Reproducibility of glycocheck measurements in patients under general anesthesia with muscle relaxants: A prospective observational study.
Takayuki Toki, Kazuyuki Mizunoya, Takashi Soejima, Yasunori Yagi, Naoko Nakamine, Yusuke Itosu, Ryo Takagi, Isao Yokota, Yuji Morimoto
Journal of clinical monitoring and computing, 10 Jul. 2025, [International Magazine]
English, Scientific journal, PURPOSE: To evaluate the inter- and intraobserver reproducibility of sublingual microcirculatory indices measured using the GlycoCheck system, including the perfused boundary region (PBR), vascular density (VD), and red blood cell filling (RBCF), in patients under general anesthesia without any motion artifacts. METHODS: Fifty patients who received general anesthesia for laparoscopic gastrointestinal surgery were included in this study. After the induction of general anesthesia, the leading observer and one of the five subobservers took two and one measurements of sublingual microcirculation with the GlycoCheck system, respectively. Inter- and intraobserver reproducibility was assessed using intraclass correlation coefficients (ICC). Interobserver reproducibility was calculated using the first measurements of the leading observer and subobservers, and intraobserver reproducibility was calculated using two consecutive measurements of the leading observer. RESULTS: The interobserver reproducibility of a single measurement was poor for all three parameters. The interobserver ICCs for PBR were 0.13 [95% CI: -0.15, 0.39], for VD was - 0.01 [95%CI: -0.29, 0.27], and for RBCF were 0.31 [95%CI: -0.45, 0.78]. The intraobserver ICCs for PBR was 0.32 [95% CI: 0.05, 0.55] for all 50 cases, 0.17 [95% CI: -0.25, 0.53] for the first 25 cases, and 0.46 [95% CI: 0.09, 0.72] for the second 25 cases. The Bland-Altman plots indicated that the measurement errors were random. CONCLUSION: In patients under general anesthesia, single PBR, VD, and RBCF measurements using the GlycoCheck system showed poor interobserver reproducibility. Although the intraobserver reproducibility of PBR measurements was poor, improving measurement proficiency might improve reproducibility. Further research is required to establish measurement methods that achieve better reproducibility and adequate observer training.

Microcirculatory alterations in fontan circulation: Load on vascular endothelial glycocalyx
Masahiro Shiraishi, Gaku Izumi, Hirokuni Yamazawa, Atsuhito Takeda, Nobuyasu Kato, Hiroki Kato, Takayuki Toki, Yusuke Itosu, Hitoshi Saito, Yuji Morimoto
Journal of hypertension, May 2025
English, Scientific journal

Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report.
Takayuki Toki, Kazuyuki Mizunoya, Misa Itabashi, Naoki Nishikawa, Koji Hoshino, Hitoshi Saito, Yuji Morimoto
JA clinical reports, 11, 1, 5, 5, 27 Jan. 2025, [International Magazine]
English, Scientific journal, BACKGROUND: Plasma exchange (PE) removes high-molecular-weight substances and is sometimes used for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with alveolar hemorrhage. Hypotension during PE is rare, except in allergic cases. We report a case of shock likely caused by increased pulmonary vascular resistance (PVR) during PE. CASE PRESENTATION: A 66-year-old man with pulmonary hypertension (PH) and glomerulonephritis was admitted with dyspnea. He had discontinued sildenafil prior to admission. Alveolar hemorrhage associated with AAV was suspected, and PE was performed. Soon after, he developed circulatory failure and hyperlactatemia. Echocardiography revealed right ventricular dilation, suggesting increased PVR. Inhaled nitric oxide (iNO) was administered, rapidly improving hyperlactatemia and oxygenation. The shock observed during PE was attributed to multiple factors, including the potential removal of sildenafil, which may have led to an increase in PVR. CONCLUSIONS: The shock was attributable to acute right heart failure caused by an exacerbation of PH, possibly due to sildenafil removal via PE, although other contributing factors could not be excluded.

Effects of ephedrine and phenylephrine on cerebral oxygenation: observational prospective study using near-infrared time-resolved spectroscopy.
Yasunori Kubo, Tomonori Kubo, Takayuki Toki, Isao Yokota, Yuji Morimoto
Journal of clinical monitoring and computing, 37, 5, 1171, 1177, Oct. 2023, [International Magazine]
English, Scientific journal, It has been reported that cerebral oxygenation (ScO2) measured by near infrared spectroscopy is maintained or increased by treatment with ephedrine, whereas almost all previous reports demonstrated that phenylephrine reduced ScO2. As the mechanism of the latter, the interference of the extracranial blood flow, that is extracranial contamination, has been suspected. Accordingly, in this prospective observational study, we utilized time-resolved spectroscopy (TRS), in which the effect of extracranial contamination is thought to be minimal, and evaluated whether the same result was obtained. We measured the changes in ScO2 as well as the total cerebral hemoglobin concentration (tHb) after treatment with ephedrine or phenylephrine during laparoscopic surgery by using a tNIRS-1 (Hamamatsu Photonics, Hamamatsu, Japan), which is a commercial instrument utilizing TRS. Based on a mixed-effects model with random intercepts for ScO2 or tHb including mean blood pressure, the mean difference and 95% confidence interval were evaluated as well as the predicted mean difference and its confidence interval using the interquartile range of mean blood pressure. Fifty treatments with ephedrine or phenylephrine were done. The mean differences of ScO2 were less than 0.1% and the predicted mean differences were less than 1.1% for the two drugs. The mean differences of tHb were less than 0.02 μM and the predicted mean differences were less than 0.2 μM for the drugs. The changes in ScO2 and tHb after treatments with ephedrine and phenylephrine were very small and clinically insignificant when measured by TRS. Previous reports about phenylephrine may have been affected by extracranial contamination.

Acquired laryngomalacia as a cause of post-extubation stridor and extubation failure following craniotomy: a case report.
Kazuyuki Mizunoya, Keisyu Onodera, Yuki Takahashi, Takayuki Toki, Hitoshi Saito, Yuji Morimoto
JA clinical reports, 9, 1, 44, 44, 15 Jul. 2023, [International Magazine]
English, Scientific journal, BACKGROUND: Laryngomalacia is a dynamic airway condition characterized by flaccid laryngeal tissue and inward collapse of supraglottic structures during inspiration. Although it may cause airway obstruction and requires careful management, there have been few reports regarding laryngomalacia after surgery. We report a case of adult-onset laryngomalacia occurred after craniotomy requiring reintubation. CASE PRESENTATION: A 21-year-old man was admitted to the ICU after craniotomy for a cerebellopontine angle tumor. He developed severe stridor immediately after extubation on the postoperative day 2 and required reintubation. On the postoperative day 5, similar episode occurred following re-extubation and fiberoptic laryngoscopy revealed a collapsed epiglottis and left arytenoid into the glottis. A diagnosis of laryngomalacia was made, and he underwent tracheostomy. Laryngomalacia had completely improved; however, bilateral vocal cord paralysis was detected 2 weeks later. CONCLUSIONS: Acquired laryngomalacia should be considered as a possible mechanism of the airway symptoms in a patient with neurological dysfunction.

Factors Affecting Transcranial Motor-Evoked Potential Measurements Using Single-Train Stimulation with an Increased Number of Pulses during Adolescent Scoliosis Surgery: A Prospective Observational Study.
Takayuki Toki, Noriaki Fujita, Tomohiro Ichikawa, Noriki Ochi, Isao Yokota, Hideki Sudo, Yuji Morimoto
Journal of clinical medicine, 12, 13, 30 Jun. 2023, [International Magazine]
English, Scientific journal, Measurement of transcranial motor-evoked potentials (TcMEPs) during scoliosis surgery helps detect postoperative new neurological defects. However, TcMEP interpretation is difficult owing to the influence of intraoperative physiological, pharmacological, and time-related factors as well as stimulation conditions. In this study, we aimed to investigate the effect of the abovementioned factors on TcMEP amplitude using single-train stimulation with an increased number of pulses (STS-INP) during adolescent scoliosis surgery; moreover, we evaluated the complications of TcMEP measurement. We included 50 patients and 706 TcMEP measurements. A total of 1412 TcMEP waveforms were analyzed, each on the bilateral abductor pollicis brevis, tibialis anterior, and abductor hallucis muscles. We estimated the mean difference (95% confidence interval (CI)) and predicted mean difference (95% CI) evaluated using the interquartile range of each factor, based on a mixed-effect model with random intercepts for TcMEP amplitude. The predicted mean differences in TcMEP amplitude were clinically small compared with the actual TcMEP amplitude, suggesting that each factor had a limited effect on TcMEP amplitude. No intraoperative bite injuries or seizures were observed. Using STS-INP during adolescent scoliosis surgery may enable accurate measurement of TcMEP amplitude with neither complications nor the influence of various intraoperative factors.

Age Difference of the Relationship Between Cerebral Oxygen Saturation and Physiological Parameters in Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Analysis Using the Random-Effects Model.
Masataka Yamamoto, Takayuki Toki, Yasunori Kubo, Koji Hoshino, Yuji Morimoto
Pediatric cardiology, 43, 7, 1606, 1614, Oct. 2022, [International Magazine]
English, Scientific journal, Recently, monitoring of cerebral oxygen saturation (ScO2) has become widespread in pediatric cardiac surgery. Our previous study reported that mean blood pressure (mBP) was the major contributor to ScO2 throughout cardiac surgery with cardiopulmonary bypass (CPB) in children weighing under 10 kg. We speculated that this result might be attributable to incomplete cerebral autoregulation in such young children. Accordingly, our hypothesis is that the relationship between ScO2 and the physiological parameters may change according to the growth of the children. ScO2 was measured with an INVOS 5100C (Somanetics, Troy, MI). Random-effects analysis was employed with ScO2 as a dependent variable, and seven physiological parameters (mBP, central venous pressure, nasopharyngeal temperature, SaO2, hematocrit, PaCO2, and pH) were entered as independent covariates. The analysis was performed during the pre-CPB, CPB, and post-CPB periods by dividing the patients into two groups: infants (Infant Group) and children who were more than 1 year old (Child Group). The Infant and Child Groups consisted of 28 and 21 patients. In the random-effects analysis, mBP was the major contributor to ScO2 during CPB in both groups. During the pre-CPB period, the effect of mBP was strongest in the Infant group. However, its effect was second to that of SaO2 in the Child Group. During the post-CPB period, SaO2 and mBP still affected ScO2 in the Infant group. However, the dominant contributors were unclear in the Child Group. Cerebral autoregulation may be immature in infants. In addition, it may be impaired during CPB even after 1 year of age.

The Relationships of Cerebral and Somatic Oxygen Saturation with Physiological Parameters in Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Analysis Using the Random-Effects Model.
Masataka Yamamoto, Toshihiro Mori, Takayuki Toki, Yusuke Itosu, Yasunori Kubo, Isao Yokota, Yuji Morimoto
Pediatric cardiology, 42, 2, 370, 378, Feb. 2021, [International Magazine]
English, Scientific journal, Recently, tissue oxygenation in pediatric heart surgery is measured by using near-infrared spectroscopy. Monitoring of cerebral oxygen saturation (ScO2) is most common but that of somatic tissue oxygen saturation (SrO2) is also gradually becoming widespread. However, the value of their monitoring is not well established. One of the reasons for this may be that the physiological factors affecting ScO2 and SrO2 have not been sufficiently clarified. Accordingly, we prospectively observed the changes in ScO2 and SrO2 simultaneously throughout cardiac surgery with cardiopulmonary bypass (CPB) in children weighing under 10 kg and evaluated their relationships with physiological parameters by using the random-effects model. ScO2 and SrO2 were measured with an INVOS 5100C (Somanetics, Troy, MI, USA). The random-effects analysis was applied for ScO2 and SrO2, as dependent variables, and seven physiological parameters (mean blood pressure, central venous pressure, rectal temperature, SaO2, hematocrit PaCO2, and pH) were entered as independent covariates. The analysis was performed during the pre-CPB, CPB, and post-CPB periods. Next, the same analysis was performed by dividing the patients into univentricular and biventricular physiological types. Forty-one children were evaluated. Through the whole surgical period, ScO2 correlated strongly with mean blood pressure regardless of the physiological type. On the other hand, the contribution of mean blood pressure to SrO2 was weak and various other parameters were related to SrO2 changes. Thus, the physiological parameters affecting ScO2 and SrO2 were rather different. Accordingly, the significance of monitoring of cerebral and somatic tissue oxygen saturation in pediatric cardiac surgery should be further evaluated.

血清抗O157LPS抗体を用いて腸管出血性大腸菌感染症と診断した小児溶血性尿毒症症候群の1例
土岐 崇幸, 斉藤 仁志, 久保 康則, 秋田 敬介, 佐々木 慶子, 森本 裕二, 日本臨床麻酔学会誌, 40, 5, 485, 489, Sep. 2020
日本臨床麻酔学会, Japanese

血漿交換によって急性増悪し吸入一酸化窒素が奏功した外国人旅行客の肺高血圧症 症例報告　　　　　　　　　　　　　　　
土岐 崇幸, 西川 直樹, 打浪 有可, 武田 圭史, 糸洲 佑介, 斉藤 仁志, 森本 裕二, 日本集中治療医学会雑誌, 27, Suppl., 448, 448, Sep. 2020
(一社)日本集中治療医学会, Japanese

幼児の神経芽腫に合併した可逆性脳血管攣縮症候群の1症例
土岐 崇幸, 干野 晃嗣, 武田 圭史, 西川 直樹, 斉藤 仁志, 森本 裕二, 日本集中治療医学会雑誌, 26, 3, 199, 200, May 2019
2歳女児。3週前より時折嘔吐し、意識障害を認め救急搬送された。高血圧と頻脈があり強直性間代性痙攣を認めたため、気管挿管されICUに搬送された。腹部造影CTでは左後腹膜腔に径63×59×73mmの腫瘤性病変を認め、腹部大動脈と左腎動静脈を巻き込み左腎萎縮と造影効果の低下を認め、生検で神経芽腫と診断された。カテコラミン産生腫瘍による高血圧と頻拍、可逆性後頭葉白質脳症による意識障害を疑った。心不全に対しnicardipine持続静注とamlodipineおよびcarvedilol経口投与を開始し、enalapril経口投与を追加してnicardipine持続静注を終了した。第3病日に全身強直性間代性痙攣を認め、MRAでは両側後大脳動脈や前大脳動脈で不整狭窄像とapparent diffusion coefficient低下や拡散強調像で高信号を認め、標記の診断とした。深鎮静管理として第8病日のMRAで脳血管攣縮は改善したが脳萎縮は進行し、意識障害が遷延した。, (一社)日本集中治療医学会, Japanese

幼児の神経芽腫に合併した可逆性脳血管攣縮症候群の1症例　　　　　　　　　　　　　　　
土岐 崇幸, 干野 晃嗣, 武田 圭史, 西川 直樹, 斉藤 仁志, 森本 裕二, 日本集中治療医学会雑誌, 26, Suppl., [P24, 4], Feb. 2019
(一社)日本集中治療医学会, Japanese

ナルデメジントシル酸塩による中枢性μオピオイド受容体拮抗作用が疑われた、術後多発脳梗塞患者の一例　　　　　　　　　　　　　　　
斉藤 仁志, 西川 直樹, 土岐 崇幸, 八木 泰憲, 森本 裕二, 日本集中治療医学会雑誌, 26, Suppl., [P34, 7], Feb. 2019
(一社)日本集中治療医学会, Japanese

VA-ECMO管理中に再発性、多発性の動脈性出血を発症した混合性結合組織病の一例　　　　　　　　　　　　　　　
斉藤 仁志, 西川 直樹, 土岐 崇幸, 八木 泰憲, 森本 裕二, 日本集中治療医学会雑誌, 26, Suppl., [P72, 6], Feb. 2019
(一社)日本集中治療医学会, Japanese

下腿切断術を末梢神経ブロックで管理した呼吸困難を伴う肺高血圧症の1症例
土岐 崇幸, 田中 暢洋, 三浦 正一郎, 糸洲 佑介, 森本 裕二, 臨床麻酔, 43, 1, 89, 91, Jan. 2019
70歳女性。閉塞性動脈硬化症に伴う左足趾壊疽に対しBKA(下腿切断術)を予定した。本症例は呼吸困難を伴う肺高血圧症を合併していたため、手術に際してはPNB(末梢神経ブロック)を用いて麻酔管理を行った。術中にSpO2が低下したため、一時マスクでの呼吸補助を要したが、手術終了まで意識状態、呼吸状態、循環動態は共に安定が得られた。術後は帰室8時間後にNRS6の創部痛が出現したが、フルルビプロフェンの頓用で改善した。また幻肢痛はなく、術後3日目にはNRS1の自制内となり、術後10日目に内科へ転科となった。, (株)シービーアール, Japanese

血小板輸血不応を呈した骨髄異形成症候群合併妊娠の緊急帝王切開の周術期管理
武田 圭史, 藤田 憲明, 本江 勲充, 土岐 崇幸, 干野 晃嗣, 森本 裕二, 麻酔, 67, 12, 1295, 1298, Dec. 2018
30歳代女性(3経妊0経産)。骨髄異形成症候群(MDS)合併妊娠のため妊娠10週6日目に当科へ紹介となった。所見では、血液検査でHb、血小板数(Plt)の減少を認め、経過中に3度の濃厚血小板(PC)輸血が行われたが、妊娠23週2日目に抗HLA抗体による血小板輸血不応を呈した。その後はPC-HLAを使用し管理したが、妊娠32週5日に常位胎盤早期剥離を認めたため、緊急帝王切開を行う方針となった。術前検査でPltは低値を示し、ランダムPCを30単位輸血したがPlt増加は不十分で、手術中止となった。本症例ではCCI(補正血小板増加数)の概念を用いて、2つのランダムPC 20単位製剤から5単位ずつ、計10単位を術前に輸血し、CCI 1時間値が11270μl^-1と基準値を超えていたことで、同製剤の残り15単位ずつを術中に有効に利用できると判断した。妊娠32週6日目に緊急帝王切開が行われ、母児ともに異常所見はみられず、術後10日目に退院となった。, 克誠堂出版(株), Japanese

ゲンタマイシン吸入が奏功した気管支拡張症急性増悪の一例
武田 圭史, 土岐 崇幸, 干野 晃嗣, 斉藤 仁志, 柳田 雄一郎, 森本 裕二, 日本集中治療医学会雑誌, 25, 3, 185, 189, May 2018
(一社)日本集中治療医学会, Japanese

人工気胸併用腹臥位の食道癌手術においてEZブロッカーが有用だった症例　　　　　　　　　　　　　　　
浜谷 絵里, 藤田 憲明, 土岐 崇幸, 森本 裕二, 日本臨床麻酔学会誌, 37, 6, S310, S310, Oct. 2017
日本臨床麻酔学会, Japanese

心臓手術術後にトルバプタン投与により人工呼吸器より離脱できた1例
糸洲 佑介, 雨森 英彦, 丸山 崇, 目黒 泰輝, 土岐 崇幸, 武田 圭史, Cardiovascular Anesthesia, 19, Suppl., 274, 274, Oct. 2015
(一社)日本心臓血管麻酔学会, Japanese