimazolam does not have a direct negative effect on cardiac contractility, which might contribute to its milder effect on cardiac contractility during the induction of general anaesthesia. The expression patterns of cardiac GABAA receptor subunits might be associated with the unique pharmacokinetics of benzodiazepines in the heart.

    DOI PubMed

  • Venoarterial extracorporeal membrane oxygenation for cardiopulmonary resuscitation: A retrospective study comparing the outcomes of fluoroscopy.

    Soichi Tanaka, Shunsuke Tachibana, Takashi Toyohara, Hajime Sonoda, Michiaki Yamakage

    Heliyon   10 ( 2 ) e24565  2024.01  [International journal]

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    BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) using venoarterial extracorporeal membrane oxygenation is performed for out-of-hospital cardiac arrest; however, it is associated with a risk of several complications. OBJECTIVE: To investigate whether the fluoroscopy equipment was removed from the emergency department (ED) and whether it would be beneficial to transport the patient to the fluoroscopy room to reduce vascular complications without affecting the induction time. METHODS: This single-center, retrospective, before-and-after analysis was conducted at a tertiary emergency medical center and included 59 patients who underwent ECPR for out-of-hospital cardiac arrest between May 2017 and March 2022. The patients were divided into two groups: those who underwent cannulation in the ED without fluoroscopy (ED-ECPR group) and those who were transferred directly from the ED to the cardiac angiography room (ECPR call group). RESULTS: The rate of vascular complications associated with ECPR was significantly lower in the ECPR group than in the ED-ECPR group (40.6 % [14/32] vs. 10 % [2/20], respectively; p = 0.014). The duration from ED arrival to venoarterial extracorporeal membrane oxygenation initiation was similar in the two groups (median: 23.0 min in the ED-ECPR group vs. 25.5 min in the ECPR call group, p = 0.71). Results adjusted for confounding factors showed that performing ECPR under fluoroscopy was a consistent and independent element of vascular complication rates (adjusted odds ratio: 9.92, 95 % confidence interval: 2.04 to 81.2, p = 0.011). CONCLUSIONS: Fluoroscopy-guided ECPR can significantly reduce the incidence of vascular complications even if the ED and fluoroscopy room are far apart. However, no significant difference was observed in the time required to establish ECPR in the cardiac catheterization laboratories.

    DOI PubMed

  • Comparing leak pressure of LMA® ProSeal™ versus i-gel® at head rotation: a randomized controlled trial.

    Tomohiro Chaki, Masatsugu Koizumi, Shunsuke Tachibana, Tomomi Matsumoto, Tomoe Kumagai, Yuki Hashimoto, Michiaki Yamakage

    Canadian journal of anaesthesia = Journal canadien d'anesthesie    2023.11  [International journal]

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    PURPOSE: The effect of head rotation on supraglottic airway (SGA) oropharyngeal leak pressure (OPLP) has not been well elucidated. The aim of this study was to help clarify which SGA device provides higher OPLP at head-rotated position. METHODS: Patients who underwent elective surgery under general anesthesia were enrolled and randomly divided into laryngeal mask airway (LMA®) ProSeal™ and i-gel® groups. The allocated SGA device was inserted under anesthesia. The primary outcome was OPLP, and secondary outcomes were ventilation score, expiratory tidal volume, and maximum pressure under volume-controlled ventilation (VCV) with an inspiratory tidal volume of 10 mL·kg-1 ideal body weight and fibreoptic view of the vocal cords at 0°, 30°, and 60° head rotation. RESULTS: Data from 78 and 76 patients were analyzed in the LMA ProSeal and i-gel groups, respectively. The mean (standard deviation) OPLP of the LMA ProSeal was significantly higher than that of the i-gel at the 60° head-rotated position (LMA ProSeal, 20.4 [6.5] vs i-gel, 16.9 [7.8] cm H2O; difference in means, 3.6; adjusted 95% confidence interval, 0.5 to 6.6; adjusted P = 0.02, adjusted for six comparisons). The maximum pressure under VCV at 60° head rotation was significantly higher in the LMA ProSeal group than in the i-gel group. The expiratory tidal volume of the LMA ProSeal did not significantly change with head rotation and was significantly higher than that of the i-gel at 60° head rotation. Ventilation score, fibreoptic view of the vocal cords, and complications were not significantly different between the ProSeal and i-gel groups. CONCLUSIONS: The LMA ProSeal provides higher OPLP than the i-gel at a 60° head-rotated position under general anesthesia. TRIAL REGISTRATION: Japan Registry of Clinical Trials (https://jrct.niph.go.jp) (JRCT1012210043); registered 18 October 2021.

    DOI PubMed

  • I-gel Plus acts as a superior conduit for fiberoptic intubation than standard i-gel

    Tomohiro Chaki, Shunsuke Tachibana, Sho Kumita, Satoshi Sato, Tomoki Hirahata, Yuta Ikeshima, Yuki Ohsaki, Michiaki Yamakage

    Scientific Reports ( Springer Science and Business Media LLC )  13 ( 1 )  2023.10

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    Abstract The supraglottic airway (SGA) is widely used. I-gel Plus is a next-generation i-gel with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel Plus and standard i-gel as conduits for FOI, a Thiel-embalmed cadaveric study was conducted. Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel Plus and standard i-gel were inserted into one cadaver, and the FOI was performed through each SGA. The primary outcome was time required for FOI. The secondary outcomes were the number of attempts and visual analog scale (VAS) score for difficulty in FOI. Moreover, fiberoptic views of the vocal cords in each SGA were assessed by an attending anesthesiologist using nine cadavers in Experiment 2. The percentage of glottic opening (POGO) score without fiberscope tip upward flexion and upward angle of the fiberscope tip to obtain a 100% POGO score were evaluated as secondary outcomes. The time for FOI through i-gel Plus was significantly shorter than that through standard i-gel (median (IQR), i-gel Plus: 30.3 (25.4–39.0) s, vs standard i-gel: 54.7 (29.6–135.0) s; median of differences, 24.4 s; adjusted 95% confidence interval, 3.0–105.7; adjusted P = 0.040). Although the number of attempts for successful FOI was not significantly different, the VAS score for difficulty in the i-gel Plus group was significantly lower (easier) than that in the standard i-gel group. Moreover, i-gel Plus required a significantly smaller upward angle of the fiberscope tip to obtain a 100% POGO score. FOI can be performed more easily using i-gel Plus than using standard i-gel because of the improved fiberoptic visibility of vocal cords.

    DOI

  • Dexmedetomidine as a cardioprotective drug: a narrative review.

    Kanako Takahashi, Yusuke Yoshikawa, Masatoshi Kanda, Naoyuki Hirata, Michiaki Yamakage

    Journal of anesthesia    2023.09  [Domestic journal]

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    Dexmedetomidine (DEX), a highly selective alpha2-adrenoceptors agonist, is not only a sedative drug used during mechanical ventilation in the intensive care unit but also a cardio-protective drug against ischemia-reperfusion injury (IRI). Numerous preclinical in vivo and ex vivo studies, mostly evaluating the effect of DEX pretreatment in healthy rodents, have shown the efficacy of DEX in protecting the hearts from IRI. However, whether DEX can maintain its cardio-protective effect in hearts with comorbidities such as diabetes has not been fully elucidated. Multiple clinical trials have reported promising results, showing that pretreatment with DEX can attenuate cardiac damage in patients undergoing cardiac surgery. However, evidence of the post-treatment effects of DEX in clinical practice remains limited. In this narrative review, we summarize the previously reported evidence of DEX-induced cardio-protection against IRI and clarify the condition of the hearts and the timing of DEX administration that has not been tested. With further investigations evaluating these knowledge gaps, the use of DEX as a cardio-protective drug could be further facilitated in the management of patients undergoing cardiac surgery and might be considered in a broader area of clinical settings beyond cardiac surgery, including patients with acute myocardial infarction.

    DOI PubMed

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Misc 【 display / non-display 】

  • 遠隔虚血プレコンディショニングは非アシル化グレリンの分泌によってJAK2/STAT3経路が活性化し心臓虚血再灌流傷害を減弱させる

    澤下泰明, 平田直之, 吉川裕介, 寺田拡文, 山蔭道明

    日本麻酔科学会学術集会(Web)   67th  2020

    J-GLOBAL

  • Anesthetic Management with Percutaneous Cardiopulmonary Support for Emergency Tracheotomy in a Patient with a Thyroid Tumor who Had Severe Tracheal Stenosis from Thyroid Tumor

    横山竜也, 新山幸俊, 吉川裕介, 高田幸昌, 山蔭道明

    麻酔   67 ( 11 )  2018

    J-GLOBAL

  • Sonoclotで無輸血手術が可能となった血小板増加症を合併した大動脈弁輪拡張症の1症例

    畠山陽介, 枝長充隆, 吉川裕介, 松本友美, 寺田拡文, 木井菜摘, 山蔭道明

    Cardiovascular Anesthesia   22 ( Suppl )  2018

    J-GLOBAL

  • 妊娠高血圧症を合併した多発性硬化症の妊婦に硬膜外麻酔のみで帝王切開を施行した1症例

    佐藤優真, 君塚基修, 吉川裕介, 枝長充隆, 山蔭道明

    日本臨床麻酔学会誌   38 ( 6 )  2018

    J-GLOBAL

  • In reply: Desflurane anesthesia and cognitive function

    Shunsuke Tachibana, Tomo Hayase, Michiaki Yamakage

    JOURNAL OF ANESTHESIA ( SPRINGER JAPAN KK )  31 ( 4 ) 637 - 637  2017.08

    Rapid communication, short report, research note, etc. (scientific journal)  

    DOI

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Awards 【 display / non-display 】

  • Takahashi Prize of Hokkaido Society of Anesthesiologiists

    2003  

  • 北海道麻酔科学会 第16回高橋賞

    2003  

  • Yamamura Memorial Prize, Japan Society of Anesthesiologists

    2002  

  • 日本麻酔科学会 第21回山村記念賞

    2002  

  • The Uehara Memorial Foundation, Incentive Grant

    2000  

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Research Projects 【 display / non-display 】

  • 低親和性神経成長因子受容体選択的リガンド：LM11A-31による術後認知機能障害予防戦略

    基盤研究(C)

    Project Year :

    2023.04
    -
    2026.03
     

    山蔭 道明, 平畑 知輝, 茶木 友浩, 佐藤 慧

  • 人工呼吸器関連肺障害における肺血管内皮グリコカリックスの動態と新たな治療法の探索

    基盤研究(C)

    Project Year :

    2022.04
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    2025.03
     

    菊池 謙一郎, 数馬 聡, 山蔭 道明

  • Prevention strategies for perioperative neuroinflammation related diseases with a focus on stabilization of intestinal microbiota

    Grant-in-Aid for Scientific Research (C)

    Project Year :

    2019.04
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    2022.03
     

    Yamakage Michiaki

    　View Summary

    In a metagenomic analysis of cecal contents collected under anesthesia after surgical intervention, we were unable to explore significant changes between the groups. It was suggested that the timeline of intervention and other factors need to be re-examined. While the composition of the cecal contents was not acutely altered, we did find changes in delirium behavior in the surgical group, with no significant differences between groups. Additional experiments are planned.
    Translated with www.DeepL.com/Translator (free version)

  • Analysis of a relationship between postoperative delirium or/and cognitive dysfunction and aging by transcriptome analysis

    Grant-in-Aid for Scientific Research (C)

    Project Year :

    2016.04
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    2019.03
     

    Yamakage Michiaki, TACHIBANA SHUNSUKE

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    Transcriptome analysis revealed that age differences resulted in significant changes in gene expression in the hippocampus after anesthesia and surgery. In other words, it was suggested that metabolisms and reactivities in the brain cause differences in responses due to aging. In addition, the sensitivity of anesthetics due to aging and the immune response to surgical insult are different, and the possibility of clarifying the mechanism of influences and differences in brain function was shown.

  • Living with chronic non-cancer pain receiving opioid therapy

    Grant-in-Aid for Scientific Research (C)

    Project Year :

    2015.04
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    2019.03
     

    SHINDO Yukari, Yamakage Michiaki, Watanabe Akihiko

    　View Summary

    Narratives of daily life of outpatients in Japan receiving opioid therapy for chronic non-cancer pain were obtained to identify health problems and barriers to obtaining a high quality of life. Participants were 34 adult volunteer outpatients treated in pain clinics. Data were collected using semi-structured interviews and analyzed through grounded theory. Participants described daily life experiences of chronic pain and opioid therapy. Informed consent and ethical approval were obtained. Six categories were extracted: “Facing injustice or extreme chronic pain and catastrophizing,” “Attempting treatments to improve the condition,” “Ambivalent about receiving medical treatment,” “Barriers to living with chronic pain,” “Finding a compromise while living with chronic pain,” and “Regaining a life.” These findings expand our understanding of Japanese patients received opioid treatment with chronic non-cancer pain and their coping in daily life.

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