研究者詳細 - 藤井　祐

論文 - 藤井　祐

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Impact of vasopressin use for postoperative atrial fibrillation in off-pump coronary artery bypass grafting

Yamane, K; Fujii, T; Aoyama, T; Nonogaki, M; Nishiwaki, K

NAGOYA JOURNAL OF MEDICAL SCIENCE 86 巻 ( 4 ) 頁： 645 - 654 2024年11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

Postoperative atrial fibrillation complicates 15–40% of cardiac surgery cases and is associated with various adverse health outcomes including high mortality. Although vasopressin administration decreases postoperative atrial fibrillation in on-pump coronary artery bypass grafting, its use in off-pump coronary artery bypass grafting has not been investigated. Therefore, we evaluated the effect of vasopressin use in off-pump coronary artery bypass grafting. For this retrospective, observational study at a single-center community hospital in Yokkaichi, Japan, 298 patients who had undergone elective or emergency off-pump coronary artery bypass grafting between April 2015 and March 2021 were enrolled. Participants were divided into two groups: vasopressin and non-vasopressin groups. The outcomes in both groups were analyzed after propensity score matching, which revealed 40 patients in each matched group. Patients with chronic atrial fibrillation and those who were converted from off-pump to on-pump surgery were excluded. The primary outcome was postoperative atrial fibrillation occurrence within 4 days post-surgery. Secondary outcomes were 30-day mortality, intensive care unit and hospital stays, and postoperative complications (acute kidney injury, stroke, acute myocardial infarction, and respiratory complications). Although 11 patients (27.5%) in the vasopressin group were affected by postoperative atrial fibrillation when compared to 18 (45%) patients in the non-vasopressin groups, the difference was not significant (P=0.163). Similarly, no significant differences were observed in the secondary outcomes between groups. In off-pump coronary artery bypass grafting, vasopressin use may contribute to reduced postoperative atrial fibrillation; however, a large prospective study needs to be conducted for confirmation.

DOI： 10.18999/nagjms.86.4.645

Accuracy of non-invasive core temperature monitoring in infant and toddler patients: a prospective observational study

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

JOURNAL OF ANESTHESIA 2024年9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: Careful perioperative temperature management is important because it influences clinical outcomes. In pediatric patients, the esophageal temperature is the most accurate indicator of core temperature. However, it requires probe insertion into the body cavity, which is mildly invasive. Therefore, a non-invasive easily and continuously temperature monitor system is ideal. This study aimed to assess the accuracy of Temple Touch Pro™ (TTP), a non-invasive temperature monitoring using the heat flux technique, compared with esophageal (Tesoph) and rectal (Trect) temperature measurements in pediatric patients, especially in infants and toddlers. Methods: This single-center prospective observational study included 40 pediatric patients (< 3 years old) who underwent elective non-cardiac surgery. The accuracy of TTP was analyzed using Bland–Altman analysis and compared with Tesoph or Trect temperature measurements. The error was within ± 0.5 °C and was considered clinically acceptable. Results: The bias ± precision between TTP and Tesoph was 0.09 ± 0.28 °C, and 95% limits of agreement were – 0.48 to 0.65 °C (error within ± 0.5 °C: 94.0%). The bias ± precision between TTP and Trect was 0.41 ± 0.38 °C and 95% limits of agreement were – 0.35 to 1.17 °C (error within ± 0.5 °C: 68.5%). In infants, bias ± precision with 95% limits of agreement were 0.10 ± 0.30 °C with – 0.50 to 0.69 °C (TTP vs. Tesoph) and 0.35 ± 0.29 °C with – 0.23 to 0.92 °C (TTP vs. Trect). Conclusion: Core temperature measurements using TTP in infants and toddlers were more accurate with Tesoph than with Trect. In the future, non-invasive TTP temperature monitoring will help perioperative temperature management in pediatric patients.

DOI： 10.1007/s00540-024-03404-7

Evaluation of the Noninvasive Estimated Continuous Cardiac Output System for Pediatric Patients: A Prospective Observational Study.

Taniguchi T, Fujii T, Takakura M, Nishiwaki K

Anesthesia and analgesia 2024年9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：Anesthesia and Analgesia

BACKGROUND: The estimated continuous cardiac output (esCCO) system is a hemodynamic monitor that uses electrocardiograms and pulse oximeter waves to noninvasively estimate cardiac output. The coefficients for esCCO measurement have been established for adult patients, but the appropriate coefficients for pediatric patients are unclear. Therefore, this study determined esCCO coefficients for pediatric patients and validated the accuracy and tracking ability of a modified esCCO system. METHODS: An initial study compared cardiac output measurements using transthoracic echocardiography and esCCO in 60 pediatric patients aged <15 years who underwent elective noncardiac surgery. Consequently, the coefficients for the esCCO measurements were redefined for pediatric patients. The main study compared cardiac output measurements between transthoracic echocardiography and modified esCCO in 80 pediatric patients. Measurements were performed pre- and postoperatively, and the accuracy and trending ability of the cardiac output measurements were evaluated using Bland-Altman analysis and a polar plot. RESULTS: The correlation coefficients between the modified esCCO and transthoracic echocardiography were 0.96 and 0.98 in the pre- and postoperative measurements, respectively. In Bland-Altman analysis, the bias (standard deviation [SD]), 95% limits of agreement, and percentage error were 0.03 (0.28), -0.53 to 0.60, and 18% in the preoperative measurement, and -0.04 (0.19), -0.42 to 0.35, and 15% in the postoperative measurement, respectively. The polar plot showed that the cardiac output changes were well tracked, with an angular bias (SD) of 2.9° (6.0°) and radial 95% limits of agreement ranging from -9.2° to 14.9°. CONCLUSIONS: Cardiac output measurement by esCCO with modified coefficients for pediatric patients showed high accuracy and tracking ability compared with cardiac output measurement by transthoracic echocardiography. This noninvasive cardiac output measurement could benefit perioperative hemodynamic monitoring in children.

DOI： 10.1213/ANE.0000000000007144

Causative agent for perioperative anaphylaxis in a child with autism successfully identified using the intradermal test under general anesthesia

Amano, Y; Mizutani, K; Kato, Y; Fujii, T; Yagami, A; Tamura, T

JA CLINICAL REPORTS 10 巻 ( 1 ) 頁： 48 2024年8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：JA Clinical Reports

Background: The skin-prick and intradermal tests are the main diagnostic methods used to identify the causative agent in patients with suspected perioperative anaphylaxis. Although the intradermal test is more sensitive than the skin-prick test, multiple intradermal injections can be painful for children. Here, we present the case of a child with autism and suspected perioperative anaphylaxis. The causative agent was successfully identified using the intradermal test under general anesthesia. Case presentation: An 8-year-old boy with autism developed anaphylaxis during general anesthesia for the fourth cleft lip and palate surgery. An allergic workout was performed, but both the skin-prick and basophil activation tests for suspected causative agents yielded negative results. The patient was afraid of multiple injections, and an intradermal test was performed under general anesthesia by anesthesiologists and allergists. Piperacillin was confirmed as the causative agent, and subsequent surgery using the same anesthetic agents without piperacillin was uneventful. Conclusions: Concerted efforts should be made to identify the causative agent for diagnosing perioperative anaphylaxis.

DOI： 10.1186/s40981-024-00733-0

Timing of onset of intraoperative transfusion anaphylaxis: a literature review

Amano, Y; Fujii, T; Tamura, T; Hirai, T; Nishiwaki, K

NAGOYA JOURNAL OF MEDICAL SCIENCE 86 巻 ( 3 ) 頁： 351 - 360 2024年8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

Clinical diagnosis of intraoperative transfusion anaphylaxis using clinical symptoms is challenging and should be made carefully, as an incorrect clinical diagnosis can exacerbate surgical bleeding secondary to stopping a clinically indicated blood transfusion. The timing of onset of anaphylaxis to start of transfusion may be the key to correctly diagnosing intraoperative transfusion anaphylaxis clinically. However, the reliability of this measure remains unknown. A literature search was conducted using MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials up to June 29, 2021. No language restriction was applied. Two pairs of review authors independently reviewed intraoperative transfusion anaphylaxis cases and extracted data on the timing of onset of anaphylaxis to start of transfusion. A total of 8, 918 articles were reviewed, the full texts of 186 articles were assessed, and 20 intraoperative transfusion anaphylaxis cases were included in this study. The 20 intraoperative transfusion anaphylaxis cases included a precise timing of onset. With nine cases, cardiovascular surgery was the most prevalent, and one case was fatal. Fifteen cases had a timing of onset in minutes, and of those, 14 reported timeframes within 30 minutes of initiation of transfusion (median: 15.5, 5–30 minutes). Almost all cases of intraoperative transfusion anaphylaxis occurred within 30 minutes of the transfusion initiation. This timeframe may be helpful in the clinical diagnosis of intraoperative transfusion anaphylaxis.

DOI： 10.18999/nagjms.86.3.351

Thromboelastographic evaluation after cardiac surgery optimizes transfusion requirements in the intensive care unit: a single-center retrospective cohort study using an inverse probability weighting method

Tamura, T; Suzuki, S; Fujii, T; Hirai, T; Imaizumi, T; Kubo, Y; Shibata, Y; Narita, Y; Mutsuga, M; Nishiwaki, K

GENERAL THORACIC AND CARDIOVASCULAR SURGERY 72 巻 ( 1 ) 頁： 15 - 23 2024年1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：General Thoracic and Cardiovascular Surgery

Objective: There are no reports from Japan showing the effects of using the thromboelastography algorithm on transfusion requirements after Intensive Care Unit (ICU) admission, and post-implementation knowledge regarding the thromboelastography algorithm under the Japanese healthcare system is insufficient. Therefore, this study aimed to clarify the effect of the TEG6s thromboelastography algorithm on transfusion requirements for patients in the ICU after cardiac surgery. Methods: We retrospectively compared the requirements for blood transfusion up to 24 h after ICU admission using the thromboelastography algorithm (January 2021 to April 2022) (thromboelastography group; n = 201) and specialist consultation with surgeons and anesthesiologists (January 2018 to December 2020) (non-thromboelastography group; n = 494). Results: There were no significant between-group differences in terms of age, height, weight, body mass index, operative procedure, duration of surgery or cardiopulmonary bypass, body temperature, or urine volume during surgical intervention. Moreover, there was no significant between-group difference in the amount of drainage at 24 h after ICU admission. However, crystalloid and urine volumes were significantly higher in the thromboelastography group than in the non-thromboelastography group. Additionally, fresh-frozen plasma (FFP) transfusion volumes were significantly lower in the thromboelastography group. However, there were no significant between-group differences in red blood cell count or platelet transfusion volume. After variable adjustment, the amount of FFP used from the operating room to 24 h after ICU admission was significantly reduced in the thromboelastography group. Conclusions: The thromboelastography algorithm optimized transfusion requirements at 24 h after admission to the ICU following cardiac surgery.

DOI： 10.1007/s11748-023-01941-8

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

Risk factors for postoperative sore throat associated with i-gel™, a supraglottic airway device

Taniguchi, T; Fujii, T; Taniguchi, N; Nishiwaki, K

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 2 ) 頁： 319 - 326 2022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：Nagoya Journal of Medical Science

i-gel™ is a supraglottic airway device widely used for airway management during general anesthesia as an alternative to tracheal intubation. It sometimes results in a sore throat postoperatively; however, the risk factors for a postoperative sore throat caused by i-gel remain unclear. Here, we clarify the risk factors for a postoperative sore throat associated with i-gel insertion. We retrospectively reviewed the data of 426 adult patients who received general anesthesia with i-gel at our institution from January 2018 to December 2019. The incidence of postoperative sore throat and intraoperative data (size of i-gel, number of insertion attempts, total insertion time, and dose of the neuromuscular blocker and opioid) were evaluated. Logistic regression analysis was performed to identify the risk factors. Postoperative sore throat following i-gel insertion occurred in 24/426 patients (5.6%). The insertion time was significantly associated with the incidence of postoperative sore throat in the univariate analysis, but not in the multivariate analysis (P=0.519). Increased doses of neuromuscular blockers before i-gel insertion (odds ratio [OR], 5.46; 95% confidence interval [CI], 1.50–19.80; P=0.001) and reduced doses of intraoperative fentanyl (OR, 0.51; 95% CI, 0.28–0.93; P=0.028) were risk factors in the univariate and multivariate analyses. In the subgroup that used neuromuscular blockers before i-gel insertion, only an increased dose of neuromuscular blocker (OR, 17.2; 95%, CI 1.06–280; P=0.046) was an associated risk factor in the univariate and multivariate analyses. Overall, increased doses of neuromuscular blockers before i-gel insertion could contribute to the development of postoperative sore throat.

DOI： 10.18999/nagjms.84.2.319

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

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