Transition of Anesthesia Management and Anesthetics Used for 50 Years Since the Establishment of Anesthesiology Department in Hiroshima University

広島大学麻酔蘇生学教室は1967年1月に盛生倫夫が初代教授に就任し開講した。開講50周年を機に，麻酔科開設以来の麻酔管理に用いた麻酔薬の変遷を辿った。開講当初から１９８５年までは亜酸化窒素とハロタンを中心とした吸入麻酔薬の時代，1990年から2005年はエンフルラン，イソフルラン，セボフルランなどの吸入麻酔薬とフェンタニルの併用の時で，2010年からはプロポフォールとレミフェンタニルの全静脈麻酔あるいはセボフルランあるいはデスフルランとレミフェンタニル併用の時代であった。開講から1980年頃まではスキサメトニウムを主に使ったが，それ以降は非脱分極性筋弛緩薬であるパンクロニウムへ，そしてベクロニウムへ推移し，現在はロクロニウムが主流となっている。使用麻酔薬の変遷は麻酔薬の科学的な評価とそれらを使用する麻酔科医の考え方を反映していた。Department of Anesthesiology and Critical Care, Hiroshima University, started in January 1967 when Dr. Michio Morio became the first professor.　With the 50th anniversary of the establishment of the department, the transition of the anesthetics used in our long history of anesthesia care was investigated since the beginning of the department. Inhalation anesthetics was mainly used in combination with nitrous oxide and halothane from the beginning to 1985. Inhalation anesthetics such as enflurane, isoflurane, sevoflurane and intravenous fentanyl were used from 1990 to 2005, and the total intravenous anesthesia by using propofol and remifentanil was introduced and used currently. Sevoflurane or desflurane combined with remifentanil was also a mainstream since 2010.　From the beginning to 1980, suxamethonium was mainly used for muscle relaxation, followed by pancuronium thereafter and shifted to vecuronium and to rocuronium. The transition of anesthetics applied for clinical anesthesia in our department seemed to be reflecting the selection based on scientific validity

General Anesthesia Management Combined with Thoracic Wall Block for Mastectomy on a Patient with a History of Aortic Valve Replacement

Thoracic wall block is a useful tool for analgesia in a patient receiving mastectomy. To select an analgesic method with sufficient analgesic effect and little influence on cardiovascular dynamics is important for perioperative management of the patients whose cardiovascular dynamics are desirable to be stable. We experienced a patient who had an increased pressure gradient from the left ventricle to the aortic valve, accompanied by the sigmoid shaped ventricular septum developed after aortic valve replacement. By using pectoral nerve block and transversus thoracic muscle plane block combined with general anesthesia, we managed this patient uneventfully and safely.本論文の要旨は，日本麻酔科学会　中国・四国支部　第53回学術集会（2016年，岡山）で発表した

Subacute postoperative myofascial pain diagnosed and treated successfully by ultrasound: a case after laparoscopic hepatectomy

Abstract Background Myofascial pain syndrome is one of the causes of prolonged postoperative pain after abdominal surgery. However, diagnosis and treatment of myofascial pain syndrome, especially its myofascial trigger point (MTrP), have not been well established. Case presentation A 55-year-old man experienced severe subacute abdominal pain after laparoscopic hepatectomy despite aggressive postoperative pain management. He had a positive Carnett’s sign, indicating abdominal wall pain, 2 weeks after the surgery. Ultrasonography showed a hyperechoic spot surrounded by a hypoechoic area in the inner abdominal oblique muscle under the palpable spot that fulfills the criteria of MTrP. The echogenic MTrP disappeared after repetitive ultrasound-guided trigger point injections (USG TPIs) with pain relief. Conclusions Our present case indicates that diagnosing myofascial pain by visualizing the echogenic MTrPs in the abdominal muscles, and subsequent USG TPIs, might provide an accurate maneuver for diagnosis and treatment of subacute myofascial pain after abdominal surgery

Amiselimod (MT-1303), a novel sphingosine 1-phosphate receptor-1 functional antagonist, inhibits progress of chronic colitis induced by transfer of CD4+CD45RBhigh T cells.

Amiselimod (MT-1303) is a novel sphingosine 1-phosphate receptor-1 (S1P1 receptor) modulator with a more favorable cardiac safety profile than other S1P1 receptor modulators. MT-1303 phosphate (MT-1303-P), an active metabolite of MT-1303, exhibits S1P1 receptor agonism at a lower EC50 value than other S1P1 receptor modulators currently being developed. We aimed to evaluate the efficacy of MT-1303 and its mode of action in chronic colitis using an inflammatory bowel disease (IBD) model. Oral administration of MT-1303 (0.3 mg/kg) once daily for 3 days to mice almost completely abolished S1P1 receptor expression on CD4+ T cells from mesenteric lymph nodes, which corresponded to a marked decrease in CD4+ T cell count in peripheral blood, indicating that MT-1303-P acts as a functional antagonist of the S1P1 receptor. The potential benefit of MT-1303 for IBD was assessed using immunodeficient SCID mice with chronic colitis induced by adoptive transfer of CD4+CD45RBhigh T cells from BALB/c mice. An oral dose of 0.1 and 0.3 mg/kg MT-1303 administered daily one week after the cell transfer inhibited the development of chronic colitis with an efficacy comparable to that of an anti-mTNF-α mAb (250 μg/mouse). In addition, MT-1303 administration significantly reduced the number of infiltrating Th1 and Th17 cells into the lamina propria of the colon in colitis mice. Our results suggest that MT-1303 acts as a functional antagonist of the S1P1 receptor on lymphocytes, regulates lymphocyte trafficking, and inhibits infiltration of colitogenic Th1 and Th17 cells into the colon to inhibit the development of chronic colitis

Efficacy of Low-Level Laser Therapy for Oral Mucositis in Hematologic Patients Undergoing Transplantation: A Single-Arm Prospective Study

Oral mucositis significantly affects the quality of life in hematologic cancer patients undergoing hematopoietic stem cell transplantation. Despite global evidence supporting the efficacy of low-level laser therapy (LLLT) for mucositis prevention, its clinical adoption in Japan is limited. This study aimed to fill this gap by evaluating the safety and efficacy of LLLT in a Japanese patient population. In a single-group, non-blinded, exploratory trial, we compared 21 LLLT-treated patients against a historical control of 96 patients. The primary endpoint was the incidence of Grade ≥ 2 mucositis, based on NCI-CTCAE ver. 4.0. The LLLT group showed a significantly lower incidence of Grade ≥ 2 mucositis (23.8%) compared to the control group (64.6%) (p = 0.0006). Furthermore, Grade ≥ 2 mucositis correlated with increased oral dryness and longer hospital stays. Our study confirms the efficacy of LLLT in reducing the onset of severe oral mucositis among Japanese hematologic cancer patients, advocating for its clinical introduction as a preventive measure in Japan