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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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• Gut Microbiota Influences Developmental Anesthetic Neurotoxicity in Neonatal Rats.

  Tomohiro Chaki, Yuri Horiguchi, Shunsuke Tachibana, Satoshi Sato, Tomoki Hirahata, Noriaki Nishihara, Natsumi Kii, Yusuke Yoshikawa, Kengo Hayamizu, Michiaki Yamakage

  Anesthesia and analgesia    2025年02月  [国際誌]

  　概要を見る

  BACKGROUND: Anesthetic exposure during childhood is significantly associated with impairment of neurodevelopmental outcomes; however, the causal relationship and detailed mechanism of developmental anesthetic neurotoxicity remain unclear. Gut microbiota produces various metabolites and influences the brain function and development of the host. This relationship is referred to as the gut-brain axis. Gut microbiota may influence developmental anesthetic neurotoxicity caused by sevoflurane exposure. This study investigated the effect of changes in the composition of gut microbiota after fecal microbiota transplantation on spatial learning disability caused by developmental anesthetic neurotoxicity in neonatal rats. METHODS: Neonatal rats were allocated into the Control (n = 10) and Sevo (n = 10) groups in Experiment 1 and the Sevo (n = 20) and Sevo+FMT (n = 20) groups in Experiment 2, according to the randomly allocated mothers' group. The rats in Sevo and Sevo+FMT groups were exposed to 2.1% sevoflurane for 2 hours on postnatal days 7 to 13. Neonatal rats in the Sevo+FMT group received fecal microbiota transplantation immediately after sevoflurane exposure on postnatal days 7 to 13. The samples for fecal microbiota transplantation were obtained from nonanesthetized healthy adult rats. Behavioral tests, including Open field, Y-maze, Morris water maze, and reversal Morris water maze tests, were performed to evaluate spatial learning ability on postnatal days 26 to 39. RESULTS: Experiment 1 revealed that sevoflurane exposure significantly altered the gut microbiota composition. The relative abundance of Roseburia (effect value: 1.01) and Bacteroides genus (effect value: 1.03) increased significantly after sevoflurane exposure, whereas that of Lactobacillus (effect value: -1.20) decreased significantly. Experiment 2 revealed that fecal microbiota transplantation improved latency to target (mean ± SEM; Sevo group: 9.7 ± 8.2 seconds vs, Sevo+FMT group: 2.7 ± 2.4 seconds, d=1.16, 95% confidence interval: -12.7 to -1.3 seconds, P = .019) and target zone crossing times (Sevo group: 2.4 ± 1.6 vs, Sevo+FMT group: 5.4 ± 1.4, d=1.99, 95% confidence interval: 2.0-5.0, P < .001) in the reversal Morris water maze test. Microbiota analysis revealed that the α-diversity of gut microbiota increased after fecal microbiota transplantation. Similarly, the relative abundance of the Firmicutes phylum (effect value: 1.44), Ruminococcus genus (effect value: 1.69), and butyrate-producing bacteria increased after fecal microbiota transplantation. Furthermore, fecal microbiota transplantation increased the fecal concentration of butyrate and induced histone acetylation and the mRNA expression of brain-derived neurotrophic factor in the hippocampus, thereby suppressing neuroinflammation and neuronal apoptosis. CONCLUSIONS: The alternation of gut microbiota after fecal microbiota transplantation influenced spatial learning ability in neonatal rats with developmental anesthetic neurotoxicity. Modulation of the gut microbiota may be an effective prophylaxis for developmental anesthetic neurotoxicity in children.

  DOI PubMed

• Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial.

  Tatsuya Kunigo, Yusuke Yoshikawa, Shunichi Niki, Masahiro Ohtani, Mami Muraki, Asako Nitta, Yuki Ohsaki, Kanna Nagaishi, Michiaki Yamakage

  Journal of clinical anesthesia   101   111740 - 111740  2025年01月  [国際誌]

  　概要を見る

  STUDY OBJECTIVE: We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees. DESIGN: A cadaveric observational study and a clinical randomized controlled trial. SETTING: Sapporo Medical University Hospital. PATIENTS: A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers. INTERVENTIONS: Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group). MEASUREMENTS: The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases. MAIN RESULTS: Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87-158] vs 46 s [34-54] s, p < 0.001 and 197 [156-328] vs 341 [303-488] s, p = 0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263-467] s vs 391 [354-533] s, p = 0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5 %], p = 0.019). CONCLUSIONS: Our novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.

  DOI PubMed

• Differences in circulating blood volume changes during emergence from general anesthesia in transcatheter aortic valve implantation and MitraClip implantation.

  Makishi Maeda, Yusuke Yoshikawa, Sho Ohno, Tomohiro Chaki, Michiaki Yamakage

  Journal of anesthesia   38 ( 4 ) 489 - 495  2024年08月  [国内誌]

  　概要を見る

  PURPOSE: We aimed to compare changes in the circulating blood volume (CBV) during emergence from general anesthesia in patients undergoing transcatheter aortic valve implantation (TAVI) and MitraClip implantation. METHOD: We included 97 patients who underwent TAVI or MitraClip implantation. The primary outcome was the rate of change in the estimated CBV associated with emergence from general anesthesia. The secondary outcomes were hemoglobin and hematocrit values before and after emergence from anesthesia for each procedure. Additionally, the independent factors associated with changes in the estimated CBV were assessed using multiple regression analysis. RESULTS: In the TAVI group, the hemoglobin concentration increased from 9.6 g/dL before emergence from anesthesia to 10.8 g/dL after emergence (P < 0.001; mean difference, 1.2 g/dL, 95% confidence interval [CI] 1.1-1.3 g/dL). Conversely, no statistically significant change was observed in the hemoglobin concentration before and after emergence from anesthesia in the MitraClip group. The mean rate of change in the estimated CBV was - 15.4% (standard deviation [SD] 6.4%) in the TAVI group and - 2.4% (SD, 4.7%) in the MitraClip group, indicating a significant decrease in the estimated CBV in the former than in the latter (P < 0.001; mean difference, 13.0%; 95% CI 9.9-16.1%). CONCLUSION: Emergence from general anesthesia increased the hemoglobin concentration and decreased the estimated CBV in patients undergoing TAVI but did not elicit significant changes in patients undergoing MitraClip implantation. These results may provide a rationale for minimizing blood transfusions during general anesthesia in patients undergoing these procedures.

  DOI PubMed

• INJEX50 could improve the success rate of local anesthesia for arterial cannulation in the pediatric intensive care unit: A randomized, double-blind, single-center study.

  Wataru Sakai, Tomohiro Chaki, Shunsuke Tachibana, Yuki Ichisaka, Yuko Nawa, Tomohiro Nawa, Michiaki Yamakage

  Paediatric anaesthesia    2024年05月  [国際誌]

  　概要を見る

  BACKGROUND: Quick arterial cannulation is required in pediatric emergency situation, which require effective local anesthesia to avoid withdrawal movement. However, pediatric local anesthesia could be difficult because of withdrawal movement. Jet injectors, which are needleless and provide local anesthesia quickly, could be helpful for pediatric local anesthesia during arterial cannulation. AIMS: This study aimed to examine whether new jet injector "INJEX50" could improve the success rate of local anesthesia for arterial cannulation in pediatric intensive care unit compared with the current standard of care, infiltration using a 26-gauge needle. METHODS: This study was a randomized, double-blind, single-center study. Participants were infants and young children in the pediatric intensive care unit, who required an arterial line. Local anesthesia was performed with either a 26-gauge needle (group C) or INJEX50 (group I) before arterial cannulation. The primary outcome (success of local anesthesia) was the presence of withdrawal movement at the time of skin puncture for arterial cannulation. The secondary outcomes included rescue sedation during arterial cannulation. Data were analyzed using Fisher's exact test and the Mann-Whitney U-test, with values of p < .05 considered statistically significant. RESULTS: Seventy patients were randomly assigned to groups C and I. The local anesthesia success rate in group I (30/35 [86%]) was significantly higher than that in group C (15/35 [43%], odds ratio, 8.00; 95% confidence interval, 2.51-25.5; p = .0005). In conclusion, INJEX50 could improve success rate of local anesthesia for arterial cannulation in pediatric intensive care unit compared with 26-gauge needle.

  DOI PubMed

• Effect of using hypotension prediction index versus conventional goal-directed haemodynamic management to reduce intraoperative hypotension in non-cardiac surgery: A randomised controlled trial.

  Yusuke Yoshikawa, Makishi Maeda, Tatsuya Kunigo, Tomoe Sato, Kanako Takahashi, Sho Ohno, Tomoki Hirahata, Michiaki Yamakage

  Journal of clinical anesthesia   93   111348 - 111348  2024年05月  [国際誌]

  　概要を見る

  STUDY OBJECTIVE: It remains unclear whether it is the hypotension prediction index itself or goal-directed haemodynamic therapy that mitigates intraoperative hypotension. DESIGN: A single centre randomised controlled trial. SETTING: Sapporo Medical University Hospital. PATIENTS: A total of 64 adults patients undergoing major non-cardiac surgery under general anaesthesia. INTERVENTIONS: Patients were randomly assigned to either group receiving conventional goal-directed therapy (FloTrac group) or combination of the hypotension prediction index and conventional goal-directed therapy (HPI group). To investigate the independent utility of the index, the peak rates of arterial pressure and dynamic arterial elastance were not included in the treatment algorithm for the HPI group. MEASUREMENTS: The primary outcome was the time-weighted average of the areas under the threshold. Secondary outcomes were area under the threshold, the number of hypotension events, total duration of hypotension events, mean mean arterial pressure during the hypotension period, number of hypotension events with mean arterial pressure < 50 mmHg, amounts of fluids, blood products, blood loss, and urine output, frequency and amount of vasoactive agents, concentration of haemoglobin during the monitoring period, and 30-day mortality. MAIN RESULTS: The time-weighted average of the area below the threshold was lower in the HPI group than in the control group; 0.19 mmHg (interquartile range, 0.06-0.80 mmHg) vs. 0.66 mmHg (0.28-1.67 mmHg), with a median difference of -0.41 mmHg (95% confidence interval, -0.69 to -0.10 mmHg), p = 0.005. Norepinephrine was administered to 12 (40%) and 5 (17%) patients in the HPI and FloTrac groups, respectively (p = 0.045). No significant differences were observed in the volumes of fluid and blood products between the study groups. CONCLUSIONS: The current randomised controlled trial results suggest that using the hypotension prediction index independently lowered the cumulative amount of intraoperative hypotension during major non-cardiac surgery.

  DOI PubMed

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• 脳脊髄液減少症に対して,三度にわたる腹臥位X線透視下ブラッドパッチにより症状が改善した一症例

  枝長充隆, 諸原清香, 濱田耕介, 小松克也, 立花俊祐, 山蔭道明

  日本呼吸療法医学会学術集会プログラム・抄録集   46th (Web)  2024年

  J-GLOBAL

• Blocking of the saphenous and obturator nerves using a pectineus muscle plane block

  Hironobu Ueshima, Atsushi Sawada, Michiaki Yamakage, Mineko Fujimiya

  Journal of Clinical Anesthesia ( Elsevier Inc. )  60   2 - 3  2020年03月

  速報，短報，研究ノート等（学術雑誌）  

  DOI PubMed

• 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

• 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

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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 】

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• 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

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  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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