McGRATH™ MAC size 1 vs. 2 blades: infant intubation time.
Yuka Uchinami, Noriaki Fujita, Kazuyuki Mizunoya, Isao Yokota, Yuji Morimoto
Journal of anesthesia, 2024年06月12日, ［国内誌］
英語

Cerebral oxygenation saturation in childhood: difference by age and comparison of two cerebral oximetry algorithms.
Yasunori Kubo, Yusuke Itosu, Tomonori Kubo, Hitoshi Saito, Kazufumi Okada, Yoichi M Ito, Yuji Morimoto
Journal of clinical monitoring and computing, 38, 3, 639, 648, 2024年06月, ［国際誌］
英語, 研究論文（学術雑誌）, Few reports are available on the monitoring of regional cerebral oxygen saturation (rSO2) in pediatric patients undergoing non-cardiac surgical procedures. In addition, no study has examined the rSO2 levels in children of a broad age range. In this study, we aimed to assess and compare rSO2 levels in pediatric patients of different age groups undergoing non-cardiac surgery. We used two oximeters, tNIRS-1, which uses time-resolved spectroscopy, and conventional INVOS 5100C. Seventy-eight children-26 infants, 26 toddlers, and 26 schoolchildren-undergoing non-cardiac surgery were included. We investigated the differences in the rSO2 levels among the age groups and the correlation between the models and physiological factors influencing the rSO2 values. rSO2 measured by INVOS 5100C was significantly lower in infants than those in other patients. rSO2 measured by tNIRS-1 was higher in the toddler group than those in the other groups. The rSO2 values of tNIRS-1 and INVOS 5100C were moderately correlated (r = 0.41); however, those of INVOS 5100C were approximately 20% higher, and a ceiling effect was observed. The values in INVOS 5100C and tNIRS-1 were affected by blood pressure and the minimum alveolar concentration of sevoflurane, respectively. In pediatric patients undergoing non-cardiac surgery, rSO2 values differed across the three age groups, and the pattern of these differences varied between the two oximeters employing different algorithms. Further research must be conducted to clarify cerebral oxygenation in children.

Differences of cerebral oxygen saturation in dialysis patients: a comparison of three principals of near infrared spectroscopy.
Yasunori Yagi, Yasunori Kubo, Koji Hoshino, Kazufumi Okada, Kiyohiko Hotta, Nobuo Shinohara, Yuji Morimoto
Journal of anesthesia, 2023年08月30日, ［国内誌］
英語, 研究論文（学術雑誌）, PURPOSE: It has been reported that cerebral oxygen saturation (rSO2) measured by near infrared spectroscopy is low in dialysis patients. We compared the rSO2 values of dialysis patients before living donor kidney transplantation and their donors as controls by using three spectroscopes that utilize different principals, the INVOS 5100C (spatially resolved spectroscopy), FORE-SIGHT ELITE (modified Beer-Lambert law) and tNIRS-1 (time-resolved spectroscopy). METHODS: Before induction of anesthesia, the sensors of one of the three spectroscopes were placed on the forehead and rSO2 values were recorded followed by the same measurement using the other two spectroscopes. The primary objective was to compare the rSO2 values of the dialysis patients and controls using the three spectroscopes by the unpaired t test. Then we compared the rSO2 values among the spectroscopes in both dialysis patients and controls by one-way ANOVA. Finally, we examined the relations between the rSO2 values and the physiological values by using the Pearson correlation coefficient. RESULTS: Fifteen pairs of dialysis patients and controls were studied. With the INVOS 5100 C, the values of the dialysis patients (59.7 ± 9.7% (mean ± standard deviation) were 13% lower than those of the controls (73.3 ± 6.9%) (P < 0.01). With the tNIRS-1, the values were 57.8 ± 4.8% in the dialysis patients and 63.3 ± 3.5% in the controls (P < 0.01). Almost no differences were observed with the FORE-SIGHT ELITE (71.6 ± 4.9% [dialysis patients] vs. 70.8 ± 4.3% [Controls]) (P = 0.62). Among the spectroscopes, the values were significantly different in both dialysis patients and controls. For the INVOS 5100C and tNIRS-1, correlation coefficients between rSO2 values and blood Hb and serum Alb were more than 0.5. CONCLUSIONS: The rSO2 values for comparisons between the dialysis patients and the controls were different according to differences of the principles of the near infrared spectroscopes. In the INVOS 5100C and tNIRS-1, rSO2 values may be related to blood Hb and serum Alb.

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, 2023年07月15日, ［国際誌］
英語, 研究論文（学術雑誌）, 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, 2023年06月30日, ［国際誌］
英語, 研究論文（学術雑誌）, 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.

The comparison of postoperative analgesic requirements between modified thoracoabdominal nerve block through perichondrial approach versus wound infiltration analgesia in patients undergoing gynecological laparoscopic surgery: a retrospective, exploratory study
China Atsumi, Katsuhiro Aikawa, Keita Takahashi, Kazufumi Okada, Yuji Morimoto
JA Clinical Reports, 9, 1, Springer Science and Business Media LLC, 2023年06月24日
研究論文（学術雑誌）, Abstract

Introduction

Recently, modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) has been introduced as a novel trunk block. To date, studies comparing its clinical advantages with those of existing local anesthetic techniques are scarce. We aimed to compare the analgesic efficacy of M-TAPA to that of wound infiltration analgesia (WIA) in patients who underwent gynecological laparoscopic surgeries.

Methods

We studied medical records from January 2020 to July 2021 at Hokkaido University Hospital. The primary outcome was the number of analgesic requirements in the first 24 h postoperatively. Secondary outcomes were the time until the first analgesic requirement and adverse events regarding local anesthetic techniques. To address confounding, a regression model was used.

Results

Data from 90 of 231 patients were analyzed (M-TAPA group, n = 40; WIA group, n = 50). For the primary outcome, means and 95% confidence intervals for each group and between-group differences were as follows: 2.25 (1.74, 2.76), 2.28 (1.81, 2.75), and −0.03 (−0.72, 0.66), respectively. Adjusted mean difference was 0.39 (−0.32, 1.11). There were no significant differences in means between groups, with or without adjustment for covariates (p = 0.93, 0.28). Furthermore, no significant difference was detected in the time until the first analgesic requirement and adverse events related to local anesthesia.

Conclusion

Our results demonstrate that M-TAPA did not reduce postoperative analgesic requirements compared to WIA. In a future clinical trial, sufficient visceral pain control may be required to evaluate the effectiveness of M-TAPA over WIA in patients undergoing laparoscopic gynecological surgery.

Chronological changes in plasma levobupivacaine concentrations after bilateral modified thoracoabdominal nerve block through perichondrial approach.
Katsuhiro Aikawa, Yuka Uchinami, Yuji Morimoto
Journal of anesthesia, 2023年06月06日, ［国内誌］
英語, 研究論文（学術雑誌）, The local anesthetic (LA) systemic toxicity of trunk blocks is a major concern. Recently, modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) has attracted attention; however, plasma LA level is unknown. We tested whether the peak plasma LA concentration following M-TAPA, using 25 mL of 0.25% levobupivacaine mixed with epinephrine on each side, would be below the toxic level (2.6 μg/mL). We recruited 10 patients undergoing abdominal surgery with planned M-TAPA between November 2021 and February 2022. In all patients, 25 mL of 0.25% levobupivacaine mixed with 1:200,000 epinephrine was administered on each side. Blood samples were obtained at 10, 20, 30, 45, 60, and 120 min after the block. The highest individual peak and the mean peak plasma LA concentrations were 1.03 and 0.73 μg/mL, respectively. We could not capture the peak in five patients; however, the highest concentrations in all patients were significantly lower than the toxic level. A negative correlation between the peak level and body weight was observed. Our results indicated that the plasma LA concentration following M-TAPA using total of 50 mL of 0.25% levobupivacaine with epinephrine remains below the toxic level. Further research is required due to the small sample size of this study.Trial registry number: UMIN000045406.

Effect of cerebrospinal fluid drainage pressure in descending and thoracoabdominal aortic repair: a prospective multicenter observational study.
Kenji Yoshitani, Soshiro Ogata, Shinya Kato, Akito Tsukinaga, Tsunenori Takatani, Nobuhide Kin, Mariko Ezaka, Jun Shimizu, Yuko Furuichi, Shoichi Uezono, Kotaro Kida, Katsuhiro Seo, Shinichi Kakumoto, Hiroshi Miyawaki, Mikito Kawamata, Satoshi Tanaka, Manabu Kakinohana, Shunsuke Izumi, Hiroyuki Uchino, Takayasu Kakinuma, Kimitoshi Nishiwaki, Kazuko Hasegawa, Mishiya Matsumoto, Kazuyoshi Ishida, Atsuo Yamashita, Michiaki Yamakage, Yusuke Yoshikawa, Yuji Morimoto, Hitoshi Saito, Takahisa Goto, Tetsuhito Masubuchi, Masahiko Kawaguchi, Kosuke Tsubaki, Satoshi Mizobuchi, Norihiko Obata, Yoshimi Inagaki, Kazumi Funaki, Yoshiki Ishiguro, Masamitsu Sanui, Kazutaka Taniguchi, Kunihiro Nishimura, Yoshihiko Ohnishi
Journal of anesthesia, 37, 3, 408, 415, 2023年06月, ［国内誌］
英語, 研究論文（学術雑誌）, PURPOSE: Cerebrospinal fluid drainage (CSFD) is recommended during open or endovascular thoracic aortic repair. However, the incidence of CSFD complications is still high. Recently, CSF pressure has been kept high to avoid complications, but the efficacy of CSFD at higher pressures has not been confirmed. We hypothesize that CSFD at higher pressures is effective for preventing motor deficits. METHODS: This prospective observational study included 14 hospitals that are members of the Japanese Society of Cardiovascular Anesthesiologists. Patients who underwent thoracic and thoracoabdominal aortic repair were divided into four groups: Group 1, CSF pressure around 10 mmHg; Group 2, CSF pressure around 15 mmHg; Group 3, CSFD initiated when motor evoked potential amplitudes decreased; and Group 4, no CSFD. We assessed the association between the CSFD group and motor deficits using mixed-effects logistic regression with a random intercept for the institution. RESULTS: Of 1072 patients in the study, 84 patients (open surgery, 51; thoracic endovascular aortic repair, 33) had motor deficits at discharge. Groups 1 and 2 were not associated with motor deficits (Group 1, odds ratio (OR): 1.53, 95% confidence interval (95% CI): 0.71-3.29, p = 0.276; Group 2, OR: 1.73, 95% CI: 0.62-4.82) when compared with Group 4. Group 3 was significantly more prone to motor deficits than Group 4 (OR: 2.56, 95% CI: 1.27-5.17, p = 0.009). CONCLUSION: CSFD is not associated with motor deficits in thoracic and thoracoabdominal aortic repair with CSF pressure around 10 or 15 mmHg.

気管切開後に非典型的な出血源による大量喀血を呈した2症例　　　　　　　　　　　　　　　
副島 崇旨, 斉藤 仁志, 森本 裕二
日本集中治療医学会雑誌, 30, Suppl.1, S589, S589, (一社)日本集中治療医学会, 2023年06月
日本語

Tilt Tableの傾斜角度変化における呼吸筋機能について　　　　　　　　　　　　　　　
堀 弘明, 佐橋 健人, 斉藤 仁志, 森本 裕二
日本集中治療医学会雑誌, 30, Suppl.1, S826, S826, (一社)日本集中治療医学会, 2023年06月
日本語

大動脈縮窄・離断症に対する大動脈弓形成手術後気道出血発症のリスク因子　　　　　　　　　　　　　　　
泉 岳, 斉藤 仁志, 加藤 裕貴, 水野谷 和之, 糸洲 佑介, 西川 直樹, 武田 充人, 山澤 弘州, 加藤 伸康, 森本 裕二
日本集中治療医学会雑誌, 30, Suppl.1, S648, S648, (一社)日本集中治療医学会, 2023年06月
日本語

大動脈縮窄・離断症に対する大動脈弓形成手術後気道出血発症のリスク因子　　　　　　　　　　　　　　　
泉 岳, 斉藤 仁志, 加藤 裕貴, 水野谷 和之, 糸洲 佑介, 西川 直樹, 武田 充人, 山澤 弘州, 加藤 伸康, 森本 裕二
日本集中治療医学会雑誌, 30, Suppl.1, S648, S648, (一社)日本集中治療医学会, 2023年06月
日本語

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, 2023年05月27日, ［国際誌］
英語, 研究論文（学術雑誌）, 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.

肝胆膵手術後患者における過大腎クリアランス発生に関する検討 症例対照研究
中峯 奈央子, 水野谷 和之, 佐々木 慶子, 出村 理海, 斉藤 仁志, 森本 裕二
日本集中治療医学会雑誌, 30, 3, 171, 177, (一社)日本集中治療医学会, 2023年05月
日本語, 【目的】外傷や敗血症患者で過大腎クリアランス(augmented renal clearance,ARC)が報告されている。本研究では,これまで報告が少ない腹部大手術におけるARC発生状況を調査し,発生リスク因子を検討した。【方法】2018年10月から2021年3月に当院ICUに入室した肝胆膵長時間手術後患者をARC発生の有無で比較検討した。6時間蓄尿によるクレアチニンクリアランス(creatinine clearance,CrCl)≧130mL/min/1.73m2をARCと定義した。【結果】対象144例(年齢中央値71歳)のうち,ARC発生は55例(38%)であった。多変量解析の結果,年齢(若年),術前腎機能,術中赤血球輸血がARC発生と関連していた。術翌日の推算糸球体濾過量(estimated glomerular filtration rate,eGFR)とCrClには比例誤差を認め,ARC症例では大きな乖離が生じていた。【結語】高齢患者群でも術前腎機能が正常であれば肝胆膵手術後のARCは高率に発生し,その認識にはCrClによる評価が必要である。(著者抄録)

肝胆膵手術後患者における過大腎クリアランス発生に関する検討 症例対照研究
中峯 奈央子, 水野谷 和之, 佐々木 慶子, 出村 理海, 斉藤 仁志, 森本 裕二
日本集中治療医学会雑誌, 30, 3, 171, 177, (一社)日本集中治療医学会, 2023年05月
日本語, 【目的】外傷や敗血症患者で過大腎クリアランス(augmented renal clearance,ARC)が報告されている。本研究では,これまで報告が少ない腹部大手術におけるARC発生状況を調査し,発生リスク因子を検討した。【方法】2018年10月から2021年3月に当院ICUに入室した肝胆膵長時間手術後患者をARC発生の有無で比較検討した。6時間蓄尿によるクレアチニンクリアランス(creatinine clearance,CrCl)≧130mL/min/1.73m2をARCと定義した。【結果】対象144例(年齢中央値71歳)のうち,ARC発生は55例(38%)であった。多変量解析の結果,年齢(若年),術前腎機能,術中赤血球輸血がARC発生と関連していた。術翌日の推算糸球体濾過量(estimated glomerular filtration rate,eGFR)とCrClには比例誤差を認め,ARC症例では大きな乖離が生じていた。【結語】高齢患者群でも術前腎機能が正常であれば肝胆膵手術後のARCは高率に発生し,その認識にはCrClによる評価が必要である。(著者抄録)

Change in cerebral circulation during the induction of anesthesia with remimazolam.
Takashi Soejima, Kentaro Ueda, Sakae Hasegawa, Hiromitsu Motoe, Kazufumi Okada, Yoichi M Ito, Koji Hoshino, Yuji Morimoto
Journal of anesthesia, 37, 1, 92, 96, 2023年02月, ［国内誌］
英語, 研究論文（学術雑誌）, PURPOSE: Remimazolam is a new ultra-short-acting benzodiazepine with unknown effects on cerebral circulation. We measured total cerebral hemoglobin concentrations, which reflect cerebral blood volume (CBV), and cerebral oxygen saturation, using time-domain near-infrared spectroscopy, which can measure the absolute values of cerebral hemoglobin concentrations. We also measured cerebral blood flow velocity (CBFV) in the middle cerebral artery using transcranial Doppler as an indicator of cerebral blood flow (CBF). We did so to examine the effect of remimazolam on cerebral circulation in humans, as assessed CBV, CBF, and cerebral oxygen saturation. METHODS: This was a prospective, observational study. Fifteen patients without serious complications scheduled for general anesthesia were recruited. We measured total cerebral hemoglobin concentrations, CBFV, and cerebral oxygen saturation throughout the anesthetic induction course with remimazolam. RESULTS: Total cerebral hemoglobin concentrations did not change during the process (p = 0.51). In contrast, the mean CBFV was reduced by 11% (significant, p = 0.04). The drop in mean blood pressure following the induction of anesthesia was 17%; however, it was within the range of cerebrovascular autoregulation. Moreover, cerebral oxygen saturation increased by 4% (statistically significant, p < 0.01). CONCLUSIONS: We found that anesthetic induction with remimazolam did not alter CBV and reduced CBF in uncomplicated patients.

Tilt Tableの傾斜角度変化における肺活量測定時の腹部筋厚について　　　　　　　　　　　　　　　
堀 弘明, 千葉 健, 佐橋 健人, 斉藤 仁志, 森本 裕二
日本集中治療医学会雑誌, 29, Suppl.1, 415, 415, (一社)日本集中治療医学会, 2022年11月
日本語

敗血症性脳症治療の最前線 敗血症が海馬シナプス可塑性へ与える影響と治療可能性　　　　　　　　　　　　　　　
干野 晃嗣, 副島 崇旨, 打浪 有可, 森本 裕二
日本集中治療医学会雑誌, 29, Suppl.1, 280, 280, (一社)日本集中治療医学会, 2022年11月
日本語

神経発達を見据えた麻酔 神経発達と麻酔薬の選択
斉藤 仁志, 内田 洋介, 森本 裕二
日本小児麻酔学会誌, 27, Suppl., 62, 62, (一社)日本小児麻酔学会, 2022年10月
日本語

麻酔導入後に高度低血圧を呈した回腸導管造設後患者の一例
出村 理海, 斉藤 仁志, 本江 勲充, 森本 裕二
日本臨床麻酔学会誌, 42, 6, S252, S252, 日本臨床麻酔学会, 2022年10月
日本語

全身麻酔中の肺保護換気
水野谷 和之, 斉藤 仁志, 森本 裕二
麻酔, 71, 10, 1068, 1075, 克誠堂出版(株), 2022年10月
日本語, 術中の肺保護換気の概念は,低容量換気,プラトー圧制限,呼気終末陽圧(positive end-expiratory pressure:PEEP)の付加,リクルートメント手技から構成される。これまでの無作為化比較試験やメタ解析は,低容量換気に適度なPEEPを加えることを支持しているが,術後呼吸器合併症の減少効果について十分な結論は得られていない。近年,新しい概念である駆動圧,食道内圧に基づく経肺圧の理論が術中呼吸管理にも用いられ始めた。呼気経肺圧の考え方は患者や手術特性に応じて個別化されたPEEP設定を可能にし,呼吸器系メカニクスを改善させることが示されている。肺保護換気に個別化PEEP設定を組み合わせた呼吸管理が術後アウトカムへ与える影響が今後の検討課題である。(著者抄録)

The relationship between years of anesthesia experience and first-time intubation success rate with direct laryngoscope and video laryngoscope in infants: a retrospective observational study.
Yuka Uchinami, Noriaki Fujita, Takashi Ando, Kazuyuki Mizunoya, Koji Hoshino, Isao Yokota, Yuji Morimoto
Journal of anesthesia, 2022年09月20日, ［国内誌］
英語, 研究論文（学術雑誌）, PURPOSE: Studies in adults have reported that video laryngoscope is more useful than direct laryngoscope when training less experienced anesthesiologists. However, whether this is true for infants remains unclear. Therefore, this study aimed to evaluate whether the use of video laryngoscope would result in smaller differences in success rate according to anesthesiologists' expertise than those in direct laryngoscope. METHODS: Medical records and video recordings from the operating room of patients aged < 1 year who underwent non-cardiac surgery between March 2019 and September 2021 were reviewed. Tracheal intubations between April 8, 2020, and June 20, 2021, were excluded due to the shortage of video laryngoscope blades during the COVID-19 pandemic. Rates of first-time tracheal intubation success were compared by years of anesthesia experience and initial intubation device. RESULTS: In total, 125 of 175 tracheal intubations were analyzed (direct laryngoscope group, n = 72; video laryngoscope group, n = 53). The first-time tracheal intubation success rate increased with years of experience as an anesthesiologist in the direct laryngoscope group (odds ratio OR 1.70, 95% confidence interval CI 1.15, 2.49; P = 0.0070), but not the video laryngoscope group (OR 0.99, 95% CI 0.74, 1.35; P = 0.99). CONCLUSION: The differences in success rate according to the anesthesiologists' years of experience were non-significant when using video laryngoscope in infants, compared to those in direct laryngoscope.

Changes in Cerebral Hemodynamics During Systemic Pulmonary Shunt and Pulmonary Artery Banding in Infants with Congenital Heart Disease.
Yoshifumi Takeda, Masataka Yamamoto, Koji Hoshino, Yoichi M Ito, Nobuyasu Kato, Satoru Wakasa, Yuji Morimoto
Pediatric cardiology, 2022年09月01日, ［国際誌］
英語, 研究論文（学術雑誌）, Palliative surgery is often performed in the treatment of congenital heart disease. Two representative palliative procedures are the systemic pulmonary shunt and pulmonary artery banding. Dramatic changes in cerebral hemodynamics may occur in these operations due to changes in the pulmonary-to-systemic blood flow ratio and systemic oxygenation. However, there seem to be almost no studies evaluating them. Accordingly, we evaluated cerebral perfusion by transcranial Doppler ultrasonography and cerebral oxygenation by near infrared spectroscopy during these procedures. In the post hoc analysis of a previous prospective observational study, cerebral blood flow velocities of the middle cerebral artery measured by transcranial Doppler were compared between the start and end of surgery as were the pulsatility index and resistance index. The cerebral oxygenation values were also compared between the start and end of surgery. Twenty-two infants with systemic pulmonary shunt and 20 infants with pulmonary artery banding were evaluated. There were no significant differences of the flow velocities between the start and end of surgery in either procedure. The pulsatility index significantly increased after pulmonary artery banding, which may compete with the increase in cerebral perfusion due to the increase in systemic blood flow. The cerebral oxygenation decreased in both procedures, possibly due to an increase in body temperature. Arterial oxygen saturation was almost the same before and after both procedures. Contrary to our expectation, the changes in cerebral hemodynamics in the palliative operations were small if the management of physiological indices such as arterial oxygen saturation was properly performed during the procedures.

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, 2022年06月03日, ［国際誌］
英語, 研究論文（学術雑誌）, 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.

【発達期の脳に対する麻酔・鎮静薬の影響:いまとこれから】基礎研究の立場から 自験例を含めた文献報告を踏まえ現在わかっていること
内田 洋介, 斉藤 仁志, 森本 裕二
LiSA, 29, 5, 470, 474, (株)メディカル・サイエンス・インターナショナル, 2022年05月
日本語, ＜文献概要＞麻酔薬の中枢神経系抑制作用は可逆的であると考えられてきたが,新生児および乳幼児に対する全身麻酔が,発達期の脳に対して長期的かつ不可逆的影響を与えるかもしれないという懸念が1980年代から報告され始めた。特に1990年代後半から,生まれて間もない齧歯類へ投与された麻酔薬がアポトーシス誘導を主とする神経細胞毒性を起こすことが報告され,以後,麻酔薬の神経毒性に関する研究が世界的に急速に進められてきた。本稿では動物モデルを中心とした基礎研究から得られた知見について紹介する。

Intraoperative myocardial infarction and refractory cardiogenic shock during major hepatectomy: a case report.
Yasunori Yagi, Kazuyuki Mizunoya, Toshihiro Mori, Hitoshi Saito, Yuji Morimoto
JA clinical reports, 8, 1, 19, 19, 2022年03月09日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Myocardial infarction (MI) complicated by cardiogenic shock during non-cardiac surgery is a rare but fatal complication. The management of intraoperative MI is challenging. CASE PRESENTATION: A 77-year-old hypertensive man with good functional capacity was scheduled for hepatectomy. After the start of liver resection, the electrocardiogram monitor showed ST depression, and the patient developed refractory cardiogenic shock. Transesophageal echocardiography revealed severe hypokinesis of the anteroseptal wall. The surgery was suspended, and an intra-aortic balloon pump was placed following immediate abdominal closure. Coronary angiography revealed severe stenosis of the left main coronary trunk, and percutaneous coronary intervention (PCI) was performed. Myocardial wall motion improved, and blood pressure stabilized. Two days after PCI, hepatectomy, which had been suspended, was successfully completed. CONCLUSIONS: Once intraoperative MI has occurred, early diagnosis and multidisciplinary approaches are important to manage the difficult clinical situation.

Neonatal isoflurane exposure disturbs granule cell migration in the rat dentate gyrus
Yosuke UCHIDA, Toshikazu HASHIMOTO, Hitoshi SAITO, Koichi TAKITA, Yuji MORIMOTO
Biomedical Research, 43, 1, 1, 9, Biomedical Research Press, 2022年02月17日
研究論文（学術雑誌）

Clinical features and significance of leukopenia occurring immediately after endovascular surgery.
Takashi Soejima, Kazuyuki Mizunoya, Yuki Izumi, Takeshi Yokoyama, Ryo Takagi, Yuji Morimoto
Journal of anesthesia, 36, 1, 144, 151, 2022年02月, ［国内誌］
英語, 研究論文（学術雑誌）, PURPOSE: Inflammation after stent graft surgery is known as postimplantation syndrome (PIS) and it causes leukocytosis. However, we have experienced leukopenia in the very early postoperative phase of endovascular surgery at our institution. We investigated leukopenia, an under-recognized phenomenon that occurred after transcatheter aortic valve implantation (TAVI), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR). METHODS: Records of patients who underwent TAVI, EVAR, and TEVAR between March 2018 and February 2019 were retrospectively reviewed. Primary outcomes were the decline rate of white blood cell count (DR-WBC) in the immediate postoperative period and its differences among surgical procedures. The secondary endpoint was the relationship between DR-WBC and infectious complications. Furthermore, the incidence of PIS and its differences among the procedures and associations with DR-WBC were evaluated. RESULTS: A total of 108 patients (TAVI 41, EVAR 37, TEVAR 30) were included. DR-WBC immediately after surgery was higher in the TAVI group when compared with other groups (TAVI, 43.1 ± 22.6%; EVAR, 27.6 ± 17.3%; TEVAR, 25.4 ± 27.4%; P < 0.01). DR-WBC was not significantly different regardless of postoperative infection (P = 0.45) or PIS (P = 0.62). The incidence rate of PIS was higher in the EVAR group compared with the TAVI group, and was not associated with DR-WBC. CONCLUSIONS: Leukopenia was a common phenomenon immediately after endovascular surgery, especially TAVI. It resolved a day after surgery and was not associated with PIS or infectious complications. Therefore, it seems to be a transient abnormal hematological finding and a self-limiting condition.

急性A型大動脈解離の緊急手術を施行したBm血液型亜型の1症例
小野寺 慧洲, 原澤 克巳, 枝窪 俊輔, 水野谷 和之, 森本 裕二
麻酔, 70, 12, 1332, 1335, 克誠堂出版(株), 2021年12月
日本語, 40歳代、男性の症例である。Stanford A型急性大動脈解離に対して上行弓部大動脈人工血管置換術を施行した。術前の検査で血液型が確定できず、本人に確認したところBm亜型であったため、危機的出血への対応ガイドラインにのっとり異型適合血輸血を行った。術中・術後とも合併症なく良好な経過をたどった。血液型検査ではさまざまな原因でオモテ・ウラ不一致となるが、その割合は非常に少ない。血液型亜型では交差適合試験で輸血を選択することが可能であるが、緊急手術で血液型が確定できない場合にはガイドラインにのっとった輸血を行うことで重篤な副作用や合併症を回避できる。(著者抄録)

Evaluation of sensory loss obtained by modified-thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study.
Katsuhiro Aikawa, Isao Yokota, Yosuke Maeda, Yuji Morimoto
Regional anesthesia and pain medicine, 47, 2, 134, 135, 2021年07月20日, ［国際誌］
英語, 研究論文（学術雑誌）

非心臓手術の術中管理における最近の脳循環の話題　　　　　　　　　　　　　　　
森本 裕二, 糸洲 佑介, 久保 康則, 相川 勝洋
臨床麻酔, 45, 7, 949, 956, 真興交易(株)医書出版部, 2021年07月
日本語

Changes of cerebral oxygenation indices measured by near infrared time-resolved spectroscopy during spinal anesthesia for cesarean section: Simultaneous measurement with cerebral blood flow.
Yusuke Itosu, Yasunori Kubo, Mamoru Morikawa, Hidemichi Watari, Yuji Morimoto
The journal of obstetrics and gynaecology research, 47, 7, 2371, 2379, 2021年07月, ［国際誌］
英語, 研究論文（学術雑誌）, AIM: To measure the changes in cerebral oxygenation indices by near infrared time-resolved spectroscopy and the cerebral blood flow simultaneously after spinal anesthesia for cesarean section. METHODS: This prospective observational study was conducted for 25 pregnant women scheduled for elective cesarean section under spinal anesthesia. During a period of 15 min after spinal anesthesia, cerebral oxygenation (ScO2 ), and the total cerebral hemoglobin concentration (tHb) were measured using near infrared time-resolved spectroscopy and mean cerebral blood flow velocity (Vm) was measured using transcranial Doppler ultrasonography. Next, in the women who had nausea during the observed period, we compared these values when nausea was detected with those when it was not. RESULTS: Mean arterial pressure (MAP) decreased to around 60 mmHg (by 25% compared to the control) 6 min after spinal anesthesia. Compared to the control, ScO2 decreased by about 3% after 6 min and then gradually increased. The tHb, which reflects cerebral blood volume started to decrease just after spinal anesthesia and this continued until 12 min (the decrease was about 12%). Vm decreased by about 7%. In the 14 women who had nausea, MAP, Vm, and ScO2 values when nausea was detected were significantly lower than when it was not. CONCLUSION: The changes in cerebral hemodynamics may be small after spinal anesthesia in ordinary cesarean section compared to the reduction of systemic arterial blood pressure. There might be greater decreases in cerebral blood flow and oxygenation when nausea occurred in the pregnant women who experienced it after spinal anesthesia.

Effects of The Prone Position on Regional Neutrophilic Lung Inflammation According To 18F-FDG PET In An Experimental Ventilator-Induced Lung Injury Model.
Susumu Nakahashi, Hiroshi Imai, Nobutake Shimojo, Yasuhiro Magata, Takahiro Einama, Mineji Hayakawa, Takeshi Wada, Yuji Morimoto, Satoshi Gando
Shock (Augusta, Ga.), 57, 2, 298, 308, 2021年06月08日, ［国際誌］
英語, 研究論文（学術雑誌）, ABSTRACT: Ventilator-induced lung injury (VILI) can be life-threatening and it is important to prevent the development of VILI. It remains unclear whether the prone position affects neutrophilic inflammation in the lung regions in vivo, which plays a crucial role in the pathogenesis of VILI. This study aimed to assess the relationship between the use of the prone position and the development of VILI-associated regional neutrophilic lung inflammation. Regional neutrophilic lung inflammation and lung aeration during low tidal volume mechanical ventilation were assessed using in vivo 2-deoxy-2-[ (18)F] fluoro-D-glucose (18F-FDG) positron emission tomography and computed tomography in acutely experimentally injured rabbit lungs (lung injury induced by lung lavage and excessive ventilation). Direct comparisons were made among three groups: control, supine, and prone position. After approximately 7 hours, tissue-normalized 18F-FDG uptake differed significantly between the supine and prone positions (SUP: 0.038 ± 0.014 vs. PP: 0.029 ± 0.008, P = 0.038), especially in the ventral region (SUP: 0.052 ± 0.013 vs. PP: 0.026 ± 0.007, P = 0.003). The use of the prone position reduced lung inhomogeneities, which was demonstrated by the correction of the disproportionate rate of voxel gas over the given lung region. The progression of neutrophilic inflammation was affected by the interaction between the total strain (for aeration) and the inhomogeneity. The prone position is effective in slowing down the progression of VILI-associated neutrophilic inflammation. Under low-tidal-volume ventilation, the main drivers of the its effect may be homogenization of lung tissue and that of mechanical forces.

Diagnostic timing dependent characteristics of acute kidney injury following hepatectomy: a retrospective historical cohort analysis.
Kazuyuki Mizunoya, Yasunori Yagi, Hirofumi Kamachi, Toshiya Kamiyama, Yuji Morimoto, Akinobu Taketomi
HPB : the official journal of the International Hepato Pancreato Biliary Association, 2021年05月18日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The timing of diagnosis of post-hepatectomy acute kidney injury (AKI) has rarely been investigated. The aim of this retrospective study was to reveal the differences between AKI subtypes following hepatectomy, as classified by timing of diagnosis. METHOD: Post-hepatectomy AKI was classified as very transient AKI (vtAKI; criteria satisfied by the serum creatinine value immediately after surgery) or non-transient AKI (ntAKI; all other AKI types except for vtAKI). Multivariate logistic regression analyses for both AKI types were performed separately to identify differences in known perioperative AKI risk factors. The impacts of each AKI subtype on postoperative complications, hospital stay and renal outcome at discharge were also evaluated. RESULTS: AKI was diagnosed in 135 of 750 patients (18.0%); 82 and 53 patients were classified as vtAKI and ntAKI, respectively. In multivariate analysis, even among the perioperative factors associated with whole AKI, there were distinct relationships depending on vtAKI or ntAKI. Furthermore, only ntAKI was associated with postoperative complications, longer hospital stays and impaired renal function at discharge. CONCLUSIONS: Based on the results of this study, future post-hepatectomy AKI studies should only include ntAKI and exclude vtAKI, as vtAKI has minimal clinical impact despite accounting for a significant proportion of AKI patients. CLINICAL TRIAL REGISTRATIONS: None.

心房性ナトリウム利尿ペプチドの持つ第3の作用 血管透過性とグリコカリックスに与える影響
水野谷 和之, 森本 裕二
日本集中治療医学会雑誌, 28, 3, 173, 179, (一社)日本集中治療医学会, 2021年05月
日本語, 心房性ナトリウム利尿ペプチド(atrial natriuretic peptide,ANP)は,心不全治療や心臓手術周術期など様々な場面での臨床効果を検討されてきたが,現在でも定まったエビデンスは得られていない。一方で,ANPには血管透過性を制御する作用があることはあまり知られていない。ANPによる体液量および心前負荷の調節には,利尿作用,血管拡張作用とともに,血管透過性亢進作用が強く関与していることが示されている。さらに,ANPには傷害された血管内皮細胞の透過性亢進を抑制する作用も報告されている。これらに加えて,近年,ANPが血管内皮上に存在するグリコカリックスを傷害する因子であることが疑われている。このように,ANPは血管内皮細胞やグリコカリックスに影響を与え,生体内での血管透過性の制御を担う重要な役割を持つ可能性がある。(著者抄録)

Altered microvascular reactivity assessed by near-infrared spectroscopy after hepato-pancreato-biliary surgery.
Kazuyuki Mizunoya, Yasunori Yagi, Yuji Morimoto, Satoshi Hirano
Journal of clinical monitoring and computing, 36, 3, 703, 712, 2021年04月07日, ［国際誌］
英語, 研究論文（学術雑誌）, Little is known about microcirculatory dysfunction following abdominal surgeries. This study aimed to evaluate changes in microvascular reactivity (MVR) before and after major abdominal surgery, assessed by near-infrared spectroscopy in conjunction with a vascular occlusion test. This prospective observational study included 50 adult patients who underwent hepato-pancreato-biliary surgery lasting ≥ 8 h. MVR was assessed by tissue oxygen saturation (StO2) changes in the plantar region of the foot during 3 min of vascular occlusion and subsequent release under general anesthesia before and after surgery. The primary outcome was alteration in the recovery slope of StO2 (RecStO2) and recovery time (tM) between the preoperative and postoperative values. Postoperative short-term outcome was represented by the Post-operative Morbidity Survey (POMS) score on the morning of postoperative day 2. After surgery, RecStO2 was reduced (0.74% [0.58-1.06]/s vs. 0.89% [0.62-1.41]/s, P = 0.001), and tM was longer (57.0 [42.9-71.0] s vs. 41.3 [35.5-56.5] s, P < 0.001), compared to the preoperative values. Macrohemodynamic variables such as cardiac index, arterial pressure, and stroke volume during postoperative measurement did not differ with or without relative MVR decline. In addition, the POMS score was not associated with postoperative alterations in microcirculatory responsiveness. MVR in the plantar region of the foot was reduced after major hepato-pancreato-biliary surgery regardless of macrocirculatory adequacy. Impaired MVR was not associated with short-term outcomes as long as macrocirculatory indices were well maintained. The impact of relative microcirculatory changes, especially combined with inadequate macrocirculation, on postoperative complications remains to be elucidated.Clinical Trial Registrations UMIN-CTR trial ID: 000033461.

ビーチチェア体位での関節鏡下肩手術における脳酸素飽和度の変化 空間分解分光法を用いた前向き観察研究
糸洲 佑介, 原田 聡子, 田中 暢洋, 加藤 亮子, 森本 裕二
麻酔, 70, 4, 367, 373, 克誠堂出版(株), 2021年04月
日本語, ビーチチェア体位による関節鏡下肩手術時の脳酸素飽和度への影響を、測定原理として空間分解分光法を用いたNIRO-200NX(浜松ホトニクス、浜松市)を使用して測定した。組織酸素化指標(TOI)は、ビーチチェア体位に変換することにより5%程度低下したが、過去に報告されている、測定原理としてmodified Beer-Lambert法を用いた機種による脳酸素飽和度ほど著明な低下を示さなかった。一方、脳内ヘモグロビン濃度変化では、ビーチチェア体位中、酸素化ヘモグロビンと総ヘモグロビン濃度の有意な低下を認め、いわゆる脳虚血パターンを示した。以上から、ビーチチェア体位中の血圧や生理学的指標の適正管理は、脳循環維持のために重要と考えられた。(著者抄録)

特発性腹腔内出血により出血性ショックに至った患者の超緊急帝王切開の麻酔経験
安藤 貴士, 水野谷 和之, 雨森 英彦, 斉藤 仁志, 森本 裕二
麻酔, 70, 4, 413, 416, 克誠堂出版(株), 2021年04月
日本語, 症例は30歳代の初産婦で、妊娠33週6日夜に下腹部痛を自覚し、翌早朝に救急外来を受診した。入院後に循環不全を認め、胎児機能不全もみられたため全身麻酔下での超緊急帝王切開を決定した。十分な酸素化ののちに、フェンタニル100μg、チアミラール300mg、スキサメトニウム60mgで麻酔導入し、レミフェンタニル0.1〜0.3μg/kg/min、プロポフォール2〜3.5mg/kg/hr、ロクロニウム20mg/hrを用いて全身麻酔を維持した。腹腔内に凝血塊を含む大量の出血を認めたが、手術開始後2分で胎児を娩出した。胎児娩出後も母体の循環不全の改善はみられず、腹腔内の検索により左内腸骨動脈分枝から活動性出血を認めたため外科的止血を行った。術後は挿管鎮静下でICUへ入室し、PRC 10単位、FFP 10単位、血小板濃厚液20単位を追加投与したのち、同日夕に抜管した。術後1日目に一般病棟へ転棟し、後遺症なく術後7日目に独歩退院となった。

Interleukin-1β Modulates Synaptic Transmission and Synaptic Plasticity During the Acute Phase of Sepsis in the Senescence-Accelerated Mouse Hippocampus.
Koji Hoshino, Yuka Uchinami, Yosuke Uchida, Hitoshi Saito, Yuji Morimoto
Frontiers in aging neuroscience, 13, 637703, 637703, 2021年, ［国際誌］
英語, 研究論文（学術雑誌）, Background: Aging and pre-existing cognitive impairment are considered to be independent risk factors for sepsis-associated encephalopathy. This study aimed to investigate the manner in which aging and pre-existing cognitive dysfunction modified neuroinflammation, synaptic plasticity, and basal synaptic transmission during the acute phase of sepsis using Senescence-Accelerated Mice Prone 8 (SAMP8) and Senescence-Accelerated Resistant Mice 1 (SAMR1). Methods: We used 6-month-old SAMP8 and SAMR1. Sepsis was induced using cecal ligation and puncture (CLP). The animal's hippocampi and blood were collected for subsequent investigations 24 h after surgery. Results: Long-term potentiation (LTP) was impaired in the Shaffer-collateral (SC)-CA1 pathway of the hippocampus in SAMP8 without surgery compared to the age-matched SAMR1, which was reflective of cognitive dysfunction in SAMP8. CLP impaired the SC-CA1 LTP in SAMR1 compared to the sham-operated controls, but not in SAMP8. Moreover, CLP decreased the input-output curve and increased the paired-pulse ratio in SAMP8, suggesting the reduced probability of basal synaptic transmission due to sepsis. Immunohistochemical analysis revealed that CLP elevated IL-1β levels, especially in the hippocampi of SAMP8 with microglial activation. In vivo peripheral IL-1 receptor antagonist (IL-1ra) administration in the septic SAMP8 revealed that the neuroinflammation was not correlated with the peripheral elevation of IL-1β. Ex vivo IL-1ra administration to the hippocampus ameliorated LTP impairment in SAMR1 and the reduction in basal transmission in SAMP8 after sepsis. Conclusions: The mechanism of the modulation of synaptic transmission and synaptic plasticity by the acute stage of sepsis differed between SAMR1 and SAMP8. These changes were related to centrally derived IL-1 receptor-mediated signaling and were accompanied by microglial activation, especially in SAMP8.

An effective case of shichimotsukokato treatment for postherpetic neuralgia in a patient with chronic kidney disease
Tomoaki Fujii, Yuji Morimoto
Traditional & Kampo Medicine, 7, 3, 180, 182, Wiley, 2020年12月
研究論文（学術雑誌）

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, 2020年11月17日, ［国際誌］
英語, 研究論文（学術雑誌）, 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.

ECMO補助下の呼吸不全患者の航空搬送経験
糸洲 佑介, 斉藤 仁志, 打浪 有可, 本間 慶憲, 吉田 知由, 干野 晃嗣, 西川 直樹, 森本 裕二
日本集中治療医学会雑誌, 27, 6, 491, 492, (一社)日本集中治療医学会, 2020年11月
日本語, 30歳代女性。呼吸困難を主訴に近医を受診し、間質性肺炎の急性増悪と診断され加療されたが症状は改善せず、当院(札幌市)に転院となった。ただちに気管挿管し人工呼吸療法を開始したが、呼吸不全が進行し、転院3日目にVV-ECMOを導入した。その後、人工呼吸器を離脱したが、自己肺の改善はみられず、ECMOの離脱は困難な状態となり、東北大学病院へ転院し生体肺移植を受ける予定となった。転院26日目に北海道庁に災害派遣要請を行い、36日目に、高度な医療監視が行える機動衛生ユニットを有するC-130H型輸送機で航空自衛隊千歳基地から仙台空港へ搬送され、仙台空港から救急車で東北大学病院へ搬送された。一般にECMO患者の搬送は機器の脱落やライントラブルの危険性があるが、本例ではECMO装置とシリンジポンプが装着可能なバックボード装着型架台システム(BBT-2000)を使用したことでライントラブルを回避でき、移動時間の短縮にも繋がったと考えられた。

Subanesthetic ketamine exerts antidepressant-like effects in adult rats exposed to juvenile stress.
Katsuhiro Aikawa, Takayuki Yoshida, Yu Ohmura, Kerise Lyttle, Mitsuhiro Yoshioka, Yuji Morimoto
Brain research, 1746, 146980, 146980, 2020年11月01日, ［国際誌］
英語, 研究論文（学術雑誌）, Juvenile stress, like that caused by childhood maltreatment, is a significant risk factor for psychiatric disorders such as depression later in life. Recently, the antidepressant effect of ketamine, a noncompetitive N-methyl-d-aspartate receptor antagonist, has been widely investigated. However, little is known regarding its efficacy against depressive-like alterations caused by juvenile stress, which is clinically relevant in human depression. In the present study, we evaluated the antidepressant-like effect of ketamine in adult rats that had been subjected to juvenile stress. Depressive-like behavior was assessed using the forced swim test (FST), and electrophysiological and morphological alterations in the layer V pyramidal cells of the prelimbic cortex were examined using whole-cell patch-clamp recordings and subsequent recording-cell specific fluorescence imaging. We demonstrated that ketamine (10 mg/kg) attenuated the increased immobility time caused by juvenile stress in the FST, restored the diminished excitatory postsynaptic currents, and caused atrophic changes in the apical dendritic spines. Ketamine's effects reversing impaired excitatory/inhibitory ratio of postsynaptic currents were also revealed. These results indicated that ketamine could be effective in reversing the depression-like alterations caused by juvenile stress.

Bm血液型亜型で急性A型大動脈解離の緊急手術を必要とした1症例
小野寺 慧洲, 枝窪 俊輔, 森本 裕二
日本臨床麻酔学会誌, 40, 6, S269, S269, 日本臨床麻酔学会, 2020年10月
日本語

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, 日本臨床麻酔学会, 2020年09月
日本語, 志賀毒素産生性腸管出血性大腸菌(STEC)感染に伴う溶血性尿毒症症候群(ST-HUS)の診断には便からの病原菌や志賀毒素の検出が必要であるが,偽陰性も多く診断が困難となる症例がある.今回われわれは,便培養では診断不可能であったが,血清抗O157リポ多糖体(LPS)抗体検査を用いてST-HUSと診断した症例を経験した.臨床的にSTEC感染症が疑われる症例では血清抗LPS抗体検査は有用である可能性がある.(著者抄録)

診療報酬改定による多人数用高気圧酸素治療の現状
武貞 敬介, 石川 勝清, 平子 竜大, 岡本 花織, 岩崎 毅, 佐々木 亮, 法邑 まなみ, 松本 剛直, 千葉 裕基, 村田 裕宣, 植村 勇人, 室谷 黎奈, 寒河江 磨, 太田 稔, 森本 裕二
公益社団法人北海道臨床工学技士会会誌, 30, 150, 152, (公社)北海道臨床工学技士会, 2020年09月
日本語, 診療報酬改定から1年が経過した当院における高気圧酸素治療(HBO)の現状を報告した。平成26年度から平成30年度にHBOを施行した患者を対象に、診療報酬の改定前後における患者数と延べ治療回数、診療報酬額を算出した。診療報酬改定前の外来患者数は平成29年度の77名まで増加傾向であったが、改定後の平成30年度は45名に減少した。延べ治療回数は外来では平成29年度まで増加傾向にあったが平成30年度は441回に減少し、入院では患者数の推移に相似し増減したが、改定後の平成30年度は前年から約200回増加した。診療報酬請求額は改定後の平成30年度は前年比で外来934%、入院332%と大幅な増加を認め、診療報酬改定に伴い収益は増加した。今後の診療報酬改定では、長期間の治療が求められる末梢循環障害や骨髄炎等の治療回数の上限の改善が望まれる。

術前心血管合併症低リスク患者において肝切除術中に心筋梗塞をきたした一例
八木 泰憲, 水野谷 和之, 森 敏洋, 斉藤 仁志, 森本 裕二
Cardiovascular Anesthesia, 24, Suppl., 140, 140, (一社)日本心臓血管麻酔学会, 2020年09月
日本語

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, 日本臨床麻酔学会, 2020年09月
日本語

Cantrell症候群に合併した大動脈縮窄複合に対するNorwood手術の一例
坂井 俊朗, 斉藤 仁志, 水野谷 和之, 田中 暢洋, 森本 裕二
Cardiovascular Anesthesia, 24, 1, 127, 130, (一社)日本心臓血管麻酔学会, 2020年08月
日本語, Cantrell症候群は上腹部腹壁欠損,胸骨下部欠損,横隔膜前部欠損,横隔膜部心膜欠損に先天性心疾患を伴う稀な疾患である。今回大動脈縮窄複合,心臓脱を合併したCantrell症候群児に対し,生後2日目にNorwood手術と右室-肺動脈conduit,脱出心の胸腔内還納を行った症例を経験した。閉創前後に呼吸循環状態の慎重な観察と人工呼吸器設定の調整を要したが,良好な転帰を得た。本疾患においては胸腔内容積の不足により,並列循環における呼吸循環動態の管理が一層困難となるため,厳重なモニタリングと適切な術中術後管理が必要となる。(著者抄録)

Cantrell症候群に合併した大動脈縮窄複合に対するNorwood手術の一例
坂井 俊朗, 斉藤 仁志, 水野谷 和之, 田中 暢洋, 森本 裕二
Cardiovascular Anesthesia, 24, 1, 127, 130, (一社)日本心臓血管麻酔学会, 2020年08月
日本語, Cantrell症候群は上腹部腹壁欠損,胸骨下部欠損,横隔膜前部欠損,横隔膜部心膜欠損に先天性心疾患を伴う稀な疾患である。今回大動脈縮窄複合,心臓脱を合併したCantrell症候群児に対し,生後2日目にNorwood手術と右室-肺動脈conduit,脱出心の胸腔内還納を行った症例を経験した。閉創前後に呼吸循環状態の慎重な観察と人工呼吸器設定の調整を要したが,良好な転帰を得た。本疾患においては胸腔内容積の不足により,並列循環における呼吸循環動態の管理が一層困難となるため,厳重なモニタリングと適切な術中術後管理が必要となる。(著者抄録)

ビデオ喉頭鏡McGRATH MACを用いて気管チューブ交換を行った際に、外科的止血を要する右扁桃損傷を生じた1症例　　　　　　　　　　　　　　　
前田 洋典, 西田 紳悟, 水野谷 和之, 森 敏洋, 斉藤 仁志, 森本 裕二
臨床麻酔, 44, 6, 869, 871, 真興交易(株)医書出版部, 2020年06月
日本語, 症例は50歳代男性で、左室補助人工心臓植込み術後、両側膿胸に対して両側胸腔ドレナージ中であった。排液が減少したため両側の胸腔ドレーンが抜去されたが、1時間半後より呼吸状態が悪化し、左胸壁ドレーン抜去部からの出血が疑われた。呼吸状態安定化のために気管挿管され、左胸腔内出血に対する胸腔鏡下血腫除去止血術および右膿胸に対する胸腔鏡下膿胸掻爬術を予定した。術後は気管挿管下にICU帰室予定であったため、麻酔導入時同様にビデオ喉頭鏡(McGRATH MAC)のブレード4を使用しチューブ交換を行った。ICU帰室準備中に多量の口腔内出血を認め、何度か口腔内吸引を行ったがおさまらず、ICU帰室後に耳鼻科医に診察を依頼した。前口蓋弓-後口蓋弓を数針圧縮縫合して止血することができ、原病に対しての抗凝固療法は術翌日より再開し、その後、新規出血なく経過した。

全身麻酔導入時の脳循環変化 時間分解近赤外分光法と経頭蓋ドプラを用いた前向き観察研究
副島 崇旨, 内田 洋介, 斉藤 仁志, 森本 裕二
麻酔, 69, 5, 530, 537, 克誠堂出版(株), 2020年05月
日本語, プロポフォールからセボフルラン投与の麻酔導入過程での脳循環変化を、時間分解近赤外分光法を用いた脳血液量と脳組織酸素飽和度、経頭蓋ドプラを用いた脳血流量変化を指標として、気管挿管約20分後まで経時的に測定した。麻酔導入より、血圧は約25%低下し、脳血流量は20%程度、脳血液量は7%程度低下した。これは主にプロポフォールのボーラス投与による影響と考えられた。その後、脳血液量はさらに低下したが、脳血流量は増加し、両者とも対照の10%減となった。これはセボフルランによる脳血液量減少を反映したものと考えられた。一方、脳酸素飽和度は経過中ほぼ一定で、代謝・血流量連関が維持されていることが分かった。(著者抄録)

術前に甲状腺機能低下状態が確認された場合の手術延期の是非について　　　　　　　　　　　　　　　
森本 裕二, 相川 勝洋, 三好 寛二, 堤 保夫
臨床麻酔, 44, 5, 715, 718, 真興交易(株)医書出版部, 2020年05月
日本語

【ICU治療指針 III】手術・麻酔と周術期管理 成人肝移植術の周術期管理(術後管理を中心に)　　　　　　　　　　　　　　　
斉藤 仁志, 加藤 裕貴, 森本 裕二
救急・集中治療, 31, 4, 1523, 1528, (株)総合医学社, 2020年03月
日本語, ＜POINT＞●我が国における肝移植は、生体肝移植の頻度が高い。脳死移植法案の施行後も十分な肝供給があるとは言えず、移植待機中に死亡する症例も多い。手術成績は年々向上しており、2017年度報告でのレシピエントの生存率は1年後、5年後でそれぞれ86.8%、80.4%と、欧米の成績と比しても高水準にある。●術前管理では、肝不全患者の病態生理を理解し、肝、肺、心、腎、血液凝固など、多岐にわたる全身評価・管理と、積極的な栄養療法を実施する。術後管理では、致死的な早期合併症である拒絶反応、感染症を常に警戒し、グラフト血流を継続的に評価しつつ、免疫抑制剤と抗生剤を適切に選択すること、さらには術後早期からの栄養療法、リハビリテーションを実施する。本稿では、術前管理および術中管理は誌面の都合で割愛し、術後管理について述べる。(著者抄録)

【ICU治療指針 III】手術・麻酔と周術期管理 小児肝移植の周術期管理　　　　　　　　　　　　　　　
斉藤 仁志, 干野 晃嗣, 森本 裕二
救急・集中治療, 31, 4, 1529, 1532, (株)総合医学社, 2020年03月
日本語, ＜POINT＞●成人に比し、閉腹の遅れ、大量の腹水などによる循環呼吸管理に難渋し、比較的長期間の管理を要することがあるため注意を要する。●血管の狭窄、血栓閉塞リスクが高いと言われており、out flow blockの可能性を常に念頭においた、より慎重なグラフト血流の評価と管理が必要となる。(著者抄録)

【ICU治療指針 III】手術・麻酔と周術期管理 周術期の血液製剤の用い方　　　　　　　　　　　　　　　
斉藤 仁志, 水野谷 和之, 森本 裕二
救急・集中治療, 31, 4, 1584, 1589, (株)総合医学社, 2020年03月
日本語, ＜POINT＞●急性出血は赤血球や凝固因子を喪失するだけでなく、全身臓器に対して様々な影響をもたらすことが知られている。その病態生理を概観した上で、早急かつ適切に対応することが重要である。●一部の疾患、病態に対してはトリガー輸血による予後の改善が報告されているため、各種ガイドラインを参考に適切な輸血療法を施行する。(著者抄録)

【ICU治療指針 III】手術・麻酔と周術期管理 周術期の血液製剤の用い方　　　　　　　　　　　　　　　
斉藤 仁志, 水野谷 和之, 森本 裕二
救急・集中治療, 31, 4, 1584, 1589, (株)総合医学社, 2020年03月, ［査読有り］
日本語, ＜POINT＞●急性出血は赤血球や凝固因子を喪失するだけでなく、全身臓器に対して様々な影響をもたらすことが知られている。その病態生理を概観した上で、早急かつ適切に対応することが重要である。●一部の疾患、病態に対してはトリガー輸血による予後の改善が報告されているため、各種ガイドラインを参考に適切な輸血療法を施行する。(著者抄録)

【ICU治療指針 III】手術・麻酔と周術期管理 小児肝移植の周術期管理　　　　　　　　　　　　　　　
斉藤 仁志, 干野 晃嗣, 森本 裕二
救急・集中治療, 31, 4, 1529, 1532, (株)総合医学社, 2020年03月, ［査読有り］
日本語, ＜POINT＞●成人に比し、閉腹の遅れ、大量の腹水などによる循環呼吸管理に難渋し、比較的長期間の管理を要することがあるため注意を要する。●血管の狭窄、血栓閉塞リスクが高いと言われており、out flow blockの可能性を常に念頭においた、より慎重なグラフト血流の評価と管理が必要となる。(著者抄録)

Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy.
Katsuhiro Aikawa, Nobuhiro Tanaka, Yuji Morimoto
Journal of clinical anesthesia, 59, 44, 45, 2020年02月, ［査読有り］, ［国際誌］
英語

Anesthetic management by blockage of thoracoabdominal nerves through perichondrial approach (TAPA) for open nephrectomy in a pediatric patient with Wilms tumor.
Nobuhiro Tanaka, Yasunori Yagi, Katsuhiro Aikawa, Yuji Morimoto
Journal of clinical anesthesia, 59, 51, 52, 2020年02月, ［査読有り］, ［国際誌］
英語

Two-stage goal-directed therapy protocol for non-donor open hepatectomy: an interventional before-after study.
Kazuyuki Mizunoya, Tomoaki Fujii, Masataka Yamamoto, Nobuhiro Tanaka, Yuji Morimoto
Journal of anesthesia, 33, 6, 656, 664, 2019年12月, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, PURPOSE: Hemodynamic management during low central venous pressure (L-CVP)-assisted hepatectomy involves fluid restriction during resection and fluid resuscitation after resection. Recently, high stroke volume variation (SVV) has been reported as an alternative to L-CVP for reducing blood loss during a hepatectomy. The current study evaluated the impact of a newly implemented SVV-based goal-directed therapy (GDT) protocol on blood loss during hepatectomy. METHODS: We conducted a before-after comparative study, which included L-CVP-assisted hepatectomy cases (control group) and GDT-assisted hepatectomy cases (intervention group). The GDT protocol included SVV, cardiac index, and mean arterial pressure as hemodynamic parameters. The target SVV ranges were ≥ 13% and ≤ 12% before and after the resection, respectively. The primary endpoint was the proportion of patients whose blood loss was < 400 mL (median of our hepatectomy cases) in the GDT group, and it was compared to a predefined threshold of 50%. We also investigated factors associated with blood loss using multiple regression analysis. RESULTS: We included 66 patients in the control group and 50 in the GDT group. In the GDT group, the median blood loss was 220 mL and 36 patients (72%) lost < 400 mL blood. This was significantly greater than 50% (P < 0.001). Post-resection GDT-guided fluid optimization reduced positive intraoperative fluid balance compared to that achieved by the conventional fluid therapy used in the control. Multiple regression analysis showed that GDT application, epidural anesthesia, operative time, and hydroxyethyl-starch infusion volume were associated with blood loss. CONCLUSION: Compared to conventional management, SVV-guided GDT may reduce blood loss during hepatectomies.

Changes of Cerebral Blood Volume During Robot-Assisted Laparoscopic Radical Prostatectomy: Observational Prospective Study Using Near-Infrared Time-Resolved Spectroscopy.
Tanaka N, Yamamoto M, Abe T, Osawa T, Matsumoto R, Shinohara N, Saito H, Uchida Y, Morimoto Y
Journal of endourology, 33, 12, 995, 1001, 2019年12月, ［査読有り］, ［国際誌］
英語, 研究論文（学術雑誌）, Purpose:
Robot-assisted laparoscopic radical prostatectomy (RARP) requires a steep head-down tilt and pneumoperitoneum, which may cause an increase in cerebral blood volume (CBV). With a new near-infrared time-resolved spectroscopy device, the tNIRS-1, we can measure the absolute value of the cerebral hemoglobin concentration and hence calculate CBV and cerebral oxygen saturation (rSO2). Using this device, we evaluated the time course of CBV during surgery and also evaluated the changes in rSO2 simultaneously.
Materials and Methods:
We performed a prospective observational study of 21 patients scheduled for RARP. We evaluated CBV and rSO2 by using the tNIRS-1 at 10 time points during surgery.
Results:
The CBV was 2.92 ± 0.38 mL ·100 g-1 after the end of anesthetic preparation. It significantly increased to 3.05 ± 0.44 mL ·100 g-1 after the head-down tilt and was around 3.1 mL ·100 g-1 until 120 minutes after the head-down tilt. However, just before the return to the horizontal position, it decreased to 2.93 ± 0.46 mL ·100 g-1 and then decreased more after the return to the horizontal position. Changes in rSO2 over time were within only 3%, and no significant differences from the control value were observed.
Conclusions:
The increase in CBV was <10% despite the steep head-down tilt and pneumoperitoneum, and it was compensated for at around the end of surgery. Clinically significant changes in rSO2 were not observed during the surgery.

A pediatric cancer patient with suspected chemical coping following high-dose opioid therapy: a case report.
Mototsugu Miura, Kenkichi Tsuruga, Yuji Morimoto
Journal of medical case reports, 13, 1, 353, 353, 2019年11月30日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Chemical coping is an inappropriate method for dealing with stress through the use of opioids; it is considered the stage prior to abuse and dependence. In patients with cancer, it is important to evaluate the risk of chemical coping when using opioids. There are some pediatric opioid use-related tolerances and addictions; however, no mention of chemical coping has been found. CASE PRESENTATION: We present a case of an 11-year-old Japanese boy with acute lymphocytic leukemia. After transplantation, he complained of abdominal and articular pain, which are considered as symptoms of graft-versus-host disease; thus, opioid therapy was initiated, and the dose was gradually increased for pain management, resulting in a high dose of 2700 μg/day of fentanyl (4200-4700 μg/day including the rescue dose). After switching from fentanyl to oxycodone injections, he continued to experience pain, and there was no change in the frequency of oxycodone rescue doses. Physically, his pain was considered to have alleviated; thus, there was the possibility of mental anxiety resulting in the lowering of pain threshold and the possibility of chemical coping. Mental anxiety and stress with progress through schooling was believed to have resulted in chemical coping; thus, efforts were made to reduce the boy's anxiety, and opioid education was provided. However, dose reduction was challenging. Ultimately, with guidance from medical care providers, the opioid dose was reduced, and the patient was successfully weaned off opioids. CONCLUSIONS: When chemical coping is suspected in pediatric patients, after differentiating from pseudo-addiction, it might be necessary to restrict the prescription for appropriate use and to provide opioid education while taking into consideration the emotional background of the patient that led to chemical coping.

Acute compartment syndrome of the lower leg causing cardiac arrest after resection of the right external iliac vein for autologous graft: a case report.
Koji Hoshino, Toru Nakamura, Mineji Hayakawa, Yusuke Itosu, Hitoshi Saito, Satoshi Hirano, Yuji Morimoto
JA clinical reports, 5, 1, 65, 65, 2019年10月23日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The right external iliac vein (REIV) is often used for portal vein reconstruction in patients undergoing pancreatoduodenectomy with portal-superior mesenteric vein resection. We report a case of cardiac arrest caused by acute lower leg compartment syndrome as a result of REIV resection. CASE PRESENTATION: A 53-year-old man underwent pancreatoduodenectomy with portal vein resection. Hyperkalemia progressed during surgery due to intestinal reperfusion injury, which caused recurrent ventricular arrhythmia required for cardio-pulmonary resuscitation. The surgery was discontinued after resuscitation, and portal vein reconstruction using the REIV was performed 2 days post-operatively. Acute compartment syndrome was diagnosed immediately following the surgery. Hyperkalemia progressed, causing pulseless ventricular tachycardia. Emergent fasciotomy was performed, but right leg dysfunction persisted after discharge. CONCLUSION: REIV resection can cause lower-extremity acute compartment syndrome. The status, including intracompartmental pressure, of the lower extremity should be carefully observed after REIV resection during and after surgery.

不可逆的な高度心機能低下を呈した副腎外褐色細胞腫症例に対する麻酔経験
副島 崇旨, 水野谷 和之, 安藤 義崇, 斉藤 仁志, 森 敏洋, 森本 裕二
麻酔, 68, 10, 1099, 1102, 克誠堂出版(株), 2019年10月, ［査読有り］
日本語, 19歳男。湿性咳嗽を主訴に近医を受診し、感冒の診断で内服加療されたが改善せず、10日後に呼吸困難で救急搬送された。諸検査の結果から副腎外褐色細胞腫とカテコールアミン心筋症を強く疑い、全身麻酔下に腫瘍摘出術を施行した。一般に褐色細胞腫の術中管理ではカテコールアミンサージに備えるためにα遮断薬やβ遮断薬の投与が行われ、薬物による循環維持が困難な場合は体外循環も考慮される。本例では麻酔導入後の血圧低下に対してドブタミンとノルアドレナリンを投与し、結果的に有効な循環を確立できた。手術開始後は予想に反してカテコールアミンサージによる血圧上昇を認めず、これは本例が高度な心機能低下状態であったことに加え、内部壊死を伴う副腎外褐色細胞腫であったことと関係があると考えられた。

Modified TAPAを用いて麻酔管理を行った腹腔鏡下スリーブ状胃切除術2例に関する検討
相川 勝洋, 田中 暢洋, 森本 裕二
日本臨床麻酔学会誌, 39, 6, S244, S244, 日本臨床麻酔学会, 2019年10月, ［査読有り］
日本語

【血圧】血圧をあやつる 高血圧による合併症と対処法
森 敏洋, 森本 裕二
LiSA 別冊, 26, 別冊'19秋号, 207, 212, (株)メディカル・サイエンス・インターナショナル, 2019年09月
日本語

小児開心術における中枢神経障害 麻酔薬の中枢神経毒性　　　　　　　　　　　　　　　
斉藤 仁志, 内田 洋介, 干野 晃嗣, 打浪 有可, 森本 裕二
Cardiovascular Anesthesia, 23, Suppl., [SY4, 3], (一社)日本心臓血管麻酔学会, 2019年09月, ［査読有り］
日本語

生体肺移植待機中に膜型人工肺(V-V ECMO)が導入された患者に高流量鼻カヌラ療法(HFNC)を併用することによって安全に麻酔導入が出来た一症例　　　　　　　　　　　　　　　
黒川 達哉, 田中 暢洋, 坂井 俊朗, 糸洲 佑介, 斉藤 仁志, 森本 裕二
Cardiovascular Anesthesia, 23, Suppl., [DP2, 01], (一社)日本心臓血管麻酔学会, 2019年09月, ［査読有り］
日本語

Changes in cerebral oxygen saturation during one-lung ventilation determined using spatially resolved spectroscopy and contributing factors.
Tanaka N, Katoh RI, Yamamoto M, Hoshino K, Morimoto Y, Ito YM, Kato T
Journal of clinical anesthesia, 59, 99, 100, ELSEVIER SCIENCE INC, 2019年07月, ［査読有り］
英語

【小児麻酔のいま】麻酔薬の神経毒性 その基礎と臨床、過去と未来　　　　　　　　　　　　　　　
斉藤 仁志, 内田 洋介, 森本 裕二
臨床麻酔, 43, 6, 790, 798, 真興交易(株)医書出版部, 2019年06月
日本語, 1990年代の動物実験、そして後ろ向きコホート研究は、麻酔薬が幼弱脳における神経細胞のアポトーシスを誘導する、そして長期的な異常行動や学習能力低下を惹起しうる、というセンセーショナルな報告をもたらした。一方で、最近の前向き介入研究の多くは、「単回かつ短時間の全身麻酔は安全である」という結論を出しており、これには多くの臨床家が安堵したに違いない。しかし、長時間手術や集中治療室における影響は未だ不明であり「安全性」が保障されたとは言いがたい。レミフェンタニル、デクスメデトミジンなど、神経毒性の報告がない薬物を使用した新たな鎮静・鎮痛方法の模索も始まっており、今後の研究報告が期待される。(著者抄録)

Anesthetic management for cesarean section in a patient receiving transplacental treatment of fetal tachyarrhythmia: a case report.
Nobuhiro Tanaka, Tomoaki Fujii, Niina Mikami, Yuka Uchinami, Hitoshi Saito, Yuji Morimoto
JA clinical reports, 5, 1, 31, 31, 2019年05月07日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although rare, long-lasting fetal tachyarrhythmia often leads to fetal heart failure and hydrops. Some mothers receive transplacental treatment of fetal tachyarrhythmia (TTFT), which can potentially worsen maternal hypotension and bradycardia. Moreover, the use of rescue cardiovascular agents intraoperatively can worsen fetal tachycardia. However, reports of the anesthetic management of patients receiving TTFT are rare. CASE PRESENTATION: A 31-year-old woman who was receiving digoxin and sotalol for TTFT underwent planned elective cesarean section. The fetus had hypoplastic left heart syndrome, hydrops, and tachycardia. We used combined spinal-epidural anesthesia with a reduced dose of local anesthetic. We also employed a non-invasive continuous hemodynamic monitoring system. The mother's systolic blood pressure remained at ≥ 90% of the baseline value; intraoperative administration of rescue cardiovascular agents was not required. CONCLUSIONS: We successfully anesthetized a woman for cesarean section, who was receiving TTFT for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring.

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, (一社)日本集中治療医学会, 2019年05月, ［査読有り］
日本語, 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。

七物降下湯がアロディニアに有効であった複合性局所疼痛症候群の1例
藤井 知昭, 三浦 基嗣, 長谷 徹太郎, 敦賀 健吉, 森本 裕二
日本ペインクリニック学会誌, 26, 1, 36, 39, 一般社団法人 日本ペインクリニック学会, 2019年
日本語,

複合性局所疼痛症候群（complex regional pain syndrome：CRPS）はアロディニアを伴うことが多い．アロディニアは慢性痛患者の生活の質を損ねるだけでなく，治療に難渋することも多い．抑肝散は動物実験において抗アロディニア作用を有することが示されている．今回，抑肝散の内服継続が困難なCRPS症例に対して七物降下湯を投与したところ，抑肝散と同様の抗アロディニア作用が得られた．七物降下湯は，抑肝散の抗アロディニア作用の中心的生薬と考えられる釣藤鈎を含んでおり，抑肝散と同様の抗アロディニア作用を有する可能性がある．

Isoflurane induced c-Fos expression in the area postrema of the rat.
Hase T, Hashimoto T, Saito H, Uchida Y, Kato R, Tsuruga K, Takita K, Morimoto Y
Journal of Anesthesia, 33, 4, 562, 566, 2019年, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, INTRODUCTION: Volatile anesthetics are speculated to cause postoperative nausea and vomiting via stimulation of the chemoreceptor trigger zone (CTZ). However, the precise mechanism underlying the emetic action of these drugs is not well understood. In this study, we assessed whether isoflurane induced the expression of c-Fos, a neuronal activation marker, in the area postrema (AP), the locus of the CTZ, in rats, which do not have vomiting action. MATERIALS AND METHODS: Male rats were exposed to 1.3% isoflurane for 0-240 min, or to various concentrations of isoflurane (0, 1.3%, or 2.6%) for 120 min. Finally, the rats were exposed to 1.3% isoflurane for 120 min after ondansetron administration. After the treatments, immunohistochemistry of the rat AP was performed using c-Fos antibody staining. RESULTS: One-way analysis of variance showed that isoflurane exposure significantly increased c-Fos expression in the AP; however, the rats pretreated with 4 mg/kg ondansetron showed significantly decreased c-Fos expression. Moreover, we evaluated the effect of the anesthetic on inducing pica in the rats, and found that kaolin intake was not influenced by isoflurane exposure. CONCLUSION: Overall, these results suggest that isoflurane activates AP neurons and may be involved in the emetic mechanism of isoflurane. This study further suggests the feasibility of using rats as a model for studying emetic mechanisms of drugs, despite their lack of vomit action.

Anesthetic management with subcostal transversus abdominis plane block in recessive dystrophic epidermolysis bullosa for peritoneal dialysis catheter replacement: a case report
Katsuhiro Aikawa, Nobuhiro Tanaka, Yuji Morimoto
JA Clinical Reports, 4, 1, Springer Science and Business Media LLC, 2018年12月
研究論文（学術雑誌）

脊柱起立筋面ブロックを用いて管理した胸筋温存乳房切除術3症例についての検討
伊藤 智樹, 相川 勝洋, 安藤 貴士, 森本 裕二
日本臨床麻酔学会誌, 38, 6, S265, S265, 日本臨床麻酔学会, 2018年10月
日本語

胸部外科手術においてretrolaminar blockを施行した一例
田中 暢洋, 村上 仁志, 森本 裕二
日本小児麻酔学会誌, 24, Suppl., 148, 148, 日本小児麻酔学会, 2018年10月, ［査読有り］
日本語

先天性心疾患を有する児の脳循環 酸素化障害の有無での検討
山本 真崇, 森 敏洋, 森本 裕二
Cardiovascular Anesthesia, 22, Suppl., 174, 174, (一社)日本心臓血管麻酔学会, 2018年09月
日本語

腎静脈内腫瘍に対する根治的腎摘出術中に発症した肺動脈塞栓症の一例
松村 優, 武田 圭史, 田中 暢洋, 森 敏洋, 森本 裕二
Cardiovascular Anesthesia, 22, Suppl., 248, 248, (一社)日本心臓血管麻酔学会, 2018年09月, ［査読有り］
日本語

Evaluation of external reference levels for central venous pressure measurements of severely obese patients in the supine position
Kazuyuki Mizunoya, Hitoshi Saito, Yuji Morimoto
Journal of Anesthesia, 32, 4, 1, 7, Springer Tokyo, 2018年05月28日, ［査読有り］
英語, 研究論文（学術雑誌）, Purpose: A proper reference level is important for measuring intracardiac pressures, especially for parameters with small normal values such as central venous pressure (CVP). Although several external zero reference levels (eZRLs) have been proposed for non-obese patients, none has been reported for severely obese patients. The aim of this study was to investigate an appropriate eZRL for CVP measurements of severely obese patients. Methods: Chest computed tomography images of 65 patients with body mass index (BMI) ≥ 35 kg/m2 were retrospectively reviewed. The anteroposterior thoracic diameter and height of the mid-right atrium (RA) were measured. Four reported eZRLs for CVP measurements (midthoracic level, two-thirds and four-fifths of the thoracic diameter above table level, and 5 cm below the anterior thorax) were examined for error when predicting the midpoint of the RA. Results: The median BMI was 36.9 kg/m2 [interquartile range (IQR), 36.0–39.2]. There was a significant difference in the calculated errors for the midpoint of the RA among the four eZRLs (Kruskal–Wallis test, P <
0.001). Two-thirds of the thoracic diameter above table level was the most accurate reference level for CVP measurement (Steel–Dwass post hoc analysis, P <
0.001). The Bland–Altman plot showed acceptable agreement for clinical use (mean difference, − 7 mm
95% limit of agreement, − 23 to 9 mm). Conclusion: The most accurate eZRL for CVP measurements of severely obese patients in the supine position was two-thirds of the thoracic diameter above table level. This result is consistent with that of a previous report of non-obese patients.

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, (一社)日本集中治療医学会, 2018年05月, ［査読有り］
日本語, 気管支拡張症は気管支の不可逆的な形態変化を呈する慢性の進行性疾患であり、反復性の気道感染症を引き起こす。急性増悪例では時に治療に難渋し、致死的になりうるが、定まった有効な治療法はない。症例は59歳、女性。30年前に気管支拡張症と診断され、外来管理されていた。呼吸困難感を主訴に救急搬送され、CT検査で著明な気管支拡張と気管支内に液面を形成するほど多量の喀痰貯留を認めた。ICUで人工呼吸管理、薬物的治療、体位ドレナージが開始されたが治療反応に乏しく、入院7日後よりゲンタマイシン120mg12時間ごとの吸入療法を開始したところ、喀痰の減少と呼吸状態の改善を認め、治療開始34日目で人工呼吸離脱が可能となった。通常の薬物・理学療法に抵抗性の気管支拡張症急性増悪に対し、ゲンタマイシン吸入は有効な可能性がある。(著者抄録)

Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass.
Yumiko Yamazaki, Koji Oba, Yoshiro Matsui, Yuji Morimoto
Journal of anesthesia, 32, 2, 167, 173, 2018年04月, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, PURPOSE: The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery. METHODS: A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed "poor outcome", which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation. RESULTS: After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51-18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10-2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28-2.74, p = 0.001). CONCLUSIONS: The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults.

Systolic Anterior Motion of the Mitral Valve During Pulmonary Endarterectomy in a Patient with Chronic Thromboembolic Pulmonary Hypertension
Koji Hoshino, Koichi Takita, Masami Demura, Tomonori Kubo, Yuji Morimoto
Journal of Cardiothoracic and Vascular Anesthesia, 32, 2, 807, 810, W.B. Saunders, 2018年04月01日, ［査読有り］
英語, 研究論文（学術雑誌）

Influence of nitrous oxide on granule cell migration in the dentate gyrus of the neonatal rat
Hitoshi Saito, Rui Kato, Toshikazu Hashimoto, Yosuke Uchida, Tetsutaro Hase, Kenkichi Tsuruga, Koichi Takita, Yuji Morimoto
Biomedical Research (Japan), 39, 1, 39, 45, Biomedical Research Foundation, 2018年, ［査読有り］
英語, 研究論文（学術雑誌）, For several decades, the neurotoxicities of anesthetics to the developing brain have been reported by many researchers focusing on various phenomena such as apoptosis, neurodegeneration, electrophysiological aberrations, and behavioral abnormalities. According to these reports, signals via N-methyl-D-aspartate receptors (NMDA-r) and/or γ-aminobutyric acid type A receptors (GABAA-r) are implicated in the anesthetic neurotoxicity. On the other hand, during brain development, NMDA-r and GABAA-r are also recognized to play primary roles in neural cell migration. Therefore, anesthetics exposed in this period may influence the neural cell migration of neonates, and increase the number of hilar ectopic granule cells, which are reported to be a cause of continuous neurological deficits. To examine this hypothesis, we investigated immunohistochemically granule cell distribution in the hippocampal dentate gyrus of Wistar/ST rats after nitrous oxide (N2O) exposure. At postnatal day (P) 6, 5-bromo-2’-deoxyuridine (BrdU) was administered to label newly generated cells. Then, rats were divided into groups (n = 6 each group), exposed to 50% N2O at P7, and evaluated at P21. As a result, we found that ectopic ratios (ratio of hilar/total granule cells generated at P6) were decreased in rats at P21 compared with those at P7, and increased in N2O exposed rats for over 120 min compared with the other groups. These results suggest that 50% N2O exposure for over 120 min increases the ratios of ectopic granule cells in the rat dentate gyrus.

Sevoflurane inhibits presynaptic calcium influx without affecting presynaptic action potentials in hippocampal CA1 region.
Hasegawa K, Kamiya H, Morimoto Y
Biomedical research (Tokyo, Japan), 39, 5, 223, 230, 2018年, ［査読有り］, ［国内誌］
英語, 研究論文（学術雑誌）, Although diverse effects of volatile anesthetics have been investigated in various studies, the mechanisms of action of such anesthetics, especially sevoflurane, remain elusive. In contrast to their potent modulation of inhibitory synaptic transmission there is little information about their effects on excitatory transmission in the brain. In this study, we examined the effect of sevoflurane on the excitatory synaptic transmission at CA1 synapses in hippocampal slices of mice. Sevoflurane at 5% was mixed with 95% O2 and 5% CO2 and bubbled in artificial cerebral spinal fluid (0.69 mM). Extracellular recordings of the field excitatory postsynaptic potential (fEPSP) and presynaptic fiber volley (FV) were made at physiological temperature. In addition, fluorescent measurements of presynaptic Ca2+ transients were performed while simultaneously recording fEPSP. Application of sevoflurane reduced the amplitude of fEPSP (45 ± 8%, n = 5). This effect was accompanied by concurrent enhancement of the paired-pulse facilitation of fEPSP (127 ± 5%, n = 12), suggesting a possible presynaptic site of action of sevoflurane. The amplitude of FV was not significantly affected (102 ± 5%, n = 5). In contrast, fluorescent measurements revealed that presynaptic Ca2+ influx was suppressed by sevoflurane (69 ± 5%, n = 7), as was simultaneously recorded fEPSP (44 ± 5%, n = 7). Our results suggest that sevoflurane potently suppresses excitatory synaptic transmission via inhibition of presynaptic Ca2+ influx without affecting presynaptic action potentials.

経胎盤的抗不整脈投与療法中の母体の帝王切開においてクリアサイトを用いて管理をした1症例の麻酔経験
三上 仁衣奈, 打浪 有可, 田中 暢洋, 斉藤 仁志, 森本 裕二
日本臨床麻酔学会誌, 37, 6, S291, S291, 日本臨床麻酔学会, 2017年10月, ［査読有り］
日本語

双胎間輸血症候群に対する胎児鏡下胎盤吻合血管レーザー凝固術の周術期管理についての検討
長谷川 栄, 打浪 有可, 斉藤 仁志, 田中 暢洋, 森本 裕二
日本臨床麻酔学会誌, 37, 6, S296, S296, 日本臨床麻酔学会, 2017年10月, ［査読有り］
日本語

幼若期ストレスによるラットのうつ様行動に対するケタミンの効果とその神経基盤研究　　　　　　　　　　　　　　　
相川 勝洋, 吉田 隆行, 大村 優, 泉 剛, 吉岡 充弘, 森本 裕二
日本生物学的精神医学会・日本神経精神薬理学会合同年会プログラム・抄録集, 39回・47回, 163, 163, 日本生物学的精神医学会・日本神経精神薬理学会, 2017年09月
日本語

MINOCYCLINE PREVENTS THE IMPAIRMENT OF HIPPOCAMPAL LONG-TERM POTENTIATION IN THE SEPTIC MOUSE
Koji Hoshino, Mineji Hayakawa, Yuji Morimoto
SHOCK, 48, 2, 209, 214, LIPPINCOTT WILLIAMS & WILKINS, 2017年08月, ［査読有り］
英語, 研究論文（学術雑誌）, Sepsis-associated encephalopathy is a major complication during sepsis, and an effective treatment remains unknown. Although minocycline (MINO) has neuroprotective effects and is an attractive candidate for treating sepsis-associated encephalopathy, the effect of MINO on synaptic plasticity during sepsis is still unclear. In the present study, we investigated the effects of MINO on long-term potentiation (LTP) in the hippocampus in a cecal ligation and puncture (CLP) mouse model. We divided mice into four groups; sham + vehicle, sham + MINO (60 mg/kg, i.p. for 3 consecutive days before slice preparation), CLP+vehicle, and CLP+MINO. We tested LTP in the CA1 region of the hippocampus, using slices taken 24 h after surgery. Because MINO is also anti-inflammatory, LTP was analyzed following 30 min of IL-1 receptor antagonist (IL-1ra) perfusion. The endotoxin level in the blood was increased at 24 h after CLP operations regardless of MINO administrations, and LTP in the CLP + vehicle group mice was severely impaired (P<0.05). High doses of MINO prevented the LTP impairment during sepsis in the CLP + MINO group. Interleukin (IL)-1ra administration ameliorated LTP impairment only in the CLP + vehicle group (P<0.05); it had no additional effects on LTP in the CLP + MINO group. In conclusion, we have provided the first evidence that MINO prevents impaired LTP related to sepsis-induced encephalopathy in the mouse hippocampus, and that mechanisms associated with IL-1 receptor activity may be involved.

Changes of Cerebral Oxygenation in Sequential Glenn and Fontan Procedures in the Same Children
Yasunori Yagi, Masataka Yamamoto, Hitoshi Saito, Toshihiro Mori, Yuji Morimoto, Takayoshi Oyasu, Tsuyoshi Tachibana, Yoichi M. Ito
PEDIATRIC CARDIOLOGY, 38, 6, 1215, 1219, SPRINGER, 2017年08月, ［査読有り］, ［国際誌］
英語, 研究論文（学術雑誌）, Recently, it is common to perform the Fontan procedure after the Glenn procedure as surgical repair for the univentricular heart. How the brain oxygen saturation (rSO(2)) values change with the cardiac restoration and the process of growth during these procedures in individual children remains unknown. In this study, we retrospectively studied rSO(2) data as well as the perioperative clinical records of 30 children who underwent both Glenn and Fontan procedures by the same surgeon in the same institute. The rSO(2) was measured at the beginning and end of each procedure with an INVOS 5100C. Cerebral perfusion pressure was calculated by subtracting central venous pressure from mean arterial pressure. Arterial oxygen saturation (SaO(2)) and the hemoglobin concentration were obtained as candidates affecting rSO(2) changes at the start and the end of both procedures. The rSO(2) increased during the Glenn procedure, but this increase was slight and insignificant. On the other hand, the rSO(2) significantly increased during the Fontan procedure. Significant increases in SaO(2) were observed only between the beginning and end of the Fontan procedure. Correlation coefficients determined by linear regression analysis were more than 0.5 between rSO(2) and SaO(2) in both procedures. Multiple linear regression analysis showed that SaO(2) was the key determinant of the rSO(2). The rSO(2) increases step by step from the Glenn to the Fontan procedure in the same patient. Within each procedure, SaO(2) is the key determinant of the rSO(2). The significance of rSO(2) monitoring in these procedures should be further evaluated.

Brain micro-inflammation at specific vessels dysregulates organ-homeostasis via the activation of a new neural circuit
Yasunobu Arima, Takuto Ohki, Naoki Nishikawa, Kotaro Higuchi, Mitsutoshi Ota, Yuki Tanaka, Junko Nio-Kobayashi, Mohamed Elfeky, Ryota Sakai, Yuki Mori, Tadafumi Kawamoto, Andrea Stofkova, Yukihiro Sakashita, Yuji Morimoto, Masaki Kuwatani, Toshihihiko Iwanaga, Yoshichika Yoshioka, Naoya Sakamoto, Akihiko Yoshimura, Mitsuyoshi Takiguchi, Saburo Sakoda, Marco Prinz, Daisuke Kamimura, Masaaki Murakami
ELIFE, 6, ELIFE SCIENCES PUBLICATIONS LTD, 2017年08月, ［査読有り］
英語, 研究論文（学術雑誌）, Impact of stress on diseases including gastrointestinal failure is well-known, but molecular mechanism is not understood. Here we show underlying molecular mechanism using EAE mice. Under stress conditions, EAE caused severe gastrointestinal failure with high-mortality. Mechanistically, autoreactive-pathogenic CD4+ T cells accumulated at specific vessels of boundary area of third-ventricle, thalamus, and dentate-gyrus to establish brain micro-inflammation via stress gateway reflex. Importantly, induction of brain micro-inflammation at specific vessels by cytokine injection was sufficient to establish fatal gastrointestinal failure. Resulting micro-inflammation activated new neural pathway including neurons in paraventricular-nucleus, dorsomedial-nucleus-ofhypothalamus, and also vagal neurons to cause fatal gastrointestinal failure. Suppression of the brain micro-inflammation or blockage of these neural pathways inhibited the gastrointestinal failure. These results demonstrate direct link between brain micro-inflammation and fatal gastrointestinal disease via establishment of a new neural pathway under stress. They further suggest that brain micro-inflammation around specific vessels could be switch to activate new neural pathway(s) to regulate organ homeostasis.

近赤外時間分解分光法による麻酔導入時の経時的脳血液量変化測定　　　　　　　　　　　　　　　
副島 崇旨, 山本 真崇, 田中 暢洋, 森本 裕二
日本神経麻酔集中治療学会プログラム・抄録集, 21回, 35, 35, 日本神経麻酔集中治療学会, 2017年06月, ［査読有り］
日本語

Laboratory findings: To what degree can we extrapolate the animal data to the bedside?
Yuji Morimoto, Yosuke Uchida, Hitoshi Saito
Anesthesia and Neurotoxicity, 3, 15, Springer Japan, 2017年05月30日, ［査読有り］
英語, 論文集(書籍)内論文, After the "famous" paper by Jevtovic-Todorovic et al. published in the Journal of Neuroscience in 2003, the number of articles about the neurotoxicity of anesthetics in developing animals has increased year by year. Thus, it is no exaggeration to say that most anesthetics are neurotoxic to the developing animal brain. The mechanism was first suggested to be neuronal apoptosis, and then abnormality of neurotransmission, especially the manipulation of the GABAergic system during the most intense phase of synaptogenesis. Recently, based on various animal studies, many hypotheses have been reported. However, this finding has not been proven in humans yet. Moreover, the clinical impression that anesthesia has a negative effect on the neurological development of infants and children seems extremely rare for the clinician. Thus, there seem to be big discrepancies between the findings for animals and humans. The reasons for this are hypothesized to be respiratory depression caused by anesthetics, the absence of noxious stimulation during neonatal animal experiments, and the differences of the life span (that is, the length of anesthetic time) and the period of the brain growth spurt between humans and animals. Accordingly, we are now awaiting the results of several ongoing prospective clinical studies to determine whether anesthetics are really neurotoxic to the developing human brain.

Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children
Yuka Uchinami, Fumika Sakuraya, Nobuhiro Tanaka, Koji Hoshino, Eri Mikami, Taro Ishikawa, Hitomi Fujii, Takehiko Ishikawa, Yuji Morimoto
PEDIATRIC ANESTHESIA, 27, 5, 516, 523, WILEY, 2017年05月, ［査読有り］
英語, 研究論文（学術雑誌）, BackgroundUltrasound-guided rectus sheath block and local anesthetic infiltration are the standard options to improve postoperative pain for children undergoing surgery with a midline incision. However, there is no study comparing the effect of ultrasound-guided rectus sheath block with local anesthetic infiltration for children undergoing laparoscopic surgery.
AimsThe aim of this trial was to compare the onset of ultrasound-guided rectus sheath block with that of local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children.
MethodsWe performed an observer-blinded, randomized, prospective trial. Enrolled patients were assigned to either an ultrasound-guided rectus sheath block group or a local anesthetic infiltration group. The ultrasound-guided rectus sheath block group (n = 17) received ultrasound-guided rectus sheath block with 0.2 mlkg(-1) of 0.375% ropivacaine per side in the posterior rectus sheath compartment. The local anesthetic infiltration group (n = 17) received local anesthetic infiltration with 0.2 mlkg(-1) of 0.75% ropivacaine. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores were recorded at 0, 30, 60 min after arrival at the postanesthesia care unit.
ResultsOf the 37 patients enrolled in this study, 34 completed the study protocol. A significant difference in the pain scale between the ultrasound-guided rectus sheath block group and local anesthetic infiltration group was found at 0 min (median: 0, interquartile range [IQR]: 0-1.5, vs median: 1, IQR 0-5, confidence interval of median [95% CI]: 0-3, P = 0.048), but no significant difference was found at 30 min (median: 1, IQR: 0-4 vs median: 6, IQR: 0-7, 95% CI: 0-5, P = 0.061), or 60 min (median: 0, IQR: 0-2 vs median: 1, IQR: 0-3, 95% CI: -1 to 1, P = 0.310). No significant difference was found in anesthesia time between the ultrasound-guided rectus sheath block and local anesthetic infiltration groups. No procedure-related complications were observed in either group.
ConclusionUltrasound-guided rectus sheath block is a quicker way to control postoperative pain for pediatric patients undergoing laparoscopic extraperitoneal closure than local anesthetic infiltration, and thus may provide a clinical benefit.

Synapse-specific effects of IL-1β on long-term potentiation in the mouse hippocampus.
Hoshino K, Hasegawa K, Kamiya H, Morimoto Y
Biomedical research (Tokyo, Japan), 38, 3, 183, 188, BIOMEDICAL RESEARCH PRESS LTD, 2017年, ［査読有り］
英語, 研究論文（学術雑誌）, Interleukin-1 beta (IL-1 beta) is a key molecule in the inflammatory responses elicited during infection and injury. It exerts local effects on synaptic plasticity by binding to IL-1 receptors that are expressed at high levels in the hippocampus. We examined the effects of IL-1 beta on synaptic plasticity in different hippocampal regions in acute mouse brain slices by measuring long-term potentiation (LTP). IL-1 beta (1 ng/mL) was applied for 30 min before LTP was induced with high-frequency stimulation (HFS). LTP was significantly impaired by either IL-1 beta application to the Schaffer collateral- CA1 synapses or the associational/commissural (A/C) fiber-CA3 synapses, which are both dependent on N-methyl-D-aspartate (NMDA) receptor activation. However, mossy fiber-CA3 LTP, which is expressed presynaptically in an NMDA-independent manner, was not impaired by IL-1 beta. Our results demonstrate that IL-1 beta exerts variable effects on LTP at different kinds of synapses, indicating that IL-1 beta has synapse-specific effects on hippocampal synaptic plasticity.

Left subclavian artery malperfusion due to thoracic outlet syndrome during total vertebrectomy for invasive lung cancer: a case report.
Mizunoya K, Ueda K, Takeda Y, Takita K, Morimoto Y
JA clinical reports, 3, 1, 61, 61, 2017年, ［査読有り］, ［国際誌］
英語, 研究論文（学術雑誌）, Thoracic outlet syndrome (TOS) can interrupt blood flow to upper limbs by vascular compression. We report a case of a 52-year-old man who presented left subclavian artery malperfusion due to TOS during total vertebrectomy (Th2-4) in the prone position for invasive lung cancer. At the time of resection of the vertebral bodies, his left radial systolic blood pressure had begun to drop intermittently and we noticed an interarm pressure difference. Accordingly, we began to monitor the right radial artery pressure and found that only the left radial artery pressure decreased as a result of compressive force from the surgical site. The operation was continued with intermittent malperfusion of the left arm, and when it was prolonged, we asked the surgeons to release the compression. No symptoms of ischemia or nerve injuries in the left arm were observed after the surgery. Retrospective review of his preoperative enhanced computed tomography images suggested a slightly compressed left subclavian artery in the costoclavicular space. Combination of the prone position and a specific upper limb position may be a risk factor for intraoperative TOS. An interarm blood pressure difference is a clue to detect accidental arterial TOS during general anesthesia.

Interference between M-entropy and thermistor probe fixed on the forehead during general　　　　　　　　　　　　　　　
Kazuyuki Mizunoya, Takeshi Yokoyama, Katsuyuki Katayama, Yuji Morimoto
Japanese Journal of Anesthesiology, 65, 12, 1279, 1281, Kokuseido Publishing Co. Ltd, 2016年12月01日
日本語, 研究論文（学術雑誌）, We report a case in which M-Entropy was affected by the thermistor probe of tissue-core thermometer (Coretemp®, TERUMO, Tokyo, Japan) fixed on the forehead. A 26-year-old man underwent osteosynthesis for forearm fracture under general anesthesia combined with brachial plexus block. General anesthesia was induced and maintained with fentanyl and target-controlled infusion of propofol. We use Coretemp® to measure core temperature and put the thermistor probe on forehead next to the M-Entropy sensor. Thirty minutes after start of the surgery, state and response entropy rose suddenly to extremely high levels. In spite of slow waves and sleep spindles on raw electroencephalogram (EEG) waveform, his vital signs showed no changes after the rise of entropy values. We suspected Coretemp® probe interfering with M-Entropy, and removed the probe from his forehead. M-Entropy returned to the default values immediately and this phenomenon was reproducible by attaching and detaching the probe. We therefore concluded that some electrical noise from the Coretemp® probe affected M-Entropy. The patient awoke from anesthesia smoothly, and had no memory of intraoperative awareness.This case suggests that we should always consider artifacts in EEG monitors and if their values do not correspond with clinical status, we should check raw EEG waveforms to judge the depth of anesthesia.

人工心肺を使用した心臓手術後の急性腎傷害に関する検討
水野谷 和之, 横山 健, 川名 信, 片山 勝之, 森本 裕二
日本集中治療医学会雑誌, 23, 2, 141, 147, (一社)日本集中治療医学会, 2016年03月
日本語, 【目的】心臓手術後の急性腎傷害(acute kidney injury、AKI)は短期長期的な予後と関連する。今回我々は、人工心肺を使用した心臓手術後に発生するAKIに関して後方視的に検討した。【方法】2011年から2013年の期間に当院で人工心肺使用下に心臓手術を行った成人症例を対象とした。AKIは術後7日以内に発症したものと定義し、診断にはAcute Kidney Injury Networkの基準を使用した。【結果】対象症例は263例、AKI発症例は64例(24.3%)であった。2例が術後1週間以内に腎代替療法を必要とした。多変量解析の結果、男性、糖尿病、BMI、術前の推算糸球体濾過量、人工心肺時間がAKI発症に有意に関連していた。AKI群の91%がstage 1、78%が2日以内にAKIから離脱していた。【結論】性別以外のAKIリスク因子は過去の報告例と共通するものであった。AKI群の多くが軽症であり、短期間で改善が得られていた。(著者抄録)

人工膝関節置換術における関節周囲浸潤麻酔と坐骨神経ブロックの効果に関する検討
相川 勝洋, 橋本 聡一, 糸洲 佑介, 藤井 知昭, 堀口 貴行, 雨森 英彦, 森本 裕二
麻酔, 65, 1, 50, 55, 克誠堂出版(株), 2016年01月
日本語, 人工膝関節置換術を持続大腿神経ブロックに加えて(1)坐骨神経ブロックを併用した群(9症例)と、(2)関節周囲浸潤麻酔を併用した群(8症例)で後ろ向きに比較した。坐骨神経ブロック群では9症例中6症例で術直後の足関節背屈障害が生じたが、関節周囲浸潤麻酔群では生じなかった。持続大腿神経ブロックと関節周囲浸潤麻酔の併用により、腓骨神経麻痺を起こすことなく良好な術後鎮痛を得ることができた。(著者抄録)

[症例]急性一酸化炭素中毒に対する高気圧酸素治療経験
本間多恵子, 柳田雄一郎, 石川岳彦, 森本裕二, 石川勝清, 丸藤哲
ICUとCCU, 40, 61, 64, 2016年, ［査読有り］
日本語, 研究論文（学術雑誌）

Comparison of the effect of periarticular infiltration analgesia versus sciatic nerve block for total knee arthroplasty
Katsuhiro Aikawa, Toshikazu Hashimoto, Yusuke Itosu, Tomoaki Fujii, Takayuki Horiguchi, Hidehiko Amenomori, Yuji Morimoto
Japanese Journal of Anesthesiology, 65, 1, 50, 55, Kokuseido Publishing Co. Ltd, 2016年01月01日, ［査読有り］
日本語, 研究論文（学術雑誌）, Background : Sciatic nerve block (SNB) is widely used as a supplemental analgesia after total knee arthroplasty (TKA) combined with femoral nerve block (FNB). Despite its effectiveness, SNB often causes peroneal nerve paralysis, which makes it difficult to detect peroneal nerve injury by surgical process Recently, periarticular infiltration analgesia (PIA) is reported that it provides analgesia without peroneal nerve paralysis. We conducted a retrospective analysis to compare the effectiveness of SNB and PIA. Methods : This study was approved by the local institutional ethics committee
17 patients undergoing TKA under general anesthesia with continuous femoral nerve block were enrolled in the study. All patients received continuous FNB. Nine patients received sciatic nerve block successively, while 8 patients received PIA around the time of insertion of artificial joint Primary outcome measure was the frequency of peroneal nerve paralysis when the patients woke up. Secondary outcome measures included numerical rating scale (NRS) until postoperative day 3. Results : While there were 6 patients who had peroneal nerve paralysis in the SNB group, none of them had it in the PIA group (P=0.009). There were no significant differences of the NRSs between the two groups. Conclusions : PIA provided sufficient analgesia after TKA without peroneal nerve paralysis.

Plantar injection of formalin in rats reduces the expression of a potassium chroride cotransporter KCC2 in the spinal cord and a kinase inhibitor suppresses this reduction
Kenkichi Tsuruga, Toshikazu Hashimoto, Ryoko Kato, Rui Kato, Yousuke Uchida, Tetsutaro Hase, Yuji Morimoto
BIOMEDICAL RESEARCH-TOKYO, 37, 4, 243, 249, BIOMEDICAL RESEARCH PRESS LTD, 2016年, ［査読有り］
英語, 研究論文（学術雑誌）, Brain-derived neurotrophic factor (BDNF) is released from activated microglia during neuropathic pain and is hypothesized to downregulate the expression of the potassium chloride cotransporter 2 (KCC2) via the TrkB receptor. Previous studies reported that KCC2 is downregulated 5 min after the plantar injection of formalin in rats; however, the mechanism behind this decrease in KCC2 expression during acute inflammatory pain remains unknown. In this study, we determined whether the TrkB receptor contributes to the expression of KCC2 during the acute pain. Five minutes after the plantar injection of formalin in rats, the ratio of KCC2-immunoreactive area in layer II of the spinal cord significantly decreased on the stimulated side compared to the unaffected side. On the other hand, this response was inhibited by the injection of a kinase inhibitor, K252a, in the subarachnoid space 15 min before the formalin injection. These findings suggest that in acute pain, the TrkB receptor may contribute to the decrease in the expression of KCC2.

フォンタン型手術時の脳ならびに末梢動脈血酸素飽和度と短期予後との関係
山本 真崇, 八木 泰憲, 森 敏洋, 森本 裕二
Cardiovascular Anesthesia, 19, Suppl., 222, 222, (一社)日本心臓血管麻酔学会, 2015年10月
日本語

未根治チアノーゼ型先天性心疾患に対する肺葉切除術の麻酔経験
森 敏洋, 藤田 憲明, 森本 裕二
Cardiovascular Anesthesia, 19, Suppl., 250, 250, (一社)日本心臓血管麻酔学会, 2015年10月
日本語

同一患者におけるグレン-フォンタン手術時の脳酸素飽和度変化
八木 泰憲, 山本 真崇, 森 敏洋, 森本 裕二
Cardiovascular Anesthesia, 19, Suppl., 284, 284, (一社)日本心臓血管麻酔学会, 2015年10月
日本語

近赤外分光法を用いた小児開心術における脳血流自動調節能の検討
干野 晃嗣, 西本 尚樹, 森本 裕二
麻酔, 64, 9, 960, 965, 克誠堂出版(株), 2015年09月
日本語, 小児の脳血流自動調節能に対する年齢と人工心肺の影響を明らかにするため、当院で心房/心室中隔欠損閉鎖術を受けた15歳未満の患者67名を対象とし、術中の血圧と近赤外分光法による局所脳酸素飽和度(rSO2)の関係を後ろ向きに検討した。平均血圧とrSO2に関し単回帰分析を行い、回帰係数(ΔrSO2/Δ平均血圧)が大きいほど自動調節能が機能していないとし、年齢と人工心肺による回帰係数の変化を検討した。その結果、4歳以下では自動調節能が未熟であり、5歳以上でも人工心肺中の自動調節能の障害が示唆された。また、混合効果モデルを用いた解析では、人工心肺中、平均血圧がrSO2にもっとも強く影響を与えると推察された。(著者抄録)

Examination of the influence of age and cardiopulmonary bypass on cerebral autoregulation in pediatric patients for the cardiac surgery by using near-infrared spectroscopy
Koji Hoshino, Naoki Nishimoto, Yuji Morimoto
Japanese Journal of Anesthesiology, 64, 9, 960, 965, Kokuseido Publishing Co. Ltd, 2015年09月01日, ［査読有り］
日本語, 研究論文（学術雑誌）, Background: We evaluated the impact of age and cardiopulmonary bypass (CPB) on cerebral autoregulation in pediatric patients for the cardiac surgery with near-infrared spectroscopy. Methods: This retrospective study was conducted with 67 children undergoing closure of atrial or ventricular septal defects with CPB. The regression coefficient [▹regional cerebral oxygenation index (rSO<
inf>
2<
/inf>
)/▹ mean arterial blood pressure (mABP)] for each patient was calculated by simple regression analysis, assuming that higher regression coefficients indicate less functional cerebral autoregulation. In addition, to determine the vital parameters affecting rSO<
inf>
2<
/inf>
values during CPB, we analyzed the data from on-line continuous blood gas monitor with random effects-mixed model. Results: The regression coefficients were frequently high among younger children (0-4 years), suggesting that the cerebral autoregulation was immature. Although regression coefficient values in younger children remained high through the operation, those in older children (5-14 years) increased significantly only during CPB, suggesting that cerebral autoregulation was dysfunctional during CPB. With random effectsmixed model, we revealed that mABP had the most significant effect on rSGO<
inf>
2<
/inf>
values during CPB. Conclusions: Cerebral autoregulation in younger children is immature. Moreover, it does not work during CPB even in older children, and clinicians must ensure perfusion pressure carefully during CPB in pediatric patients.

Neurotoxicity of anesthetic agents for developing and adult brain
Rui Kato, Toshikazu Hashimoto, Yuji Morimoto
Neuroanesthesia and Cerebrospinal Protection, 127, 137, Springer Japan, 2015年08月07日, ［査読有り］
英語, 論文集(書籍)内論文, 1. Neurotoxicity of anesthetic agents to the developing brain: The neurotoxicity of various anesthetic and sedative agents to the developing brain has been clearly established in various laboratory animals, including subhuman primates. According to recent reports, anesthetic agents which block N-methyl-D-aspartate-type glutamate receptors and/or activate gammaaminobutyric acid-A receptors have neurotoxic properties when used during synaptogenesis. Despite numerous reports, however, the precise mechanisms underlying this neurotoxicity remain unknown. Moreover, it is believed that these results cannot be easily extrapolated into human clinical practice. The results of clinical studies on the neurotoxicity of anesthesia in pediatric patients have been conflicting, and definitive epidemiological evidence remains to be established. Therefore, it would be inappropriate to suggest that anesthesiologists change their anesthetic practice based on these studies at the present time. 2. Neurotoxicity of anesthetic agents to the adult brain: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are cognitive complications occurring after surgery under anesthesia. POD is a transient disturbance of consciousness, attention, cognition, or perception or disorganized thinking and can lead to various complications. It is important to determine the preoperative and intraoperative risk factors for POD in tackling this problem. It is also crucial to recognize and manage its underlying causes in ensuring an appropriate environment for a POD-free recovery. POCD is usually defined as persistent cognitive deterioration, which is clinically diagnosed using various types of neuropsychological tests. POCD and POD are both associated with the aggravation of complications after surgery under anesthesia. Although various factors such as systemic neuroinflammation have been postulated as causes of POCD, its underlying pathogenic mechanism remains to be clearly elucidated. POCD is often observed following cardiac surgery. However, recent studies have revealed that it can occur regardless of type of surgery or anesthesia. Suggested risk factors for POCD include advanced age, prolonged duration of surgery, respiratory and infectious complications, and the need for a second operation.

小児腹腔鏡下鼠径ヘルニア日帰り手術の術後鎮痛法 超音波ガイド下腹直筋鞘ブロックvs局所浸潤麻酔
打浪 有可, 石川 太郎, 田中 暢洋, 櫻谷 文香, 三上 惠理, 藤井 ひとみ, 森本 裕二
日本小児麻酔学会誌, 21, 1, 115, 115, 日本小児麻酔学会, 2015年08月, ［査読有り］
日本語

新生児期における先天性嚢胞性腺腫様奇形に対する肺切除術2例の麻酔管理　　　　　　　　　　　　　　　
田中 暢洋, 加藤 亮子, 瀧田 恒一, 森本 裕二
日本小児麻酔学会誌, 21, 1, 203, 207, 日本小児麻酔学会, 2015年08月
日本語, 先天性嚢胞性腺腫様奇形(congenital cystic adenomatoidmalformation:CCAM)に対する新生児期の根治術の麻酔を2例経験した。1例目は左肺上葉にCCAMを認める日齢9の女児で、胸腔鏡下左肺上葉切除術が予定された。2例目は右肺中葉にCCAMを認める日齢12の男児で胸腔鏡下右肺中葉切除術が予定された。分離肺換気の有用性と危険性を検討した結果、両肺換気下での麻酔管理を行った。両症例とも過度の縦隔圧迫による血圧低下と肺の用手的圧排による血性分泌物が原因の挿管チューブの閉塞もしくは一回換気量の低下が見られた。2例目では循環管理を容易にする意図で中心静脈カテーテルを挿入し、ノルアドレナリンを持続投与した結果、フェニレフリンの間歇投与の回数が減少した。術後は問題なく経過した。新生児期の肺切除術の管理を、分離肺換気を行うことなく、適切な呼吸管理、循環管理を行うことにより、良好な経過を得た。(著者抄録)

A pain-mediated neural signal induces relapse in murine autoimmune encephalomyelitis, a multiple sclerosis model
Yasunobu Arima, Daisuke Kamimura, Toru Atsumi, Masaya Harada, Tadafumi Kawamoto, Naoki Nishikawa, Andrea Stofkova, Takuto Ohki, Kotaro Higuchi, Yuji Morimoto, Peter Wieghofer, Yuka Okada, Yuki Mori, Saburo Sakoda, Shizuya Saika, Yoshichika Yoshioka, Issei Komuro, Toshihide Yamashita, Toshio Hirano, Marco Prinz, Masaaki Murakami
ELIFE, 4, ELIFE SCIENCES PUBLICATIONS LTD, 2015年08月, ［査読有り］
英語, 研究論文（学術雑誌）, Although pain is a common symptom of various diseases and disorders, its contribution to disease pathogenesis is not well understood. Here we show using murine experimental autoimmune encephalomyelitis (EAE), a model for multiple sclerosis (MS), that pain induces EAE relapse. Mechanistic analysis showed that pain induction activates a sensory-sympathetic signal followed by a chemokine-mediated accumulation of MHC class II+CD11b+ cells that showed antigen-presentation activity at specific ventral vessels in the fifth lumbar cord of EAE-recovered mice. Following this accumulation, various immune cells including pathogenic CD4+ T cells recruited in the spinal cord in a manner dependent on a local chemokine inducer in endothelial cells, resulting in EAE relapse. Our results demonstrate that a pain-mediated neural signal can be transformed into an inflammation reaction at specific vessels to induce disease relapse, thus making this signal a potential therapeutic target. DOI: 10.7554/eLife.08733.001

Perioperative management of a patient with severe Parkinson's disease with intravenous levodopa administration
Satoko Terashima, Yurina Yanagida, Akira Watabe, Masahiro Yamane, Yuji Morimoto
Japanese Journal of Anesthesiology, 64, 8, 845, 848, Kokuseido Publishing Co. Ltd, 2015年08月01日, ［査読有り］
日本語, 研究論文（学術雑誌）, A 70-year-old man with severe Parkinson's disease was scheduled for thoracic aortic aneurysm resection and aortic valve replacement We administered levodopa intravenously during the perioperative period to avoid the malignant syndrome which is reported to arise with abrupt cessation of anti-Parkinson's drugs. The dose of intravenous administration was tapered with the resumption of oral intake. No manifestation of malignant syndrome was observed. We measured blood concentrations of levodopa several times during the perioperative period. The concentration of levodopa during the surgery was relatively high however no adverse events of overdose (e.g. dyskinesis) occurred. In the postoperative period, administration of levodopa was changed to the oral route and serum levels of levodopa showed a notable decrease, the cause of which may be poor absorption through the digestive system during the perioperative period. Therefore, in the peri- And post-operative periods, it is necessary to take great care when reducing the infusion dose.

スガマデクス投与後、冠攣縮による心停止を繰り返し発症した1症例　　　　　　　　　　　　　　　
干野 晃嗣, 加藤 類, 長沢 紗也香, 神津 将仁, 森本 裕二
麻酔, 64, 6, 622, 627, 克誠堂出版(株), 2015年06月, ［査読有り］
日本語, 58歳男。左内頸動脈閉塞に対して浅側頭動脈-中大脳動脈バイパス術を施行した。約1年後、右脳底動脈-上小脳動脈の未破裂脳動脈瘤に対して脳動脈瘤クリッピング術を施行した。スガマデクスを投与し、自発呼吸、開眼、咳嗽反射を確認後、抜管した。抜管直後よりST上昇、徐脈、血圧低下を認めた。エフェドリン、アトロピン、フェニレフリン、アドレナリンを投与したが、血圧低下は改善せず、自発呼吸も減弱した。スガマデクス投与22分後、心室頻拍へ移行したため、胸骨圧迫を開始し、アドレナリンを投与した。洞調律に復帰したが、その後も心室性頻拍を繰り返した。その後、心室性不整脈の再発予防を目的にアミオダロン持続静注を開始した。以降の循環動態は安定し、不整脈の出現は認めなかった。心電図所見および冠動脈に有意狭窄を認めなかったことより、手術終了時の循環虚脱は冠攣縮性狭心症に起因した可能性が高いと考えられた。

I-131治療後の放射線性耳下腺炎による顔面の痛みに高気圧酸素治療が有効であった1例
長谷 徹太郎, 内田 洋介, 長谷川 完, 田中 暢洋, 敦賀 健吉, 森本 裕二
日本ペインクリニック学会誌, 22, 3, 443, 443, (一社)日本ペインクリニック学会, 2015年06月, ［査読有り］
日本語

A case of repetitive cardiac arrest due to coronary vasospasm after sugammadex administration
Koji Hoshino, Rui Kato, Sayaka Nagasawa, Masahito Kozu, Yuji Morimoto
Japanese Journal of Anesthesiology, 64, 6, 622, 627, Kokuseido Publishing Co. Ltd, 2015年06月01日, ［査読有り］
日本語, 研究論文（学術雑誌）, A 58-year-old man with no history of cardiac disease was scheduled for a cerebral aneurysm clipping surgery. Anesthesia was administered with propofol, rocuronium, fentanyl, and remifentanil. At the end of the surgery, extubation was performed 3 min after the administration of 200 mg sugammadex, along with a simultaneous blood-pressure decrease with ST elevation on lead II. Cardiopulmonary resuscitation was performed owing to the occurrence of lethal arrhythmia, and the patient was successfully resuscitated. Subsequent emergent coronary angiography revealed normal coronary arteries. Twelve days after the first surgery, a tracheostomy was performed owing to persistent disturbance of consciousness. Anesthesia was administered with sevoflurane, fentanyl, and rocuronium. Sugammadex 200 mg was administered after the insertion of a tracheal cannula, and 5 min later, the blood pressure were gradually decreased with ST depression on lead V<
inf>
5<
/inf>
. Finally, cardiopulmonary resuscitation was required, and the patient recovered again. An acetylcholine provocation test performed later showed positive results. We suspect sugammadex to be the cause of coronary vasospasm, because the time courses of the two cardiac arrest episodes after sugammadex administration were very similar. Therefore, clinicians should consider sugammadex as one of the causative agents of cardiac arrest in the operating room.

チアノーゼ性および非チアノーゼ性先天性心疾患の小児手術における脳の酸素飽和度の変化(Changes in cerebral oxygen saturation during pediatric surgery in patients with cyanotic and non-cyanotic congenital heart defects)
Tanaka Nobuhiro, Tokuyama Hideo, Uchida Yosuke, Morimoto Yuji, Tachibana Tsuyoshi
循環制御, 36, 1, 18, 24, 日本循環制御医学会, 2015年04月
英語, 先天性心疾患に対し心肺バイパス術(CPB)下にて心臓手術を行なった6歳以下の小児111名を対象に、術中の脳の酸素飽和度(rSO2)の変化を調べ、変化の原因について検討した。チアノーゼ群53名(男児52.8%、平均7ヵ月)と非チアノーゼ群58名(男児43.1%、平均20ヵ月)に分けて解析した。rSO2は近赤外分光法を用いて5分毎に測定し、術前、術中および術後の平均値を解析に用いた。手術開始時(T1)、開始5分後(T2)、術後10分(T3)時点で生理学的データを測定した。非チアノーゼ群では、術前および術後に比べ、術中の平均rSO2は有意に低く、平均動脈圧とヘモグロビン濃度はT2で有意に低かった。チアノーゼ群では、平均rSO2に差はみられなかったが、PaO2やヘモグロビンなどの生理学的データが大きく変化した。CPBにおけるrSO2の変化パターンは、チアノーゼの有無によって異なり、生理学的データの変化がrSO2の変化に影響していることが示された。

SensiLase PAD3000を用いた星状神経節ブロック前後の皮膚灌流圧の評価
長谷 徹太郎, 加藤 類, 田中 暢洋, 長谷川 完, 内田 洋介, 敦賀 健吉, 橋本 聡一, 森本 裕二
日本ペインクリニック学会誌, 22, 1, 77, 77, (一社)日本ペインクリニック学会, 2015年02月, ［査読有り］
日本語

Effect of age difference of cerebral oxygen saturation to predict early outcome in pediatric cardiac surgery for ventricular septal defect
Fujita Noriaki, Meguro Yasuteru, Saito Hitoshi, Tokuyama Hideo, Morimoto Yuji, Tachibana Tsuyoshi
循環制御, 36, 2, 106, 110, Japan Society of Circulation Control in Medicine, 2015年
日本語

Nociceptin/orphanin FQ slows inspiratory rhythm via its direct effects on the pre-Bötzinger complex.
Takita K, Morimoto Y
Respiratory Physiology & Neurobiology, 207, 14, 21, 2015年, ［査読有り］, ［国際誌］
英語, 研究論文（学術雑誌）, In a previous study, we showed that in an in vitro en bloc preparation of newborn rats perfused with standard [K(+)] (6.2mM) and high [K(+)] (11.2mM) artificial cerebrospinal fluid (aCSF), nociceptin/orphanin FQ (N/OFQ) suppresses bursting of pre-inspiratory neurons with 1:1 coupling to the fictive inspiration. However, it is unclear whether the pre-Bötzinger complex (preBötC) is involved in the N/OFQ-induced slowing. Using in vitro en bloc preparations with and without the retrotrapezoid nucleus/parafacial respiratory group (RTN/pFRG) perfused with high [K(+)] aCSF, we found the following: (1) there were no differences in the effects of N/OFQ on the inspiratory rhythm between the preparations with and without the RTN/pFRG, (2) N/OFQ decreased the input resistance of inspiratory neurons (Insps) in the preparations without the RTN/pFRG and suppressed their ectopic firing activities, and (3) N/OFQ suppressed the spontaneous firing of Insps under a chemical synaptic transmission blockade. In conclusion, it is possible that the preBötC is involved in N/OFQ-induced inspiratory rhythm slowing.

Dexmedetomidine suppresses long-term potentiation in the hippocampal CA1 field of anesthetized rats
Ryoko Ito Kato, Kaori Tachibana, Toshikazu Hashimoto, Koichi Takita, Yuji Morimoto
JOURNAL OF ANESTHESIA, 28, 6, 828, 832, SPRINGER JAPAN KK, 2014年12月, ［査読有り］
英語, 研究論文（学術雑誌）, The aim of this study was to evaluate the effect of dexmedetomidine (DEX) on hippocampal synaptic activity in vivo.
The adult rats used for this study received a intraperitoneal bolus injection of 3, 10, 30, or 100 mu g/kg of DEX or an equivalent volume of saline. Electrophysiological recording of the hippocampal CA1 region was initiated 20 min after drug administration. The results are expressed as the percentages of the population spike amplitude measured just before high-frequency stimulation (HFS). The electrophysiological data were analyzed with an area under the curve (AUC) of 10-60 min after HFS. Moreover, to investigate the sedative dose of DEX in rats, we recorded the duration of loss of spontaneous movement after the administration of each dose of DEX.
Intraperitoneal administration of DEX at doses of 30 and 100 mu g/kg induced a range of sedative effects. The AUC measurements were significantly lower in the 30 and 100 mu g/kg groups than in those injected with vehicle (vehicle: 8.81 +/- A 0.49, n = 7; DEX 30 A mu g/kg: 6.02 +/- A 0.99, n = 6; DEX 100 A mu g/kg: 5.10 +/- A 0.43, n = 5; P < 0.05).
The results of our in vivo study reveal that sedative doses of DEX impaired the induction of hippocampal long-term potentiation (LTP). These findings may signify a causal link between DEX-induced sedative action and hippocampal LTP suppression, providing a better understanding of the mechanisms underlying the DEX-induced sedative and/or amnestic effect.

糖尿病患者の脳局所酸素飽和度は、人工心肺使用時に非糖尿病患者より低値を示す
森 敏洋, 森本 裕二
Cardiovascular Anesthesia, 18, Suppl., 295, 295, (一社)日本心臓血管麻酔学会, 2014年09月
日本語

ROTEMを用いてTCPC conversionの麻酔管理を施行した3症例
太安 孝允, 田中 暢洋, 森 敏洋, 神津 将仁, 森本 裕二
Cardiovascular Anesthesia, 18, Suppl., 288, 288, (一社)日本心臓血管麻酔学会, 2014年09月, ［査読有り］
日本語

新生児期における先天性嚢胞性腺腫様奇形に対する肺切除術2例の麻酔管理
田中 暢洋, 森本 裕二
日本小児麻酔学会誌, 20, 1, 173, 173, 日本小児麻酔学会, 2014年08月, ［査読有り］
日本語

Co-existing liver disease increases the risk of postoperative thrombocytopenia in patients undergoing hepatic resection: implications for the risk of epidural hematoma associated with the removal of an epidural catheter
Koichi Takita, Yosuke Uchida, Tetsutaro Hase, Toshiya Kamiyama, Yuji Morimoto
JOURNAL OF ANESTHESIA, 28, 4, 554, 558, SPRINGER JAPAN KK, 2014年08月, ［査読有り］
英語, 研究論文（学術雑誌）, A common surgical diagnosis for hepatic resection in Japan is hepatocellular carcinoma secondary to chronic viral hepatitis. It is known that chronic liver disease causes a decrease in blood platelet count. We retrospectively reviewed the perioperative changes in blood platelet count associated with hepatic resection at a Japanese institution and evaluated the incidence and risk factors for postoperative thrombocytopenia, which may increase the potential risk of epidural hematoma.
We analyzed the data of 165 patients who underwent hepatic resection between 1 March 2010 and 30 June 2012 at Hokkaido University Hospital. The criterion of the platelet count for the unsafe removal of epidural catheter was < 100,000/mu L. Logistic regression was used to model the association between postoperative thrombocytopenia and co-existing liver disease, estimated blood loss and type of hepatic resection.
After hepatic resection, 42.4 % of patients without preoperative thrombocytopenia experienced thrombocytopenia. The presence of co-existing liver disease was identified as a risk factor for postoperative thrombocytopenia [odds ratio 3.17 (95 % confidence interval 1.63-6.18)]. There was no epidural hematoma in the 149 patients who had epidural anesthesia.
Hepatic resection can cause postoperative thrombocytopenia that may increase the potential risk of epidural hematoma associated with catheter removal, and the presence of co-existing liver disease heightens concerns for postoperative crucial thrombocytopenia.

発達段階の脳に対する麻酔薬の影響　　　　　　　　　　　　　　　
森本 裕二
医学のあゆみ, 249, 1244, 1248, 2014年, ［招待有り］

デクスメデトミジン使用下にラリンジアルマスクに入れ替え、円滑な抜管に成功した小児喉頭気管軟化症の2症例　　　　　　　　　　　　　　　
山崎 由美子, 斉藤 仁志, 森 敏洋, 久野 健二郎, 木田 敦知, 森本 裕二
臨床麻酔, 37, 12, 1809, 1810, 真興交易(株)医書出版部, 2013年12月
日本語, 症例1は1歳6ヵ月男児で、もやもや病に対して右浅側頭動脈-中大脳動脈吻合術を施行した。初回手術時に抜管直後より上気道閉塞、換気困難となり、再挿管となった経緯があった。気道閉塞を避けるためデクスメデトミジンによる鎮静下に抜管した。抜管後も呼吸状態は安定し、以後経過良好であった。症例2は3歳8ヵ月女児で、総排泄腔遺残に対して生直後より横行結腸人工肛門造設、膀胱瘻造設、会陰切開など手術歴が有り、人工肛門閉鎖術と膀胱皮膚瘻閉鎖術を予定した。会陰形成術、肛門形成術を受けた際に抜管が困難で再挿管となった経緯があった。ラリンジアルマスクを挿入し、デクスメデトミジンのみを継続し鎮静下に抜管した。披管後も呼吸状態は安定し、以後経過良好であった。

Neonatal exposure to sevoflurane causes significant suppression of hippocampal long-term potentiation in postgrowth rats
Rui Kato, Kaori Tachibana, Naoki Nishimoto, Toshikazu Hashimoto, Yosuke Uchida, Ryoko Ito, Kenkichi Tsuruga, Koichi Takita, Yuji Morimoto
Anesthesia and Analgesia, 117, 6, 1429, 1435, 6, 2013年12月, ［査読有り］
英語, 研究論文（学術雑誌）, BACKGROUND:: The inhaled anesthetic sevoflurane is commonly used for neonates in the clinical setting. Recent studies have indicated that exposure of neonatal rodents to sevoflurane causes acute widespread neurodegeneration and long-lasting neurocognitive dysfunction. Although acute toxic effects of sevoflurane on cellular viability in the hippocampus have been reported in some studies, little is known about the effects of neonatal sevoflurane exposure on long-term hippocampal synaptic plasticity, which has been implicated in the processes of learning and memory formation. Our study is the first to examine the long-term electrophysiological impact of neonatal exposure to a clinically relevant concentration of sevoflurane. METHODS:: On postnatal day 7, rats were exposed to sevoflurane (1% or 2% for 2 hours) with oxygen. To eliminate the influence of blood gas abnormalities caused by sevoflurane-induced respiratory suppression, a group of rats were exposed to a high concentration of carbon dioxide (8% for 2 hours) to duplicate respiratory disturbances caused by 2% sevoflurane exposure. RESULTS:: Exposure of neonatal rats to 2% sevoflurane for 2 hours caused significant suppression of long-term potentiation (LTP) induction in the postgrowth period. There was no significant difference between the control group and the CO2-exposed group in LTP induction, indicating that sevoflurane-induced LTP suppression was not caused by blood gas abnormalities. CONCLUSION:: Our present findings indicate that neonatal exposure to sevoflurane at a higher concentration can cause alterations in the hippocampal synaptic plasticity that persists into adulthood. Copyright © 2013 International Anesthesia Research Society.

甲状腺中毒症患者に対する冠動脈バイパス術の麻酔・周術期管理の経験
水野谷 和之, 丸山 崇, 藤井 知昭, 那須 智樹, 田中 暢洋, 雨森 英彦, 橋本 聡一, 森本 裕二
麻酔, 62, 10, 1214, 1217, 克誠堂出版(株), 2013年10月
日本語, 甲状腺中毒状態の不安定狭心症患者(61歳女性)に対するCABGの麻酔・周術期管理を経験した。一般に、甲状腺中毒症患者では周術期に甲状腺クリーゼを起こすリスクが高いため、原則として手術は延期されるべきであるが、本例は左主幹部の高度狭窄による不安定狭心症であり、甲状腺ホルモン値が正常化するまで待機するリスクが高いと判断し、薬物治療に対する反応がみられた時点で手術に踏み切った。周術期の頻脈に対するβ遮断薬として、術前には作用時間の長いプロプラノロールを使用し、術中・術後にはプロプラノロールよりも調節性に優れた短時間作用型のランジオロールを用いた。強心薬の選択にあたっては、術前の心収縮力が良好であったことを考慮し、冠灌流圧を保つ目的で少量のノルアドレナリンのみを使用して人工心肺からの離脱を試み、良好な結果が得られた。

Anesthetic and perioperative management of a patient with uncontrolled thyrotoxicosis undergoing coronary artery bypass grafting surgery
Kazuyuki Mizunoya, Takashi Maruyama, Tomoaki Fujii, Satoki Nasu, Nobuhiro Tanaka, Hidehiko Amenomori, Toshikazu Hashimoto, Yuji Morimoto
Japanese Journal of Anesthesiology, 62, 10, 1214, 1217, 10, 2013年10月, ［査読有り］
日本語, 研究論文（学術雑誌）, Uncontrolled hyperthyroidism is a risk factor of perioperative thyrotoxic crisis. We report a case of a 61-year-old woman with thyrotoxicosis diagnosed with unstable angina pectoris. She needed to have an early scheduled coronay artery bypass grafting surgery, because percutaneous intervention for the left main coronary artery in support of intra-aortic balloon pumping (IABP) resulted in failure. Tachycardia and hyperthermia were observed at admission to the ICU, and hemodynamic parameters suggested high-output heart failure. Preoperative management using antithyroid drug, inorganic iodine, corticosteroid and propranolol stabilized her hemodynamic condition, and then CABG was performed on ICU day 3. Intraoperative and postoperative use of landiolol, a short acting beta blocker, was useful for maintaining hemodynamic stability. Surgery was uneventfully completed and she was extubated on postoperative day 1 following IABP withdrawal. Appropriate preoperative management and perioperative use of the short acting beta blocker were useful for management of the patient with uncontrolled hyperthyroid state.

Are routine preoperative hemostatic screening tests necessary in Japanese institutions?
Koichi Takita, Yumiko Yamazaki, Yuji Morimoto
Journal of Anesthesia, 27, 3, 481, 482, 2013年06月, ［査読有り］
英語

Neonatal exposure to high concentration of carbon dioxide produces persistent learning deficits with impaired hippocampal synaptic plasticity
Kaori Tachibana, Toshikazu Hashimoto, Koichi Takita, Ryoko Ito, Rui Kato, Yuji Morimoto
BRAIN RESEARCH, 1507, 83, 90, ELSEVIER SCIENCE BV, 2013年04月, ［査読有り］
英語, 研究論文（学術雑誌）, Although respiratory complications with blood gas abnormalities contribute significantly to neurodevelopment in the immature brain, little is known about the mechanisms via which blood gas abnormalities, such as hypoxic hypercapnia, impair neurocognitive outcomes. To investigate the possible long-term consequences of neonatal exposure to hypoxic hypercapnia regarding learning ability, we investigated, the effect of neonatal hypoxic hypercapnia on later functions in the hippocampus, which is a structure that has been implicated in many learning and memory processes. Neonatal rat pups (postnatal day 7; P7) were exposed to a high concentration of carbon dioxide (CO2; 13%) for 2 or 4 h. Exposure to CO2 in P7 rat pups caused blood gas abnormalities, including hypercapnia, hypoxia, and acidosis, and disrupted later learning acquisition, as assessed in 10-week-old adult rats subjected to a Morris water maze test. Induction of long-term potentiation (LTP) in the synapses of the hippocampal CA1 area was also impaired, whereas the paired-pulse responses of population spikes exhibited a significant increase, in CO2-exposed rats, suggesting decreased recurrent inhibition in the hippocampus. Such long-lasting modifications in hippocampal synaptic plasticity may contribute to the learning impairments associated with perinatal hypoxic hypercapnia and acidosis. (C) 2013 Elsevier B.V. All rights reserved.

慢性血栓塞栓性肺高血圧症に対する血栓内膜摘除術7症例の麻酔経験
長沢紗也香, 原澤克巳, 森本裕二
麻酔, 61, 11, 1226, 1229, 2012年11月
日本語, 研究論文（学術雑誌）, We report seven cases of anesthetic management for pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH) during past seven years in our hospital. All the patients were suffering from right heart failure and pulmonary hypertension, and the preoperative mean pulmonary artery pressure (mPAP) was 51.2±10.2 mmHg, and the pulmonary vascular resistance (PVR) was 894.2±207.7 dyne·sec-1·cm-5. The surgical operation was performed using the deep hypothermia and circulatory arrest technique. The postoperative mPAP and PVR decreased to 15.5±7.5 mmHg and 181.6±84 dyne·sec-1·cm-5, respectively. The patients' symptoms such as shortness of breath, and dyspnea improved and they were discharged without any serious complications.

Anesthetic management of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension - Series of severe cases
Sayaka Nagasawa, Katsumi Harasawa, Yuji Morimoto
Japanese Journal of Anesthesiology, 61, 11, 1226, 1229, 11, 2012年11月, ［査読有り］
日本語, 研究論文（学術雑誌）, We report seven cases of anesthetic management for pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH) during past seven years in our hospital. All the patients were suffering from right heart failure and pulmonary hypertension, and the preoperative mean pulmonary artery pressure (mPAP) was 51.2±10.2 mmHg, and the pulmonary vascular resistance (PVR) was 894.2±207.7 dyne·sec-1·cm-5. The surgical operation was performed using the deep hypothermia and circulatory arrest technique. The postoperative mPAP and PVR decreased to 15.5±7.5 mmHg and 181.6±84 dyne·sec-1·cm-5, respectively. The patients' symptoms such as shortness of breath, and dyspnea improved and they were discharged without any serious complications.

過去5年間の一酸化炭素中毒症例の臨床検討
本間多恵子, 本間慶憲, 山本浩, 柳田雄一郎, 上垣慎二, 久保田信彦, 早川峰司, 澤村淳, 石川岳彦, 丸藤哲, 森本裕二
日本救急医学会雑誌, 23, 10, 529, 2012年10月15日
日本語

脊椎脊髄外科麻酔の諸問題 5 脊髄損傷と麻酔管理
長谷徹太郎, 森本裕二
臨床麻酔(真興交易), 36, 9, 1318, 1326, 2012年09月20日
日本語

Neonatal administration with dexmedetomidine does not impair the rat hippocampal synaptic plasticity later in adulthood
Kaori Tachibana, Toshikazu Hashimoto, Rui Kato, Yosuke Uchida, Ryoko Ito, Koichi Takita, Yuji Morimoto
PEDIATRIC ANESTHESIA, 22, 7, 713, 719, WILEY, 2012年07月, ［査読有り］
英語, 研究論文（学術雑誌）, Background and objective: The use of dexmedetomidine (DEX), a selective alpha-2 agonist, in pediatric practice is expanding as a result of its desirable properties. To clarify the long-term neurological consequences of neonatal administration of DEX, we investigated the long-term effects of neonatal administration of DEX on hippocampal synaptic activity. Methods: The rat pups received a bolus intraperitoneal injection of either 5 or 10 mu g center dot kg-1 DEX, or an equivalent volume of vehicle on postnatal day 7 (P7). Nine weeks after administration, evoked potentials (population spike, PS) and long-term potentiation (LTP) in the hippocampal CA1 region of rats were studied in vivo. Results: Dexmedetomidine had a considerable sedative effect at these doses with little respiratory depression on P7. Nine weeks after administration of DEX, the amplitude of PS in the two treated groups was similar to that in the control group. DEX-treated rats showed no impairment in the induction of LTP. Furthermore, the response in PS to the paired stimuli was not impaired by neonatal administration of DEX. Conclusion: These findings demonstrate that a single administration of DEX to rats on P7 preserves hippocampal synaptic plasticity as well as synaptic transmission later in life. In view of the some evidence that have demonstrated the permanent detrimental impact of commonly used anesthetics on neurological outcomes after neonatal exposure, our findings may suggest the relative safety of DEX administered as a sedative agent to neonatal animals with regard to the development of hippocampal synaptic functions.

Use of near-infrared spectroscopy in combination with monitoring of external jugular vein pressure for early detection of cerebral ischemia by unintentional superior vena cava obstruction
Ryoko Ito, Koichi Takita, Kazuyuki Mizunoya, Atsunori Kida, Yuji Morimoto
Journal of Cardiothoracic and Vascular Anesthesia, 26, 3, e27, e28, 3, 2012年06月, ［査読有り］
英語

北海道大学病院での最近6カ年(2005‐2010)の高度挿管困難症の現況
瀧田恒一, 森本裕二
麻酔, 61, 4, 418, 423, 2012年04月10日, ［国内誌］
日本語, 研究論文（学術雑誌）, BACKGROUND: Recently, in addition to bronchofiberscope, the new equipments to manage difficult intubation are available. However, it is unknown whether the incidence of difficult intubation decreases or not. In order to determine the incidence of severe difficult intubation, we conducted a survey of patients who presented with severely difficult intubation during 2005-2010. METHODS: From data of patients in whom tracheal intubation was attempted in the operating rooms in Hokkaido university hospital from January 2005 to December 2010, the data was collected on the patients who presented with severely difficult intubation, defined as the inability to secure tracheal intubation in less than 20 min from induction of anesthesia. RESULTS: A total of 21,982 tracheal intubations were attempted during the study period. The incidence of severely difficult intubation was 0.3% (65 intubations for 58 patients). There was no significant difference among the years in the incidence of severely difficult intubation. CONCLUSIONS: The incidence of severely difficult intubation was 0.3% in Hokkaido university hospital during 2005-2010.

Survey of patients presented with severely difficult intubation in Hokkaido University Hospital (2005-2010)
Koichi Takita, Yuji Morimoto
Japanese Journal of Anesthesiology, 61, 4, 418, 423, 4, 2012年04月10日, ［査読有り］
日本語, 研究論文（学術雑誌）, Background : Recently, in addition to bronchofiberscope, the new equipments to manage difficult intubation are available. However, it is unknown whether the incidence of difficult intubation decreases or not. In order to determine the incidence of severe difficult intubation, we conducted a survey of patients who presented with severely difficult intubation during 2005-2010. Methods : From data of patients in whom tracheal intubation was attempted in the operating rooms in Hokkaido university hospital from January 2005 to December 2010, the data was collected on the patients who presented with severely difficult intubation, defined as the inability to secure tracheal intubation in less than 20 min from induction of anesthesia. Results : A total of 21,982 tracheal intubations were attempted during the study period. The incidence of severely difficult intubation was 0.3% (65 intubations for 58 patients). There was no significant difference among the years in the incidence of severely difficult intubation. Conclusions : The incidence of severely difficult intubation was 0.3% in Hokkaido university hospital during 2005-2010.

術後出血から第XIII因子欠損症と診断された患者の麻酔経験
山内麻紗子, 木田敦知, 森本裕二
臨床麻酔(真興交易), 36, 2, 231, 232, 2012年02月20日
日本語

軽度低体温の脳保護効果の機序
森本裕二
日本臨床麻酔学会誌, 32, 1, 020, 026, 2012年
日本語

A case of lung torsion after esophagectomy
Yosuke Uchida, Satoko Ando, Atsunori Kida, Yuji Morimoto
Japanese Journal of Anesthesiology, 60, 11, 1321, 1325, 11, 2011年11月10日, ［査読有り］
日本語, 研究論文（学術雑誌）, A 77-year-old man underwent esophagectomy for esophageal cancer. Chest radiograph just after the operation showed opacification of the right lung. Although chest radiograph still showed a marked opacification of almost whole right lung in the ICU in spite of multiple bronchoscopy examination and suctioning of pulmonary secretions, he showed no dyspnea. On the second postoperative day, his respiratory symptoms deteriorated unexpectedly. Computed tomography showed torsion of the right upper and middle lobes, and urgent surgery was scheduled. Following double-lumen endotracheal intubation, thoracotomy was performed under one lung ventilation. The lung was found rotated. The surgeons tried to reduce the torsion to preserve the viable lung, but failed. Bleeding from infarcted lung was observed (approximately 150 ml). Accordingly, stapled lobectomy was performed. After the second surgery, he fortunately recovered without any complications. Although lung torsion is a rare complication, not only thoracic surgeons, but also we, anesthesiologists, should be aware of this disease.

ラステリ手術閉胸時にPHクライシス様ショックを起こした1例
久保 康則, 木田 敦知, 森 敏洋, 森本 裕二
Cardiovascular Anesthesia, 15, Suppl., 189, 189, (一社)日本心臓血管麻酔学会, 2011年10月
日本語

Coagulation profiles following donor hepatectomy and implications for the risk of epidural hematoma associated with epidural anesthesia
Tetsutaro Hase, Koichi Takita, Toshikazu Hashimoto, Yuji Morimoto
Japanese Journal of Anesthesiology, 60, 7, 840, 845, 7, 2011年07月10日, ［査読有り］
日本語, 研究論文（学術雑誌）, Background : Continuous epidural analgesia has become an accepted technique used in laparotomy including liver resections. Although American Society of Regional Anesthesia and Pain Medicine recommends that epidural catheter be removed with prothrombin time-international normalized ratio (PT-INR) less than 1.5, it is possible that liver surgery causes coagulation disturbances. We examined the postoperative changes in coagulation profiles of living liver donors to elucidate whether hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters or not. Methods : From January 2007 to October 2009, 42 living liver related transplantations were performed in Hokkaido University Hospital. We reviewed the donor data including PT-INR obtained during perioperative days [preoperative, immediately postoperative, postoperative day 1, 3 and 7] and epidural catheter-related-complications, retrospectively. Results : While in all donors values of PT-INR obtained during preoperative periods were within normal limits, 14 donors had a PT-INR over 1.5 during postoperative periods. There was no epidural hematoma case in this study. Conclusions : Our study suggested that hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters, even in the living liver transplant donors with normal liver function.

Long-lasting effects of neonatal pentobarbital administration on spatial learning and hippocampal synaptic plasticity
Kaori Tachibana, Toshikazu Hashimoto, Rui Kato, Kenkichi Tsuruga, Ryoko Ito, Yuji Morimoto
BRAIN RESEARCH, 1388, 69, 76, ELSEVIER SCIENCE BV, 2011年05月, ［査読有り］
英語, 研究論文（学術雑誌）, Exposure of newborn rats to antiepileptics such as barbiturates has long-lasting detrimental effects on the hippocampus and hippocampus-dependent behavior. However, the long-term consequences of neonatal administration with barbiturates on the hippocampal synaptic plasticity remain unresolved. In this study, we investigated the long-lasting effects of a neonatal administration of pentobarbital on spatial memory, paired-pulse plasticity in the population spikes, and long-term potentiation (LTP) in the hippocampal CA1 region of rats in vivo. Eight weeks after administration of pentobarbital (10 or 20 mg/kg) on the seventh postnatal day (P7), rats showed impaired induction in LTP. During paired-pulse stimulation, pentobarbital-treated rats exhibited a greater facilitation of the test pulse population spike, suggesting a disruption in the inhibitory GABAergic synaptic transmission. Spatial learning in hidden platform task of the Morris water maze was impaired in pentobarbital-treated rats. Our present findings indicate that neonatal treatment with pentobarbital causes alterations in function of the hippocampal inhibitory synaptic transmission that persist into adulthood, likely contributing to the long-lasting abnormalities in the hippocampal LTP as well as learning ability. We also demonstrated significant respiratory disturbances, i.e., severe hypoxia, hypercapnia, and extracellular acidosis, in rats treated with pentobarbital on P7. Given that extracellular acidosis can also modulate synaptic transmission in the developing hippocampus, this finding led us to speculate regarding the influence of respiratory disturbances in pentobarbital-induced long-lasting hippocampal dysfunctions. (C) 2011 Elsevier B.V. All rights reserved.

肝切除術後の凝固能変化と硬膜外カテーテル抜去に伴う血腫のリスク：生体肝移植ドナーでの検討．　　　　　　　　　　　　　　　
長谷徹太郎, 瀧田恒一, 橋本聡一, 森本裕二
麻酔, 61, 840, 845, 2011年
日本語

肝硬変合併開心術の予後と麻酔管理
田中 暢洋, 森本 裕二
日本臨床麻酔学会誌, 30, 6, S330, S330, 日本臨床麻酔学会, 2010年10月, ［査読有り］
日本語

Effect of mild and moderate hypothermia on hypoxic injury in nearly pure neuronal culture
Yu Hua, Kenjiro Hisano, Yuji Morimoto
JOURNAL OF ANESTHESIA, 24, 5, 726, 732, SPRINGER TOKYO, 2010年10月, ［査読有り］
英語, 研究論文（学術雑誌）, The effects of mild and moderate hypothermic therapy on cerebral injury are still controversial. Our hypothesis is that mild and moderate hypothermia should have some effects on neurons themselves if they really have protective effects. By using a nearly pure neuronal culture, we evaluated the effects and mechanism of hypothermia against hypoxic insult.
A nearly pure neuronal culture from cortices of 18-day-old Wister rats was used. The neurons were exposed to below 1% oxygen at 3 different temperatures (30, 33 and 37A degrees C). First, cell viability was measured by assessing viable neurons with trypan blue. Second, to evaluate the mechanism, the extracellular glutamate concentration was measured by high-performance liquid chromatography after hypoxia; cell viability after exposure to extrinsic glutamate was also evaluated. Next, mitochondrial membrane potential was estimated, by monitoring aggregation of MitoCapture (TM), and the percentage of apoptotic cells was evaluated by staining with Hoechst 33342 and propidium iodide.
After 24-h hypoxic insult, cell viability at 30 and 33A degrees C was significantly higher than at 37A degrees C. There was no significant difference between extracellular concentrations of glutamate after hypoxia or cell viability after glutamate exposure among the 3 temperature groups. In moderate hypothermia, the number of neurons with mitochondrial injury and the percentage of apoptotic cells were significantly reduced.
Mild and moderate hypothermia inhibited hypoxic neuronal cell death. The mechanism of this effect may be related to protection of mitochondrial function, presumably followed by inhibition of apoptosis, at least in moderate hypothermia.

Therapeutic Potentials of an Artificial Oxygen-Carrier, Liposome-Encapsulated Hemoglobin, for Ischemia/Reperfusion-Induced Cerebral Dysfunction in Rats
Jin Kakehata, Taku Yamaguchi, Hiroko Togashi, Ichiro Sakuma, Hiroshi Otani, Yuji Morimoto, Mitsuhiro Yoshioka
JOURNAL OF PHARMACOLOGICAL SCIENCES, 114, 2, 189, 197, JAPANESE PHARMACOLOGICAL SOC, 2010年10月, ［査読有り］
英語, 研究論文（学術雑誌）, We performed this study to elucidate whether a newly developed liposome-encapsulated hemoglobin, TRM-645 (TRM), can prevent cerebral dysfunction resulting from acute ischemic stroke when used as an oxygen carrier. Hippocampal long-term potentiation (LTP) in the perforant path dentate gyrus synapses and anxiety-related behaviors in the elevated plus-maze test were evaluated as indices of cerebral functional outcomes in the rat with two-vessel occlusion (2VO), which was induced by 10-min clamping of bilateral common carotid arteries. Saline or TRM (hemoglobin concentration of 6 g/dl: 2.5 or 5 ml/kg) was administered via the tail vein immediately after ischemic insult. Hippocampal LTP formation was markedly impaired and the open arm durations in the elevated plus-maze decreased significantly 4 days after 2VO, compared to those of sham-operated (control) rats, suggesting the hippocampal synaptic dysfunction and anxio-genic properties in 2VO rats. TRM (5 ml/kg) restored the hippocampal LTP formation and normalized the anxiety-related behavior. TRM also improved the decreased tissue oxygen partial pressure in the 2VO rat hippocampus, possibly due to oxygen delivery to ischemic regions. Liposome-encapsulated hemoglobin TRM might have therapeutic potentials for protecting the brain from neurological complications associated with acute ischemic stroke, as a promising blood substitute for oxygen therapy.

Effects of sevoflurane on respiratory rhythm oscillators in the medulla oblongata
Koichi Takita, Yuji Morimoto
RESPIRATORY PHYSIOLOGY & NEUROBIOLOGY, 173, 1, 86, 94, ELSEVIER SCIENCE BV, 2010年08月, ［査読有り］
英語, 研究論文（学術雑誌）, Using in vitro newborn rat brainstem-spinal cord preparations with and without the parafacial respiratory group (pFRG), we examined the effects of the volatile anaesthetic sevoflurane on the respiratory rhythm oscillators of the pFRG and the preBotzinger complex (preBotC). Our study indicated that sevoflurane depressed pre-inspiratory neurons (Pre-Is) in the pFRG via gamma-aminobutyric acid-A (GABA(A))ergic and glycinergic inhibition and that it depressed preBotC inspiratory neurons via GABA(A)ergic but not via glycinergic inhibition. We also found that sevoflurane had stimulant effects on the respiratory rhythm oscillators. Our results shed light on respiratory rhythm generation. In all preparations (n = 16) in which Pre-Is activity was recorded, inspiratory-related cervical motor output remained after application of 0.47 mM sevoflurane, despite the disappearance of the burst activity of Pre-Is. This finding shows that Pre-Is are not essential for respiratory rhythm generation and suggests that sevoflurane, when applied at a proper concentration, might offer a pharmacological means to eliminate pFRG function while preserving preBotC activity. (C) 2010 Elsevier B.V. All rights reserved.

A comparison of acetated ringer's solution and bicarbanated ringer's solution for fluid therapy during extended hystectomy
Satoko Andou, Yuji Morimoto
Japanese Journal of Anesthesiology, 59, 8, 971, 975, 8, 2010年08月, ［査読有り］
日本語, 研究論文（学術雑誌）, Background: We investigated the efficacy of two types of Ringer's solutions, acetated Ringer (AR) and bicarbanated Ringer (BR), during and after high invasive abdominal surgery. Methods: We divided 16 patients scheduled for extended hystectomy into 2 groups of AR or BR infusion group. Either AR or BR solution was administered to keep CVP at 2-8 cmH2O and Hb above 7 g·dl-1 during the entire anesthetic period. Acid base balance, serum magnesium (Mg) and metabolic products such as lactate, pyruvic acid, citric acid, acetoacetic acid and hydroxybutyric acid were measured during and after surgery. IL-6 was determined early on the next morning. Results: Metabolic products and IL-6 were not different between the two groups
however, base excess and HCO3- during surgery were kept higher in BR group than in AR group. Intraoperative serum Mg was also maintained higher in BR group. Conclusions: From the aspect of the ability to keep acid base balance and Mg level, BR seems to be a more suitable infusion fluid than AR in high invasive abdominal surgery such as extended hystectomy.

難治性潰瘍、骨髄炎治療の進歩 下顎骨骨髄炎に対する高気圧酸素治療の有効性
伊藤 亮子, 石川 勝清, 新田 幸絵, 加藤 類, 敦賀 健吉, 橋本 聡一, 森本 裕二
日本高気圧環境・潜水医学会雑誌, 44, 3, 148, 148, (一社)日本高気圧環境・潜水医学会, 2009年09月
日本語

Protective effects of the free radical scavenger edaravone against glutamate neurotoxicity in nearly pure neuronal culture
Kenjiro Hisano, Masahiko Watanabe, Yuji Morimoto
JOURNAL OF ANESTHESIA, 23, 3, 363, 369, SPRINGER TOKYO, 2009年08月, ［査読有り］
英語, 研究論文（学術雑誌）, Edaravone, a free radical scavenger, has shown neuroprotection in both animals and humans. To evaluate the mechanism of this protection, we examined the effect of edaravone on neurons themselves against glutamate neurotoxicity.
Neurons were collected from 18-day fetal rat brains and a culture of almost pure neurons was obtained after 14-day culture. The neurons were exposed to 50 mu M glutamate for 10 min, followed by normal culture for 24 h. Edaravone was added to the medium during the glutamate insult (prophylactic effect) or after the insult (treatment effect). First, the cell survival rate was measured by staining with trypan blue. Second, the cells were stained with 6-carboxy-2', 7'-dichlorodihydrofluorescein diacetate, di-(acetoxymethyl ester) (C-DCDHF-DA) and the relative amount of reactive oxygen species (ROS) was measured by flow cytometry. Third, the cells were stained with Hoechst 33342 and propidium iodide and the numbers of apoptotic and necrotic cells were counted.
A dose-dependent prophylactic effect was observed and the cell survival rate in 500 mu M edaravone was significantly higher than that without it. However, there was no treatment effect beyond 2 h after the insult. The amount of ROS under 500 mu M edaravone at 4 h after the glutamate insult was significantly lower than the control amount. Necrosis, but not apoptosis, was significantly inhibited by edaravone.
Edaravone mainly showed a prophylactic effect on neurons against glutamate neurotoxicity, possibly through the inhibition of necrosis via the suppression of ROS production. However, for a protective effect, a higher, supraclinical concentration was required, compared to the concentrations producing a protective effect in glial and endothelial cells in previous studies.

終末期のモルヒネによるせん妄に対する複方オキシコドンへの : 部オピオイドローテーションの有用性
瀧川 千鶴子, 小村 好弘, 上田 敬子, 森本 祐二
The journal of the Japan Society of Pain Clinicians = 日本ペインクリニック学会誌, 16, 2, 153, 157, 一般社団法人 日本ペインクリニック学会, 2009年05月25日
日本語, 静脈内モルヒネ投与によりせん妄が生じたと考えられる症例に対し，モルヒネ使用量を80%に減量し，残りの20%を複方オキシコドンに変更することでせん妄が改善するかどうかを検討した．緩和病棟入院中にモルヒネが主因でせん妄を生じた32名を対象に，モルヒネと一部変更した複方オキシコドンを患者自己調節鎮痛機器で投与した．変更前と3日後に，せん妄をMemorial Delirium Assessment Scale日本語版（MDAS-J）で，痛みをフェーススケール（FS）で，眠気をSchedule for Treatment Assessment Scale日本語版（STAS-J）で評価した．疼痛管理法を変更した2名と頭蓋内病変があった3名の計5名を除外し，27名で解析した．せん妄は21名で改善した．平均では，せん妄はMDAS-Jで16.2から9.2へ，痛みはFSで2.2から1.7へ，眠気はSTAS-Jで2.6から1.7に軽減した．無効例の変更後の生存期間は19.8日であった．モルヒネ使用中のせん妄では，モルヒネの20%を複方オキシコドンへ変更することは，予後を見極めたうえで，有用である．

Anesthetic management for severe aortic regurgitation in an infant repaired by Ross procedure
Akira Watabe, Hitoshi Saito, Katsumi Harasawa, Yuji Morimoto
JOURNAL OF ANESTHESIA, 23, 2, 270, 274, SPRINGER TOKYO, 2009年05月, ［査読有り］
英語, 研究論文（学術雑誌）, We report the anesthetic management of a 7-month-old male infant with severe aortic regurgitation (AR) scheduled for the Ross procedure. To the best of our knowledge, this is the first report from the viewpoint of anesthetic management for the Ross procedure performed in an infant. He had been suffering from severe AR that occurred suddenly when he was 5 months old. The cause of the AR was considered to be spontaneous rupture of a fenestrated aortic valve, owing to congenital tissue defect in part of the aortic valvular leaflet. The Ross procedure was scheduled to be performed under general anesthesia using deep hypothermic cardiopulmonary bypass (CPB). Continuous infusion of nitroglycerin was started during CPB and continued after CPB to dilate the newly implanted coronary arteries for the prevention of myocardial ischemia and to decrease afterload and pulmonary vascular resistance. Weaning from CPB was performed without difficulty, but after the prolonged CPB he had a bleeding tendency that needed transfusion and a hemostatic drug. Monitoring with transesophageal echocardiography was very useful for evaluating myocardial ischemia, and for assessing the procedure and the completion of surgical repair. His postoperative course was uneventful and he was discharged on the 25th postoperative day.

Altered synaptic transmission in rat anterior cingulate cortex following peripheral nerve injury
Kaori Tachibana, Rui Kato, Kenkichi Tsuruga, Koichi Takita, Toshikazu Hashimoto, Yuji Morimoto
BRAIN RESEARCH, 1238, 53, 58, ELSEVIER SCIENCE BV, 2008年10月, ［査読有り］
英語, 研究論文（学術雑誌）, Background: Patients with neuropathic pain present not only with persistent pain but also a complex set of additional symptoms, including mood disorders and cognitive disturbance. Given the important roles of the anterior thalamic nuclei (ATN) and anterior cingulate cortex (ACC) in the cognitive and emotional aspects of pain, investigation of the properties of ATN-ACC synapses will help us to understand the mechanisms underlying neuropathic pain. Methods: We studied changes in ATN-evoked ACC excitatory postsynaptic potentials (EPSPs) induced by neuropathic pain in a rat model under halothane anaesthesia. Results: Neuropathic pain caused significant suppression of EPSPs in the ACC compared with rats subjected to sham surgery. Similar to previous evidence, acute inflammatory pain induced by formalin injection into the hind paw significantly increased synaptic efficacy in the ACC compared with naive rats. Neither of the pain paradigms altered the paired-pulse responses. Conclusions: A possible explanation for the neuropathic pain-related suppression of EPSPs is that the ACC was already sufficiently active at baseline as a result of neuropathic pain, and ATN stimulation could not further increase the already elevated level of ACC activity. This abnormal excitability of the ATN-ACC synapse may be important in understanding the mechanism underlying neuropathic pain, particularly with respect to the affective and cognitive aspects. (C) 2008 Elsevier B.V. All rights reserved.

Child B肝硬変患者の開心術
森 敏洋, 山崎 由美子, 秦 琢磨, 森本 裕二
麻酔, 57, 6, 775, 775, 克誠堂出版(株), 2008年06月
日本語

Anatomical features of the right internal jugular vein in infants and young children undergoing heart surgery for congenital disease: comparison between cyanotic and noncyanotic patients
Yuji Morimoto, Kenjiro Hisano, Koichi Takita, Toshikazu Hashimoto
JOURNAL OF ANESTHESIA, 22, 1, 1, 6, SPRINGER TOKYO, 2008年02月, ［査読有り］
英語, 研究論文（学術雑誌）, Purpose. It has been reported that children with cyanotic heart disease have elevated systemic levels of vascular endothelial growth factor, which may be related to the development of vessels. However, it is unknown whether the anatomical features of the internal jugular vein (IJV) differ between cyanotic and noncyanotic children. In this study, we compared anatomical information about the IJV of these two groups of patients.
Methods. We measured the distance between the right IJV and the right carotid artery (distance), the diameter of the IJV (diameter), and the depth of the IJV from the skin (depth), using an ultrasound device, in 100 children (0-34 months) undergoing heart surgery for congenital disease. First, we evaluated the relationship of these measurement values with patient demographic data (age, height, and body weight). Next, we evaluated the effect of the 15 Trendelenburg position on these measurement values.
Results. There were 62 cyanotic and 38 noncyanotic patients. Distance and diameter, but not depth, were well correlated with the demographic data in both patient groups. Diameter in cyanotic patients was highly correlated with the demographic data. Clinically significant changes in the measurement values were not observed in the 15 Trendelenburg position compared with the horizontal position in either patient group.
Conclusion. The anatomical features of the right IJV in infants and young children with congenital heart disease were not different in cyanotic and noncyanotic patients, except for the relationship between diameter and the demographic data. In the small patients examined in our study (72% of them were infants), the diameter of the IJV was not sufficiently enlarged by the Trendelenburg position, regardless of whether the patients were cyanotic or noncyanotic.

Nociceptin/orphanin FQ causes non-quantal slowing of respiratory rhythm in brainstem-spinal cord preparation from newborn rat.
Takita K, Morimoto Y
Neuroscience Letters, 443, 129, 133, 2008年, ［査読有り］
英語, 研究論文（学術雑誌）

Effects of propofol and halothane on long-term potentiation in the rat hippocampus after transient cerebral ischaemia
J. Kakehata, H. Togashi, T. Yamaguchi, Y. Morimoto, M. Yoshioka
EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 24, 12, 1021, 1027, LIPPINCOTT WILLIAMS & WILKINS, 2007年12月, ［査読有り］
英語, 研究論文（学術雑誌）, Background: Propofol is reported to have protective effects on cerebral ischaemia-induced neuronal death. The aim of this study was to explore whether propofol and halothane can protect hippocampal neuronal function from ischaemic injury during general anaesthesia in rats. Methods: Rats were divided into 2-vessel occlusion (incomplete cerebral ischaemia) and 4-vessel occlusion (complete cerebral ischaemia) groups consisting of three subgroups each (sham-operated, propofol and halothane groups). One hour after starting propofol 1 mg kg(-1) min(-1) with 30% O(2) and N(2) or halothane 0.8% in 30% O(2) and N(2) rats with or without bilateral vertebral artery occlusion had bilateral common carotid arteries occluded by vessel clips for 10 min. Anaesthesia was maintained for another 1 h. Seven days after ischaemia-reperfusion, hippocampal long-term potentiation in the perforant path-dentate gyrus synapse was determined as an index of cerebral outcome. Results: In the propofol groups, the formation of long-term potentiation was significantly impaired in the 2-vessel and 4-vessel occlusion groups compared to the respective sham-operated groups (P < 0.01 and P < 0.05, respectively). Impaired formation of long-term potentiation in propofol groups was comparable to that in halothane groups. The formation of long-team potentiation in the propofol and halothane 2-vessel group was not significantly different from that in the awake 2-vessel group. Conclusions: Propofol and halothane administered during ischaemia do not possess protective effects against hippocampal neuronal dysfunction induced by cerebral ischaemia-reperfusion as evaluated by our transient ischaemic rat models.

Isoflurane bidirectionally modulates the paired-pulse responses in the rat hippocampal CA1 field in vivo
Kaori Tachibana, Koichi Takita, Toshikazu Hashimoto, Machiko Matsumoto, Mitsuhiro Yoshioka, Yuji Morimoto
ANESTHESIA AND ANALGESIA, 105, 4, 1006, 1011, LIPPINCOTT WILLIAMS & WILKINS, 2007年10月, ［査読有り］
英語, 研究論文（学術雑誌）, BACKGROUND: We studied the effects of isoflurane on hippocampal synaptic transmission and paired-pulse plasticity, under in vivo intact interneuron circuitry.
METHODS: Using rats chronically implanted with electrodes, excitatory postsynaptic potential (EPSP) and population spike amplitude (PSA) were measured in the hippocampal CA1 field by stimulating Schaffer collaterals. The lungs of the rats were mechanically ventilated with 0.25-1.5 minimum alveolar anesthetic concentration (MAC) isoflurane. A control value was obtained in the absence of isoflurane.
RESULTS: Isoflurane depressed EPSP responses and enhanced synaptic efficacy. PSA was not depressed except under high concentrations, presumably reflecting a well-balanced combination with the decreased EPSP and enhanced synaptic efficacy. Low concentrations of isoflurane (0.25 and 0.5 MAC) increased paired-pulse facilitation, (PPF), whereas a high concentration of isoflurane (1.5 MAC) prolonged the paired-pulse depression.
CONCLUSIONS: Isoflurane appeared to affect multiple sites of CA1 synapses: 1) the depression of presynaptic glutamatergic transmission as shown by depressed EPSP and increased PPF; 2) the depression of pyramidal neurons as shown by prolonged PPF and depressed PSA under high concentration; and 3) the depression of interneurons as shown by the greater synaptic efficacy. The degree of each of these inhibitory effects seemed to vary at different concentrations, and the overall direction of the synaptic properties may depend on the balances between these inhibitory effects in vivo.

Postoperative inflammatory reactions after coronary artery bypass grafting performed on-pump with preceding glucocorticoid therapy compared with those after grafting performed off-pump
Katsumi Harasawa, Yuji Morimoto
Japanese Journal of Anesthesiology, 56, 6, 666, 670, 6, 2007年06月, ［査読有り］
日本語, 研究論文（学術雑誌）, Background : Compared with conventional coronary artery bypass graft surgery (CABG) using cardiopulmonary bypass, less postoperative acute inflammatory responses are expected in off-pump CABG. Therefore, we retrospectively studied the difference in post-operative inflammatory reactions between on-pump and off-pump surgical groups. Methods : We selected 15 patients for on-pump and 19 for off-pump groups, respectively, from the past 3 years. One gram of methylpredonisolone was administered before institution of cardiopulmonary bypass only in the on-pump group. The white blood cell count and the level of C-reactive protein were compared in both groups for 10 days postoperatively. Results : The white blood cell count reached a maximum in each group 2 days after surgery. However the values were significantly greater in the on-pump group than in the off-pump group at postoperative days 3 through 6. The level of C-reactive protein was also increased postoperatively in each group. In the off-pump group without receiving any steroid therapy, the values were greater than in the on-pump group on postoperative days 1 through 6. Conclusions : In off-pump CABG, the level of C-reactive protein increases significantly in the postoperative period.

疼痛緩和におけるレーザー治療の役割
橋本 聡一, 敦賀 健吉, 森本 裕二, 劔物 修
日本レーザー医学会誌 = The Journal of Japan Society for Laser Medicine, 28, 1, 58, 67, Japan Society for Laser Surgery and Medicine, 2007年04月16日
日本語, レーザー治療は様々な疼痛性疾患の患者に対して応用されている．ガリウム・アルミニウム・砒素半導体レーザーとヘリウム・ネオンレーザーが疼痛緩和のために広く用いられている．レーザーの鎮痛作用の機序は基礎的研究によって明らかにされてきている．レーザー照射によって知覚神経の伝導が抑制されることが示された．また，レーザー治療の疼痛緩和における有効性は多くの臨床研究で報告されている．レーザー治療は帯状疱疹，帯状疱疹後神経痛，緊張型頭痛および腰痛の治療において高い有効性を示すようである．レーザー治療は安全で副作用はまれであるが，厳密な適応やその適切な治療期間についてはさらなる検討が必要である．

Stored autologous blood from a pregnant woman showing a considerable amount of agglutinates
Junka Sekishita, Fumika Sakuraya, Katsumi Harasawa, Yuji Morimoto
Japanese Journal of Anesthesiology, 56, 3, 326, 328, 3, 2007年03月, ［査読有り］
日本語, 研究論文（学術雑誌）, A 30-year-old woman was admitted to our hospital to undergo simultaneous cesarean section and radical hysterectomy when the pregnancy became 30 weeks. An ultrasonic examination had found hypoechoic region at the cervix uteri. Because she wished autologous blood transfusion, 100 ml each of her own blood was obtained 3 times preoperatively. All the stored blood was returned to the patient through a filtering system (40 μm in the pore size) during surgery. However, we found paste-like agglutinates floating in the bags. We transfused the blood carefully while confirming that there were no agglutinates in the reservoir below the filter. The paste-like agglutinates were also found on the filter. By microscopic observation fibrin-like substances attached by blood cells were detected. When the autologous blood from pregnant women is returned, special care should be taken because the blood is likely to form agglutinates even though the blood test data are within normal ranges.

ベッドサイド活性酸素・フリーラジカル評価システムFRAS4の使用経験.　　　　　　　　　　　　　　　
加藤類, 小川彰子, 橋本聡一, 瀧田恒一, 森本裕二
臨床麻酔, 31, 897, 901, 2007年
日本語

神経因性疼痛に対する酢酸フレカイニドの鎮痛効果と血中濃度の関係
山﨑浩二郎, 武隈 洋, 志賀弘康, 菅原 満, 小澤剛久, 柴田万里子, 橋本聡一, 森本裕二
ＴＤＭ研究, 23, 4, 253, 256, 2006年10月, ［査読有り］
日本語, 研究論文（学術雑誌）

Motor cortex stimulation for post-stroke pain using neuronavigation and evoked potentials: Report of 3 cases
Masaki Ito, Satoshi Kuroda, Kazuya Takano, Katsuhiko Maruichi, Yasuhiro Chiba, Yuji Morimoto, Yoshinobu Iwasaki
NEUROLOGICAL SURGERY, 34, 9, 919, 924, IGAKU-SHOIN LTD, 2006年09月, ［査読有り］
日本語, 研究論文（学術雑誌）, Although motor cortex stimulation (MCS) has been accepted as an effective therapeutic option for central pain, the efficacy of MCS widely varies among previous reports. In this report, we describe our recent trial for successful MCS in 3 patients with central pain due to cerebral stroke. Medical treatments were transiently effective, but gradually became ineffective in all of the cases. During surgery, the appropriate cortical target was determined by using neuronavigation, somatosensory evoked potential (SEP), and motor evoked potential (MEP). A flat, four-plate electrode was positioned on the dura mater parallel to the motor cortex. After surgery, pain almost resolved in 2 of 3 patients and markedly improved in another. The pain relief depended on their motor function. These findings strongly suggest that both patient selection and intraoperative monitoring for targeting the motor cortex are quite important for successful MCS, although further studies were essential.

Electrophysiological and neurochemical characterization of the effect of repeated treatment with milnacipran on the rat serotonergic and noradrenergic systems
Kaori Tachibana, Machiko Matsumoto, Hiroyo Koseki, Hiroko Togashi, Taku Kojima, Yuji Morimoto, Mitsuhiro Yoshioka
JOURNAL OF PSYCHOPHARMACOLOGY, 20, 4, 562, 569, SAGE PUBLICATIONS LTD, 2006年07月, ［査読有り］
英語, 研究論文（学術雑誌）, The present study was undertaken to elucidate the effects of repeated treatment with milnacipran, a serotonin (5-HT) and noradrenaline (NA) reuptake inhibitor (SNRI), on the synaptic plasticity in the hippocampal CA1 field, focusing on the interaction between the serotonergic and noradrenergic system. Repeated treatment with milnacipran (30mg/kg, i.p. after 30 mg/kg, p.o. X 14 days) completely restored the suppression of the tong-term potentiation (LTP) induced by single milnacipran treatment (30mg/kg, i.p.). Single and repeated milnacipran increased to a similar extent extracellular NA in the hippocampus. Single milnacipran increased extracellular 5-HT and this effect tended to be enhanced by repeated treatment. The restoration of LTP and facilitation of the 5-HT level were not shown after repeated treatment with a selective 5-HT reuptake inhibitor (SSRI) fluvoxamine (30mg/kg, p.o. X 14 days). These results suggest that milnacipran-induced restoration of LTP suppression is responsible for the enhancement of 5-HT neurotransmission, whichappears to be associated with noradrenergic neuronal activity. In addition, the 5-HT1A receptor agonist tandospirone-induced suppression of LTP was completely blocked by repeated treatment with milnacipran, indicating the possibility that this reversal effect is due to the functional changes in postsynaptic 5-HT1A receptors. Taken together, the present data suggest that the interaction between the serotonergic and noradrenergic mechanism play an important rote in the modulation of synaptic plasticity caused by repeated treatment with milnacipran, which may be implicated in the therapeutic effects of SNRI on psychiatric disorders.

Life-saving detection of right hemothorax by transesophageal echocardiography after femorofemoral bypass
K Harasawa, T Maruyama, Y Morimoto
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 20, 2, 229, 231, W B SAUNDERS CO-ELSEVIER INC, 2006年04月, ［査読有り］
英語, 研究論文（学術雑誌）

Gastric intramucosal perfusion during descending aortic repair under femoro-femoral bypass
K Tachibana, K Hisano, F Sakuraya, SJ Tang, N Shiiya, T Hashimoto, K Takita, Y Morimoto
ASAIO JOURNAL, 52, 1, 92, 95, LIPPINCOTT WILLIAMS & WILKINS, 2006年01月, ［査読有り］
英語, 研究論文（学術雑誌）, The changes in gastric mucosal perfusion during distal aortic perfusion with femoro-femoral bypass (F-F bypass) were assessed by air-automated gastric tonometry. A prospective study was performed in six patients who underwent descending aortic surgery for aortic aneurysm under F-F bypass with mild hypothermia (34 degrees C). Gastric intramucosal pH (pHi) and PaCO2-PgCO(2) gap (PCO2 gap) were measured. Data are presented as means and standard deviations and analyzed by using one-way analysis of variance followed by Scheffe test. Perioperative variables of hepatorenal functions are also evaluated. The PCO2 gap significantly increased during F-F bypass (3.0 +/- 2.1 mm Hg at control, 14.2 +/- 5.5 mm Hg during F-F bypass; p = 0.004), indicating abnormal gastric mucosal perfusion during F-F bypass. Significantly low pHi was found at weaning from F-F bypass (7.35 +/- 0.05 at control, 7.21 +/- 0.10 at weaning; p = 0.009), which might be related to progressing systemic metabolic acidosis. No impairment of hepatorenal functions was observed after the surgery. Distal perfusion with F-F bypass during descending aortic surgery could impair the gastric mucosal perfusion, but may have little effect on postoperative visceral dysfunction.

Performance of a tonometer for arterial pressure measurement during anesthesia in the elderly
Katsumi Harasawa, Masahiro Yamane, Yuji Morimoto, Osamu Kemmotsu
Journal of Anesthesia, 18, 4, 316, 317, 4, 2004年11月, ［査読有り］
英語, 研究論文（学術雑誌）, We investigated performance of an arterial tonometer during anesthesia in the elderly. Thirty patients (17 men and 13 women), ranging from 70 to 86 years old, were included, and agreement between tonometric arterial pressure (TAP) and intraarterial pressure (IAP) was calculated. A total of 6487 paired points was sampled, and values for precision (mean absolute difference ± SD) were 6.8 ± 5.2 for systolic, 6.9 ± 4.6 for mean, and 9.2 ± 5.4 mmHg for diastolic blood pressures. Values for bias and limits of agreement [mean difference (TAP - IAP) ± SD, mean difference (TAP - IAP) ± 2 SD, respectively] for systolic, mean, and diastolic pressure were 1.2 ± 8.4 and 1.2 ± 16.8, 5.7 ± 5.9 and 5.7 ± 11.8, and 8.6 ± 6.2 and 8.6 ± 12.4 mmHg, respectively. Compared with previous data, aging is likely to affect the performance of an arterial tonometer. © JSA 2004.

Milnacipran, a serotonin and noradrenaline reuptake inhibitor, suppresses long-term potentiation in the rat hippocampal CA1 field via 5-HT1A receptors and alpha(1)-adrenoceptors
K Tachibana, M Matsumoto, H Togashi, T Kojima, Y Morimoto, O Kemmotsu, M Yoshioka
NEUROSCIENCE LETTERS, 357, 2, 91, 94, ELSEVIER SCI IRELAND LTD, 2004年03月, ［査読有り］
英語, 研究論文（学術雑誌）, Pharmacological characteristics of a serotonin (5-HT) and noradrenaline reuptake inhibitor (SNRI), milnacipran, in modulation of the synaptic plasticity were investigated. Milnacipran (30 mg/kg, i.p.) suppressed the long-term potentiation (LTP) in the hippocampal CA1 field of anesthetized rats. Milnacipran-induced suppression was reversed by pretreatment with the selective 5-HT1A receptor antagonist WAY 100635 (0.1 mg/kg, i.v.) or the alpha(1)-adrenoceptor antagonist prazosin (1 and 10 mug/rat, i.c.v.). The alpha(2)-adrenoceptor antagonist idazoxan (5 mg/kg, i.p.) did not influence the milnacipran-induced synaptic responses. These data suggest that the inhibitory effects of milnacipran on LTP induction are mediated via both 5-HT1A receptors and alpha(1)-adrenoceptors. In other words, functional interaction between the serotonergic and noradrenergic neuronal systems is involved in alteration of the hippocampal synaptic plasticity, which may be implicated in the SNRI-induced therapeutic effect on psychiatric disorders. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Successes and failures with the laryngeal mask airway (LMA) in patients with Treacher Collins syndrome - a case series
K Takita, S Kobayashi, M Kozu, Y Morimoto, O Kemmotsu
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 50, 9, 969, 970, CANADIAN ANESTHESIOLOGISTS SOC, 2003年11月, ［査読有り］
英語

The height-based formula for prediction of left-sided double-lumen tracheal tube depth
K Takita, Y Morimoto, O Kemmotsu
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 17, 3, 412, 413, W B SAUNDERS CO, 2003年06月, ［査読有り］
英語

当院における肺塞栓症の診断と治療
早川 峰司, 丸藤 哲, 佐藤 朝之, 久保 公三, 星野 弘勝, 亀上 隆, 森本 裕二, 松原 泉
日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine, 10, 2, 129, 130, 日本集中治療医学会, 2003年04月01日
日本語, 肺塞栓症(pulmonary embolism, PE)の治療については明確な指針はなく,PEの原因である深部静脈血栓症(deepvein thrombosis, DVT)に関しても,統一された見解は得られていない。さらに最近は,下大静脈フィルター(inferiorvena cava filter, Filter)や,経皮的血栓除去カテーテル の開発によりPE治療の選択の幅が広がってきた。今回,当施設におけるPEの診断と治療法を若干の文献的考察を加え報告する。

高度肺高血圧を伴った僧帽弁狭窄症妊婦の帝王切開の麻酔経験
久保田 信彦, 森本 裕二, 劔物 修
麻酔, 52, 2, 177, 179, 克誠堂出版, 2003年02月
日本語

The ED95 of end-tidal sevoflurane concentration for the smooth exchange of the tracheal tube for a laryngeal mask airway is 2.97%
K Takita, M Yamane, Y Morimoto, O Kemmotsu
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 50, 2, 184, 188, CANADIAN ANESTHESIOLOGISTS SOC, 2003年02月, ［査読有り］
英語, 研究論文（学術雑誌）, Purpose: Exchanging the tracheal tube for the laryngeal mask airway (the TT/LMA exchange) while the patient is still anesthetized avoids coughing associated with tracheal extubation. This study was conducted to determine the end-tidal concentration of sevoflurane that prevented response to this exchange in 50% patients (MAC(TT/LMA)).
Methods: We studied 21 adult male patients, ASA 1, aged 21-54 yr Anesthesia was induced with thiamylal and sevoflurane, and the trachea was intubated following vecuronium neuromuscular blockade. Anesthesia was maintained with sevoflurane and nitrous oxide in oxygen. After surgery, a predetermined end-tidal sevoflurane concentration was achieved and a steady state was maintained for at least 20 min. The concentration at which the TT/LMA exchange was attempted was determined by a modification of Dixon's up-and-down method with 0.25% as the step size. At the time of the TT/LMA exchange, no residual nitrous oxide > 3% was detected, and the return to normal neuromuscular function was confirmed. When the TT/LMA exchange was accomplished without coughing, movement, or airway obstruction, it was considered a smooth exchange.
Results: Sevoflurane MACTT/LMA determined using the up-and-down method was 2.63% +/- 0.14%. The 50% effective dose obtained using a probit analysis was similar [2.53% (95% confidence limits, 2,13-2.82%)].
Conclusion: Sevoflurane MAC(TT/LMA) in adult male patients was 2.63% (1.54 MAC) and may be useful for the smooth exchange of the tracheal tube for the LMA in a clinical setting.

Anesthetic management for cesarian section in a patient with mitral stenosis and severe pulmonary hypertension
Nobuhiko Kubota, Yuji Morimoto, Osamu Kemmotsu
Japanese Journal of Anesthesiology, 52, 2, 177, 179, 2, 2003年02月01日, ［査読有り］
日本語, 研究論文（学術雑誌）, Mitral stenosis is one of the complicating cardiac diseases during pregnancy. We experienced cesarean section in a patient with mitral stenosis and severe pulmonary hypertension (94/41 mmHg). During surgery, complete analgesia below T 4 level was obtained by epidural anesthesia with two catheters inserted at L 3-4 and T 11-12 interspaces. By epidural anesthesia, pulmonary arterial pressure decreased to 60/30 mmHg and other hemodynamic variables were stable. A baby (BW:1880g) was intubated because of tachypnea although Apgar scores were 6-8-8. The anesthetic course of the patient was uneventful.

血漿交換を用いず持続的血液濾過および新鮮凍結漿輸注で治療した劇症肝不全の3例
早川 峰司, 丸藤 哲, 星野 弘勝, 山崎 圭, 亀上 隆, 森本 裕二, 松原 泉
日本救急医学会雑誌, 14, 1, 16, 22, 日本救急医学会, 2003年01月15日
日本語, 劇症肝不全は,Treyらによって定められた急激な肝細胞壊死による重度の肝機能障害を起こし,発症から8週以内に肝性脳症や凝固障害を中心とする肝不全症状を認めるきわめて予後不良な疾患である。国内ではウイルス性肝炎を原因とするものが多いため,Treyらの基準をもとにした同様の診断基準(犬山シンポジウムの診断基準)で劇症肝炎と称されている。劇症肝不全に対しても肝移植が可能な現況ではあるが,その治療の中心は人工肝補助療法artificial liver support (ALS)を中心とした内科的治療である。また肝移植を行う場合で も,bridge useとしてALSは重要な位置を占めている。現在までに,血漿交換plasma exchange(以下PEと略す)や持続的血液濾過透析,血液吸着など様々な血液浄化法がALSとして報告されているが,その評価は定まっていない。しかし,国内では間欠的もしくは持続 的なPEがALSの中心として考えられており,重症肝障害の内科的治療においてPEは欠くことのできないものとされている。われわれは劇症肝不全の治療にPEは必須ではないとの立場より,中分子領域の物質の除去が可能な持続的血液濾過continuous hemofiltration (CHF)を中心とした治療を行い,PEを行うことなく意識を改善させた3症例について,若干の文献的考察を加えて報告し,P...

腎移植後にアザチオプリンが原因と思われる間質性肺炎を生じた1症例
早川 峰司, 丸藤 哲, 鹿野 恒, 山崎 圭, 佐藤 朝之, 亀上 隆, 森本 裕二, 松原 泉
日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine, 10, 1, 29, 32, 日本集中治療医学会, 2003年01月01日
日本語, 腎移植後の免疫抑制薬投与中のcornpromised hostに発生したアザチオプリン(azathioprine,AZ)によると考えられる間質性肺炎を経験した。患者は腎移植後であり,AZなどの免疫抑制薬を投与されていた。移植から9ヵ月経過した頃より,発熱と咳嗽が出現し,その1週間後に当院入院となった。胸部CTなどで軽度の間質性肺炎を認めた。日和見感染による間質性肺炎を疑い,各種感染症に対する治療も開始したが反応せず,入院から4週後に死亡した。AZの総投与量は15,750mgであった。剖検にて,肺は間質性肺炎の像を示していたが感染を示唆する所見はなかった。原因は確定できなかったが,AZが最も疑われた。AZの投与を受けている患者はcompromised hostであり,日和見感染による間質性肺炎にも注意が必要であるが,AZによる間質性肺炎も鑑別疾患の一つとして重要である。

Changes in cerebral oxygenation in children undergoing surgical repair of ventricular septal defects
Y Morimoto, Y Niida, K Hisano, Y Hua, O Kemmotsu, T Murashita, K Yasuda
ANAESTHESIA, 58, 1, 77, 83, BLACKWELL PUBLISHING LTD, 2003年01月
英語, 研究論文（学術雑誌）, There have been few published studies on changes in cerebral oxygenation during paediatric cardiac surgery as measured by conventional near-infrared spectroscopy. We studied changes in cerebral oxygenation in 16 children undergoing surgical repair of ventricular septal defects. Fifteen of the patients showed similar patterns of changes: brain tissue concentrations of oxyhaemoglobin decreased significantly during cardiopulmonary bypass, whereas there was no significant change in brain tissue concentrations of deoxyhaemoglobin. In the remaining patient, who suffered decreased blood flow to the lower body during surgery, the pattern of changes was different to that of the other subjects. This patient suffered postoperative respiratory and renal failure. This study suggests that conventional near-infrared spectroscopy may be useful for clinical monitoring during ventricular septal defect repair.

Changes in cerebral oxygenation and blood volume during tracheal intubation: Comparison between thiamylal and propofol.
MORIMOTO Yuji, KEMMOTSU Osamu, HISANO Kenjiro, HUA Yu, TANG Sijian, MORIMOTO Yoshiko
Circulatory Control, 24, 2, 124, 130, 2003年
英語

Effect of acidosis on apoptosis and necrosis induced by hypoxia in neuronal PC 12 cells.
Circulatory Control, 24, 1, 53, 57, 2003年

Effects of epinephrine and phosphodiesterase III inhibitors on bupivacaine-induced myocardial depression in guinea-pig papillary muscle
M Azuma, M Yamane, K Tachibana, Y Morimoto, O Kemmotsu
BRITISH JOURNAL OF ANAESTHESIA, 90, 1, 66, 71, OXFORD UNIV PRESS, 2003年01月, ［査読有り］
英語, 研究論文（学術雑誌）, Background. This study was designed to investigate the effects of epinephrine and the phosphodiesterase III inhibitors amrinone and milrinone on bupivacaine-induced myocardial depression in guinea-pig papillary muscles using an electrophysiological method.
Methods. Electrophysiological studies of the effects of bupivacaine, epinephrine, amrinone and milrinone in normal and high K+ Tyrode's solution were measured with guinea-pig papillary muscles. Specifically, epinephrine, amrinone and milrinone reversal of bupivacaine-induced depression was measured.
Results. Bupivacaine reduced the action potential duration (APD), the maximum rate of rise of the AP ((V) over dot(max)) and contractile force. Although epinephrine increased the contractile force similarly to amrinone and milrinone, it shortened the APD at 50% repolarization (APD(50)) and 90% repolarization (APD(90)). A high concentration of amrinone shortened APD, while milrinone did not affect APD except for a prolongation of APD(20). In high K+ Tyrode's solution (25 mM), epinephrine, amrinone and milrinone increased the APD and the contractile force. Epinephrine reversed bupivacaine depression of APD and contractile force to control levels. Amrinone and milrinone restored not only the contractile force but also APD. There was an incomplete recovery of APD(50) for amrinone and the prolongation of APD(20) for milrinone.
Conclusions. Our results suggest that bupivacaine decreases the Ca+ current (I-Ca) and Na+ current (I-Na). Epinephrine and amrinone may increase I-Ca and the delayed outward current (I-k), whereas milrinone may increase I-Ca. The profound cardiovascular depression caused by bupivacaine was effectively reversed by amrinone and milrinone in a manner similar to epinephrine.

The roles of nociceptin/orphanin FQ and nociceptin/orphanin FQ peptide (NOP) receptor in respiratory rhythm generation in the medulla oblongata： an in vitro study.
Takita K, Morimoto Y, Kemmotsu O
British Journal of Anaesthesia, 91, 385, 389, 2003年, ［査読有り］
英語, 研究論文（学術雑誌）

Imbalances between the levels of tissue factor and tissue factor pathway inhibitor in ARDS patients
S Gando, T Kameue, N Matsuda, M Hayakawa, Y Morimoto, T Ishitani, O Kemmotsu
THROMBOSIS RESEARCH, 109, 2-3, 119, 124, PERGAMON-ELSEVIER SCIENCE LTD, 2003年01月, ［査読有り］
英語, 研究論文（学術雑誌）, Introduction: To evaluate the pathogenetic role of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and neutrophil elastase in acute respiratory distress syndrome (ARDS), as well as to test the hypothesis that TFPI levels modified by neutrophil activation are not sufficient to prevent TF-dependent intravascular coagulation, leading to sustained systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), which determine the prognosis of these patients. Materials and methods: The study subjects consisted of 55 patients with trauma and sepsis who were divided into three groups according to the Lung Injury Score. Ten normal healthy volunteers served as control. Plasma levels of TF, TFPI, and neutrophil elastase were measured on the day of injury or the day of diagnosis of sepsis (day 0) and days 1 through 4. The number of SIRS criteria that the patient met and the disseminated intravascular coagulation (DIC) score is determined daily. Results: Patients (15) developed ARDS, 23 were at risk for but did not develop the syndrome, and 17 patients were without risk for ARDS. TF and neutrophil elastase levels in ARDS patients were persistently higher than those in other two groups and control subjects. However, the TFPI levels showed no difference among the three groups, which retained normal or slightly elevated levels compared to the control subjects. DIC scores did not improve and SIRS continued during the study period in patients with ARDS. The ARDS patients showed higher numbers of dysfunctioning organs and associated with poorer outcome than the other two groups. Conclusion: Systemic activation of the TF-dependent pathway not adequately balanced by TFPI is one of the aggravating factors of ARDS. High levels of neutrophil elastase released from activated neutrophils may explain the imbalance of TF and TFPI. Persistent DIC and sustained SIRS contribute to MODS, determining the prognosis of ARDS patients. (C) 2003 Elsevier Science Ltd. All rights reserved.

Satisfactory recovery of consciousness after prolonged cardiopulmonary resuscitation due to unexpected hemorrhage during a conduit ileum examination
Mariko Haga, Katsumi Harasawa, Yuji Morimoto, Osamu Kemmotsu
Journal of Anesthesia, 17, 3, 190, 192, 3, 2003年, ［査読有り］
英語, 研究論文（学術雑誌）

脊硬麻で管理した拡張型心筋症合併の帝王切開手術
久野 健二郎, 青木 剛太, 玉 花, 森本 裕二, 劔物 修
循環制御 = CIRCULATION CONTROL, 23, 4, 441, 444, 2002年12月20日
日本語

僧帽弁形成術のために使用したTEEプローブが原因と思われる術後反回および舌下神経麻痺をきたした一症例
橘 かおり, 久野 健二郎, 小林 繁明, 森本 裕二, 劔物 修
循環制御 = CIRCULATION CONTROL, 23, 4, 449, 451, 2002年12月20日
日本語

Combined activation of coagulation and inflammation has an important role in multiple organ dysfunction and poor outcome after severe trauma
S Gando, T Kameue, N Matsuda, M Hayakawa, T Ishitani, Y Morimoto, O Kemmotsu
THROMBOSIS AND HAEMOSTASIS, 88, 6, 943, 949, SCHATTAUER GMBH-VERLAG MEDIZIN NATURWISSENSCHAFTEN, 2002年12月, ［査読有り］
英語, 研究論文（学術雑誌）, We tested the hypothesis that activated neutrophil-endothelial cell interaction in DIC can cause endothelial injury contributing to multiple organ dysfunction syndrome (MODS) and a poor outcome after trauma. Fifty-eight severe trauma patients, 29 with DIC and 29 without DIC were studied. Serial levels of soluble L-, P-, and E-selectins, ICAM-1, VCAM-1, thrombomodulin, and neutrophil elastase were measured on days 0-4 after trauma. The numbers of systemic inflammatory response syndrome (SIRS) criteria that patients met were determined, simultaneously. In the DIC patients, higher DIC scores, lower platelet counts, and a longer duration of SIRS were found compared with the non-DIC patients. The incidence of ARDS and MODS were higher in patients with DIC than in those patients without DIC, and the DIC patients had poor outcome. Soluble L-selectin (sL-selectin) level on Day 1 in the DIC patients who died was markedly lower than those in the non-DIC patients. The levels of sP- and sE-selectins, sICAM-1, and sVCAM-1 were more elevated in the patients with DIC than in those without DIC on days 2 to 4. Neutrophil elastase and sThrombomodulin levels in the DIC patients persistently increased during the study period compared to those in the non-DIC patients. Maximum DIC scores in the DIC group showed good correlations with peak levels of sICAM-1, sVCAM-1, neutrophil elastase, sThrombomodulin, and the number of dysfunctioning organs. Highly activated and sustained inflammation caused by neutrophil-endothelium interaction in DIC gives rise to MODS and poor outcome in patients with severe trauma. These results suggest a close relationship between inflammation and thrombosis in posttrauma DIC.

Abdominal compartment syndrome and intrahepatic portal venous gas: a possible complication of endoscopy
M Hayakawa, S Gando, T Kameue, Y Morimoto, O Kemmotsu
INTENSIVE CARE MEDICINE, 28, 11, 1680, 1681, SPRINGER-VERLAG, 2002年11月, ［査読有り］
英語

Effects of mild and moderate hypothermia on apoptosis in neuronal PC12 cells
T Shibano, Y Morimoto, O Kemmotsu, H Shikama, K Hisano, Y Hua
BRITISH JOURNAL OF ANAESTHESIA, 89, 2, 301, 305, OXFORD UNIV PRESS, 2002年08月
英語, 研究論文（学術雑誌）, Background. There is still a possibility that mild hypothermic therapy may be useful as a neuroprotective tool during the intraoperative period, although the mechanism of cerebral protection by mild hypothermia is not well understood. We hypothesized that mild hypothermia may be protective against cerebral ischaemia by inhibiting post-ischaemia apoptosis. In this study, we used serum-deprived PC12 cells as the neuronal apoptotic model and examined the direct effects of mild and moderate hypothermia.
Methods. Apoptosis was induced by depriving the cell culture medium of serum, which is one of the most representative methods to induce apoptosis, but not necrosis, in PC12 cells. Effects of mild (35 and 33degreesC) and moderate (31 and 29degreesC) hypothermia on apoptosis were evaluated. Cytotoxicity (lactate dehydogenase leakage) and the percentage of apoptotic cells (calculated by flow cytometry with propidium iodide) were evaluated 4 days after induction of apoptosis. As a control, cells without induction of apoptosis were incubated under the same conditions as the apoptosis group.
Results. Without induction at 37degreesC, cytotoxicity and the percentage of apoptotic cells were over 60 and 90%, respectively. At each temperature examined below 35degreesC, significant decreases in cytotoxicity and the percentage of apoptotic cells were observed. Mean cytotoxicity at 31 and 29degreesC was 50.2 (sd 4.2)% and 47.9 (4.4)%, respectively. The percentage of apoptotic cells at 31 and 29degreesC was 42.5 (7.4)% and 36.5 (7.3)%, respectively. In the control group, cytotoxicity and the percentage of apoptotic cells were significantly higher at 29degreesC than at 37degreesC.
Conclusions. Mild and moderate hypothermia (29-35degreesC) inhibited apoptosis, although hypothermia below 30degreesC may induce apoptosis in intact cells.

Sevoflurane metabolite production in a small cohort of coronary artery bypass graft surgery patients
H Sakamoto, T Mayumi, Y Morimoto, O Kemmotsu, H Wakisaka, T Ohno
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 16, 4, 463, 467, W B SAUNDERS CO, 2002年08月, ［査読有り］
英語, 研究論文（学術雑誌）, Objective: To determine hepatic and renal effects of hexafluoroisopropanol in patients undergoing coronary artery bypass graft surgery under sevoflurane anesthesia.
Design: Prospective, clinical comparison.
Setting: University hospital.
Participants: Adult patients scheduled for coronary artery bypass graft surgery (n = 56) were divided into 3 groups according to renal function: group 1, patients with normal renal function (plasma creatinine <1.7 mg/dL), subdivided into 2 groups (group la and group 1b), and group 2, patients with impaired renal function (plasma creatinine greater than or equal to1.7 mg/dL).
Interventions: Anesthesia was maintained with fentanyl, 20 mug/kg, and sevoflurane. In group la and group 2, sevoflurane dosage was 0.5 minimum alveolar concentration (MAC). In group 1b, it was 1.0 MAC of sevoflurane. During cardiopulmonary bypass, the same concentration of sevoflurane was given through a membrane oxygenator.
Measurements and Main Results: Serum hexafluoroisopropanol concentration was measured before induction of anesthesia, at the initiation of cardiopulmonary bypass, at the release of the aortic cross-clamp, at the end of cardiopulmonary bypass, at the end of surgery, and on the 1st postoperative day. Blood urea nitrogen, creatinine, 24-hour urinary output, aspartate aminotransferase, alanine aminotransferase, and total bilirubin were measured at preoperative evaluation, at the end of surgery, and on the 1st and 3rd postoperative days. The levels of hexafluoroisopropanol increased and peaked on the 1st postoperative day. Laboratory values showed no significant differences among all groups.
Conclusion: The serum level of hexafluoroisopropanol after 0.5 MAC of sevoflurane anesthesia does not aggravate hepatic and renal functions. Copyright 2002, Elsevier Science (USA). All rights reserved.

Tissue factor production not balanced by tissue factor pathway inhibitor in sepsis promotes poor prognosis
S Gando, T Kameue, Y Morimoto, N Matsuda, M Hayakawa, O Kemmotsu
CRITICAL CARE MEDICINE, 30, 8, 1729, 1734, LIPPINCOTT WILLIAMS & WILKINS, 2002年08月, ［査読有り］
英語, 研究論文（学術雑誌）, Objective: To determine the precise relationship among tissue factor, tissue factor pathway inhibitor (TFPI), and neutrophil elastase in sepsis, as well as to test the hypothesis that low TFPI concentrations are not sufficient to prevent tissue factor-dependent intravascular coagulation, leading to multiple organ dysfunction syndrome and death.
Design: Prospective, cohort study.
Setting: General intensive care unit of tertiary care emergency department.
Patients: Thirty-one consecutive patients with sepsis, classified as 15 survivors and 16 nonsurvivors. Ten normal, healthy volunteers served as controls.
Interventions: None.
Measurements and Main Results: Tissue factor antigen concentration (tissue factor), TFPI, neutrophil elastase, and global variables of coagulation and fibrinolysis were measured on the day of diagnosis of sepsis, severe sepsis, and septic shock and days on 1-4 after diagnosis. The number of systemic inflammatory response syndrome criteria that patients met and the disseminated intravascular coagulation score were determined simultaneously. The results of these measurements were compared between the survivors and the nonsurvivors. In the nonsurvivors, significantly higher concentrations of tissue factor and neutrophil elastase were found compared with the survivors and control subjects. However, the TFPI values showed no difference between the two groups. No correlation was found between the peak concentrations of tissue factor and TFPI. Disseminated intravascular coagulation scores and numbers of the SIRS criteria met by the survivors significantly decreased from day 0 to day 4, but those of the nonsurvivors did not improve during the study period. The nonsurvivors showed thrombocytopenia and higher numbers of dysfunctioning organs than did the survivors.
Conclusions: We systematically elucidated the relationship between tissue factor and TFPI in patients with sepsis, severe sepsis, and septic shock. Activation of tissue factor-dependent coagulation pathway not adequately balanced by TFPI has important roles in sustaining DIC and systemic inflammatory response syndrome, and it contributes to multiple organ dysfunction syndrome and death. High concentrations of neutrophil elastase released from activated neutrophils may explain, in part, the imbalance of tissue factor and TFPI in sepsis.

Ventricular fibrillation after pseudo-Bartter's syndrome
M Hayakawa, S Sugimoto, Matsubara, I
ANNALS OF EMERGENCY MEDICINE, 39, 2, 205, 206, MOSBY, INC, 2002年02月, ［査読有り］
英語

生体肝移植患者における持続血液ろ過透析(CHDF)施行時のタクロリムス及びフルコナゾールの血中動態
越浪由加, 細井健, 武隈洋, 小林道也, 森本裕二, 丸藤哲, 古川裕之, 藤堂省, 宮崎勝巳
TDM研究, 19, 1, 39, 43, (一社)日本TDM学会, 2002年01月, ［査読有り］
日本語, 研究論文（学術雑誌）, 生体部分肝移植を受けタクロリムス(TAC)およびフルコナゾール(FCZ)を投与した患者4名(女3名・男1名,35〜55歳)について持続血液濾過透析(CHDF)に伴う薬物体内動態の影響について検討した.全血中TAC濃度はCHDF中止に伴う著しい上昇は認められなかった.一方,血漿中FCZ濃度はCHDF非施行患者では投与量依存的に変動したが,CHDF施行患者ではFCZ投与量を増量したにも拘わらず,血漿中濃度は著しく推移し最低有効血中濃度を維持することが難しいことが判明した.このことから,CHDF施行によりFCZ濃度が著しい影響を受けることが明らかになり,CHDF施行患者に対してFCZを適正に使用するためにはCHDF施行時の体内動態に基づいて投与を行うことが必要であることが示唆された

Systematic elucidation of effects of tranexamic acid on fibrinolysis and bleeding during and after cardiopulmonary bypass surgery
T Kojima, S Gando, Y Morimoto, H Mashio, Y Goda, H Kawahigashi, O Kemmotsu
THROMBOSIS RESEARCH, 104, 5, 301, 307, PERGAMON-ELSEVIER SCIENCE LTD, 2001年12月, ［査読有り］
英語, 研究論文（学術雑誌）, The aim of this study was to systematically elucidate the effects of tranexamic acid on fibrinolysis and bleeding during and after cardiopulmonary bypass (CPB) surgery. Twenty-two patients undergoing CPB surgery were randomized to receive 100 mg/kg tranexamic acid or an equal volume of saline after anesthesia induction and prior to skin incision. Plasma levels of tissue plasminogen activator (t-PA) antigen and activity, crosslinked fibrin degradation products (D-dimer), alpha2-antiplasmin-plasmin complex, and plasminogen activator inhibitor-1 (PAI-1) antigen were measured. Blood samples were obtained after induction of anesthesia, before, during, and after CPB, at the end of surgery, and the next morning after surgery. Intraoperative and postoperative blood loss during 24 h after surgery was recorded. Patients' demographics were similar between the two groups. No patients suffered from thrombotic complications after surgery. In the tranexamic acid group, fibrinolytic activity and secondary fibrinolysis as measured by t-PA activity and D-dimer were markedly suppressed during CPB surgery (P=.042 and P=.015, respectively). Decreased fibrinolytic activity and fibrinolysis were accompanied by reduction of perioperative bleeding in the tranexamic acid group. We could also find a good positive correlation between the peak levels of t-PA activity and D-dimer (r(2) =.4203, P=.0011). No differences in the t-PA antigen, PAI-1 antigen release, and plasmin inhibition by alpha2-antiplasmin were apparent between the two groups. In a randomized, prospective trial of patients undergoing CPB surgery, we demonstrated that the synthetic antifibrinolytic drug tranexamic acid effectively suppresses fibrinolysis by inhibiting t-PA and plasmin activity with clear reduction of perioperative blood loss. While tranexamic acid had no effects on the other important fibrinolytic inhibitors like PAI-1 and alpha2-antiplasmin. (C) 2001 Elsevier Science Ltd. All rights reserved.

甲状腺機能亢進症治療中のhungry bone syndrome と症候性精神病および心停止
早川 峰司, 丸藤 哲, 森本 裕二, 野崎 浩司, 中村 宏治, 古根 高, 松原 泉
日本救急医学会雑誌, 12, 7, 372, 376, 日本救急医学会, 2001年07月15日
日本語, 甲状腺機能亢進症に対する抗甲状腺薬の投与は標準的な治療である。代表的な抗甲状腺薬であるプロピルチオウラシル(以下PTUと略す)は,無顆粒球症に代表される様々な副作用を呈しう る。 しかし, 本薬物による甲状腺機能の急激な抑制により出現する様々な症状について,多くは知られていない 。 今回,甲状腺機能亢進症に対してPTUを投与中に複雑な病態を呈し,診断に苦慮した症例を経験したので報告する。

Macrophage migration inhibitory factor is a critical mediator of systemic inflammatory response syndrome
S Gando, J Nishihira, S Kobayashi, Y Morimoto, S Nanzaki, O Kemmotsu
INTENSIVE CARE MEDICINE, 27, 7, 1187, 1193, SPRINGER-VERLAG, 2001年07月, ［査読有り］
英語, 研究論文（学術雑誌）, Objective: To determine the relations between macrophage migration inhibitory factor (MIF), tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and cortisol in patients with systemic inflammatory response syndrome (SIRS) and to determine whether their levels correlate with patient survival.
Design: Prospective, observational, cohort study.
Setting: General intensive care unit in a university hospital.
Patients and participants: The study included 17 consecutive patients who met the criteria for SIRS; the patients were classified into subgroups, survivors (n = 8) and nonsurvivors (n = 9); eight healthy volunteers served as control subjects.
Interventions: None.
Measurements and results: Serum MIF, TNF-alpha, IFN-gamma, and cortisol levels were measured serially when the patients were first identified as having SIRS (day 0), and on days 1-4. Except for the high tendency of acute respiratory distress syndrome in nonsurvivors (44%) compared to survivors (13%), there were no differences in the clinical backgrounds of the patients between the two groups. All patients had multiple organ dysfunction syndrome. The values of MIF and TNF-alpha in the nonsurvivors were significantly more elevated than those cytokines measured in the survivors and control subjects. Peak MIF levels significantly correlated with peak TNF-alpha levels (r(2) = 0.448, P = 0.002), but did not correlate with peak levels of cortisol and IFN-gamma. Although the levels of IFN-gamma and cortisol showed a marked increase compared to those of the control subjects, we could not find differences in these variables between the survivors and the nonsurvivors.
Conclusions: High MIF and TNF-alpha levels are closely linked with poor outcome in patients with SIRS. MIF and TNF-alpha may act together and have pathogenic roles in SIRS.

Postoperative myocardial ischemia in thoracic aortic aneurysms
S Sasaki, K Yasuda, S Nanzaki, S Kobayashi, Y Morimoto, S Gando, O Kemmotsu
JOURNAL OF CARDIOVASCULAR SURGERY, 42, 3, 333, 338, EDIZIONI MINERVA MEDICA, 2001年06月, ［査読有り］
英語, 研究論文（学術雑誌）, Background. To determine the incidence and predictors of postoperative myocardial ischemia in non-coronary risk patients undergoing surgery for thoracic aortic aneurysms.
Methods. Design: a prospective, observational study. Setting: a general intensive care unit in a university hospital. Participants: twenty patients without ischemic heart disease, scheduled for elective surgical repair of thoracic or thoracoabdominal aortic aneurysms. Interventions: all patients underwent aortic replacement with prosthetic graft and routine postoperative care. Patients who developed myocardial ischemia received an infusion of coronary vasodilators.
Results. ECG episodes of myocardial ischemia were defined as reversible ST-segment changes of either >1 min of depression or >2 min of elevation at the J point. All patients survived operation. Eleven patients (ischemia group) developed myocardial ischemia, and 9 patients did not (non-ischemia group). These episodes were transient in 8 cases, but lasted longer than 3 days in 3 cases. In univariate analysis of perioperative factors between the two groups, the use of total cardiopulmonary bypass (p<0.01), the cardiac index at ICU admission (P<0.05), and the incidence of preexistent hypertension (P<0.05) were significantly different. Multiple regression analysis identified the use of total cardiopulmonary bypass as the only predictor of myocardial ischemia.
Conclusions. The use of total cardiopulmonary bypass is predictive of perioperative myocardial ischemia in surgery for thoracic aortic aneurysms, probably due to the production of proinflammatory cytokines by systemic ischemia and reperfusion. Prophylactic use of coronary vasodilators may be validated in these cases.

常用量のジスチグミンによるコリン作動性クリーゼ
早川 峰司, 丸藤 哲, 森本 裕二, 武山 佳洋, 中村 宏治, 古根 高, 松原 泉
日本救急医学会雑誌, 12, 5, 256, 260, 日本救急医学会, 2001年05月15日
日本語, 排尿困難に対して、コリンエステラーゼ阻害薬であるジスチグミンが古くから用いられている。今回、常用量のジスチグミンを4回内服したのみで、コリン作動性クリーゼからショック状態に陥った症例を経験したので、若干の文献的考察を加えて報告する。Distigmine bromide is an anticholinesterase used to treat urinary retention. We describe a case of life-threateningcholinergic crisis induced by a usual oral dose of distigmine bromide for postoperative urinary retention.An 82-year-old man with mild chronic renal failure was transferred to our emergency room due to cholinergiccrisis accompanied by cyanosis, hypotension, and consciousness disturbance. The patient was 10mg/day of distigminebromide orally administered for 2 days....

集中治療室入室予定手術患者に対する集中治療専属医からのインフォームド ・ コンセントの有用性
森本 裕二, 青山 真樹, 佐々木 重幸, 丸藤 哲, 劔物 修
日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine, 8, 2, 135, 136, The Japanese Society of Intensive Care Medicine, 2001年04月01日
日本語

生体肝移植患者における持続血液濾過透析(CHDF)施行時のタクロリムス及び抗真菌剤の血中動態
越浪 由加, 須田 範行, 武隈 洋, 小林 道也, 岸野 吏志, 森本 裕二, 丸藤 哲, 古川 裕之, 藤堂 省, 宮崎 勝巳
TDM研究, 18, 2, 169, 170, (一社)日本TDM学会, 2001年04月
日本語

小児小切開開心術を対象とした手術室での抜管の試み
新井田 周宏, 原澤 克巳, 橋本 聡一, 森本 裕二, 劔物 修
循環制御 = CIRCULATION CONTROL, 22, 1, 26, 28, 2001年03月30日
日本語

冠動脈血行再建術中に生じた無症候性大動脈解離の診断に経食道心エコー法が有用であった1症例
橘 かおり, 神田 知枝, 原澤 克巳, 森本 裕二, 劔物 修
循環制御 = CIRCULATION CONTROL, 22, 1, 29, 31, 2001年03月30日
日本語

呼吸困難で発症した遅発性ボクダレックヘルニア
早川 峰司, 丸藤 哲, 森本 裕二, 武山 佳洋, 中村 宏治, 古根 高, 松原 泉
日本救急医学会雑誌, 12, 2, 63, 66, 日本救急医学会, 2001年02月15日
日本語, Late-onset Bochdalek's hernia is rare enough to be frequently diagnosed incorrectly. We present a case of lateonset Bochdalek's hernia associated with severe dyspnea and cyanosis. A 14-month-old female infant was admitted to our emergency clinic due to severe dyspnea and cyanosis. A chest radiogram and computed tomographic (CT) scan revealed a gastrointestinal shadow in the left thorax, necessitating emergency surgery that confirmed Bochdalek's hernia. Although left lung dysplasia was observed, we found no other malformation. A few days later, the endotracheal tube was extubated and the pat...

Tissue factor pathway inhibitor response does not correlate with tissue factor-induced disseminated intravascular coagulation and multiple organ dysfunction syndrome in trauma patients
S Gando, S Nanzaki, Y Morimoto, T Ishitani, O Kemmotsu
CRITICAL CARE MEDICINE, 29, 2, 262, 266, LIPPINCOTT WILLIAMS & WILKINS, 2001年02月, ［査読有り］
英語, 研究論文（学術雑誌）, Objective: To determine the precise relationship between tissue factor and tissue factor pathway inhibitor (TFPI) after trauma, as well as to test the hypothesis that low TFPI levels are not sufficient to prevent tissue factor-dependent intravascular coagulation, leading to multiple organ dysfunction syndrome (MODS).
Design: Prospective, observational cohort study.
Setting: Emergency room and intensive care unit in a university hospital.
Patients: Thirty-three trauma patients, 18 with disseminated intravascular coagulation (DIG) and 15 without DIG were studied. Ten normal, healthy volunteers served as control subjects.
Interventions: None.
Measurements and Main Results: Antigen concentration of tissue factor and TFPI, and global parameters of coagulation and fibrinolysis:were measured on the day of admission, and on days 1-4 after admission. The number of systemic inflammatory response syndrome (SIRS) criteria that patients met and the DIG score were determined, simultaneously. The results of these measurements, incidence of MODS, and outcome were compared between the DIG patients and those without Die. In the Die patients, significantly higher tissue factor levels (p = .0049) and lower platelet counts (p = .0016) were found compared with the non-DIG patients and control subjects. However, the TFPI values remained at normal levels during the study period. No correlation was found between the peak levels of tissue factor and TFPI. The mean duration of SIRS and the maximum number of the SIRS criteria being met by the patients in the Die group were statistically longer and higher than those in the non-DIG patients. The incidence of MODS and the number of the dysfunctioning organs were higher in the Die patients compared with those in the non-Die patients, and the DIG patients had a poor outcome.
Conclusions: We systematically elucidated the relationship between tissue factor and TFPI in post-trauma patients. Highly activated tissue factor-dependent coagulation pathway is not sufficiently prevented by the normal TFPI levels in patients with DIG. The DIG associated with thrombotic and inflammatory responses causes MODS, and leads to poor outcome in post-trauma patients.

Significance of systemic inflammatory response syndrome after hepatectomy.　　　　　　　　　　　　　　　
Circulatory Control, 22, 215, 219, 2001年

Do all patients with mandibular hypoplasia present difficulty in endotracheal intubation?
K. Takita, T. Minamimoto, Y. Morimoto, O. Kemmotsu
Japanese Journal of Anesthesiology, 50, 4, 387, 389, 2001年, ［査読有り］
日本語, 研究論文（学術雑誌）, On 7 patients with Pierre-Robin syndrome (PR), 8 patients with first and second brachial arch syndrome (BA) and 7 patients with Treacher Collins syndrome (TC), we examined retrospectively the number of patients whom anesthesiologists found difficult to perform laryngoscopy and intubation, the number of attempt necessary for proper insertion of the tracheal tube, the number of patients in whom the endotracheal intubation with laryngoscopy was given up and the rime necessary for endotracheal intubation. We compared these with those from 22 control patients. Our results suggest that the difficult laryngoscopy and intubation are more frequent in TC. On the other hand, most of PR and BA may not present difficulty in intubation.

Pathological evaluation of venous emboli during total hip arthroplasty
M. Hayakawa, Y. Fujioka, Y. Morimoto, A. Okamura, O. Kemmotsu
Anaesthesia, 56, 6, 571, 575, 2001年, ［査読有り］
英語, 研究論文（学術雑誌）, One of the possible causes of bone cement implantation syndrome during total hip arthroplasty is pulmonary embolism, as has been suggested by a characteristic image seen during transoesophageal echocardiography, the so-called 'Snow Flurry'. However, the nature of the embolic material has not been definitively determined. We studied seven patients undergoing cemented or uncemented total hip arthroplasty. 'Snow Flurry' images were detected in all patients. Blood was aspirated from the right atrium during 'Snow Flurries' and was subjected to pathological examination. Amorphous, eosinophilic, fine granular material was seen in all specimens. The material did not originate from cement. Fat and bone marrow were not detected. The material seen may consist of fine particles of bone ('bone dust') originating from reamed bone.

Systemic macrophage migration inhibitory factor release following hepatic resection
S Gando, J Nishihira, S Kobayashi, Y Morimoto, M Matsushita, O Kemmotsu
SURGERY TODAY, 31, 7, 605, 609, SPRINGER-VERLAG, 2001年, ［査読有り］
英語, 研究論文（学術雑誌）, We set out to determine the responses of macrophage migration inhibitory factor (MIF) to hepatic resection and investigate its role in predicting short-term postoperative morbidity and outcome. Blood samples from 29 patients undergoing hepatic resection and eight healthy volunteers were obtained serially for 24h and assayed for serum MIF, cortisol, and tumor necrosis factor (TNF)-alpha. The MIF and cortisol levels showed a parallel increase and their peak levels were significantly correlated (r(2) = 0.33, P = 0.0011). The TNF-alpha levels also increased during and after hepatic resection, but did not correlate with the MIF levels. The patients were classified into an extended hepatectomy group (n = 9); a lobectomy/segmentectomy group (n = 12); and a subsegmentectomy group (n = 8). There were no differences in the time courses of MIF (P = 0.8699), cortisol (P = 0.7485), and TNF-alpha (P = 0.3819) among the three groups. No patients developed organ dysfunction and all were discharged from the intensive care unit without any complications. Our findings demonstrate that MIF production occurs in patients undergoing hepatic resection. Surgical stress may play a more important role in MIF secretion than inflammatory stimulus by TNF-alpha in these patients. Therefore, MIF minimally affects short-term postoperative morbidity and outcome.

Serial measurement of arterial lactate concentrations as a prognostic indicator in relation to the incidence of disseminated intravascular coagulation in patients with systemic inflammatory response syndrome
S Kobayashi, S Gando, Y Morimoto, S Nanzaki, O Kemmotsu
SURGERY TODAY, 31, 10, 853, 859, SPRINGER-VERLAG, 2001年, ［査読有り］
英語, 研究論文（学術雑誌）, To demonstrate the prognostic value of measuring blood lactate concentrations and to investigate the mechanisms of lactate production in patients with systemic inflammatory response syndrome (SIRS), we conducted a prospective cohort study. Among 22 patients with SIRS, there were 9 survivors and 13 nonsurvivors. Serial arterial lactate concentrations were measured on the day of admission to the intensive care unit (day 0), then on days 1-4. The subjects of this study consisted of 14 patients with SIRS, 6 with severe sepsis, and 2 with septic shock. On admission, the lactate concentrations did not differ between the two groups, but remained high in the nonsurvivors throughout the study period, while they progressively decreased in the survivors. The incidence of disseminated intravascular coagulation (DIC) was significantly higher in the nonsurvivors than in the survivors. The nonsurvivors had persistently higher DIC scores and lower platelet counts than the survivors. The changes in lactate concentration over time were statistically different between the patients with DIC and those without DIC. The findings of this study clearly demonstrated that serial arterial lactate measurements can predict a poor outcome in patients with SIRS, severe sepsis, or septic shock. DIC might play an important role in the pathogenesis of lactate production in these newly defined critically ill patients.

Predictors of mortality in patients treated with continuous hemodiafiltration for acute renal failure in an intensive care setting
S Sasaki, S Gando, S Kobayashi, S Nanzaki, T Ushitani, Y Morimoto, O Demmotsu
ASAIO JOURNAL, 47, 1, 86, 91, LIPPINCOTT WILLIAMS & WILKINS, 2001年01月, ［査読有り］
英語, 研究論文（学術雑誌）, We performed this study to identify predictors of mortality in critically ill patients treated with continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure in an intensive care setting. It was an uncontrolled, observational study that took place in a general intensive care unit in a university hospital. Forty-one patients undergoing CVVHDF for acute renal failure in a consecutive sample of 1,018 ICU treatments were studied. The underlying disease included 25 postsurgical cases and 16 medical cases. Between survivors (n = 23) and nonsurvivors (n = 18), the following factors were assessed: demographic data; the number and type of failed organs; Acute Physiology and Chronic Health Evaluation (APACHE) II scores; urine production; pH; base excess; serum creatinine levels; bilirubin levels; lactate levels; platelet counts; and hemodynamic variables, including cardiac index and central venous pressure. On univariate analyses, the number of failed organs (p < 0.01), presence of hepatic failure (p < 0.01), APACHE II scores (p < 0.01), pH (p < 0.01), base excess (p < 0.001), average urinary production before the initiation of CVVHDF (p < 0.05), and serum bilirubin (p < 0.01) and lactate levels (p < 0.001) were significantly different. Multiple regression analysis identified serum bilirubin (p < 0.01) and lactate levels (p < 0.01) as the predictors of hospital mortality. Presence of hepatic failure was also predictive of hospital mortality (p < 0.01) in the analysis of the type of organ failure. The cut-off value set at bilirubin levels > 10 mg/dl or arterial lactate levels > 3.5 mmol/L provided 83.3% sensitivity and 90.9% specificity in the prediction of hospital death. The crucial factors in predicting outcome of critically ill patients undergoing CVVHDF for renal failure are elevated serum bilirubin and lactate levels at the onset of CVVHDF. Presence of hepatic failure, defined as both jaundice and coagulopathy, may also worsen outcome of critically ill patients undergoing CVVHDF for renal failure. The cut-off value set at bilirubin levels > 10 mg/dl or arterial lactate levels > 3.5 mmol/L may serve as beneficial predictors of hospital mortality.

下顎低形成を伴う顔面先天異常患者は挿管困難の頻度が高いか．
瀧田恒一, 南本俊之, 森本裕二, 劔物修
麻酔, 50, 4, 387, 389, 2001年
日本語

Do age-based formulae predict the appropriate endotracheal tube sizes in Japanese children?
Takita K, Morimoto Y, Okamura A, Kemmotsu O
Journal of Aneshtesia, 15, 3, 145, 148, 2001年, ［査読有り］
英語, 研究論文（学術雑誌）

Increased sensitivity to vecuronium and prolonged duration of its action in patients with end-stage renal failure.
Sakamoto H, Takita K, Kemmotsu O, Morimoto Y, Mayumi T
Journal of Clinical Anesthesia, 13, 193, 197, 2001年, ［査読有り］
英語, 研究論文（学術雑誌）

Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation.
Takita K, Morimoto Y, Kemmotsu O
Canadian Journal of Anesthesia, 48, 732, 736, 2001年, ［査読有り］
英語, 研究論文（学術雑誌）

ハーモニックスカルペル®による気管内チューブ損傷
早川 峰司, 森本 裕二, 劔物 修
麻酔, 49, 11, 1261, 1262, 2000年11月
日本語, 超音波駆動メス(Harmonic Scalpel®, 以下HS, Johnson & Johnson Medical社, 東京)を用いた扁桃摘出術中に気管チューブの損傷を来し, 著しいカフ漏れを起こした症例を経験したので報告する.

経皮的腎砕石術による水中毒
早川 峰司, 森本 裕二, 劔物 修
臨床麻酔, 24, 9, 1521, 1522, 真興交易, 2000年09月
日本語, A 61–year-old man underwent percutaneous nephrolithotripsy (PNL) for renal stone under general anesthesia. At fist, physiologic saline was used as irrigation fluid. This was changed to 3% sorbitol by an order of the urologist because the surgery would be prolonged. Total of 6L of physiologic saline and 15L of 3% sorbitol were used as irrigation fluid. After the surgery, the patient complained of nausea and severe hypotension was observed. Laboratory data showed severe anemia and hyponatremia indicating intraoperative bl...

再拡張性肺水腫を合併した緊急帝王切開の周術期管理
早川 峰司, 森本 裕二, 劔物 修
麻酔, 49, 9, 1015, 1017, 克誠堂出版, 2000年09月
日本語, 妊娠後期に発見された大量胸水貯留に対しドレナージを施行後，再拡張性肺水腫を来し，さらに胎児心音の低下を認めたため緊急帝王切開となった症例を経験したので，報告する。

Phosphodiesterase III inhibitor olprinone chlorate is not significantly removed by continuous venovenous hemodiafiltration
H Amenomori, S Sasaki, K Hiraoka, Y Morimoto, S Gando, O Kemmotsu
ASAIO JOURNAL, 46, 5, 635, 638, LIPPINCOTT WILLIAMS & WILKINS, 2000年09月, ［査読有り］
英語, 研究論文（学術雑誌）, The study objective was to determine whether a phosphodiesterase III inhibitor, olprinone chlorate, is effectively removed by continuous venovenous hemodiafiltration (CV-VHDF) in a patient with cardiac and renal failure. The patient was a 73 year old man who had undergone coronary artery bypass grafting for ischemic heart disease and who developed cardiac and renal failure postoperatively. A 0.2 mu g/kg per minute dosage of olprinone chlorate was administered intravenously for 120 minutes white the patient was treated with CVVHDF. Samples from the arterial and venous blood catheters and those from the ultradiafiltrate for 12 hours were collected to calculate pharmacokinetic parameters and clearance of hemodiafiltration. The calculated parameters were as follows: half-life of elimination phase: 4.96 hours; total clearance 3.40 ml/min per kg. The clearance of CVVHDF was 0.33 ml/min per kg. The olprinone chlorate clearance of CVVHDF approximates only 10% of total clearance in this case. CVVHDF may not produce significant reduction in the serum olprinone chlorate level. It is recommended that the infusion dosage of olprinone chlorate should be reduced when given to patients with renal failure even if treated with CVVHDF.

直列式一回注入量3.0mlディスポーザブルPCA装置を用いた硬膜外鎮痛
掛端 仁, 渋谷 真希子, 横田 祥, 瀧川 千鶴子, 辻永 宏文, 蔦原 祥, 森本 裕二, 劔物 修
麻酔, 49, 8, 851, 856, 克誠堂出版(株), 2000年08月
日本語, 婦人科の手術患者22名を対象とし,ディスポーザブル注入ポンプ(2.1ml・h-1)を使用して,持続硬膜外投与を行った持続群と,同ポンプに一回注入量3.0mlのディスポーザブルpatient-controlled analgesia(PCA)装置を接続し,patient-controlled epidural analgesia(PCEA)を行ったPCEA群の2群に分け,使用したPCA装置の有用性について検討した.安静時痛,体動時痛共に,視覚アナログ尺度(VAS)には両群間で有意差はなかった.しかし,PCEAの使用前後では,VASは6.8±1.6から1.0±1.3へと低下し,有意な鎮痛効果が認められた.これは,硬膜外腔で鎮痛に必要な薬液の広がりがあり,鎮痛効果が得られたことによるものと考えられた.副作用では,悪心・嘔吐が約半数の症例でみられたが,呼吸抑制等の重篤なものはなかった

パテントブルーによる偽性メトヘモグロビン血症
早川 峰司, 森本 裕二, 劔物 修
麻酔, 49, 7, 774, 776, 2000年07月
日本語, パテントブルーとニトログリセリンの同時使用下において，パルスオキシメ一群と血液ガス分析の異常値の評価に混乱を来し，メトヘモグロビン血症と誤判断した症例を経験した。

Patent blue-induced false-methemoglobinemia
Mineji Hayakawa, Yuji Morimoto, Osamu Kemmotsu
Japanese Journal of Anesthesiology, 49, 7, 774, 776, 2000年07月, ［査読有り］
日本語, 研究論文（学術雑誌）, We experienced an anesthetic case, in which interference in oxygen saturation values by patent blue was mistaken for nitroglycerin-induced methemoglobinemia. A 40-year-old woman underwent mastectomy for breast cancer under general anesthesia. Nitroglycerin was infused to produse hypotensive anesthesia. Patent blue was locally injected around the cancer by a surgeon and surgery was started. A few minutes later, oxygen saturation by finger pulse oximeter suddenly decreased from 100% to 90%. And then, blood gas analysis was performed to confirm this change. The decrease of oxygen saturation and the increase of methemoglobin were also observed in the finding of blood gas analysis. At first, we judged these changes as methemoglobinemia by nitroglycerin infusion. Finally, however, we concluded that all these changes were attributable to the interference by patent blue on oxygen saturation value because we found that there had been some inconsistent findings as methemoglobinemia. The fact seems that nothing happened to the patient during the episode. This case showed us that anesthesiologists should understand the principle of hematological monitors and the meaning of the data obtained by monitors.

心刺創に対する経食道心エコー図の有用性
早川 峰司, 岡村 篤, 松田 直之, 森本 裕二, 劔物 修
循環制御 = CIRCULATION CONTROL, 21, 2, 205, 208, 日本循環制御医学会, 2000年06月30日
日本語, 交通事故や自殺の増加，暴力事件の過激化などにより，胸部外傷の頻度は増加している．救急医療の現場で，これらの症例に遭遇する機会も増えていると思われる．この様な状況の中で，胸部外傷患者に対する診断と治療には種々の手段がある．今回，心臓に達していることが考えられる胸部刺創において，経食道心エコー図（以下TEE）が有用であった症例を経験したので報告する．

Hypercapnea after minitracheotomy
Naoyuki Matsuda, Takashi Nakamura, Yuji Morimoto, Osamu Kemmotsu
Japanese Journal of Anesthesiology, 49, 4, 428, 431, 2000年04月, ［査読有り］
日本語, 研究論文（学術雑誌）, Minitracheotomy is a useful procedure for the respiratory management of patients with sputum retention observed frequently in chronic lung disease and postoperative respiratory failure. However, we experienced a case of hypercapnea after minitracheotomy. An 83-year-old woman was scheduled for gastrectomy. She had respiratory failure of Hugh-Jones 5 with fibroid lungs and the infection with atypical Mycobacterium and MRSA. Her sputum was adhesive and showed persistent increase during pre- and intra-operative periods. After the operation, minitracheotomy was carried out against the sputum retention by using Portex Mini-Trach II kit. Hypercapnea, however, was observed in spite of no evidence of the surgical complications such as bleeding or inadequate care for sputum from the inserted tube. Bronchofiberscope revealed adhesive sputum stuck to the space between the inserted tube and the trachea. In this case, hypercapnea was improved by opening the top of the inserted tube and frequent care for sputum. In cases with a large amount of adhesive sputum, sputum retention may easily occur not only at the peripheral bronchial branch but also between the inserted tube and the trachea and it can cause hypercapnea which may be overlooked.

硬麻併用全麻の覚醒および抜管の循環動態 : 気管チューブとラリンジアルマスクの比較
清水 泰行, 野 繁雄, 森本 裕二, 四釜 裕睦, 石川 岳彦, 劔物 修
循環制御 = CIRCULATION CONTROL, 21, 1, 28, 31, 2000年03月31日
日本語

片肺換気において麻酔薬がPao_2に与える影響 : プロポフォールとイソフルランの比較
小村 好弘, 加藤 学, 森本 佳子, 森本 裕二, 劒持 修
日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia, 20, 2, 97, 100, 2000年03月15日
日本語

後咽頭間隙血腫による遅発性上気道閉塞
早川 峰司, 丸藤 哲, 森本 裕二, 劔物 修
日本救急医学会雑誌, 11, 3, 129, 133, 日本救急医学会, 2000年03月10日
日本語, 後咽頭間隙血腫の報告はきわめてまれであり,国内においては数例の報告をみるに過ぎない。しかし,後咽頭間隙の解剖学的特徴から,同部位への血腫形成は気道を圧迫し呼吸困難や呼吸停止を来す可能性があるため的確な対応が必要な救急疾患のひとつである。今回,頭頸部の軽微な外傷により遅発性の後咽頭間隙血腫を来し,呼吸困難に陥った症例を経験したので文献的考察を加えて報告する。

Perioperative management for emergency cesarean section of a patient with reexpansion pulmonary edema
M. Hayakawa, Y. Morimoto, O. Kemmotsu
Japanese Journal of Anesthesiology, 49, 9, 1015, 1017, 2000年, ［査読有り］
日本語, 研究論文（学術雑誌）, A 27-year-old woman with 39 week gestation was admitted because of cough and dyspnea accompanied by massive right-sided pleural effusion. Following the right thoracocentesis, about 2000 ml of bloody pleural effusion was drained. Just after the thoracocentesis, the fetal heart rate (FHR) temporarily showed a variable deceleration pattern but the rate was restored spontaneously. One hour later, cough and dyspnea became worse. Changes in FHR pattern indicated the premature separation of the normally implanted placenta. Accordingly, an emergency cesarean section was performed under general anesthesia. Massive foamy tracheal secretion was drained from the tracheal tube during surgery. As her chest X-ray showed signs of pulmonary edema in the right lung, her status was diagnosed as reexpansion pulmonary edema (RPE). She was transferred to the intensive care unit and treated with mechanical ventilation, prednisolone and diuretics. Extubation was performed on the 2nd day after the surgery. On reexpansion of the collapsed lung, it is always necessary to con. sider not only the hemodynamic changes just after reexpansion but also RPE following reexpansion.

Tracheal tube damage by harmonic scalpel® during tonsillectomy
M. Hayakawa, Y. Morimoto, O. Kemmotsu
Japanese Journal of Anesthesiology, 49, 11, 1261, 1262, 2000年, ［査読有り］
日本語, 研究論文（学術雑誌）, We experienced a case in which a tracheal tube was damaged by a Harmonic Scalpel® during tonsillectomy, A 33-year-old man with chronic tonsillitis underwent tonsillectomy under general anesthesia. The trachea was intubated by Polar Preformed Tracheal Tube® (Polar tube). About 45 minutes after the start of surgery, sudden massive air leakage in the trachea occurred, Surgery was accomplished under oral suctioning. After extubation, we found that an inflation cuff tube was cut off by the Harmonic Scalpel®. The cause of damage was the position of an inflation cuff tube which had been in the dorsal side of the tracheal tube (near the surgical field) in the Polar tube. Anesthesiologists should be aware of the characteristics of the surgical equipment newly introduced.

Out-of-hospital cardiac arrest increases soluble vascular endothelial adhesion molecules and neutrophil elastase associated with endothelial injury
S Gando, S Nanzaki, Y Morimoto, S Kobayashi, O Kemmotsu
INTENSIVE CARE MEDICINE, 26, 1, 38, 44, SPRINGER VERLAG, 2000年01月, ［査読有り］
英語, 研究論文（学術雑誌）, Objectives:To investigate the inflammatory responses in patients with out-of-hospital cardiac arrest, we examined the changes in markers of endothelial activation, neutrophil activation, and endothelial injury.
Design: Prospective, cohort study.
Setting: General intensive care unit of a tertiary care center.
Patients and participants: Forty-four out-of-hospital cardiac arrest patients were classified into two groups, those who achieved return of spontaneous circulation (ROSC) (n = 23) and those without ROSC (n = 21). Eight normal healthy volunteers served as control subjects.
Measurements ann results: Serial levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin) as markers of endothelial activation, neutrophil elastase as a marker of neutrophil activation, and soluble thrombomodulin as a marker of endothelial injury were measured during and after cardiopulmonary resuscitation (CPR). In patients with ROSC,cardiac arrest and CPR led to increases in the levels of three vascular endothelial adhesion molecules, neutrophil elastase, and soluble thrombomodulin thar peaked 6 h or 24 h after arrival at the emergency department. In patients without ROSC, only neutrophil elastase showed moderate elevation during CPR. We could not find significant differences in all measured parameters between the two groups.
Conclusions: As evidence of inflammatory responses in whole-body ischemia and reperfusion, our study demonstrates neutrophil-endothelium interaction with signs of endothelial injury in patients with out-of-hospital cardiac arrest. These inflammatory changes may have an important role in post-resuscitation syndrome after human cardiac arrest.

Systemic activation of tissue-factor dependent coagulation pathway in evolving acute respiratory distress syndrome in patients with trauma and sepsis
S Gando, S Nanzaki, Y Morimoto, S Kobayashi, O Kemmotsu
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 47, 4, 719, 723, LIPPINCOTT WILLIAMS & WILKINS, 1999年10月, ［査読有り］
英語, 研究論文（学術雑誌）, Background: Extravascular coagulation and fibrin deposition coupled with perturbations of intravascular coagulation occurs in association with acute respiratory distress syndrome (ARDS), To evaluate the pathogenetic role of an extrinsic coagulation pathway in the intravascular coagulation of ARDS patients and to explore the time course of the changes of tissue factor levels, platelet counts, and disseminated intravascular coagulation (DIC), we performed a prospective cohort study,
Methods: The study subjects consisted of 113 patients: 27 patients with ARDS, 31 patients at risk for but not developing the syndrome, and 55 patients without ARDS, According to the underlying disease, the patients were further subdivided into two groups: patients with trauma (n = 76) and patients with sepsis (n = 37), Tell normal healthy volunteers served as control subjects. Plasma tissue factor antigen (tissue factor) levels and platelet counts were measured on the day of admission and on days 1 through 4 after admission. Simultaneously, the DIC scores were determined.
Results: The values of tissue factor in the patients with ARDS were significantly more elevated than those measured in the other two groups (p < 0.001) and control subjects (p < 0.001) on the day of admission. The values continued to be markedly high up to day 4 of admission. On the day of admission, the platelet counts in the ARDS patients showed significantly lower values (p < 0.05) than those in the other two groups. The incidence of DIC and the DIC scores in ARDS patients mere significantly higher than those in the other tyro groups. The tissue factor levels (r(s) = 0.428, p < 0.0001) and DIC scores (r(s) = 0.357, p < 0.0002) correlated significantly with Lung Injury Score. When the patients were subdivided into two subgroups, i.e., trauma and sepsis, some differences of the tissue factor levels were noted between the two groups.
Conclusion: We demonstrated that tissue-factor dependent coagulation pathway of plasma is extensively activated in patients with ARDS, followed by intravascular coagulation and platelet consumption. We further provide precise information on the time course of tissue factor levels and DIC in patients with ARDS and those at risk for developing this syndrome.

Tissue factor and tissue factor pathway inhibitor levels during and after cardiopulmonary resuscitation
S Gando, S Nanzaki, Y Morimoto, S Kobayashi, O Kemmotsu
THROMBOSIS RESEARCH, 96, 2, 107, 113, PERGAMON-ELSEVIER SCIENCE LTD, 1999年10月, ［査読有り］
英語, 研究論文（学術雑誌）, Disseminated intravascular coagulation frequently occurs after global ischemia and reperfusion due to cardiac arrest. The present study was performed to demonstrate the role of tissue factor for coagulation pathway activation, as well as to investigate the precise time course of tissue factor pathway inhibitor (TFPI) during and after cardiopulmonary resuscitation (CPR), Thirty-two of out-of-hospital cardiac arrest patients were classified into two groups, those who achieved return of spontaneous circulation (ROSC) (n=13) and those without ROSC (n=19), Ten normal healthy volunteers served as control subjects. Serial levels of tissue factor and TFPI were measured during and after cardiac arrest and CPR. In patients with ROSC, cardiac arrest and CPR led to persistent increases in the levels of tissue factor that peaked 6 hours after arrival at the Emergency Department. Tissue factor levels in patients without ROSC also showed marked elevations compared to those of the control subjects. In both groups, the levels of TFPI were significantly lower than those in the control subjects. However, we could not find differences in the levels of the two markers between the patients with ROSC and those without ROSC, In conclusion, we demonstrated persistent elevation of the tissue factor levels associated with low TFPI during and after CPR in patients with out-of-hospital cardiac arrest. These results indicate the activation of the extrinsic coagulation pathway without adequate TFPI generation, which may contribute to thrombin activation and fibrin formation after whole-body ischemia and reperfusion, (C) 1999 Elsevier Science Ltd. All rights reserved.

脳虚血に対するペントバルビタール, ミダゾラムの保護効果の機序 : アポトーシス抑制の可能性
森本 裕二, 森本 佳子, 劔物 修, 柴野 岳樹, 四釜 裕睦
循環制御 = CIRCULATION CONTROL, 20, 3, 255, 258, 1999年09月30日
日本語

患者情報管理システム導入前後における麻酔管理の変化 : 術中に生じた致死性不整脈への対応の比較
石川 岳彦, 神田 知枝, 岡村 篤, 森本 裕二, 劔物 修
循環制御 = CIRCULATION CONTROL, 20, 3, 299, 309, 1999年09月30日
日本語

胸腔鏡下切開術を施行した先天性縦隔嚢胞の1症例
秦 琢磨, 伊東 義忠, 森本 裕二
麻酔, 48, 9, 1017, 1019, 克誠堂出版, 1999年09月
日本語

Alterations of soluble L- and P-selectins during cardiac arrest and CPR
S Gando, S Nanzaki, Y Morimoto, S Kobayashi, O Kemmotsu
INTENSIVE CARE MEDICINE, 25, 6, 588, 593, SPRINGER VERLAG, 1999年06月, ［査読有り］
英語, 研究論文（学術雑誌）, Objective:To investigate the relationship between cytokines and the inflammatory responses in patients with out-of-hospital cardiac arrest, we examined the changes of cytokines as well as alterations in the markers of neutrophil activation, platelet and endothelial activation, and endothelial injury.
Design: Prospective. cohort study.
Setting: General intensive cart: unit of a tertiary care center.
Patients and participants: 26 out-of-hospital cardiac arrest patients were classified into two groups: these who achieved return of spontaneous circulation (ROSC) (n = 10) and those with no ROSC (n = 16). Eight normal healthy volunteers served as control subjects.
Measurements and results: Serial levels of soluble L-selectin (sL-selectin), soluble P-selectin (sP-selectin), neutrophil elastase, and soluble thrombomodulin were measured during and after cardiopulmonary resuscitation (CPR). Serial levels of tumor necrosis factor alpha (TNF alpha) and interleukin-1 beta (IL-1 beta) were also measured. We could not find any elevations in either cytokine during the study period. In both groups, sP-selectin levels were significantly higher than these in control subjects from the time of arrival at the emergency department to 24 h after admission, sL-selectin levels in the two groups were markedly lower compared to these in control subjects at all sampling points. In patients with ROSC, cardiac arrest and CPR led to an increase in the levels of neutrophil elastase and soluble thrombomodulin that peaked 6 h or 24 h after arrival at the emergency department. No statistical differences in the levels of the two selectins, neutrophil elastase, and soluble thrombomodulin between the two groups were found during CPR.
Conclusions: Out-of-hospital cardiac arrest and CPR induces platelet, neutrophil. and endothelial activation and is associated with endothelial injury, Inflammatory cytokines may not have an important role in human whole-body ischemia-reperfusion injury.

近赤外分光法による脳内酸素飽和度測定
森本 裕二, 劔物 修
日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia, 19, 4, 248, 251, 1999年05月15日
日本語

心肺蘇生におけるCa^<2+>の役割
丸藤 哲, 森本 裕二, 劔物 修
蘇生, 18, 1, 15, 20, The Japanese Society of Reanimatology, 1999年04月20日
日本語, 心肺蘇生におけるカルシウム投与の歴史的変遷を述べ, 心停止および心肺蘇生中の血中イオン化カルシウム (Ca²⁺) 動態とその変化をきたす機序に関して概説した。内因性院外心停止症例では心停止, 心肺蘇生に伴いCa²⁺は減少する。この機序としてCa²⁺の細胞内移行が想定され, 一部投与された重炭酸イオンとの結合が関与していると考えられる。虚血によって細胞内に蓄積したカルシウムによる心筋損傷, および神経細胞障害を増悪させ, かつ神経学的予後を悪くする可能性が指摘され, 心肺蘇生におけるカルシウムは1980年代後半に必須薬物から除外された。Ca²⁺減少の機序およびカルシウム投与の歴史的変遷の過程を考慮すると心肺蘇生に伴うCa²⁺の低下が心肺蘇生におけるカルシウム投与を正当化するものではないことは明らかである。

CABG手術における麻酔薬の選択が局所脳内酸素飽和度(rSo_2)に及ぼす影響
木下 平次郎, 坂本 浩, 脇坂 博士, 神田 知枝, 森本 裕二, 真弓 享久, 劔物 修
循環制御 = CIRCULATION CONTROL, 19, 4, 538, 541, 1998年12月18日
日本語

Anesthesia for fourteen cases of auto-renal transplantation
Akira Inoue, Yuji Morimoto, Yoshihiro Ohta, Osamu Kemmotsu
Japanese Journal of Anesthesiology, 47, 10, 1221, 1225, 1998年10月, ［査読有り］
日本語, 研究論文（学術雑誌）, We experienced anesthetic management of 14 cases of auto-renal transplantation. The causative disease are stenosis (n = 7) and aneurysm of the renal artery (n = 5) as well as renal cancer (n = 2). The mean time intervals for operation anesthesia, and clamping of the renal artery were 10 h 54 min, 12 h 42 min and 4 h 14 min, respectively. In the patients whose serum creatinine values were above 1 mg · dl-1 within the 3 rd postoperative day, time intervals for operation and anesthesia were significantly longer than in the patients whose serum creatinine values remained below 1 mg · dl-1. The water balance in the former patients was significantly positive in comparison with the latter patients. The auto- renal transplantation is a highly invasive surgery so that proper fluid management and sufficient urination seem to be especially important for the perioperative management of patients of this category.

心肺脳蘇生とアシド-シス
森本 裕二, 剣物 修, 森本 佳子
麻酔, 47, 7, 792, 805, 克誠堂出版, 1998年07月
日本語

Effect of temperature on apoptosis in neuronal cells
Takaki Shibano, Yuji Morimoto, Osamu Kemmotsu
Critical Care Medicine, 26, 1, A81, Lippincott Williams and Wilkins, 1998年
英語, 研究論文（学術雑誌）, Introduction: Recent reports strongly support the protective effect of mild and moderate hypothermia for the treatment of acute head trauma or stroke. However, the mechanism of this protective effect is not wed clarified. One possible mechanism is the inhibition ot neuronal apoptosis. We, accordingly, evaluated the effect ot temperature (37. 35, 33 °C) on apoptosts in neuronal cells using PC 12 cells, which is derived from rat pheochromocytoma. Methods: PC 12 cells were maintained in Dulbecco's modified Eagles medium supplemented with 5 % fetal bovine serum and 5 % horse serum. Apoptosts was induced by depriving serum from the medium, which is one of the most representative methods to induce apoptosis in PC 12 cefls. The ceHs with or without induction of apoptosis were randomly incubated in the chamber, in which the temperature was constantly kept at 37, 35, or 33 °C under 5 % of CU2 The percentage of apoptic cells was calculated by flow cytometry 4 days arter the start of protocol. The cells were tripsinized, harvested by centrifugation. The cells were then washed in PBS, fixed in 70 % ethanol and stored at -20 °C. Alter staining the cete by propidium iodide, the celular ONA content was measured by flow cytometry. Apoptic eels were regarded as the population which contained less ONA than 31 peak. Results: The percentage of apoptic cells in 37, 35, or 33 °C is 88.1 ±22.6, 68.7 ±21.5. or 58.1 ±16.1 (mean ±SO, n=7) after the 4th day foBowing induction of apoptosis. There was significantly different among the groups (p=0.04 by ANOVA). The percentage of apoptic cells in 33 °C was significantly less than that in 37 °C (p=0.04 by Scherte). Among the groups incubated for 4 days without induction of apoptosis, the percentage of apoptic cells did not differ significantly. Conclusion: Our data indicate that the inhibition of apoptosis may be the mechanism of protective effect of mild and moderate hypothermia against acute head trauma and stroke.

Effect of pentobarbital and midazolam on apoptosis in neuronal cells
Yuji Morimoto, Yoshiko Morimoto, Osamu Kemmotsu, Takaki Shibano
Critical Care Medicine, 26, 1, A36, Lippincott Williams and Wilkins, 1998年
英語, 研究論文（学術雑誌）, Introduction: Recently, it is suggested that delayed neuronal cell death in cerebral ischemia may be related to neuronal apoptosis. In the ICU setting, the chance to use barbiturates and/or benzodiazepines is not rare for the sedation and/or treatment ot the patients with acute head trauma or stroke. However, the effect of these drugs on neuronal apoptosis in not known. We, accordingly, evaluated the effect of pentobarbital and midazolam on apoptosis in neuronal cells using PC 12 cells, which is derived from rat pheochromocytoma. Methods: PC 12 cells were maintained in Dulbecco's modified Eagles medium supplemented with 5% fetal bovine serum and 5% horse serum. Apoptosis was induced by depriving serum from the medum, which is one of the most representative methods to induce apoptosis in PC 12 cells. First, the cells were (1× 107) lysed in lysis buffer (10mM Tris-HCl, 10mM EDTA. 0.5% Triton X-100). The DNA was extracted using phenol and chloroform and precipitated with ethanol and sodium acetate. Agarose gel etectrophoresis was performed and the DNA was visualized under ultraviolet. Second, the effect of pentobarbital (0.5, 5, 50 μg/ml) and midazolam (0.12, 1.2, 12 μg/ml) on cell death was evaluated 4 days after the induction of apoptosis. Cell death was defined as the ratio of LDH activity (%LDH) in the medum against total activity. Third, the percentage of apoptic cells was calculated by flow cytometry 4 days after the induction of apoptosis. The ceils were fixed in 70 % ethanol and stained by propidium iodide. The cellular DNA content was measured by flow cytometry. Apoptic eels were regarded as the population which contained less DNA than G1 peak. Results: Etectrophoresis of the DNA exhibited DNA fragmentation (typical ladder pattern) from the 1st day after the induction of apoptosis. After the 4th day, %LDH without drugs was 53.9 ± 24.3 % (mean ± SD, n=12). Pentobarbital inhibited cell death in a dose-dependent fashion (p=0.03 by ANOVA). The percentage of apoptic cells without drugs was 94.9 ±6.3 % (n=9) after the 4th day. By the treatment of 50 μg/ml pentobarbital, percentage of apoptic cells significantly decreased to 61.8 ± 21.3 % (p<
0.01 by Scheffe). Such effects were not seen in the cells treated by midazolam. Conclusion: Our data indicate that pentobarbital may have a protective effect against apoptic cells death in neuronal cells.

心肺脳蘇生とアシドーシス
森本 裕二, 剣物 修, 森本 佳子
麻酔, 47, 7, 792, 805, 克誠堂出版, 1998年
日本語

Cardiopulmonary Cerebral Resuscitation and Acidosis
Yuji Morimoto, Osamu Kemmotsu, Yoshiko Morimoto
Japanese Journal of Anesthesiology, 47, 7, 801, 805, 1998年, ［査読有り］
英語, 研究論文（学術雑誌）, It is still controversial whether sodium bicarbonate is effective for the correction of acidemia during cardiopulmonary resuscitation (CPR). To resolve this issue, we must clarify the influence of acidosis accompanied by cardiac arrest on the cardiac and cerebral resuscitability. The influence of acidosis on cardiac resuscitability The factors which determine the cardiac resuscitability during asystole or ventricular fibrillation are the presser response to administered catecholamines and the threshold of defibrillation. However, there is still no evidence that acidosis inhibits these factors during CPR. Recent reports suggested that CO 2 itself impaired cardiac resuscitability rather than acidosis. On the other hand, our study using isolated perfused rat hearts proposed that the effect of acidosis is not still eliminated. The influence of acidosis on the cerebral resuscitability There are two contrary opinions. One is that acidosis deteriorates the cerebral damage after resuscitation. The other is that acidosis is rather protective against the cerebral damage. In the studies which support the latter opinion, the evaluation of the effect of reperfusion is lacking. Accordingly, any factors which develop during the reper-fusion phase may be enhanced by acidosis. These findings indicate that the influence of acidosis accompanied by cardiac arrest is complicated and that it includes many unresolved ques-tions. Until we clarify these questions, we can not conclude that the correction of acidemia is necessary during CPR.

心臓大血管手術における患者情報管理システムの使用
岡村 篤, 森本 裕二, 椎谷 紀彦, 佐藤 直樹, 太田 善博, 真弓 享久, 劔物 修
循環制御 = CIRCULATION CONTROL, 18, 4, 577, 582, 1997年12月19日
日本語

トノメトリ法による動脈圧測定 : 較正カフの測定値に与える影響
岡村 篤, 原澤 克己, 太田 善博, 森本 裕二, 劔物 修
日本臨床生理学会雑誌 = Japanese journal of applied physiology, 27, 6, 369, 372, 1997年12月01日
日本語

Successful use of propofol for anesthesia for plasty of eyelids in epidermolysis bullosa
Ryo Inoue, Shigeaki Kobayashi, Yuji Morimoto, Osamu Kemmotsu
Japanese Journal of Anesthesiology, 46, 12, 1590, 1593, 1997年12月, ［査読有り］
日本語, 研究論文（学術雑誌）, A 21-year-old male with recessive dystrophic epidermolysis, required anesthesia for plastic surgery of eyelids. We took special care for the attachment of monitoring equipments and placing an intravenous cannula. Anesthesia was induced by intravenous propofol 1 mg · kg-1 and maintained with local injection of 1.0% lidocaine and continuous infusion of propofol 3- 4 mg · kg-1 !. hr-1. Tracheal intubation was not performed and oxygen was given through a nasal cannula and spontaneous breathing was maintained throughout the anesthetic management. Respiratory condition was monitored by measuring Spo2 and end-tidal CO2 by capnography obtained from the nasal cannula. Operation was performed successfully and he was discharged without any major complications.

肝臓切除前後の消化管粘膜内pH変動
加藤 敏文, 小村 好弘, 森本 裕二, 佐藤 直樹, 内野 純一, 劒物 修
日本手術医学会誌 = Journal of Japanese Association for Operating Room Technology, 16, 4, 595, 599, 1995年11月30日
日本語

ドパミン持続投与は麻酔による消化管酸素代謝異常を改善させるか
加藤 敏文, 小村 好弘, 森本 裕二, 森本 佳子, 太田 善博, 劔物 修
循環制御 = CIRCULATION CONTROL, 16, 3, 371, 376, 1995年09月30日
日本語

Noninvasive, continuous blood pressure measurement by arterial tonometry during anesthesia in children.
Kemmotsu O, Ohno M, Takita K, Sugimoto H, Otsuka H, Morimoto Y, Mayumi T
Anesthesiology, 81, 1162, 1164, 1994年, ［査読有り］
英語, 研究論文（学術雑誌）

虚血性脳侵襲に及ぼすアシドーシスの影響 -ラット海馬スライスにおける無酸素・無グルコースモデルを用いた解析-　　　　　　　　　　　　　　　
北海道医学雑誌, 68, 5, 717, 727, 1993年

Hemodynamic effects of nicardipine-induced hypotension during enflurane/nitrous oxide anesthesia in man
Atsushi Okamura, Osamu Kemmotsu, Yuji Morimoto, Takeyasu Yamamura, Takehiko Ishikawa, Fusazo Nakata
Journal of Anesthesia, 6, 4, 401, 406, 1992年10月, ［査読有り］
英語, 研究論文（学術雑誌）, Hemodynamic effects of nicardipine-induced hypotension during enflurane/nitrous oxide were evaluated in 10 surgical patients. An infusion of nicardipine was titrated to maintain mean arterial pressure at 60 to 70 mmHg under enflurane 1.5 to 2.0 vol% and nitrous oxide 60 vol%. Mean arterial pressure was well controlled with the nicardipine infusion, whereas cardiac index increased with decreased systemic vascular resistance. Heart rate increased concomitantly with decreased blood pressure, which indicated that enflurane 1.5 to 2.0 vol% did not suppress baroreceptor reflex during nicardipine administration. However, rate-pressure-product was not increased by the nicardipine. Right and left ventricular systolic work indices were not increased by the nicardipine. Right ventricular ejection fraction was not also changed by the nicardipine. Although serum norepinephrine level increased during the nicardipine infusion, the values remained within physiological ranges. Our results suggest that nicardipine-induced hypotension may be safely performed during enflurane/nitrous oxide anesthesia because neither ventricular work nor myocardial oxygen demand was increased by nicardipine. © 1992 Japanese Society of Anesthesiologists.

心肺蘇生中における中心静脈血の酸塩基平衡状態と心拍再開成功率との関係
森本裕二
ICUとCCU, 15, 1, 41, 46, 1991年

慢性疼痛疾患に対する低出力レーザー治療の応用
佐藤 賢一, 劔物 修, 原田 幸二, 古御堂 均, 華岡 由香里, 大塚 浩司, 森本 裕二, 〓野 繁雄
日本レーザー医学会誌, 11, 4, 3, 9, 特定非営利活動法人 日本レーザー医学会, 1991年
日本語, 麻酔科ペインクリニック外来において, 過去4年間に各種の慢性疼痛疾患152症例に対して低出力レーザー治療を応用し, 即時効果および長期効果の有効性について検討した。全症例に対する平均治療回数は28.1回であった。即時効果は著効36例 (23.7%), 有効65例 (42.8%), 不変50例 (32.9%), 増悪1例 (0.6%) で, 著効, 有効を合わせた有効率は66,4%であった。長期効果では疼痛消失21例 (13.8%), 軽快92例 (60.5%), 不変39例 (25.7%), 増悪例は認めず, 消央, 軽快を合わせた有効率は74.3%であった。とくに難治性とされている帯状疱疹後神経痛に対する即時効果, 長期効果はともに約90%の高い有効性を認あた。合併症に関しては, 金身倦怠感, 照射部位の熱感、一過性疼痛増悪を認めたが重篤な副作用はなかった。低出力レーザー治療はその簡便性と無侵襲的治療法であるため, 今後, 広く普及することが期待される。

聴覚中潜時反応(MLR)および頭頂部緩反応の(SVR)の意識障害評価への応用
森本 裕二
救急医学, 14, 4, p483, 488, へるす出版, 1990年04月
日本語

International repatriationの問題点--ロサンゼルスまでの患者搬送経験を通して
森本 裕二
救急医学, 14, 3, p391, 393, へるす出版, 1990年03月
日本語

心肺蘇生中の呼気終末炭酸ガス濃度 -心拍再開の予後予測手段としての有用性-
森本 裕二, 住谷 俊治, 丸藤 哲, 松原 泉, 手戸 一郎, 劔物 修
日本救急医学会誌, 1, 1, 19, 24, Japanese Association for Acute Medicine, 1990年
日本語, 心肺蘇生中の呼気終末炭酸ガス濃度(以下ETCO₂)は,動物実験において心臓マッサージの有効性ならびに,心拍再開の指標として有用とされている。さらに,心拍再開例の値は非再開例の値に比較し有意に高値であることから,心拍再開の可否を予測する手段としても期待されている。しかし,臨床において,最後の予測手段としての有用性については一定の見解が得られていない。そこで,今回,来院時心肺停止症例50例(外傷疾患は除外)についてETCO₂が予測手段となるかどうか検討した。心拍再開の有無と記録開始1分前後のETCO₂値との関係では,心拍再開例で非再開例に比較して有意に高値を示した(1.3±0.7% vs 0.7±0.4%)。しかし,個々の値では,低値であっても心拍再開する症例,また逆に高値であっても心拍再開をみない症例もあり,初期のETCO₂の値から心拍再開の可否を推定することはむずかしいものと思われた。DOAの原因疾患別にみたとき,心停止の原因が非心疾患による症例では(呼吸器疾患もしくは脳疾患),蘇生例のETCO₂値は非蘇生例に比較して有意に高く,さらに蘇生例では全例で0.8%以上であり,逆に0.8%以下では一例も蘇生されていない。すなわち非心疾患によるDOAではETCO₂値が心拍再開の予後を予測する手段になる可能性が示唆された。臨床において,ETCO₂が心拍再開の可否を予測できるかどうかについては依然議論の分かれるところである。しかし,その原因として背景にある心停止の原因の相違が影響していると推察され,すなわち心停止の原因が非心疾患の場合には有用である可能性が示唆された。

聴覚中潜時反応(MLR)および頭頂部緩反応(SVR)の意識障害評価への応用
森本 裕二
救急医学, 14, 4, 483, 488, へるす出版, 1990年
日本語

NEUROLOGIC PROGNOSIS FOLLOWING OUT-OF-HOSPITAL CARDIAC-ARREST - EVALUATION BY AUDITORY BRAIN-STEM RESPONSES (ABR)
Y MORIMOTO, S GANDO, MATSUBARA, I, TEDO, I, O KEMMOTSU
INTENSIVE AND CRITICAL CARE MEDICINE, 885, 994, 994, ELSEVIER SCIENCE PUBL B V, 1990年, ［査読有り］
英語, 研究論文（国際会議プロシーディングス）

麻酔前ｒａｎｉｔｉｄｉｎｅ投与の胃液量，胃液ｐＨに及ぼす効果
横田 祥, 水嶋 雅子, 今井 真, 森本 裕二, 劒物 修
臨床薬理, 19, 2, 417, 422, The Japanese Society of Clinical Pharmacology and Therapeutics, 1988年
日本語, Effects of pre-operative administration of ranitidine on pH and volume of gastric juicewere evaluated in 42 patients undergoing elective surgery under general anesthesia. Allpatients were randomly divided into two groups: placebo group (group P), and ranitidinegroup (group R).Patients in group P received placebo (lactose) and served as controls.Patients in group R received ranitidine 300 mg orally at 9: 00 p.m.on the day before surgeryand 50 mg iv immediately after induction of anesthesia (9: 15a.m.). The pH and volumeof gastric juice were measured during induction of anesthesia and every one hour duringsurgery in both groups by continuous sampling of gastric juice utilizing a low-pressuremethod. Plasma ranitidine levels were measured by high performance liquid chromatographyin 5 patients of group R and compared with those of oral administration alone in 6 patientsand of iv administration alone in 6 patients. The gastric pH just after induction of anesthesiawas lower than 2. 5 in 67% of group P and 4% of group R (P<0.05). The gastric volumeover 25ml was seen in 17% of group P and none of group R. There were significantelevations in gastric pH at induction and 1, 2, 3, 5, and 6 hr following induction ofanesthesia in group R compared with group P. The total volume of gastric juice during 4-5hr surgery were 20 ml in group R and 37 ml in group P respectively (P<0.05). Theplasma ranitidine levels 3 hr after iv administration were 186 ng/ml in group R and 128ng/ml in patients of iv administration group alone (P<0.05), and 78ng/ml in patients oforal administration group alone. It is essential to keep gastric pH over 2.5 and gastricvolume less than 25 ml in order to prevent aspiration pneumonitis during anesthesia.Therefore, our data indicate that pre-operative administration (oral plus intravenous) ofranitidine is sufficiently effective to prevent aspiration pneumonitis related to acidity and volume of gastric juice during anesthesia.

重症呼吸不全を伴う高度側彎症患者の経尿道的手術に,超音波ガイド下脊髄くも膜下麻酔が有用であった1症例—Successful Application of Ultrasound-guided Spinal Anesthesia for Transurethral Surgery in a Patient with Severe Scoliosis and Respiratory Failure
安達 大揮, 小野寺 慧洲, 三浦 基嗣, 相川 勝洋, 森本 裕二, 麻酔 = The Japanese journal of anesthesiology : 日本麻酔科学会準機関誌, 73, 6, 383, 386, 2024年06月
[東京] : 克誠堂出版, 日本語

留置後症候群(PIS)
副島崇旨, 水野谷和之, 森本裕二, 臨床麻酔(真興交易), 46, 8, 2022年

重症COVID-19患者の緊張性縦隔気腫に対してVA-ECMOをbridgingしてVV-ECMOで管理した1例
水野谷和之, 土岐崇幸, 斉藤仁志, 森本裕二, 日本呼吸療法医学会学術集会プログラム・抄録集, 44th (Web), 2022年

開胸術後急性期の背部痛に術中体位による筋・筋膜性疼痛症候群の関与が考えられた1症例
藤井 知昭, 前田 洋典, 三浦 基嗣, 長谷 徹太郎, 敦賀 健吉, 森本 裕二, 日本ペインクリニック学会誌, 28, 7, 156, 157, 2021年07月
(一社)日本ペインクリニック学会, 日本語

オピオイド漸減中止後に離脱症状が遷延した1症例
前田 洋典, 敦賀 健吉, 藤井 知昭, 三浦 基嗣, 長谷 徹太郎, 森本 裕二, 日本ペインクリニック学会誌, 28, 7, 159, 159, 2021年07月
(一社)日本ペインクリニック学会, 日本語

肝胆膵手術後患者における過大腎クリアランス(Augmented renal clearance:ARC)発生に関する検討
中峯奈央子, 水野谷和之, 佐々木慶子, 斉藤仁志, 森本裕二, 日本集中治療医学会北海道支部学術集会プログラム・抄録集(Web), 5th, 2021年

カテコラミン誘発性心室頻拍合併妊婦の帝王切開の麻酔経験
糸洲佑介, 八木泰憲, 山本真崇, 水野谷和之, 干野晃嗣, 森本裕二, Cardiovascular Anesthesia, 25, Suppl (CD-ROM), 2021年

“北大式”TOF根治術周術期管理法
干野晃嗣, 水野谷和之, 糸洲佑介, 八木泰憲, 森本裕二, Cardiovascular Anesthesia, 25, Suppl (CD-ROM), 2021年

腹式子宮全摘術後に劇症型A群&Beta溶血性連鎖球菌感染症を発症し救命しえた1例
佐々木慶子, 出村理海, 干野晃嗣, 水野谷和之, 斉藤仁志, 森本裕二, 日本集中治療医学会学術集会(Web), 48th, 2021年

Tilt Tableの傾斜角度変化と呼吸機能との関連性
堀弘明, 千葉健, 藤内宏典, 大須賀聡, 佐橋健人, 斉藤仁志, 森本裕二, 日本集中治療医学会学術集会(Web), 48th, 2021年

Modified-blockage of thoracoabdominal nerves through perichondrial approach(M-TAPA)により得られる胸腹部の鎮痛範囲に関する検討
相川勝洋, 前田洋典, 森本裕二, 日本麻酔科学会学術集会(Web), 68th, 2021年

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, 2020年09月
(一社)日本集中治療医学会, 日本語

老化促進マウスを用いた敗血症急性期の海馬神経炎症とミクログリア活性化の検討　　　　　　　　　　　　　　　
干野 晃嗣, 打浪 有可, 内田 洋介, 斉藤 仁志, 森本 裕二, 日本神経麻酔集中治療学会プログラム・抄録集, 24回, 24, 24, 2020年08月
日本神経麻酔集中治療学会, 日本語

陸空路ECMO搬送時のバックボード装着型架台の構築と搬送経験　　　　　　　　　　　　　　　
岡本 花織, 太田 稔, 矢萩 亮児, 川端 和美, 吉田 知由, 糸洲 佑介, 斉藤 仁志, 森本 裕二, 日本臨床工学技士会会誌, 69, 284, 284, 2020年04月
(公社)日本臨床工学技士会, 日本語

腰痛を伴う進行膵がんに対する透視下腹腔神経叢ブロックの際に、腰椎椎体骨折が発見された1例
前田 洋典, 敦賀 健吉, 三浦 基嗣, 藤井 知昭, 長谷 徹太郎, 森本 裕二, 日本ペインクリニック学会誌, 27, 1, 129, 129, 2020年02月
(一社)日本ペインクリニック学会, 日本語

ECMO補助下の呼吸不全患者の航空搬送経験
糸洲佑介, 斉藤仁志, 打浪有可, 本間慶憲, 吉田知由, 干野晃嗣, 西川直樹, 森本裕二, 日本集中治療医学会雑誌(Web), 27, 6, 2020年

診療報酬改定による第2種高気圧酸素治療の現状 第2報　　　　　　　　　　　　　　　
武貞 敬介, 石川 勝清, 平子 竜大, 寒河江 磨, 岡本 花織, 千葉 裕基, 太田 稔, 森本 裕二, 日本高気圧環境・潜水医学会雑誌, 54, 3, 170, 171, 2019年09月
(一社)日本高気圧環境・潜水医学会, 日本語

当院での先行オピオイド併用メサドン導入方法と使用経験　　　　　　　　　　　　　　　
三浦 基嗣, 敦賀 健吉, 前田 洋典, 藤井 知昭, 長谷 徹太郎, 森本 裕二, 日本ペインクリニック学会誌, 26, 3, O17, 2, 2019年06月
(一社)日本ペインクリニック学会, 日本語

筋筋膜性疼痛症候群による痛みに低反応レベルレーザー治療(LLLT)が有効だった2症例　　　　　　　　　　　　　　　
長谷 徹太郎, 藤井 知昭, 前田 洋典, 三浦 基嗣, 敦賀 健吉, 森本 裕二, 日本ペインクリニック学会誌, 26, 3, P1, 27, 2019年06月
(一社)日本ペインクリニック学会, 日本語

神経ブロックにより最後まで在宅療養を継続できた1症例　　　　　　　　　　　　　　　
前田 洋典, 敦賀 健吉, 三浦 基嗣, 藤井 知昭, 長谷 徹太郎, 森本 裕二, 日本ペインクリニック学会誌, 26, 3, P3, 34, 2019年06月
(一社)日本ペインクリニック学会, 日本語

環軸椎亜脱臼を認めた乳児の点状軟骨異形成症患者に対する脊椎後方固定術の麻酔経験　　　　　　　　　　　　　　　
久保 康則, 森本 裕二, 日本神経麻酔集中治療学会プログラム・抄録集, 23回, 179, 179, 2019年03月
日本神経麻酔集中治療学会, 日本語

妊娠期の筋腫変性痛に対して芍薬甘草湯が有効であった1例
藤井 知昭, 三浦 基嗣, 長谷 徹太郎, 敦賀 健吉, 森本 裕二, 日本ペインクリニック学会誌, 26, 1, 89, 90, 2019年02月
(一社)日本ペインクリニック学会, 日本語

術前からの不安の強い患者の腹腔鏡下手術後に遷延性術後痛を生じた1例
伊藤 智樹, 長谷 徹太郎, 前田 洋典, 三浦 基嗣, 藤井 知昭, 敦賀 健吉, 森本 裕二, 日本ペインクリニック学会誌, 26, 1, 91, 91, 2019年02月
(一社)日本ペインクリニック学会, 日本語

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(Web), 26, 3, 2019年

小児における局所脳酸素飽和度-年齢区分と機種による相違
久保康則, 糸洲佑介, 斉藤仁志, 森本裕二, 日本麻酔科学会学術集会(Web), 66th, 2019年

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学術集会(Web), 46th, 2019年

老化促進マウスにおける敗血症急性期の海馬シナプス応答の変化は非老化マウスとは異なる
干野晃嗣, 内田洋介, 斉藤仁志, 打浪有可, 森本裕二, 日本麻酔科学会学術集会(Web), 66th, 2019年

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学術集会(Web), 46th, 2019年

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, 2019年01月
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。, 真興交易(株)医書出版部, 日本語

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, 2018年12月
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), 日本語

小児胸部外科手術で超音波ガイド下Retrolaminar Blockを用いて周術期管理をした1症例
田中 暢洋, 藤井 知昭, 打浪 有可, 糸洲 佑介, 相川 勝洋, 森本 裕二, 臨床麻酔, 42, 11, 1511, 1513, 2018年11月
6歳男児。右後縦隔腫瘍に対し全身麻酔下に腹腔鏡下縦隔腫瘍摘出術が予定された。麻酔はセボフルランで導入し、フェンタニルとロクロニウムを投与して気管挿管を行った。続いて、超音波ガイド下retrolaminar blockを用いて麻酔管理を行った。超音波ガイド下に第5胸椎椎弓後面に平行法で穿刺し、レボブピバカインを注入した。薬液は椎弓後面に留まらず、横突棘筋の筋内や横突棘筋と胸棘筋の間に広がった。麻酔維持はセボフルランとレミフェンタニルで行い、フェンタニルとロクロニウムを適宜投与した。手術は第5〜6肋間の小切開創による胸腔鏡下手術で完遂した。手術終了後の病棟帰室直後にドレーン穿刺部に痛みが出現し、APPを投与した。痛みは改善し、術翌日にアセトアミノフェン定期内服を開始した。術後5日に有害事象なく退院となった。, 真興交易(株)医書出版部, 日本語

大動脈基部置換術および弓部大動脈全置換術における無輸血手術の1症例
新井田周宏, 菊谷浩樹, 井上聡巳, 大川陽史, 森本裕二, 臨床麻酔(真興交易), 42, 10, 1355‐1359, 2018年10月20日
日本語

周術期急性腎障害(AKI)
水野谷和之, 森本裕二, 臨床麻酔(真興交易), 42, 7, 941‐948, 948, 2018年07月20日
近年、周術期に発生する急性腎障害(AKI)は、以前に考えられていたよりも発症頻度が高いこと、周術期にAKIを発症した患者には短期予後だけでなく長期予後にも問題が生じることがわかってきた。周術期管理を担う麻酔科医には、周術期AKIの現状をよく理解し、可能な限りAKI発症リスクを低下させることが求められる。最初にAKIの診断基準と周術期AKIについて概説し、次いで周術期AKIの発生頻度、病態とリスク、予後、予防について述べた。, 真興交易(株)医書出版部, 日本語

統合的ストレス応答の阻害は術後認知機能障害を防止する　　　　　　　　　　　　　　　
内田 洋介, 斉藤 仁志, 干野 晃嗣, 打浪 有可, 森本 裕二, 日本神経麻酔集中治療学会プログラム・抄録集, 22回, 47, 47, 2018年06月
日本神経麻酔集中治療学会, 日本語

非閉鎖式動脈圧ライン回路からの採血時の三方活栓操作が採血結果に与える影響についての検討
高島史樹, 水野谷和之, 森本裕二, 麻酔, 67, 2, 203‐207, 207, 2018年02月10日
非閉鎖式動脈圧ラインから三方活栓(以下、三活)を使用して採血する場合、シリンジを交換する際に三活のロック操作が必要となる。三活のロック方法によっては患者血液に回路内輸液が混入する可能性があるため、模擬回路を作成して三活操作が採血結果に与える影響を検討した。実験の結果、シリンジ交換の際に三活のコックを垂直にした場合、斜めにした場合と比較して大きな採血誤差を生じる可能性が示された。(著者抄録), 克誠堂出版(株), 日本語

無輸血自己弁温存大動脈基部置換術の1症例
新井田周宏, 森本裕二, 紙谷寛之, 大川陽史, 柳清洋佑, 井上聡巳, 臨床麻酔(真興交易), 42, 1, 29‐32, 2018年01月20日
日本語

Cantrell症候群に合併した大動脈縮窄複合に対するNorwood手術の1例
坂井俊朗, 斉藤仁志, 森本裕二, Cardiovascular Anesthesia, 22, Suppl, 2018年

難治性の高度肺胞出血の補助治療として肺血流制限を試みた救命例
糸洲佑介, 早坂怜, 斉藤仁志, 石川岳彦, 森本裕二, 日本集中治療医学会学術集会(Web), 45th, 2018年

特発性腹腔内出血により出血性ショックに至った患者の超緊急帝王切開術の麻酔経験
安藤貴士, 斉藤仁志, 森本裕二, 日本臨床麻酔学会誌, 38, 6, 2018年

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(Web), 25, 3, 2018年

B群連鎖球菌による壊死性筋膜炎を発症し,感染性心内膜炎を合併した,高度肥満患者の一例
早坂怜, 斉藤仁志, 石川岳彦, 森本裕二, 丸藤哲, 日本集中治療医学会学術集会(Web), 45th, 2018年

小児心臓手術中に人工心肺回路が閉塞した1症例
久保康則, 干野晃嗣, 森敏洋, 森本裕二, 臨床麻酔(真興交易), 41, 12, 1677‐1679, 1679, 2017年12月20日
1歳男児。左心低形成症候群に対しtotal cavopulmonary connection手術を予定した。体外循環回路は輸血による充填を行い、このときの活性化全血凝固時間が347秒であったためヘパリンを追加投与した。人工心肺開始8分後に人工肺の閉塞が疑われたため直ちに体外循環から離脱し人工肺の交換を行った。交換に要した時間は約7分であり、その間自脈で血圧は保たれていた。人工肺交換後に体外循環を再開し、手術は予定通り終了し、明らかな神経学的後遺症を認めず術後15日目に集中治療室を退室した。人工肺の製造元による調査報告では、ガス交換部のマイクロスコープ観察では交換膜に全層にわたり付着物を認め、電子顕微鏡による観察では中空糸の間隙に血小板とその周囲にフィブリン網が絡みつくように形成されているのが確認された。, 真興交易(株)医書出版部, 日本語

常染色体優性多発嚢胞腎および肝嚢胞の痛みに対してオピオイド治療を開始した1例
藤井 知昭, 三浦 基嗣, 長谷 徹太郎, 敦賀 健吉, 森本 裕二, 日本ペインクリニック学会誌, 24, 4, 349, 352, 2017年10月
常染色体優性多発性嚢胞腎(autosomal dominant polycystic kidney disease:ADPKD)患者の多くはなんらかの痛みを有しており、その管理法として段階的治療が提唱されている。今回、多発肝嚢胞を合併したADPKDに伴う痛みの症例を経験した。非ステロイド性抗炎症薬やアセトアミノフェンよりもトラマドールが有効であったことと、低濃度局所麻酔薬を用いた硬膜外ブロックにより痛みが軽減したこと、リドカイン全身投与が無効であったことから、内臓由来の痛みが主であると判断した。腹腔神経叢ブロックの有効性も検討したうえで、オピオイド治療を開始することにより、良好に管理しえた。オピオイド鎮痛薬はバソプレシン作用増強による腎嚢胞増大の可能性に注意する必要があるが、内臓由来の痛みに対しては有効と考えられる。(著者抄録), (一社)日本ペインクリニック学会, 日本語

経胎盤的抗不整脈投与療法中の母体の帝王切開においてクリアサイトを用いて管理をした1症例の麻酔経験
三上 仁衣奈, 打浪 有可, 田中 暢洋, 斉藤 仁志, 森本 裕二, 日本臨床麻酔学会誌, 37, 6, S291, S291, 2017年10月
日本臨床麻酔学会, 日本語

双胎間輸血症候群に対する胎児鏡下胎盤吻合血管レーザー凝固術の周術期管理についての検討
長谷川 栄, 打浪 有可, 斉藤 仁志, 田中 暢洋, 森本 裕二, 日本臨床麻酔学会誌, 37, 6, S296, S296, 2017年10月
日本臨床麻酔学会, 日本語

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, 2017年10月
日本臨床麻酔学会, 日本語

麻酔薬の神経毒性に関する議論
斉藤 仁志, 内田 洋介, 森本 裕二, 小児科, 58, 11, 1349, 1355, 2017年10月
金原出版(株), 日本語

左心低形成症候群を合併した食道閉鎖症患者の麻酔経験
糸洲 佑介, 田中 暢洋, 森本 裕二, Cardiovascular Anesthesia, 21, Suppl., 261, 261, 2017年09月
(一社)日本心臓血管麻酔学会, 日本語

小児心臓手術中に人工心肺回路が閉塞した1症例
久保 康則, 水野谷 和之, 干野 晃嗣, 森 敏洋, 森本 裕二, Cardiovascular Anesthesia, 22, Suppl., 287, 287, 2017年09月
(一社)日本心臓血管麻酔学会, 日本語

左室肥大や流出路狭窄がない患者の非弁膜症手術中に僧帽弁収縮期前方運動が生じた1症例
出村 理海, 干野 晃嗣, 森 敏洋, 水野谷 和之, 久保 康則, 森本 裕二, Cardiovascular Anesthesia, 22, Suppl., 360, 360, 2017年09月
(一社)日本心臓血管麻酔学会, 日本語

幼若期ストレスによるラットのうつ様行動に対するケタミンの効果とその神経基盤研究　　　　　　　　　　　　　　　
相川 勝洋, 吉田 隆行, 大村 優, 泉 剛, 吉岡 充弘, 森本 裕二, 日本生物学的精神医学会・日本神経精神薬理学会合同年会プログラム・抄録集, 39回・47回, 163, 163, 2017年09月
日本生物学的精神医学会・日本神経精神薬理学会, 日本語

第2種高気圧酸素治療装置における油圧ユニットの圧力計破損の経験　　　　　　　　　　　　　　　
平子 竜大, 石川 正勝, 岡本 花織, 太田 稔, 長谷 徹太郎, 敦賀 健吉, 森本 裕二, 日本高気圧環境・潜水医学会雑誌, 52, Suppl., 50, 50, 2017年09月
(一社)日本高気圧環境・潜水医学会, 日本語

高気圧酸素治療における創部用ドレナージバック破損の経験　　　　　　　　　　　　　　　
平子 竜大, 石川 勝清, 岡本 花織, 太田 稔, 長谷 徹太郎, 敦賀 健吉, 森本 裕二, 日本高気圧環境・潜水医学会雑誌, 52, Suppl., 51, 51, 2017年09月
(一社)日本高気圧環境・潜水医学会, 日本語

抜管後の喉頭痙攣への対処法について　　　　　　　　　　　　　　　
干野 晃嗣, 森本 裕二, 楠本 篤弘, 臨床麻酔, 41, 8, 1137, 1141, 2017年08月
真興交易(株)医書出版部, 日本語

抗リン脂質抗体症候群を合併した帝王切開12症例の検討
田中 暢洋, 村上 仁志, 佐藤 美奈, 森本 裕二, 森川 守, 水上 尚典, 麻酔, 66, 8, 818, 823, 2017年08月
抗リン脂質抗体症候群を合併した帝王切開の麻酔管理では、抗血小板薬、抗凝固薬の投薬により麻酔方法の選択に悩む場合が少なくない。同一施設での複数の症例をまとめた報告は少なく、当施設における最近7年間の12症例の麻酔経験を報告する。全身麻酔管理が7症例、脊髄くも膜下硬膜外併用麻酔での管理が3症例、脊髄くも膜下麻酔単独での管理が2症例であった。術後、出血イベントが2症例、母体の集中治療を要したのが1症例存在した。(著者抄録), 克誠堂出版(株), 日本語

気道管理 当院における乳児挿管困難症例の原因についての検討　　　　　　　　　　　　　　　
打浪 有可, 藤田 憲明, 森本 裕二, 日本小児麻酔学会誌, 23, 1, 125, 125, 2017年08月
日本小児麻酔学会, 日本語

特殊疾患 小児陽子線治療に伴い、短期間に複数回の連続挿管を要した2症例の検討　　　　　　　　　　　　　　　
藤田 憲明, 敦賀 健吉, 森本 裕二, 日本小児麻酔学会誌, 23, 1, 144, 144, 2017年08月
日本小児麻酔学会, 日本語

無輸血Modified Bentall手術5例の経験　　　　　　　　　　　　　　　
新井田 周宏, 萩原 綾希子, 森本 裕二, 大川 陽史, 柳清 洋佑, 井上 聡巳, 臨床麻酔, 41, 7, 987, 990, 2017年07月
同種血輸血によって心臓大血管手術の予後が悪化するとの報告があり、当院では無輸血心臓大血管手術に取り組んでいる。今回5例の無輸血modified Bentall手術を経験した。患者は年齢57±12歳(平均±標準偏差)で、全例大動脈弁輪拡張症(AAE)であった。麻酔導入後に希釈式自己血輸血(ANH)を1,090±340mL採血した。人工心肺(CPB)中の最低ヘモグロビン(Hb)5.9±1.1g/dLで、赤血球濃厚液(RBC)輸血を回避しえた。CPB後ANH返血後に止血が得られた。ANH実施後のROTEMはEXTEM A10 37.6±1.1mm、FIBTEM A10 4.8±1.3mmであった。また、回収式自己血輸血678±222mLを実施した。全例同種血輸血を回避した周術期無輸血Bentall手術が可能となり、合併症を認めずに退院した。(著者抄録), 真興交易(株)医書出版部, 日本語

くも膜下フェノールブロックによってメサドンを減量し在宅療養に移行できた1症例　　　　　　　　　　　　　　　
敦賀 健吉, 長谷 徹太郎, 三浦 基嗣, 森本 裕二, 日本ペインクリニック学会誌, 24, 3, 172, 172, 2017年06月
(一社)日本ペインクリニック学会, 日本語

七物降下湯がアロディニアに有効であったCRPSの一例　　　　　　　　　　　　　　　
藤井 知昭, 三浦 基嗣, 長谷 徹太郎, 敦賀 健吉, 森本 裕二, 日本ペインクリニック学会誌, 24, 3, 392, 392, 2017年06月
(一社)日本ペインクリニック学会, 日本語

メサドン導入時の薬剤調整の検討　　　　　　　　　　　　　　　
三浦 基嗣, 敦賀 健吉, 長谷 徹太郎, 森本 裕二, 日本ペインクリニック学会誌, 24, 1, 91, 91, 2017年02月
(一社)日本ペインクリニック学会, 日本語

多発性嚢胞腎及び肝嚢胞の痛みに対してオピオイド導入を行い自宅退院が可能となった1例　　　　　　　　　　　　　　　
藤井 知昭, 三浦 基嗣, 長谷 徹太郎, 敦賀 健吉, 森本 裕二, 日本ペインクリニック学会誌, 24, 1, 92, 92, 2017年02月
(一社)日本ペインクリニック学会, 日本語

体外膜型酸素化装置を要した急性骨髄性白血病の寛解導入療法後肺炎に合併した輸血関連急性肺障害の一例
斉藤 仁志, 舘澤 亮大, 早坂 怜, 水野谷 和之, 石川 岳彦, 森本 裕二, 丸藤 哲, 日本集中治療医学会雑誌, 24, Suppl., DP30, 1, 2017年02月
(一社)日本集中治療医学会, 日本語

血友病A患者に対する脳死肝移植の経験　　　　　　　　　　　　　　　
水野谷 和之, 藤好 直, 石川 岳彦, 森本 裕二, 丸藤 哲, 日本集中治療医学会雑誌, 24, Suppl., DP76, 1, 2017年02月
(一社)日本集中治療医学会, 日本語

ミノサイクリンは敗血症マウス海馬のシナプス可塑性低下を抑止する　　　　　　　　　　　　　　　
干野 晃嗣, 森本 裕二, 日本集中治療医学会雑誌, 24, Suppl., O34, 1, 2017年02月
(一社)日本集中治療医学会, 日本語

前額部に貼付した体温測定プローブの干渉により脳波エントロピーが異常高値を示した1症例
水野谷 和之, 横山 健, 片山 勝之, 森本 裕二, 麻酔, 65, 12, 1279, 1281, 2016年12月
26歳男性。左橈尺骨骨折に対し観血的骨接合術が予定された。フェンタニル、プロポフォールで麻酔導入し、気道確保後に右前額部から右側頭部にかけてエンテロピーモジュール(M-Entropy)のセンサーを貼付し、手術開始時からプローブPDIを貼付して体温測定を開始した。手術開始から30分で誘因なく突然エントロピー値が高値を示したが、脳波の原波形では徐波(σ波)と睡眠紡錘波を認めていたため、何らかのノイズなどによるエラーを疑い、麻酔深度は変更しなかった。脳波の表示振幅を100μVから50μVに変更したところ、低振幅の速波と思われる波形の混入が認められ、その後の検討から前額部に貼付した体温測定プローブの干渉により脳波エントロピーが異常高値を示したと結論に至った。, 克誠堂出版(株), 日本語

【麻酔関連機器の現況と課題】 脳波モニタと筋弛緩モニタ
水野谷 和之, 森本 裕二, 医療機器学, 86, 6, 543, 548, 2016年12月
(一社)日本医療機器学会, 日本語

気管内挿管下全身麻酔管理で陽子線治療を実施した小児がんの2症例(Proton beam therapy for pediatric cancer with endotracheal intubation under the general anesthesia: A report of two cases)
橋本 孝之, 敦賀 健吉, 小林 浩之, 井口 晶裕, 本多 昌平, 杉山 未奈子, 安田 耕一, 宮城 久之, 山口 秀, 藤田 憲明, 大島 淳二郎, 長 祐子, 鬼丸 力也, 清水 伸一, 寺坂 俊介, 森本 裕二, 白土 博樹, 日本小児血液・がん学会雑誌, 53, 4, 366, 366, 2016年11月
(NPO)日本小児血液・がん学会, 英語

当院での小児鎖肛手術におけるアセトアミノフェン静注薬の使用と周術期管理への影響についての検討
田中 暢洋, 森本 裕二, 日本臨床麻酔学会誌, 36, 6, S289, S289, 2016年10月
日本臨床麻酔学会, 日本語

抜管一ヵ月後に再挿管を要する急激な喉頭炎と両側声帯麻痺を発症した頭部外傷患者の一例
相川 勝洋, 森本 裕二, 日本臨床麻酔学会誌, 36, 6, S348, S348, 2016年10月
日本臨床麻酔学会, 日本語

無輸血Bentall手術4例の経験　　　　　　　　　　　　　　　
新井田 周宏, 萩原 綾希子, 森本 裕二, Cardiovascular Anesthesia, 20, Suppl., 231, 231, 2016年09月
(一社)日本心臓血管麻酔学会, 日本語

小児心臓手術における術後循環作動薬投与量と短期予後との関係
山本 真崇, 森 敏洋, 森本 裕二, Cardiovascular Anesthesia, 20, Suppl., 268, 268, 2016年09月
(一社)日本心臓血管麻酔学会, 日本語

第2種高気圧酸素治療装置における油圧ユニットの圧力計破損の経験　　　　　　　　　　　　　　　
平子 竜大, 石川 勝清, 岡本 花織, 佐々木 亮, 松本 剛直, 前野 幹, 千葉 裕基, 村田 裕宣, 太田 稔, 森本 裕二, 敦賀 健吉, 長谷 徹太郎, 日本高気圧環境・潜水医学会雑誌, 51, 3, 176, 176, 2016年09月
(一社)日本高気圧環境・潜水医学会, 日本語

子どものエキスパートに聞く 麻酔はヒトの小児の神経発達に本当に悪影響を及ぼすか?　　　　　　　　　　　　　　　
森本 裕二, 日本小児麻酔学会誌, 22, 1, 55, 55, 2016年09月
日本小児麻酔学会, 日本語

亜酸化窒素はNMDA受容体阻害作用により新生仔ラット海馬歯状回における新生顆粒細胞の移動を阻害する　　　　　　　　　　　　　　　
斉藤 仁志, 森本 裕二, 日本神経麻酔集中治療学会プログラム・抄録集, 20回, 30, 30, 2016年07月
日本神経麻酔集中治療学会, 日本語

脊柱側彎症手術における運動誘発電位低下症例の検討　　　　　　　　　　　　　　　
藤田 憲明, 森本 裕二, 市川 智大, 村上 望, 澁谷 斉, 加畑 馨, 清水 力, 日本神経麻酔集中治療学会プログラム・抄録集, 20回, 35, 35, 2016年07月
日本神経麻酔集中治療学会, 日本語

胸腹部大動脈瘤手術におけるプロポフォール投与量に関する検討　　　　　　　　　　　　　　　
斉藤 仁志, 森 敏洋, 森本 裕二, 日本神経麻酔集中治療学会プログラム・抄録集, 20回, 41, 41, 2016年07月
日本神経麻酔集中治療学会, 日本語

高度の頸動脈狭窄にIABPが有用であった心臓手術の1症例　　　　　　　　　　　　　　　
新井田 周宏, 森本 裕二, 日本神経麻酔集中治療学会プログラム・抄録集, 20回, 54, 54, 2016年07月
日本神経麻酔集中治療学会, 日本語

強度難治性のがん性痛に対して多剤併用で終末期の緩和ケアを行った1症例　　　　　　　　　　　　　　　
敦賀 健吉, 田巻 知宏, 森本 裕二, 日本ペインクリニック学会誌, 23, 1, 77, 77, 2016年02月
(一社)日本ペインクリニック学会, 日本語

フォンタン型手術時の乳酸値と短期予後との関係　　　　　　　　　　　　　　　
山本 真崇, 八木 泰憲, 斉藤 仁志, 森 敏洋, 森本 裕二, 日本集中治療医学会雑誌, 23, Suppl., 447, 447, 2016年01月
(一社)日本集中治療医学会, 日本語

Saccharomyces cereviciaeによる真菌敗血症の1例
斉藤 仁志, 森本 裕二, 日本集中治療医学会雑誌, 23, Suppl., 670, 670, 2016年01月
(一社)日本集中治療医学会, 日本語

シリコン製充填材による気管支充填術の有用性 -難治性気管支胸膜瘻を呈した後天性免疫不全症候群の一例-
斉藤仁志, 品川尚文, 石川岳彦, 丸藤哲, 森本裕二, 日本集中治療医学会雑誌(Web), 22, 5, 2015年

超音波内視鏡下吸引穿刺生検術後に血胸を来した1例
斉藤 仁志, 石川 岳彦, 丸藤 哲, 森本 裕二, 日本集中治療医学会雑誌, 22, Suppl., [DP106, 5], 2015年01月
(一社)日本集中治療医学会, 日本語

産科異常妊娠の麻酔 (特集 産科と麻酔 : 帝王切開と無痛分娩の麻酔法) -- (帝王切開麻酔の実際と留意点)
加藤 亮子, 森本 裕二, 産婦人科の実際, 63, 8, 1073, 1077, 2014年08月
金原出版, 日本語

NEONATAL EXPOSURE TO NITROUS OXIDE DISTURBS GRANULE CELL MIGRATION IN THE RAT DENTATE GYRUS
H. Saito, R. Kato, T. Hashimoto, Y. Uchida, T. Hase, K. Takita, Y. Morimoto, ANESTHESIA AND ANALGESIA, 118, S174, S174, 2014年05月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

幼若ラットの海馬機能に対する全身麻酔薬の長期的な障害作用
加藤 類, 橘 かおり, 内田 洋介, 橋本 聡一, 瀧田 恒一, 森本 裕二, 日本臨床麻酔学会誌, 34, 1, 18, 24, 2014年
近年，神経発達期の実験動物に対する全身麻酔薬暴露が神経細胞死や認知機能障害を引き起こすことが報告されている．海馬における長期増強現象（long-term potentiation：LTP）は認知機能に深く関与しているが，幼若期の麻酔薬暴露により長期的な影響を受ける可能性がある．われわれは，幼若期のラットにペントバルビタール，セボフルラン，プロポフォールを暴露し，海馬機能に与える長期的な影響を電気生理学的手法を用いて検討した．その結果これらの薬剤は，海馬CA1領域におけるLTPを長期的に抑制することが明らかとなった．幼若期の麻酔薬暴露は長期的なシナプス可塑性の異常を誘導し，成長後の認知機能障害の原因となる可能性が示唆された．, THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA, 日本語

招請講演 麻酔薬はヒトの脳にとって本当に悪いのか? (日本麻酔科学会第60回学術集会講演特集号)
森本 裕二, 橘 かおり, 加藤 類, 麻酔, 62, S11, 20, 2013年11月
克誠堂出版, 日本語

医学部における高気圧酸素治療に関する教育についての検討
橋本聡一, 長谷徹太郎, 内田洋介, 加藤類, 敦賀健吉, 森本裕二, 日本高気圧環境・潜水医学会雑誌, 47, Supplement, 38, 2012年09月30日
日本語

難治性疼痛に対する強オピオイドとトラマドール配合錠の効果比較
敦賀健吉, 長谷徹太郎, 内田洋介, 加藤類, 橋本聡一, 森本裕二, 日本ペインクリニック学会誌, 19, 3, 328, 2012年06月25日
日本語

全身麻酔薬の細胞保護効果(サイトプロテクション)
森本裕二, 日本麻酔科学会リフレッシャーコース(Web), 11th, WEB ONLY, 2012年
日本語

高気圧酸素治療における臨床高気圧酸素治療技師によるプリセプター制度の検討
石川勝清, 遠田麻美, 岡本花織, 竹内千尋, 佐々木亮, 前野幹, 太田稔, 敦賀健吉, 加藤類, 伊藤亮子, 橋本聡一, 森本裕二, 日本高気圧環境・潜水医学会雑誌, 46, 4, 253, 2011年12月31日
日本語

Sevoflurane do not induce cardioprotection in patients undergoing off-pump coronary artery bypass surgery
H. Sakamoto, K. Harasawa, Y. Morimoto, H. Wakisaka, EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 27, 1, 73, 74, 2010年06月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

1秒量が1lを下回る患者に対する全身麻酔-過去5年間の症例検討も交えて-
斉藤仁志, 秦琢磨, 森本裕二, 麻酔, 57, 6, 2008年

Isoflurane bidirectionally modulates the hippocampal paired-pulse responses in vivo
Kaori Tachibana, Yuji Morimoto, NEUROSCIENCE RESEARCH, 58, S191, S191, 2007年
ELSEVIER IRELAND LTD, 英語, 研究発表ペーパー・要旨（国際会議）

脊髄損傷合併妊娠・分娩管理の1例　　　　　　　　　　　　　　　
森川 守, 山田 秀人, 平山 恵美, 山田 俊, 島田 茂樹, 片岡 宙門, 長 和俊, 森本 裕二, 櫻木 範明, 水上 尚典, 北海道産科婦人科学会会誌, 50, 1, 95, 95, 2006年06月
北海道産科婦人科学会, 日本語

メチルマロン酸血症の小児に対する生体部分肝移植における麻酔管理
敦賀健吉, 真弓享久, 森本裕二, 藤堂省, 窪田満, Journal of Anesthesia, 20, Supplement (CD-ROM), 2006年

一過性脳虚血-再灌流障害に対する人工酸素運搬体(TRM645)の効果
掛端仁, 山口拓, 富樫広子, 森本裕二, 吉岡充弘, Journal of Anesthesia, 20, Supplement (CD-ROM), 2006年

Electrophysiological and neurochemical characterization of milnacipran on the rat serotonergic and noradrenergic systems
Kaori Tachibana, Machiko Matsumoto, Mitsuhiro Yoshioka, Yuji Morimoto, JOURNAL OF PHARMACOLOGICAL SCIENCES, 101, 115, 115, 2006年
JAPANESE PHARMACOLOGICAL SOC, 英語, 研究発表ペーパー・要旨（国際会議）

A free radical scavenger, edaravone (MCI-186) protects nearly pure neuronal culture against hypoxic and glutamate insult.
K Hisano, Y Morimoto, Y Hua, N Kimura, CRITICAL CARE MEDICINE, 33, 12, A101, A101, 2005年12月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

脊髄損傷合併妊娠・分娩管理の1例　　　　　　　　　　　　　　　
森川 守, 山田 秀人, 平山 恵美, 山田 俊, 島田 茂樹, 片岡 宙門, 長 和俊, 森本 裕二, 櫻木 範明, 水上 尚典, 日本産科婦人科学会東北連合地方部会誌, 53, 69, 69, 2005年11月
日本産科婦人科学会-東北連合地方部会, 日本語

集中治療領域におけるエンドトキシンおよび(1→3)-β-D-グルカン値に関する基礎的・臨床的検討 : 人工心肺手術と肝移植手術における変化
丸藤 哲, 石谷 利光, 小島 琢, 伊藤 敬子, 櫻谷 文香, 森本 裕二, 日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine, 12, 4, 387, 393, 2005年10月01日
日本語

脊髄損傷合併妊娠の1例
森川 守, 山田 秀人, 平山 恵美, 片岡 宙門, 島田 茂樹, 渡利 道子, 山田 俊, 長 和俊, 森本 裕二, 水上 尚典, 周産期医学, 35, 3, 427, 430, 2005年03月
30歳女.27歳時に交通事故でTh7/8での脱臼骨折を被り,胸髄損傷の診断を受け,Th6-10での後方整復固定術が施行された.その後,車椅子移乗自力可能な状態で退院となり,29歳時に妊娠した.妊娠25週で子宮頸管長2.9cmと短縮を認め,妊娠29〜31週に5.4kgの体重増加を認めたため,妊娠31週より入院管理となった.分娩は経腟/帝王切開のダブルセットアップ,硬膜外麻酔と硫酸マグネシウム(MgSO4)静脈内持続投与による自律神経過緊張症(AH)のコントロール下で行うこととし,同時にAH発症時の対応法を取り決めた.妊娠35週まで塩酸リトドリン静脈内持続点滴投与による切迫早産管理を行い,36週からはMgSO4静脈内持続投与に変更した.妊娠37週に硬膜外麻酔下で分娩誘発を実施し経腟分娩を目指したが,児心音悪化を認め緊急帝王切開術施行となった.結果2690gの男児をapgar score5分後6点で娩出し,分娩後9日目に母児とも経過良好にて退院した, (株)東京医学社, 日本語

多発性筋炎を合併した長期臥床患者の麻酔経験　　　　　　　　　　　　　　　
越後谷 雄一, 佐藤 泰征, 松浦 弘司, 安達 昭, 森本 裕二, 臨床麻酔, 29, 3, 617, 618, 2005年03月
65歳男性.患者は多発性筋炎を合併し長期臥床中で,左外腸骨動脈と左総大腿動脈閉塞に対し右総大腿-左深大腿動脈バイパス術を予定していた.麻酔法は腰部硬膜外麻酔を主体とし,ミダゾラムと亜酸化窒素による全身麻酔を併用とした.その結果,自発呼吸下で麻酔管理を行ったが,術中の血行動態は安定し,良好な周術期管理を得ることができた, 真興交易(株)医書出版部, 日本語

プロポフォールの一過性脳虚血障害に対する影響
掛端仁, 富樫広子, 吉岡充弘, 森本裕二, Journal of Anesthesia, 19, Supplement (CD-ROM), 2005年

神経因性疼痛に対する酢酸フレカイニドの鎮痛効果の検討　　　　　　　　　　　　　　　
武隈 洋, 山﨑浩二郎, 志賀弘康, 菅原 満, 宮崎勝巳, 小澤剛久, 柴田万里子, 橋本聡一, 森本裕二, 第6回抗不整脈薬TDM研究会（東京）, 2005年

デクスメデトミジン　　　　　　　　　　　　　　　
中村高士, 加藤類, 関下純可, 佐藤大輔, 櫻谷文香, 唐思健, 桑原稔, 柴田万里子, 瀧田恒一, 橋本聡一, 森本裕二, 臨床麻酔, 29, 729, 733, 2005年
日本語, 記事・総説・解説・論説等（その他）

麻酔薬に脳保護効果はあるか-プロポフォール, イソフルラン, セボフルランに関する5年間のレビュー-
森本裕二, 臨床麻酔, 7, 1159, 1174, 2004年

Effects of propofol on action potential and ionic currents in guinea pig cardiomyocytes
F Sakuraya, S Kobayashi, M Azuma, T Ishitani, N Matsuda, Y Morimoto, S Gando, J Kimura, Y Hattori, JOURNAL OF PHARMACOLOGICAL SCIENCES, 94, 160P, 160P, 2004年
JAPANESE PHARMACOLOGICAL SOC, 英語, 研究発表ペーパー・要旨（国際会議）

Regional differences in milnacipran-induced synaptic plasticity between prefrontal cortex and hippocampus
K Tachibana, M Matsumoto, K Tahara, H Togashi, Y Morimoto, M Yoshioka, JOURNAL OF PHARMACOLOGICAL SCIENCES, 94, 92P, 92P, 2004年
JAPANESE PHARMACOLOGICAL SOC, 英語, 研究発表ペーパー・要旨（国際会議）

神経因性疼痛に対する酢酸フレカイニドの鎮痛効果とTDMの有用性　　　　　　　　　　　　　　　
山﨑浩二郎, 武隈 洋, 志賀弘康, 菅原 満, 宮崎勝巳, 小澤剛久, 柴田万里子, 橋本聡一, 森本裕二, 第18回北海道TDM研究会 研究発表会（札幌）, 2004年

Cerebral oxygenation changes during pediatric surgeries for cyanotic cardiac diseases
K Hisano, Y Morimoto, INTENSIVE CARE MEDICINE, 29, S51, S51, 2003年09月
SPRINGER-VERLAG, 英語, 研究発表ペーパー・要旨（国際会議）

Effect of acidosis on apoptosis and necrosis induced by hypoxia in neuronal PC 12 cells.
Hirochika Shikama, Yuji Morimoto, Satoshi Watanabe, Takaki Shibano, Kenjiro Hisano, Yu Hua, Sijian Tang, Osamu Kemmotsu, Circulatory Control, 24, 1, 53, 57, 2003年

Chnages in Cerebral Oxygenation State and Blood Volume During Tracheal Intubation : Comparison Between Thiamylal and Propofol
MORIMOTO Yuji, KEMMOTSU Osamu, HISANO Kenjiro, HUA Yu, TANG Sijian, MORIMOTO Yoshiko, 循環制御, 24, 2, 124, 130, 2003年
英語

Changes in cerebral oxygenation in children undergoing surgical repair of ventricular septal defects
Y Morimoto, Y Niida, K Hisano, Y Hua, O Kemmotsu, T Murashita, K Yasuda, ANAESTHESIA, 58, 1, 77, 83, 2003年01月
There have been few published studies on changes in cerebral oxygenation during paediatric cardiac surgery as measured by conventional near-infrared spectroscopy. We studied changes in cerebral oxygenation in 16 children undergoing surgical repair of ventricular septal defects. Fifteen of the patients showed similar patterns of changes: brain tissue concentrations of oxyhaemoglobin decreased significantly during cardiopulmonary bypass, whereas there was no significant change in brain tissue concentrations of deoxyhaemoglobin. In the remaining patient, who suffered decreased blood flow to the lower body during surgery, the pattern of changes was different to that of the other subjects. This patient suffered postoperative respiratory and renal failure. This study suggests that conventional near-infrared spectroscopy may be useful for clinical monitoring during ventricular septal defect repair., BLACKWELL PUBLISHING LTD, 英語

血液ガス (特集 ERにおける循環器疾患の管理) -- (4 検査)
森本 裕二, 丸藤 哲, 救急医学, 26, 10, 1253, 1256, 2002年09月
へるす出版, 日本語

Effects of mild and moderate hypothermia on apoptosis in neuronal PC12 cells
T Shibano, Y Morimoto, O Kemmotsu, H Shikama, K Hisano, Y Hua, BRITISH JOURNAL OF ANAESTHESIA, 89, 2, 301, 305, 2002年08月
Background. There is still a possibility that mild hypothermic therapy may be useful as a neuroprotective tool during the intraoperative period, although the mechanism of cerebral protection by mild hypothermia is not well understood. We hypothesized that mild hypothermia may be protective against cerebral ischaemia by inhibiting post-ischaemia apoptosis. In this study, we used serum-deprived PC12 cells as the neuronal apoptotic model and examined the direct effects of mild and moderate hypothermia.
Methods. Apoptosis was induced by depriving the cell culture medium of serum, which is one of the most representative methods to induce apoptosis, but not necrosis, in PC12 cells. Effects of mild (35 and 33degreesC) and moderate (31 and 29degreesC) hypothermia on apoptosis were evaluated. Cytotoxicity (lactate dehydogenase leakage) and the percentage of apoptotic cells (calculated by flow cytometry with propidium iodide) were evaluated 4 days after induction of apoptosis. As a control, cells without induction of apoptosis were incubated under the same conditions as the apoptosis group.
Results. Without induction at 37degreesC, cytotoxicity and the percentage of apoptotic cells were over 60 and 90%, respectively. At each temperature examined below 35degreesC, significant decreases in cytotoxicity and the percentage of apoptotic cells were observed. Mean cytotoxicity at 31 and 29degreesC was 50.2 (sd 4.2)% and 47.9 (4.4)%, respectively. The percentage of apoptotic cells at 31 and 29degreesC was 42.5 (7.4)% and 36.5 (7.3)%, respectively. In the control group, cytotoxicity and the percentage of apoptotic cells were significantly higher at 29degreesC than at 37degreesC.
Conclusions. Mild and moderate hypothermia (29-35degreesC) inhibited apoptosis, although hypothermia below 30degreesC may induce apoptosis in intact cells., OXFORD UNIV PRESS, 英語

The Use of A Perioperative Patient Information System for Improved Point-of-care Data Management
OKAMURA Atsushi, MORIMOTO Yuji, HARASAWA Katsumi, SATO Naoki, KEMMOTSU Osamu, 循環制御 = CIRCULATION CONTROL, 23, 2, 164, 170, 2002年06月28日
英語

Percutaneous Cardiopulmonary Support in the Last Decade
SASAKI Shigeyuki, ISHITANI Toshiteru, NANZAKI Satoshi, MORIMOTO Yuji, KEMMOTSU Osamu, GANDO Satoshi, YASUDA Keishu, 循環制御 = CIRCULATION CONTROL, 22, 2, 125, 131, 2001年06月30日
英語

Significance of systemic inflammatory response syndrome after hepatectomy.　　　　　　　　　　　　　　　
Circulatory Control, 22, 215, 219, 2001年

Tissue factor pathway inhibitor response does not correlate with tissue factor-induced DIC and MODS in trauma patients
S Gando, S Nanzaki, T Kameue, Y Morimoto, O Kemmotsu, CRITICAL CARE MEDICINE, 28, 12, A140, A140, 2000年12月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

Hypokalemic coma with tetany following pseudo-Bartter syndrome
M Hayakawa, S Gando, Y Morimoto, Y Takeyama, T Sato, Matubara, I, INTENSIVE CARE MEDICINE, 26, 11, 1711, 1711, 2000年11月
SPRINGER-VERLAG, 英語, 速報，短報，研究ノート等（学術雑誌）

輸液・輸血加温法および装置 (特集 アトラス ベッドサイド処置) -- (2 循環器系の手技)
森本 裕二, 丸藤 哲, 救急医学, 24, 10, 1216, 1219, 2000年09月
へるす出版, 日本語

Effect of acidosis and antioxidants on neuronal cell death due to hypoxia
H Shikama, Y Morimoto, T Shibano, O Kemmotsu, ANESTHESIOLOGY, 93, 3A, U186, U186, 2000年09月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

An Increase in Macrophage Migration Inhibitory Factor Release in Patients with Cardiopulmonary Bypass Surgery
GANDO SATOSHI, NISHIHIRA JUN, KEMMOTSU OSAMU, KOBAYASHI SHIGEAKI, MORIMOTO YUJI, MATSUI YOSHIRO, YASUDA KEISHU, Surgery today : the Japanese journal of surgery, 30, 8, 689, 694, 2000年08月01日
英語

The effect of calcium channel blockers on cerebral oxygenation during tracheal extubation
Y Morimoto, Y Morimoto, O Kemmotsu, S Gando, T Shibano, H Shikama, ANESTHESIA AND ANALGESIA, 91, 2, 347, 352, 2000年08月
Calcium channel blockers are effective in stabilizing systemic hemodynamics during tracheal extubation. However, they may increase cerebral blood flow (CBF) during tracheal extubation because of cerebral vasodilation, even if systemic arterial blood pressure decreases. In this study, we observed changes in cerebral oxygenation during tracheal extubation by using near-infrared spectroscopy and evaluated the effect of nicardipine and diltiazem on the resultant changes. We studied 45 women undergoing elective gynecologic surgery. After surgery, the patients were randomly allocated to three groups (n = 15 each): saline (control), 0.02 mg/kg nicardipine, and 0.2 mg/kg diltiazem. After 2 min, we started to aspirate secretions for 2 min and then, extubated the trachea. Changes in cerebral oxygenated hemoglobin (Hbo(2)) and deoxygenated hemoglobin were measured during the extubation procedure for 9 min after drug treatment. Systemic hemodynamics, including mean arterial blood pressure, heart rate, end-tidal Co-2, end-tidal sevoflurane concentration, and peripheral arterial oxygen saturation were also monitored. During extubation, Hbo(2) increased significantly, presumably caused by the increase in CBF. Changes in deoxygenated hemoglobin were minimal. Compared with the control, nicardipine and diltiazem significantly inhibited the increase in mean arterial blood pressure. On the contrary, they significantly enhanced the increase in Hbo(2). In conclusion, calcium channel blockers may increase CBF during extubation, even if these drugs stabilize systemic hemodynamics., LIPPINCOTT WILLIAMS & WILKINS, 英語

Development of severe diabetic keto-acidosis with shock after changing interferon-beta into interferon-alpha for chronic hepatitis C
M Hayakawa, S Gando, Y Morimoto, O Kemmotsu, INTENSIVE CARE MEDICINE, 26, 7, 1008, 1008, 2000年07月
SPRINGER-VERLAG, 英語, 速報，短報，研究ノート等（学術雑誌）

Pentobarbital inhibits apoptosis in neuronal cells
Y Morimoto, Y Morimoto, J Nishihira, O Kemmotsu, T Shibano, S Gando, H Shikama, CRITICAL CARE MEDICINE, 28, 6, 1899, 1904, 2000年06月
Objective: Previous reports have demonstrated that barbiturates have a protective effect against cerebral ischemia, although the mechanisms are incompletely understood. Recently, it has been suggested that apoptosis is involved in ischemic neuronal death. This study examined the effect of pentobarbital on neuronal apoptosis,
Design: Randomized, controlled, prospective study.
Setting: University research laboratory.
Subjects: PC12 cells derived from rat pheochromocytoma as a model of neuronal tissue.
Interventions: Apoptosis was induced by depriving serum from the cell culture medium. Effect of pentobarbital (0.5, 5, 50 mu g/ml) was evaluated.
Measurements and Main Results: First, electrophoresis of DNA and fluorescence microscopic examination were performed to ascertain whether apoptosis was really induced after serum deprivation in our cells. Second, the effect of pentobarbital an cytotoxicity (evaluated by a leakage assay of lactic dehydrogenase) was evaluated. Third, the percentage of apoptotic cells was calculated by measuring cellular DNA content with flow cytometry. Calculation of the percentage of apoptotic cells was based on cumulative frequency curves of the appropriate DNA histograms. DNA electrophoresis exhibited a typical ladder pattern from the first day after the induction of apoptosis. The cells with chromatin condensation and/or fragmentation increased day by day after depriving serum in fluorescence microscopic examination. Four days after the induction of apoptosis, cytotoxicity without pentobarbital was 53.9 +/- 24.3% (mean +/- SD). Pentobarbital significantly inhibited cell death in a dose-dependent fashion. The percentage of apoptotic cells without pentobarbital was 94.9 +/- 6.3% 4 days after the induction of apoptosis. The treatment with 50 mu g/mL pentobarbital significantly decreased the percentage of apoptotic cells to 61.8 +/- 21.3%.
Conclusions: Our data indicate that pentobarbital inhibits apoptosis induced by serum deprivation in PC12 cells., LIPPINCOTT WILLIAMS & WILKINS, 英語

minitracheotomy後の換気不全の1症例
松田 直之, 中村 高士, 森本 裕二, 麻酔, 49, 4, 428, 431, 2000年04月
克誠堂出版, 日本語

ARDSの予後規定因子 (特集 ARDSとその周辺)
丸藤 哲, 森本 裕二, 剣物 修, 救急医学, 23, 8, 951, 958, 1999年08月
へるす出版, 日本語

End-tidal CO₂ and Resuscitation　　　　　　　　　　　　　　　
Current Opinion in Anaesthesiology, 12, 2, 173, 7, 1999年

多臓器不全におけるDIC (特集 DIC--救急領域における位置づけ)
丸藤 哲, 南崎 哲史, 森本 裕二, 救急医学, 22, 11, 1671, 1678, 1998年10月
へるす出版, 日本語

Effect of hypothermia on apoptosis in neuronal cells
T Shibano, Y Morimoto, O Kemmotsu, ANESTHESIOLOGY, 89, 3A, U708, U708, 1998年09月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

Pathological evaluation of venous emboli during total hip arthroplasty
M Hayakawa, Y Fujioka, Y Morimoto, O Kemmotsu, ANESTHESIOLOGY, 89, 3A, U952, U952, 1998年09月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

Automated Anesthesia Record Keeping by Engineering Work Station Four Years Experience
OKAMURA Atsushi, MORIMOTO Yuji, OHTA Yoshihiro, SATOH Naoki, KEMMOTSU Osamu, OHSAKI Yasuhiko, 循環制御 = CIRCULATION CONTROL, 19, 2, 246, 254, 1998年06月30日
英語

Effects of NMDA receptor glycine recognition site antagonism on cerebral metabolic rate for glucose and cerebral blood flow in the conscious rat
Y Morimoto, B Wu, RD Bart, Y Morimoto, RD Pearlstein, DS Warner, BRAIN RESEARCH, 779, 1-2, 170, 176, 1998年01月
Glycine is a requisite cofactor for glutamatergic activation of the N-methyl-D-aspartate (NMDA) receptor. Antagonism of glutamate at the NMDA receptor has been shown to cause substantial changes in regional cerebral metabolic rate for glucose utilization (CMRglu) and blood flow (CBF). This study examined CMRglu and CBF changes caused by antagonism of glycine at the NMDA receptor recognition site. Rats were anesthetized with halothane and vascular access was obtained. The animals were then awakened. One hour later, either vehicle (control) or ACEA 1021 (5 mg/kg followed by 3.5 mg.kg(-1).h(-1) or 10 mg/kg followed by 7 mg.kg(-1).h(-1)) was infused intravenously. CMRglu and CBF were then determined. Autoradiographic analysis of 25 regions revealed effects of ACEA 1021 on CMRglu in the frontal, sensory, parietal and auditory cortices and the anteroventral and subthalamic nuclei. These changes deviated less than 15% from control. Effects on CBF were also small. The CMRglu and CBF effects of ACEA 1021 are substantially less than those previously observed for either competitive or non-competitive glutamate NMDA antagonists. We conclude that inhibition of the NMDA glycine recognition site has little or no effect on CMRglu or CBF at the doses examined. This is consistent with the absence of psychotomimetic effects observed for this class of drugs. (C) 1998 Elsevier Science B.V., ELSEVIER SCIENCE BV, 英語

High-dose fentanyl does not adversely affect outcome from forebrain ischemia in the rat
Y Morimoto, Y Morimoto, RD Bart, RD Pearlstein, F Dexter, DS Warner, JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 9, 4, 316, 323, 1997年10月
Fentanyl citrate has properties, including agonism of the mu-opioid receptor and proconvulsant activity, that theoretically could pose adverse effects in ischemic brain. This study examined the effects of high-dose fentanyl on outcome in rats subjected to transient near-complete forebrain ischemia. Rats were anesthetized with halothane and surgically prepared for ischemia. In one group (fentanyl; n = 15), intravenous fentanyl (400 mu g/kg followed by an infusion of 16 mu g/kg/min for 20 min) was administered and halothane was discontinued. In the remaining rats (control: n = 15), halothane administration was continued and no fentanyl was given. Following 10 min of bilateral carotid artery occlusion and profound systemic hypotension, animals were maintained normocapnic, normothermic, and mildly hyperoxemic for 8 h. Four days later, histologic and neurologic outcomes were assessed. In another group of rats also administered halothane (uncontrolled recovery, n = 15), no attempt was made to control physiologic variables during recovery from ischemia. Fentanyl caused preischemic evidence of epileptoid activity but decreased the percentage of neurons that died in the CA(1) sector of the hippocampus relative to control (p = 0.0005). Damage in the cortex or caudoputamen was not different from that in the control group. Rats with an uncontrolled recovery had decreased damage in the cortex (p = 0.005) and caudoputamen (p = 0.00015) relative to control. In this model of forebrain ischemia, fentanyl caused no worsening of histologic damage in the cortex or caudoputamen and decreased hippocampal CA(1) injury despite major electroencephalographic activation in the immediate preischemic period., LIPPINCOTT-RAVEN PUBL, 英語

Extracellular acidosis delays cell death against glucose-oxygen deprivation in neuroblastoma x glioma hybrid cells
Y Morimoto, Y Morimoto, O Kemmotsu, ES Alojado, CRITICAL CARE MEDICINE, 25, 5, 841, 847, 1997年05月
Objective: To determine whether extracellular acidosis delays cell death against glucose-oxygen deprivation and, if so, whether this result is due to inhibition of calcium (Ca2+) influx or preservation of cellular energy state.
Design: Randomized, controlled, prospective study.
Setting: University research laboratory.
Subjects: Differentiated neuroblastoma x glioma NG108-15 cells.
Interventions: Experiment 1: cells were incubated for 8 hrs in N-(2-hydroxyethyl)piperazine-N'-2-ethane acid buffered medium under glucose-oxygen deprivation at pH 7.4, 6.8, 6.5, 6.2, 5.6, or 5.0, Experiment 2: cells were incubated for 8 hrs under glucose-oxygen deprivation after excluding extracellular calcium from culture medium at pH 7.4 or 6.2, Experiment 3: cells were incubated for 2, 4, 6, or 8 hrs in N-(2-hydroxyethyl)piperazine-N'-2 ethanesulfonic acid-buffered medium under glucose-oxygen deprivation at pH 7.4 or 6.2 and assayed for high energy phosphates.
Measurements and Main Results: Cell viability was measured with flow cytometry after the cells were stained with fluorescein diacetate and propidium iodide, Cellular adenosine triphosphate, adenosine diphosphate, and adenosine monophosphate were analyzed with high performance liquid chromatography, Cell viability was significantly greater at pH 6.2 than at pH 7.4 in experiment 1, By excluding extracellular calcium, a significant difference in viability between pH 7.4 and 6.2 persisted in experiment 2, Energy charge and the concentration of adenosine triphosphate were significantly greater at pH 6.2 than at pH 7.4 in the intervals preceding manifestation of a differential effect of acidosis on cell viability in experiment 3.
Conclusions: Extracellular acidosis at pH 6.2 delayed cell death against glucose-oxygen deprivation. This protective effect by extracellular acidosis may be due to preservation of the cellular energy state in NG108-15 cells, although this study does not exclude the possibility that in other cell types, inhibition of calcium influx may have an effect., LIPPINCOTT WILLIAMS & WILKINS, 英語

Mechanism of cellular swelling induced by extracellular lactic acidosis in neuroblastoma-glioma hybrid (NG108-15) cells
ES Alojado, Y Morimoto, Y Morimoto, O Kemmotsu, ANESTHESIA AND ANALGESIA, 83, 5, 1002, 1008, 1996年11月
The mechanism of cellular swelling induced by extracellular lactic acidosis and the effect of diuretics were studied using neuroblastoma-glioma hybrid (NG108-15) cells. The cells were incubated in one of three lactate concentrations (0, 15, or 30 mM), each of which was randomized to one of three pH groups (7.4, 6.2, or 5.0). Analysis of the swelling was measured using a Coulter counter technique. Cellular swelling was most prominent at pH 6.2 at all lactate levels. Cellular swelling was noted to be pH dependent but not lactate dependent. The addition of 1 mM amiloride completely blocked cellular swelling, suggesting that the main mechanism of neuronal cellular swelling induced by extracellular lactic acidosis was the activation of Na+/H+ exchange. Second, three dissimilar diuretic drugs were used for cellular swelling: amiloride (Na+/H+ exchange inhibitor), mannitol (osmotic diuretic), and bumetanide (loop diuretic). Amiloride and mannitol were found effective in reducing the lactic acidosis-induced cellular swelling. Furthermore, the combination of these drugs had additive effects. However, bumetanide was not effective. The results indicate that the direct inhibition of Na+/H+ exchange and/or removal of water from the cell by mannitol was effective against cellular swelling induced by the activation of Na+/H+ exchange in NG108-15 cells., WILLIAMS & WILKINS, 英語

Extramyocardial acidosis impairs cardiac resuscitability in isolated, perfused, rat hearts
Y Morimoto, O Kemmotsu, Y Morimoto, CRITICAL CARE MEDICINE, 24, 10, 1719, 1723, 1996年10月
Objectives: Patients suffering out-of-hospital cardiac arrest have various degrees of acidemia when cardiopulmonary resuscitation is initiated. Myocardial hypercarbia, rather than decreases in myocardial pH, may determine cardiac resuscitability. Accordingly, we questioned whether different degrees of acidemia accompanying cardiac arrest affect cardiac resuscitability. We evaluated the effect of different degrees of extramyocardial acidosis on cardiac performance and resuscitability after ventricular fibrillation using isolated, perfused, rat hearts.
Design: Prospective, randomized, controlled study.
Setting: Experimental animal laboratory in a university hospital.
Subjects: Thirty one male, Sprague-Dawley rats.
Interventions: Rat hearts were perfused with N-[2-hydroxyethyl]piperazine-N-[2-ethanesulfonic acid] (HEPES) buffered solution (sodium chloride 145 mM, potassium chloride 4 mM, sodium dihydrogen phosphate dihydrate 1.25 mM, magnesium chloride 1.5 mM, calcium chloride 2 mM, HEPES 6 mM, glucose 10 mM), which was bubbled with 100% oxygen and adjusted to a pH of 7.4. The perfusion pressure was held constant at 60 mm Hg. After 60 mins of stabilization, the control perfusion solution was switched to one of the solutions titrated to pH 6.2, 6.5, 6.8, 7.1, or 7.4, using 1 N of sodium hydroxide. Hearts were allocated randomly to each group. After 15 mins of perfusion, the perfusion was discontinued, and artificial ventricular fibrillation was induced by electrical stimulation for 5 mins. The hearts were then perfused again in one of the same acidotic solutions for 30 mins.
Measurements and Main Results: Left ventricular developed pressure (left ventricular pressure minus end-diastolic left ventricular pressure), positive change in left ventricular pressure over time, heart rate (HR), and coronary flow were continuously measured. After 60 mins of stabilization, the values of left ventricular developed pressure, positive change in left ventricular pressure over time, HR, and coronary flow were not significantly different between groups. After 5 mins of ventricular fibrillation, all hearts were asystolic and left ventricular developed pressure, positive change in left ventricular pressure over time, HR, and coronary flow were all zero. After 30 mins of reperfusion, all values in the acidotic groups were significantly lower than the values in the pH 7.4 group. When we judged the recovery of left ventricular developed pressure at >35 mm Hg as ''resuscitated,'' resuscitability was impaired at a pH of <7.1. No hearts recovered after perfusion below a pH of 6.5.
Conclusions: Extramyocardial acidosis below pH 7.1 decreased cardiac performance and resuscitability after ventricular fibrillation. This result indicates that progressive acidemia during cardiac arrest is one of the important determinants of cardiac resuscitability., WILLIAMS & WILKINS, 英語

Acute changes in intracranial pressure and pressure-volume index after forebrain ischemia in normoglycemic and hyperglycemic rats
Y Morimoto, Y Morimoto, DS Warner, RD Pearlstein, STROKE, 27, 8, 1405, 1409, 1996年08月
Background and Purpose Hyperglycemia enhances the deleterious effect of global cerebral ischemia. One possible explanation is that increased anaerobic glycolysis leads to exaggeration of intracellular acidosis and increased postischemic edema. To examine the importance of this edema on postischemic cerebral perfusion dynamics, we measured acute changes in intracranial pressure (ICP), specific gravity, and the pressure-volume index (PVI) after forebrain ischemia in normoglycemic and hyperglycemic rats.
Methods Rats underwent 15 minutes of forebrain ischemia and 90 minutes of reperfusion. ICP and mean arterial pressure were continuously monitored. Before ischemia, rats received either saline or glucose intravenously. Ninety minutes after ischemia, the specific gravity of the neocortex was measured. In a second experiment, the PVI was measured at 20 and 60 minutes after ischemia.
Results Preischemic ICP (mean+/-SD) was 7+/-1 mm Hg in both groups. A peak ICP (approximate to 11 mm Hg) occurred within 15 to 20 minutes after ischemia in both groups. Between 25 and 80 minutes after ischemia, ICP was significantly but only slightly greater in hyperglycemic than in normoglycemic rats. Cerebral perfusion pressure was similar between groups and remained greater than 100 mm Hg. Specific gravity was also similar for both groups but was less than normal values. The PVI in hyperglycemic rats was lower than in normoglycemic rats, indicating reduced compliance.
Conclusions These findings indicate that hyperglycemia-augmented intraischemic tissue acidosis does not contribute to worsened outcome by means of compromised cerebral perfusion pressure during the early stages of recovery. Nevertheless, evidence was found for decreased cerebral compliance, indicating an effect of hyperglycemia on intracranial volume compartments other than cortical parenchyma., LIPPINCOTT WILLIAMS & WILKINS, 英語

気管内挿管 (特集 救急処置中のトラブルと対策)
森本 裕二, 救急医学, 20, 4, 374, 377, 1996年04月
へるす出版, 日本語

27.麻酔情報管理における高性能ワークステーション : 3年間の改良点と今後の展望 : 第71回日本医科器械学会大会予稿集
岡村 篤, 佐藤 直樹, 森本 裕二, 劔物 修, 医科器械学, 66, 4, 224, 224, 1996年04月01日
日本医療機器学会, 日本語

自動麻酔記録システム : 3年間の実績と問題点の評価
岡村 篤, 森本 裕二, 松田 英彦, 劒物 修, 日本手術医学会誌 = Journal of Japanese Association for Operating Room Technology, 17, 1, 80, 81, 1996年02月28日
日本語

EFFECT OF SINGLE OR COMBINED TREATMENT WITH DIURETICS OF THE LACTIC ACIDOSIS-INDUCED NEURONAL CELL SWELLING
ES ALOJADO, Y MORIMOTO, Y MORIMOTO, O KEMMOTSU, ANESTHESIOLOGY, 83, 3A, A719, A719, 1995年09月
LIPPINCOTT-RAVEN PUBL, 英語, 研究発表ペーパー・要旨（国際会議）

153. 内視鏡下手術用フィブリングルー・スプレーの使用経験
西部 俊哉, 佐藤 直樹, 森本 裕二, 椎谷 紀彦, 武田 直樹, 伊藤 美智子, 内野 純一, 道家 充, 大久保 哲之, 高橋 利幸, 奥芝 俊一, 本原 敏司, 加藤 紘之, 西部 正泰, 日本手術医学会誌 = Journal of Japanese Association for Operating Room Technology, 16, 3, 507, 509, 1995年08月31日
日本語

157.術後MRSA感染症の治療 : 整形外科手術例を中心に
武田 直樹, 佐藤 直樹, 椎谷 紀彦, 森本 裕二, 西部 俊哉, 伊藤 美智子, 内野 純一, 日本手術医学会誌 = Journal of Japanese Association for Operating Room Technology, 16, 3, 515, 516, 1995年08月31日
日本語

血液感染症の術前スクリーニング結果の動向とその意義
椎谷 紀彦, 武田 直樹, 西部 俊哉, 森本 裕二, 佐藤 直樹, 安田 慶秀, 日本手術医学会誌 = Journal of Japanese Association for Operating Room Technology, 16, 2, 318, 319, 1995年05月31日
日本語

Auditory brainstem responses after out-of-hospital cardiac arrest: Are they useful for outcome prediction?
Yuji Morimoto, Osamu Kemmotsu, Koichi Kitami, Izumi Matsubara, Ichiro Tedo, Journal of Anesthesia, 9, 1, 22, 26, 1995年03月
We evaluated whether we could predict the neurologic outcome in 55 out-of-hospital cardiac arrest patients using auditory brainstem responses (ABR). ABR patterns were classified into one of 3 types by evaluation of 5 components: type 1, with all 5 components
type 2, lack of at least one response between the 2nd and 5th components
type 3, with only the first component or no response. The relation between the ABR patterns on the 3rd day following resuscitation and the neurologic outcome on hospital discharge was evaluated. The specificity that the 5 awake patients had type-1 ABR was 38%. The sensitivity that the 10 brain dead patients had type-3 ABR was 60%. In the type-1 ABR patients, the negative predictive value that the patients were awake was 100%. In the type-3 ABR patients, the negative predictive value that the patients became brain dead was 90.9%. These results suggest that ABR on the 3rd post-resuscitation day may not be useful for predicting if patients are awake or become brain dead, although the loss of components may be a sign of morbidity, and the presence of the 2nd or later components indicates possible future prevention of brain death. © 1995 JSA., Springer-Verlag, 英語

PHOSPHOLIPASE-C INHIBITOR, NEOMYCIN PROTECTS THE NEURONAL CELLS AGAINST AN ISCHEMIC INSULT
Y MORIMOTO, Y MORIMOTO, O KEMMOTSU, ANESTHESIOLOGY, 81, 3A, A826, A826, 1994年09月
LIPPINCOTT WILLIAMS & WILKINS, 英語, 研究発表ペーパー・要旨（国際会議）

Crossover effects of acidosis on the recovery of neuronal function following glucose-oxygen deprivation in rat hippocampal slices
Yuji Morimoto, Takeyasu Yamamura, Osamu Kemmotsu, Journal of Anesthesia, 8, 3, 334, 338, 1994年09月
The present study was designed to determine whether acidosis modifies the effect of simulated ischemia on neuronal function. Hippocampal evoked potentials were recorded in vitro from the CA1 region after stimulation of the Schaffer collaterals and the change in the evoked potentials was analyzed in response to glucose-oxygen deprivation under variable acid-base conditions ranging from pH 7.4 to pH 4.5. Population spike (PS) activity was almost abolished with glucose-oxygen deprivation except for pH 6.5, indicating that mild acidosis minimizes the depressant effect of glucose-oxygen deprivation on neuronal transmission. The recovery of PS amplitude during recovery from glucose-oxygen deprivation was not significantly inhibited by moderate acidosis of pH 6 and 5.5 but was significantly inhibited when the pH was 5 or lower. The results suggest that severe acidosis may depress PS amplitude and prevent their recovery after reversal of glucose-oxygen deprivation, and that moderate acidosis may have no significant effect on PS amplitudes on their recovery. © 1994 JSA., Springer-Verlag, 英語

EFFECT OF LACTIC AND CO2 ACIDOSIS ON NEURONAL FUNCTION FOLLOWING GLUCOSE OXYGEN DEPRIVATION IN RAT HIPPOCAMPAL SLICES
Y MORIMOTO, O KEMMOTSU, Y MORIMOTO, BRAIN RESEARCH, 654, 2, 273, 278, 1994年08月
The present study was designed to determine whether lactate changes the critical pH point at which the recovery of rat population spike is inhibited following glucose-oxygen deprivation and second, which degree of lactic acidosis is similar to the effect of CO2 acidosis. The population spike was recorded from the hippocampal CA1 region after stimulation of the Schaffer collaterals. Slices were randomly perfused with various acidotic solutions for 30 min. During the last 15 min, glucose-oxygen deprivation was combined with the acidotic perfusion. Then the hippocampal slices were perfused with a standard solution of pH 7.4 for 60 min and recovery was compared to the control population spike and expressed as a percentage of the control value. In the control acidotic solution, the critical pH point was 5.0. When 15 mM or 30 mM lactate were added to the control solution, the critical pH point changed to 5.5 or 6.0, suggesting that the inhibition of the population spike was enhanced by lactate in a dose-dependent fashion. The recovery of the population spike was inhibited by exposing the slices to CO2 of 25% or above (pH was 5.76 or below) and this inhibition of recovery associated with CO2 acidosis was the same degree as occurred with 30 mM, namely severe lactic acidosis., ELSEVIER SCIENCE BV, 英語

END-TIDAL CO2 CHANGES UNDER CONSTANT CARDIAC-OUTPUT DURING CARDIOPULMONARY-RESUSCITATION
Y MORIMOTO, O KEMMOTSU, F MURAKAMI, T YAMAMURA, T MAYUMI, CRITICAL CARE MEDICINE, 21, 10, 1572, 1576, 1993年10月
Objectives: To evaluate a) whether end-tidal CO2 values change under constant cardiac output during cardiopulmonary resuscitation (CPR), and b)what factors are responsible for the change.
Design: A cohort study.
Setting. University research laboratory.
Subjects: Nine mongrel dogs.
Interventions. Ventricular fibrillation was electrically induced. After 2 mins, open-chest cardiac massage was initiated to maintain cardiac output at 0.2 L/min (23% of baseline cardiac output) by the measurement of blood flow with an electromagnetic flow probe on the ascending aorta. The cardiac massage was kept constant until 50 mins after the induction of ventricular fibrillation.
Measurements and Main Results: Before and during ventricular fibrillation, end-tidal CO2, minute volume of alveolar ventilation, and CO2 excretion were continuously monitored. Blood gases and oxygen saturation values were also measured in arterial and the mixed venous blood samples. CO2 content was calculated. After induction of ventricular fibrillation, end-tidal CO2 decreased and thereafter continued to increase until the end of the experiment. Two mechanisms may have contributed to the early reduction in end-tidal CO2. One mechanism is a further decrease in CO2 excretion compared with the reduction in alveolar ventilation and the other is an increase in alveolar deadspace (estimated from the increase in the difference between Paco 2 and end-tidal CO2) . The subsequent increase in end-tidal CO2 was mainly due to a change in CO2 excretion. There are two hypotheses concerning the subsequent increase in CO2 excretion: the increase in pulmonary capillary blood flow (estimated from the change in the arteriovenous CO2 content gradient) and the increase in CO2 Production itself.
Conclusions. End-tidal CO2 changes under constant cardiac output during CPR. When end-tidal CO2 is used to estimate the effectiveness of the cardiac massage, this type of change must be recognized., WILLIAMS & WILKINS, 英語

EFFECTS OF LACTIC AND CO2 ACIDOSIS ON OXYGEN-GLUCOSE DEPRIVATION IN THE RAT HIPPOCAMPAL SLICES
Y MORIMOTO, T YAMAMURA, O KEMMOTSU, ANESTHESIOLOGY, 79, 3A, A743, A743, 1993年09月
LIPPINCOTT-RAVEN PUBL, 英語, 研究発表ペーパー・要旨（国際会議）

INFLUENCE OF HYPOXIC AND HYPERCAPNIC ACIDOSIS ON BRAIN WATER-CONTENT AFTER FOREBRAIN ISCHEMIA IN THE RAT
Y MORIMOTO, T YAMAMURA, O KEMMOTSU, CRITICAL CARE MEDICINE, 21, 6, 907, 913, 1993年06月
Objective. To determine whether hypoxia or hypercapnia superimposed on ischemia affects brain water content after ischemia.
Design: Prospective, randomized, controlled trial.
Subjects. Thirty-one male Wistar rats.
Interventions. The rats were assigned randomly into one of six groups: a) control; b) ischemia; c) ischemia combined with hypoxia; d) ischemia combined with hypercapnia;e) hypoxia; f) hypercapnia. Forebrain ischemia was induced for 5 mins by clamping both carotid arteries and inducing exsanguination. Either hypoxia or hypercapnia was induced until the arterial pH decreased to 7.0. The rats were decapitated after the protocol.
Measurements and Main Results: After the decapitation, the specific gravities of the neocortex, caudatoputamen, hippocampus, cerebellum, and midbrain were measured using a variable-density bromobenzene-kerosene column technique as an index of brain swelling. The specific gravities of the hippocampus and the neocortex were significantly lower in the ischemic group than in the control group. Specific gravities of the caudatoputamen and neocortex in the ischemia plus hypercapnia group, and specific gravities of the caudatoputamen, neocortex, and hippocampus in the ischemia plus hypercapnia group, were significantly lower than in the ischemia group.
Conclusions. Cerebral water content increases more when ischemia is accompanied by hypoxia or hypercapnia than after ischemia alone. Hypoxic and/or hypercapnic acidosis during the periresuscitation period may be one of the causes of brain swelling after the resuscitation of patients after an anoxic-ischemic insult., WILLIAMS & WILKINS, 英語

ACUTE BRAIN-SWELLING AFTER OUT-OF-HOSPITAL CARDIAC-ARREST - PATHOGENESIS AND OUTCOME
Y MORIMOTO, O KEMMOTSU, K KITAMI, MATSUBARA, I, TEDO, I, CRITICAL CARE MEDICINE, 21, 1, 104, 110, 1993年01月
Objectives. First, to examine factors that may be related to brain swelling, which was identified by the absence or compression of the lateral and third ventricles and perimesencephalic cisterns on brain computed tomography (CT) scans in the early postresuscitation period in patients who suffered an out-of-hospital cardiac arrest. Second, to characterize the neurologic outcome in those patients in whom cardiac arrest was followed by brain swelling.
Design: Prospective and retrospective analyses.
Settings. General ICU, tertiary care hospital Patients. Fifty-three patients (35 male, 18 female) who had an out-of-hospital cardiac arrest and who also had a brain CT examination on the third day after resuscitation. The 53 patients were divided into two groups: group A (25 patients) experienced brain swelling on postresuscitation day 3; group B (28 patients) did not experience noticeable brain swelling.
Interventions None Measurements and Main Results: There was a significant difference between the two groups in the etiology of the cardiac arrest. Twenty-three of 25 patients in group A had cardiac arrest due to respiratory distress, whereas this finding was true in only five patients in group B. In laboratory data, arterial pH was significantly lower in group A than in group B (6.93 vs. 7.09), as was base deficit (-21.0 mmol/L in group A vs. -13.7 mmol/L in group B). Neurologic outcome was evaluated 1 wk after resuscitation. There were significantly more patients in group A who were not awake and who were diagnosed as brain dead.
Conclusions: The cause of brain swelling may be related to the development of the metabolic acidosis (possibly lactic acidosis) due to hypoxia before the resuscitation period. Brain swelling may be one of the indicators that predicts a poor neurologic outcome in the patients who suffer an out-of-hospital cardiac arrest., WILLIAMS & WILKINS, 英語

Fickの原理による連続的血行動態解析　　　　　　　　　　　　　　　
大塚 浩司, 山村 剛康, 佐藤 賢一, 古御堂 均, 森本 裕二, 劔物 修, 救急医学, 3月臨時増刊号, S, 270, 1990年03月
(株)へるす出版, 日本語

重度低酸素性乳酸アシドーシスに対するNaHCO3とDCAの比較検討　　　　　　　　　　　　　　　
森本 裕二, 村上 富裕美, 仲田 房蔵, 中野 達, 水嶋 雅子, 山村 剛康, 櫻谷 憲彦, 劔物 修, 救急医学, 3月臨時増刊号, S, 415, 1990年03月
(株)へるす出版, 日本語

Fickの原理のよる連続的血行動態解析　　　　　　　　　　　　　　　
大塚 浩司, 山村 剛康, 佐藤 賢一, 古御堂 均, 森本 裕二, 劔持 修, 救急医学, 10月臨時増刊号, S, 733, 1989年10月
(株)へるす出版, 日本語

Anesthesia and Neurotoxicity　　　　　　　　　　　　　　　
森本 裕二
Springer Japan, 2017年, ［編者(編著者)］

統合的ストレス応答が敗血症関連脳障害に果たす役割の解明
科学研究費助成事業
2021年04月01日 - 2025年03月31日
森本 裕二, 内田 洋介, 干野 晃嗣
我々の目的は、敗血症モデルマウスを用いて敗血症性脳症(SAE)における統合的ストレス応答(ISR)の関与、ISRを制御する薬剤であるISRIBの効果について検討することである。
初年度は、敗血症マウスのモデル作成の手技の確立と、認知機能低下の検出を行うこととした。敗血症モデルマウスは盲腸結紮穿刺（CLP）を行い、その重症度は盲腸の結紮箇所と盲腸の穿通の太さ、回数等で調整した。
盲腸端から1.2cmを結紮し、21G針で２回穿刺、術後抗生剤投与を行ったモデルで１週間後の生存率は85%程度となり、このモデルを採用することとした。CLP後の体重推移、活動性について調査した。CLP群では、術後３日程度体重減少が続き、そこからは緩やかに体重が増加した。術後１週間後でのopen fieldでは、ラインクロス回数、Rearing(立ち上がり)、Grooming(毛繕い)のいずれもCLP群で有意に低下しており、明らかに活動性の低下が認められた。術後２週間時点のopen field では、ラインクロス回数、Rearing(立ち上がり)、Grooming(毛繕い)についてsham群とCLP群の差は有意でなく、活動性が回復したものと考えられた。
CLP後２週間時点で、Trace Fear conditioningを行った。trainingの２４時間後のtestにおいてfreezing％を測定したが、sham群とCLP群で有意差は検出できなかった。このことから、本研究で用いたCLPモデルでは、CLP後１週間時点では活動性が低下しているため、行動学の評価は不適当であること、CLP後２週間時点では、活動性が回復しているが、認知機能の低下の低下も検出できないことがわかった。このことから、CLPモデルでは活動性の低下の影響が長く続くため、行動学での認知機能低下の検出が難しい可能性があると考えている。
日本学術振興会, 基盤研究(C), 北海道大学, 21K08917

老化促進モデルマウスを用いた術後高次脳機能障害ならびに認知症への麻酔・手術の影響
科学研究費助成事業
2018年04月01日 - 2021年03月31日
森本 裕二, 斉藤 仁志
加齢・認知機能障害合併マウスにおいて、麻酔・手術が認知機能に及ぼす影響を検討した。結果は、通常マウスにおいては、手術後にのみ神経炎症が増強していたのに比較して、加齢・認知機能障害合併マウスでは、麻酔暴露のみでも海馬における炎症性サイトカインの上昇を認め、神経炎症の増強を明らかにした。
しかし、行動学試験においては加齢・認知機能障害合併マウスの、術後認知機能障害について検出できなかった。理由としては、麻酔・手術を行わないコントロール群で既に認知機能が大幅に低下しており、麻酔・手術の影響を検出することができなかったためと考えている。
日本学術振興会, 基盤研究(C), 北海道大学, 18K08843

術後認知機能障害の機序ー神経炎症からの検討ー
科学研究費助成事業
2013年04月01日 - 2017年03月31日
森本 裕二, 長谷川 完, 干野 晃嗣, 神谷 温之, 橘 かおり
IL-1βがマウス海馬のシナプス可塑性におよぼす影響を検討するために、海馬急性スライスを用い、海馬の様々部位において電気生理学的にシナプスの長期増強（long-term potentiation: LTP）を測定した。結果、IL-1βは海馬の部位によって異なる作用を示し、シナプス特異的な効果があることが明らかとなった。
また、敗血症マウス海馬のシナプス可塑性に対するミノサイクリンの効果を明らかにするために、盲腸結紮穿孔マウスの海馬を用いて実験を行った。結果、ミノサイクリンは敗血症マウス海馬のLTP低下を抑止し、その機序にIL-1受容体を介したシグナルが関与している可能性が示唆された。
日本学術振興会, 基盤研究(C), 北海道大学, 25462420

術後認知機能障害　　　　　　　　　　　　　　　
2013年
森本 裕二
研究代表者, 競争的資金

幼弱脳における麻酔薬の神経毒性の機序-高二酸化炭素血症との関連についてー
科学研究費助成事業
2010年 - 2012年
森本 裕二, 橘 かおり, 敦賀 健吉
新生児期の低酸素性高二酸化炭素血症が、成長後の学習能力に関してどのような影響を与えるかを調査するために、ラットを用い成長後の海馬機能を検討した。生後7の日目新生児ラットを、高濃度二酸化炭素(CO2;13%)に、2または4時間暴露した。生後10週間目でのモリス水迷路テストで、CO2へ暴露されたラットは学習習得能力が低下した。海馬CA1領域におけるシナプスの長期可塑性(long-termpotentiation)形成は抑制された。一方、短期可塑性(paired-pulseresponses)の反応は増強した。新生児期の低酸素性高二酸化炭素血症は、成長後の海馬シナプス可塑性障害を来たし、それが学習障害の一因となっている可能性が示された。
日本学術振興会, 基盤研究(C), 北海道大学, 22591699

幼弱脳における麻酔薬の神経毒性に関する研究
科学研究費助成事業
2006年 - 2007年
森本 裕二, 橘 かおり, 吉岡 充弘, 敦賀 健吉
本実験では、幼若期における全身麻酔薬投与が成長後の海馬機能に与える影響をin vivoで調査した。生後7日目のラットにPentobarbita1(以下Pento,10 mg/kg and 20 mg/kg)を腹腔内投与し、成長後(生後10-12週)の海馬機能を電気生理学的ならびに行動学的(Open-field test;以下OFT)に測定した。電気生理学的検討では、麻酔下ラットの海馬に経頭蓋的に電極を挿入し、Schaffer側枝の刺激によるCA1領域における集合スパイク電位を測定した。高頻度刺激による集合スパイク電位の増加はシナプス長期増強(Long-term potentiation;以下LTP)と呼ばれ、記憶・学習の電気生理学的基盤とされている。本実験では、海馬CA1領域におけるLTP形成は、幼若期Pento投与により著明に抑制された。またOFTでは、ボックスにラットを放ち、水平移動量と垂直移動量とを測定した。これらの値はそれぞれ総運動量と探索行動量の指標とされており、特に探索行動量(垂直移動量)は海馬機能と関連すると報告されている。幼若期Pento投与により、OFTにおいて総運動量に変化は認められなかったが、探索行動量は減少する傾向が示された。以上の結果より、幼若期Pento投与により、成長後の海馬機能が低下している可能性が示唆された。一方で、幼若ラットへのPentoの腹腔内投与は著明な呼吸抑制をまねき、数時間に及ぶ著明な低酸素血症ならびに全身性アシドーシスをきたした(Control;Pa02 113.4±6.0mmHg,pH7.43±0.01,Pento20mg/kg;Pa02 65.3±10.6mmHg,pH7.11±0.09,p<0.01)。幼若ラットへの全身麻酔による成長後の神経学的異常を検討する際には、呼吸抑制作用による低酸素等の影響を加味する必要があると考えられた。
日本学術振興会, 基盤研究(C), 北海道大学, 18591683

シナプス形成期における麻酔薬の神経毒性
科学研究費助成事業
2005年 - 2006年
森本 裕二
シナプス形成期の未成熟脳が麻酔に暴露されると広範囲に細胞死が起こることが、報告されている(J Neurosci 2003;23:876)。ある種の麻酔の組み合わせで、NMDAレセプタの遮断とGABAレセプタの賦活が同時に生じると神経細胞の活動が異常に抑制され、その結果、細胞死に至るという機序が推測されている。しかし、この知見に関する報告はまだ極めて少なく、機序も推測の域を出ない。
本研究ではグリア細胞を排除した選択的初代神経培養系を確立し、上記知見を追試するとともに、その機序について検討を行った。
妊娠18日のWisterラットから胎児を摘出し、開頭の後に大脳を摘出し、前脳を分離し、得られた神経細胞を培養皿上に散布した。培養液はNeurobasal mediumを用い、グリア等を排除した選択的神経細胞培養を使用した。
まず、NMDA拮抗薬MK801とGABAの組み合わせで、負荷1日後の神経細胞死を評価し、培養14日後の細胞で神経細胞死が有意に助長されたが、それより前の7日後、後の21日後では有意な変化は認めなかった。吸入麻酔薬のイソフルランでも同様な結果が見られ、培養神経細胞でも麻酔薬に障害作用がある事、さらにはその障害作用にはtime windowがある事を確認した。次に、細胞死がアポトーシスとネクローシスかを鑑別するため、蛍光顕微鏡(propidium iodide、Ho342染色)による形態学的解析を行った。結果、ネクローシスと比較して、アポトーシスが主に起こることが証明された。
以上より、選択的初代神経培養系においても、NMDAレセプタの遮断とGABAレセプタの賦活でtime windowを有した神経細胞死が生じ、これは主にアポトーシスの進行によることが確認された。
日本学術振興会, 萌芽研究, 北海道大学, 17659482

麻酔薬の神経毒性　　　　　　　　　　　　　　　
2005年
森本 裕二
研究代表者, 競争的資金

吸入麻酔薬の作用機序-超短パルスレーザーを用いた神経細胞膜の動的変化による解析
科学研究費助成事業
2003年 - 2004年
森本 裕二
吸入麻酔薬の作用機序は、これまで色々な角度から検討されてきたにもかかわらず、未だ確定していない。超短パルスレーザーによる細胞膜の動的構造変化の解析は物理化学的手法の中でも高感度で、かつ生理学的条件に近い環境で測定できる方法であるが、これを用いて吸入麻酔薬の作用機序を検討した報告は内外に見あたらない。私たちはこの方法を用い、吸入麻酔薬の生体膜脂質に対する影響を検討した。平成15年度は、生体膜としてヒト赤血球膜脂質を採用し,セボフルラン濃度5%に対する膜脂質流動性変化でも、温度がわずか2℃上昇した時と等価であり、その変化は極めて小さいという結論を得た。平成16年度はセボフルレンとイソフルレンの人工脂質膜に対する影響について調べた。
【方法】DPPC(Dipalmitoyl-L-α-Phosphatidylcholine)で単層脂質膜を作製した。吸入麻酔薬セボフルレンとイソフルレン溶解液はそれぞれ0.1,0.2,0.5,1,2,4mMに調製した。ガスクロマトグラフィで測定した溶解液の麻酔薬含有量はセボフルレン溶液では0.1mM≒0.7MAC,0.5mM≒2.8MAC、イソフルレン溶液ではそれぞれ0.5MACと2MACであった。脂質膜の粘性変化は蛍光偏光解消法により蛍光異光度を測定することで相転移温度を算出し評価した。
【結果】麻酔薬未投与の場合、相転移温度は42℃であったのに対して、濃度が0.2mM以下の場合もほぼ同じく42℃と有意な変化を認めなかった。0.5mM以上ではじめて約2℃低くなり、相転移温度が40℃前後に低下した。
【考察】臨床濃度(〜2MAC)での脂質膜流動性の変化は少なく、臨床濃度を超えた濃度ではじめて流動性亢進(粘性低下)が認められた。以上より、臨床濃度の吸入麻酔薬の膜脂質に対する影響は極めて小さく、作用機序としての膜脂質の可能性は小さいと考えられた。
日本学術振興会, 萌芽研究, 北海道大学, 15659364

初代神経細胞培養系を用いた虚血性神経細胞障害に対する各種麻酔薬・低体温の効果
科学研究費助成事業
2001年 - 2002年
森本 裕二
各種麻酔薬や軽度低体温には、脳保護効果があるとされている。昨今の研究では、その機序は代謝の抑制ではなく、他の何らかの機序が働いていると示唆されているが、その詳細は依然確定していない。本研究では胎仔ラット初代神経細胞培養系を用い、興奮性アミノ酸の代表であるグルタミン酸負荷による神経毒性に対するバルビタールや軽度低体温の保護効果について検討した。妊娠ラットから胎生18日程度の胎仔を取り出した。実体顕微鏡下に大脳半球を摘出し、トリプシンにより細胞を分散し、神経細胞選択性が高いとされるB-27 supplement、N-2 supplement添加Neurobasal mediumを用い、神経細胞を培養した。6日後、37℃で50μMグルタミン酸に30分間暴露し、暴露後にバルビタールや軽度低体温負荷を行った。負荷24時間後に細胞外に流出したLDH活性を測定することにより保護効果を評価した。結果、軽度低体温(33,30度)は温度依存性に保護効果を認めたが、バルビタールには保護効果は認めなかった。一方、グルタミン酸負荷時のみ低体温を併用した群では、保護効果は認めなかった。さらに、軽度低体温の保護効果について、特にアポトーシスと関連しているとされる活性酸素産生とカスペース活性の2点から検討したが有意な結果は得られなかった。以上より、低体温は、グルタミン酸の直接的な作用ではなく、侵襲後に起こる経路の何れかを抑制することが示唆されたが、その経路を確定することは今回の検討では出来なかった。
日本学術振興会, 基盤研究(C), 北海道大学, 13671556

脳虚血に対する軽度低体温,バルビツレートの保護効果-神経細胞を用いた解析-
科学研究費助成事業
1999年 - 2000年
森本 裕二, 渡辺 智
33度前後の軽度低体温の脳虚血に対する脳保護効果は、現在内外で大きく注目されている。また、静脈麻酔薬の一つであるバルビツレートにも脳保護効果があるとされている。しかし、保護効果の機序については依然確定していない。一方、昨今、脳虚血による細胞死はネクローシス以外に、アポトーシスの形態をとることが報告されている。申請者らは「軽度低体温やバルビツレートが何らかの機序によりアポトーシスを抑制し、その結果脳虚血に対する保護効果を発揮する」という仮説を立てた。そこで神経系細胞(PC12細胞)を使い血清除去によりアポトーシスを誘導し、平成11年度は低体温の影響を検討した。本年(平成12年度)はバルビツレートの影響を検討した。LDH活性による細胞傷害率、flow cytometryでDNA含量を測定するすることによるアポトーシス細胞の割合を測定した。その結果、臨床濃度のペントバルビタールは細胞傷害率、アポトーシスの割合は低下した。その機序として以下の2つを測定した。
(1)活性酸素産生の測定
細胞内活性酸素の特異的蛍光指示薬であるC-DCDHF-DAを細胞に添加し、細胞内活性酸素量をフローサイトメトリーにより測定した。アポトーシス誘導により細胞内活性酸素量は約2倍となった。アポトーシス誘導6時間後臨床濃度のペントバルビタールは細胞内活性酸素量を有意に抑制した。
(2)カスペース3活性の測定
特異的合成ペプチド蛍光基質の切断を蛍光により測定し、カスペース3活性を測定した。アポトーシス誘導によりカスペース3活性は増加したがペントバルビタールにより抑制されなかった。以上より神経系細胞におけるペントバルビタールのアポトーシス抑制機序は、活性酸素産生抑制が関与していると考えられた。
日本学術振興会, 基盤研究(C), 北海道大学, 11671474

神経細胞のアポトーシスに及ぼす各種麻酔薬の影響
科学研究費助成事業
1997年 - 1998年
森本 裕二
ある種の静脈麻酔薬や吸入麻酔薬、昨今では軽度低体温に脳保護効果があることが注目されている。最近の研究では、その機序が単に代謝の抑制ではなく、その他の機序の関与が示唆されているが、いまだ確定していない。ネクローシスは主に細胞内エネルギー欠乏により起こるため、代謝の抑制がネクローシス抑制につながりうる。しかしアポトーシスは、細胞内カルシウム濃度の増加、遺伝子の発現、ある種の蛋白分解酵素(caspase)の活性化など、細胞内カスケードの活性化によって起こる。すなわち、代謝抑制ではなく、これらカスケード抑制がアポトーシス抑制につながる可能性がある。そこで私たちは、麻酔薬、軽度低体温の保護効果の機序が、上記カスケードを抑制する結果、アポトーシスを抑制するのではないかという仮説をたてた。平成9年度は静脈麻酔薬が神経系アポトーシスにどのような影響を与えるか検討した。平成10年度は低体温、吸入麻酔薬の影響を検討した。
神経系細胞のモデルとしてラット副腎髄質褐色細胞腫由来のPC12細胞を用い、培養液からの血清除去によりアポトーシスを誘導した。評価は細胞死の判定とアポトーシス細胞の定量化で行った。すなわち、細胞死の判定は培養液中に遊離した乳酸脱水素酵素活性によって、アポトーシス細胞の定量化は細胞をアルコール固定後ヨウ化プロピジウムで染色しフローサイトメトリーによりDNA含量を測定し行った。結果、29-37℃の低体温は温度依存性に、細胞死ならびにアポトーシス細胞の割合の増大を抑制した。一方、イソフルラン、セボフルランなどの吸入麻酔薬にはアポトーシス抑制効果を認めなかった。本研究により、神経系アポトーシスに対して軽度低体温が抑制的であることが初めて明らかにされた。
日本学術振興会, 奨励研究(A), 北海道大学, 09771133

脳虚血時の伝達物質放出と麻酔薬の抑制効果-海馬スライスを用いた解析-
科学研究費助成事業
1996年 - 1996年
森本 裕二
脳虚血時種々の伝達物質が放出される。特にグルタミン酸などの興奮性アミノ酸の放出は、興奮性神経細胞死の原因として注目されている。in vivoの研究では対照群も麻酔下の状態にあり、実際麻酔薬が非麻酔下の状態と比較して伝達物質の放出を抑制するか不明である。したがってラットの海馬スライスに虚血様侵襲を加えて以下の実験を行った。Wister系ラットから麻酔下に大脳半球を摘出しマイクロスライサ-にて350μmの厚さの海馬スライスを作製した。グルコースを除去した人工脳脊髄液で満たされた小dishにスライスを移し、このdishを100%窒素で飽和させたincubatorに移した。すなわちスライスをグルコース、酵素を除去した状態に暴露しin vitroでの虚血様侵襲とした。虚血様侵襲と同時に吸入麻酔薬(イソフルレン、ハロセン)、静脈麻酔薬(ペントバルビタール、プロポフォール)のいずれかを負荷した。虚血様侵襲によりdishの人工脳脊髄液内に放出された興奮正アミノ酸(グルタミン酸、アスパラギン酸)を高速液体クロマトグラフィーにより測定した。コントロールとして塩化カリウム負荷により脱分極させ興奮性アミノ酸を放出させた切片を使用した。一時間の虚血様侵襲により興奮性アミノ酸はコントロールと比較して6倍も上昇した。この上昇はイソフルレン、ハロセンで約1/3に、ペントバルビタールで約半分に抑制されたが、プロポフォールでの抑制効果はみられなかった。以上より、ある種の麻酔薬では虚血様侵襲による興奮性アミノ酸上昇を抑制することが判明した。なお本研究施行中にアメリカのグループより同様の報告がなされたため、新たに脳切片培養を用い興奮性アミノ酸上昇抑制効果と予後との関係を検討すべく研究計画を企図中である。
日本学術振興会, 奨励研究(A), 北海道大学, 08771169

麻酔中の脳酸素化変化　　　　　　　　　　　　　　　
1996年
競争的資金

Cerebral oxygenated state during anesthesia　　　　　　　　　　　　　　　
1996年
競争的資金

維代培養細胞を用いた虚血性神経細胞障害の機序及び各種薬物の保護的効果に関する検討-フローサイトメリ-法による解析-
科学研究費助成事業
1994年 - 1994年
森本 裕二
1.虚血性神経細胞障害時の細胞内Ca^<2+>上昇の機序とその意義:NG108-15細胞に低酸素無グルコース負荷により虚血性侵襲を与え、細胞外Ca^<2+>除去および細胞内Ca^<2+>キレート剤であるBAPTA-AM添加時の生存率をフローサイトメトリーにより測定した。その結果、単に虚血性侵襲のみを加えた場合と比較して、これら負荷時の生存率に有意な増加を認めなかった。したがって、低酸素無グルコース負荷によるNG108-15細胞障害の機序に、細胞内外からのCa^<2+>流入は重要な役割を演じないと結論した。
2.神経虚血に付随するアシドーシスの影響とその機序:NG108-15細胞を種々の程度のアシドーシス下におき、低酸素無グルコース負荷により虚血性侵襲を与えた。その結果pH6.8からpH5.6の間で、pH7.4と比較して生存率の増加を認め、その増加率はpH6.2で最大であった。すなわち、この程度のアシドーシスは虚血性侵襲に対して保護効果を有することが明らかとなった。さらに、この保護効果の機序につきCa^<2+>動態と細胞内エネルギー保存の両面から検討を加えた。その結果後者が重要な機序となる可能性が示唆された。また乳酸アシドーシス単独の細胞浮腫と生存率に及ぼす影響についても検討を行った。この結果、生存率低下はpH、乳酸濃度依存性に起こるが細胞浮腫は非依存性であり浮腫が細胞障害の直接的原因ではないと結論した。
3.虚血後の酸素負荷の影響とその機序:低酸素無グルコース負荷後の純酸素と大気それぞれに暴露した2群を設定し、その生存率を比較したが有意差は認めなかった。
4.薬物の影響については、L型Ca^<2+>チャネル拮抗剤であるニカルジピンは生存率に対して効果を認めなかった。乳酸アシドーシスによる細胞浮腫に対して、浸透圧利尿薬やループ利尿薬と比較してNa^+/H^+交換阻害薬に最も抗浮腫効果を認めた。
日本学術振興会, 奨励研究(A), 北海道大学, 06771177

mRNA注入受容体発現モデルを用いた細胞内2次情報伝達系に対する麻酔薬の作用
科学研究費助成事業
1993年 - 1993年
太田 善博, 森本 裕二
本研究では、細胞内二次情報伝達系に対する揮発性麻酔薬の影響を検討するためにラット脳より抽出したmRNAをアフリカツメガエルに注入し、中枢神経系モデルを作成した。このモデルでは代謝調節型受容体、G蛋白質、phospholipase C(PLC),inositoltrisphosphate(IP3)を介して,Ca^<2+>が放出されCl^-チヤネルが開口し、最終的にCl^-電流が観察される。このCl^-電流を指標として一連の細胞内情報伝達系に対する揮発性麻酔薬の影響の解析が可能となる。本研究では代謝調節型受容体のアゴニストとして5-hydroxy-triptamine(5-HT)を用いた。さらに直接細胞内にIP_3,Ca^<2+>を注入して誘発されるCl^-電流を指標に揮発性麻酔薬の作用点の同定を行った。
揮発性麻酔薬であるハロタン,イソフルラン,メトキシフルランのいずれも、5-HT誘発性Cl^-電流を濃度依存性に抑制し、この変化は可逆的であった。メトキシフルレンによる濃度-反応曲線では、ED_<50>が右方偏位することなく最大値が抑制されたので非競合的抑制であることが示唆された。IP_3,Ca^<2+>注入によって誘発される電流応答はハロタン、イソフルラン、メトキシフルランのいずれによっても変化を認めなかった。
本研究の成績から以下の2点が明かとなった。
1)揮発性麻酔薬は代謝調節型受容体を介する細胞内二次情報伝達系を抑制した。
2)代謝調節型受容体、G蛋白質、PLCなどの細胞膜に存在する成分が揮発性麻酔薬の重要な作用点であることが示唆された。
日本学術振興会, 一般研究(C), 北海道大学, 05671246

脳虚血に対する麻酔薬の保護効果　　　　　　　　　　　　　　　
1989年
競争的資金

Protective effect of anesthetic agents on brain ischemia　　　　　　　　　　　　　　　
1989年
競争的資金

心肺脳蘇生に及ぼす酸塩基平衡異常の影響　　　　　　　　　　　　　　　
1987年
競争的資金

The effect of abnormal acid-base status on cerbral cardiopulmonary resuscitation　　　　　　　　　　　　　　　
1987年
競争的資金