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• 　

  -

  1993年

  札幌医科大学 大学院  

• 　

  -

  1988年

  札幌医科大学  

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• 博士（医学）

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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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• ライフサイエンス   麻酔科学  

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• 札幌医科大学   医学部 医学科学科目（臨床医学部門）   教授  

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• 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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• 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年03月  [国際誌]

  　概要を見る

  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年01月  [国際誌]

  　概要を見る

  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年11月  [国際誌]

  　概要を見る

  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年10月

  　概要を見る

  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

• A case of safe airway management by fiber-optic nasotracheal intubation in general anesthesia in a pediatric patient with Hajdu-Cheney syndrome: a case report.

  Atsushi Kokita, Tomohiro Chaki, Michiaki Yamakage

  JA clinical reports   9 ( 1 ) 33 - 33  2023年06月  [国際誌]

  　概要を見る

  BACKGROUND: Hajdu-Cheney syndrome (HCS) is an extremely rare disorder characterized by progressive acro-osteolysis. A unique facial structure and deformity of the cervical spine are associated with a difficult airway. Although several reports describe general anesthesia with orotracheal intubation for patients with HCS, there have been no reports of nasotracheal intubation with a risk of skull base fracture. We describe nasotracheal intubation for oral surgery in a patient with HCS. CASE PRESENTATION: A 13-year-old girl with HCS was scheduled for dental surgery. Preoperative computed tomography revealed no abnormalities including fractures in the skull base or cervical spine. After confirming a lack of vocal cord paralysis by bronchofiberscopic inspection from the nose, general anesthesia was induced with sevoflurane, remifentanil, and rocuronium. Fiber-optic nasotracheal intubation was successfully performed without complications such as depletion of oxygen saturation and massive epistaxis, and the surgery was completed uneventfully. She was discharged the day after surgery with no anesthesia-related complications. CONCLUSIONS: We were able to safely manage the airway of a patient with HCS by nasotracheal intubation under general anesthesia.

  DOI PubMed

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• 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年

  J-GLOBAL

• 経皮的心肺補助下に緊急気管切開術を施行した甲状腺腫瘍の1症例

  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年

  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年

  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年

  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年08月

  速報，短報，研究ノート等（学術雑誌）  

  DOI

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受賞 【 表示 ／ 非表示 】

受賞 【 表示 ／ 非表示 】

• Takahashi Prize of Hokkaido Society of Anesthesiologiists

  2003年  

• 北海道麻酔科学会 第16回高橋賞

  2003年  

• Yamamura Memorial Prize, Japan Society of Anesthesiologists

  2002年  

• 日本麻酔科学会 第21回山村記念賞

  2002年  

• The Uehara Memorial Foundation, Incentive Grant

  2000年  

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共同研究・競争的資金等の研究課題 【 表示 ／ 非表示 】

共同研究・競争的資金等の研究課題 【 表示 ／ 非表示 】

• 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)

  研究期間:

  2023年04月

  -

  2026年03月

   

  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)

  研究期間:

  2022年04月

  -

  2025年03月

   

  菊池 謙一郎, 数馬 聡, 山蔭 道明

• 腸内細菌叢の安定化を主軸とした、周術期神経炎症関連疾患の予防戦略

  基盤研究(C)

  研究期間:

  2019年04月

  -

  2022年03月

   

  山蔭 道明, 立花 俊祐, 西原 教晃

  　研究概要を見る

  手術麻酔介入後に麻酔下で盲腸内容物を回収したメタゲノム解析においては、群間に有意な変化を探索することができなかった。介入のタイムラインなどを再検討する必要があることが示唆された。盲腸内容物の構成変化は、急性に変化するものでない一方で、手術モデル群におけるせん妄行動変化は確認できた。ELISA法における検討を加えたものの、群による大きな差はこちらも見られなかった。追加実験を行う予定である。

• トランスクリプトーム解析による術後せん妄・認知機能障害とエイジングの関連解析

  基盤研究(C)

  研究期間:

  2016年04月

  -

  2019年03月

   

  山蔭 道明, 早瀬 知, 立花 俊祐

  　研究概要を見る

  トランスクリプトーム解析の手法を用いて解析を行ったところ、週齢の違い（年齢の違い）によって、手術後の海馬における遺伝子発現が大きく変わっていたということを明らかにした。つまり脳内での代謝や反応性は、エイジングの影響によって、反応の違いを生じることが示唆された。 また、エイジングによる麻酔薬の感受性や、手術侵襲への免疫反応に違いがあり、脳機能への影響と差異の機序に関しても明らかにできる可能性が示された。

• 長期にオピオイド鎮痛薬治療を受けている難治性非がん性慢性疼痛患者の生活体験の軌跡

  基盤研究(C)

  研究期間:

  2015年04月

  -

  2019年03月

   

  進藤 ゆかり, 青柳 道子, 山蔭 道明, 渡邊 昭彦

  　研究概要を見る

  非がん性慢性痛に対するオピオイド療法を受けている患者の生きてきた生活体験を明らかにするため、非がん性慢性痛患者34人に対し、半構造化インタビューを用い質的に分析した。 結果、8カテゴリが抽出された。患者は「消耗させる痛みを抱えた生活に対する憔悴」や、「不条理な痛みによって抱えた心の闇」を抱えていた。「状況打開を目指した試み」を行いながら、「医療に対するジレンマ」を抱え、特に「オピオイド治療による両価性な気持ち」があり、「慢性痛と生きることへの社会の壁」を感じていた。一方で、「慢性的な痛みと暮らしながら妥協していく」や、「活きることへの再起」に向かっていた。

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