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• ライフサイエンス   麻酔科学  

• ライフサイエンス   ゲノム生物学  

• ライフサイエンス   細胞生物学  

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• 札幌医科大学   麻酔科学講座   講師  

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• anesthesiology

• cardiopulmonary bypass

• dexmedetomidine

• cardiovascular surgery

• cardiology

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• New insights in cardiovascular anesthesia: a dual focus on clinical practice and research.

  Takahiro Tamura, Yusuke Yoshikawa, Satoru Ogawa, Mitsuru Ida, Naoyuki Hirata

  Journal of anesthesia    2024年10月  [国内誌]

  　概要を見る

  Accumulation of the results of basic and clinical research has advanced the safety and quality of management in cardiovascular anesthesia. To address recent developments in this field, a symposium was held during the 71th Japanese Society of Anesthesiologists annual meetings in 2024, focusing on new advancements in both clinical and basic research in cardiovascular anesthesia. During this symposium, four experts reviewed recent findings in their respective areas of study, covering the following topics: clinical reliability and concerns regarding volatile anesthetics during cardiopulmonary bypass; novel basic and clinical findings regarding the cardioprotective effects of dexmedetomidine; advancements in optimizing blood and hemostasis management during cardiovascular surgery; and innovative strategies for managing postoperative cognitive disorders following cardiovascular and thoracic surgery. Each expert summarized recent novel findings, clinical reliability and concerns, as well as future directions in their respective topics. We believe that this special article provides valuable insights into both clinical practice and basic research in cardiovascular anesthesia while also inspiring anesthesiologists to pursue further research in this field.

  DOI PubMed

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

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

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

  　概要を見る

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

  DOI PubMed

• Acid-sensing ion channel 1a blockade reduces myocardial injury in rodent models of myocardial infarction.

  Meredith A Redd, Yusuke Yoshikawa, Nemat Khan, Maleeha Waqar, Natalie J Saez, Jennifer E Outhwaite, Jake S Russell, Amy D Hanna, Han S Chiu, Sing Yan Er, Neville J Butcher, Karine Mardon, John F Fraser, Mark L Smythe, Lachlan D Rash, Walter G Thomas, Glenn F King, Melissa E Reichelt, Nathan J Palpant

  European heart journal   45 ( 17 ) 1571 - 1574  2024年05月  [国際誌]

  DOI PubMed

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

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

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

  　概要を見る

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

  DOI PubMed

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

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

  Clinical and experimental pharmacology & physiology   51 ( 3 ) e13840  2024年03月  [国際誌]

  　概要を見る

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

  DOI PubMed

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• 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年09月 ISBN: 9784498055469

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• 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年09月

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

  澤下泰明, 平田直之, 吉川裕介, 寺田拡文, 山蔭道明

  日本麻酔科学会学術集会(Web)   67th  2020年

  J-GLOBAL

• 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年09月

• 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年11月

  　概要を見る

  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年10月

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• 糖尿病が周術期心筋傷害に及ぼす影響の解明と治療戦略：RNAシーケンスを用いた解析

  基盤研究(C)

  研究期間:

  2024年04月

  -

  2027年03月

   

  前田 真岐志, 吉川 裕介

• 敗血症関連脳症の新たな治療ターゲットとしての血液脳関門グリコカリックスの動態解析

  基盤研究(C)

  研究期間:

  2023年04月

  -

  2026年03月

   

  数馬 聡, 吉川 裕介, 齋藤 菜摘

• 漢方薬で心臓を守るー六君子湯の心保護作用の解明ー

  基盤研究(C)

  研究期間:

  2023年04月

  -

  2026年03月

   

  佐藤 智恵, 吉川 裕介

• 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)

  研究期間:

  2022年04月

  -

  2025年03月

   

  吉川 裕介

• デクスメデトミジンによる心筋保護効果をもたらすmicroRNAの探索

  若手研究(B)

  研究期間:

  2017年04月

  -

  2019年03月

   

  吉川 裕介

  　研究概要を見る

  DEX投与後のmRNAとmiRNAの発現変化を，ラット心筋を用いて網羅的に解析した．さらに，バイオインフォマティクス解析により，DEXによる心保護作用の鍵となりうるパスウェイを探索した．165のmRNAと6のmiRNAがDEX投与により発現変動した．発現変化した全mRNAに対するバイオインフォマティクス解析の結果，MAPキナーゼチロシンスレオニンフォスファターゼ活性などのGO termやp53などのパスウェイが候補としてあげられたが，miRNAのターゲットmRNAでは有意なパスウェイはなかった．DEXの心保護に関するmiRNAは同定できなかったが，いくつかのパスウェイが候補としてあげられた．

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