Yoshikawa Yuusuke

写真a

Affiliation

School of Medicine, Department of Anesthesiology

Job title

Lecturer
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Research Areas 【 display / non-display 】

  • Life sciences   Anesthesiology  

  • Life sciences   Genomics  

  • Life sciences   Cell biology  

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Affiliation 【 display / non-display 】

  • Sapporo Medical University   Department of Anesthesiology   Assistant Professor  

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Research Interests 【 display / non-display 】

  • anesthesiology

  • cardiopulmonary bypass

  • dexmedetomidine

  • cardiovascular surgery

  • cardiology

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Papers 【 display / non-display 】

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

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

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

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

    DOI PubMed

  • Dexmedetomidine as a cardioprotective drug: a narrative review.

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

    Journal of anesthesia    2023.09  [Domestic journal]

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

    DOI PubMed

  • Validity and Utility of Early Parameters in TEG6s Platelet Mapping to Assess the Coagulation Status During Cardiovascular Surgery With Cardiopulmonary Bypass.

    Yusuke Yoshikawa, Makishi Maeda, Sho Ohno, Kanako Takahashi, Yasuaki Sawashita, Tomoki Hirahata, Yutaka Iba, Nobuyoshi Kawaharada, Mitsutaka Edanaga, Michiaki Yamakage

    Cureus   15 ( 4 ) e38044  2023.04  [International journal]

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    Background The aim of this retrospective observational study was to explore the early predictive parameters for maximum amplitudein the kaolin with heparinase (HKH) assay (MAHKH) of TEG6s Platelet Mapping in cardiovascular surgery including cardiopulmonary bypass (CPB) period. The relationship between each parameter of the assay and laboratory data was also assessed. Methods We included the patients who underwent TEG6s Platelet Mapping during cardiovascular surgery under CPB between November 2021 and May 2022. The correlation between MAHKH and the early parameters was assessed. The association between each parameter of Platelet Mapping and a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000µL was also evaluated by the receiver operating characteristic (ROC) curve. Results In 23 patients who underwent TEG6s Platelet Mapping during the study period, 62 HKH assay data including 59 pairs of data (HKH assay and laboratory data) were analyzed. K and angle, but not R, were significantly correlated with MAHKH (r [95% CI]: -0.90 [-0.94, -0.83], p < 0.0001 for K, and 0.87 [0.79, 0.92], p < 0.0001 for angle). Furthermore, ROC curves suggested that these parameters predicted a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000/µL with high accuracy. Similar results were confirmed in the heparinized blood samples obtained during CPB. Conclusion These findings suggest that not only MAKHK but also K and angle, which are early parameters in the HKH assay, provide clinically significant information that will facilitate rapid decision-making regarding coagulation strategies during cardiovascular surgery including the CPB period.

    DOI PubMed

  • Apnea management during WATCHMAN device deployment with apneic oxygenation: A case report of three cases.

    Makishi Maeda, Yusuke Yoshikawa, Shunsuke Oura, Kanako Takahashi, Sho Ohno, Naoyuki Hirata, Michiaki Yamakage

    Annals of cardiac anaesthesia   26 ( 4 ) 458 - 460  2023  [International journal]

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    WATCHMAN is a percutaneous left atrial appendage closure device that is implanted in patients who are unsuitable for anticoagulation therapy for atrial fibrillation. During WATCHMAN implantation, inducing apnea in the patient is preferable to allow stable deployment. We present three cases in which apneic oxygenation was employed to maintain oxygenation during apnea, and oxygen reserve index (ORiTM) was measured to evaluate its safety and efficacy. Oxygen was administered continuously via the endotracheal tube during apnea. During all four apneic events in three patients (mean duration of 356 seconds), the ORi values maintained above 0.24, which is generally considered the threshold of partial pressure of arterial oxygen (PaO2) > 100 mmHg. Transcutaneous oxygen saturation and PaO2 remained above 99% and 300 mmHg, respectively. There were no respiratory or circulatory complications during or after the surgery.

    DOI PubMed

  • レミマゾラムによる全身麻酔導入が血行動態パラメータに与える影響 プロポフォールとの比較

    大浦 峻介, 吉川 裕介, 平田 直之, 枝長 充隆, 山蔭 道明

    Cardiovascular Anesthesia ( (一社)日本心臓血管麻酔学会 )  26 ( Suppl. ) 165 - 165  2022.09

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Books and Other Publications 【 display / non-display 】

  • 心臓血管麻酔Positive and Negativeリスト25 : その麻酔管理方法にエビデンスはあるのか?

    山蔭, 道明, 平田, 直之, 吉川, 裕介(麻酔科学)

    中外医学社  2020.09 ISBN: 9784498055469

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Misc 【 display / non-display 】

  • 右心機能不全を有する患者はOPCABの脱転時に高用量の昇圧薬と強心薬を必要とする

    救仁郷 達也, 吉川 裕介, 山本 修司, 山蔭 道明

    Cardiovascular Anesthesia ( (一社)日本心臓血管麻酔学会 )  24 ( Suppl. ) 93 - 93  2020.09

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

    澤下泰明, 平田直之, 吉川裕介, 寺田拡文, 山蔭道明

    日本麻酔科学会学術集会(Web)   67th  2020

    J-GLOBAL

  • セボフルランは心保護効果を持つ非アシル化グレリンの分泌を促進し、虚血再灌流障害の軽減に関与する

    澤下 泰明, 平田 直之, 吉川 裕介, 寺田 拡文, 山蔭 道明

    Cardiovascular Anesthesia ( (一社)日本心臓血管麻酔学会 )  23 ( Suppl. ) [F - 3]  2019.09

  • 経皮的心肺補助下に緊急気管切開術を施行した甲状腺腫瘍の1症例

    横山 竜也, 新山 幸俊, 吉川 裕介, 高田 幸昌, 山蔭 道明

    麻酔 ( 克誠堂出版(株) )  67 ( 11 ) 1213 - 1215  2018.11

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    症例は67歳女性で、甲状腺腫瘍と腫瘍の気管内浸潤による最小径4mmの気管狭窄に対して、緊急気管切開術の目的で搬送された。麻酔管理上の問題点として術中の酸素化の維持、腫瘍からの出血に対する肺の保護、手術を容易にするための不動化の必要性が挙げられ、局所麻酔下での気管切開術は困難が予想された。そこで、術前に協議を行い、術中の酸素化維持および循環虚脱時の循環補助を目的として経皮的心肺補助併用下、気管挿管による全身麻酔を選択し、麻酔導入は急速導入とした。気道確保に際してはエアウェイスコープを併用し、ブジーを先行して気管チューブを挿入したところ、挿入時の抵抗はなく、挿管操作において明らかな出血は認めなかった。

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

    佐藤 優真, 君塚 基修, 吉川 裕介, 枝長 充隆, 山蔭 道明

    日本臨床麻酔学会誌 ( 日本臨床麻酔学会 )  38 ( 6 ) S297 - S297  2018.10

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Research Projects 【 display / non-display 】

  • 2型糖尿病合併心筋におけるデクスメデトミジンのポストコンディショニング効果

    基盤研究(C)

    Project Year :

    2022.04
    -
    2025.03
     

    吉川 裕介

  • Identification of miRNA in Dexmedetomidine-Induced Cardioprotection

    Grant-in-Aid for Young Scientists (B)

    Project Year :

    2017.04
    -
    2019.03
     

    Yoshikawa Yusuke

    　View Summary

    We studied differentially expressed mRNAs and miRNAs after DEX administration in rat hearts by comprehensive analysis. Additionally, bioinformatics analysis was applied to explore candidate genes and pathways that might play important roles in DEX-induced cardioprotection. The results of microarray analysis showed that 165 mRNAs and 6 miRNAs were differentially expressed after DEX administration. Through bioinformatics analysis using differentially expressed mRNAs, gene ontology (GO) terms including MAP kinase tyrosine/serine/threonine phosphatase activity and pathways including the p53 pathway were significantly enriched in the down-regulated mRNAs. On the other hand, no significant pathway was found in the target mRNAs of deregulated miRNAs. The results indicated some possible key genes and pathways that seem to be of significance in DEX-induced cardioprotection, although miRNAs seem to be unlikely to contribute to cardioprotection induced by DEX.

  • Direct cardioprotective effect of dexmedetomidine against ischemia/reperfusion injury in hypertensive hypertrophied myocardium

    Grant-in-Aid for Young Scientists (B)

    Project Year :

    2014.04
    -
    2017.03
     

    Yoshikawa Yusuke, HIRATA Naoyuki

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    The present study revealed that dexmedetomidine maintains the direct cardioprotective effect against ischemia/reperfusion injury in hypertensive hypertrophied myocardium via different mechanism from normal healthy heart. Dexmedetomidine protects normal healthy heart through eNOS phosphorylation via alpha2 adrenoreceptor. On the other hand, the results of the present study revealed that the cardioprotective effect of dexmedetomidine in hypertensive hypertrophied myocardium is via imidazoline 1 receptor, which remains in normal expression level, not via alpha2 adrenoreceptor, which is up-regulated in hypertrophied myocardium. Furthermore, our data indicated that eNOS phosphorylation does not contribute to the cardioprotective effect of dexmedetomidine in hypertensive hypertrophied myocardium.

  • The efficacy of nitrite for cardioprotection

    Grant-in-Aid for Young Scientists (B)

    Project Year :

    2012.04
    -
    2014.03
     

    HIRATA Noyuki, YOSHIKAWA Yusuke, MARUYAMA Daisuke, MIYASHITA Ryu, KAWAGUCHI Ryoichi

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    Recently, the number of elderly patients with ischemic heart disease, who receive surgical procedure, are increasing. Therefore, anesthesiologists are required for safety and high quality peri-operative management. Recent studies have shown that nitrite has cardioprotective effects against ischemia-reperfusion injury. We examined the effects of nitrite on ischemic hearts using rat models. Our results demonstrates that 0.15mg/kg nitrite can attenuate ischemia-induced ventricular arrhythmias. Nitric oxide reduced from nitrite may be involved in this anti-arrhythmia effect via preservation of gap junction proteins, connexin 43. Ischemia-induced arrhythmias leads to a lethal condition in acute coronary syndrome. Therefore, our results highlight a potential of nitrite for cardioprotection not only in peri-operative management but also in emergency medicine.

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