研究者詳細 - 藤井　祐

論文 - 藤井　祐

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Intraoperative hypotension affects postoperative acute kidney injury depending on the invasiveness of abdominal surgery: A retrospective cohort study.

Fujii T, Takakura M, Taniguchi T, Tamura T, Nishiwaki K

Medicine 102 巻 ( 48 ) 頁： e36465 2023年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Medicine

Intraoperative hypotension (IOH) or highly invasive surgery adversely affects postoperative clinical outcomes. It is, however, unclear whether IOH affects postoperative acute kidney injury (AKI) depending on the invasiveness of abdominal surgery. We speculated that IOH in highly invasive abdominal surgery is a significant risk factor for postoperative AKI. We retrospectively reviewed the data of 448 patients who underwent abdominal surgery. Patients were divided into 3 groups: highly (such as pancreaticoduodenectomy and hepatectomy), moderately (open abdominal surgery), and minimally (laparoscopic surgery) invasive surgeries. The association between the time-weighted average (TWA) of mean arterial pressure (MAP) values (≤60 and ≤ 55 mm Hg) and AKI occurrences in each group was assessed. Postoperative AKI occurred after highly, moderately, and minimally invasive surgeries in 33 of 222 (14.9%), 14 of 110 (12.7%), and 12 of 116 (10.3%) cases, respectively (P = .526). The median [interquartile range] of TWA-MAP ≤ 60 mm Hg, as an IOH parameter, was 0.94 [0.33-2.08] mm Hg in highly, 0.54 [0.16-1.46] mm Hg in moderately, and 0.14 [0.03-0.57] mm Hg in minimally invasive surgeries (P < 0001). In addition, there was a significant association between TWA-MAP and AKI in highly invasive surgery, unlike in moderately and minimally invasive surgery, with adjusted odds ratios (95% confidence interval) for TWA-MAP ≤ 60 and ≤ 55 mm Hg associated with AKI of 1.23 [1.00-1.52] (P = .049) and 1.55 [1.02-2.36] (P = .041), respectively. Intraoperative MAP ≤ 60 mm Hg in highly invasive abdominal surgery is associated with postoperative AKI, compared to moderately and minimally invasive surgeries. Additionally, low MAP thresholds in highly invasive surgery increase postoperative AKI risk.

DOI： 10.1097/MD.0000000000036465

Effect of intensive insulin therapy on inflammatory response after cardiac surgery using bedside artificial pancreas: A propensity score-matched analysis

Fujii Tasuku, Hirai Takahiro, Tamura Takahiro, Suzuki Shogo, Nishiwaki Kimitoshi

ARTIFICIAL ORGANS 47 巻 ( 6 ) 頁： 982 - 989 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Artificial Organs

Background: Perioperative hyperglycemia leads to poor postoperative clinical outcomes, including compromised immune function, cardiovascular events, and mortality. The optimal perioperative blood glucose levels during cardiac surgery remain unclear. A closed-loop glycemic control system (artificial pancreas, target blood glucose range:120–150 mg/dl) prevents postoperative inflammatory response more effectively than conventional insulin therapy (<200 mg/dl). However, the clinical effects of intensive insulin therapy with strict glycemic control (80–110 mg/dl) are controversial. This study aimed to determine whether intensive insulin therapy would further suppress postoperative inflammatory reactions. Methods: This study analyzed 262 patients who underwent cardiovascular surgery with cardiopulmonary bypass. The patients were divided into two groups according to their target blood glucose range: 80–110 mg/dl and 120–150 mg/dl. The primary outcome was the difference in the C-reactive protein levels between the two groups. Results: Propensity score matching resulted in 95 patients in each group based on their covariates. There was no difference in the postoperative maximum C-reactive protein levels between the two groups (14.81 ± 5.93 mg/dl vs. 14.34 ± 5.52 mg/dl; p = 0.571) following propensity score matching. Hypoglycemia did not occur during intensive insulin therapy. Conclusions: Intensive insulin therapy following cardiac surgery with cardiopulmonary bypass did not demonstrate significant advantages in the suppression of postoperative inflammatory reactions compared to that with mild glycemic control. However, intensive insulin therapy using an artificial pancreas was found to be safe, with no hypoglycemic events.

DOI： 10.1111/aor.14418

Accuracy of a noninvasive estimated continuous cardiac output measurement under different respiratory conditions: a prospective observational study

Takakura Masashi, Fujii Tasuku, Taniguchi Tomoya, Suzuki Shogo, Nishiwaki Kimitoshi

JOURNAL OF ANESTHESIA 37 巻 ( 3 ) 頁： 394 - 400 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Anesthesia

Purpose: The estimated continuous cardiac output (esCCO) system was recently developed as a noninvasive hemodynamic monitoring alternative to the thermodilution cardiac output (TDCO). However, the accuracy of continuous cardiac output measurements by the esCCO system compared to TDCO under different respiratory conditions remains unclear. This prospective study aimed to assess the clinical accuracy of the esCCO system by continuously measuring the esCCO and TDCO. Methods: Forty patients who had undergone cardiac surgery with a pulmonary artery catheter were enrolled. We compared the esCCO with TDCO from mechanical ventilation to spontaneous respiration through extubation. Patients undergoing cardiac pacing during esCCO measurement, those receiving treatment with an intra-aortic balloon pump, and those with measurement errors or missing data were excluded. In total, 23 patients were included. Agreement between the esCCO and TDCO measurements was evaluated using Bland–Altman analysis with a 20 min moving average of the esCCO. Results: The paired esCCO and TDCO measurements (939 points before extubation and 1112 points after extubation) were compared. The respective bias and standard deviation (SD) values were 0.13 L/min and 0.60 L/min before extubation, and − 0.48 L/min and 0.78 L/min after extubation. There was a significant difference in bias before and after extubation (P < 0.001); the SD before and after extubation was not significant (P = 0.315). The percentage errors were 25.1% before extubation and 29.6% after extubation, which is the criterion for acceptance of a new technique. Conclusion: The accuracy of the esCCO system is clinically acceptable to that of TDCO under mechanical ventilation and spontaneous respiration.

DOI： 10.1007/s00540-023-03176-6

Enteral liquid ventilation oxygenates a hypoxic pig model 国際誌

Fujii Tasuku, Yoneyama Yosuke, Kinebuchi Akiko, Ozeki Naoki, Maeda Sho, Saiki Norikazu, Chen-Yoshikawa Toyofumi Fengshi, Date Hiroshi, Nishiwaki Kimitoshi, Takebe Takanori

ISCIENCE 26 巻 ( 3 ) 頁： 106142 - 106142 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：iScience

The potential of extrapulmonary ventilation pathways remains largely unexplored. Here, we assessed the enteral ventilation approach in hypoxic porcine models under controlled mechanical ventilation. 20 mL/kg of oxygenated perfluorodecalin (O2-PFD) was intra-anally delivered by a rectal tube. We simultaneously monitored arterial and pulmonary arterial blood gases every 2 min up to 30 min to determine the gut-mediated systemic and venous oxygenation kinetics. Intrarectal O2-PFD administration significantly increased the partial pressure of oxygen in arterial blood from 54.5 ± 6.4 to 61.1 ± 6.2 mmHg (mean ± SD) and reduced the partial pressure of carbon dioxide from 38.0 ± 5.6 to 34.4 ± 5.9 mmHg. Early oxygen transfer dynamics inversely correlate with baseline oxygenation status. SvO2 dynamic monitoring data indicated that oxygenation likely originated from the venous outflow of the broad segment of large intestine including the inferior mesenteric vein route. Enteral ventilation pathway offers an effective means for systemic oxygenation, thus warranting further clinical development.

DOI： 10.1016/j.isci.2023.106142

Interference of a ventricular assist device with magnetic navigation during insertion of Sherlock 3CG (TM), a bedside peripherally inserted central catheter

Takakura Masashi, Fujii Tasuku, Suzuki Shogo, Nishiwaki Kimitoshi

JOURNAL OF ARTIFICIAL ORGANS 25 巻 ( 2 ) 頁： 105 - 109 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Artificial Organs

Recently, the Sherlock 3CG™ Tip Confirmation System, including a magnetic tracking system and an intracavitary electrocardiography guidance system, has been introduced for bedside peripherally inserted central catheter (PICC) insertion. Magnetic field sources interfere with the magnetic tracking system. Electromagnetic interference of the ventricular assist device (VAD) has already been reported with various devices but not on Sherlock 3CG™. We assessed the availability of the magnetic tracking system in patients with and without a VAD during Sherlock 3CG™ insertion and evaluated the rate of optimal PICC tip position. We retrospectively reviewed 99 patients who had undergone PICC insertion using Sherlock 3CG™ on the bedside at our institutional intensive care unit from February 2018 to December 2020. Patients were divided into groups with and without a VAD. The availability of magnetic navigation and the success rate of optimal catheter tip position in each group were assessed. Among 87 cases analyzed, there were 12 and 75 cases with a VAD and without a VAD, respectively. The availability of magnetic navigation during Sherlock 3CG™ insertion was significantly lower in the group with a VAD [4/12 (33%) with VAD vs. 72/75 (96%) without VAD, P < 0.001]. In addition, the rate of optimal PICC tip position was also significantly lower in the group with a VAD [6/12 (50%) vs. 63/75 (84%), P = 0.015] The VAD significantly led to magnetic tracking system failure due to its electromagnetic interference during Sherlock 3CG™ insertion and significantly reduced the success rate of PICC insertions in the optimal position.

DOI： 10.1007/s10047-021-01293-1

Incidence of intraoperative anaphylaxis caused by blood products: a 12-year single-center, retrospective study

Amano Yasuhiro, Tamura Takahiro, Fujii Tasuku, Nishiwaki Kimitoshi

JOURNAL OF ANESTHESIA 36 巻 ( 3 ) 頁： 390 - 398 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Anesthesia

Purpose: Intraoperative anaphylaxis caused by blood products is uncommon, but it is unclear whether the rarity of this reaction is attributable to the difficulty of diagnosis, underreporting, or both. We investigated the incidence of intraoperative transfusion anaphylaxis and its reporting to the hemovigilance system. Methods: We retrospectively reviewed cases wherein general anesthesia was used at a single hospital during a 12-year period. Cases of intraoperative anaphylaxis were extracted using an electronic search strategy and determined using the recently developed grading and clinical scoring system. The causative blood products were determined by the onset duration based on literature regarding intraoperative transfusion anaphylaxis cases. Results: Among the 62,146 general anesthesia cases, 22 cases of intraoperative anaphylaxis were identified, and 11 of the 22 cases received transfusions before the onset of anaphylaxis. Intraoperative transfusion anaphylaxis was defined as occurring within 30 min of transfusion. Finally, nine cases of intraoperative transfusion anaphylaxis were analyzed. The overall incidence of intraoperative transfusion anaphylaxis was 1/3,994, with the highest incidence noted for fresh frozen plasma (1/2146; 95% confidence interval [CI] 1/6610–1/920), platelet concentrate (1/2348; 95% CI 1/92,742–1/422), and red blood cells (1/22,867; 95% CI 1/903,199–1/4,105). No evidence indicated that these cases were reported to the Japanese hemovigilance system, although all intraoperative transfusion anaphylaxis cases were diagnosed by anesthesiologists. Conclusion: The incidence of intraoperative anaphylaxis caused by blood products was higher than that reported and may be underreported to the Japanese hemovigilance system. Further research, particularly multicenter studies, is needed to confirm our results.

DOI： 10.1007/s00540-022-03059-2

Ketamine reduces the dose of remifentanil required during prolonged head and neck surgery: a propensity-matched analysis

Fujii Tasuku, Nishiwaki Kimitoshi

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 1 ) 頁： 1 - 6 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

High-dose opioids induce hyperalgesia and tolerance, which negatively affects postoperative recovery.Prolonged surgery inevitably requires higher opioid doses. Ketamine reduces perioperative opioid consumptionand prevents opioid-induced tolerance. However, its effects in cases of prolonged surgery remainunknown. This study aimed to evaluate the dose of intraoperative remifentanil, an ultrashort-acting μ-opioidagonist, administered after an intravenous ketamine bolus during prolonged head and neck surgery. Thissingle-center, retrospective, observational study included 251 patients who underwent head and necksurgery (operation time ≥8 h) between January 2015 and December 2019. The participants were stratifiedinto two groups: those who received an intravenous bolus of ketamine and those who did not (ketaminegroup and non-ketamine group, respectively). Propensity score-matching was used to match patients in a1:1 ratio between the two groups, based on their covariates. The difference in intraoperative remifentanildose administered between the two groups was assessed. After 1:1 propensity score-matching, 89 matchedpatients were selected from each group. The mean ± standard deviation dose of remifentanil administeredwas significantly lower in the ketamine group than in the non-ketamine group before (0.15±0.05 vs0.17±0.05 μg/kg/min; P=0.01) and after matching (0.15±0.06 vs 0.17±0.05 μg/kg/min; P=0.03). In conclusion,intravenous ketamine administration may reduce the intraoperative dose of remifentanil requiredduring prolonged head and neck surgery. However, further studies are required to evaluate the effect ofthis finding on enhanced recovery after surgery

DOI： 10.18999/nagjms.84.1.1

Non-linear regression analysis for estimating the intraoperative motor evoked potential recovery time after bolus neuromuscular blockade

Tatsuoka Tetsuro, Fujii Tasuku, Furuhashi Takeshi, Nishiwaki Kimitoshi

JOURNAL OF CLINICAL MONITORING AND COMPUTING 35 巻 ( 6 ) 頁： 1333 - 1339 2021年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Clinical Monitoring and Computing

The recovery time of the motor evoked potential (MEP) amplitude following a neuromuscular blockade (NMB) during surgery is useful for interpreting low-amplitude waveforms or selecting the baseline waveform. In this study, the MEP data of 195 orthopedic cases who received a bolus dose of rocuronium at the beginning of surgery, between June 2009 and January 2016 were used. A non-linear regression analysis was applied to MEP amplitude data of multiple patients. The time taken for 90% of the maximum-amplitude recovery was estimated from the identified time series model. The 90% amplitude recovery time was 88.6 min in the pharmacological model and 89.4 min in the logistic model. These results were included in the 95% confidence interval of the previous studies. Although MEP amplitude is relatively unstable because of anesthesia, the averaged time series model of MEP amplitude can be estimated by using a large number of data.

DOI： 10.1007/s10877-020-00600-0

Surgical Site Infections and Inflammatory Reaction After Cardiac Surgery; Bedside Artificial Pancreas Versus Conventional Insulin Therapy: A Propensity Score-Matched Analysis.

Fujii T, Hirai T, Suzuki S, Nishiwaki K

Journal of cardiothoracic and vascular anesthesia 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiothoracic and Vascular Anesthesia

Objectives: Perioperative hyperglycemia is associated with poor postoperative recovery, including compromised immune function and increased risk of infection. A closed-loop glycemic control system (artificial pancreas) has demonstrated strict safe perioperative glycemic control without hypoglycemia risk. The authors hypothesized that the artificial pancreas would reduce surgical site infections (SSIs) and postoperative inflammatory reactions. This study aimed to assess the effect of the artificial pancreas on SSIs and C-reactive protein (CRP) levels after cardiac surgery. Design: A single-center retrospective, propensity score–matched analysis. Setting: A university hospital. Participants: In total, 295 patients who underwent cardiovascular surgery with cardiopulmonary bypass were included. Interventions: Patients were divided into two groups: artificial pancreas (target blood glucose: 120-150 mg/dL) and intravenous insulin infusion (conventional insulin therapy, target blood glucose: <200 mg/dL). Measurements and Main Results: The differences in the incidence of SSIs and CRP levels between the two groups were assessed. After 1:1 propensity score matching based on their covariates, 101 matched patients were selected from each group. The incidence of SSIs was reduced by 3%, 5% (conventional insulin therapy), and 2% (artificial pancreas), but the reduction was not statistically significant (p = 0.45). The postoperative maximum CRP level was significantly lower in the artificial pancreas group than in the conventional insulin therapy group, mean (standard deviation)14.53 (5.64) mg/dL v 16.57 (5.58) mg/dL; p = 0.01. Conclusions: The artificial pancreas did not demonstrate a significant reduction in the incidence of SSIs. However, the artificial pancreas was safe and suppressed postoperative inflammation compared with conventional insulin therapy.

DOI： 10.1053/j.jvca.2021.04.047

Comparing oscillometric noninvasive and invasive intra-arterial blood pressure monitoring in term neonates under general anesthesia: A retrospective study

Fujii Tasuku, Nishiwaki Kimitoshi

PEDIATRIC ANESTHESIA 30 巻 ( 12 ) 頁： 1396 - 1401 2020年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Paediatric Anaesthesia

Background: Oscillometric noninvasive blood pressure and/or invasive intra-arterial blood pressure are commonly used to measure the systolic, diastolic, and mean components of blood pressure. Agreement between the two methods has been reported in adults, children, and infants, but rarely in neonates, especially under general anesthesia. Aims: This retrospective study compared the agreement of each measured blood pressure value (oscillometric noninvasive or invasive intra-arterial blood pressure monitoring) in term neonates under general anesthesia. Methods: Data were collected from neonates born at ≥36 weeks of gestation whose body weight was ≥2500 g and who underwent abdominal or noncardiac thoracic surgery with both oscillometric noninvasive and invasive intra-arterial blood pressure measurements from January 2015 to March 2020. The primary outcome was the agreement of systolic, diastolic, and mean blood pressure values between the two methods using Bland-Altman analysis. Results: Paired blood pressure measurements (n = 1193) from 67 cases were compared. In Bland-Altman analysis, bias (standard deviation), 95% limits of agreement, and percentage error were −9.3 (8.4), −26.1-7.6, and 26.9% for systolic; 1.6 (6.5), −11.3-14.6, and 38.7% for diastolic; and −1.3 (5.8), −13.0-10.3, and 26.9% for mean blood pressure, respectively. During low blood pressure (intra-arterial mean blood pressure ≤30 mm Hg), the biases (standard deviation) of systolic, diastolic, and mean blood pressure were −11.4 (5.7), −0.7 (3.7), and −5.1 (4.2), whereas during high blood pressure (intra-arterial mean blood pressure ≥60 mm Hg), the values were 0.1 (9.7), 5.6 (9.4), and 6.4 (7.4), respectively. Conclusions: Based on the bias and percentage error, the mean blood pressure exhibited the most acceptable agreement between oscillometric noninvasive and invasive intra-arterial blood pressure monitoring in term neonates under general anesthesia. However, during hypertension or hypotension, there was a large discrepancy between the two methods.

DOI： 10.1111/pan.14020

Sizing of mitral annuloplasty rings using real-time three-dimensional transesophageal echocardiography and the difference between patients with and without recurrent mitral regurgitation: retrospective cohort study

Fujii Tasuku, Yoshitani Kenji, Kanemaru Eiki, Nakai Michikazu, Nishimura Kunihiro, Ohnishi Yoshihiko, Nishiwaki Kimitoshi

JOURNAL OF ECHOCARDIOGRAPHY 18 巻 ( 3 ) 頁： 169 - 174 2020年9月

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：Journal of Echocardiography

Background: Previous studies showed that the mitral inter-commissural (IC) distance differed by a few millimeters between the systolic and diastolic cardiac cycles. However, sizing of the mitral annuloplasty ring with a ring sizer, which should be performed in the systole, is performed in diastole during hyperkalemic cardioplegic arrest. The aim of this study was to investigate whether three-dimensional transesophageal echocardiography (3D-TEE) measurements of the mitral valve in end-systole are effective to determine the size of the annuloplasty ring. Methods: This study retrospectively reviewed 92 patients who underwent mitral annuloplasty for degenerative. The IC distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systole. The annuloplasty ring size was measured by the surgeons using specific ring sizers. We compared the IC distance measured by 3D-TEE with the implanted annuloplasty size. We also investigated differences in IC distance, A2 height, and ratio of A2 height to IC distance in patients with and without recurrent mild to moderate MR for 36 months. Results: There was a significant correlation between the IC distance by 3D-TEE and the implanted ring size (R2 = 0.7023, p < 0.001). Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059). Conclusions: Our results demonstrated a larger ratio of A2 height to IC distance in patients with recurrent MR. 3D-TEE could be useful for the ring sizing.

DOI： 10.1007/s12574-020-00465-x

Transverse vs. parasagittal in-plane approaches in ultrasound-guided paravertebral block using a microconvex probe A randomised controlled trial

Fujii Tasuku, Shibata Yasuyuki, Shinya Sonoe, Nishiwaki Kimitoshi

EUROPEAN JOURNAL OF ANAESTHESIOLOGY 37 巻 ( 9 ) 頁： 752 - 757 2020年9月

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：European Journal of Anaesthesiology

BACKGROUND Several approaches have been proposed for ultrasound-guided thoracic paravertebral block, but the best approach remains unclear. OBJECTIVE We compared two ultrasound-guided in-plane approaches using a microconvex probe, transverse and parasagittal. We assessed whether either approach would facilitate successful catheter placement in the paravertebral space. DESIGN Randomised controlled trial. SETTING University hospital, July 2015 to March 2016. PATIENTS Sixty patients scheduled to undergo thoracotomy were randomly allocated into two groups. INTERVENTIONS A microconvex probe was placed transversely between adjacent ribs (transverse) or sagittally between adjacent transverse processes (parasagittal). When the Tuohy needle reached the paravertebral space, a catheter was inserted to a depth of 4 cm. Then, 0.5-ml radiocontrast was injected through the catheter under fluoroscopy. MAIN OUTCOME MEASURES The primary outcome was successful catheter placement in the paravertebral space; secondary outcomes were 0 to 100 mm visual analogue scale pain score and morphine consumption in the first 24 h. RESULTS All patients received the allocated paravertebral block. Correct catheter placement occurred in 23 (77%) and 24 patients (80%) using the transverse (n=30) and parasagittal approaches (n=30), respectively (P = 1.00). Five patients were excluded due to changes in surgical procedure. Postoperative pain, represented by median [IQR] visual analogue scale score, was 19.5 [12 to 25] at rest and 55 [44 to 77] on movement with the transverse approach (n=28) vs. 22 [12 to 33.5] at rest and 59 [41.5 to 75] on movement with the parasagittal approach (n=27) (P = 0.57 at rest, P = 0.76 on movement). Median morphine consumption was 11.5 [5 to 21] and 11 [5 to 18] mg in the transverse and parasagittal approaches, respectively (P = 0.99). CONCLUSION There were no clinically significant differences between approaches for continuous ultrasound-guided thoracic paravertebral block using a microconvex probe, and both approaches achieved a high rate of correct catheter placement.

DOI： 10.1097/EJA.0000000000001223

Chronic pain after breast surgery - still many unanswered questions: a reply

Fujii T., Nishiwaki K.

ANAESTHESIA 75 巻 ( 3 ) 頁： 416 - 417 2020年3月

Clarification on chronic pain - a painfully persistent problem? A reply

Fujii T., Nishiwaki K.

ANAESTHESIA 75 巻 ( 3 ) 頁： 408 - 409 2020年3月

A single paravertebral injection via a needle vs. a catheter for the spreading to multiple intercostal levels: a randomized controlled trial

Fujii Tasuku, Shibata Yasuyuki, Ban Yasutaka, Shitaokoshi Akira, Takahashi Kunihiko, Matsui Shigeyuki, Nishiwaki Kimitoshi

JOURNAL OF ANESTHESIA 34 巻 ( 1 ) 頁： 72 - 78 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Anesthesia

Purpose: Thoracic paravertebral block (TPVB) provides a unilateral nerve block at multiple intercostal levels allowing injection of a local anesthetic into paravertebral space (PVS) via a needle or catheter. However, the most effective injection method remains unclear. This study compared the real-time spread of ropivacaine between two paravertebral injection methods using thoracoscopy. Methods: Thirty-four patients scheduled for thoracoscopic surgery were randomly allocated into the Needle or Catheter groups, and performed transverse in-plane ultrasound-guided TPVB. The Needle group received 20 ml of 0.5% ropivacaine via a needle placed into the lateral edge of PVS; the Catheter group received the same dose of ropivacaine via a catheter inserted 5 cm into PVS. The primary outcome was the spreading pattern of ropivacaine in each group. The secondary outcome was intraoperative vasopressor requirement after paravertebral injection. Results: In the Needle group, all cases showed ropivacaine spread to multiple intercostal levels, mainly across the ribs. Contrastingly, the Catheter group showed variable spreading patterns; multiple intercostal levels (n = 10) [across the ribs (n = 4), anterolateral aspect of the vertebral bodies (n = 6)] or unobservable spreading (no change; n = 7) (P = 0.007). Vasopressors were required in two and ten cases in the Needle and Catheter groups, respectively (P = 0.010). Conclusion: Paravertebral injection via a needle typically resulted in spreading to multiple intercostal levels, especially across the ribs on the peripheral side of injection site, whereas injection via a catheter resulted in variable spreading patterns. Therefore, injections via needles are more stable.

DOI： 10.1007/s00540-019-02713-6

Efficacy of pectoral nerve block type-2 (Pecs II block) versus serratus plane block for postoperative analgesia in breast cancer surgery: a retrospective study

Kubodera Kazumi, Fujii Tasuku, Akane Akiko, Aoki Wakana, Sekiguchi Akiko, Iwata Keiko, Ban Makiko, Ando Reiko, Nakamura Nozomi, Shibata Yasuyuki, Nishiwaki Kimitoshi

NAGOYA JOURNAL OF MEDICAL SCIENCE 82 巻 ( 1 ) 頁： 93 - 99 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

Thoracic wall nerve blocks reduce postoperative acute pain after breast cancer surgery (BCS); however, their short-term effects and the most effective technique remain unclear. To compare the effects of pectoral nerve block type-2 (Pecs II block) and serratus plane block for postoperative short-term analgesia, we retrospectively reviewed 43 BCS patients who underwent Pecs II block (n=22) or serratus plane block (n=21). The primary outcome was the proportion of patients with no complaints of pain 2 months post-BCS. The odds ratio (OR) was assessed, adjusting for axillary lymph node dissection. The secondary outcomes were pain severity 24 hours and 2 months post-operation using the numerical rating scale score, and morphine consumption within 24 hours. The proportion of patients without pain 2 months post-BCS was significantly less with Pecs II block than in patients with serratus plane block (55% vs. 19%, adjusted OR, 5.04; 95% confidence interval, 1.26-20.07; P=0.02); the median [interquartile range] score for pain 2 months post-operation was also significantly lower with Pecs II block (Pecs II block 0.5 [0-1] vs. serratus plane block 1 [1-2]); P=0.03). Regarding post-BCS acute analgesia, the median [interquartile range] postoperative 24-hour pain score was 2 [1-3] and 3 [1.5-3.5], and the median morphine consumption within 24 hours was 1.5 [0.75-5.5] and 3 [1.5-10] mg in Pecs II block and serratus plane block (P=0.47 and P=0.11), respectively. This study suggests that Pecs II block prevents short-term post-BCS pain better than serratus plane block. However, further studies are needed in order to support this finding.

DOI： 10.18999/nagjms.82.1.93

Comparison of Right Ventricular Function Between Patients With and Without Pulmonary Hypertension Owing to Left-Sided Heart Disease: Assessment Based on Right Ventricular Pressure-Volume Curves 国際誌

Kanemaru Eiki, Yoshitani Kenji, Kato Shinya, Fujii Tasuku, Tsukinaga Akito, Ohnishi Yoshihiko

JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 34 巻 ( 1 ) 頁： 143 - 150 2020年1月

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：Journal of Cardiothoracic and Vascular Anesthesia

Objectives: Right ventricular (RV) failure with pulmonary hypertension (PH) is frequently encountered in patients with advanced left-sided heart disease (LHD). However, RV energetics in patients with postcapillary PH because of LHD has not been well studied. The authors investigated intraoperative RV energetics in patients with PH due to LHD based on pressure–volume curves with three-dimensional transesophageal echocardiography and pulmonary artery catheterization. Design: Exploratory study. Setting: National center. Participants: Thirty-three patients who underwent cardiac surgery for LHD were enrolled. Ten patients had PH (mean pulmonary artery pressure ≥ 25 mmHg). Interventions: None. Measurements and Main Results: RV stroke work index (RVSWI) was calculated by integrating the area bounded by the pressure–volume curve. RV minute work index (RVMWI) was calculated as RVSWI × heart rate. Right ventriculo-arterial coupling was estimated as stroke volume divided by end-systolic volume (SV/ESV). The authors compared RV energetics between patients with and without PH because of LHD. RVSWI and RVMWI were significantly higher in patients with PH (690.7 mmHg·mL/m2 [601.6-737.1] v 440.9 mmHg·mL/m2 [330.8-585.3], p = 0.015, and 60,068 mmHg·mL/m2/min [35,547-68,741] v 26,351 mmHg·mL/m2/min [17,316-32,517], p = 0.011, respectively), although cardiac index was nearly identical. SV/ESV was significantly lower in patients with PH (0.520 [0.305-0.810] v 0.820 (0.650-1.090), p = 0.007). Conclusions: Although cardiac index was similar, RVSWI and RVMWI were significantly higher and SV/ESV was significantly lower in patients with PH because of LHD, suggesting that patients with postcapillary PH have inefficient RV performance.

DOI： 10.1053/j.jvca.2019.05.025

A randomised controlled trial of pectoral nerve-2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

Fujii T., Shibata Y., Akane A., Aoki W., Sekiguchi A., Takahashi K., Matsui S., Nishiwaki K.

ANAESTHESIA 74 巻 ( 12 ) 頁： 1558 - 1562 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Anaesthesia

Thoracic interfascial plane blocks are effective for post-mastectomy acute analgesia. However, their effects on chronic pain are uncertain. We randomly allocated 80 women equally to pectoral nerve-2 (PECS 2) block or serratus plane block. The pectoral nerve-2 block reduced the rate of moderate or severe chronic pain from 13/40 (33%) with the serratus plane block to 4/40 (10%), p = 0.03, adjusted odds ratio (95%CI) 0.23 (0.07–0.80), p = 0.02. The rates of pain-free women at six postoperative months were indeterminate, 10/40 (25%) after serratus plane block vs. 19/40 (48%) after pectoral nerve-2 block, p = 0.06, adjusted odds ratio (95%CI) 2.9 (1.1–7.5), p = 0.03. Health-related quality of life at six postoperative months was similar after serratus plane and pectoral nerve-2 blocks, mean (SD) EQ-5D-3L scores 0.87 (0.15) vs. 0.91 (0.14), respectively, p = 0.21. The pectoral nerve-2 block reduced median (IQR [range]) morphine consumption in the first 24 postoperative hours from 6 (3–9 [1–25]) mg to 4 (2–7 [0–37]) mg, p = 0.04. However, acute pain scores after serratus plane and pectoral nerve-2 blocks were similar, median (IQR [range]) 23 (11–35 [0–70]) mm vs. 18 (11–27 [0–61]) mm, respectively, p = 0.44. Pectoral nerve-2 block reduced chronic pain 6 months after mastectomy compared with serratus plane block.

DOI： 10.1111/anae.14856

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/anae.14856

Measurement of the Aortic Annulus Area and Diameter by Three-Dimensional Transesophageal Echocardiography in Transcatheter Aortic Valve Replacement. 国際誌

Ebuchi K, Yoshitani K, Kanemaru E, Fujii T, Tsukinaga A, Shimahara Y, Ohnishi Y

Journal of cardiothoracic and vascular anesthesia 33 巻 ( 9 ) 頁： 2387 - 2393 2019年9月

Catheterization in an ultrasound-guided thoracic paravertebral block using thoracoscopy.

Fujii T, Shibata Y, Ban Y, Shitaokoshi A, Nishiwaki K

Asian journal of anesthesiology 55 巻 ( 1 ) 頁： 24 - 25 2017年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Asian Journal of Anesthesiology

Thoracic paravertebral block (TPVB) is an efficient alternative to epidural anesthesia. The location of a catheter within the thoracic paravertebral space (TPVS) has been examined in the human cadaver studies, but it is unclear how it goes into the TPVS during catheterization. In this report, thoracoscopy was used to observe the thoracic cavity in real-time during a parasagittal in-plane approach of ultrasound-guided TPVB. During thoracoscopy, we observed whether a paravertebral catheter could be advanced caudally beyond the ribs into the neighboring TPVS. Our result demonstrated that the catheter was difficult to be advanced beyond the ribs and confined within the same level of TPVS as where it was inserted. In the previous thoracoscopic observation of the paravertebral spread, we assumed that the local anesthetic acts most strongly at the intercostal level of the injection. Therefore, we recommend to insert the catheter for TPVB at the level corresponding to the incision site of thoracotomy.

DOI： 10.1016/j.aja.2017.05.004

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