2021/10/20 更新

写真a

ミツマ ユウスケ
三ツ間 祐介
MITSUMA Yusuke
所属
医歯学総合病院 麻酔科 助教
職名
助教
外部リンク

学位

  • 修士(医学) ( 2021年3月   愛媛大学 )

  • 修士 ( 2011年4月   愛媛大学 )

経歴

  • 新潟大学   医歯学総合病院 麻酔科   助教

    2020年4月 - 現在

 

論文

  • Propofol reduces the amplitude of transcranial electrical motor-evoked potential without affecting spinal motor neurons: a prospective, single-arm, interventional study.

    Hiroyuki Deguchi, Kenta Furutani, Yusuke Mitsuma, Yoshinori Kamiya, Hiroshi Baba

    Journal of anesthesia   2021年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: Propofol inhibits the amplitudes of transcranial electrical motor-evoked potentials (TCE-MEP) in a dose-dependent manner. However, the mechanisms of this effect remain unknown. Hence, we investigated the spinal mechanisms of the inhibitory effect of propofol on TCE-MEP amplitudes by evaluating evoked electromyograms (H-reflex and F-wave) under general anesthesia. METHODS: We conducted a prospective, single-arm, interventional study including 15 patients scheduled for spine surgery under general anesthesia. Evoked electromyograms of the soleus muscle and TCE-MEPs were measured at three propofol concentrations using target-controlled infusion (TCI: 2.0, 3.0, and 4.0 µg/mL). The primary outcome measure was the left H-reflex amplitude during TCI of 4.0- compared to 2.0-µg/mL propofol administration. RESULTS: The median [interquartile range] amplitudes of the left H-reflex were 4.71 [3.42-6.60] and 5.6 [4.17-7.46] in the 4.0- and 2.0-μg/mL TCI groups (p = 0.4, Friedman test), respectively. There were no significant differences in the amplitudes of the right H-reflex and the bilateral F-wave among these groups. However, the TCE-MEP amplitudes significantly decreased with increased propofol concentrations (p < 0.001, Friedman test). CONCLUSION: Propofol did not affect the amplitudes of the H-reflex and the F-wave, whereas TCE-MEP amplitudes were reduced at higher propofol concentrations. These results suggested that propofol can suppress the TCE-MEP amplitude by inhibiting the supraspinal motor pathways more strongly than the excitability of the motor neurons in the spinal cord.

    DOI: 10.1007/s00540-021-02927-7

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  • Epidural Administration of Ropivacaine Reduces the Amplitude of Transcranial Electrical Motor-Evoked Potentials: A Double-Blinded, Randomized, Controlled Trial. 国際誌

    Kenta Furutani, Toshiyuki Tobita, Hideaki Ishii, Hiroyuki Deguchi, Yusuke Mitsuma, Yoshinori Kamiya, Hiroshi Baba

    Anesthesia and analgesia   132 ( 4 )   1092 - 1100   2021年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: An epidurally administered local anesthetic acts primarily on the epidural nerve roots and can act directly on the spinal cord through the dural sleeve. We hypothesized that epidurally administered ropivacaine would reduce the amplitude of transcranial electrical motor-evoked potentials by blocking nerve conduction in the spinal cord. Therefore, we conducted a double-blind, randomized, controlled trial. METHODS: Thirty adult patients who underwent lung surgery were randomly allocated to 1 of 3 groups, based on the ropivacaine concentration: the 0.2% group, the 0.375% group, and the 0.75% group. The attending anesthesiologists, neurophysiologists, and patients were blinded to the allocation. The epidural catheter was inserted at the T5-6 or T6-7 interspace by a paramedian approach, using the loss of resistance technique with normal saline. General anesthesia was induced and maintained using propofol and remifentanil. Transcranial electrical motor-evoked potentials were elicited by a train of 5 pulses with an interstimulus interval of 2 milliseconds by using a constant-voltage stimulator and were recorded from the tibialis anterior muscle. Somatosensory-evoked potentials (SSEPs) were evoked by electrical tibial nerve stimulation at the popliteal fossa. After measuring the baseline values of these evoked potentials, 10 mL of epidural ropivacaine was administered at the 0.2%, 0.375%, or 0.75% concentration. The baseline amplitudes and latencies recorded before administering ropivacaine were defined as 100%. Our primary end point was the relative amplitude of the motor-evoked potentials at 60 minutes after the epidural administration of ropivacaine. We analyzed the amplitudes and latencies of these evoked potentials by using the Kruskal-Wallis test and used the Dunn multiple comparison test as the post hoc test for statistical analysis. RESULTS: The data are expressed as the median (interquartile range). Sixty minutes after epidurally administering ropivacaine, the motor-evoked potential amplitude was lower in the 0.75% group (7% [3%-18%], between-group difference P < .001) and in the 0.375% group (52% [43%-59%]) compared to that in the 0.2% group (96% [89%-105%]). The latency of SSEP was longer in the 0.75% group compared to that in the 0.2% group, but the amplitude was unaffected. CONCLUSIONS: Epidurally administered high-dose ropivacaine lowered the amplitude of motor-evoked potentials and prolonged the onset latencies of motor-evoked potentials and SSEPs compared to those in the low-dose group. High-dose ropivacaine can act on the motor pathway through the dura mater.

    DOI: 10.1213/ANE.0000000000005236

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  • Precautions with right supraclavicular approach and oximetry central venous catheter. 国際誌

    Tomohiro Yamamoto, Yusuke Mitsuma, Ehrenfried Schindler

    Anaesthesiology intensive therapy   2021年3月

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  • Low-dose droperidol suppresses transcranial electrical motor-evoked potential amplitude: a retrospective study. 国際誌

    Hiroyuki Deguchi, Kenta Furutani, Yusuke Mitsuma, Yoshinori Kamiya, Hiroshi Baba

    Journal of clinical monitoring and computing   35 ( 1 )   175 - 181   2021年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Low-dose droperidol has been widely used as an antiemetic during and after surgery. Although high-dose droperidol affects motor-evoked potential, the effects of low-dose droperidol on motor-evoked potential amplitude are unclear. The aim of this study was to investigate whether low-dose droperidol affects motor-evoked potential amplitude. We retrospectively reviewed the data of patients who underwent spine surgery under general anesthesia with motor-evoked potential monitoring from February 2016 to 2017. The outcome was the motor-evoked potential amplitude of the bilateral abductor pollicis brevis muscle, tibialis anterior muscle, and abductor hallucis muscle within 1 and 1-2 h after droperidol administration, compared with the baseline motor-evoked potential value. Thirty-four patients were analyzed. The median dose of droperidol was 21 µg/kg. The motor-evoked potential amplitudes of all muscles were significantly reduced after droperidol administration and recovered to baseline values within 2 h. The reduction of all motor-evoked potential amplitudes after droperidol administration was 37-45% of baseline values. There were no significant differences in other drugs administered. There were no serious adverse effects of droperidol administration. Motor-evoked potential amplitude was suppressed by low-dose droperidol. During intraoperative motor-evoked potential monitoring in spine surgery, anesthesiologists should pay careful attention to the timing of administration of droperidol, even at low doses. Based on the results of this study, we are conducting a randomized controlled trial.

    DOI: 10.1007/s10877-020-00464-4

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  • A Bolus Dose of Ketamine Reduces the Amplitude of the Transcranial Electrical Motor-evoked Potential: A Randomized, Double-blinded, Placebo-controlled Study. 国際誌

    Kenta Furutani, Hiroyuki Deguchi, Mari Matsuhashi, Yusuke Mitsuma, Yoshinori Kamiya, Hiroshi Baba

    Journal of neurosurgical anesthesiology   2019年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: A low-dose bolus or infusion of ketamine does not affect transcranial electrical motor-evoked potential (MEP) amplitude, but a dose ≥1 mg/kg may reduce MEP amplitude. We conducted a randomized, double-blinded, placebo-controlled study to evaluate the effect of ketamine (1 mg/kg) on transcranial electrical MEP. METHODS: Twenty female patients (aged 12 to 18 y) with adolescent idiopathic scoliosis scheduled to undergo posterior spinal fusion were randomly allocated to receive ketamine or saline. General anesthesia was induced and maintained with continuous infusions of propofol and remifentanil. MEP was elicited by supramaximal transcranial electrical stimulation. MEP recordings were obtained at baseline and then at 2, 4, 6, 8, and 10 minutes after administration of ketamine (1 mg/kg) or saline (0.1 ml/kg). The primary endpoint was the minimum relative MEP amplitude (peak-to-peak amplitude, % of baseline value) recorded from the left tibialis anterior muscle. The baseline amplitude recorded before test drug administration was defined as 100%. RESULTS: Medians (interquartile range) minimum MEP amplitudes in the left tibialis anterior muscle in the ketamine and saline groups were 26% (9% to 34%) and 87% (55% to 103%) of the baseline value, respectively (P<0.001). MEP amplitudes in other muscles were significantly reduced by ketamine. The suppressive effect of ketamine lasted for at least 10 minutes in each muscle. CONCLUSION: A 1-mg/kg bolus dose of ketamine can reduce MEP amplitude. Anesthesiologists should consider the dosage and timing of intravenous ketamine administration during MEP monitoring.

    DOI: 10.1097/ANA.0000000000000653

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  • Be on the alert again for the risk of pulmonary air embolisation in paediatric patients during the insertion of a central venous catheter under general anaesthesia with spontaneous respiration. 国際誌

    Tomohiro Yamamoto, Yusuke Mitsuma, Hiroshi Baba

    Anaesthesiology intensive therapy   51 ( 5 )   412 - 413   2019年

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    記述言語:英語  

    DOI: 10.5114/ait.2019.89225

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  • Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report. 国際誌

    Kenta Furutani, Mari Matsuhashi, Hiroyuki Deguchi, Yusuke Mitsuma, Nobuko Ohashi, Hiroshi Baba

    Journal of medical case reports   12 ( 1 )   204 - 204   2018年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: It is believed that ketamine does not affect motor-evoked potential amplitude, whereas various anesthetic drugs attenuate the amplitude of transcranial motor-evoked potential. However, we encountered a patient with marked attenuation of motor-evoked potential amplitude after intravenous bolus administration of ketamine. CASE PRESENTATION: A 15-year-old Japanese girl with a diagnosis of adolescent idiopathic scoliosis was admitted to our hospital to undergo posterior spinal fusion at T4-L3. After induction of general anesthesia using a continuous infusion of propofol and remifentanil, we confirmed that transcranial electrical motor-evoked potentials were being recorded correctly. Ketamine 1.25 mg/kg was administered intravenously for intraoperative and postoperative analgesia. About 3 minutes later, the motor-evoked potential amplitude was markedly attenuated. No other drugs were administered except for ketamine. The patient's vital signs were stable, and the surgery had not yet started. The motor-evoked potential amplitude was recovered at about 6 minutes after administration of ketamine. The surgery was performed uneventfully, and the patient had no neurologic deficit when she emerged from general anesthesia. CONCLUSIONS: Although there is a widely held belief in the field of anesthesiology that ketamine does not affect motor-evoked potential amplitude, it has been suggested that ketamine could affect its monitoring.

    DOI: 10.1186/s13256-018-1741-9

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▶ 全件表示

共同研究・競争的資金等の研究

  • ドロペリドールの脊髄における作用機序の解明

    研究課題/領域番号:18K16440  2018年4月 - 2021年3月

    日本学術振興会  科学研究費助成事業 若手研究  若手研究

    三ツ間 祐介

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    配分額:3770000円 ( 直接経費:2900000円 、 間接経費:870000円 )

    ドロペリドールは制吐作用を有し術後嘔気嘔吐対策として臨床使用されている。その主たる作用はドパミン受容体の抑制作用によると考えられているが、作用機序の詳細は明らかではない。様々な受容体に作用することでドパミンやセロトニンの作用を修飾し、その薬理作用を発揮すると思われるが、その核心に迫る研究はなされていない。研究代表者は、制吐作用を期待し用いた低用量のドロペリドールが、運動誘発電位(MEP)の振幅を著明に減少させることに気付いた。これを契機に、低用量ドロペリドールは皮質脊髄路のシナプス伝達機構を修飾する作用を有し、それによりMEP振幅を減少させる作用があるのではないかと仮説を立てた。
    本仮説を検証するため、まず臨床研究に着手した。MEPによる皮質脊髄路全体の評価だけでなく、誘発筋電図を合わせて計測することで、 脊髄前角のシナプスから下位運動ニューロンの評価も行えるよう設計した。本学の倫理審査委員会の承認を受け、臨床研究推進センターの協力のもと、二重盲検無作為化比較対照研究を開始した。置換ブロック法によりランダム化を行い、被験者と担当医師を二重盲検化した。対象はASA 1-2, 特発性側弯症に対する後方矯正固定術を予定された, 12歳以上20歳以下の女性20名とした。割付に従って生理食塩液(NS)もしくはドロペリドール(DR)(20μg/kg)を投与しMEPを測定した。主要評価項目は試験薬投与前後の左前脛骨筋のMEP相対振幅とした。
    DR群は10例、NS群は8例だった。データは中央値[四分位範囲]で表す。左前脛骨筋のMEP相対振幅は、NS群と比較しDR群で有意に減少した(DR:37%[30-55%]およびNS:76%[58-93%]、p <0.01)。低用量ドロペリドールは経頭蓋電気刺激によるMEP振幅をアラームポイント付近まで有意に減少させることが分かった。

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