研究者詳細 - 山蔭　道明

症例1は72歳女で、弓部大動脈瘤に対し弓部人工血管置換術を受け、術後ICU入室となった。第1病日のX線では横隔膜の挙上は認めなかったが、抜管後6時間で努力性呼吸となり、再挿管後も陽圧呼吸低下を認めた。第5病日に横隔神経電動検査を行い、両側性の横隔神経麻痺(PNP)の診断に至った。第13病日の再伝動検査では改善を認めず、第16病日に非閉塞性腸間膜動脈虚血による多臓器障害で死亡した。症例2は82歳女で、狭心症に対して冠動脈バイパス術を施行後、ICU入室となった。術後の経過は良好であったが、抜管後に頻呼吸となり、再挿管と抜管を繰り返し、14病日に横隔神経電動検査を行い、右側PNPと診断した。その後、気管切開を行い、6ヵ月経過しても人工呼吸器からの離脱が困難であり、転院となった。

DOI

Can age-related mitochondrial dysfunction affect volatile anesthetic potency?

Michiaki Yamakage

JOURNAL OF ANESTHESIA ( SPRINGER JAPAN KK ) 28 ( 6 ) 805 - 806 2014年12月

その他

DOI

最近のペインクリニック (特集最新の腰痛・膝関節痛の診療)

新谷知久, 山蔭道明

臨牀と研究 ( 大道学館出版部 ) 91 ( 11 ) 1465 - 1468 2014年11月

CiNii

局所麻酔薬の頭皮下投与後の血中濃度

山下美妃, 向祐志, 戸田貴大, 猪爪信夫, 郡修徳, 茶木友浩, 杉野繁一, 早瀬知, 山蔭道明

臨床薬理 ( (一社)日本臨床薬理学会 ) 45 ( Suppl. ) S267 - S267 2014年11月

スガマデクスナトリウム(MK-8616,Org25969)の筋弛緩拮抗作用 : 浅い筋弛緩状態からの回復

武田純三, 岩崎寬, 山蔭道明

麻酔 ( 克誠堂出版 ) 63 ( 10 ) 1075 - 1082 2014年10月

CiNii

MMPIが介入方針の補助となった対照的な慢性痛の2症例

杉目史行, 山内正憲, 新谷知久, 岩崎創史, 山蔭道明

日本ペインクリニック学会誌 ( 一般社団法人日本ペインクリニック学会 ) 21 ( 1 ) 40 - 44 2014年02月

ミネソタ多面人格目録（MMPI）の施行が，慢性痛患者への介入方針を決める際に役立った2症例を報告する．症例1は70歳代，男性．腰部脊柱管狭窄症による腰痛と，6年前に受けた肺がん手術後の肋間神経痛の改善目的で紹介となった．臨床心理士の査定は"情緒的に不幸感や神経過敏で悩みやすい面と，ストレスに対して症状を悪化させやすい面が存在する"という評価であった．治療方針は情動面へのアプローチに重点をおいて，1カ月に1回の診察で症状の確認と傾聴，および母性的な対話，内服薬処方を行った．5カ月後，患者は痛みを受容し，リハビリに通い，車の運転が可能となった．症例2は60歳代，男性．4年前に右膝蓋骨骨折に対し骨接合術を受けたが，術後下肢痛が持続し当科紹介となった．MMPIの結果は"真面目で社会に同調し，他者と協調できる適応的なタイプ"という評価であった．治療方針は身体的な治療を優先し，脊髄刺激療法を行った．ADLの改善を認め仕事に復帰し，外来フォローとなった．MMPIが介入方針の補助となった対照的な慢性痛の2症例を経験した．MMPIは慢性痛患者に介入する適切な行動様式を判断する客観的な指標となりうる．

DOI CiNii

特発性肺高血圧症を合併した成人の部分肺静脈還流異常症修復術の麻酔経験

西原教晃, 川口亮一, 吉川裕介, 時永泰行, 山蔭道明

Cardiovascular Anesthesia 18 ( Suppl ) 2014年

J-GLOBAL

脊椎外科手術後鎮痛 : 麻酔科からの視点 (特集術後疼痛管理の最前線)

新山幸俊, 山蔭道明

整形・災害外科 ( 金原出版 ) 56 ( 13 ) 1571 - 1575 2013年12月

CiNii

体温調節のメカニズム (特集体温 : 測定から管理まで) -- (体温総論)

岩﨑創史, 山蔭道明

救急医学 = The Japanese journal of acute medicine ( へるす出版 ) 37 ( 9 ) 991 - 995 2013年09月

CiNii

札幌医大附属病院緩和ケアチームにおけるオピオイド使用動向と今後の課題

渡邊昭彦, 水口亜紀, 佐藤明美, 山内正憲, 山蔭道明

日本緩和医療学会学術大会プログラム・抄録集 ( (NPO)日本緩和医療学会 ) 18回 385 - 385 2013年06月

難治性慢性疼痛患者の満足度に与える因子の検討

杉目史行, 山内正憲, 新谷知久, 岩崎創史, 水上奈穂美, 大森英哉, 一宮尚裕, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 20 ( 3 ) 362 - 362 2013年06月

多発性骨髄腫の疼痛管理の問題点

水口亜紀, 渡辺昭彦, 佐藤明美, 山内正憲, 山蔭道明

日本緩和医療学会学術大会プログラム・抄録集 ( (NPO)日本緩和医療学会 ) 18回 514 - 514 2013年06月

小児の術後鎮痛における経静脈的自己調節鎮痛法の現状についての後ろ向き調査

水上奈穂美, 杉目史行, 山内正憲, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 20 ( 3 ) 375 - 375 2013年06月

棘上筋下のガングリオンを超音波ガイド下に穿刺・吸引した1症例

関根利佳, 山内正憲, 杉目史行, 佐々木英昭, 山蔭道明, 一宮尚裕

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 20 ( 3 ) 414 - 414 2013年06月

手術麻酔におけるX線透視下硬膜外カテーテル留置術

枝長充隆, 山内正憲, 山蔭道明

麻酔 ( 克誠堂出版 ) 62 ( 4 ) 488 - 494 2013年04月

CiNii

胸部大動脈瘤ステントグラフト内挿術中にアデノシン三リン酸(ATP)誘発性気管支痙攣を生じた3症例

高田幸昌, 川岸俊也, 木井菜摘, 樋口美沙子, 山内正憲, 山蔭道明

麻酔 ( 克誠堂出版(株) ) 62 ( 4 ) 402 - 405 2013年04月

胸部大動脈瘤ステントグラフト内挿術中に、アデノシン三リン酸(ATP)が原因と思われる気管支痙攣を3症例経験した。術者の希望で一時的な心拍停止手段として投与したATPが直接の原因であったが、3症例とも気管支喘息もしくは慢性閉塞性肺疾患を合併していたことが症状を重篤にしたと考えられた。ATPを気道過敏性を有する患者において静注する際は、気管支痙攣を誘発する危険性があるため慎重に適応を考慮する必要がある。(著者抄録)

局所麻酔薬の過剰投与に対する脂肪乳剤の有用性

藤本万理恵, 大瀬戸翔大, 山下美妃, 郡修徳, 新谷知久, 山内正憲, 山蔭道明

日本薬学会年会要旨集 ( (公社)日本薬学会 ) 133年会 ( 4 ) 129 - 129 2013年03月

超音波ガイド下中腋窩線および肋骨弓下腹横筋膜面ブロック Thiel遺体を用いた薬液の広がりの検討

室内健志, 山内正憲, 魏慧玲, 高田幸昌, 水口亜紀, 山蔭道明, 藤宮峯子

麻酔 ( 克誠堂出版(株) ) 62 ( 1 ) 60 - 63 2013年01月

腹横筋膜面ブロックの中腋窩線法および肋骨弓下法を行い、Thiel固定遺体に注入した色素に染まる領域により効果範囲を検討した。中腋窩線上法ならびに肋骨弓下法それぞれに異なる色素を10ml注入し、色素注入10分後に解剖し、色素の広がりを確認した。4遺体7腹壁全症例で、T8-T11に広がるブロックが可能であった。より簡便な手技で広範囲の鎮痛を得られる可能性が示唆された。(著者抄録)

Pharmacokinetics and safety of 6% hydroxyethyl starch 130/0.4 in healthy male volunteers of Japanese ethnicity after single infusion of 500 ml solution

YAMAKAGE Michiaki, BEPPERLING Frank, WARGENAU Manfred, MIYAO Hideki

Journal of anesthesia 26 ( 6 ) 851 - 857 2012年12月

CiNii

体温マッサージ療法がアトピー・アレルギー性皮膚炎に与える影響

佐々木英昭, 山内正憲, 山蔭道明, 山本みえ子

臨床体温 ( 「臨床体温」編集委員会 ) 30 ( 1 ) 49 - 49 2012年12月

デコルテマッサージがアトピー・アレルギー性皮膚炎に与える影響

佐々木英昭, 山内正憲, 山蔭道明, 山本みえ子

臨床体温 ( 「臨床体温」編集委員会 ) 30 ( 1 ) 3 - 7 2012年12月

軽度低体温ならびにアトピー・アレルギー性皮膚炎に悩む成人20名を対象にデコルテマッサージを行い、体温と皮膚症状に与える影響を検討した。体温はマッサージ施行前に腋窩温を測定し、皮膚症状は最も気になる部位の写真を画像処理ソフトでRGB成分に分け、正常部位との色定量差値を計算した。デコルテマッサージの施行期間は259日(中央値)、試行回数は25回で、平均体温は35.45℃から36.42℃と有意に上昇した(p<0.001)。皮膚症状にも改善を認め、色定量差値はデコルテマッサージを導入する前のR34.0、G72.0、B66.5から、導入後にはR2.5、G10.5、B7.5と有意に減少した(p<0.001)。デコルテマッサージは体温を上昇させる効果に加え、ホメオスタシスの維持改善に効果を及ぼし、アトピー・アレルギー性皮膚炎を軽減する可能性が示唆された。(著者抄録)

1980年～2010年の当院での術中心停止の変遷と全国麻酔関連偶発症例における心停止の比較検討

川島如仙, 岩崎創史, 山内正憲, 山蔭道明

蘇生 ( 日本蘇生学会 ) 31 ( 3 ) 140a - 140a 2012年10月

DOI CiNii

Risk factors for gastric distension in patients with acute appendicitis : a retrospective cohort study

KIMURA Yoshinobu, YAMAUCHI Masanori, INOUE Hikaru, KIMURA Saori, YAMAKAGE Michiaki, AIMONO Mako, SUMITA Shinzou

Journal of anesthesia 26 ( 4 ) 574 - 578 2012年08月

CiNii

Ultrasound-guided and radiographic monitoring-assisted peripherally inserted central catheterization

Mitsutaka Edanaga, Ryu Azumaguchi, Michiaki Yamakage

JOURNAL OF ANESTHESIA ( SPRINGER JAPAN KK ) 26 ( 4 ) 623 - 624 2012年08月

速報，短報，研究ノート等（学術雑誌）

DOI

重度の拘束性換気障害を合併した脊髄性進行性筋萎縮症患者の麻酔経験

宇野あゆみ, 新山幸俊, 橘信子, 山内正憲, 渡邊昭彦, 山蔭道明

麻酔 ( 克誠堂出版(株) ) 61 ( 8 ) 830 - 833 2012年08月

症例は43歳女性で、4歳時より脊髄性進行性筋萎縮症(SPMA)を指摘され四肢筋力低下、嚥下障害を認め、日常生活動作は全介助、精神発達は正常であった。10年前、卵巣奇形腫を指摘されたが、良性腫瘍で周術期の呼吸器合併症の危険性を考慮し経過観察された。腫瘍は増大し、3年前より腹痛を認め、呼吸機能増悪が懸念されたため、全身麻酔下に開腹腫瘍摘出術を予定した。気管挿管下に全身麻酔で、硬膜外麻酔を併用した。呼吸は可能な限り、自発呼吸を温存した圧補助換気を行った。レミフェンタニル投与中は筋固縮に注意しながら、同期的間欠的強制呼吸を行ったが、自発呼吸は残存しており、呼吸状態は200〜300ml、呼吸回数12〜15回/min-1であった。腫瘍摘出後、レミフェンタニルを中止し呼吸も圧補助換気のみとなったが、中止前後で呼吸状態に大きな変化を認めなかった。重度の拘束性呼吸障害を合併するSPMA患者における開腹術に対して、自発呼吸を温存した呼吸管理と硬膜外麻酔を積極的に施行し、呼吸機能を悪化させることなく安全に周術期管理を行うことができた。

肩甲帯離断術後の幻肢痛・幻肢感覚に対してガバペンチンが奏効した3症例

水上奈穂美, 新谷知久, 山内正憲, 橘信子, 高橋三佳, 山蔭道明

The journal of the Japan Society of Pain Clinicians = 日本ペインクリニック学会誌 ( 一般社団法人日本ペインクリニック学会 ) 19 ( 2 ) 111 - 114 2012年06月

上腕骨悪性腫瘍に対して肩甲帯離断術を施行した患者における，術後の幻肢痛ならびに幻肢感覚に対してガバペンチンが奏効した3症例を経験したので報告する．症例1は切断後5日目にnumerical rating scale（NRS）で2-3/10の幻肢痛が出現し，オキシコドン（10 mg，分2）で対応したが，14日目より幻肢痛がNRSで8/10と増悪したためガバペンチン300 mg/日を開始したところ，痛みはNRSで0-1/10に改善した．症例2は切断前から腫瘍による神経障害痛が出現しており，ガバペンチン300 mg/日の投与によりNRSで5/10から3/10になり痛みの程度の改善を認めた．切断後9日目より生じた右上腕全体の幻肢感覚に対しても，同量のガバペンチンが奏効し幻肢感覚は消失した．症例3は切断後2日目より重量感を伴う幻肢痛が出現したが，ガバペンチン600 mg/日で痛みはNRSで6/10から2/10に改善した．四肢切断後の幻肢痛や幻肢感覚に対して，ガバペンチンは有効であることが示唆された．

DOI CiNii

難治性疼痛患者への介入におけるMMPIの有用性

杉目史行, 山内正憲, 水口亜紀, 新谷知久, 渡邊昭彦, 大森英哉, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 19 ( 3 ) 322 - 322 2012年06月

カルバマゼピン血中濃度測定に基づく抗てんかん薬のローテーション

橘信子, 山内正憲, 渡邊昭彦, 高橋三佳, 山澤弦, 御村光子, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 19 ( 3 ) 389 - 389 2012年06月

緩和ケアチームがかかわった骨髄移植関連症例における鎮痛剤の使用状況

渡邊昭彦, 水口亜紀, 山内正憲, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 19 ( 3 ) 416 - 416 2012年06月

がん患者の疼痛緩和におけるトラムセットの有効性

水口亜紀, 渡邊昭彦, 山内正憲, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 19 ( 3 ) 417 - 417 2012年06月

緩和ケアチーム介入患者における集中治療室利用症例の検討

渡邊昭彦, 水口亜紀, 高橋三佳, 水上奈穂美, 藤井明美, 山内正憲, 山蔭道明

日本緩和医療学会学術大会プログラム・抄録集 ( (NPO)日本緩和医療学会 ) 17回 368 - 368 2012年06月

呼吸不全と敗血症性ショックを呈した患者の体外膜型人工肺補助下での縦隔洗浄ドレナージの麻酔経験

河村真衣子, 黒田浩光, 渋川圭介, 鎌田康宏, 山内正憲, 山蔭道明

臨床麻酔 ( 真興交易(株)医書出版部 ) 36 ( 4 ) 607 - 610 2012年04月

食道異物穿孔による縦隔炎に、敗血症、急性呼吸促迫症候群、DIC、意識障害および重症ショックを合併した74歳の男性の麻酔を経験した。P/F比が80以下ときわめて低く、縦隔洗浄とドレナージの緊急手術に対して、体外膜型人工肺(extracorporeal membrane oxygenation:ECMO)使用下に酸素化を改善しながら開胸洗浄とドレナージを行った。術後は腹臥位人工呼吸管理により酸素化能が改善し、ショックから離脱した。約1ヵ月後に人工呼吸器を離脱し、その後順調に退院した。(著者抄録)

【ペインクリニック教育の課題と展望】学生・初期臨床研修医が理解と興味を持つペインクリニック教育札幌医科大学医学部

山内正憲, 山蔭道明

ペインクリニック ( 真興交易(株)医書出版部 ) 33 ( 3 ) 335 - 342 2012年03月

医学生や初期臨床研修医への教育について、現状分析、理想的な教育、改善点をまとめた。麻酔科やペインクリニックの疼痛治療はプライマリケアの一つとして必要であるが、直接興味を持つ学生は少ない。また、ペインクリニック教育を行う時間も人手も少ないため、十分な教育やアピールができないのが現状である。そこで、プライマリケアとしての痛み治療の必要性、比較的理解しやすい術後鎮痛からの継続的な教育、適切な到達目標の設定などにより、興味を持って学びやすい環境を作っていくことが必要である。(著者抄録)

痛みの評価

山内正憲, 山蔭道明

ペインクリニック ( 真興交易(株)医書出版部 ) 33 ( 2 ) 271 - 279 2012年02月

痛みは個人差が大きく、主観的なため客観的な評価が難しい。原因や病態については神経学的な評価や各種画像検査などを行い、適切に診断することが重要である。痛みの性質や要素を分けて判断し、身体的な痛みの強さは上限値が10または100のスコア化により定量する。情動やストレス、total painの考えにおける社会的な痛み、精神的な痛み、スピリチュアルペインは、生活の質や行動、心理テストなどで評価する。身体的な痛みとそれ以外の痛みやストレスを適切に評価し、患者の理解につなげることで治療を進めることが可能となる。(著者抄録)

1%ブドウ糖加酢酸リンゲル液は手術中の脂肪・タンパク異化を抑制する

澤田敦史, 吉川裕介, 山内正憲, 渡辺昭彦, 山蔭道明

麻酔 61 ( 4 ) 2012年

J-GLOBAL

重度の拘束性呼吸障害を合併した脊髄性進行性筋萎縮症患者の麻酔経験

宇野あゆみ, 新山幸俊, 橘信子, 山内正憲, 渡辺昭彦, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S464 - S464 2011年10月

腕神経叢ブロックとプロポフォールを用いて管理したMELAS症候群の1症例

立花俊祐, 山内正憲, 岩崎創史, 渡辺昭彦, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S443 - S443 2011年10月

30秒で予測できる新型電子体温計の有用性

桶谷章夫, 山内正憲, 新山幸俊, 山蔭道明, 諸原清香

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S518 - S518 2011年10月

プレガバリン内服治療中に小脳腫瘍が見つかった一例

並木正伸, 山内正憲, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S507 - S507 2011年10月

麻酔科医によるテルモ社製CVレガフォースEXの使用感について

玉城敬史, 山内正憲, 渡辺昭彦, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S473 - S473 2011年10月

確定診断まで時間を要し疼痛管理に難渋したEwing肉腫の一症例

水口亜紀, 渡辺昭彦, 高橋三佳, 山内正憲, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S370 - S370 2011年10月

札幌医科大学附属病院緩和ケアチームにおける近年の活動実績と今後の課題

高橋三佳, 渡辺昭彦, 水口亜紀, 山内正憲, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S369 - S369 2011年10月

札幌医科大学附属病院緩和ケアチームでのトラマドール使用状況と今後の課題

渡辺昭彦, 高橋三佳, 水口亜紀, 山内正憲, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S271 - S271 2011年10月

術中心停止症例の検討当院における1980年代、1990年代と2000年代の変遷

川島如仙, 岩崎創史, 山内正憲, 渡辺昭彦, 山蔭道明

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 31 ( 6 ) S271 - S271 2011年10月

The usefulness of an earphone-type infrared tympanic thermometer during cardiac surgery with cardiopulmonary bypass : clinical report

MASAMUNE Taishi, YAMAUCHI Masanori, WADA Keiichi, IWASHITA Hironobu, OKUYAMA Katsumi, INO Hirofumi, YAMAKAGE Michiaki, ISHIYAMA Tadahiko, MATSUKAWA Takashi

Journal of anesthesia 25 ( 4 ) 576 - 579 2011年08月

CiNii

Intrathecal neurolytic block in a patient with refractory cancer pain

WATANABE Akihiko, YAMAKAGE Michiaki

Journal of anesthesia 25 ( 4 ) 603 - 605 2011年08月

CiNii

外傷性多発骨折に対する緊急手術の麻酔終了直後に発症した脂肪塞栓症候群の1例

吉田司, 新谷知久, 山内正憲, 成松英智, 山蔭道明

臨床麻酔 ( 真興交易(株)医書出版部 ) 35 ( 8 ) 1294 - 1296 2011年08月

20歳男。歩行中に乗用車にはねられて受傷し、右上腕骨と右脛骨腓骨の骨折に対し髄内釘挿入術、創外固定術を予定した。麻酔はプロポフォールで導入し、ロクロニウム投与後に気管挿管して酸素、空気、セボフルランおよびレミフェンタニル持続静注で維持した。術中の呼吸循環動態は安定していたが、術終了後に酸素で換気し抜管したところ、直後よりシバリングを生じ、SpO2が90%、PaO2は50mmHgと低酸素血症を認めた。加温でシバリングは改善したが、低酸素血症が継続したためICUに入室した。X線で末梢血管陰影増強を認め肺水腫と診断し、気管挿管して人工呼吸を開始した。超音波では下大静脈内にシャワー状の高輝度浮遊物を、第2病日のMRIでは両側大脳半球に多発脳梗塞を認め、中枢神経障害、血小板減少などの徴候より脂肪塞栓症候群と診断した。その後、SIRS、DIC、敗血症を併発したが、人工呼吸管理と薬物治療で改善し、リハビリテーションを経て半年後に車椅子移動が可能となった。

30秒で測定できる新型電子体温計の小児での使用経験

諸原清香, 新谷知久, 山内正憲, 山蔭道明

臨床体温 ( 「臨床体温」編集委員会 ) 29 ( 1 ) 73 - 73 2011年08月

帝王切開後の硬膜外自家血注入における超音波画像の有用性

山下淳, 山内正憲, 山蔭道明

麻酔 ( 克誠堂出版 ) 60 ( 7 ) 870 - 872 2011年07月

CiNii

頭頸部放射線治療に伴う重症口内炎に対する痛み治療の満足度評価の検討

水上奈穂美, 渡邊昭彦, 山内正憲, 高橋三佳, 山蔭道明

日本緩和医療学会学術大会プログラム・抄録集 ( (NPO)日本緩和医療学会 ) 16回 396 - 396 2011年06月

骨転移が疑われた慢性腰下肢痛に対し、集学的アプローチにより骨髄炎との診断・治療に繋がった1例

高橋三佳, 藤井明美, 米田舞, 吉永敏弘, 渡辺昭彦, 山内正憲, 山蔭道明

日本緩和医療学会学術大会プログラム・抄録集 ( (NPO)日本緩和医療学会 ) 16回 541 - 541 2011年06月

神経ブロック直前に薬剤性血小板減少症が疑われた帯状疱疹神経痛の1例

新谷知久, 山内正憲, 山蔭道明, 渡邊昭彦, 水口亜紀

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 18 ( 3 ) 324 - 324 2011年06月

札幌医科大学附属病院-当科における経緯と展望-

山内正憲

ペインクリニック ( 真興交易(株)医書出版部 ) 32 ( 3 ) 336 - 344 2011年03月

当科は、1980年代から慢性疼痛の治療にリン酸コデインまたは塩酸モルヒネを使用してきたが、保険診療との絡みや、効果をどう評価するかという課題があった。現在は、オピオイドの長期投与または強オピオイドを投与する場合、患者との信頼関係と痛み以外の客観的評価をチームカンファレンスで確認している。フェンタニル貼付剤への変更により医療費は増加するが、満足度は向上し、副作用が軽減する。今後は、慢性疼痛患者へのオピオイド投与が若手ペインクリニック担当医や他科の医師から理解され、エビデンスとして確立される必要がある。(著者抄録)

CiNii

Colloid solutions: A clinical update

Tomi T. Niemi, Ryo Miyashita, Michiaki Yamakage

Journal of Anesthesia 24 ( 6 ) 913 - 925 2010年12月

書評論文，書評，文献紹介等

DOI PubMed

肩関節術後痛に対する鎖骨上アプローチでの持続腕神経叢ブロックの効果

新谷知久, 山内正憲, 水上奈穂美, 新山幸俊, 大曽根順平, 本間広則, 川股知之, 山蔭道明, 廣瀬總明

麻酔 ( 克誠堂出版(株) ) 59 ( 11 ) 1385 - 1390 2010年11月

肩関節術を受ける症例41症例を鎖骨上アプローチによる0.2%ロピバカインの持続腕神経叢ブロックの投与量の違いで4ml・hr-1群、6ml・hr-1群、8ml・hr-1群および対照群(持続投与なし)の4群に分け、術後の疼痛スコアとNSAIDsのレスキュー施行回数を検討した。6ml・hr-1群の術後24時間の疼痛スコアはほかの2群と比較して有意(P<0.05)に低値であり、平均レスキュー施行回数は対照群と比較して有意に少なかった。8ml・hr-1群は薬液の皮下漏れ、頭痛を呈した症例が1症例ずつあった。0.2%ロピバカイン6ml・hr-1による持続腕神経叢ブロックは、肩関節術後痛に対して合併症が少なく、質の高い鎮痛効果を得ることができた。(著者抄録)

右心房内を占拠した巨大心臓腫瘍の1症例

宮下龍, 君島知彦, 濱田耕介, 浦濱聡, 山内正憲, 山蔭道明

Cardiovascular Anesthesia ( (一社)日本心臓血管麻酔学会 ) 14 ( Suppl. ) 170 - 170 2010年10月

癌患者および慢性疼痛患者の下肢冷感に対する漢方薬の有効性

高橋三佳, 山内正憲, 渡辺昭彦, 高橋和伸, 水上奈穂美, 新谷知久, 山蔭道明

臨床体温 ( 「臨床体温」編集委員会 ) 28 ( 1 ) 22 - 26 2010年08月

基礎疾患とそれに伴う痛みや体力低下、合併症など多様な症状を有する患者の下肢の冷感に対し、漢方薬が有効であった2例を経験した。症例1:77歳女性。主訴は骨盤内再発腫瘍による下肢動脈圧迫に伴う下肢冷感と、鎮痛薬による傾眠傾向であった。葛根湯の内服により翌日から症状が軽快した。症例2:75歳女性。主訴は脊柱管狭窄症による慢性腰下肢痛と下肢冷感であった。牛車腎気丸の内服により、翌週から症状が軽快した。全身状態に合わせて漢方薬を投与することにより、併用薬副作用の出現を抑え、多種多様な症状を伴う患者の下肢冷感をバランスよく緩和することが可能である。(著者抄録)

整形外科領域における痛み整形外科疾患に対するペインクリニック

山内正憲, 山蔭道明

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 ) 52 ( 1 ) 20 - 24 2010年08月

癌性および慢性疼痛患者の下肢冷感に対する漢方薬の有効性

高橋三佳, 渡邊昭彦, 水上奈穂美, 新谷知久, 山内正憲, 渡辺廣昭, 山蔭道明

臨床体温 ( 「臨床体温」編集委員会 ) 28 ( 1 ) 45 - 45 2010年08月

エアウェイスコープ^【○!R】とカフインフレーション法で経鼻挿管に成功した開口障害の1例

川端一裕, 千田典史, 山内正憲, 山蔭道明

日本歯科麻酔学会雑誌 38 ( 3 ) 311 - 312 2010年07月

CiNii

麻酔の深度と麻酔からの覚醒 (AYUMI 麻酔の質と手術患者の覚醒)

山蔭道明, 岩崎創史

医学のあゆみ ( 医歯薬出版 ) 234 ( 2 ) 131 - 135 2010年07月

CiNii

超音波装置による仙尾靱帯同定の有用性

橘信子, 山内正憲, 水上奈穂美, 新谷知久, 渡邊昭彦, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 17 ( 3 ) 363 - 363 2010年06月

頭頸部放射線治療に伴う重症口内炎に対する痛み治療の満足度の調査

水上奈穂美, 渡邊昭彦, 山内正憲, 橘信子, 山蔭道明

日本ペインクリニック学会誌 ( (一社)日本ペインクリニック学会 ) 17 ( 3 ) 366 - 366 2010年06月

吸入麻酔薬の最新の知見

山蔭道明, 澤田敦史

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 30 ( 3 ) 342 - 355 2010年05月

CiNii

バルーン式ディスポーザブル持続注入器の投与速度に及ぼす温度と抵抗圧の影響

福岡英子, 山内正憲, 水上奈穂美, 山蔭道明, 渡辺廣昭, 並木昭義

臨床体温 ( 「臨床体温」編集委員会 ) 27 ( 1 ) 50 - 54 2009年08月

設定流量4〜6ml/hrの5種類の患者自己調節鎮痛装置付きバルーン式のディスポーザブル持続注入器(バルーン式ポンプ)の流量精度を、温度および注入抵抗を変えて測定した。バルーン内を5%ブドウ糖液で満たし、温度は25℃または35℃、注入抵抗は0,5または10cmH2Oとして、投与開始から30時間後まで実測流量を計測した。どの種類も投与開始から数時間は実側流量が多く、先端圧が高いと実測流量が少なくなった。25℃よりも35℃の方が実測流量は多く、注入抵抗が10cmH2Oになるとどの種類も極端に実測流量が減少し、設定流量よりも少なくなった。種類によって温度の影響を受けやすいものと、注入抵抗の影響を受けやすいものなどの傾向があった。バルーン式ポンプはそれぞれの種類の特性や、使用する条件の変化に配慮して使用することが望まれる。(著者抄録)

ロクロニウムにアナフィラキシー反応を示した心臓外科手術の1症例

望月宏樹, 山蔭道明, 吉田真一郎, 古瀬晋吾, 山内正憲, 並木昭義

臨床麻酔 ( 真興交易(株)医書出版部 ) 33 ( 6 ) 1051 - 1053 2009年06月

61歳男。僧帽弁閉鎖不全症に対する人工心肺下僧帽弁形成術を行った。ミダゾラム、フェンタニルで入眠し、ロクニウム投与、セボフルラン吸入を開始した。リドカインで局所麻酔し気管挿管直後より顔面から腹部に発赤と膨疹が出現し、肺コンプライアンス低下、高二酸化炭素血症、眼球結膜浮腫・充血を認めた。導入薬によるアナフィラキシー反応を疑って手術を中止し問診をした結果、20歳代に喘息の既往があり、ハウスダストを始め全ての原因物質が陽性であったことが判明した。59歳時にベクロニウムを用いて全身麻酔で腹腔鏡下胆嚢摘出術を行った際に問題はなかった。各種麻酔薬の皮内テストの結果、ロクロニウムのみ強陽性を示し、2回目の手術では筋弛緩薬を使用せずに、プロポフォールによる入眠、レミフェンタニル持続投与にて麻酔管理を行った。なお、日本おけるロクロニウムによるアナフィラキシーの報告は、本例が2例目である。

CiNii

新しい局所麻酔薬レボブピバカイン概要

山蔭道明

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 29 ( 3 ) 275 - 289 2009年05月

CiNii

Two cases of Menkes disease: airway management and dental fragility

J. Yamashita, M. Yamakage, S. Kawana, A. Namiki

ANAESTHESIA AND INTENSIVE CARE ( AUSTRALIAN SOC ANAESTHETISTS ) 37 ( 2 ) 332 - 333 2009年03月

速報，短報，研究ノート等（学術雑誌）

麻酔科クリニカルクラークシップにおけるバイタルサインの教育

樋口美沙子, 杉野繁一, 平田直之, 古瀬晋吾, 山蔭道明, 久米田幸弘, 並木昭義

麻酔 ( 克誠堂出版(株) ) 58 ( 3 ) 393 - 393 2009年03月

神経ブロックに特化した携帯型超音波診断装置S-Nerve

本間広則, 山蔭道明, 君塚基修, 山内正憲, 並木昭義

臨床麻酔 ( 真興交易(株)医書出版部 ) 33 ( 2 ) 253 - 257 2009年02月

麻酔科医10名が、画像描出領域を頸部・腋下領域に限定し、S-Nerveの携帯性・操作性・画質・処理速度・情報共有性を評価した。総合評価は4.1(5段階評価)で、携帯性は3.3、操作性は3.6、画質は4.7、処理速度4.1、情報共有性3.6であった。また、自己評価で「エコーができる、使える」と思っている者ほど「使用頻度」が高くなる傾向にあった。S-Nerveの評価は概ね高く、安全、かつ確実な神経ブロック施行のためには、シミュレーションも含め、使用頻度を高めていくことが重要であると考えられた。

Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease

Michiaki Yamakage, Sohshi Iwasaki, Akiyoshi Namiki

JOURNAL OF ANESTHESIA ( SPRINGER TOKYO ) 22 ( 4 ) 412 - 428 2008年11月

書評論文，書評，文献紹介等

Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

DOI

ペインビジョンによる健常者の痛み程度の測定

望月宏樹, 新谷知久, 西條博正, 水上奈緒美, 山内正憲, 山蔭道明, 並木昭義

ペインクリニック ( 真興交易(株)医書出版部 ) 29 ( 11 ) 1549 - 1549 2008年11月

Urinary bladder and oesophageal temperatures correlate better in patients with high rather than low urinary flow rates during non-cardiac surgery

H. Sato, M. Yamakage, K. Okuyama, Y. Imai, H. Iwashita, T. Ishiyama, T. Matsukawa

EUROPEAN JOURNAL OF ANAESTHESIOLOGY ( CAMBRIDGE UNIV PRESS ) 25 ( 10 ) 805 - 809 2008年10月

Background and objective: To investigate the effect of urinary flow rate on the urinary bladder temperature, we compared the accuracy and precision of urinary bladder temperature with oesophageal temperature at both high and low urine flow rates. Methods: Twenty-four patients ASA physical status I or II who were undergoing tympanoplasty were randomly assigned to two groups with different intravenous fluid volumes: high (10 mL kg(-1) h(-1), n = 12) and low (3 mL kg(-1) h(-1), n = 12). General anaesthesia was induced with propofol and maintained with sevoflurane (1.5-2.5%) in nitrous oxide and oxygen. Urinary bladder temperature was measured using a Foley urinary catheter; distal oesophageal temperature was measured using a stethoscope thermocouple. These temperatures were measured every 5 min during surgery and the accuracy and precision of urinary bladder temperature with oesophageal temperature were determined using regression and Bland and Altman analyses. Results: The correlation coefficient for oesophageal and urinary bladder temperature was 0.90 in the high urinary volume group and 0.75 in the low urinary volume group. The offset (oesophageal-urinary bladder) was -0.13 +/- 0.32 degrees C and -0.46 +/- 0.45 degrees C, respectively. Conclusion: Urinary bladder temperature appears to be more accurate at high urinary flow rates than at low urinary flow rates for clinical use.

DOI

経皮的気管切開キットを用いた緊急気道確保 fresh cadaverによる検討

関忍, 杉野繁一, 中山雅康, 山内正憲, 佐藤順一, 山蔭道明, 並木昭義, 青木光広, 鈴木大輔, 辰巳治之

麻酔 ( 克誠堂出版(株) ) 57 ( 7 ) 908 - 909 2008年07月

筋弛緩のリバースと効果残存に伴う問題 (特集筋弛緩薬--薬理と臨床の新展開)

大曽根順平, 山蔭道明, 室内健志

麻酔 ( 克誠堂出版 ) 57 ( 7 ) 838 - 844 2008年07月

CiNii

難治性心室性不整脈により体外循環離脱に難渋した1例

澤田敦史, 平田直之, 山内正憲, 山蔭道明, 金谷憲明, 並木昭義

北海道外科雑誌 ( 北海道外科学会 ) 53 ( 1 ) 127 - 127 2008年06月

入室時の発作性心房細動のため手術延期となったが同日、緊急手術となった骨盤内臓全摘術の1症例

澤田敦史, 杉野繁一, 福岡英子, 山蔭道明, 金谷憲明, 並木昭義

北海道外科雑誌 ( 北海道外科学会 ) 53 ( 1 ) 127 - 127 2008年06月

Isovolaemic haemodilution decreases the shivering threshold in rabbits

Y. Imai, M. Yamakage, H. Sato, K. Okuyama, T. Ishiyama, T. Matsukawa

EUROPEAN JOURNAL OF ANAESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 25 ( 6 ) 450 - 453 2008年06月

Background and objective: The inhibition of thermoregulatory control by anaesthesia is manifested by reduced vasoconstriction and shivering thresholds. As intraoperative bleeding can result in haemodynamic changes, including vasoconstriction, we investigated the effect of experimental bleeding on the shivering threshold in rabbits. Methods: Twenty-four rabbits were randomly assigned to one of three treatment strategies: (1) no blood removal (control), (2) 5 mL kg(-1) isovolaemic blood removal and (3) 10 mL kg(-1) isovolaemic blood removal. After tracheal intubation under isoflurane anaesthesia, anaesthesia was maintained with 5096 nitrous oxide in oxygen. The removed blood volume was replaced with the same volume of warm hydroxyethyl starch colloid solution. Oesophageal temperature was measured as a core temperature at 1-min intervals. After blood removal, the animal's body was cooled at a rate of 2-3 degrees C h(-1) by perfusing water at 10 degrees C through a U-shaped thermode positioned in the colon. Hypothermic shivering was evaluated by visual inspection, and the core temperature at which shivering was triggered was identified as the thermoregulatory threshold for this response. Results: just before the cooling, the body temperature of the animals was around 38.6 degrees C in all of the three groups. The shivering threshold in the control group was 37.2 +/- 0.2 degrees C (mean +/- SD). The shivering thresholds in the 5 mL kg(-1) (36.9 degrees +/- 0.3 degrees C) and 10 mL kg(-1) (36-5 degrees +/- 0.5 degrees C) blood removal groups were significantly lower and in proportion with the volume of blood removed than that in the control group. Conclusion: Isovolaemic haemodilution decreased the shivering threshold in rabbits in proportion with the volume of blood removed.

DOI

体外循環の離脱にMg2+の投与が有効であった一症例

澤田敦史, 平田直之, 山蔭道明, 山内正憲, 並木昭義

麻酔と蘇生 ( 広島麻酔医学会 ) 43 ( 4 ) 77 - 80 2007年12月

陳旧性心筋梗塞により心機能の低下した患者の大動脈弓部人工血管置換術と大動脈弁置換術において,難治性の心室性不整脈を生じ体外循環離脱に難渋したが,抗不整脈薬の投与とMg2+の投与により循環補助装置を使用することなく手術を終了することができた一症例を経験した。本症例のように器質的心疾患を合併した患者においては,心室性不整脈の誘因となる低Mg2+血症を招かないように血清Mg2+濃度を測定し,補正することは,周術期管理の大切なポイントであると考える。(著者抄録)

手術前の酸化ストレスに及ぼす加齢の影響

佐藤智洋, 山蔭道明, 佐藤順一

麻酔 ( 克誠堂出版 ) 56 ( 12 ) 1422 - 1424 2007年12月

CiNii

Work stress in medical anaesthesiology trainees

M. Yamakage, T. Hayase, J. -I. Satoh, A. Namiki

EUROPEAN JOURNAL OF ANAESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 24 ( 9 ) 809 - 811 2007年09月

速報，短報，研究ノート等（学術雑誌）

DOI

レミフェンタニルの薬理作用

山蔭道明

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 27 ( 4 ) 369 - 380 2007年07月

CiNii

ORナースのためのトピックス超短時間作用性オピオイド鎮痛薬レミフェンタニル

平田直之, 山蔭道明

オペナーシング ( メディカ出版 ) 22 ( 7 ) 774 - 776 2007年07月

CiNii

心臓外科手術における超短時間作用性オピオイド鎮痛薬レミフェンタニルの有用性

山蔭道明, 平田直之, 並木昭義

循環制御 = CIRCULATION CONTROL 28 ( 1 ) 41 - 48 2007年03月

CiNii

超音波画像を用いて仙骨硬膜外カテーテルを挿入した1例

樋口美沙子, 山内正憲, 中山雅康, 杉野繁一, 山蔭道明, 並木昭義

臨床麻酔 ( 真興交易(株)医書出版部 ) 31 ( 2 ) 253 - 254 2007年02月

2歳4ヵ月男児。出生後からRDS、気管支痙攣、慢性肺疾患、副腎不全のため小児科でフォローされており、今回、尿道下裂に対して尿道形成術を予定した。前投薬としてトリクロホスナトリウムを服用させ、酸素・亜酸化窒素・セボフルランによる緩徐導入とベクロニウム静脈内投与で気管挿管を行った後、右側臥位として仙骨硬膜外穿刺を行った。仙骨裂孔を触診で確認し、抵抗消失法で18GのTuohy針を進め、皮膚から2cmで硬膜外腔に到達した。他の麻酔医が5〜10MHzリニア型超音波プローブを用いてL5/S1の水平断像を描出し、穿刺者が硬膜、黄色靱帯を観察しながら硬膜外カテーテルを挿入した。カテーテルを硬膜外に11cm進めた時、カテーテルの動きに同期したL5/S1の動きを確認し、その部位に留置した。硬膜外腔へは20万倍アドレナリン添加1%リドカインを執刀20分前に8ml、手術開始75分後、140分後に4mlずつ投与した。鎮痛効果は良好で、手術は問題なく終了した。

高齢者の体温調節と麻酔の影響

山蔭道明

Biomedical thermology : the journal of the Japanese Society of Thermorogy = 医学・生物学サーモロジー 26 ( 2 ) 29 - 34 2006年10月

CiNii

電子麻酔記録を用いた麻酔診療評価の試み

川口亮一, 杉野繁一, 山内正憲, 山蔭道明, 渡辺廣昭, 明和裕司, 並木昭義

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 26 ( 6 ) S413 - S413 2006年10月

超音波画像を用いて仙骨硬膜外カテーテル挿入を施行した1例

樋口美沙子, 山内正憲, 中山雅康, 杉野繁一, 山蔭道明, 並木昭義

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 26 ( 6 ) S291 - S291 2006年10月

デクスメデトミジンを用いて気道管理した気管ステント挿入術の1症例

河村真衣子, 杉野繁一, 岩崎創史, 山蔭道明, 渡辺廣昭, 並木昭義

日本臨床麻酔学会誌 ( 日本臨床麻酔学会 ) 26 ( 6 ) S302 - S302 2006年10月

拮抗性鎮痛薬エプタゾシンによる術後硬膜外持続投与の有用性

今久子, 山蔭道明, 古瀬晋吾, 永井荘一郎, 並木昭義

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 26 ( 5 ) 594 - 601 2006年09月

CiNii

麻酔科必修クリニカル・クラークシップに対する学生の評価と改善点

山内正憲, 山蔭道明, 川股知之, 新山幸俊, 並木昭義

LiSA ( (株)メディカル・サイエンス・インターナショナル ) 13 ( 6 ) 592 - 598 2006年06月

過去3年間のクリニカル・クラークシップ(CC)教育プログラムに対する学生の評価ならびにそのフィードバックに関して解析し検討した.必修CCを受けた2003〜2005年度の第5〜6学年学生(101,104,95例)を対象とした.学生からの評価を教育プログラムにフィードバックして改善した.毎年評価が上がり,2005年度は全科を通して最も高い評価を得た.主な変更点は,教育熱心な教員への担当変更,カルテ記入・患者診察の機会提供,緩和医療チームへの参加であった.項目別では,「医療手技の機会提供」が3年間を通して最も高い評価が得られた

Preferable inotropic action of procaterol, a potent bronchodilator, on impaired diaphragmatic contractility in an intraabdominal septic model

UZUKI MITSURU, YAMAKAGE MICHIAKI, FUJIMURA NAOYUKI, NAMIKI AKIYOSHI

Journal of anesthesia 20 ( 2 ) 145 - 148 2006年05月

CiNii

事例で学ぶ実践!周術期の体温管理(第8回)体位と術式(2)大量出血手術

平田直之, 山蔭道明

オペナーシング ( メディカ出版 ) 21 ( 5 ) 521 - 525 2006年05月

CiNii

事例で学ぶ実践!周術期の体温管理(7)加温方法(2)輸液や手術野に使う液体の加温

山内正憲, 山蔭道明

オペナーシング ( メディカ出版 ) 21 ( 3 ) 322 - 324 2006年03月

CiNii

Anandamide absorption by direct hemoperfusion with polymixin B-immobilized fiber improves the prognosis and organ failure assessment score in patients with sepsis

KOHRO SHINJI, IMAIZUMI HITOSHI, YAMAKAGE MICHIAKI, MASUDA YOSHIKI, NAMIKI AKIYOSHI, ASAI YASUHUMI, MARUYAMA IKUO

Journal of anesthesia 20 ( 1 ) 11 - 16 2006年02月

CiNii

紹介テオフィリン血中濃度簡易測定キット(アキュメータテオフィリン)の周術期管理における有用性

岩崎創史, 山蔭道明, 佐藤順一

麻酔 ( 克誠堂出版 ) 54 ( 12 ) 1385 - 1391 2005年12月

CiNii

事例で学ぶ実践!周術期の体温管理(3)全身麻酔による低体温

平田直之, 山蔭道明

オペナーシング ( メディカ出版 ) 20 ( 11 ) 1099 - 1102 2005年11月

CiNii

事例で学ぶ実践!周術期の体温管理(第1回)術前の問題点とその対応

山内正憲, 山蔭道明

オペナーシング ( メディカ出版 ) 20 ( 9 ) 876 - 879 2005年09月

CiNii

吸入麻酔薬の作用機序に関する最近の知見

山蔭道明, 佐藤順一, 岩崎創史, 山内正憲, 並木昭義

臨床麻酔 ( 真興交易(株)医書出版部 ) 29 ( 8 ) 1353 - 1356 2005年08月

Adequate shunt occlusion confirmed by near-infrared spectroscopy in a patient with arteriovenous malformation in the leg

IWASAKI Sohshi, YAMAKAGE Michiaki, NAKAYAMA Masayasu, SATOH Jun-ichi, NAMIKI Akiyoshi

Journal of anesthesia 19 ( 2 ) 183 - 184 2005年05月

CiNii

Intermittent pneumatic foot compression can activate blood fibrinolysis without changes in blood coagulability and platelet activation

S Kohro, M Yamakage, K Sato, JI Sato, A Namiki

ACTA ANAESTHESIOLOGICA SCANDINAVICA ( BLACKWELL MUNKSGAARD ) 49 ( 5 ) 660 - 664 2005年05月

Background: Intermittent pneumatic foot compression (IPC) is a useful technique for prophylaxis of peri-operative venous thromboembolism. The aim of this study was to determine the effect of IPC on blood coagulation/fibrinolysis and platelet function using a blood viscometer (Sonoclot(TM)) and a platelet aggregation monitor (WBA analyzer(TM)), respectively. Using the same blood samples, serum levels of tissue-type plasminogen activator (t-PA), thrombomodulin (TM) and activated protein C (APC) were also measured. Methods: The soles and legs of each subject (n = 8) were compressed for 3 s (130 mmHg) at a 0.3-Hz interval using an IPC device. Parameters were measured 2 min before and at the end of 60-min compression. Results: Parameters of the Sonoclot time-to-peak were shortened and clot retraction rate was increased significantly by IPC, whereas the other parameters did not change. These results indicate that IPC can activate blood fibrinolysis but not coagulability. A parameter of the WBA analyzer PATI (platelet aggregatory threshold index) did not change, indicating that IPC cannot activate platelet function per se. The concentration of t-PA decreased slightly but significantly. A decrease in the concentration of t-PA can lead to activation of fibrinolysis. Other humoral parameters did not change, indicating that IPC has no effect on endothelial function. Although neither blood coagulability nor platelet function were affected by IPC, fibrinolytic activity increased slightly, probably by activation of t-PA function. Conclusion: IPC is useful for prophylaxis for thromboembolism by activation of blood fibrinolysis as well as inhibition of blood stasis.

DOI

A trial of introduction of portfolio to elective clinical clerkship in anesthesiology

Michiaki Yamakage, Hiroki Yamamoto, Shinji Kohro, Akiyoshi Namiki

Japanese Journal of Anesthesiology 54 ( 5 ) 551 - 556 2005年05月

Background: Portfolio as one of the educational techniques was introduced to elective clinical clerkship (CC) of Anesthesiology in Sapporo Medical University School of Medicine in the 2003 fiscal year. Methods: Fourteen medical students who elected Anesthesiology CC for 3 weeks had a duty to study and feed back their CC everyday by writing portfolio, and the attending checked and fed back their portfolio every week. At the end of the CC, questionnaire surveys by 5 step Likert measure and group discussion were conducted to determine the evaluation by students of the portfolio in Anesthesiology CC. Results: The average score of the questionnaire surveys was high (4.78). However, the scores of usefulness of the portfolio for feedback to student's attitude and to good relationship among medical staff were relatively low (4.6 and 4.4, respectively). Conclusions: The use of a portfolio as a educational technique in elective CC seems to be useful, and further education to chief/senior medical staff for feedback to student's attitude and other kinds of educational techniques for feedback to good relationship among medical staff are needed.

PubMed

Evaluation by undergraduate medical students of Clinical Clerkships in the Department of Anesthesiology - Comparison with the evaluation in previous fiscal year

Michiaki Yamakage, Shinji Kohro, Hiroki Yamamoto, Akiyoshi Namiki

Japanese Journal of Anesthesiology 54 ( 5 ) 541 - 550 2005年05月

Background: Clinical Clerkships in the Department of Anesthesiology were evaluated by undergraduate medical students and compared with other clinical departments and those of previous fiscal year 2003. Methods: Questionnaire surveys by 5 step Likert measure were conducted to ask the students for the evaluation of each department or division, and formative evaluation was performed after the all 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 of our department was 4.40 (mean, 5th grade of all 26 departments/divisions), and the score of the question on provision of medical practice (4.71) was the best among the all departments/divisions. The evaluation grading was rather low for the question on chance for physical examinations (3.80). 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 physical examinations, is also needed for undergraduate students in the program by including palliative medical care program.

PubMed

クロニジン前投与患者に発症した麻酔覚醒直後の腹痛症例

岩崎創史, 山蔭道明, 渡辺政徳, 山内正憲, 浅野真, 並木昭義

臨床麻酔 ( 真興交易(株)医書出版部 ) 29 ( 5 ) 846 - 848 2005年05月

クロニジンを前投与して全身麻酔管理を行った63名中5名が,筋弛緩拮抗薬ネオスチグミン投与直後に腹痛を発症した.2名は自然寛解したが,残りの3名はブチルスコポラミンの投与を必要とした.前投薬として使用したクロニジン,筋弛緩拮抗薬のネオスチグミンの相互作用による自律神経のアンバランスが機序として推測された.クロニジンは少量でかつ単回投与で消化管運動に影響を与えることが指摘されているため,筋弛緩拮抗薬などの自律神経作用薬との相互作用により腹痛などの合併症を引き起こすことがある(著者抄録)

紹介麻酔科選択クリニカル・クラークシップへのポートフォリオ導入の試み

山蔭道明, 山本浩貴, 佐藤順一

麻酔 ( 克誠堂出版 ) 54 ( 5 ) 551 - 556 2005年05月

CiNii

2種のプロポフォール製剤における微生物増殖試験

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

CiNii

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

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

輸液と体温管理

麻酔 53 10 - 22 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

必携麻酔科初期研修マニュアル 2004年

Anticoagulants and Antiplatelet agents

J Clin Anesth (Jpn) 28 342 - 354 2004年

Guideline for basic techniques

Manual for Residents in Anesthesiology 2004年

麻酔の知識

オペナーシング 19 394 - 400 2004年

GVHD

Anesthesia Clinical Practice 14 97 - 120 2004年

抗凝固薬と抗血小板薬

臨床麻酔 28 342 - 354 2004年

医療ガス，体温管理

役に立つ手術室ハンドブック 2004年

Knowledge for Basic Anesthesia

Openursing 19 394 - 400 2004年

A Case of Suspected Pulmonary Thrombosis in a Patient with Reactive Thrombocytemia Who Underwent Liver Subsegmentectomy

Shin-Ichiro Yoshida, Shinji Kohro, Michiaki Yamakage, Masayasu Nakayama, Akiyoshi Namiki

Japanese Journal of Anesthesiology 52 ( 12 ) 1320 - 1322 2003年12月

A 68·year-old man with reactive thrombocytemia (platelet count:97.2x104·mm-3) underwent liver subsegmentectomy for hepatocellular carcinoma. Thoracic epidural combined with general anesthesia was carried out for the surgery. Platelet aggregability was monitored during the operation. At the beginning of the operation, platelet aggregability to aggregating factor ADP showed an abnormal pattern without dose dependency. In spite of continuous administration of gabexate mesilate for inhibition of thrombosis, the patient developed hypercapnia with low end tidal CO2 pressure (PETco2) and hypoxia, suggesting pulmonary embolism. PETco2 and Spo2 recovered soon after heparin administration. The patient recoverd without any neurologic complications. This case demonstrated that hyperaggregability is possible in patients with thrombocytemia and suggests that monitoring of platelet function in patients with thrombocytemia is difficult.

PubMed

術中肺塞栓症を発症した反応性血小板増加症の麻酔経験

吉田真一郎, 紅露伸司, 山蔭道明

麻酔 ( 克誠堂出版 ) 52 ( 12 ) 1320 - 1322 2003年12月

CiNii

The infusion rate of most disposable, non-electric infusion pumps decreases under hypobaric conditions

M Mizuuchi, M Yamakage, S Iwasaki, A Kimura, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANESTHESIOLOGISTS SOC ) 50 ( 7 ) 657 - 662 2003年08月

Purpose: To examine the delivery rates of four disposable, non-electric infusion pumps during hypobaric conditions. Methods: Four models categorized by three different driving forces, one vacuum unit (Coopdech Syringector), one spring unit (Linear-fuser), and two elastomeric balloon-powered units (Multirate Infuser LV and Large DIB), were tested. Each infusion pump was placed in an airtight container, and the pressure in the container was decreased to 1,000, 900, and 800 hPa. The catheter tip of each pump was exposed either to atmospheric pressure (1,000 hPa) or to similar hypobaric conditions (800-1,000 hPa). Results: Under normal atmospheric pressure, each pump showed an accurate delivery rate in the range of -2% to +8% of the set infusion rate (4.0-5.0 mL.hr(-1)). With the catheter tip exposed to atmospheric pressure, the infusion rate of each pump was reduced from 35% in the case of the Large DIB to 64% in the case of the Coopdech Syringector, depending on the magnitude of change in hypobaric pressure. When the pressure acting on the catheter tip was reduced to a level similar to that exerted on the pump body, infusion rate was reduced (by 19%-27%) in all three types of pump, and the Large DIB showed no significant difference in performance compared to normal atmospheric pressure. Conclusion: The infusion rates of disposable infusion pumps are reduced under hypobaric conditions. Even though we still do not know how the epidural pressure changes under hypobaric conditions, clinicians should be aware that the infusion rate of disposable infusion pumps is decreased under hypobaric conditions.

電気メス使用時に極度の徐脈をきたしたペースメーカー埋め込み患者の1例

岩崎創史, 古瀬晋吾, 渡辺政徳, 山内正憲, 浅野真, 山蔭道明, 並木昭義

北海道外科雑誌 ( 北海道外科学会 ) 48 ( 1 ) 117 - 117 2003年06月

Repeated or prolonged isoflurane exposure reduces mitochondrial oxidizing effects

S Kohro, QH Hogan, Y Nakae, M Yamakage, ZJ Bosnjak

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 98 ( 1 ) 275 - 278 2003年01月

DOI

Deep temperature monitoring using a zero-heat-flow method

Michiaki Yamakage, Akiyoshi Namiki

Journal of Anesthesia 17 ( 2 ) 108 - 115 2003年

書評論文，書評，文献紹介等

DOI PubMed CiNii

Effects of intermittent pneumatic foot compression on blood coagulability and fibrinolysis assessed by a whole blood viscometer Sonoclot

Shinji Kohro, Michiaki Yamakage, Toshiyuki Takahashi, Koichi Ota, Mitsu Kondo, Akiyoshi Namiki

Journal of Anesthesia 17 ( 3 ) 208 - 210 2003年

DOI PubMed CiNii

Cellular mechanisms of airway smooth muscle relaxant effects of anesthetic agents

Michiaki Yamakage, Akiyoshi Namiki

Journal of Anesthesia 17 ( 4 ) 251 - 258 2003年

書評論文，書評，文献紹介等

DOI PubMed CiNii

Anesthetic induction technique in adult

Volatile induction and maintenance of anesthesia (VIMA) - Practice from Today - 2003年

Comparative study of the efficiency of four kinds of oxygen delivery system

Can J Anaesth 50 1052 - 5 2003年

ペースメーカと麻酔

Life Support and Anesthesia 10 750 - 753 2003年

Recent aspects of medical education in Japan

Sapporo Medical Journal 72 37 - 48 2003年

体温のモニター機器

周術期管理に役立つ臨床モニター機器の知識と使い方 2003年

Equipments for body temperature monitoring

Perioperative monitoring equipments 2003年

Preoperative evaluation and perioperative management of patients with pulmonary emphysema

Life Support and Anesthesia 10 216 - 220 2003年

成人の導入法の工夫

今日から実践できるVIMA 2003年

麻酔・手術と血小板・血液凝固能

臨床麻酔 27 351 - 364 2003年

Cardiac pacemaker and Anesthesia

Life Support and Anesthesia 10 750 - 753 2003年

最近の医学教育の変遷と動向

札幌医学雑誌 72 37 - 48 2003年

Keynote, iMovie, iDVD

Nice presentation for everyone 2003年

肺気腫患者の術前評価と管理

Life Support and Anesthesia 10 216 - 220 2003年

Anesthesia/Operation and Platelet/Coagulation Function

J Clin Anesth (Jpn) 27 351 - 364 2003年

周術期体温に関する基礎知識

山蔭道明

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 22 ( 8 ) S130 - S131 2002年09月

CiNii

Prophylactic IM small-dose phenylephrine blunts spinal anesthesia-induced hypotensive response during surgical repair of hip fracture in the elderly

K Nishikawa, M Yamakage, K Omote, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 95 ( 3 ) 751 - 756 2002年09月

In a double-blinded, placebo-controlled, randomized study, we evaluated the effect of prophylactic IM phenylephrine at doses of 1.5 and 3 mg on hyperbaric tetracaine spinal anesthesia-induced hypotension in 90 normotensive and hypertensive patients aged >65 yr undergoing surgery for hip fracture. Thirty normotensive patients received 1.5 or 3 mg of phenylephrine IM (N/P-1.5 and N/P-3.0 groups; n = 15 in each), whereas controls received saline (N/C group; n = 15), and 45 hypertensive patients were treated in a similar manner (H/P-1.5, H/P-3.0, and H/C groups; n = 15 in each). All groups had a peak sensory block height of T9, with a range of T8 to T10. The incidence of hypotension (>25% decrease in mean arterial blood pressure [MAP] from baseline) was significantly lower in the patients who received phenylephrine 1.5 or 3 mg than in the controls, both in the normotensive and hypertensive groups (P < 0.01). The N/P-3.0 and N/P-1.5 groups and the H/P-3.0 group had significantly lower percentage reductions in MAP (P < 0.05) and required significantly smaller doses of rescue IV ephedrine (P < 0.05) than did the N/C group or the H/C group. The H/P-1.5 group also required significantly less rescue IV ephedrine (P < 0.05), although it was not sufficient to significantly attenuate the percentage decrease in MAP compared with that in the H/C group. Bradycardia (heart rate <50 bpm) as an adverse effect after IM administration of phenylephrine was not observed in any of the groups. Hypertension (MAP >20% increase from baseline) after medication occurred in the N/P-3.0 and H/P-3.0 groups, but not in the N/P-1.5 and H/P-1.5 groups. We conclude that prophylactic IM injection of 1.5 mg of phenylephrine is a safe (defined as the inhibition of bradycardia and hypertension) and effective means of reducing the incidence of hypotension associated with spinal anesthesia in normotensive and hypertensive elderly patients.

DOI

Inhibitory effects of volatile anesthetics on currents produced on heterologous expresssion of KvLQT1 and minK in Xenopus oocytes

XD Chen, M Yamakage, Y Yamada, N Tohse, A Namiki

VASCULAR PHARMACOLOGY ( ELSEVIER SCIENCE INC ) 39 ( 1-2 ) 33 - 38 2002年07月

The slowly activating component of delayed rectifier K+ current (I-Ks) in the heart modulates the repolarization of cardiac action potential. We investigated the effects of the volatile anesthetics isoflurane and sevoflurane on cloned I-Ks coexpressed by KvLQTI and minK. Currents were induced following injection into oocytes of KvLQTI mRNA (10 ng) with or without minK mRNA (I ng), which were transcribed in vitro from cDNAs of normal rats hearts. A two-electrode voltage-clamp recording technique was used to investigate the effects of isoflurane (0-1.5 minimum alveolar concentration, MAC) and sevoflurane (0-1.5 MAC) on I-Ks (KvLQTI with minK) and KvLQTI alone currents. Currents were activated by step depolarizations to a series of potentials from a holding potential of -80 mV and measured as the deactivating tail current on repolarization to -60 mV. Following a 2-s depolarization to 40 mV, isoflurane and sevoflurane caused potency-dependent reductions in I-Ks and KvLQTI currents. Both of the volatile anesthetics tested accelerated the deactivation of I-Ks and KvLQTI currents. We conclude that the significant inhibitory effect of volatile anesthetics on the cloned I-Ks may partly contribute to the clinical observations of the prolongation of the ventricular repolarization (Q-T interval) by the anesthetics. (C) 2002 Elsevier Science Inc. All rights reserved.

DOI

A truncated splice variant of KCNQ1 cloned from rat heart

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

BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS ( ACADEMIC PRESS INC ELSEVIER SCIENCE ) 294 ( 2 ) 199 - 204 2002年06月

KCNQ1 encodes a pore-forming subunit of potassium channels. Mutations in this gene cause inherited diseases, i.e., Romano-Ward syndrome and Jervell and Lange-Nielsen syndrome. A truncated isoform of KCNQ1 was reported to be expressed physiologically and to suppress a delayed rectifier potassium current dominant-negatively in human heart. However, it is not known whether this way of modulation occurs in other species. We cloned another truncated splice variant of KCNQ1 (tr-rKCNQ1) from rat heart. Judging from the deleted sequence of the tr-rKCNQ1, the genomic structure of rat in this portion might be different from those of human and mouse. Otherwise, an unknown exon might exist. RT-PCR analysis demonstrated that the tr-rKCNQ1 was expressed in fetal and neonatal hearts. When this gene was expressed along with a full-length KCNQ1, it suppressed potassium currents, whether a regulatory subunit minK was co-expressed or not. (C) 2002 Elsevier Science (USA). All rights reserved.

DOI PubMed CiNii

Editorial II - Effects of anaesthetic agents on airway smooth muscles

M Yamakage

BRITISH JOURNAL OF ANAESTHESIA ( OXFORD UNIV PRESS ) 88 ( 5 ) 624 - U2 2002年05月

その他

DOI

Intermittent pneumatic compression prevents venous stasis in the lower extremities in the lithotomy position

S Kohro, M Yamakage, T Takahashi, M Kondo, K Ota, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANESTHESIOLOGISTS SOC ) 49 ( 2 ) 144 - 147 2002年02月

Purpose: To investigate the interactions of a new lithotomy positioning device (LPD) with two intermittent pneumatic compression (IPC) devices by measuring femoral venous flow velocity. Methods: Subjects were divided into three groups: 1) supine position as a control, 2) lithotomy position using a conventional LPD, and 3) lithotomy position using a new LPD, Levitator(TM), These three groups were further divided in two according to the type of IPC device used: AV-impulse(TM) (rapid IPC) and SeQuel(TM) (standard IPC). Peak femoral venous flow velocity was measured by using an ultrasonic echo diagnostic device. Data were analyzed by one-way ANOVA with Fisher's test or by the unpaired two-tailed t test. Results: Moving to the conventional lithotomy position from the supine position, venous flow velocity was decreased by 38% in both IPC device groups. Even when the new LPD was used to support the lithotomy position, the flow velocity was decreased by 24%, but the velocity was significantly higher than in the conventional lithotomy position. Both rapid and standard IPC devices increased flow velocity to 77% and 107% (first compression) and to 71 % and 84% (fifth compression) of the control values during compression, respectively. In the lithotomy position group using the new LPD, similar increases in flow were seen with the use of IPC devices. Conclusion: Both rapid and standard IPC devices are useful for maintaining venous flow of the lower extremities in the lithotomy position.

Inhibitory effects of volatile anesthetics on K+ and Cl- channel currents in porcine tracheal and bronchial smooth muscle

XD Chen, M Yamakage, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 96 ( 2 ) 458 - 466 2002年02月

Background. K+ and Ca2+-activated Cl- (Cl-Ca) channel currents have been shown to contribute to the alteration of membrane electrical activity in airway smooth muscle. This study was conducted to investigate the effects of volatile anesthetics, which are potent bronchodilators, on the activities of these channels in porcine tracheal and bronchial smooth muscles. Methods: Whole-cell patch clamp recording techniques were used to investigate the effects of superfused isoflurane (0-1.5 minimum alveolar concentration) or sevoflurane (0-1.5 minimum alveolar concentration) on K+ and Clue channel currents in dispersed smooth muscle cells. Results: Isoflurane and sevoflurane inhibited whole-cell K+ currents to a greater degree in tracheal versus bronchial smooth muscle cells. More than 60% of the total K+ currents in tracheal smooth muscle appeared to be mediated through delayed rectifier K+ channels compared with less than 40% in bronchial smooth muscle. The inhibitory effects of the anesthetics were greater on the delayed rectifier K+ channels than on the remaining K+ channels. Cl- currents through Cl-Ca channels were significantly inhibited by the anesthetics. The inhibitory potencies of the anesthetics on the Clue channels were not different in tracheal and bronchial smooth muscle cells. Conclusions: Volatile anesthetics isoflurane and sevoflurane significantly inhibited Cl- currents through Cl-Ca channels, and the inhibitory effect is consistent with the relaxant effect of volatile anesthetics in airway smooth muscle. Different distributions and different anesthetic sensitivities of K+ channel subtypes could play a role in the different inhibitory effects of the anesthetics on tracheal and bronchial smooth muscle contractions.

Calcium channels - basic aspects of their structure, function and gene encoding; anesthetic action on the channels - a review

M Yamakage, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANESTHESIOLOGISTS SOC ) 49 ( 2 ) 151 - 164 2002年02月

書評論文，書評，文献紹介等

Purpose: To review recent findings concerning Call channel subtype/structure/function from electrophysiological and molecular biological studies and to explain Ca2+ channel diseases and the actions of anesthetics on Ca2+ channels. Source: The information was obtained from articles published recently and from our published work. Principal findings: Voltage-dependent Ca2+ channels serve as one of the important mechanisms for Ca2+ influx into the cells, enabling the regulation of intracellular concentration of free Ca2+, Recent advances both in electrophysiology and in molecular biology have made it possible to observe channel activity directly and to investigate channel functions at molecular levels, The Ca2+ channel can be divided into subtypes according to electrophysiological characteristics, and each subtype has its own gene. The L-type Ca2+ channel is the target of a large number of clinically important drugs, especially dihydropyridines, and binding sites of Ca2+ antagonists have been clarified. The effects of various kinds of anesthetics in a variety of cell types have been demonstrated, and some clinical effects of anesthetics can be explained by the effects on Ca2+ channels. It has recently become apparent that some hereditary diseases such as hypokalemic periodic paralysis result from calcium channelopathies. Conclusion: Recent advances both in electrophysiology and in molecular biology have made it possible to clarify the Ca2+ channel structures, functions, genes, and the anesthetic actions on the channels in detail. The effects of anesthetics on the Ca2+ channels either of patients with hereditary channelopathies or using gene mutation techniques are left to be discovered.

Sevoflurane inhibits contraction of uterine smooth muscle from pregnant rats similarly to halothane and isoflurane

M Yamakage, N Tsujiguchi, XD Chen, Y Kamada, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANESTHESIOLOGISTS SOC ) 49 ( 1 ) 62 - 66 2002年01月

Purpose: The present study was designed to clarify the direct effects of the volatile anesthetics halothane, isoflurane and sevoflurane on oxytocin-induced uterine smooth muscle contraction from pregnant rats. Methods: Longitudinal smooth muscle layers were obtained from pregnant rats. Intracellular concentration of free Ca++ ([Ca++](i)) was measured, using a fluorescence technique, simultaneously with muscle tension. Inward Ba++ current (I-Ba) through voltage-dependent Ca++ channels (VDCCs) was measured using a whole cell patch clamp technique. After incubation with 20 nM oxytocin, halothane, isoflurane or sevoflurane (1, 2, and 3%) was introduced into the tissue bath. Results: Ail volatile anesthetics significantly inhibited muscle contraction concomitant with a decrease in [Ca++](i). Volatile anesthetics also inhibited the peak I-Ba, When the anesthetic concentrations were expressed as multiples of minimum alveolar concentrations, there were no differences in the inhibitory potencies of the three volatile agents tested for muscle tension and VDCC. Conclusions: Volatile anesthetics halothane, isoflurane and sevoflurane reduce the oxytocin-induced contraction of pregnant uterine smooth muscle. Inhibition of the contraction by the volatile anesthetics is due, at least in part, to the decrease in [Ca++](i) and the decrease in [Ca++](i) may be mediated by inhibition of VDCC activity.

The repolarizing effects of volatile anesthetics on porcine tracheal and bronchial smooth muscle cells

M Yamakage, XD Chen, A Kimura, S Iwasaki, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 94 ( 1 ) 84 - 88 2002年01月

This study was conducted to determine the effects of volatile anesthetics (potent bronchodilators) on membrane potentials in porcine tracheal and bronchial smooth muscle cells. We used a current-clamp technique to examine the effects of the volatile anesthetics isoflurane (1.5 minimum alveolar anesthetic concentration [MAC]) and sevoflurane (1.5 MAC) on membrane potentials of porcine tracheal and bronchial (third- to fifth-generation) smooth muscle cells depolarized by a muscarinic agonist, carbachol (1 muM). The effects of volatile anesthetics on muscarinic receptor binding affinity were also investigated by using a radiolabeled receptor assay technique. The volatile anesthetics isoflurane and sevoflurane induced significant repolarization of the depolarized cell membranes in the trachea (from -19.8 to -23.6 mV and to -24.8 mV, respectively) and bronchus (from -24.7 to -29.3 mV and -30.4 mV, respectively) without affecting carbachol binding affinity to the muscarinic receptor, The repolarizing effect was abolished by a Ca2+-activated Cl- channel blocker, niflumic acid. These results indicate that volatile anesthetic-induced repolarization of airway smooth muscle cell membranes might be caused by a change in Ca2+-activated Cl channel activity and that the different repolarized effects of the volatile anesthetics could in part contribute to the different effects of volatile anesthetics on tracheal and bronchial smooth muscle contractions.

Usefulness of oral hypnotic premedication for volatile induction of anesthesia in adults

Michiaki Yamakage, Shigeo Tsuchiya, Naomi Ohtsuka, Sohshi Iwasaki, Akiyoshi Namiki

Journal of Anesthesia 16 ( 3 ) 194 - 197 2002年

Purpose. We investigated the effects of oral hypnotic premedication for smooth anesthetic induction and for the patient's comfort under anesthesia, using sevoflurane without nitrous oxide. Methods. Adult patients were divided into four groups: control (n = 12), triazolam (0.25mg n = 12), zopiclone (7.5mg n = 12), and clonidine (0.15mg n = 12) groups. Each premedication was given to each patient 1 h before the anesthesia. The patients breathed out to residual volume and then the anesthetic mask was fitted. The repeated vital capacity breathing technique was used, with 5% sevoflurane in 101·min-1 oxygen. Induction time, specific induction side effects, and acceptability of this technique by the patients were recorded by an independent observer. Results. Induction time in the premedicated groups ranged from 66 ± 12s (mean ± SD) to 76 ± 14s, and these values were significantly shorter than that in the control group (92 ± 16s). The number of patients in whom adverse effects occurred during anesthetic induction was significantly greater in the control group (4 patients 33%) than in the premedicated groups (1 patient each 8%). Acceptability of the smell of sevoflurane was significantly higher in the premedicated groups (8-10 patients 67%-83%) than in the control group (5 patients 42%). Conclusion. Oral hypnotic premedications with either triazolam (0.25 mg), zopiclone (7.5 mg), or clonidine (0.15 mg) are recommended for smoother volatile anesthetic induction and for the patient's comfort in adults.

DOI CiNii

Evaluation of four techniques of warming intravenous fluids

Naomi Ohtsuka, Michiaki Yamakage, Xiangdong Chen, Yasuhiro Kamada, Akiyoshi Namiki

Journal of Anesthesia 16 ( 2 ) 145 - 149 2002年

Purpose. This study was conducted to compare the fluid warming capabilities at different flow rates in four different warming systems. Methods. The intravenous (IV) fluid warmers used in this study were a water-bath warmer, a forced-air warmer, a dry-heat plate warmer, and an IV fluid tube warmer. Ringer's solution at room temperature or at ice-cold temperature (120-3000 ml·h-1) was used as an IV fluid, and the IV fluid temperatures were measured with thermocouples at the end of a 1-m tube connected to the warmer. Results. The temperature of the IV fluid delivered by the water bath and the forced-air warming system increased as the flow rate increased up to 1200 ml·h-1 but decreased with further increase of the flow rate. The temperature of the IV fluid delivered by the dry-heat plate warmer significantly increased as the flow rate increased within the range studied. The delivered temperature did not depend on the flow rate within the range studied when the IV fluid tube warmer was used. Conclusion. It is important to choose a warmer according to its characteristics as well as its performance.

DOI

Topics related to tabacco

YAMAKAGE M

Journal of Clinical Anesthesia Japan 24 641 - 651 2002年

CiNii

Evaluation of a newly developed monitor of deep body temperature

Michiaki Yamakage, Sohshi Iwasaki, Akiyoshi Namiki

Journal of Anesthesia 16 ( 4 ) 354 - 357 2002年

DOI CiNii

Body temperature management

J Clin Anesth (Jpn) 26 1681 - 1692 2002年

Nitrous oxide

Medical Gases and risk management 2002年

自験例からみた体温管理

臨床麻酔 26 1681 - 1692 2002年

Non-obstetric anesthesia during pregnancy

Practice in Clinical Anesthesia 2002年

Respiratory diseases

Anesthesiologists and Consultation 2002年

呼吸器系疾患

麻酔科医とコンサルテーション 2002年

医療ガス−用途とその作用・管理法−．５．亜酸化窒素

日常診療に役立つ医療ガスと危機管理 2002年

妊娠初期・後期患者の非産科手術の麻酔

麻酔科診療プラクティス 2002年

たばこにまつわる問題点

臨床麻酔 24 641 - 651 2002年

A case report of inflammatory pseudotomors of the liver and spleen

Anesth Resus 38 61 - 63 2002年

Anesthetic effects on mitochondrial ATP-sensitive K channel

S Kohro, QH Hogan, Y Nakae, M Yamakage, ZJ Bosnjak

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 95 ( 6 ) 1435 - 1440 2001年12月

Background Volatile anesthetics show an ischemic preconditioning-like cardioprotective effect, whereas intravenous anesthetics, have cardioprotective effects for ischemic-reperfusion injury. Although recent evidence suggests that mitochondrial adenosine triphosphate-regulated potassium (mitoK(ATP)) channels are important in cardiac preconditioning, the effect of anesthetics on mitoK(ATP) is unexplored. Therefore, the authors tested the hypothesis that anesthetics act on the mitoK(ATP), channel and mitochondrial flavoprotein oxidation. Methods: Myocardial cells were isolated from adult guinea pigs. Endogenous mitochondrial flavoprotein fluorescence, an Indicator of mitochondrial flavoprotein oxidation, was monitored with fluorescence microscopy while myocytes were exposed individually for 15 min to isoflurane, sevoflurane, propofol, and pentobarbital. The authors further Investigated the effect of 5-hydroxydeanoate, a specific mitoK(ATP) channel antagonist, on isoflurane- and sevoflurane-induced flavoprotem oxidation. Additionally, the effects of propofol and pentobarbital on isoflurane-induced flavoprotein oxidation were measured. Results: Isoflurane and sevoflurane induced dose-dependent increases in flavoprotein oxidation (Isoflurane: R2 = 0.71, n = 50; sevoflurane: R2 = 0.86, n = 20). The fluorescence increase produced by both isoflurane and sevoflurane was eliminated by 5-hydroxydeanoate. Although propofol and pentobarbital showed no significant effects on flavoprotein oxidation, they both dose-dependently inhibited isoflurane-induced flavoprotein oxidation. Conclusions: Inhalational anesthetics induce flavoprotein oxidation through opening of the mitoK(ATP) channel. This may be an important mechanism contributing to anesthetic-induced preconditioning. Cardioprotective effects of intravenous anesthetics may not be dependent on flavoprotein oxidation, but the administration of propofol or pentobarbital may potentially inhibit the cardioprotective effect of inhalational anesthetics.

腹腔鏡下胆嚢摘出術における麻酔方法の検討

辻口直紀, 山蔭道明, 小瀧正年, 並木昭義

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 21 ( 9 ) 409 - 415 2001年11月

CiNii

Mechanisms of direct inhibitory action of propofol on uterine smooth muscle contraction in pregnant rats

N Tsujiguchi, M Yamakage, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 95 ( 5 ) 1245 - 1255 2001年11月

Background: Although propofol directly inhibits uterine smooth muscle contraction, the mechanisms of this effect are still unknown. The current study aimed to clarify the mechanisms of the inhibitory effect of propofol on oxytocin-induced uterine smooth muscle contraction by measuring (1)the concentration of intracellular free Ca2+ ([Ca2+](i)) simultaneously with muscle tension, (2) the amount of intracellular inositol 1,4,5-triphosphate ([IP3](i)), and (3) voltage-dependent Ca2+ channel (VDCC) activity. Methods: Uterine smooth muscle tissues were obtained from pregnant rats (in late gestation). [Ca2+](i) with isometric tension was monitored by the 500-nm light emission ratio of preloaded Ca2+ indicator fura-2. [IP3](i) and VDCC activity were measured by radioimmunoassay and patch clamp techniques, respectively. The uterine smooth muscle was stimulated by 20 nm oxytocin and exposed to propofol (10(-7) similar to 10(-4) M). Results: Propofol had significant inhibitory effects on oxytocin-induced uterine smooth muscle contraction and increased [Ca2+]i in pregnant rats in a dose-dependent manner, without affecting the agonist-receptor binding affinity. Propofol inhibited the increase in [IP3](i) induced by oxytocin. Propofol also inhibited VDCC activity in both activated and inactivated states. The solvent Intralipid((R)) had no effects on these parameters. Conclusions: Propofol inhibits oxytocin-induced uterine smooth muscle contraction, at least in part, by decreasing [Ca2+](i) without affecting agonist-receptor binding; the inhibitory effect of propofol on [Ca2+](i) might be mediated both by a decrease in [IP3](i) and by inhibition of VDCC activity.

Use of the fibreoptic stylet scope (Styletscope (TM)) reduces the hemodynamic response to intubation in normotensive and hypertensive patients

A Kimura, M Yamakage, XD Chen, Y Kamada, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANESTHESIOLOGISTS SOC ) 48 ( 9 ) 919 - 923 2001年10月

Purpose: To compare hemodynamic changes after tracheal intubation when using a new fibreoptic stylet scope (Styletscope (TM)) and a conventional laryngoscope in normotensive and hypertensive patients. Methods: Normotensive (N; n=30) and hypertensive (H; n=30) patients undergoing general anesthesia participated in this study. Each group was divided into two groups. In one group, patients were intubated by using a stylet scope with a laryngoscope as an adjuvant (S; n= 15 each), while patients in the other group were intubated using a laryngoscope by the usual technique (L; n = 15 each). The time necessary for intubation, hemodynamic changes, and adverse effects were recorded. Results: Patients in the normotensive groups (SN and LN groups) showed significant increases in both systolic and diastolic blood pressures from before induction to one minute after intubation; however, blood pressures in the SN group were significantly lower than those in the LN group. Both systolic and diastolic blood pressures increased after intubation in the LH group, but not in the SH group. Heart rates in all four groups showed significant increases, and there were no differences between heart rates in the stylet scope and laryngoscope groups or between the normotensive and hypertensive groups. The number of patients who complained of sore throat was greater in the laryngoscope groups. Conclusions: Tracheal intubation with a stylet scope can attenuate hemodynamic changes and reduce the incidence of sore throat in comparison with the conventional laryngoscope technique in both normotensive and hypertensive patients.

Production of compound A under low-flow anesthesia is affected by type of anesthetic machine

M Yamakage, A Kimura, XD Chen, N Tsujiguchi, Y Kamada, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANESTHESIOLOGISTS SOC ) 48 ( 5 ) 435 - 438 2001年05月

Purpose: The purpose was to compare the concentrations of compound A in inspired gas breathed by patients produced by different types of anesthetic machines under prolonged sevoflurane low-flow anesthesia. Methods: The anesthetic machines tested were Excel (TM) 210 SE (Datex-Ohmeda, Louisville, CO), Cicero (TM) (Drager, Lubeck, Germany), and AS/3 (TM) ADU (Datex-Ohmeda, Louisville, CO). Anesthesia expected to last more than four hours was maintained with 2.0% sevoflurane and nitrous oxide (0.5 L(.)min(-1)) / oxygen (0.5 L(.)min(-1)). The concentrations of compound A, obtained from the inspiratory limb of the circle system, were measured using a gas chromatograph. Results: When Excel (TM) and Cicero (TM) were used, concentrations of compound A increased steadily from the baseline values to 28 and 29 (mean) ppm, respectively, at two hours after exposure to sevoflurane and became constant. There was no significant difference between the concentrations of compound A produced by these anesthetic machines. In contrast, the new anesthetic machine AS/3 (TM) was associated with lower concentrations of compound A (6 ppm at one hour. P <0.05 compared with Excel (TM) and Cicero (TM)), and the concentration did not change significantly thereafter. Conclusion: In spite of the use of a conventional carbon dioxide (CO2) absorbent with strong bases. the anesthetic machine AS/3 (TM) with a small volume of canister/soda lime (900 ml/700 ml) produced lower concentrations of compound A than those produced by the other machines.

Different inhibitory effects of volatile anesthetics on T- and L-type voltage-dependent Ca2+ channels in porcine tracheal and bronchial smooth muscles

M Yamakage, XD Chen, N Tsujiguchi, Y Kamada, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 94 ( 4 ) 683 - 693 2001年04月

Background: The distal airway is more important in the regulation of airflow resistance than is the proximal airway, and volatile anesthetics have a greater inhibitory effect on distal airway muscle tone. The authors investigated the different reactivities of airway smooth muscles to volatile anesthetics by measuring porcine tracheal or bronchial (third to fifth generation) smooth muscle tension and intracellular concentration of free Ca2+ ([Ca2+](i)) and by measuring inward Ca2+ currents (I-Ca) through voltage-dependent Ca2+ channels (VDCs). Methods: Intracellular concentration of free Ca2+ was monitored by the 500-nm light emission ratio of Ca2+ indicator fura-2, Isometric tension was measured simultaneously. Whole-cell patch clamp recording techniques were used to investigate the effects of volatile anesthetics on I-Ca in dispersed smooth muscle cells. Isoflurane (0-1.5 minimum alveolar concentration) or sevoflurane (0-1.5 minimum alveolar concentration) was introduced into a bath solution. Results: The volatile anesthetics tested had greater inhibitory effects on carbachol-induced bronchial smooth muscle contraction than on tracheal smooth muscle contraction. These inhibitory effects by the anesthetics on muscle tension were parallel to the inhibitory effects on [Ca2+](i). Although tracheal smooth muscle cells had only L-type VDCs, some bronchial smooth muscle cells (similar to 30%) included T-type VDC, Each of the two anesthetics significantly inhibited the activities of both types of VDCs in a dose-dependent manner; however, the anesthetics had greater inhibitory effects on T-type VDC activity in bronchial smooth muscle. Conclusions: The existence of the T-type VDC in bronchial smooth muscle and the high sensitivity of this channel to volatile anesthetics seem to be, at least in part, responsible for the different reactivities to the anesthetics in tracheal and bronchial smooth muscles.

Celite-activated viscometer Sonoclot can measure the suppressive effect of tranexamic acid on hyperfibrinolysis in cardiac surgery

K. Kamada, M. Yamakage, T. Niiya, N. Tsujiguchi, X. Chen, A. Namiki

Journal of Anesthesia 15 ( 1 ) 17 - 21 2001年

Purpose. To investigate the usefulness of the celite-activated viscometer Sonoclot for monitoring fibrinolytic status in cardiac surgery, we demonstrated the demonstrated effectiveness of high doses of tranexamic acid, an antifibrinolytic agent, in reducing post-operative bleeding. Methods. Thirty-two American Society of Anesthesiologists (ASA) physical status III patients who required cardiac surgery with cardiopulmonary bypass (CPB) were studied. Anesthesia was induced by a high dose of fentanyl and midazolam with oxygen and was maintained by the intermittent administration of these agents. Patients were divided into two groups: the control group (n = 15) and patients receiving tranexamic acid (TA n = 17). The TA group received a high dose (50 mg/kg) of TA twice, once before and once after CPB. The percentage diminishing rate of the Sonoclot tracing 15 min after maximum clot signal (DR15) and the amount of postoperative bleeding were measured. Results. After CPB, DR15 in the control group (mean 28.3%) increased significantly by 45%, and the DR15 in the TA group (16.1%) was significantly lower than that in the control group. The amount of postoperative bleeding in the TA group (546 ml) was significantly less, by 34%, than that in the control group (829 ml). Conclusion. Prophylactic administration of high-dose TA in cardiac surgery reduces postoperative bleeding, and this effect is consistent with changes in the diminishing rate using Sonoclot. The celite-activated viscometer Sonoclot is recommended for use in cardiac surgery for rapid assessment of fibrinolytic status.

DOI CiNii

呼吸機能の評価

麻酔のHow To−診断編− 2001年

Usefulness of midazolam premedication for volatile induction of anesthesia in adults

J. I. Hattori, M. Yamakage, S. Iwasaki, X. Chen, N. Tsujiguchi, A. Namiki

Journal of Anesthesia 15 ( 2 ) 117 - 119 2001年

DOI CiNii

Changes in sedative level during induction of anesthesia using a single volatile anesthetic

M. Yamakage, X. Chen, Y. Kamada, N. Tsujiguchi, A. Namiki

Japanese Journal of Anesthesiology 50 ( 4 ) 383 - 386 2001年

We investigated the changes in sedative level during induction of anesthesia using a single volatile anesthetic, sevoflurane, compared with the changes when propofol and sevoflurane were used. We used a bispectral index (BIS™) monitor (Aspect, Newton, USA) to monitor the sedative level. Thirty patients were randomly divided into one group receiving sevoflurane alone (S group, n= 15) and another group receiving propofol and sevoflurane (PS group, n=15). The S group received 5% sevoflurane with nitrous oxide 6 l ·min-1 and oxygen 3 l · min-1 via a face mask, while the PS group received propofol 1.5 mg · kg-1 iv followed by step-wise increasing sevoflurane up to 5%. Induction times, as assessed by loss of eyelash reflex, were 32 s in the PS group and 65 s in the S group. The decrease in the BIS value was smooth in the S group, whereas it increased transiently and varied greatly in the PS group. Two patients in the PS group showed body movement during induction of anesthesia, and the BIS values in both cases transiently exceeded 60. BIS monitor is useful for monitoring the sedative level during induction of anesthesia, and induction using a single volatile anesthetic such as sevoflurane is smooth.

PubMed

Low Flow Anesthesia (>1 L/min)

Low Flow Anesthesia 2001年

吸入麻酔薬が気管支に及ぼす影響

Anet 5 3 - 7 2001年

Pulmonary embolism and Pneumothorax

Clinical Practice of Anesthesia, Vol. 2 2001年

Guidelines of sedation and analgesia for non-anesthesiologists

Techniques of Sedation and Analgesia for Examination and Minor Surgery 2001年

Evaluation of respiratory function

How to of Anesthesia - Diagnosis version - 2001年

肺梗塞，気胸・胸水

麻酔科診療プラクティス第2巻「麻酔科専門医に必要な画像診断」 2001年

Effects of volatile anesthetics on airway/bronchus

Anet 5 3 - 7 2001年

Low-flow anesthesia and volatile induction and maintenance of anesthesia with sevoflurane

YAMAKAGE M

Anesth Resus 37 61 - 68 2001年

CiNii

Human genomics and anesthesiology

J Clin Anesth (Jpn) 25 1597 - 1603 2001年

Comparative survey of cardiac arrests during anesthesia and surgery in the 1980s and 1999s

S. Iwasaki, M. Yamakage, K. Nishikawa, X. Chen, A. Namiki

Japanese Journal of Anesthesiology 50 ( 2 ) 136 - 143 2001年

A survey of unexpected cardiac arrests, excluding those associated with cardiac surgery, that had occurred during anesthesia and surgery in the period 1980-1999 was conducted. There was no significant difference between the number of such cardiac arrests that occurred in the 1980s (29/36, 159, 0.080%) and the number in the 1990s (33/37, 643, 0.088%). According to the classification by Keenan et al., there were 3 cases (0.0083%) in the 80s and 4 cases (0.0106%) in the 90s that occurred due to anesthetic management. Cardiac arrests due to surgery itself significantly decreased from 21 cases in the 80 s to 6 cases in the 90s, probably due to proper treatment for massive bleeding, a decrease in the number of cases of anaphylactic shock, and the development of novel anesthetics. Conversely, cardiac arrests due to preoperative conditions of the patients significantly increased from 5 cases in the 80 s to 23 cases in the 90s. This increase seems to be due to an increase in the number of severe and multiple injuries and an increase in complicated major surgery. The increase in number of cases due to preoperative conditions also depends on coronary spasm and cardiac conduction insufficiency. Taking into consideration the improvement in intraoperative monitoring and the development of novel anesthetics in the 90s, greater efforts should be made by anesthesiologists to reduce the incidence of cardiac arrest due to anesthetic management, and preoperative evaluation of surgical patients needs to be reconsidered.

PubMed

セボフルランを用いた低流量麻酔（LFA）と単一吸入麻酔薬による麻酔導入維持法（VIMA）

麻酔と蘇生 37 61 - 68 2001年

ヒトゲノムと麻酔科学

臨床麻酔 25 1597 - 1603 2001年

非麻酔専門医による鎮静・鎮痛法ガイドライン

検査・小手術の鎮静法と鎮痛法 2001年

無理のない低流量麻酔の実際（新鮮ガス流量１L/min程度まで）

今日から実践できる低流量麻酔 2001年

成人の体温管理 : 開心術症例の特徴

山蔭道明

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 20 ( 8 ) S212 2000年09月

CiNii

Different inhibitory effects of volatile anesthetics on T- and L-type calcium channels in airway smooth muscle

M Yamakage, XD Chen, N Tsujiguchi, Y Kamada, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 93 ( 3A ) U234 - U234 2000年09月

研究発表ペーパー・要旨（国際会議）

Carbon dioxide absorbents containing KOH/NaOH produce much higher concentrations of compound A from sevoflurane in clinical practice

M Yamakage, S Yamada, XD Chen, S Iwasaki, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 93 ( 3A ) U225 - U225 2000年09月

研究発表ペーパー・要旨（国際会議）

Interaction between volatile anesthetics and hypoxia in porcine tracheal smooth muscle

M Yamakage, XD Chen, N Tsujiguchi, Y Kamada, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 93 ( 3A ) U234 - U234 2000年09月

研究発表ペーパー・要旨（国際会議）

脊椎麻酔時の皮膚表面温変化による麻酔域の推定

伊藤幸代, 山蔭道明, 中山禎人, 鎌田康宏, 陳向東, 並木昭義

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 20 ( 6 ) 372 - 375 2000年07月

CiNii

Carbon dioxide absorbents containing potassium hydroxide produce much larger concentrations of compound A from sevoflurane in clinical practice

M Yamakage, S Yamada, XD Chen, S Iwasaki, N Tsujiguchi, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 91 ( 1 ) 220 - 224 2000年07月

We investigated the concentrations of degraded sevoflurane Compound A during low-flow anesthesia with four carbon dioxide (CO2) absorbents. The concentrations of Compound A, obtained from the inspiratory limb of the circle system, were measured by using a gas chromatograph. In the groups administered 2 L/min fresh gas flow with 1% sevoflurane, when the conventional CO2 absorbents, Wakolime(TM) (Wako, Tokyo, Japan) and Dragersorb(TM) (Drager, Lubeck, Germany), were used, the concentrations of Compound A increased steadily from a baseline to 14.3 ppm (mean) and 13.2 ppm, respectively, at 2 h after exposure to sevoflurane. In contrast, when the other novel types of absorbents containing decreased or no potassium hydroxide/sodium hydroxide, Medisorb(TM) (Datex-Ohmeda, Louisville, CO) and Amsorb(TM) (Armstrong, Coleraine, Northern Ireland), were used, Compound A remained at baseline (<2 ppm) throughout the study. In the groups administered 1 L/min fresh gas now with 2% sevoflurane, Wakolime(TM) and Dragersorb(TM) produced much larger concentrations of Compound A (35.4 ppm and 34.2 ppm, respectively) at 2 h after exposure to sevoflurane. Medisorb(TM) showed measurable concentrations of Compound A (8.6 ppm at 2 h), but they were significantly smaller than those produced by the two conventional absorbents. In contrast, when Amsorb(TM) was used, Compound A concentrations remained at baseline throughout the study period.

Low-temperature modification of the inhibitory effects of volatile anesthetics on airway smooth muscle contraction in dogs

N Yamakage, N Tsujiguchi, J Hattori, Y Kamada, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 93 ( 1 ) 179 - 188 2000年07月

Background: Because exposure to low temperature can modify the effect of volatile anesthetics on airway smooth muscle contraction, this study was conducted to investigate low-temperature modifications of the inhibitory effects of isoflurane and sevoflurane on canine tracheal smooth muscle tone by simultaneously measuring the muscle tension and intracellular concentration of Ca2+ ([Ca2+](i)) and by measuring voltage-dependent Ca2+ channel activity. Methods: [Ca2+](i) was monitored by the 500-nm light emission ratio of preloaded fura-2, a Ca2+ indicator. Isometric tension was measured simultaneously. Whole cell patch clamp recording techniques were used to observe voltage-dependent Ca2+ channel activity in dispersed muscle cells. Isoflurane (0-3.0%) or sevoflurane (0-3%) was introduced to a bath solution at various temperatures (37, 34, or 31 degrees C). Results: Low temperature (34 or 31 degrees C) reduced high-K+-induced (72.7 mM) muscle contraction and increased [Ca2+](i), but it enhanced carbachol-induced (1 mu M) muscle contraction with a decrease in [Ca2+](i). The volatile anesthetics tested showed significant inhibition of both high-K+-induced and carbachol-induced airway smooth muscle contraction, with a concomitant decrease in [Ca2+](i). The inhibition of the carbachol-induced muscle contraction by volatile anesthetics was abolished partially by exposure to low temperature. Volatile anesthetics and low-temperature exposure significantly inhibited voltage-dependent Ca2+ channel activity of the smooth muscle. Conclusions: Exposure of airway smooth muscle to low temperature leads to an increase in agonist-induced muscle contractility, with a decrease in [Ca2+](i). The inhibition of voltage-dependent Ca2+ channel activity by exposure to low temperature and by volatile anesthetics cam be attributed, at least in part, to the decrease in [Ca2+](i).

The usefulness of celite-activated thromboelastography (sonoclot (TM)) in cardiac surgery for evaluating fibrinolyctic status

M Yamakage, Y Kamada, T Niiya, S Kohro, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 90 ( 2 ) U76 - U76 2000年02月

研究発表ペーパー・要旨（国際会議）

Modified simple technique of anesthetic induction in adults by administering sevoflurane via the face mask

M Yamakage, J Hattori, Y Kamada, N Tsujiguchi, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 90 ( 2 ) 2000年02月

研究発表ペーパー・要旨（国際会議）

Predictive variables of hypothermia in the early phase of general anesthesia

M Yamakage, Y Kamada, Y Honma, N Tsujiguchi, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 90 ( 2 ) 456 - 459 2000年02月

Core temperature decreases precipitously for 1 h and then decreases slowly for 2-3 h after the induction of general anesthesia. WE investigated the predictive variables of hypothermia by measuring peripheral skin temperature and total body fat (TBF). We studied 60 adult patients who required general anesthesia with isoflurane. The following variables were measured preoperatively: right palmar skin temperature by using an infrared thermometer and skin thickness at arm and scapula by using a standard caliper. TBF was calculated by using the regression equation of Durnin and Womersley. Rectal temperature, taken to represent core temperature, was measured during the operation. The gradient of hypothermia induced by general anesthesia was divided into two parts: 1) a precipitous decrease for the first hour and 2) a slow decrease for the following 2-3 h. Preoperative palmar skin temperature had a significant linear relationship with the precipitous decrease in temperature over the first hour (r = 0.69, P < 0.0001), and TBF had a significant linear relationship with the subsequent slow decrease in temperature (r = 0.63, P < 0.0001). By simple measurements, we can predict the extent of hypothermia in the early phase of general anesthesia and prevent its onset by using body-warming techniques. Implications: After the induction of general anesthesia, palmar skin temperature had a Linear relationship with the precipitous decrease in rectal temperature over the first hour, and total body fat had a linear relationship with the subsequent decrease in temperature. Thus, by simple measurements, we can predict the extent of hypothermia in the early phase of general anesthesia.

Preoperative evaluation

Expert Nursing for Management of Anesthesia in Operating Rooms 2000年

Anesthetic management of a patient with Freeman-Sheldon syndrome

M. Namiki, T. Kawamata, M. Yamakage, A. Matsuno, A. Namiki

Japanese Journal of Anesthesiology 49 ( 8 ) 901 - 902 2000年

We describe a case of Freeman-Sheldon syndrome that presented some problems for anesthetic management. A 2-yr-old girl required orthopedic surgery for the bilateral lower extremities. Anesthesia was induced via a mask with oxygen (2l · min-1), nitrous oxide (4l · min-1) and sevoflurane (-5%). Tracheal intubation by direct laryngoscopy was successfully achieved. Combined caudal epidural block was, however, avoided because spina bifida occulta was suspected. Spina bifida occulta was revealed postoperatively by X-ray. For anesthetic management of a patient with Freeman-Sheldon syndrome, the spine should be evaluated preoperatively when performing epidural/spinal anesthesia.

PubMed

Meaning of Statistics

Basic Statistics and How to Make Figures and Slides 2000年

General anesthesia with epidural block and control of body temperature

J Clin Anesth (Jpn) 24 1416 - 1424 2000年

麻酔の申し込み，麻酔前診察

手術室における麻酔・全身管理エキスパートナーシング 2000年

統計学の意味

図解−やさしい統計学と図表・スライドの作り方 2000年

硬膜外麻酔併用全身麻酔と体温調節

臨床麻酔 24 1416 - 1424 2000年

Direct inhibitory effect of intravenous anesthetics on the myometrium of pregnant rats

N Tsujiguchi, M Yamakage, Y Kamada, J Hattori, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 91 ( 3A ) U442 - U442 1999年09月

研究発表ペーパー・要旨（国際会議）

Volatile anesthetics inhibit voltage-dependent Ca2+channels in the myometrium from pregnant rats

M Yamakage, M Watanabe, J Hattori, Y Kamada, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 91 ( 3A ) U443 - U443 1999年09月

研究発表ペーパー・要旨（国際会議）

Direct effects of adrenergic stimulus on the CA2+and K+ channel activities of dorsal root ganglion neurons in a rat neuropathic pain model

Y Honma, M Yamakage, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 91 ( 3A ) U381 - U381 1999年09月

研究発表ペーパー・要旨（国際会議）

The predictive parameters of hypothermia in the early phase of general anesthesia

M Yamakage, Y Kamada, Y Honma, N Tsujiguchi, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 91 ( 3A ) U265 - U265 1999年09月

研究発表ペーパー・要旨（国際会議）

Changes in respiratory pattern and arterial blood gases during sedation with propofol or midazolam in spinal anesthesia

M Yamakage, Y Kamada, M Toriyabe, Y Honma, A Namiki

JOURNAL OF CLINICAL ANESTHESIA ( ELSEVIER SCIENCE INC ) 11 ( 5 ) 375 - 379 1999年08月

Study Objectives: To investigate changes in respiratory pattern and arterial blood gases during sedation with, propofol or midazolam in spinal anesthesia. Design: Randomized, placebo-controlled study. Setting: Operating room of a university-affiliated hospital. Patients: 40 ASA physical status I and II patients who required spinal anesthesia. Interventions: Spinal anesthesia with tetracaine and subsequent sedation with propofol (n = 15), midazolam (n = 15), or placebo (n = 10) was performed. Measurements: Respiratory pattern [rib cage contribution to the tidal volume (%RC) and phase shift between rib cage and abdominal movements (PSrc-ab)] with a respiratory inductive plethysmograph (Respigraph(TM)) and arterial blood gas analysis (pH, pO(2), and pCO(2)) Were recorded. Main Results: Spinal anesthesia per se increased %RC by 35% without changing PSrc-ab values (1.00). Sedation with propofol and midazolam decreased %RC by 60% and by 40%, respectively. PSrc-ab increased in both groups following sedation, and the increase in this parameter was higher in the propofol group (1.12) than in the midazolam group (1.04). In the placebo group, %RC decreased by 20% without ang change in PSrc-ab. The decrease in pO(2) was more significant in the propofol group (65.1 mmHg) than in the midazolam (74.2 mmHg) and placebo (83.1 mmHg) groups. Conclusion: Significant decreases in %RC and pO(2) during propofol sedation seem to depend on paradoxical respiration due, in part, to upper airway obstruction; therefore, attention should be directed to the respiratory pattern during sedation, especially with propofol. (C) 1999 by Elsevier Science Inc.

DOI

健常者ならびに全身麻酔症例での安全で効果的な電気敷布の設定方法

川端ルミ, 伊東琴絵, 平野裕子, 堀内千尋, 山内正憲, 山蔭道明, 並木昭義

臨床体温 ( 「臨床体温」編集委員会 ) 17 ( 1 ) 49 - 53 1999年08月

意識のある健常者ならびに全身麻酔症例で,電気敷布の温度設定の違いが体温変化に与える影響を検討した.健常者では体の下に敷いた電気敷布(電子制御敷毛布CS-262C,東京芝浦電気)の温度設定の違いにより,最も低い温度設定で使用した「L群」,最も高い温度設定で使用した「H群」,その中間で使用した「M群」の3群に健常者を分けた.全身麻酔症例(A群)は耳鼻科手術を受ける症例を対象とした.60分間の電気敷布の使用後の温度はL群35.5℃,M群38.0℃,H群41.9℃であった.健常者は3群とも核心温に変化はなかった.H群では電気敷布が43℃以上となると発汗を生じる者がいた.反対にL群では寒さを訴える者がいた.A群はM群と同じ温度設定で電気敷布を使用したところ,核心温,末梢温共に良好に保たれた.健常者,全身麻酔症例共に長時間の使用に安全で効果的な電気敷布の温度設定は37℃前後であることが明らかとなった

Effects of adrenergic stimulus on the activities of Ca2+ and K+ channels of dorsal root ganglion neurons in a neuropathic pain model

Y Honma, M Yamakage, T Ninomiya

BRAIN RESEARCH ( ELSEVIER SCIENCE BV ) 832 ( 1-2 ) 195 - 206 1999年06月

We hypothesized that abnormal activity and adrenergic sensitivity in injured dorsal root ganglion (DRG) neurons are due to an intrinsic alteration of the cell body membrane. We investigated the effects of adrenergic stimulus on the activities of Ca2+ and K+ channels of DRG neurons in a rat chronic constriction injury (CCI) model. At first, we demonstrated thermal hyperalgesia and sprouting sympathetic nerve fibers in the ipsilateral L4-L5 DRGs. Using whole-cell patch clamp techniques, we found that alpha(2)-adrenergic stimulus by 10 mu M norepinephrine (NE) inhibited inward currents (I-Ba, Ba2+ as a charge carrier) through voltage-dependent Ca2+ channels (VDCCs) of DRGs in the CCI model by 42%, whereas it enhanced the I-Ba by 18% in control animals. The inhibitory effect of NE disappeared by pretreatment with the N-type VDCC antagonist omega-conotoxin GVIA (1 mu M). NE shifted the inactivation curve to a more negative potential, showing that it has inhibitory effects on I-Ba both in activated and in inactivated states. alpha(2)-Adrenergic stimulus also inhibited outward K+ currents by 24% in the CCI model, while it had no effect on the currents in control animals. The inhibitory effect of NE was blocked by pretreatment with the Ca2+-activated K+ (K-Ca) channel antagonist charybdotoxin (40 nM). The NE-induced inhibitory effects both on N-type VDCC and on K-Ca channels in injured DRG neurons of the CCI model could lead to cell membrane depolarization, resulting in a spontaneous discharge of action potential and an increase in sensitivity to adrenergic stimulus. (C) 1999 Elsevier Science B.V. All rights reserved.

DOI PubMed CiNii

The direct effects of heparin and protamine on canine tracheal smooth muscle tone

M Yamakage, T Matsuzaki, N Tsujiguchi, T Mori, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 88 ( 6 ) 1232 - 1238 1999年06月

Heparin and protamine are used for cardiopulmonary bypass in cardiac surgery; however, the direct effects and mechanisms of these drugs on airway smooth muscle tone are still not fully known. We investigated the in vitro effects of these drugs on canine tracheal smooth muscle by measuring the muscle tension and intracellular Ca2+ con centration ([Ca2+](i)) and by measuring inward Ca2+ currents (I-Ca) through voltage-dependent Ca2+ channels. [Ca2+](i) was monitored by the 500-nm light emission ratio of preloaded Ca2+ indicator fura-2. Isometric tension was measured simultaneously. Whole-cell patch clamp recording techniques were used to investigate the effects of the drugs on I-Ca in freshly dispersed smooth muscle cells. Heparin (0.12-120 U/mL), protamine (0.15-150 U/mL), or heparin-protamine complex (4:5 U/U) was introduced into a bath solution. Protamine and heparin-protamine complex dose-dependently inhibited both carbachol-induced contraction of the muscle and increase in [Ca2+](i). These drugs also decreased the I-Ca of the muscle cells and shifted the inactivation curve to a more negative potential. Heparin itself had a slight enhancing effect on carbachol-induced muscle contraction without changing [Ca2+](i). Protamine and heparin-protamine complex can decrease the agonist-induced increase in [Ca2+](i), by the inhibition of voltage-dependent Ca2+ channels both in the activated and inactivated states. Implications: Protamine and heparin-protamine complex inhibited carbachol-induced canine tracheal smooth muscle con traction by inhibiting the increase in int acellular concentration of free Ca. These drugs can decrease the agonist-induced increase in intracellular Ca2+ by the inhibition of voltage-dependent Ca2+ channels in both the activated and inactivated states.

DOI

In vitro effects of propofol on blood coagulability and fibrinolysis by the use of thromboelastograph technique

S Kohro, M Yamakage, T Omote, A Namiki

ACTA ANAESTHESIOLOGICA SCANDINAVICA ( MUNKSGAARD INT PUBL LTD ) 43 ( 2 ) 217 - 219 1999年02月

Background: To investigate the in vitro effects of propofol on blood coagulability and fibrinolysis by the use of thromboelastograph (TEG) technique. Methods: The blood samples, obtained from 14 healthy volunteers, were divided into two groups: propofol (n=7) and intralipid (n=7), and 360 mu l volumes of whole blood were incubated with 2 mu l of 1% propofol and with its solvent intralipid, respectively. The incubated sample was then used for TEG measurements. Results: The maximum amplitude (MA), which reflects coagulability, in the intralipid group significantly increased by about 7% and 16% compared to the control and propofol groups, respectively (P<0.05), whereas the MA in the propofol group did not change. The fibrinolytic rate (FR) in the propofol group significantly increased by about 170% and 210% compared to the control and intralipid groups, respectively (P<0.05), whereas the FR in the intralipid group did not change. Conclusions: Propofol, per se, has at the concentration of 55.6 mu g . ml(-1) an in vitro accelerative effect on blood fibrinolysis detected by TEG.

DOI

Does sevoflurane anesthesia shorten vecuronium muscle relaxation during induction?

H Tsuchida, M Yamakage, H Iwasaki, A Matsuno, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 88 ( 2 ) U45 - U45 1999年02月

研究発表ペーパー・要旨（国際会議）

Circulatory response to endotracheal intubation after propofol induction - Comparative study of fentanyl with nitrous oxide sevoflurane anesthesia

H Tsuchida, A Matsuno, H Iwasaki, M Yamakage, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 88 ( 2 ) U78 - U78 1999年02月

研究発表ペーパー・要旨（国際会議）

Inhibitory effects of diazepam and midazolam on Ca2+ and K+ channels in canine tracheal smooth muscle cells

M Yamakage, T Matsuzaki, N Tsujiguchi, Y Honma, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 90 ( 1 ) 197 - 207 1999年01月

Background: Benzodiazepines have a direct bronchodilator action in airway smooth muscle, but the mechanisms by which these agents produce muscle relaxation are not fully understood, The current study was performed to identify the effects of the benzodiazepines diazepam and midazolam on Ca2+ and K+ channels in canine tracheal smooth muscle cells. Methods: Whole-cell patch-clamp recording techniques were used to evaluate the effects of the benzodiazepines diazepam (10(-8) to 10(-3) M) and midazolam (10(-8) to 10(-3) M) on inward Ca2+ and outward K+ channel currents in dispersed canine tracheal smooth muscle cells. The effects of the antagonists flumazenil (10(-5) M) and PK11195 (10(-5) M) on these channels were also studied. Results: Each benzodiazepine tested significantly inhibited Ca2+ currents in a dose-dependent manner, with 10(-6) nr diazepam and 10(-5) ar midazolam each causing approximately 50% depression of peak voltage-dependent Ca2+ currents. Both benzodiazepines promoted the Inactivated state of the channel at more-negative potentials. The Ca2+-activated and voltage-dependent K+ currents were inhibited by diazepam and midazolam (> 10(-5) M and > 10(-4) M, respectively). Flumazenil and PK11195 had no effect on these channel currents or on the inhibitory effects of the benzodiazepines. Conclusions: Diazepam and midazolam had inhibitory effects on voltage-dependent Ca2+ channels, which lead to muscle relaxation. However, high concentrations of these agents were necessary to inhibit the K+ channels. The lack of antagonized effects of their antagonists is related to the non-gamma-aminobutyric acid-mediated electrophysiologic effects of benzodiazepines on airway smooth muscle contractility.

Mechanisms of contraction and relaxation of airway smooth muscle

Anesthesiologists and Basic Research - Muscle contraction/relaxation and anesthetics 1999年

MAC

Volatile Anesthetic Sevofrane 1999年

術中体温管理のポイント

オペナーシング 14 33 - 37 1999年

Points of intraoperative management of body temperature

Ope Nursing 14 33 - 37 1999年

気道平滑筋の収縮・弛緩機構

麻酔科医と基礎研究「筋の収縮・弛緩と麻酔薬」 1999年

The usefulness of celite-activated thromboelastography for evaluation of fibrinolysis

M Yamakage, N Tsujiguchi, S Kohro, H Tsuchida, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANAESTHETISTS SOC INC ) 45 ( 10 ) 993 - 996 1998年10月

Purpose: Although thromboelastography is useful for measuring both coagulability and fibrinolysis, it takes about two hours to measure all parameters including fibrinolytic rate. The present study aimed to investigate the usefulness of celite-activated thromboelastography (TEGc) to evaluate fibrinolytic status in non-cardiac surgery. Methods: Whole blood samples were obtained from 30 patients for non-cardiac surgery, and used for measurements of both native TEG (TEGn) and TEGc. The final concentration of I % (w/v) celite was used for TEGc. Results: Time for measurement of the fibrinolytic rate (FR) of TEGc in patients (56.7 +/- 4.0 min) was less than half that of FR of TEGn (123.3 +/- 15.6 min) (P < 0.05), suggesting a more rapid assessment of fibrinolytic status. A linear relationship was observed between FR values of TEGc and those of TEGn (r = 0.93, P < 0.0001), suggesting the usefulness of the fibrinolytic parameter of TEGc. Conclusion: TEGc is a useful technique for a more rapid assessment fibrinolytic status.

Inhibitory effect of noradrenalin on voltage-dependent Ca2+ channels of rat sensory neurons in neuropathic pain model

Y Honma, M Yamakage, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 89 ( 3A ) U934 - U934 1998年09月

研究発表ペーパー・要旨（国際会議）

Inhibitory effects of halothane, isoflurane, and sevoflurane on contractility and intracellular Ca2+ concentration of pregnant myometrium in rats

M Yamakage, T Mori, N Tsujiguchi, S Kawana, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 89 ( 3A ) U881 - U881 1998年09月

研究発表ペーパー・要旨（国際会議）

Low-temperature modification of the inhibitory effect of halothane on airway smooth muscle contraction in dogs

M Yamakage, N Tsujiguchi, T Mori, T Matsuzaki, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 89 ( 3A ) U1054 - U1054 1998年09月

研究発表ペーパー・要旨（国際会議）

Formalin-induced releases of glutamate and nitric oxide, and their relationship in the skin of the rat hindpaw

K Omote, T Kawamata, M Kawamata, M Yamakage, E Narimatsu, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 89 ( 3A ) U723 - U723 1998年09月

研究発表ペーパー・要旨（国際会議）

小児前投薬のアトロピンとミダゾラムが体温に与える影響

土田亜矢, 山内正憲, 山蔭道明, 並木昭義

臨床体温 ( 「臨床体温」編集委員会 ) 16 ( 1 ) 45 - 49 1998年08月

小児の小手術において前投薬に用いるアトロピンによる体温上昇の程度,及び術前の鎮静状態と体温の関係について検討した.前投薬としてのアトロピン投与により手術室入室時に37.0℃以上となる症例数は多かったが,ミダゾラム投与による鎮静はアトロピンの体温上昇作用を抑制できなかった.麻酔前投薬としてのアトロピン投与は麻酔導入時の口腔内分泌物を減少させるが,手術室入室時の体温上昇は避けがたい

Role of intracellular Ca2+ stores in the inhibitory effect of halothane on airway smooth muscle contraction

M Yamakage, S Kohro, T Matsuzaki, H Tsuchida, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 89 ( 1 ) 165 - 173 1998年07月

Background Halothane directly inhibits contraction of airway smooth muscle, mainly by decreasing the intracellular concentration of free Ca2+ ([Ca2+](i)). The role of intracellular Ca2+ stores, sarcoplasmic reticulum, is still unclear. We investigated the role of sarcoplasmic reticulum in the inhibitory effect of halothane on contraction of airway smooth muscle by measuring [Ca2+](i) and intracellular concentration of inositol 1,4,5-triphosphate ([IP3](i)), a second messenger for release of Ca2+ from sarcoplasmic reticulum, Methods: [Ca2+](i) was monitored by measuring the 500-nm light emission ratio (F-340/F-380) of a Ca2+ indicator fura-2 with isometric tension of canine tracheal smooth muscle strip. During Ca2+-free conditions, carbachol (10(-5) M) was introduced with pretreatment of halothane (0-3%). During Ca2+-free conditions, 20 nM caffeine, a Ca2+-induced Ca2+ release channel opener, was introduced with or without halothane, We measured [IP3](i) during exposure to carbachol and halothane by radioimmunoassay technique. Results Pretreatment with halothane significantly diminished carbachol-induced increases in [Ca2+](i) by 77% and muscle tension by 83% in a dose-dependent manner. Simultaneous administration of halothane significantly enhanced caffeine-induced transient increases in [Ca2+](i) and muscle tension in a dose-dependent manner, by 97% and 69%, respectively. Pretreatment with halothane abolished these responses. Rapid increase in [IP3](i) produced by carbachol was significantly inhibited by 32% by halothane in a dose-dependent manner. Conclusions: Halothane, during Ca2+-free conditions, inhibits transient contraction of airway smooth muscle induced by muscarinic receptor stimulation, mainly by attenuating the increase in [Ca2+](i). Depletion of Ca2+ from sarcoplasmic reticulum via Ca2+-induced Ca2+ release channels also may contribute to the attenuation of the increase in [Ca2+](i) by halothane.

DOI

急速輸液の中枢温の及ぼす影響と輸液加温装置の有用性

山内正憲, 中山禎人, 山蔭道明

麻酔 ( 克誠堂出版(株) ) 47 ( 5 ) 606 - 610 1998年05月

心臓血管外科手術を受ける成人35名を対象に,30分間に投与する乳酸リンゲル液の温度(室温又は38℃),輸液量(1,000又は250ml)及び投与経路(前腕末梢静脈又は鎖骨下静脈)の違いが,中枢温(肺動脈温)の変化に及ぼす影響について検討した.室温(約19℃)で,かつ投与量が多い場合(1,000ml),中枢温は有意に低下した(0.8〜1.0℃).輸液温を38℃と一定に保つ加温装置HOT LINEを用いて輸液を投与すると,輸液経路に依存せずにこの体温低下を50〜80%予防できた

Surgical/tourniquet pain accelerates blood coagulability but not fibrinolysis

S Kohro, M Yamakage, J Arakawa, M Kotaki, T Omote, A Namiki

BRITISH JOURNAL OF ANAESTHESIA ( PROF SCI PUBL ) 80 ( 4 ) 460 - 463 1998年04月

Tissue damage during surgery induces coagulation factors and activates platelets. Surgical pain may provoke release of catecholamines, leading to hypercoagulability. We have investigated the effect of surgical pain on blood coagulability and fibrinolysis in orthopaedic operations using tourniquets in 22 patients undergoing total knee replacement. Patients were allocated to one of two groups to receive extradural anaesthesia (EA; n=11) or general anaesthesia (GA; n=11). The EA group received lumbar extradural block with lidocaine. The GA group received only general anaesthesis, maintained with 1.5-2.5% sevoflurane and 66% nitrous oxide in oxygen. Using a thrombelastogram technique, blood coagulability and fibrinolysis were measured. Mean maximum amplitude (MA), which reflects coagulability, increased after tourniquet inflation (11%) in group GA whereas MA in group EA did not change. After tourniquet deflation, MA values in both GA and EA groups increased significantly (10% and 20%, respectively) (P<0.05), and there was also a significant difference in MA between groups (P<0.05). The fibrinolytic rate did not change in either group during tourniquet inflation, but increased significantly (160%) after tourniquet deflation. There was no significant difference in fibrinolytic rate between the groups. We conclude that the hypercoagulability seen in group GA could have been caused by surgical or tourniquet pain, or both, and that extradural anaesthesia is a useful technique to prevent hypercoagulability.

Triggering delay time and work of breathing in three paediatric patient-triggered ventilators

Y Nakae, M Yamakage, M Aimono, K Tamiya, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANAESTHETISTS SOC INC ) 45 ( 3 ) 261 - 265 1998年03月

Purpose: To compare the effectiveness of three patient-triggered ventilators by evaluating triggering delay time and pressure-volume loops during initiation of inspiration. Methods: In a two-part study, a model lung was used in part I and 20 children, after tracheal intubation, in part 2. Triggering delay time and work of breathing (WOB) during pressure support ventilation using three patient-triggered ventilators: Servo Ventilator 300(TM), VIP Bird(TM), and SLE 2000 Neonatal Ventilator(TM), Triggering delay time was from the beginning of negative deflection in the oesophageal pressure trace, to re onset of inspiration. The WOE was estimated directly by measuring the oesophageal pressure-volume loop, Results: The Servo demonstrated superior triggering delay time and reduced WOE in the model study The VIP Bird demonstrated shorter triggering delay and reduced WOE in the clinical component of the study in the model lung, triggering delay time in the Servo 300 [62 +/- 6 msec (mean +/- SD)] was shorter than that in the VIP Bird (76 +/- 7 msec) (P < 0.05), and WOE with the SLE 2000 (202 +/- 37 g.cm) was greater than with other ventilators, (Servo 300, 112 +/- 32 gem and VIP Bird 72 +/- 41 g.cm) (P < 0.05), in the clinical study, triggering delay time in the VIP Bird (52 +/- 19 msec) was shorter than in the other ventilators, Servo 300 (66 +/- 14 msec), SLE 2000 (68 +/- 65 msec) (P < 0.05). The Servo 300 (56 +/- 34 g.cm) required higher WOE than the other ventilators: VIP Bird (22 +/- 12 g.cm), SLE 2000 (14 +/- 3 g.cm) (P < 0.05, Conclusion: Comparative model lung performance of these ventilators does not correspond with their clinical performance, In our clinical evaluation, the VIP Bird ventilator demonstrated superior performance with shorter triggering delay time, low WOB needed to initiate inspiration, and little air leak.

Effect of recycled autologous blood transfusion on in vitro blood coagulability and fibrinolysis

T Takeda, S Kohro, M Yamakage, N Tsujiguchi, H Tsuchida, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 86 ( 2S ) U79 - U79 1998年02月

研究発表ペーパー・要旨（国際会議）

Effects of propofol on common bile duct pressure in the canine choledochoduodenal junction

H Iwasaki, H Tsuchida, K Omote, M Yamakage, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 86 ( 2S ) U282 - U282 1998年02月

研究発表ペーパー・要旨（国際会議）

The effect of scalp infiltration with bupivacaine on blood coagulability and fibrinolysis in neurovascular surgery

N Tsujiguchi, S Kohro, M Yamakage, J Arakawa, T Omote, A Namiki

ANESTHESIA AND ANALGESIA ( LIPPINCOTT WILLIAMS & WILKINS ) 86 ( 2S ) U219 - U219 1998年02月

研究発表ペーパー・要旨（国際会議）

胸部大動脈瘤麻酔のピットフォール

臨床麻酔 22 347 - 351 1998年

Effects of anesthetics on platelet function and perioperative changes in blood coagulability/fibrinolysis

J Clin Anesth (Jpn) 22 1371 - 1382 1998年

Basic knowledge of management of body temperature

Basics of management of body temperature 1998年

麻酔薬の血小板機能に及ぼす影響と周術期の血液凝固線溶能の変化

臨床麻酔 22 1371 - 1382 1998年

喘息−周術期での喘息発作に対する対応

麻酔緊急「あなたならどうする」のコツとポイントVol. 2 1998年

Pitfall of anesthesia for thoracic aortic aneurysm

J Clin Anesth (Jpn) 22 347 - 351 1998年

人工呼吸管理で使用される記号，略語とその解説

よくわかる人工呼吸管理テキスト 1998年

体温管理の基礎知識

図解−体温管理入門 1998年

Symbols and abbreviations used for artificial respiratory management

Textbook of artificial respiratory management 1998年

Asthma

Emergency of anesthesia, Vol. 2 1998年

「心肺蘇生法をいつ,どのような状態で中止するか」に関するアンケート調査

並木昭義, 新井達潤, 重松昭生, 天羽敬祐, 鈴樹正大, 堀川秀男, 氏家良人, 表哲夫, 今泉均, 山蔭道明

蘇生 ( The Japanese Society of Reanimatology ) 17 ( 2 ) 87 - 107 1998年

日本蘇生学会の「蘇生に関する倫理委員会」では, 心肺蘇生法をいつ, どのような状態で中止するかについて, 日本蘇生学会, 日本集中治療医学会および日本麻酔学会の評議員392名に対してアンケート調査を行った。回答率は58.4%であった。心肺蘇生法を中止する判断基準として, 心肺停止時間30分以上, 心電図での心静止, 患者の状態とくに末期患者, 重篤な外傷・熱傷患者を重要視していた。30分以内の心停止では心肺蘇生法の実施は30分間程度を目安とし, 5分以内の心肺停止, 15歳未満の小児, 25℃以下の低体温, 元来健康であった人, 基礎疾患の軽い患者の場合には1時間以上行うものが多かった。閉胸式心肺蘇生法が効果がなかった場合, 開胸式および体外循環への変更を考えるものがそれぞれ46%および28%あり, 体外循環を行ったうち74%が蘇生に成功していた。心肺蘇生法の中止に関するマニュアル作成の要望が多かったが, 現時点では困難な面が多いため, 本委員会としてはガイドラインの作成を目標に置いている。

DOI CiNii

Onset of vecuronium neuromuscular blockade at the hand with an arterio-venous shunt

H Iwasaki, M Yamauchi, E Narimatsu, M Yamakage, H Tsuchida, A Namiki

CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE ( CANADIAN ANAESTHETISTS SOC INC ) 44 ( 11 ) 1208 - 1210 1997年11月

Purpose: To evaluate the onset of vecuronium neuromuscular blockade in the hand with an arterio-venous shunt for haemodialysis. Methods: In 15 adult patients receiving haemodialysis for renal failure the onset vecuronium-induced neuromuscular blockade after 0.08 mg.kg(-1) vecuronium iv was measured. Using train-of-four mechanomyographic monitoring, the force of contraction of the adductor pollicis of both hands with and without arterio-venous shunt was measured simultaneously. Results: The times from the injection to the first depression of twitch response (latent onset) and 95% twitch depression (onset) in the hand with and without arterio-venous shunt were 114.7 +/- 33.4 and 218.7 +/- 59.9 and 117.3 +/- 34.3 and 208.7 +/- 60.9 sec respectively. No difference in the onset of vecuronium neuromuscular blockade in the hand an arterio-venous shunt was demonstrated. Conclusion: The presence of an arteriovenous fistula does not modify the onset on neuromuscular blockade. Either arm can be used to monitor onset of neuromuscular blockade in chronic renal failure patients with an arterio-venous shunt in the hand for haemodialysis.

DOI

Effects of heparin and protamine on canine tracheal smooth muscle contractility and intracellular Ca2+

T Matsuzaki, M Yamakage, Y Honma, H Tsuchida, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 87 ( 3 ) A1085 - A1085 1997年09月

研究発表ペーパー・要旨（国際会議）

The effects of propofol on blood coagulability and fibrinolysis by the use of thromboelastogram technique

S Kohro, J Arakawa, T Omote, M Yamakage, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT-RAVEN PUBL ) 87 ( 3 ) A335 - A335 1997年09月

研究発表ペーパー・要旨（国際会議）

The inhibitory effects of benzodiazepines on voltage-dependent Ca2+ and K+ channels in canine tracheal smooth muscle cells

M Yamakage, T Matsuzaki, Y Honma, H Iwasaki, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 87 ( 3 ) A1115 - A1115 1997年09月

研究発表ペーパー・要旨（国際会議）

二重チューブ式血液・輸液加温装置(HOT LINETM)の使用経験

山内正憲, 中山禎人, 山蔭道明

臨床体温 ( 「臨床体温」編集委員会 ) 15 ( 1 ) 18 - 22 1997年09月

脊椎麻酔下での経尿道的手術におけるWarm TouchTMの加温効果

岡崎加代子, 山内正憲, 山蔭道明

臨床体温 ( 「臨床体温」編集委員会 ) 15 ( 1 ) 39 - 43 1997年09月

1)脊椎麻酔下での経尿道的手術を受ける患者を対象に,送風式加温装置Warm Touchの有効性を体温変化,体温温度及び快適さの点から検討した. 2)対照群では中心温の低下がみられたが,本装置を用いた上半身の加温は,鼓膜温,手掌表面温の低下を抑制し,体感温度,快適さを向上させた. 3)Warm Touchの使用は体温低下の予防に加え,手術室内での患者のQOL向上につながることが示唆された

セボフルラン反復麻酔の肝・腎機能に及ぼす影響

山蔭道明, 関純彦, 佐藤紀, 大森英哉, 岩崎寛, 並木昭義

日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 17 ( 6 ) 378 - 383 1997年07月

CiNii

Inhibition of voltage-dependent Ca2+ channels of porcine tracheal smooth muscle by the novel Ca2+ channel antagonist RWJ-22108

M Yamakage, CA Hirshman, A Namiki, TL Croxton

GENERAL PHARMACOLOGY ( PERGAMON-ELSEVIER SCIENCE LTD ) 28 ( 5 ) 689 - 694 1997年05月

1. We compared electrophysiological effects of the bronchoselective Ca2+ channel antagonist RWJ-22108 on voltage-dependent Ca2+ channels (VDCs) of porcine tracheal smooth muscle cells to the effects of nicardipine and verapamil. 2. Each of the three Ca2+ channel antagonists tested inhibited inward Ca2+ currents (I-Ca) measured by whole-cell patch clamp techniques. Inhibition was dose-dependent with similar to 50% inhibition of peak I-Ca at +20 mV obtained with 3 x 10(-6) M RWJ-22108, 3 x 10(-7) M nicardipine, or 10(-5) M verapamil. 3. Both RWJ-22108 (3 x 10(-6) M) and nicardipine (3 x 10(-7) M) shifted the voltage dependence of steady-state inactivation to more negative potentials; however, the change in the potential of half-maximal inactivation induced by RWJ-22108 (-18 mV) was significantly greater than that induced by nicardipine (-12 mV). Verapamil did not alter the voltage dependence of inactivation. 4. We conclude that inhibition of VDCs by RWJ-22108 is qualitatively similar to that by nicardipine but with a greater stabilizing effect on the inactivated channel state. (C) 1997 Elsevier Science Inc.

DOI PubMed CiNii

The relationship between respiratory patterns and work of breathing during halothane anesthesia with spontaneous ventilation

M Yamakage, S Kohro, Y Honma, M Edanaga, M Okanuma, A Namiki

ANESTHESIA AND ANALGESIA ( WILLIAMS & WILKINS ) 84 S599 - S599 1997年02月

研究発表ペーパー・要旨（国際会議）

Onset of vecuronium and pancuronium neuromuscular block with and without severe cardiac valvular disease

H Iwasaki, M Yamauchi, H Tsuchida, M Yamakage, H Ohmori, A Namiki

ANESTHESIA AND ANALGESIA ( WILLIAMS & WILKINS ) 84 S503 - S503 1997年02月

研究発表ペーパー・要旨（国際会議）

Thromboelastogram showing an undesirable effect of platelet transfusion on blood coagulability and fibrinolysis in a patient with aplastic anemia

S. Kohro, M. Yamakage, T. Takeda, A. Namiki

Journal of Anesthesia 11 ( 4 ) 303 - 306 1997年

DOI

Role of intracellular Ca2+ stores in the inhibitory effect of halothane on airway smooth muscle contraction

M Yamakage, S Kohro, A Namiki

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 85 ( 3A ) A1128 - A1128 1996年09月

研究発表ペーパー・要旨（国際会議）

EFFECTS OF HALOTHANE ON INTRACELLULAR CA2+ REGULATORY SYSTEMS IN HUMAN PLATELET

S KOHRO, M YAMAKAGE, A NAMIKI

ANESTHESIOLOGY ( LIPPINCOTT-RAVEN PUBL ) 83 ( 3A ) A309 - A309 1995年09月

研究発表ペーパー・要旨（国際会議）

INHIBITION OF VOLTAGE-DEPENDENT CA2+ CHANNELS IN PORCINE TRACHEAL SMOOTH-MUSCLE BY KETAMINE, PROPOFOL, AND THIOPENTAL

M YAMAKAGE, TL CROXTON, CA HIRSHMAN

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 83 ( 3A ) A1203 - A1203 1995年09月

研究発表ペーパー・要旨（国際会議）

Patch clamp techniques to study effects of anesthetics on airway smooth muscle cells

YAMAKAGE Michiaki, CROXTON Thomas, HIRSHMAN Carol A

Journal of anesthesia 9 ( 1 ) 111 - 112 1995年02月

CiNii

THE EFFECTS OF EXTRACELLULAR PH ON INTRACELLULAR PH, CA2+ AND TENSION OF CANINE TRACHEAL SMOOTH-MUSCLE STRIPS

M YAMAKAGE, S KOHRO, M YAMAUCHI, A NAMIKI

LIFE SCIENCES ( PERGAMON-ELSEVIER SCIENCE LTD ) 56 ( 8 ) PL175 - PL180 1995年01月

速報，短報，研究ノート等（学術雑誌）

The effects of changes in extracellular pH (pH(o)) on intracellular Ca2+ concentration ([Ca2+](i)) or intracellular pH (pH(i)) were measured simultaneously with muscle tension in canine tracheal smooth muscle strips. [Ca2+](i) and pH(i) were measured using the fluorescent dyes fura-2 and BCECF, respectively. During high K+-induced contractions (24.2, 36.4 or 72.7 mM) at pH 7.4, pH(o) was changed to 7.8 or 7.0 with NaOH or HCl, respectively. Induced changes in pH(i) were equal to similar to 50% of the changes in pH(o). Alkalinization significantly increased [Ca2+](i) and enhanced muscle contraction at all concentrations of K+ but did not alter the relationship between muscle tension and [Ca2+](i). Acidification significantly decreased [Ca2+](i) without changing muscle tone; hence, the muscle tension - [Ca2+](i) relationship was shifted to the left. These results suggest that changes in pH(o), can alter airway smooth muscle tone by changing [Ca2+](i) and pH(i).

腹部大動脈瘤および閉塞性動脈硬化症の人工血管置換術における足底深部温の変化

山内正憲, 山蔭道明, 其田一

臨床体温 ( 「臨床体温」編集委員会 ) 14 ( 2 ) 51 - 55 1994年12月

INHIBITION BY HALOTHANE OF VOLTAGE-DEPENDENT CA2+ CURRENTS IN PORCINE TRACHEAL SMOOTH-MUSCLE CELLS

M YAMAKAGE, TL CROXTON, CA HIRSHMAN

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 81 ( 3A ) A1445 - A1445 1994年09月

研究発表ペーパー・要旨（国際会議）

DIRECT INHIBITORY MECHANISMS OF HALOTHANE ON HUMAN PLATELET-AGGREGATION

S KOHRO, M YAMAKAGE, A NAMIKI

ANESTHESIOLOGY ( LIPPINCOTT-RAVEN PUBL ) 81 ( 3A ) A442 - A442 1994年09月

研究発表ペーパー・要旨（国際会議）

平滑筋に対する吸入麻酔薬の直接作用機序

山蔭道明, 土田英昭, 並木昭義

麻酔 ( 克誠堂出版 ) 42 ( 11 ) p1578 - 1586 1993年11月

CiNii

EFFECTS OF ACIDOSIS AND HYPOXIA ON THE CONTRACTILITY OF CANINE TRACHEAL SMOOTH-MUSCLE - ROLE OF INTRACELLULAR CA2+ AND PH

M YAMAKAGE, T KAWAMATA, S KOHRO, A NAMIKI

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 79 ( 3A ) A1208 - A1208 1993年09月

研究発表ペーパー・要旨（国際会議）

INHIBITORY EFFECTS OF HALOTHANE ON HIGH K+-INDUCED CANINE TRACHEAL SMOOTH-MUSCLE CONTRACTION AND INTRACELLULAR CA2+

M YAMAKAGE, T KAWAMATA, S KOHRO, A NAMIKI

ANESTHESIOLOGY ( LIPPINCOTT WILLIAMS & WILKINS ) 79 ( 3A ) A1207 - A1207 1993年09月

研究発表ペーパー・要旨（国際会議）

重度熱傷患者の術中体温低下の原因の検討

山蔭道明, 吉田泉, 川股知之, 山内正憲, 並木昭義

日臨麻会誌 ( 日本臨床麻酔学会 ) 13 ( 6 ) 548 - 554 1993年

Burn Indexが30以上の重度熱傷患者5名,計26回の手術症例において,体温低下の原因となる諸因子について検討した.麻酔導入時の体温と手術室退室時の体温との差を「体温変化(°C)」とした.体温変化と,Burn Index,麻酔時間,手術時間,出血量,輸血量,および手術時の露出体表面積との間には有意な相関関係を認めなかった.麻酔法に関しては,体温変化は笑気・酸素+ケタミン・ミダゾラム群(GO+KM群;n=16)で-0.80±0.30(平均±標準偏差)°C,笑気・酸素・イソフルレン群(GOI群;n=10)で-1.48±0.58°CでありGOI群がGO+KM群に比較して有意に低かった(P<0.01).体位に関しては,体温変化は仰臥位群(n=12)で-0.08±0.34°,腹臥位群(n=14)で-1.91±0.31°であり,腹臥位群が仰臥位群に比較して有意に低かった(P<0.005).重度熱傷患者の体温管理には,吸入麻酔薬よりもケタミンを併用した麻酔法が適切であり,さらに腹臥位手術の場合,手術開始までの時間をできるだけ短くするとともに,さらに積極的な加温方法の追加が必要である.

DOI CiNii

Mechanisms of action of volatile anesthetics on smooth muscle

M. Yamakage, H. Tsuchida, A. Namiki

Japanese Journal of Anesthesiology 42 ( 11 ) 1578 - 1586 1993年

書評論文，書評，文献紹介等

The development of intracellular Ca2+ fluorescent indicators and specific enzymatic substances as well as the application of the patch-clamp method have made it possible to clarify the mechanisms of action of volatile anesthetics on various smooth muscles. Volatile anesthetics inhibit smooth muscle contraction in part by decreasing intracellular Ca2+ concentration ([Ca2+]i) this effect is mediated by blocking calcium channels, especially the L-type voltage-operated channel, and by raising the intracellular cyclic AMP and cyclic GMP levels. Volatile anesthetic-induced suppression of smooth muscle contraction is also attributable to mechanisms independent of [Ca2+]i, which involve the depression of Ca2+ sensitization mediated by C kinase.

PubMed

三尖弁閉鎖不全を合併した拘束型心筋症の開心術麻酔経験

山内正憲, 山蔭道明, 土田英昭

臨床麻酔 ( 真興交易(株)医書出版部 ) 16 ( 7 ) 919 - 920 1992年07月

拘束型心筋症に重度のTR(三尖弁閉鎖不全)を合併した17歳男で,ミダゾラムとフェンタニールで導入し,ベクロニウムで筋弛緩を得た.肺動脈カテーテルと共にTEE(経食道内心エコー)を使用して心機能を評価し,カテコラミンの投与量などを決定した.TEEにより心房の大きさや,TRやMR(僧帽弁閉鎖不全)の程度も確認出来る為,三尖弁弁輪形成術を連続的に評価しながら補液管理を行う一方,MRの悪化に対し細心の注意を払う事が出来た

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