研究者詳細 - 山蔭　道明

Misc - 山蔭　道明

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山蔭道明, 山本浩貴, 並木昭義

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 25 ( 2 ) 154 - 161 2005年03月

Variation of "pulse amplitude" measured bya pulse oximeter may help predict intravascular volume

M Yamakage, T Itoh, SW Jeong, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANESTHESIOLOGISTS SOC ) 52 ( 2 ) 207 - 208 2005年02月

速報，短報，研究ノート等（学術雑誌）

加温ポビドンヨード製剤による手術野消毒が体温維持に及ぼす影響

及川慶浩, 石川豊子, 山蔭道明, 並木昭義

日本手術医学会誌 = Journal of Japanese Association for Operating Room Technology ( 日本手術医学会 ) 25 ( 4 ) 275 - 280 2004年11月

CiNii

Inhibitory effects of the anesthetics propofol and sevoflurane on spontaneous lymphatic vessel activity in rats

J Hattori, M Yamakage, S Seki, K Okazaki, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 101 ( 3 ) 687 - 694 2004年09月

Background: The effects of propofol and sevoflurane on lymphatic vessel activity are unknown. This study aimed to clarify the effects of these anesthetics on lymphatic vessel activity in rats by the use of a technique for mechanical removal of the endothelium. Methods: The authors first examined the effects of propofol (8 mg/kg) and sevoflurane (2.0%) on in vivo lymphatic flow by injection of dye into the femoral regions of rats. In the in vitro study, the ends of the vessel segments of rat thoracic duct were connected to a syringe and stopcock, respectively. Spontaneous changes in diameter of each segment were monitored, and the extraluminal side of each segment was exposed to propofol (1 x 10(-6) similar to 3 x 10(-5) M) or sevoflurane (0.5similar to2.0%). Endothelial function was eliminated by perfusion of air into the lumen. Results: In the dye uptake study, 80% of iliac lymphatic nodes were positively stained in a control group, whereas only 10% and 20% were positively stained in propofol and sevoflurane groups, respectively. in the in vitro study, both of the anesthetics significantly decreased the amplitude of spontaneous activity of lymphatic vessels with or without endothetial function. Sevolflurane inhibited the frequency of lymphatic vessel activity but propofol had no effect on it. When the endothetial function was eliminated, both anesthetics decreased the frequency of spontaneous activity of lymphatic vessels. Conclusions: Propofol and sevoflurane seem to have some different effects on endothelial function, which regulates the pacemaking of spontaneous contraction of lymphatic vessels.

DOI

Assessment of the quality of information on departments/divisions of anesthesiology available on the World Wide Web

Michiaki Yamakage, Sei-Ichiro Ishiyama, Hiroki Yamamoto, Sohshi Iwasaki, Akiyoshi Namiki

Japanese Journal of Anesthesiology 53 ( 9 ) 1069 - 1073 2004年09月

Background: The quality of health information available in the World Wide Web is an important issue, but no review of the quality of such information has been performed. Methods: We investigated the quality of information available on the World Wide Web regarding departments/divisions of anesthesiology in 82 specific functioned hospitals in Japan. Results: Eighty-eight percent of the hospitals have their own web site for anesthesiology. Although only general clinical information was available on 64-71% of the web sites, detailed information on clinical results and members having diploma of the board was available on 11-26% of the sites. Regarding education, only 4% of the sites provided information on contents of lectures, whereas 75% of the sites have pages for medical students. Conclusions: Departments/divisions of anesthesiology, especially in specific functioned hospitals, should recognize an important role of web pages for medical consumers (= e-patient) and renew their web sites appropriately and opportunely.

PubMed

The type of carbon dioxide absorbent has no relation to the concentration of carbon monoxide in the breathing circuit during low-flow isoflurane anaesthesia in smoking and non-smoking subjects

M Yamakage, SI Yoshida, S Iwasaki, M Mizu-Uchi, A Namiki

ANAESTHESIA AND INTENSIVE CARE ( AUSTRALIAN SOC ANAESTHETISTS ) 32 ( 2 ) 230 - 235 2004年04月

The present study was designed to investigate the concentrations of carbon monoxide (CO) in the anaesthetic circuit anti of arterial carboxyhaemoglobin (COHb)) during low-flow isoflurane anaesthesia in smoking and non-smoking subjects using three kinds of cardon dioxide (CO2) absorbent. Thirty smoking and 30 non-smoking subjects were selected for this study, and these two groups were each divided into three groups according to the type of CO? absorbent used (Wakolime(TM) A, Dragersorb(TM) Free, and Amsorb(TM)). Anaesthesia was maintained with 1.0% isoflurane and nitrous oxide (1.0l min(-1))/oxygen (1.0l min(-1)). Concentrations of CO in the inspired breathing circuit and concentrations of arterial COHb were measured at 0, 1, 2, 3, and 4 hours after exposure to isoflurane. In the smoking groups there were no significant differences in CO concentrations in the circuit between the groups and the CO concentrations did not change significantly during the study period. There were also no significant differences in the arterial COHb) values between the groups and the COHb concentrations remained constant. There was a significant linear correlation between the concentrations of CO and COHb (r=0.86, n=30, P<0.001). In the nonsmoking groups all of the parameters remained constant at low levels that were independent of the type of CO2 absorbents tested. The major source for increased intraoperative CO exposure is related to the patient's smoking status, and the type of CO2 absorbent used has no relation to an increase in CO concentration in the breathing circuit.

Evaluation by Undergraduate Medical Students of Clinical Clerkships in the Department of Anesthesiology

Michiaki Yamakage, Hiroki Yamamoto, Sohshi Iwasaki, Masaki Toriyabe, Mitsuru Uzuki, Akiyoshi Namiki

Japanese Journal of Anesthesiology 53 ( 4 ) 429 - 437 2004年04月

Background: Clerkships for undergraduate clinical training were introduced in Sapporo Medical University School of Medicine in 2002. Methods: Questionnaire surveys by 5 steps Likert measure were conducted by asking the students about the evaluation of each department or division, and overall evaluation was obtained after the clerkships. The questionnaire consisted of 12 questions on 1) orientation 2) learning chances and provision of teaching materials 3) feedback, learning promotion and teaching attitude 4) coordination of human relationship between medical staff and students and 5) overall evaluation of teacher's physician. Results: The average score for our department was 4.30 (mean, 6 th grade of all 26 departments/ divisions), and the scores on provision of medical practice (4.69) and the overall teacher's physician grading (4.65) were the best among the all departments/divisions. The evaluation gradings were rather low on chances for medical and health care interviews (3.59) physical examinations (3.83) and description of medical record (3.73). Conclusions: Reevaluation of the educational program in our department based on the results of the survey is essential for improvement of the program, and further provision of chances, especially for medical interviews, physical examinations and description of medical record is also needed for undergraduate students in the program.

PubMed

紹介麻酔科クリニカルクラークシップに対する学生の評価

山蔭道明, 山本浩貴, 岩崎創史

麻酔 ( 克誠堂出版 ) 53 ( 4 ) 429 - 437 2004年04月

CiNii

Single-channel activity of L-type Ca2+ channels reconstituted with the beta(2c) subunit cloned from the rat heart

Y Kamada, Y Yamada, M Yamakage, M Nagashima, M Tsutsuura, T Kobayashi, S Seki, A Namiki, N Tohse

EUROPEAN JOURNAL OF PHARMACOLOGY ( ELSEVIER SCIENCE BV ) 487 ( 1-3 ) 37 - 45 2004年03月

We recently cloned the beta(2c) subunit of the L-type Ca2+ channel as a functional type of beta subunit from the rat heart. In order to clarify the contribution of the beta(2c) subunit to native Ca2+ channel function, we investigated the single-channel properties of Ca2+ channels reconstituted with beta(2a) or beta(2c) subunits and compared them with the properties of native channels. In contrast to the Ca2+ channel with beta(2a) subunit, long-lasting closings were dominant in the Ca2+ channel with beta(2c) subunit and the native channel. The ensemble-averaged current of the cells with beta(2c) subunits was comparable to that of the native cardiomyocytes. Many high P-o sweeps (mode 2) were observed in the cells with beta(2a) subunits, while only a few high P-o sweeps were observed in the cells with beta(2c) subunits and the native cells. These findings suggest that the beta(2c) subunit is one of the functional beta subunits in the rat heart. (C) 2004 Elsevier B.V. All rights reserved.

DOI

Coronary Artery Spasm during Cholecystectomy with Pneumoperitoneum - A Case Report

Soushi Iwasaki, Shingo Furuse, Masanori Watanabe, Masanori Yamauchi, Makoto Asano, Hitoshi Ooiwa, Michiaki Yamakage, Akiyoshi Namiki

Japanese Journal of Anesthesiology 53 ( 1 ) 59 - 62 2004年01月

A 59-year-old man without a history of ischemic heart disease underwent elective laparoscopic cholescystectomy under general anesthesia with epidural anesthesia. About 15 min after pneumoperitoneum had been achieved, the patient developed ST elevation and hypotension. Vagal stimulation resulting from stretching peritoneum, the procedure and epidural anesthesia are thought to have induced vasospasm. The ST segment became normal after interruption of CO2 insufflation. A postoperative coronary artery angiogram showed normal coronary arteries, but diffuse coronary artery spasm was seen after intracoronary injection of acetylcholine. The patient was discharged on nitrates. Patients with gall bladder stones sometimes have coronary risk factors of obesity, hyperlipidemia and hyperglycemia. Careful attention should also be given to patients who do not have a history of coronary disease.

PubMed

Intravenous Fluid Administration and Management of Body Temperature

Michiaki Yamakage, Akiyoshi Namiki

Japanese Journal of Anesthesiology 53 ( 1 ) 10 - 22 2004年01月

書評論文，書評，文献紹介等

Hypothermia occurs due to body heat redistribution between core and peripheral tissues as well as imbalance between heat loss and production, Perioperative hypothermia not only induces offensive shivering and prolongation of anesthetic recovery but also increases blood loss and incidence of surgical wound infection, increasing postoperative morbidity. It has been shown that intraoperative intravenous fluid administration and blood product transfusion have considerable effects on body temperature. Thus, it is important to monitor and control the temperature of fluids. Anesthesthesiologists should have knowledge of the characteristics of the various kinds of fluid warmer currently available and use them appropriately according to surgical procedures and the patient's position. It was reported recently that administration of amino acid can prevent intraoperative hypothermia, possibly by increasing the heat production in the body.

PubMed

輸液と体温管理

麻酔 53 10 - 22 2004年

Safety and beneficial effect on the body core temperature of a prewarmed plasma substitute - Hydroxyethyl starch - During anesthesia

Michiaki Yamakage, Hideaki Sasaki, Seong-Wook Jeong, Sohshi Iwasaki, Akiyoshi Namiki

Journal of Anesthesia 18 ( 3 ) 166 - 171 2004年

Purpose. We investigated, first, the safety of use and stability of a plasma substitute - hydroxyethyl starch (HES) - kept in a warming cabinet for a long period, and then the effect on body core temperature of the prewarmed HES in patients during urological surgery. Methods. In the first part of the study, HES colloid solutions (500 ml per pack Hespander) were kept in a warming cabinet (40°C) for 3 months and were tested for biological and chemical safety and stability. In the second part of the study, 1000 ml of HES at room temperature (control group n = 10) or kept in a warming cabinet for a few days (warmed group n = 10) was infused via a central venous catheter for 30 min in patients undergoing urological surgery under general anesthesia with lumbar epidural anesthesia. Esophageal temperature was monitored as the core temperature. HES fluid temperatures in the pack and at the end of a 1-m intravenous tube connected to the central venous catheter were also measured. Results. The test of HES products warmed for 3 months passed all inspections performed during the study period. In the warmed group, the pack and intravenous tube temperatures of HES were still high at 15 min after infusion (37.1° ± 1.5°C [mean ± SD] and 34.8° ± 2.2°C, respectively). Core temperature in the warmed group decreased significantly, by 0.34° ± 0.06°C, but was significantly higher than that in the control group (by 0.84° ± 0.13°C) after 30 min of the infusion. Conclusions. The use of HES products kept in a warming cabinet prior to surgery can maintain warm body temperature, easily, safely, and effectively. © JSA 2004.

DOI PubMed

Effects of oral atenolol on volatile anesthetic induction with sevoflurane in adults

Michiaki Yamakage, Hideaki Sasaki, Masahito Mizuuchi, Sohshi Iwasaki, Akiyoshi Namiki

Journal of Anesthesia 18 ( 3 ) 185 - 189 2004年

Purpose. To determine whether premedication with a β-blocker can bring about a more rapid and smooth induction of anesthesia, we investigated the effect of oral premedication with atenolol on volatile anesthetic induction with sevoflurane by monitoring the cardiac output (CO) and bispectral (BIS) index. Methods. Twenty-four patients undergoing general anesthesia with endotracheal intubation were randomly divided into two groups: a control group (n = 12) and a β-blocker group (n = 12). Each patient in the β-blocker group was premedicated with oral atenolol 25 mg 1 h before the induction of anesthesia. Anesthesia was induced by the repeated vital capacity technique with 5% sevoflurane and 66% nitrous oxide. The trachea was intubated 5 min after sevoflurane exposure. The CO and BIS index, as well as the induction time and specific side effects of induction (e.g., movement of limbs), were recorded. Results. There were no significant differences in induction time and specific side effects between the groups. The downward-sloping part of the BIS index curve in the β-blocker group (mean, 2.9 ± 0.2) was significantly sharper than that in the control group (2.5 ± 0.2), and the BIS index after induction of anesthesia was significantly lower in the β-blocker group (21.0 ± 2.2) than in the control group (24.2 ± 2.0). CO in the β-blocker group was significantly lower than in the control group during the study period. The hemodynamic changes caused by endotracheal intubation were inhibited in the β-blocker group but not in the control group. Conclusion. Oral premedication with 25 mg of atenolol provides a more rapid decrease in BIS index and is recommended for use in stable volatile anesthetic induction with sevoflurane. © JSA 2004.

DOI PubMed

Knowledge for Basic Anesthesia

Openursing 19 394 - 400 2004年

腹腔鏡下胆嚢摘出術中に冠動脈攣縮が顕在化した１症例

岩崎創史, 古瀬晋吾, 渡辺政徳

麻酔 ( 克誠堂出版 ) 53 ( 1 ) 59 - 62 2004年

CiNii

ＧＶＨＤ，水中毒，低体温・シバリング

麻酔科診療プラクティス第14巻 14 97 - 120 2004年

Medical gases and management of body temperature

Handbook for operating theater 2004年

基本手技ガイドライン