Kazuya Sobue

Nagoya City University, Nagoya, Aichi, Japan

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Publications (112)205.6 Total impact

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    ABSTRACT: The onset of tachyarrhythmia after the Fontan procedure (total cavopulmonary connection; TCPC) should be considered a medical emergency. Landiolol is an ultra-short-acting β1-selective blocker whose effect on tachyarrhythmia after TCPC is unclear. We evaluated the efficacy and safety of landiolol for tachyarrhythmia after TCPC. Consecutive patients undergoing TCPC were enrolled from January 2007 to December 2011. Of 435 pediatric open heart surgeries, 28 patients underwent TCPC. Of the 28 patients, 13 were treated with landiolol for critical tachyarrhythmia. Excluding three patients who received landiolol during surgery, we investigated the remaining 10 patients and statistical analysis was performed without a 10-year-old patient as outlier. The median age was 4.08 years. The subjects comprised five patients with sinus tachycardia, four with junctional ectopic tachycardia and one with paroxysmal supraventricular tachycardia. The initial dose was 4.7 ± 2.3 μg/kg/min, without a loading dose. Landiolol reduced the heart rate from 151.8 ± 23.2 at the start to 132.9 ± 20.0 at 1 h and 126.1 ± 24.9 at 2 h (P < 0.01 and P < 0.01, respectively), without blood pressure decrease (P = 0.235). Landiolol was effective in treating critical tachyarrhythmia without hemodynamic deterioration. We believe that landiolol is a promising option for postoperative tachyarrhythmia after the Fontan procedure.
    No preview · Article · Dec 2015 · Journal of Anesthesia
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    ABSTRACT: Enteral nutrition (EN) is considered to be a more appropriate method than parenteral feeding for providing nutrition to critically ill children. However, children who undergo cardiac surgery are at high risk of postoperative gastrointestinal complications during EN. The purpose of this study was to demonstrate the safety and efficacy of our EN feeding protocol after paediatric cardiac surgery through comparison between a single-centre prospective case series and historical cases. Forty-seven children who were admitted to the ICU after cardiac surgery were enrolled ('post group'). Data for these children were compared with a similar cohort of children who were admitted before the implementation of the feeding protocol (n=62; 'pre group'). The incidence of complications including vomiting, necrotising enterocolitis and hypoglycaemia; the time until the initiation of EN; and the changes in calories provided were compared between the groups. The frequency of vomiting was significantly lower in the post group than in the pre group (36.2% versus 58.0%, P=0.038), and necrotising enterocolitis did not occur in either group. The time until the initiation of EN and the total calories provided did not differ significantly; however, in the post group the proportion of energy provided by parenteral nutrition was significantly smaller (P <0.001), and provided by EN was significantly larger (P=0.003), than in the pre group. The frequency of hypoglycaemia was similar in both groups. This study showed that our EN protocol resulted in adjustments to calories provided via EN versus parenteral nutrition after paediatric cardiac surgery, and reduced the frequency of vomiting.
    No preview · Article · Sep 2015 · Anaesthesia and intensive care
  • H. Yonekura · H. Hirate · K. Sobue
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    ABSTRACT: Background: Postoperative delirium (POD) is a common but serious complication after major surgery. The aim of this study was to investigate the incidence and effects on outcome of POD in esophagectomy patients, and to identify risk factors for developing POD. Methods: A retrospective medical record review was conducted for all patients who had received esophagectomy for esophageal cancer during a three-year period Results: In a total of 71 patients, the overall incidence of POD was 20%. Multivariable regression analysis identified two independent risk factors for POD: older age (≥70) and preoperative electrolyte abnormalities. Patients with delirium had a higher incidence of respiratory complications and longer hospital stays compared with the non-delirium patients. Conclusions: The incidence of POD in patients undergoing esophagectomy is 20%. The risk factors of POD are older age and preoperative electrolyte abnormalities. POD negatively impacts postoperative respiratory complications and hospital stay.
    No preview · Article · Jun 2015
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    ABSTRACT: Although maintaining anesthesia for myasthenia gravis (MG) with minimal muscle relaxants (MR) is common, the success rate of anesthetic management for MG without MR is not clear. We therefore retrospectively examined the success rate of anesthetic management for MG without MR among 66 consecutive cases of thymectomy for MG performed at our hospital between January 2004 and April 2010, before approval of using sugammadex. A total of 60 patients (90.9 %) were treated without MR (N group). Among the 60 cases, 17 (28.3 %) patients were not extubated in the operating room due to postoperative respiratory depression or other reasons. Therefore, the success rate of anesthetic management for thymectomy in patients with MG without treating MR was 71.7 % (43/60) [95 % confident interval (CI): 65.9-77.5 %]. The reasons for using MR included coughing at intubation in one case, bucking during surgery in two cases, and MR was considered to be safer by the attending anesthesiologist in three cases. The number of cases of impossible extubation requiring ventilation on that day was three in the N group and none in the R group. Finally, the success rate of anesthetic management for MG without MR was estimated to be 71.1 % (95 % CI: 65.9-77.5 %).
    No preview · Article · Mar 2015 · Journal of Anesthesia
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    ABSTRACT: Recent studies have suggested that a positive correlation exists between surgical interventions performed under general anesthesia and the risk of developing Alzheimer's disease (AD) in the late postoperative period. It has been reported that amyloid β-protein (Αβ) fibrillogenesis, which is closely related to AD, is accelerated by exposure to anesthetics. However, the mechanisms underlying these effects remain uncertain. This study was designed to investigate whether the anesthetic midazolam affects Αβ fibrillogenesis, and if so, whether it acts through GM1 ganglioside (GM1) on the neuronal surface. Midazolam treatment decreased GM1 expression in the detergent-resistant membrane microdomains of neurons, and these effects were regulated by the gamma-aminobutyric acid-A receptor. Midazolam inhibited Αβ fibril formation from soluble Αβ on the neuronal surface. In addition, midazolam suppressed GM1-induced fibril formation in a cell-free system. Moreover, midazolam inhibited the formation of Αβ assemblies in synaptosomes isolated from aged mouse brains. These finding suggested that midazolam has direct and indirect inhibitory effects on Αβ fibrillogenesis. Copyright © 2015 Elsevier Inc. All rights reserved.
    Preview · Article · Jan 2015 · Biochemical and Biophysical Research Communications
  • Yuji Kamimura · Mitsunori Miyazu · Kazuya Sobue
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    ABSTRACT: Tolvaptan, an arginine vasopressin V2 receptor antagonist, is considered to be an important drug for treating heart failure in children; however, there are few reports about its use in such cases. Herein, we describe our retrospective investigation into the efficacy and safety of tolvaptan in infants. This study examined 5 pediatric heart failure cases involving children with congenital heart disease (CHD) who were admitted to the ICU during the perioperative period or due to a history of CHD. The children were administered tolvaptan as a treatment for water retention after other diuretic drugs had proved to be ineffective. Improvements in their short-term clinical symptoms, such as weight reduction and increased urine volume, were observed after the administration of tolvaptan. The dosage ranged from 0.1-0.3 (median 0.1) mg/kg/day, which was lower than the doses used in previous studies, suggesting that tolvaptan is effective at low doses.
    No preview · Article · Jan 2015 · Nihon Shuchu Chiryo Igakukai zasshi
  • Tatsuya TSUJI · Mitsunori MIYAZU · Kazuya SOBUE

    No preview · Article · Jan 2015 · THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA
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    ABSTRACT: Objectives: To review our experience with pediatric veno arterial extracorporeal membrane oxygenation (VA-ECMO) at our University Hospital ICU. Methods: We reviewed the clinical records of all pediatric patients maintained on VA-ECMO between April 2008 and March 2013. Results: We experienced forty VA-ECMO runs for patients ranging in age from 3 days to 6 years. Thirty-nine of these patients had congenital heart disease (CHD). The overall survival rate was similar to the world standard at 75% and 58% for weaned off ECMO and discharged, respectively. According to a paper previously reported by our institution, the survival rate for discharged patients has significantly improved from 21% to 58% within the past 15 years. Within the last five years, the survival rate has improved from 33% to 100% for patients successfully weaned ECMO. In addition, within the same five-year period, the survival rate has remained at the same level for patients that have been successfully discharged. Conclusions: The outcomes of VA-ECMO have improved at our institution. What remains to be addressed is to identify the optimal anticoagulant therapies, improve the treatment techniques and complete further long-term observations of these patients.
    Preview · Article · Jan 2015 · Nihon Shuchu Chiryo Igakukai zasshi
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    ABSTRACT: It is recommended that the period of fasting before elective surgery should be shortened to facilitate a rapid recovery by preventing catabolism. We examined the effects of a short period of fasting on metabolism by performing indirect calorimetry (IC) under general anesthesia. A prospective observational study involving 26 consecutive patients who underwent elective surgery and whose metabolism was evaluated using IC during anesthesia was conducted. The patients were divided into two groups, those who fasted for <8 h (group S) and those who fasted for >10 h (group L). Oxygen consumption, the volume of carbon dioxide emissions (VCO2), the respiratory quotient (RQ), resting energy expenditure (REE), and basal energy expenditure (BEE) were compared. The REE, VCO2, and RQ of group L (17.7 ± 2.3 kcal/kg/day, 118.5 ± 20.8 ml/min, and 0.71 ± 0.12, respectively) were significantly lower than those of group S (19.7 ± 2.3 kcal/kg/day, 143.6 ± 30.9 ml/min, and 0.81 ± 0.09, respectively) (P < 0.05). In group L, the relationship between REE and BEE was weaker (r 2 = 0.501) and the BEE−REE slope was less steep (REE = 0.419BEE + 509.477) than those seen in group S (r 2 = 0.749 and REE = 1.113BEE − 376.111, respectively). Our findings suggest that a short period of fasting (<8 h) before surgery is more strongly associated with the conservation of basal metabolism.
    No preview · Article · Nov 2014 · Journal of Anesthesia
  • Kazuya Sobue · Hideaki Note · MinHye So
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    ABSTRACT: Number of surgeries for the elderly is increasing year by year. Postoperative cognitive dysfunction, POCD, and delirium are typical failure's of higher brain function after surgery. The mechanism of POCD and delirium has been suggested to be associated with inflammation, but its details are unknown. Alzheimer's disease leads to derangement in cognitive function. The number of patients with Alzheimer's disease is expected to increase rapidly. There is a possibility that inhalation anesthesia exacerbates the pathology of patients with impaired higher brain function such as Alzheimer's disease. On the other hand, the another suspect, that propofol is safe. However, it should be recognized that these results became clear by basic research. Further clinical study is required.
    No preview · Article · Nov 2014 · Masui. The Japanese journal of anesthesiology
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    ABSTRACT: Ultrasound (US)-guided transversus abdominis plane (TAP) block is widely-spread analgesic technique for the patients undergoing abdominal surgery and can be provided safely for the patients receiving anticoagulation therapy. We conducted a retrospective comparative trial of analgesic efficacy between the patient who received US-guided TAP block with postoperative continuous iv-fentanyl infusion (group T) and those who received epidural analgesia (group E). Twenty three patients who had undergone abdominal aortic replacement were analyzed retrospectively. The number of patients in group T was 12, and those in group E was 11. The postoperative first ambulation day, the postoperative first oral feeding day, the length of hospital stay, the use of rescue analgesic medication, and the incidence of postoperative nausea and vomiting (PONV) were compared between the two groups. P<0.05 was considered significant There were no significant differences in baseline characteristics between the two groups. There were no significant differences in postoperative first ambulation day (P=0.97), the postoperative first oral feeding day (P=0.46), the length of hospital stay (P= 0.32), the number of times of rescue analgesic medication (P=0.55), and the incidence of PONV between the two groups. US-guided TAP block is a useful option as analgesic technique for patients undergoing abdominal aortic replacement
    No preview · Article · Oct 2014 · Masui. The Japanese journal of anesthesiology
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    ABSTRACT: Throughout life, new neurons generated in the ventricular-subventricular zone take the long journey to the olfactory bulb. The intracellular mechanisms that precisely control the neurons' migration speed, enabling their well-organized movement, remain unclear. Rho signalling is known to affect the morphology and movement of various cell types, including neurons. Here we identify Gem-interacting protein (Gmip), a RhoA-specific GTPase-activating protein, as a key factor in saltatory neuronal migration. RhoA is activated at the proximal leading process of migrating neurons, where Gmip is also localized and negatively regulates RhoA. Gmip controls the saltatory movement of neurons that regulate their migration speed and 'stop' positions in the olfactory bulb, thereby altering the neural circuitry. This study demonstrates that Gmip serves as a brake for the RhoA-mediated movement of neuronal somata, and highlights the significance of speed control in the well-organized neuronal migration and the maintenance of neuronal circuits in the postnatal brain.
    Full-text · Article · Jul 2014 · Nature Communications
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    ABSTRACT: Leptin is a centrally acting hormone that controls metabolic pathways. Recent epidemiological studies suggest that plasma leptin is protective against Alzheimer's disease. However, the mechanism that underlies this effect remains uncertain. To investigate whether leptin inhibits the assembly of amyloid β-protein (Aβ) on the cell surface of neurons, we treated primary neurons with leptin. Leptin treatment decreased the GM1 ganglioside levels in the detergent-resistant membrane microdomains (DRMs) of neurons. The increase of GM1 ganglioside expression induced by leptin was inhibited after pretreatment with inhibitors of phosphatidylinositol 3-kinase (LY294002), Akt (triciribine) and the mammalian target of rapamycin (i.e. rapamycin), but not by an inhibitor of extracellular signal-regulated kinase (PD98059). In addition, pretreatment with these reagents blocked the induction of GM1 ganglioside in DRMs by leptin. Furthermore, Aβ assembly on the cell surface of neurons was inhibited greatly after treatment with leptin. This reduction was markedly inhibited after pretreatment with LY294002, triciribine and rapamycin. These results suggest that leptin significantly inhibits Aβ assembly by decreasing GM1 ganglioside expression in DRMs of the neuronal surface through the PI3K/Akt/mTOR pathway.This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2014 · Journal of Neurochemistry
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    ABSTRACT: Background We encountered markedly elevated procalcitonin (PCT) among pediatric patients during the early postoperative period of open heart surgery. The purpose of this study is to investigate what factors are associated with the PCT elevation. Methods Fifty-two pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. Plasma PCT, aspartate aminotransferase/alanine aminotransferase (AST/ALT), creatinine, lactate, and C-reactive protein (CRP) were measured on admission to ICU and during the postoperative period. The patients were categorized into high (group H) and low (group L) groups according to their peak PCT levels. Aorta cross-clamp (ACC), CPB time, ICU stay, mechanical ventilation period, peak AST/ALT, creatinine, lactate, and CRP levels were compared. Results ACC and CPB times, ICU stay period, and mechanical ventilation period were significantly longer in group H compared with group L (118.7 ± 51.6 vs. 49.4 ± 43.5 min, 244.5 ± 65.7 vs. 122.9 ± 63.0 min, 7.9 ± 4.6 vs. 4.0 ± 4.5 days, and 6.3 ± 4.1 vs. 2.9 ± 4.2 days, respectively; p < 0.01). Peak AST and creatinine were significantly higher in group H compared with group L (999.0 ± 1,990.3 vs. 88.3 ± 43.0 U/l and 0.84 ± 0.77 vs. 0.41 ± 0.17 mg/dl, respectively; p < 0.05). Conclusions ACC and CPB time-related perioperative stress is associated with elevated PCT; an association between ICU stay and mechanical ventilation period, liver enzymes, and creatinine levels was observed. PCT may be a good predictor of postoperative severity and organ dysfunction.
    Full-text · Article · Jun 2014
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    ABSTRACT: Infusion fluids may be contaminated with different types of particulates that are a potential health hazard. Particulates larger than microvessels may cause an embolism by mechanical blockage and inflammation; however, it has been reported that particulates smaller than capillary diameter are relatively safe. Against such a background, one report showed that polystyrene beads smaller than capillary diameter decreased tissue perfusion in ischemia-reperfusion injury. This report suggested that polystyrene beads from 1.5- to 6-μm diameter (dia.) may have unfavorable effects after pretreatment. Here, we investigated whether injection of polystyrene beads (3- and 6-μm dia.) as an artificial contaminant of intravenous fluid after lipopolysaccharide (LPS) injection affected mortality and organ damage in mice. Mice were divided into four groups and injected: polystyrene beads only, LPS only, polystyrene beads 30 min after LPS, or saline. A survival study, histology, blood examination, and urine examination were performed. The survival rate after LPS and polystyrene bead (6-μm dia.) injection was significantly lower than that of the other three groups. In the kidney sections, injured glomeruli were significantly higher with LPS and polystyrene bead injection than that of the other three groups. LPS and polystyrene bead injection decreased the glomerular filtration rate and led to renal failure. Inflammatory reactions induced with LPS were not significantly different between with or without polystyrene beads. Polystyrene beads were found in urine after LPS and polystyrene bead injection. Injection of polystyrene beads after LPS injection enhanced glomerular structural injury and caused renal function injury in a mouse sepsis model.
    Full-text · Article · Mar 2014
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    ABSTRACT: Pathogenesis of Alzheimer’s disease (AD) is characterized by accumulation of extracellular deposits of amyloid β-protein (Aβ) in the brain. The steady state level of Aβ in the brain is determined by the balance between its production and removal; the latter occurring through egress across blood and CSF barriers as well as Aβ degradation. The major Aβ-degrading enzymes in the brain are neprilysin (NEP) and insulin-degrading enzyme (IDE), which may promote Aβ deposition in patients with sporadic late-onset AD. Epidemiological studies have suggested an inverse relationship between the adipocytokine leptin levels and the onset of AD. However, the mechanisms underlying the relationship remain uncertain. We investigated whether leptin is associated with Aβ degradation by inducing NEP and IDE expression within primary cultured astrocytes. Leptin significantly decreased the expression of NEP but not IDE in a concentration- and time-dependent manner through the activation of extracellular signal-regulated kinase (ERK) in cultured rat astrocytes. Furthermore, leptin inhibited the degradation of exogenous Aβ in primary cultured astrocytes. These results suggest that leptin suppresses Aβ degradation by NEP through activation of ERK.
    Preview · Article · Feb 2014 · Biochemical and Biophysical Research Communications

  • No preview · Article · Jan 2014 · THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

  • No preview · Article · Jan 2014 · Nihon Shuchu Chiryo Igakukai zasshi
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    ABSTRACT: Dexmedetomidine is a highly selective central α2-agonist with anesthetic and analgesic properties for patients in intensive care units. There is little information about the relationship between dosage and plasma concentration during long drug infusions of dexmedetomidine in critically ill patients, especially in Asians. In addition, the administration of dexmedetomidine with a dosage of 0.2-0.7 μg/kg/h in Japan is different from that with a dosage of 0.2-1.4 μg/kg/h in European countries and the USA. There has been concern about obtaining an effective concentration with a small dosage and estimating the relationship between dosage and plasma concentration. We conducted a prospective, observational, cohort study measuring plasma dexmedetomidine concentrations. Plasma dexmedetomidine concentrations of 67 samples from 34 patients in an intensive care unit for 2 months were measured by ultra performance liquid chromatography coupled with tandem mass spectrometry using single-blind method, and the correlation coefficient between dosages and plasma concentrations was estimated. Exclusion criteria included young patients (<16 years) and samples obtained from patients in which the dosage of dexmedetomidine was changed within 3 h. Among the patients, 20 (58.8%) of the 34 received dexmedetomidine at 0.20-0.83 μg/kg/h, and in 40 of the 67 samples for which dexmedetomidine had been administered, this occurred for a median duration of 18.5 h (range, 3-87 h). The range of the dexmedetomidine plasma concentration was 0.22-2.50 ng/ml. By comparison with other studies, with a dosage of 0.2-0.7 μg/kg/h, the patients in this setting could obtain an effective dexmedetomidine concentration. The plasma dexmedetomidine concentration was moderately correlated with the administered dosage (r = 0.653, P < 0.01). The approximate linear equation was y = 0.171x + 0.254. The range of Richmond Agitation-Sedation Scale was 0 to -5. We concluded that, with a dosage of 0.2-0.83 μg/kg/h, the patients in this setting could obtain an effective dexmedetomidine concentration of 0.22-2.50 ng/ml. In addition, the plasma dexmedetomidine concentration was moderately correlated with the administered dosage (r = 0.653, P < 0.01). University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000009115.
    Preview · Article · Dec 2013
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    ABSTRACT: Percutaneous transtracheal ventilation (PTV) can be life-saving in a cannot ventilate, cannot intubate situation. The aim of this study was to investigate the efficacy of PTV by measuring tidal volumes (VTs) and airway pressure (Paw) in high-flow oxygen ventilation and manual ventilation using a model lung. We examined 14G, 16G, 18G, and 20G intravenous catheters and minitracheotomy catheters. In high-flow oxygen ventilation, the flow was set to 10 L/min, while the inspiratory:expiratory phases (I:E) were 1 s:4 s in the complete upper airway obstruction model and 1 s:1 s in the incomplete obstruction model. In manual ventilation, I:E were 2 s:4 s in the complete obstruction model and 2 s:3 s in the incomplete obstruction model. We ventilated through each catheter for 2 min and measured VT and Paw. In high-flow ventilation, the average VTs were approximately 150 ml and <100 ml with 14G catheters in complete and incomplete upper airway obstruction, respectively. The VTs obtained were reduced when the bore size was decreased. In manual ventilation, the average VTs were over 300 ml and approximately 260 ml with 14G catheters in complete and incomplete upper airway obstruction, respectively. In high-flow ventilation, the airway pressure tended to be higher. The minitracheotomy catheters produced over 800 ml of VT and created almost no positive end-expiratory pressure. High-flow ventilation tends to result in higher airway pressure despite a smaller VT, which is probably due to a PEEP effect caused by high flow.
    No preview · Article · Nov 2013 · Journal of Anesthesia

Publication Stats

1k Citations
205.60 Total Impact Points

Institutions

  • 1998-2015
    • Nagoya City University
      • • Department of Ansthesiology and Medical Crisis Management
      • • Graduate School of Medical Sciences
      Nagoya, Aichi, Japan
  • 2013
    • Ritsumeikan University
      Kioto, Kyōto, Japan
  • 2002
    • McGill University
      • Department of Neurology and Neurosurgery
      Montréal, Quebec, Canada
  • 2000
    • Lady Davis Institute for Medical Research
      Montréal, Quebec, Canada