2025/08/22 更新

写真a

ヨシカワ ユウスケ
吉川 裕介
所属
医学部 麻酔科学講座 講師
職名
講師
外部リンク

研究キーワード

  • angiotensinogen

  • cardiopulmonary bypass

  • dexmedetomidine

  • anesthesiology

  • cardiology

  • renin

  • cardioprotection

  • cardiovascular surgery

研究分野

  • ライフサイエンス / 麻酔科学

  • ライフサイエンス / 細胞生物学

  • ライフサイエンス / ゲノム生物学

論文

  • Gut Microbiota Influences Developmental Anesthetic Neurotoxicity in Neonatal Rats. 国際誌

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

    Anesthesia and analgesia   2025年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1213/ANE.0000000000007410

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

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

    Journal of clinical anesthesia   101   111740 - 111740   2025年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1016/j.jclinane.2024.111740

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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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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: 10.1007/s00540-024-03421-6

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  • 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8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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: 10.1007/s00540-024-03345-1

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

    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5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1093/eurheartj/ehad793

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

    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5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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: 10.1016/j.jclinane.2023.111348

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  • 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. 国際誌

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

    Clinical and experimental pharmacology & physiology   51 ( 3 )   e13840   2024年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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: 10.1111/1440-1681.13840

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  • Japanese Traditional Herbal Medicine, Rikkunshito, Partially Suppresses Inflammatory Responses in Myocardial Ischemia/Reperfusion Injury. 国際誌

    Tomoe Sato, Yasuaki Sawashita, Yusuke Yoshikawa, Michiaki Yamakage

    Cureus   16 ( 2 )   e54485   2024年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Myocardial ischemia/reperfusion (I/R) injury can cause additional damage to an ischemic myocardium, even after successful reperfusion therapy. Inflammation is a mechanism that exacerbates myocardial damage after I/R injury. Rikkunshito (RKT) is a traditional Japanese herbal medicine widely used to treat gastrointestinal symptoms. It attenuates inflammation and fibrosis in some diseases of the heart; however, it remains unclear whether RKT exerts cardioprotective effects against myocardial I/R injury. To elucidate this, we evaluated the effects of RKT pre-treatment by oral administration on the myocardium in a mouse model of in vivo I/R injury. METHODS: Mice were randomly assigned to a group receiving distilled water (DW) or one receiving RKT (1000 mg/kg/day) for 14 days orally. For each of the RKT and DW groups, a sham group, an I/R 2 h group, and an I/R 24 h group were created. On day 15, myocardial I/R surgery was performed. The left anterior descending coronary artery (LAD) was ligated for 30 min, and reperfusion time was set at 2 h or 24 h. The myocardial infarct size (IS) was measured after 2 h of reperfusion, and cardiac cytokine mRNA expression levels were evaluated by quantitative reverse transcription polymerase chain reaction (RT-PCR) after 2 h and 24 h of reperfusion. RESULTS: RKT pre-treatment significantly suppressed the cardiac mRNA expression level of interleukin-1β in the RKT-I/R 2 h group compared to the DW-I/R 2 h group (P < 0.05). Additionally, RKT significantly suppressed the mRNA expression levels of transforming growth factor-β compared to DW; the same result was obtained for the expression levels of interleukin-6. However, RKT did not reduce the IS or mRNA expression levels of the cardiac congestive markers natriuretic peptide a (NPPA) and natriuretic peptide b (NPPB). In addition, RKT did not alter the plasma concentration of ghrelin and sirtuin 1 (Sirt1), which have been reported to be stimulated by RKT. CONCLUSION: This study showed that pre-treatment of RKT for myocardial I/R injury partially suppressed inflammation-related cytokines. However, further studies are needed on the effect of RKT on the reduction of myocardial infarction size.

    DOI: 10.7759/cureus.54485

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  • Dexmedetomidine as a cardioprotective drug: a narrative review.

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

    Journal of anesthesia   2023年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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: 10.1007/s00540-023-03261-w

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

    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年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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: 10.7759/cureus.38044

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

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

    Annals of cardiac anaesthesia   26 ( 4 )   458 - 460   2023年

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    記述言語:英語  

    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: 10.4103/aca.aca_11_23

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  • 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   26 ( Suppl. )   165 - 165   2022年9月

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    記述言語:日本語   出版者・発行元:(一社)日本心臓血管麻酔学会  

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  • 経皮的左心耳閉鎖術のWATCHMANデバイス留置時に、Oxygen Reserve Indexを指標に安全な呼吸停止を行った2例

    大浦 峻介, 前田 真岐志, 大野 翔, 吉川 裕介, 平田 直之, 山蔭 道明

    Cardiovascular Anesthesia   26 ( Suppl. )   144 - 144   2022年9月

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    記述言語:日本語   出版者・発行元:(一社)日本心臓血管麻酔学会  

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  • Differential effects of remimazolam and propofol on heart rate variability during anesthesia induction.

    Gen Hasegawa, Naoyuki Hirata, Yusuke Yoshikawa, Michiaki Yamakage

    Journal of anesthesia   36 ( 2 )   239 - 245   2022年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: The effects of remimazolam on autonomic nervous activity have not been elucidated. We investigated the differential effects of remimazolam and propofol on autonomic nervous activity during anesthesia induction. METHODS: Thirty patients were randomly divided into a remimazolam group or a propofol group for anesthesia induction. Hemodynamics and indices of heart rate variability were recorded before and after anesthesia. Low frequency power (LF; 0.04-0.15 Hz, ms2) and high frequency power (HF; 0.15-0.4 Hz, ms2) were calculated from power spectral density of heart rate variability. LF reflects both sympathetic and parasympathetic activities and HF reflects parasympathetic activity. To investigate the balance between sympathetic and parasympathetic activities, the normalized unit (%) of LF (LF nu) and that of HF (HF nu) were calculated. Changes in LF nu (ΔLF nu) before and after anesthesia (ΔLF nu = LF nu at awake-LF nu after anesthesia) were compared between the groups. RESULTS: Remimazolam and propofol decreased blood pressure and power spectral density of heart rate variability. Remimazolam did not change LF nu and HF nu, while propofol increased LF nu and decreased HF nu (P = 0.020). ΔLF nu in the remimazolam group (1.4 ± 23.6%) were less than that in the propofol group (19.3 ± 22.4%, P = 0.0415). CONCLUSION: Remimazolam and propofol decreased autonomic nervous activity during anesthesia induction. Remimazolam preserved the balance of sympathetic and parasympathetic activities, while propofol modulated it to sympathetic dominance.

    DOI: 10.1007/s00540-022-03037-8

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  • Dexmedetomidine Ameliorates Perioperative Neurocognitive Disorders by Suppressing Monocyte-Derived Macrophages in Mice With Preexisting Traumatic Brain Injury. 国際誌

    Natsumi Kii, Atsushi Sawada, Yusuke Yoshikawa, Shunsuke Tachibana, Michiaki Yamakage

    Anesthesia and analgesia   134 ( 4 )   869 - 880   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Traumatic brain injury (TBI) initiates immune responses involving infiltration of monocyte-derived macrophages (MDMs) in the injured brain tissue. These MDMs play a key role in perioperative neurocognitive disorders (PNDs). We tested the hypothesis that preanesthetic treatment with dexmedetomidine (DEX) could suppress infiltration of MDMs into the hippocampus of TBI model mice, ameliorating PND. METHODS: We first performed bone marrow transplantation from green fluorescent protein-transgenic mice to C57BL/6 mice to identify MDMs. We used only male mice for homogeneity. Four weeks after transplantation, a controlled cortical impact model of TBI was created using recipient mice. Four weeks after TBI, mice received pretreatment with DEX before general anesthesia (GA). Mice performed the Barnes maze test (8-12 mice/group) 2 weeks after GA and were euthanized for immunohistochemistry (4-5 mice/group) or immunoblotting (7 mice/group) 4 weeks after GA. RESULTS: In Barnes maze tests, TBI model mice showed longer primary latency (mean difference, 76.5 [95% confidence interval, 41.4-111.6], P < .0001 versus Naïve), primary path length (431.2 [98.5-763.9], P = .001 versus Naïve), and more primary errors (5.7 [0.62-10.7], P = .017 versus Naïve) than Naïve mice on experimental day 3. Expression of MDMs in the hippocampus was significantly increased in TBI mice compared to Naïve mice (2.1 [0.6-3.7], P = .003 versus Naïve). Expression of monocyte chemotactic protein-1 (MCP1)-positive areas in the hippocampus was significantly increased in TBI mice compared to Naïve mice (0.38 [0.09-0.68], P = .007 versus Naïve). Immunoblotting indicated significantly increased expression of interleukin-1β in the hippocampus in TBI mice compared to Naïve mice (1.59 [0.08-3.1], P = .035 versus Naïve). In contrast, TBI mice pretreated with DEX were rescued from these changes and showed no significant difference from Naïve mice. Yohimbine, an α2 receptor antagonist, mitigated the effects of DEX (primary latency: 68.3 [36.5-100.1], P < .0001 versus TBI-DEX; primary path length: 414.9 [120.0-709.9], P = .0002 versus DEX; primary errors: 6.6 [2.1-11.2], P = .0005 versus TBI-DEX; expression of MDMs: 2.9 [1.4-4.4], P = .0001 versus TBI-DEX; expression of MCP1: 0.4 [0.05-0.67], P = .017 versus TBI-DEX; expression of interleukin-1β: 1.8 [0.34-3.35], P = .01 versus TBI-DEX). CONCLUSIONS: Preanesthetic treatment with DEX suppressed infiltration of MDMs in the hippocampus and ameliorated PND in TBI model mice. Preanesthetic treatment with DEX appears to suppress infiltration of MDMs in the hippocampus and may lead to new treatments for PND in patients with a history of TBI.

    DOI: 10.1213/ANE.0000000000005699

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  • Therapeutic Inhibition of Acid Sensing Ion Channel 1a Recovers Heart Function After Ischemia-Reperfusion Injury. 国際誌

    Meredith A Redd, Sarah E Scheuer, Natalie J Saez, Yusuke Yoshikawa, Han Sheng Chiu, Ling Gao, Mark Hicks, Jeanette E Villanueva, Yashutosh Joshi, Chun Yuen Chow, Gabriel Cuellar-Partida, Jason N Peart, Louise E See Hoe, Xiaoli Chen, Yuliangzi Sun, Jacky Y Suen, Robert J Hatch, Ben Rollo, Mubarak A H Alzubaidi, Snezana Maljevic, Gregory A Quaife-Ryan, James E Hudson, Enzo R Porrello, Melanie Y White, Stuart J Cordwell, John F Fraser, Steven Petrou, Melissa E Reichelt, Walter G Thomas, Glenn F King, Peter S Macdonald, Nathan J Palpant

    Circulation   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Ischemia-reperfusion injury (IRI) is one of the major risk factors implicated in morbidity and mortality associated with cardiovascular disease. During cardiac ischemia, the build-up of acidic metabolites results in decreased intracellular and extracellular pH that can reach as low as 6.0-6.5. The resulting tissue acidosis exacerbates ischemic injury and significantly impacts cardiac function. Methods: We used genetic and pharmacological methods to investigate the role of acid sensing ion channel 1a (ASIC1a) in cardiac IRI at the cellular and whole organ level. Human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs) as well as ex vivo and in vivo models of IRI were used to test the efficacy of ASIC1a inhibitors as pre- and post-conditioning therapeutic agents. Results: Analysis of human complex trait genetics indicate that variants in the ASIC1 genetic locus are significantly associated with cardiac and cerebrovascular ischemic injuries. Using hiPSC-CMs in vitro and murine ex vivo heart models, we demonstrate that genetic ablation of ASIC1a improves cardiomyocyte viability after acute IRI. Therapeutic blockade of ASIC1a using specific and potent pharmacological inhibitors recapitulates this cardioprotective effect. We used an in vivo model of myocardial infarction (MI) and two models of ex vivo donor heart procurement and storage as clinical models to show that ASIC1a inhibition improves post-IRI cardiac viability. Use of ASIC1a inhibitors as pre- or post-conditioning agents provided equivalent cardioprotection to benchmark drugs, including the sodium-hydrogen exchange inhibitor zoniporide. At the cellular and whole organ level, we show that acute exposure to ASIC1a inhibitors has no impact on cardiac ion channels regulating baseline electromechanical coupling and physiological performance. Conclusions: Collectively, our data provide compelling evidence for a novel pharmacological strategy involving ASIC1a blockade as a cardioprotective therapy to improve the viability of hearts subjected to IRI.

    DOI: 10.1161/CIRCULATIONAHA.121.054360

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  • Preoperative right ventricular dysfunction requires high vasoactive and inotropic support during off-pump coronary artery bypass grafting.

    Tatsuya Kunigo, Yusuke Yoshikawa, Shuji Yamamoto, Michiaki Yamakage

    General thoracic and cardiovascular surgery   69 ( 6 )   934 - 942   2021年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: The association of preoperative RV function with hemodynamics during OPCAB or emergency conversion is not clear. The aim of this study was to investigate the association of vasoactive-inotropic score with tricuspid annular plane systolic excursion and tricuspid regurgitation in off-pump coronary artery bypass grafting, and to calculate the optimal cut-off value of tricuspid annular plane systolic excursion to predict emergency conversion to cardiopulmonary bypass. METHODS: Patients over 20 years of age who had undergone off-pump coronary artery bypass grafting between April 2015 and March 2020 were enrolled in this study. We retrospectively assessed the association of intraoperative maximum "vasoactive-inotropic score", a weighted sum of various inotropes and vasoconstrictors, with tricuspid annular plane systolic excursion and tricuspid regurgitation. A receiver operating characteristic curve of conversion on tricuspid annular plane systolic excursion was also constructed. RESULTS: 135 patients were included in final analysis. Conversion was performed in 10 cases. Multiple regression analysis showed that tricuspid annular plane systolic excursion, mild or more tricuspid regurgitation and experienced surgeon were significantly related to vasoactive-inotropic score. The receiver operating characteristic curve to predict conversion by tricuspid annular plane systolic excursion showed an optimal cut-off value of 15.0 mm and area under the curve of 0.808. CONCLUSIONS: Tricuspid annular plane systolic excursion and tricuspid regurgitation were associated with vasoactive-inotropic score in off-pump coronary artery bypass grafting. The optimal cut-off value of tricuspid annular plane systolic excursion to predict emergency conversion was 15 mm.

    DOI: 10.1007/s11748-020-01557-2

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  • Comparison between oxygen reserve index and end-tidal oxygen concentration for estimation of oxygenation during pre-oxygenation via a tight-fitted face mask: A prospective observational study. 国際誌

    Naoyuki Hirata, Mitsuo Nishimura, Tomohiro Chaki, Yusuke Yoshikawa, Michiaki Yamakage

    European journal of anaesthesiology   38 ( 3 )   313 - 315   2021年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1097/EJA.0000000000001358

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  • Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair.

    Kenji Yoshitani, Masahiko Kawaguchi, Mikito Kawamata, Manabu Kakinohana, Shinya Kato, Kyoko Hasuwa, Michiaki Yamakage, Yusuke Yoshikawa, Kimitoshi Nishiwaki, Kazuko Hasegawa, Yoshimi Inagaki, Kazumi Funaki, Mishiya Matsumoto, Kazuyoshi Ishida, Atsuo Yamashita, Katsuhiro Seo, Shinichi Kakumoto, Kosuke Tsubaki, Satoshi Tanaka, Takashi Ishida, Hiroyuki Uchino, Takayasu Kakinuma, Yoshitsugu Yamada, Yoshiteru Mori, Shunsuke Izumi, Jun Shimizu, Yuko Furuichi, Nobuhide Kin, Shoichi Uezono, Kotaro Kida, Kunihiko Nishimura, Michikazu Nakai, Yoshihiko Ohnishi

    Journal of anesthesia   35 ( 1 )   43 - 50   2021年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Cerebrospinal fluid drainage (CSFD) is recommended as a spinal cord protective strategy in open and endovascular thoracic aortic repair. Although small studies support the use of CSFD, systematic reviews have not suggested definite conclusion and a large-scale study is needed. Therefore, we reviewed medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open and endovascular repair) at multiple institutions to assess the association between CSFD and postoperative motor deficits. METHODS: Patients included in this study underwent descending or thoracoabdominal aortic repair between 2000 and 2013 at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery. We conducted a retrospective study to investigate whether motor-evoked potential monitoring is effective in reducing motor deficits in thoracic aortic aneurysm repair. We use the same dataset to examine whether CSFD reduces motor deficits after propensity score matching. RESULTS: We reviewed data from 1214 patients [open surgery, 601 (49.5%); endovascular repair, 613 (50.5%)]. CSFD was performed in 417 patients and not performed in the remaining 797 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. After propensity score matching (n = 700), mixed-effects logistic regression performed revealed that CSFD is associated with postoperative motor deficits at discharge [adjusted odds ratio (OR), 3.87; 95% confidence interval (CI), 2.30-6.51]. CONCLUSION: CSFD may not be effective for postoperative motor deficits at discharge.

    DOI: 10.1007/s00540-020-02857-w

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  • Acute Hypobaric and Hypoxic Preconditioning Reduces Myocardial Ischemia-Reperfusion Injury in Rats. 国際誌

    Hirofumi Terada, Naoyuki Hirata, Yasuaki Sawashita, Sho Ohno, Yusuke Yoshikawa, Michiaki Yamakage

    Cardiology research and practice   2021   6617374 - 6617374   2021年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Chronic and/or intermittent exposure to hypobaric hypoxia reportedly exerts cardioprotective effects against ischemia-reperfusion injury. However, few studies have focused on the cardioprotective effects of acute and/or short-term hypobaric and hypoxic exposures. This study investigated the effects of acute hypobaric hypoxia on myocardial ischemia-reperfusion injury. Materials and Methods: Rats were assigned to groups receiving normobaric normoxia (NN group), hypobaric hypoxia (HH group), or normobaric hypoxia (NH group). HH group rats were exposed to 60.8 kPa and 12.6% fraction of inspired oxygen in a hypobaric chamber for 6 h. NH group rats were exposed to hypoxic conditions under normal pressure. After each exposure, 30 min of myocardial ischemia was followed by 60 min of reperfusion. Cardiac function and infarct size were determined after reperfusion. Expression of hypoxia-inducible factor 1 alpha (HIF1α) was also measured. Results: Cardiac function was better preserved in the HH and NH groups than in the NN group (p < 0.01 each). Median infarct size/area at risk was significantly lower in the HH group (50%, interquartile range [IQR] 48-54%; p < 0.01 vs. NN group) and NH group (45%, IQR 36-50%; p < 0.01 vs. NN group) than in the NN group (72%, IQR 69-75%). HIF1α expression was significantly higher in the HH group (p < 0.05 vs. NN group) and NH group (p < 0.01 vs. NN group) than in the NN group. Conclusions: Exposure to acute and/or short-term hypobaric and hypoxic conditions might exert cardioprotective effects against myocardial ischemia-reperfusion injury via HIF1α modulation.

    DOI: 10.1155/2021/6617374

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  • Tracheal extubation of anesthetized pediatric patients with heart disease decreases the incidence of emergence agitation: A retrospective study

    Tatsuya Kunigo, Yuko Nawa, Yusuke Yoshikawa, Michiaki Yamakage

    Annals of Cardiac Anaesthesia   23 ( 4 )   433 - 438   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wolters Kluwer Medknow Publications  

    DOI: 10.4103/aca.ACA_69_19

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  • Assessing the validity of a linear inflation method in noninvasive blood pressure monitoring during the induction period of general anaesthesia. 国際誌

    Ken-Ichiro Kikuchi, Naoyuki Hirata, Yusuke Yoshikawa, Michiaki Yamakage

    Journal of perioperative practice   31 ( 12 )   1750458920957917 - 1750458920957917   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Inflationary noninvasive blood pressure (iNIBP) monitoring can determine BP in a shorter time compared to conventional deflationary NIBP (dNIBP) monitoring. We assessed the efficacy of iNIBP monitoring during induction of general anaesthesia and tracheal intubation, which can cause rapid changes in haemodynamics. Our study included 14 surgery patients receiving tracheal intubation under general anaesthesia. Blood pressure was continuously measured using iNIBP monitoring. We recorded the percentage of successful iNIBP monitoring (measurements made without switching to dNIBP mode) during anaesthesia induction. We obtained 326 BP-measurements from 14 patients. The iNIPB mode was able to perform 90.9% of the measurements during the induction of general anaesthesia. iNIBP could determine BP even during periods of high blood pressure variability (31.6% [interquartile range; 22-40]). Our results validate the utility of iNIBP monitoring during the induction period of general anaesthesia, despite the rapid haemodynamic changes.

    DOI: 10.1177/1750458920957917

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  • Remote ischemic preconditioning reduces myocardial ischemia-reperfusion injury through unacylated ghrelin-induced activation of the JAK/STAT pathway. 国際誌

    Yasuaki Sawashita, Naoyuki Hirata, Yusuke Yoshikawa, Hirofumi Terada, Yasuyuki Tokinaga, Michiaki Yamakage

    Basic research in cardiology   115 ( 4 )   50 - 50   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Remote ischemic preconditioning (RIPC) offers cardioprotection against myocardial ischemia-reperfusion injury. The humoral factors involved in RIPC that are released from parasympathetically innervated organs have not been identified. Previous studies showed that ghrelin, a hormone released from the stomach, is associated with cardioprotection. However, it is unknown whether or not ghrelin is involved in the mechanism of RIPC. This study aimed to determine whether ghrelin serves as one of the humoral factors in RIPC. RIPC group rats were subjected to three cycles of ischemia and reperfusion for 5 min in two limbs before left anterior descending (LAD) coronary artery ligation. Unacylated ghrelin (UAG) group rats were given 0.5 mcg/kg UAG intravenously 30 min before LAD ligation. Plasma levels of UAG in all groups were measured before and after RIPC procedures and UAG administration. Additionally, JAK2/STAT3 pathway inhibitor (AG490) was injected in RIPC and UAG groups to investigate abolishment of the cardioprotection of RIPC and UAG. Plasma levels of UAG, infarct size and phosphorylation of STAT3 were compared in all groups. Infarct size was significantly reduced in RIPC and UAG groups, compared to the other groups. Plasma levels of UAG in RIPC and UAG groups were significantly increased after RIPC and UAG administration, respectively. The cardioprotective effects of RIPC and UAG were accompanied by an increase in phosphorylation of STAT3 and abolished by AG490. This study indicated that RIPC reduces myocardial ischemia and reperfusion injury through UAG-induced activation of JAK/STAT pathway. UAG may be one of the humoral factors involved in the cardioprotective effects of RIPC.

    DOI: 10.1007/s00395-020-0809-z

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  • Video Glasses Reduce Preoperative Anxiety Compared With Portable Multimedia Player in Children: A Randomized Controlled Trial. 国際誌

    Yuki Hashimoto, Tomohiro Chaki, Naoyuki Hirata, Yasuyuki Tokinaga, Yusuke Yoshikawa, Michiaki Yamakage

    Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses   35 ( 3 )   321 - 325   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: Preoperative anxiety in children is challenging for anesthesia providers and nurses. The use of video glasses (VG), an immersive head mount display, helps conceal the unfamiliar operating room environment from the patient's visual field. The aim of this study was to determine the anxiolytic effect of VG compared with that of a portable multimedia player (PMP) during the preoperative period in children. DESIGN: Prospective randomized trial. METHODS: Participants were randomized into VG or PMP groups. Patients watched their favorite animation videos using the allocated device from the time of entering the preanesthetic holding area to the end of anesthetic induction. We evaluated modified Yale Preoperative Anxiety Scale scores during anesthetic induction. FINDINGS: The modified Yale Preoperative Anxiety Scale score in the VG group was significantly lower than that in the PMP group (P = .001). CONCLUSIONS: In children, the anxiolytic effect of VG during the preoperative period is larger than that of PMP.

    DOI: 10.1016/j.jopan.2019.10.001

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  • Lipid emulsion, but not propofol, induces skeletal muscle damage and lipid peroxidation.

    Tomohiro Chaki, Naoyuki Hirata, Yusuke Yoshikawa, Shunsuke Tachibana, Yasuyuki Tokinaga, Michiaki Yamakage

    Journal of anesthesia   33 ( 6 )   628 - 635   2019年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: Prolonged propofol infusion induces skeletal muscle damage. However, it is well known that the lipid emulsion that is the solvent of propofol causes various types of tissue damage via lipid peroxidation, and that propofol, conversely, has an anti-lipid peroxidative effect. The purpose of this study was to determine whether propofol or the lipid emulsion is the cause of muscle damage following prolonged administration. METHODS: Rats were divided into four groups: NI group (no intervention), Cath group (venous catheter insertion only), Prop group (1% propofol (Maruishi) intravenous infusion at 10 mg/kg/h), and Lipid group (10% Lipofundin® intravenous infusion at 100 mg/kg/h) (n = 10, each group). 1% Propofol (Maruishi) or Lipofundin was infused at 1 mL/kg/h for 72 h. The solvent of 1% propofol (Maruishi) is a 10% lipid emulsion. Lipofundin consists of 50% long-chain triacylglycerols and 50% medium-chain triacylglycerols, similar to the propofol solvent. Plasma concentrations of creatine kinase and myoglobin, superoxide production level, and 4-hydroxynonenal and malondialdehyde expression in the gastrocnemius muscle were evaluated 72 h after the interventions. RESULTS: Plasma concentrations of creatine kinase and myoglobin in the Lipid group were significantly higher than those in the other three groups. The superoxide production level, and 4-hydroxynonenal and malondialdehyde expression in the Lipid group were also significantly higher than in the other three groups. CONCLUSION: Lipofundin induces skeletal muscle damage via lipid peroxidation, and 1% propofol (Maruishi) conversely suppresses the muscle damage via antioxidant effects.

    DOI: 10.1007/s00540-019-02676-8

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  • Association Between Motor-Evoked Potentials and Spinal Cord Damage Diagnosed With Magnetic Resonance Imaging After Thoracoabdominal and Descending Aortic Aneurysm Repair. 国際誌

    Kohshi Hattori, Kenji Yoshitani, Shinya Kato, Masahiko Kawaguchi, Mikito Kawamata, Manabu Kakinohana, Yoshitsugu Yamada, Michiaki Yamakage, Kimitoshi Nishiwaki, Shunsuke Izumi, Yusuke Yoshikawa, Yoshiteru Mori, Kazuko Hasegawa, Yoshihiko Onishi

    Journal of cardiothoracic and vascular anesthesia   33 ( 7 )   1835 - 1842   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: The authors investigated the association between intraoperative motor-evoked potential (MEP) changes and the severity of spinal cord infarction diagnosed with magnetic resonance imaging (MRI) to clarify the discrepancy between them, which was observed in patients with postoperative motor deficits after thoracic and thoracoabdominal aortic surgery. DESIGN: A multicenter retrospective study. SETTING: Motor-evoked potential <25% of control values was deemed positive for spinal cord ischemia. The severity of spinal cord infarction was categorized into grades A to D based on previous studies using the most severe axial MRI slices. The associations between MRI grade, MEP changes, and motor deficits were examined using logistic regression. PARTICIPANTS: Twenty-three of 1,245 patients (from 1999 to 2013, at 12 hospitals in Japan) were extracted from medical records of patients who underwent thoracic and thoracoabdominal aortic repair, with intraoperative MEP examinations and postoperative spinal MRI. INTERVENTIONS: No intervention (observational study). MEASUREMENTS AND MAIN RESULTS: Motor-evoked potential <25% of control value was associated significantly with motor deficits at discharge (adjusted odds ratio [OR], 130.0; p = 0.041), but not with severity of spinal cord infarction (adjusted OR, 0.917; p = 0.931). Motor deficit at discharge was associated with severe spinal cord infarction (adjusted OR, 4.83; p = 0.043), MEP <25% (adjusted OR, 13.95; p = 0.031), and combined deficits (motor and sensory, motor and bowel or bladder, or sensory and bowel or bladder deficits; adjusted OR, 31.03; p = 0.072) in stepwise logistic regression analysis. CONCLUSION: Motor-evoked potential <25% was associated significantly with motor deficits at discharge, but not with the severity of spinal cord infarction.

    DOI: 10.1053/j.jvca.2018.12.004

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  • Identification of Candidate Genes and Pathways in Dexmedetomidine-Induced Cardioprotection in the Rat Heart by Bioinformatics Analysis. 国際誌

    Yusuke Yoshikawa, Naoyuki Hirata, Hirofumi Terada, Yasuaki Sawashita, Michiaki Yamakage

    International journal of molecular sciences   20 ( 7 )   2019年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Dexmedetomidine (DEX), a highly selective alpha2 adrenergic receptor agonist, directly protects hearts against ischemia/reperfusion (I/R) injury. However, the detailed mechanism has not been fully elucidated. 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. Dusp1 and Atm were associated with the GO term of MAP kinase tyrosine/serine/threonine phosphatase activity and the p53 pathway, respectively. 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.

    DOI: 10.3390/ijms20071614

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  • Chronological change in oropharyngeal leak pressure of pediatric i-gel™. 国際誌

    Yusuke Yoshikawa, Naoyuki Hirata, Yuko Nawa, Michiaki Yamakage

    Paediatric anaesthesia   29 ( 1 )   107 - 108   2019年1月

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    記述言語:英語  

    DOI: 10.1111/pan.13546

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  • Anesthetic Management of Total Aortic Arch Replacement in a Myasthenia Gravis Patient under Deep Hypothermic Circulatory Arrest. 国際誌

    Mamiko Kondo, Yusuke Yoshikawa, Hirofumi Terada, Michiaki Yamakage

    Case reports in anesthesiology   2019   3278147 - 3278147   2019年

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    記述言語:英語  

    The anesthetic management of myasthenia gravis patients undergoing cardiac or aortic surgery under cardiopulmonary bypass, especially with deep hypothermic circulatory arrest, is challenging. We describe a case of successful anesthetic management of a myasthenia gravis patient undergoing total arch replacement with deep hypothermic circulatory arrest under neuromuscular monitoring and complete reversal of the action of neuromuscular blocking drugs by sugammadex. The present case suggests that patients with well-controlled myasthenia gravis might be safely managed in cardiac or aortic surgery under cardiopulmonary bypass with deep hypothermic circulatory arrest.

    DOI: 10.1155/2019/3278147

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  • Dexmedetomidine Does Not Affect Platelet Function Measured With TEG 6S and Platelet Mapping Assay in Whole Blood. 国際誌

    Yusuke Yoshikawa, Kanako Takahashi, Mitsutaka Edanaga, Naoyuki Hirata, Michiaki Yamakage

    Journal of cardiothoracic and vascular anesthesia   32 ( 6 )   e9-e11   2018年12月

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  • Anesthetic management with percutaneous cardiopulmonary support for emergency tracheotomy in a patient with a thyroid tumor who had severe tracheal stenosis from thyroid tumor

    Tatsuya Yokoyama, Yukitoshi Netama, Yusuke Yoshikawa, Yukimasa Takada, Michiaki Yamakage

    Japanese Journal of Anesthesiology   67 ( 11 )   1213 - 1215   2018年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Kokuseido Publishing Co. Ltd  

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  • In reply: Why remifentanil?

    Wataru Sakai, Yusuke Yoshikawa, Michiaki Yamakage

    Journal of anesthesia   32 ( 3 )   459 - 459   2018年6月

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  • Clinical Utility of Intraoperative Motor-Evoked Potential Monitoring to Prevent Postoperative Spinal Cord Injury in Thoracic and Thoracoabdominal Aneurysm Repair: An Audit of the Japanese Association of Spinal Cord Protection in Aortic Surgery Database. 国際誌

    Kenji Yoshitani, Kenichi Masui, Masahiko Kawaguchi, Mikito Kawamata, Manabu Kakinohana, Shinya Kato, Kyoko Hasuwa, Michiaki Yamakage, Yusuke Yoshikawa, Kimitoshi Nishiwaki, Tadashi Aoyama, Yoshimi Inagaki, Kazumasa Yamasaki, Mishiya Matsumoto, Kazuyoshi Ishida, Atsuo Yamashita, Katsuhiro Seo, Shinichi Kakumoto, Hironobu Hayashi, Yuu Tanaka, Satoshi Tanaka, Takashi Ishida, Hiroyuki Uchino, Takayasu Kakinuma, Yoshitsugu Yamada, Yoshiteru Mori, Shunsuke Izumi, Kunihiro Nishimura, Michikazu Nakai, Yoshihiko Ohnishi

    Anesthesia and analgesia   126 ( 3 )   763 - 768   2018年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits. METHODS: Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair. RESULTS: We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69-1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10-11.91; P < .001), spinal drainage (adjusted OR, 2.14; 95% CI, 1.32-3.47; P = .002), and endovascular procedure (adjusted OR, 0.45; 95% CI, 0.27-0.76; P = .003). The sensitivity and specificity of MEP <25% of control value for motor deficits at discharge were 37.8% (95% CI, 26.5%-49.5%) and 95.5% (95% CI, 94.7%-96.4%), respectively. CONCLUSIONS: MEP monitoring was not significantly associated with motor deficits at discharge.

    DOI: 10.1213/ANE.0000000000002749

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  • Dexmedetomidine Maintains Its Direct Cardioprotective Effect Against Ischemia/Reperfusion Injury in Hypertensive Hypertrophied Myocardium. 国際誌

    Yusuke Yoshikawa, Naoyuki Hirata, Ryoichi Kawaguchi, Yasuyuki Tokinaga, Michiaki Yamakage

    Anesthesia and analgesia   126 ( 2 )   443 - 452   2018年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Dexmedetomidine (DEX) has a direct cardioprotective effect against ischemia/reperfusion injury through endothelial nitric oxide synthase (eNOS) phosphorylation via α2-adrenoreceptor (α2-AR). By using spontaneously hypertensive rat (SHR) and Wistar-Kyoto (WKY) rat models, the cardioprotective effect of DEX in hypertrophied myocardium and the differential characteristics of cardiac α2-AR and the I1 imidazoline receptor (I1R) were examined. METHODS: Langendorff-perfused rat hearts underwent 40 minutes of global ischemia followed by 120 minutes of reperfusion in the presence or absence of DEX before ischemia. Infarct size was measured, and eNOS phosphorylation was assessed by Western blotting. The presence and expression of the receptors were assessed by immunohistochemistry, real-time reverse transcriptase polymerase chain reaction, and Western blotting. RESULTS: In WKY, DEX significantly decreased infarct size and increased phosphorylated-eNOS/eNOS. These effects were counteracted by yohimbine (α2-AR antagonist) and efaroxan (α2-AR and I1R antagonist). In SHR, DEX significantly decreased infarct size, and the effect was counteracted by efaroxan but not yohimbine. DEX did not alter phosphorylated-eNOS/eNOS in SHR. α2-AR and I1R were observed in WKY and SHR hearts. Although alpha2A-AR and alpha2B-AR messenger RNA and protein levels were upregulated in SHR, I1R expression was comparable between the 2 species. CONCLUSIONS: In the hypertrophied heart, DEX maintains its direct cardioprotective effect against ischemia/reperfusion injury via I1R in an eNOS-nondependent manner despite upregulation of α2-AR.

    DOI: 10.1213/ANE.0000000000002452

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  • Effect of remifentanil during cardiopulmonary bypass on incidence of acute kidney injury after cardiac surgery.

    Wataru Sakai, Yusuke Yoshikawa, Naoyuki Hirata, Michiaki Yamakage

    Journal of anesthesia   31 ( 6 )   895 - 902   2017年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is a well-known postoperative complication. Remifentanil, which is a commonly used ultra-short-acting opioid, has antiinflammatory and sympatholytic effects with improvement of microcirculation. METHODS: A retrospective study was conducted to clarify the effect of the use of remifentanil during CPB on the incidence of postoperative AKI. Patients who underwent valve surgery while under cardiopulmonary bypass between January 2012 and December 2014 in our hospital were enrolled in this study. The incidences of postoperative AKI were compared in patients who received remifentanil during CPB (group R) and those who did not (group N). Univariate and multivariate regression analyses were performed to determine risk factors for AKI. RESULTS: Eighty patients received remifentanil (group R) and 50 patients did not (group N). The incidences of AKI were not significantly different in group R and group N (51% vs. 36%, P = 0.10). In multivariate regression analysis, age [adjusted odds ratio (OR) 1.048, 95% CI 1.008-1.089, P = 0.017], male gender (adjusted OR 3.101, 95% CI 1.303-7.378, P = 0.011), and use of preoperative calcium channel blockers (adjusted OR 3.240, 95% CI 1.302-8.063, P = 0.011) and diuretics (adjusted OR 2.673, 95% CI 1.178-6.066, P = 0.019) were associated with the incidence of AKI. The use of remifentanil was not associated with AKI (adjusted OR 2.321, 95% CI 0.997-5.402, P = 0.051). CONCLUSION: The use of remifentanil during CPB did not decrease the incidence of postoperative AKI after cardiac surgery.

    DOI: 10.1007/s00540-017-2419-y

    PubMed

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  • Anesthetic management of a child with phosphomannomutase-2 congenital disorder of glycosylation (PMM2-CDG). 国際誌

    Wataru Sakai, Yusuke Yoshikawa, Yasuyuki Tokinaga, Michiaki Yamakage

    JA clinical reports   3 ( 1 )   8 - 8   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Glycosylation is one of the major posttranslational modifications of proteins and it is essential for proteins to obtain normal biological functions. Congenital disorders of glycosylation (CDGs) are very rare genetic disorders that lack enzymes needed for glycosylation. Phosphomannomutase-2 (PMM2)-CDG is the most common type of CDG. CDGs can cause a wide variety of clinical symptoms in almost every organ system. Muscular hypotonia is often present in patients with CDGs and is one of the most notable problems for anesthetic management because the susceptibility to nondepolarizing neuromuscular blocking agents (NMBAs) in patients with CDGs is unknown. Case presentation: The patient was a 17-month-old boy who weighed 6.5 kg and was 71 cm tall. He presented for strabismus surgery. He had muscular hypotonia, mental retardation, hepatic dysfunction, mild cerebellar hypoplasia, and some dysmorphic features including inverted nipples and abnormal subcutaneous fat distribution of the hips. Gene analysis revealed a compound heterozygous mutation in the gene encoding PMM2 and the patient was diagnosed as having PMM2-CDG. General anesthesia was performed with sevoflurane, nitrous oxide, and rocuronium. Neuromuscular monitoring was performed during anesthesia using train-of-four (TOF)-Watch® (MSD, Japan). As postoperative analgesia, the surgeon performed sub-Tenon's anesthesia. We did not use any intravenous analgesic. After completion of the operation, residual rocuronium was competed by administration of sugammadex. The patient gained consciousness and spontaneous breathing was established shortly thereafter, and the trachea was smoothly extubated. He was transported to an inpatient ward and was discharged to his home the next day without any complication. Conclusions: We performed safe anesthetic management in a 17-month-old boy with PMM2-CDG using rocuronium under neuromuscular monitoring.A patient with PMM2-CDG may show nearly normal susceptibility to nondepolarizing NMBAs.

    DOI: 10.1186/s40981-017-0080-y

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  • Unexpectedly resolved multiple mobile thrombi in a normal thoracic aorta associated with colorectal cancer and protein C deficiency

    Yusuke Yoshikawa, Yasuhiro Kamikubo, Hajime Sonoda, Michiaki Yamakage

    Journal of Cardiothoracic and Vascular Anesthesia   28 ( 3 )   714 - 717   2014年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W.B. Saunders  

    DOI: 10.1053/j.jvca.2012.11.006

    PubMed

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書籍等出版物

  • 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9月  ( ISBN:9784498055469

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    総ページ数:iii,199p   記述言語:日本語  

    CiNii Books

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共同研究・競争的資金等の研究課題

  • 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

    研究課題/領域番号:24K12052  2024年4月 - 2027年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    前田 真岐志, 吉川 裕介

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    配分額:4420000円 ( 直接経費:3400000円 、 間接経費:1020000円 )

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  • 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

    研究課題/領域番号:23K08444  2023年4月 - 2026年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    数馬 聡, 吉川 裕介, 齋藤 菜摘

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    配分額:4550000円 ( 直接経費:3500000円 、 間接経費:1050000円 )

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  • 漢方薬で心臓を守るー六君子湯の心保護作用の解明ー

    研究課題/領域番号:23K08386  2023年4月 - 2026年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    佐藤 智恵, 吉川 裕介

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    配分額:4550000円 ( 直接経費:3500000円 、 間接経費:1050000円 )

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  • 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

    研究課題/領域番号:22K09100  2022年4月 - 2025年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    吉川 裕介

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    配分額:4160000円 ( 直接経費:3200000円 、 間接経費:960000円 )

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  • 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

    研究課題/領域番号:17K16745  2017年4月 - 2019年3月

    日本学術振興会  科学研究費助成事業 若手研究(B)  若手研究(B)

    吉川 裕介

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    配分額:4160000円 ( 直接経費:3200000円 、 間接経費:960000円 )

    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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  • 高血圧性肥大心筋に対するデクスメデトミジンの直接心筋保護効果

    研究課題/領域番号:26861237  2014年4月 - 2017年3月

    日本学術振興会  科学研究費助成事業 若手研究(B)  若手研究(B)

    吉川 裕介, 平田 直之

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    配分額:3900000円 ( 直接経費:3000000円 、 間接経費:900000円 )

    デクスメデトミジンは高血圧性肥大心筋において,正常心筋とは異なるメカニズムにより,虚血再灌流障害に対する直接心筋保護作用を発揮することが明らかとなった.正常心筋ではデクスメデトミジンはα2アドレナリン受容体を介した内皮型一酸化窒素合成酵素(eNOS)の活性化により新保護作用を発揮するが,肥大心筋においては,デクスメデトミジンの心保護作用は発現が増加しているα2アドレナリン受容体ではなく,発現が正常に保たれているイミダゾリン1受容体を介していることが示唆され,さらにその保護作用はeNOS非依存的である可能性が示唆された.

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  • 亜硝酸塩ポストコンディショニングによる心筋保護作用とその分子機序の解明

    研究課題/領域番号:24791607  2012年4月 - 2014年3月

    日本学術振興会  科学研究費助成事業 若手研究(B)  若手研究(B)

    平田 直之, 吉川 裕介, 丸山 大介, 宮下 龍, 川口 亮一

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    配分額:4290000円 ( 直接経費:3300000円 、 間接経費:990000円 )

    高齢化社会により手術患者も高齢化が進み,虚血性心疾患を有する患者は増えている.亜硝酸塩は心保護作用が指摘されており,周術期への応用が期待される.
    本研究において,ラット心筋虚血モデルに対して亜硝酸塩を投与したところ0.15mg/kgの投与により虚血によって誘発される心室性不整脈が抑制されることが示された.その機序として,低酸素環境で亜硝酸塩が還元され一酸化窒素として作用し,心筋ギャップジャンクションであるコネキシン43機能が維持されることが示唆された.心筋虚血後の心室性不整脈は致死的となることが知られており,本研究により周術期だけではなく救急領域においても今後の発展が期待される.

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