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巻野 将平医学部附属病院 麻酔科講師
研究活動情報
■ 論文- We describe the perioperative management of a pregnant woman with severe needle phobia who underwent a cesarean section. General anesthesia with slow induction using an inhalant anesthetic for cesarean section is a rare and unique situation. Furthermore, the management of this case was more complicated because the patient not only refused the puncture procedure but also refused the presence of an indwelling object when she woke up from the anesthesia. After the operation, the patient was admitted to the intensive care unit (ICU) and received mechanical ventilation under deep sedation. The patient was managed under sedation until the day after surgery, and both mother and child progressed without perioperative complications.2024年04月, Cureus, 16(4) (4), e59032, 英語, 国際誌
- (一社)日本集中治療医学会, 2023年11月, 日本集中治療医学会雑誌, 30(6) (6), 463 - 464, 日本語
- A Case of a Highly Obese Covid-19 Patient with Severe Hypoxemia and Subcutaneous Mediastinal Emphysema Who Was Rescued by Early Introduction of ECMO.We conducted the treatment of a highly obese patient with severe Covid-19 pneumonia who had a history of asthma. When she arrived at the hospital, she was already intubated and had mediastinal emphysema and severe hypoxemia. Because the patient's condition did not improve with mechanical ventilation, we introduced extracorporeal membrane oxygenation (ECMO) immediately after admission. The patient improved with early induction of ECMO and prone positioning. In the management of patients with severe Covid-19 pneumonia, early introduction of ECMO should be considered if oxygenation does not improve with mechanical ventilation, and prone positioning can also be effective.2023年07月, The Kobe journal of medical sciences, 69(2) (2), E49-E51, 英語, 国内誌研究論文（学術雑誌）
- PURPOSE: Patients undergoing gynecological surgery are considered to be a high-risk cohort for postoperative nausea and vomiting (PONV). The purpose of this study was to assess the association of intraoperative end-tidal carbon dioxide (EtCO2) with risk of PONV in patients underwent gynecological open surgery. METHODS: In this single-center retrospective observational study, we included patients aged 20-60 years who underwent elective gynecological open surgery. We obtained data for the incidence of PONV within 24 h after operation. We collected EtCO2 every minute during the operation, and determined the lowest value of EtCO2. We compared the lowest EtCO2 between patients with and without PONV. Multivariate logistic regression analysis was performed to assess the independent association of EtCO2 with the risk of PONV. RESULTS: A total of 146 patients were included in the current study. There were 81 patients with PONV within 24 h after the operation. The median lowest value of EtCO2 in patients with PONV was significantly lower than that in patients without PONV (31 vs 33 mmHg, p = 0.02). In the multivariate logistic regression model, we found that lowest EtCO2 ≤ 31 mmHg was independently associated with increase in the risk of PONV (adjusted odds ratio = 3.37, p = 0.02). CONCLUSION: In this retrospective observational study, low intraoperative EtCO2 was shown to be independently associated with increased risk of PONV. However, this result may be skewed by uncollected information including previous PONV, motion sickness or other unknown bias, so future studies should be conducted to refute or confirm our findings.2020年04月, Journal of anesthesia, 34(2) (2), 195 - 201, 英語, 国内誌[査読有り]
- Anesthetic Management of Transcatheter Aortic Valve Replacement under Extracorporeal Membrane Oxygenation in a Patient with Acute Decompensated Heart Failure: A Case Report.We managed general anesthesia for transcatheter aortic valve replacement (TAVR) under elective extracorporeal membrane oxygenation (ECMO) in a patient with aortic valve stenosis (AS) complicated with acute decompensated heart failure. The patient was an 87-year-old woman with acute heart failure due to severe AS who had been hospitalized. However, her low cardiac output did not improve, and weaned her off catecholamines was difficult, so semi-urgent TAVR was performed. Due to her acute decompensated heart failure complicated by low-left ventricular function, we decided electively to use ECMO for transfemoral TAVR to prevent hemodynamic collapse during induction of anesthesia and surgery, enabling the safe perioperative management of this patient under general anesthesia.2019年11月, The Kobe journal of medical sciences, 65(3) (3), E90-E94, 英語, 国内誌[査読有り]
- PURPOSE: To assess the impact of intravenous isotonic and hypotonic maintenance fluid on the risk of delirium in adult postoperative patients, we conducted retrospective before-after study in a tertiary teaching hospital. METHODS: We examined all adult patients admitted ICU after an elective operation for head and neck cancer, or esophageal cancer from February 2014 to January 2017. From February 2014 to July 2015, patients were administered hypotonic fluid (sodium; 35 mmol/L) as the National Institute for Health and Care Excellence (NICE) have recommended. From August 2015 to January 2017, patients were administered isotonic fluid (sodium; 140 mmol/L). We defined the incidence of delirium as the primary outcome. The delirium was defined as the Intensive Care Delirium Screening Checklist during the ICU stay ≥ 4. A propensity score-matched model was used to adjust confounders. RESULTS: As postoperative intravenous maintenance fluid, hypotonic fluid was administered to 119 patients and isotonic fluid was administered to 92 patients. Among those total cohorts, the incidence of postoperative delirium in the hypotonic group was 21.8%, which was significantly higher than that (9.8%) in the isotonic group (p = 0.019). After propensity score matching, we selected 77 patients in each group. The incidence of delirium during the ICU stay in the hypotonic group was 26.0%, which was significantly higher than the incidence of 11.7% in the isotonic group (p = 0.023). CONCLUSIONS: In this study, the use of postoperative hypotonic maintenance fluid was associated with a higher risk of postoperative delirium than that when isotonic maintenance fluid was used.2019年04月, Journal of anesthesia, 33(2) (2), 287 - 294, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- Background: Hyperbilirubinemia is a common postoperative complication. Elevated direct bilirubin (D-Bil) and indirect bilirubin (I-Bil) levels are related to different pathophysiologies; therefore, their associations with outcomes also differ. However, there have been few comparative studies of such associations in postoperative patients. Methods: This retrospective study compared the associations of postoperative D-Bil and I-Bil with outcomes. We included adult patients requiring postoperative intensive care for more than 48 hours between 2008 and 2013, except those undergoing liver operations. The number of patients was determined using a power calculation. D-Bil and I-Bil measurements were obtained on postoperative days (POD) 1 and 2. The primary outcome was defined as hospital mortality, with the number of ICU-free survival days (IFSD) at POD 28 as the secondary outcome. Results: The study population consisted of 1,903 patients with a mortality rate of 2.2%. D-Bil at POD 1 was significantly higher in non-survivors than survivors (P = 0.001), but I-Bil at POD 1 showed no such relation (P = 0.209). Multivariate logistic analysis indicated that higher postoperative D-Bil was independently associated with increased postoperative mortality (POD 1: adjusted odds ratio [OR] = 2.32, P < 0.001; POD 2: adjusted OR = 1.95, P < 0.001), but I-Bil showed no such relation (POD 1: P = 0.913; POD 2: P = 0.209). Increased D-Bil was independently associated with decreased IFSD at POD 28 (POD 1: adjusted coefficient = -1.54, P < 0.001; POD 2: -1.84, P < 0.001). In contrast, increased I-Bil at POD 1 was independently associated with increased IFSD at POD 28 (POD 1: adjusted coefficient = +0.39, P = 0.021; POD 2: +0.33, P = 0.080). Conclusions: D-Bil indices have a higher capability than I-Bil for predicting poorer outcomes in critically ill postoperative patients.2018年02月, Korean journal of anesthesiology, 71(1) (1), 30 - 36, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Association between Intra-Circuit Activated Clotting Time and Incidence of Bleeding Complications during Continuous Renal Replacement Therapy using Nafamostat Mesilate: a Retrospective Pilot Observational Study.It has been proposed that anticoagulant activity during continuous renal replacement therapy with nafamostat mesilate can be monitored by using intra-circuit activated clotting time. However, it is still unclear whether activated clotting time would be useful for this purpose. We conducted a retrospective study and included 76 patients who required continuous renal replacement therapy using nafamostat mesilate. We obtained information for pre- and post-filter activated clotting times and bleeding complications. We calculated time-weighted average activated clotting time. We divided the patients into three activated clotting time groups (low, middle, high) according to the tertiles of pre- and post-filter activated clotting times. Regarding post-filter time-weighted average activated clotting time, the incidence of bleeding complications in the high activated clotting time group was significantly higher than those in the low and middle activated clotting time groups (p=0.04). The incidences of bleeding complications were not significantly different among the three groups according to pre-filter time-weighted average activated clotting time (p=0.35). In sensitive analysis, the duration on continuous renal replacement therapy without bleeding complications was significantly longer for filters with post-tw ACT<262 than for those with post-tw ACT≥262 (p=0.03). This result suggested that post-filter time-weighted average activated clotting time might be a good predictor of bleeding complications during continuous renal replacement therapy with nafamostat mesilate. Further study is required to refute or confirm our findings.2017年08月, The Kobe journal of medical sciences, 63(1) (1), E30-E36 - E36, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- 2016年01月, INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, 39(1) (1), 16 - 21, 英語[査読有り]研究論文（学術雑誌）
- 克誠堂出版, 2013年10月, 麻酔, 62(10号) (10号), 1241 - 1244, 日本語血友病Bを合併した脊柱側彎症手術の麻酔経験[査読有り]研究論文（学術雑誌）
- 2013年05月, 臨床麻酔, 37(5号) (5号), 813 - 814, 日本語全静脈麻酔による先天性胎児横隔膜ヘルニアの帝王切開術[査読有り]研究論文（学術雑誌）
- 真興交易(株)医書出版部, 2013年01月, 臨床麻酔, 37(1) (1), 89 - 90, 日本語短時間の仰臥位手術後に生じた総腓骨神経麻痺の1症例[査読有り]
- 克誠堂出版(株), 2019年09月, 麻酔, 68(9) (9), 1007 - 1010, 日本語多尿と過剰な尿糖排泄を呈した褐色細胞腫患者の周術期管理経験
- Hyperglycemia is commonly observed in critical illness. A landmark large randomized controlled trial (RCT) reported that the incidence of hyperglycemia (blood glucose concentration > 108 mg/dl) was as high as 97.2% in critically ill patients. During the past two decades, a number of RCTs and several meta-analyses and network meta-analyses have been conducted to determine the optimal target for acute glycemic control. The results of those studies suggest that serum glucose concentration would be better to be maintained between 144 and 180 mg/dl. Although there have been studies showing an association of hypoglycemia with worsened clinical outcomes, a causal link has yet to be confirmed. Nonetheless, some researchers are of the view that the data suggest even mild hypoglycemia should be avoided in critically ill patients. Since acutely ill patients who receive insulin infusion are at a higher risk of hypoglycemia, a reliable devices for measuring blood glucose concentrations, such as an arterial blood gas analyzer, should be used frequently. Acute glycemic control in patients with premorbid hyperglycemia is a novel issue. Available literature suggests that blood glucose concentrations considered to be desirable and/or safe in non-diabetic critically ill patients might not be desirable in patients with diabetes. Moreover, the optimal target for acute blood glucose control may be higher in critically ill patients with premorbid hyperglycemia. Further study is required to assess optimal blood glucose control in acutely ill patients with premorbid hyperglycemia.2017年12月, Korean journal of anesthesiology, 70(6) (6), 591 - 595, 英語, 国際誌[査読有り]
- 2016年01月, JOURNAL OF THORACIC DISEASE, 8(1) (1), E111 - E114, 英語[査読有り]記事・総説・解説・論説等（学術雑誌）
■ 講演・口頭発表等
- 第46回日本集中治療医学会学術集会, 2019年03月, 日本語, 日本集中治療医学会, 京都, 国内会議低心機能患者に対する巨大肺嚢胞切除術の周術期管理口頭発表（一般）
- 第46回日本集中治療医学会学術集会, 2019年03月, 日本語, 日本集中治療医学会, 京都, 国内会議術後維持輸液が低Na 血症に与える影響[招待有り]シンポジウム・ワークショップパネル（指名）
- 第46回日本集中治療医学会学術集会, 2019年03月, 日本語, 日本集中治療医学会, 京都, 国内会議持続腎代替療法施行時間が血小板数の変化に与える影響口頭発表（一般）
- 第46回日本集中治療医学会学術集会, 2019年03月, 日本語, 日本集中治療医学会, 京都, 国内会議交通外傷による骨盤骨折手術に際し転院後25kg の減量を行った一例口頭発表（一般）
- ANESTHESIOLOGY 2018 annual meeting, 2018年10月, 英語, San Francisco, 国際会議Comparison of the Incidence of Delirium in Adult Postoperative Patients Receiving Intravenous Isotonic Or Hypotonic Maintenance Fluids; Retrospective Before/after Observational Studyポスター発表
- 日本麻酔科学会第64回関西支部学術集会, 2018年09月, 日本語, 大阪, 国内会議難治性膿気胸に対してリハビリテーションを含めた集学的治療を行い、機能回復を認めた一例ポスター発表
- 集中治療Up To Date セミナー in 神戸, 2018年09月, 日本語, 神戸, 国内会議持続的腎代替療法が血小板数に与える影響口頭発表（一般）
- 第45回日本集中治療医学会学術集会, 2018年02月, 日本語, 日本集中治療医学会, 幕張, 国内会議咽後膿瘍の進展により 脊髄硬膜外膿瘍をきたした1例口頭発表（一般）
- 第26回兵庫県救急・集中治療研究会, 2017年11月, 日本語, 一般社団法人日本血液製剤機構, 神戸, 国内会議地域基幹病院と連携を行い, 難治性膿気胸に対して集中管理後に機能回復を認めた一例口頭発表（一般）
- 筋弛緩学術講演in神戸, 2017年11月, 日本語, MSD, 神戸, 国内会議筋弛緩モニターの理論と使い方公開講演，セミナー，チュートリアル，講習，講義等
- 日本心臓血管麻酔学会第22回学術大会, 2017年09月, 日本語, 日本心臓血管麻酔学会, 宇都宮, 栃木, 国内会議非代償性急性心不全合併大動脈弁狭窄症に対する経皮的心肺補助併用下経カテーテル大動脈弁置換術の麻酔管理ポスター発表
- 日本麻酔科学会第63回関西支部学術集会, 2017年09月, 日本語, 日本麻酔科学会, 大阪, 国内会議褐色細胞腫を合併した甲状腺髄様癌術後に過剰な尿糖排泄を伴う多尿により循環失調を来した1症例ポスター発表
- 第1回日本集中治療医学会関西支部学術集会, 2017年07月, 日本語, 日本集中治療医学会, 神戸, 国内会議脳死肝移植後の肝膿瘍治療中にメトロニダゾール脳症 （metronidazole-induced encephalopathy:MIE） を発症した1例口頭発表（一般）
- 第1回日本集中治療医学会関西支部学術集会, 2017年07月, 日本語, 日本集中治療学会関西支部, 神戸, 国内会議尿路性敗血症により急性呼吸促迫症候群を生じた妊産婦の一例口頭発表（一般）
- 第1回日本集中治療医学会関西支部学術集会, 2017年07月, 日本語, 日本集中治療医学会関西支部, 神戸, 国内会議術後集中治療患者における維持輸液の選択が酸塩基平衡におよぼす影響の検討；3号液とリンゲル液の比較口頭発表（一般）
- 第44回日本集中治療医学会学術集会, 2017年03月, 日本語, 日本集中治療医学会, 札幌, 国内会議免疫グロブリン大量療法に不応の中毒性表皮壊死症（toxic epidermal necrolysis：TEN）を救命しえた2症例口頭発表（一般）
- 第44回日本集中治療医学会学術集会, 2017年03月, 日本語, 日本集中治療医学会, 札幌, 国内会議術後集中治療患者における輸液製剤の選択が低Na血症の発生に与える影響の検討；Before-After study口頭発表（一般）
- 第44回日本集中治療医学会学術集会, 2017年03月, 日本語, 日本集中治療医学会, 札幌, 国内会議重症患者の血中Na濃度測定における生化学分析装置と血液ガス分析器の測定誤差に関する検討口頭発表（一般）
- 2017 呼吸セミナー in Kobe, 2017年02月, 日本語, コヴィディエンジャパン株式会社, 神戸, 国内会議呼吸リハビリ－基礎と大切なこと公開講演，セミナー，チュートリアル，講習，講義等
- 筋弛緩学術講演in神戸, 2016年11月, 日本語, MSD, 神戸, 国内会議筋弛緩モニターの理論と使い方公開講演，セミナー，チュートリアル，講習，講義等
- 第61回日本集中治療医学会近畿地方会, 2016年07月, 日本語, 日本集中治療医学会近畿地方会, 大阪, 国内会議重症ニューモシスチス肺炎を合併したX連鎖性複合免疫不全症の呼吸管理に経鼻高流量酸素療法が有用であった1例ポスター発表
- 第61回日本集中治療医学会近畿地方会, 2016年07月, 英語, 日本集中治療学会, 大阪, 国内会議急性リンパ性白血病の治療中にHHV-6脳炎からHHV-6肺炎を発症した一例ポスター発表
- The 35th Annual Conference of the KSCCM, The 16th Joint Scientific Congress of the KSCCM and JSICM, 2016年04月, 英語, JSICM and KSCCM Joint Scientific Congress, Seoul, Korea, 国際会議Association between intra-circuit activated clotting time and the incidence of bleeding complications using nafamostat mesilate during continuous renal replacement therapy口頭発表（一般）