小脳誘発電位の基礎的研究ならびに臨床麻酔への応用

小脳誘発電位(以下CEPs)に関する基礎的研究を行い,以下のような知見を得た.1.CEPsは,末梢神経刺激により同側の小脳皮質上に誘発される電位であり,前脊髄動脈潅流域である腹側脊髄小脳路を上行する.2.吸入麻酔薬セボフルランの吸入により,体性感覚誘発電位(以下SEPs)は2MAC(4.5%)でも測定可能であったが,運動野誘発電位(以下MEPs)は0.5%でも消失した.CEPsは,1MAC(2.5%)までは測定可能であった.3.静脈麻酔薬プロポフォールの投与では,体性感覚誘発電位(以下SEPs)はED50(30mg/kg/hour)でも測定可能であったが,MEPsは5mg/kg/hourでも消失した.CEPsは,30mg/kg/hourまでは測定可能であったが,振幅が著しく小さくなるため感度を上げる必要があった.4.5分間の脊髄虚血により,SEPsは振幅が10%程度小さくなったが虚血解除により速やかに回復した.MEPsは完全に消失してしまい波形が再出現するまでに15分を要した.CEPsでは虚血により振幅は50%以下にまで小さくなるが虚血解除により速やかにもとの大きさに復した.5.10分間の脊髄虚血により,SEPsは波形が消失したが虚血解除により速やかに回復した.MEPsは完全に消失してしまい波形は再出現しなかった。CEPsでは虚血により波形は消失し,波形が再出現するのに約10分間を要した.10分虚血群では全例が下肢麻痺となった.以上より,CEPsは麻酔薬の制限の少ない脊髄虚血モニター法として有望であり,今後臨床研究を実施する予定である.I have conducted basic researches about cerebellar evoked potentials (CEPs) and obtained the following findings;1.CEPs is evoked on ipsilateral cereballar cortex by a peripheral nerve electrical stimulation, the stimulus ascends through the ventral spinocerebellar tracts in the area perfused by the anterior spinal artery.2.Somatosenroy evoked potentials (SEPs) was recorded even under 2 MAC of sevoflurane, while motor evoked potentials (MEPs) had been faded away under 0.25 MAC of sevoflurane. CEPs could be recorded at 1.0 MAC of sevoflurane.3.SEPs was recorded even under ED50 (30mg/kg/hour) of propofol, while MEPs had been faded away under 5mg/kg/hour of propofol. CEPs could be recorded at ED50 of propofol, but its amplitude was small.4.Five min spinal ischemia reduced the amplitude of SEPs by 10%, but it recovered immediately after reperfusion, while MEPs disappeared by spinal ischemia and it required about 15 min to reemerge. The amplutude of CEPs was reduced by 50% during spinal ischemia, and it recovered promptly by reperfusion. No animals showed motor function deficiency.5.Ten min spinal ischemia had extinguished all potentials. SEPs and CEPs reemerged 2 and 10 min after reperfusion, respectively, while MEPs was not recorded even 1 hour after reperfusion. All animals showed paraplegia.In conclusion, CEPs is more sensitive to spinal ischemia than SEPs, and less restrictive about anesthetic drugs selection than MEPs. Clinical trials are necessary to prove usefulness of CEPs.研究課題/領域番号:14571424, 研究期間(年度):2002-2003出典：「小脳誘発電位の基礎的研究ならびに臨床麻酔への応用」研究成果報告書　課題番号14571424 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

動脈血酸素分圧がプロポフォール持続投与時の薬物動態に与える影響

取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1201号, 学位授与年月日：平成8年3月25日,学位授与年：199

The use of a scented face mask in pediatric patients may facilitate mask acceptance before anesthesia induction

BackgroundScented face masks are commonly used during the induction phase of anesthesia. The present study investigated whether the use of a scented mask improved mask acceptance before the slow induction of anesthesia in pediatric patients.MethodsThis prospective, randomized controlled trial enrolled patients aged 2–10 years who were scheduled to undergo surgery under general anesthesia. Patients were randomly assigned to either of regular unscented (control group) or scented (experimental group) face masks before anesthesia induction with a parent. The primary outcome was the mask acceptance score, rated on a validated 4-point from 1 point (not afraid; easily accepts the mask) to 4 points (afraid of a mask; crying or struggling). The secondary outcome was heart rate assessed by pulse oximetry in the pediatric ward before transfer to the operating room (OR), at the entrance to the OR, at the patient notification of mask fitting by the anesthesiologist, and after mask fitting.ResultsSeventy-seven patients were accessed for eligibility, with 67 enrolled in the study: 33 in the experimental group and 34 in the control group. Mask acceptance was significantly greater among patients aged 2–3 years in the experimental than in the control group (p < 0.05).ConclusionThe use of a scented mask can improve mask acceptance before anesthesia induction with a parental presence in pediatric patients aged 2–3 years.Clinical Trial Registration: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000040819

Cardiovascular and respiratory effects of the degree of head-down angle during robot-assisted laparoscopic radical prostatectomy

Background: Robot-assisted laparoscopic radical prostatectomy (RALP) requires a steep Trendelenburg position and CO2 pneumoperitoneum for several hours to secure the surgical visual field. The present study was performed to investigate the influence of each angle of Trendelenburg position during RALP on cardiovascular and respiratory homeostasis. Methods: Forty-seven ASA physical status 1 and 2 patients underwent open retropubic radical prostatectomy (RRP) or RALP. Patients receiving RALP were randomized to undergo the operation in the 20°, 25° or 30° Trendelenburg position. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end-tidal CO2 pressure (PetCO2), tidal volume (Vt), peak inspiratory pressure (PIP) and dynamic compliance (Cdyn) were recorded during the operation. Results: Angle of head-down tilt was significantly correlated with MAP, PIP and Cdyn, but not with HR, RR or PetCO2. MAP decreased gradually over time in each group in the Trendelenburg position with pneumoperitoneum. As the angle of head-down tilt became stronger, MAP, RR, PetCO2 and PIP tended to increase and Cdyn tended to decrease. Conclusions: This study demonstrated that the degree of the head-down angle at RALP affected the cardiovascular and respiratory parameters. Pneumoperitoneum with head-down position in RALP influenced the cardiovascular and respiratory system to a greater extent than RRP, and these effects were stronger with deeper head-down angle. © 2013 John Wiley & Sons, Ltd

A custom magnetoencephalography device reveals brain connectivity and high reading/decoding ability in children with autism

A subset of individuals with autism spectrum disorder (ASD) performs more proficiently on certain visual tasks than may be predicted by their general cognitive performances. However, in younger children with ASD (aged 5 to 7), preserved ability in these tasks and the neurophysiological correlates of their ability are not well documented. In the present study, we used a custom child-sized magnetoencephalography system and demonstrated that preserved ability in the visual reasoning task was associated with rightward lateralisation of the neurophysiological connectivity between the parietal and temporal regions in children with ASD. In addition, we demonstrated that higher reading/decoding ability was also associated with the same lateralisation in children with ASD. These neurophysiological correlates of visual tasks are considerably different from those that are observed in typically developing children. These findings indicate that children with ASD have inherently different neural pathways that contribute to their relatively preserved ability in visual tasks

脊髄の虚血再灌流障害に対するポストコンディショニングの効果

ラットに12分の脊髄虚血を負荷するモデルを用いて痙性麻痺に対してポストコンディショニングが有用であるか否かを検討した. 虚血解除後に30秒間の虚血・30秒間の再灌流を3サイクル加えるポストコンディショニングをおこなったところ, コントロ-ル群に比較して虚血解除後の5日間の運動機能は有意に改善した. 脊髄標本を作製し, 組織学的に検討したところ運動細胞が温存されていることが確認された.研究課題/領域番号:18591694, 研究期間(年度):2005-2008出典：「脊髄の虚血再灌流障害に対するポストコンディショニングの効果」研究成果報告書　課題番号18591694（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/report/KAKENHI-PROJECT-18591694/18591694seika/)を加工して作