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KITAURA Atsuhiro

    Department of Medicine　Lecturer in Medical School
Last Updated :2024/04/23

Researcher Information

Degree

  • Ph.D.（2021/06 Kindai University）

J-Global ID

Research Interests

  • Anesthesia for SHD procedure   LPS   remimazolam   AGEs   macrophage   Cardiovascular anesthesia   Intensive care medicine   Anesthesiology   

Research Areas

  • Life sciences / Pharmacology
  • Life sciences / Anesthesiology

Academic & Professional Experience

  • 2022/04 - Today  Kindai University Faculty of MedicineDepartment of AnesthesiologyAssistant Professor
  • 2018/04 - 2022/03  Kindai University Faculty of MedicineDepartment of Anesthesiology医学部助教A
  • 2013/04 - 2018/03  Kindai University HospitalDepartment of Anesthesiology医学部助教B
  • 2011/04 - 2013/03  Kindai UniversityFaculty of Medicine初期臨床研修医

Education

  • 2015/04 - 2021/06  Kindai University Graduate school  Graduate School of Medical Sciences
  • 2005/04 - 2011/03  Kindai University  Faculty of Medicine

Association Memberships

  • 日本医学シミュレーション学会   THE JAPANESE SOCIETY OF INTENSIVE CARE MEDICINE   JSCVA   American Society of Anesthesiologists   JAPANESE SOCIETY OF ANESTHESIOLOGISTS   

Published Papers

  • Shota Tsukimoto; Atsuhiro Kitaura; Rina Yamamoto; Chikara Hirase; Shinichi Nakao; Yasufumi Nakajima; Takuro Sanuki
    Cureus Springer Science and Business Media LLC 2168-8184 2024/04
  • Shota Tsukimoto; Atsuhiro Kitaura; Hidetaka Kuroda; Uno Imaizumi; Fumihiko Yoshino; Ayaka Yoshida; Shinchi Nakao; Noriyuki Ohta; Yasuhumi Nakajima; Takuro Sanuki
    Immunity, inflammation and disease 12 (3) e1218  2024/03 [Refereed]
     
    BACKGROUND: Anesthetic agents, particularly intravenous anesthetics, may affect immune function and tumorigenic factors. We herein investigated whether the anti-inflammatory effects of anesthetic agents are attributed to their antioxidant properties. The antioxidant and anti-inflammatory effects of remimazolam, a new anesthetic, remain unclear. We hypothesized that remimazolam exerts anti-inflammatory effects due to its antioxidant properties, which may affect the postoperative inflammatory response. This retrospective clinical study examined this hypothesis using laboratory and clinical approaches. METHODS: The antioxidant effects of remimazolam and dexmedetomidine were assessed by electron spin resonance (ESR) spectroscopy, and postoperative inflammatory responses were compared in 143 patients who underwent transcatheter aortic valve replacement at Kindai University Hospital between April 2021 and December 2022. The primary endpoint was the presence or absence of the antioxidant effects of the anesthetics themselves using ESR. RESULTS: Remimazolam at clinical concentrations exerted antioxidant effects, whereas dexmedetomidine did not. Increases in C-reactive protein (CRP) levels on POD3 from preoperative values were significantly smaller in the remimazolam group than in the dexmedetomidine group (1.33 ± 1.29 vs. 2.17 ± 1.84, p = .014). CONCLUSIONS: Remimazolam exerted stronger anti-inflammatory effects than dexmedetomidine, and these effects were enhanced by its antioxidant properties, which may have affected postoperative CRP production.
  • Hiroatsu Sakamoto; Atsuhiro Kitaura; Shota Tsukimoto; Yukari Yoshino; Takashi Mino; Haruyuki Yuasa; Yasufumi Nakajima
    JA clinical reports 10 (1) 13 - 13 2024/02 [Refereed]
  • Atsuhiro Kitaura; Hiroatsu Sakamoto; Shinichi Hamasaki; Shota Tsukimoto; Yasufumi Nakajima
    Medicina 59 (12) 2136 - 2136 2023/12 [Refereed]
  • Atsuhiro Kitaura; Hiroatsu Sakamoto; Kensuke Toho; Shota Tsukimoto; Haruyuki Yuasa; Yasufumi Nakajima
    JA clinical reports 9 (1) 83 - 83 2023/12 [Refereed]
  • Atsuhiro Kitaura; Issei Fukuda; Haruyuki Yuasa; Shota Tsukimoto; Yasufumi Nakajima
    JA clinical reports 9 (1) 80 - 80 2023/11 [Refereed]
  • Atsuhiro Kitaura; Shota Tsukimoto; Hiroatsu Sakamoto; Shinichi Hamasaki; Shinichi Nakao; Yasufumi Nakajima
    Scientific reports 13 (1) 17074 - 17074 2023/10 [Refereed]
     
    Remimazolam, an ultrashort-acting benzodiazepine, allows for rapid and reliable arousal. Rapid awakening using remimazolam may be beneficial in transcatheter aortic valve replacement (TAVR), as it allows rapid detection of neurologic deficits. The purpose of this study was to compare arousal time and outcomes between monitored anesthesia care (MAC) with remimazolam and remifentanil and conventional MAC with dexmedetomidine, propofol, and remifentanil. This study was a single center retrospective study. All TAVR cases performed under MAC (MAC-TAVR) at our institution between 2019 and 2021 were included. Patients were classified by anesthesia method into remimazolam and dexmedetomidine groups. Among 258 MAC-TAVR patients, 253 were enrolled. After propensity score matching, 76 patients were assigned to each group. The time from end of drug-administration to arousal [20.0 (16.0, 24.0) min vs. 38.5 (30.0, 56.3) min, p < 0.0001] and the time from attempted-arousal to arousal [1.0 (1.0, 1.0) min vs. 12.5 (3.0, 26.8) min, p < 0.0001] were significantly shorter in the remimazolam group. There was no significant difference in the length of ICU stay [2.0 (2.0, 2.0) days vs. 2.0 (2.0, 2.0) days, p = 0.157] and postoperative hospital stay [6.0 (4.0, 9.0) days vs. 5.0 (4.0, 8.0) days, p = 0.262].Trial registration: Clinical trial number: R03-123, Registry URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051635 Registration number: UMIN000045195, Principal investigator's name: Atsuhiro Kitaura, Date of registration: 20 August 2021.
  • 坂本 悠篤; 秋山 浩一; 北條 絵理; 北浦 淳寛; 中嶋 康文
    Cardiovascular Anesthesia (一社)日本心臓血管麻酔学会 27 (Suppl.) 239 - 239 1342-9132 2023/09
  • 鎌本 洋通; 北山 智哉子; 坂本 悠篤; 法里 慧; 北浦 淳寛; 秋山 浩一; 中嶋 康文
    Cardiovascular Anesthesia (一社)日本心臓血管麻酔学会 27 (Suppl.) 247 - 247 1342-9132 2023/09
  • Atsuhiro Kitaura; Tatsushige Iwamoto; Shinichi Hamasaki; Shota Tsukimoto; Yasufumi Nakajima
    Cureus 15 (8) e44003  2023/08 [Refereed]
     
    Andexanet alfa is an analog of activated factor X and is used as an antagonist of anti-activated factor X agents. Andexanet alfa is useful for hemostasis in emergent bleeding during direct oral anticoagulant administration, which contributes to safety. In patients undergoing surgery with cardiopulmonary bypass because of heparin resistance, anesthesiologists are faced with a choice of anticoagulants. Herein, we experienced anesthesia for vascular prostheses with cardiopulmonary bypass for acute aortic dissection in a patient who had received andexanet alfa preoperatively. Heparin was initially used as the anticoagulant during cardiopulmonary bypass; however, despite the administration of large doses and antithrombin III preparations, anticoagulation was insufficient. Therefore, nafamostat mesilate was administered and sufficient anticoagulation was attained. The patient completed surgery under cardiopulmonary bypass, coagulation function was recovered shortly after withdrawal, and no obvious adverse effects were observed.
  • Atsuhiro Kitaura; Shinichi Hamasaki; Hiroatsu Sakamoto; Shota Tsukimoto; Yasufumi Nakajima
    Cureus Springer Science and Business Media LLC 15 (7) 2168-8184 2023/07 [Refereed]
  • A comparison of intubation efficacy between airway scope and McGrath MAC video laryngoscopes by medical trainees: A randomized crossover manikin study
    Yuasa H; Kitaura A; Miura Y; Tsukimoto S; Nakajima Y; Nakao S
    Acta Med Kindai Univ. 48 (1) 21 - 26 2023/05 [Refereed]
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  • 術後意識障害の鑑別に難渋した症例
    高岡 敦; 岩元 辰篤; 坂本 悠篤; 岡本 健; 北浦 淳寛; 大田 典之; 中嶋 康文
    日本神経麻酔集中治療学会プログラム・抄録集 日本神経麻酔集中治療学会 27回 59 - 59 2023/04
  • Atsuhiro Kitaura; Rina Yamamoto; Shota Tsukimoto; Shinichi Hamasaki; Yasuhumi Nakajima
    Cureus 15 (4) e37436  2023/04 [Refereed]
     
    A small percentage of cases of dermatomyositis are positive for anti-mitochondrial antibodies (AMA), a known marker for primary biliary cirrhosis. AMA-positive myositis is a rare disease that has been reported to be accompanied by myocarditis, resulting in low left ventricular function, supraventricular arrhythmias, and abnormalities of the conduction system. We present a case of AMA-positive myocarditis resulting in sinus arrest during general anesthesia. A 66-year-old female with AMA-positive myocarditis underwent artificial femoral head replacement for osteonecrosis of the femoral head under general anesthesia. During general anesthesia, a nine-second sinus arrest occurred without any inducement. The sinus arrest was thought to be influenced by not only over-suppression caused by severe supraventricular tachycardia derived from sick sinus syndrome but sympathetic depression caused by general anesthesia. Because of the potential for life-threatening cardiovascular events during anesthesia in patients with AMA-positive myositis, it was considered essential to provide adequate preoperative management and intraoperative monitoring during anesthesia for patients with this disease. Herein, we report our case with a literature review.
  • Atsuhiro Kitaura; Shinichi Nakao; Haruyuki Yuasa; Shota Tsukimoto; Yasuhumi Nakajima
    The American journal of case reports 23 e938609  2022/12 [Refereed]
     
    BACKGROUND Prevention of lethal arrhythmias in congenital long QT syndrome type 1 (LQT1) requires avoidance of sympathoexcitation, drugs that prolong QT, and electrolyte abnormalities. However, it is often difficult to avoid all these risks in the perioperative period of open heart surgery. Herein, we report hypokalemia-induced cardiac arrest in a postoperative cardiac patient with LQT1 on catecholamine. CASE REPORT A 79-year-old woman underwent surgical aortic valve replacement for severe aortic stenosis. Although the initial plan was not to use catecholamine, catecholamine was used in the Postoperative Intensive Care Unit with attention to QT interval and electrolytes due to heart failure caused by postoperative bleeding. Serum potassium levels were controlled above 4.5 mEq/L, and no arrhythmic events occurred. On postoperative day 4, the patient was started on insulin owing to hyperglycemia. Cardiac arrest occurred after the first insulin dose; the implantable cardioverter defibrillator was activated, and the patient's own heartbeat resumed. Subsequent examination revealed that a marked decrease in serum potassium level had occurred after insulin administration. The electrocardiogram showed obvious QT prolongation and ventricular fibrillation following R on T. Thereafter, under strict potassium management, there was no recurrence of cardiac arrest events. CONCLUSIONS A patient with LQT1 who underwent open heart surgery developed ventricular fibrillation after Torsades de Pointes, probably due to hypokalemia after insulin administration in addition to catecholamine. It is important to check serum potassium levels to avoid the onset of Torsades de Pointes in patients with long QT syndrome. In addition, the impact of insulin administration was reaffirmed.
  • Atsuhiro Kitaura; Shinichi Nakao
    JA clinical reports 8 (1) 60 - 60 2022/08 [Refereed]
  • 局所麻酔鎮静下TAVIを主とする施設における術中経食道エコーの立ち位置
    北浦 淳寛; 中嶋 康文
    臨床麻酔 真興交易(株)医書出版部 46 (8) 1051 - 1056 0387-3668 2022/08 [Refereed][Invited]
  • Atsuhiro Kitaura; Reiko Kosumi; Tatsushige Iwamoto; Shinichi Nakao
    JA clinical reports 8 (1) 38 - 38 2022/06 [Refereed]
     
    BACKGROUND: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is characterized by cardiac depression, respiratory failure, myopathy, and anesthesia for affected patients is challenging. Although several anesthetics have been safely employed, there are no reports on remimazolam used in those patients. CASE PRESENTATION: A 47-year-old male with MELAS syndrome was diagnosed with mitral regurgitation and scheduled for transcatheter mitral valve repair under general anesthesia. Anesthesia was induced with remimazolam and remifentanil (0.3 µg/kg/min). Remimazolam was administered at 12 mg/kg/h until loss of consciousness for approximately 1 min. Anesthesia was maintained with 1.1-1.2 mg/kg/h of remimazolam and 0.1 µg/kg/min of remifentanil without circulatory collapse or severe metabolic acidosis. The tracheal tube was removed in the operating room. CONCLUSION: Remimazolam may be a new option for anesthesia for MELAS syndrome patients with depressed heart function.
  • Haruyuki Yuasa; Atsuhiro Kitaura; Chiyako Kitayama; Masaki Fuyuta; Takashi Mino; Ken Okamoto; Shinichi Nakao
    The American journal of case reports 22 e927756  2021/03 [Refereed]
     
    BACKGROUND Brugada syndrome is a potentially fatal cardiac arrhythmia characterized by incomplete right bundle-branch block (RBB) and characteristic ST-segment elevation in the anterior electrocardiogram (ECG) leads. This report is of a case of type 2 Brugada syndrome, and discusses the importance of preoperative history and ECG evaluation. CASE REPORT A 32-year-old man was scheduled for tympanoplasty. His preoperative ECG revealed saddleback-type J waves in V₂ (>2 mm) and ST increase (>1 mm) detected 1 week before elective surgery, but the ECG 1 year before showed normal. He had no notable past history. Anesthesia was induced with remifentanil and propofol, and maintained with sevoflurane in combination with remifentanil. Routine monitoring of vital signs was supplemented with V2 monitoring on the ECG. The heart rate was maintained at above 60 beats/min using ephedrine. The course of the operation was uneventful. CONCLUSIONS We managed anesthesia for a patient with a type 2 Brugada syndrome ECG without events, probably because he had no notable past history such as syncope. Type 2 and type 3 Brugada syndrome ECGs are difficult to recognize, and patients with them are considered to be less risky than a patient with a type I ECG. However, as Brugada syndrome ECG is dynamic and changeable, a type 2 or 3 Brugada syndrome ECG can change to a type I ECG under some conditions, and thus should not be overlooked, and the patient's past history or symptoms, such as syncope, should be carefully investigated.
  • Atsuhiro Kitaura; Takashi Nishinaka; Shinichi Hamasaki; Omer Faruk Hatipoglu; Hidenori Wake; Masahiro Nishibori; Shuji Mori; Shinichi Nakao; Hideo Takahashi
    PloS one 16 (1) e0245957  2021 [Refereed]
     
    Hyperglycaemia provides a suitable environment for infections and the mechanisms of glucose toxicity include the formation of advanced glycation end-products (AGEs), which comprise non-enzymatically glycosylated proteins, lipids, and nucleic acid amino groups. Among AGE-associated phenotypes, glycolaldehyde-derived toxic AGE (AGE-3) is involved in the pathogenesis of diabetic complications. Internalisation of endotoxin by various cell types contributes to innate immune responses against bacterial infection. An endotoxin derived from Gram-negative bacteria, lipopolysaccharide (LPS), was reported to enhance its own uptake by RAW264.7 mouse macrophage-like cells, and an LPS binding protein, CD14, was involved in the LPS uptake. The LPS uptake induced the activation of RAW264.7 leading to the production of chemokine CXC motif ligand (CXCL) 10, which promotes T helper cell type 1 responses. Previously, we reported that AGE-3 was internalised into RAW264.7 cells through scavenger receptor-1 Class A. We hypothesized that AGEs uptake interrupt LPS uptake and impair innate immune response to LPS in RAW264.7 cells. In the present study, we found that AGE-3 attenuated CD14 expression, LPS uptake, and CXCL10 production, which was concentration-dependent, whereas LPS did not affect AGE uptake. AGEs were reported to stimulate the receptor for AGEs and Toll-like receptor 4, which cause inflammatory reactions. We found that inhibitors for RAGE, but not Toll-like receptor 4, restored the AGE-induced suppression of CD14 expression, LPS uptake, and CXCL10 production. These results indicate that the receptor for the AGE-initiated pathway partially impairs the immune response in diabetes patients.
  • Mayuka Matsushima; Seishi Kimura; Atsuhiro Kitaura; Shinichi Hamasaki; Tatsushige Iwamoto; Takashi Mino; Kenichi Masui; Shinichi Nakao
    Journal of clinical pharmacy and therapeutics 46 (2) 433 - 439 2020/10 [Refereed]
     
    WHAT IS KNOWN AND OBJECTIVE: Propofol is the most commonly used intravenous anaesthetic worldwide and is considered to be safe for all ages. However, there have been some reports that propofol induces severe atrioventricular (AV) blocks in humans and some studies demonstrated that propofol suppressed the cardiac conduction system in animals. A precise mechanism by which the block is induced has not been elucidated yet in humans. The objective of this study was to investigate the effects of propofol on the cardiac conduction system and the cardiac autonomic nervous balance in children. METHODS: We enrolled 23 paediatric patients (age: 6-15 years; males: 16, females: 7) who were scheduled to undergo radiofrequency catheter ablation (RFCA) under general anaesthesia. Anaesthesia was induced with 2 mg/kg propofol and 0.5 µg/kg/min remifentanil, and tracheal intubation was performed with the aid of 1 mg/kg rocuronium. Anaesthesia was maintained with 5-7 mg/kg/h propofol and 0.2 µg/kg/min remifentanil during the RFCA. After the completion of the RFCA, anaesthesia was further maintained with 5 mg/kg/h propofol and 0.2 µg/kg/min remifentanil for at least 10 min (LC: low propofol concentration state), followed by the injection of 2 mg/kg propofol and the infusion of 10 mg/kg/h propofol for 10 min (HC: high propofol concentration state). The sinus node recovery time (SNRT), sinoatrial conduction time (SACT), atrial-His (AH) interval and the His-ventricular (HV) interval were measured at the end of both the LC and HC. Cardiac autonomic regulation was simultaneously assessed based on heart rate variability. RESULTS AND DISCUSSION: Propofol significantly suppressed intrinsic cardiac HV conduction, but did not affect the SNRT, SACT or the AH interval. As HV blocks, which occur below the His bundle, are often life-threatening, the HV conduction delay may be a cause of severe AV blocks induced by propofol. Propofol directly suppressed parasympathetic nerve activity, and sympathetic nerve activity was also suppressed. WHAT IS NEW AND CONCLUSION: These results indicate that propofol suppresses the HV conduction and might help to elucidate the mechanism by which propofol causes lethal AV blocks.
  • Haruyuki Yuasa; Yukio Onoda; Atsuhiro Kitaura; Takashi Mino; Shota Tsukimoto; Shinichi Nakao
    JA clinical reports 6 (1) 72 - 72 2020/09 [Refereed]
     
    BACKGROUND: In a patient with very long-chain acyl-Coenzyme A dehydrogenase (VLCAD) deficiency, metabolism of fatty acids is impaired and a supply of alternative energy is limited when glucose level is insufficient on starvation. CASE PRESENTATION: A 37-year-old woman with VLCAD deficiency was diagnosed with an ovarian cyst and was scheduled for laparoscopic ovarian cystectomy. Glucose was administered intravenously with the start of fasting. Anesthesia was induced with remifentanil, midazolam, and thiamylal, maintained with desflurane and remifentanil. Body temperature was maintained at 36.2-36.7 °C. During anesthesia, hypoglycemia did not occur, creatine kinase levels were in the normal range, and myoglobinuria was not detected. No shivering was observed after extubation. CONCLUSIONS: Glucose was administered to avoid perioperative hypoglycemia. Body temperature was controlled to avoid shivering, which would otherwise increase skeletal muscle energy needs. Blood creatine kinase did not increase, and myoglobinuria was not detected; thus, rhabdomyolysis was unlikely to develop.
  • Takashi Mino; Seishi Kimura; Atsuhiro Kitaura; Tatsushige Iwamoto; Haruyuki Yuasa; Yasutaka Chiba; Shinichi Nakao
    PloS one 15 (11) e0241591  2020 [Refereed]
     
    BACKGROUND: Severe aortic stenosis (AS) is increasing in the aging society and is a serious condition for anesthetic management. However, approximately one-third of patients with severe AS are asymptomatic. Echocardiography is the most reliable method to detect AS, but it takes time and is costly. METHODS: Data were obtained retrospectively from patients who underwent surgery and preoperative transthoracic echocardiography (TTE). LVH on ECG was determined by voltage criteria (Sv1 + Rv5 or 6 ≥3.5 mV) and/or the strain pattern in V5 and V6. Severe AS was defined as a mean transaortic pressure gradient ≥40 mmHg or aortic valve area ≤1.0 cm2 by TTE. RESULTS: Data for 470 patients aged 28-94 years old were obtained. One hundred and twenty-six patients had severe AS. LVH on ECG by voltage criteria alone was detected in 182 patients, LVH by strain pattern alone was detected in 80 patients and LVH by both was detected in 55 patients. Multivariable logistic analysis revealed that LVH by the strain pattern or voltage criteria, diabetes mellitus, and age were significantly associated with severe AS. The AUC for the ROC curve for LVH by voltage criteria alone was 0.675 and the cut-off value was 3.84 mm V, and the AUC for the ROC for age was 0.675 and the cut-off value was 74 years old. CONCLUSION: Our study suggests that patients who are 74 years old or over with LVH on ECG, especially those with DM, should undergo preoperative TTE in order to detect severe AS.
  • Kitaura A; Houri K; Nakao S
    The American journal of case reports 20 1104 - 1107 2019/07 [Refereed]
     
    BACKGROUND Denervation supersensitivity to sympathomimetic drugs has been noted in patients with Parkinson's disease (PD) whose cardiac sympathetic nerves are denervated. This phenomenon is not as well recognized as other complications of PD patients, but anesthesiologists should be aware of it because sympathomimetic drugs can sometimes be dangerous to these patients. CASE REPORT A 60-year-old woman was scheduled for total hip joint replacement under combined spinal-epidural anesthesia and sedation. She had been diagnosed as PD (stage 4 on the Hoehn and Yahr scale) with a history of orthostatic hypotension. Her ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy revealed marked reduction of ¹²³I-MIBG accumulation in the heart. In the operating room, we placed an epidural catheter through the Th12-L1 space, and spinal anesthesia (2.6 mL of 0.5% normobaric bupivacaine) was administered. During the surgery, we infused propofol at 100 mg·hr⁻¹ for sedation. When 4 mg of ephedrine was administered intravenously because of marked decrease in patient's blood pressure, we observed unexpectedly large increases in the systolic blood pressure, from 78 mmHg to 168 mmHg, and the heart rate increased from 52 to 84 beats per minute (bpm). This phenomenon recurred each time 4 mg of ephedrine was administered. CONCLUSIONS We report a case in which ephedrine induced unexpectedly large increases in blood pressure and heart rate in a patient who suffered from PD with severe cardiac sympathetic nerve denervation. We speculate that this phenomenon was caused by denervation supersensitivity of the patient's heart.
  • Mesenteric traction syndrome-like symptoms caused by lung traction: A report of two cases
    Aoki R; Iwamoto T; Shirai T; Fuyuta M; Kitaura A; Nakao S
    J Anesth Clin Res 10 (7) 2019 [Refereed]
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  • Shinichi Hamasaki; Takuro Kobori; Yui Yamazaki; Atsuhiro Kitaura; Atsuko Niwa; Takashi Nishinaka; Masahiro Nishibori; Shuji Mori; Shinichi Nakao; Hideo Takahashi
    Scientific Reports Nature Publishing Group 8 (1) 5901  2045-2322 2018/12 [Refereed]
     
    Advanced glycation end-products (AGEs), which comprise non-enzymatically glycosylated proteins, lipids, and nucleic acid amino groups, play an important role in several diseases and aging processes including angiopathy, renal failure, diabetic complications, and neurodegenerative diseases. Among AGE-associated phenotypes, toxic AGEs, glyceraldehyde-derived AGE-2, and glycolaldehyde-derived AGE-3 are involved in the pathogenesis of diabetic complications. In addition, macrophages are reported to remove extracellular AGEs from tissues via scavenger receptors, leading to the progression of atherosclerosis. In the present study, we found that AGE-2 and AGE-3 enhanced their own endocytic uptake by RAW264.7 mouse macrophage-like cells in a concentration-dependent manner. Furthermore, we demonstrated, for the first time, the morphology of phagocytic macrophages and the endocytosis of AGE particles. The toxic AGEs induced the expression of a scavenger receptor, CD204/scavenger receptors-1 class A (SR-A). Notably, an antibody against CD204 significantly prevented toxic AGE uptake. Moreover, an SR-A antagonistic ligand, fucoidan, also attenuated the AGE-2- and AGE-3-evoked uptake in a concentration-dependent manner. These results indicated that SR-A stimulation, at least in part, plays a role in AGE uptake.
  • Takuro Kobori; Shinichi Hamasaki; Atsuhiro Kitaura; Yui Yamazaki; Takashi Nishinaka; Atsuko Niwa; Shinichi Nakao; Hidenori Wake; Shuji Mori; Tadashi Yoshino; Masahiro Nishibori; Hideo Takahashi
    Frontiers in Immunology Frontiers Media S.A. 9 334  1664-3224 2018/03 [Refereed]
     
    M2 macrophage (Mψ) promotes pathologic angiogenesis through a release of pro-angiogenic mediators or the direct cell-cell interaction with endothelium in the micromilieu of several chronic inflammatory diseases, including rheumatoid arthritis and cancer, where interleukin (IL)-18 also contributes to excessive angiogenesis. However, the detailed mechanism remains unclear. The aim of this study is to investigate the mechanism by which M2 Mψs in the micromilieu containing IL-18 induce excessive angiogenesis in the in vitro experimental model using mouse Mψ-like cell line, RAW264.7 cells, and mouse endothelial cell line, b. End5 cells. We discovered that IL-18 acts synergistically with IL-10 to amplify the production of Mψ-derived mediators like osteopontin (OPN) and thrombin, yielding thrombin-cleaved form of OPN generation, which acts through integrins α4/α9, thereby augmenting M2 polarization of Mψ with characteristics of increasing surface CD163 expression in association with morphological alteration. Furthermore, the results of visualizing temporal behavior and morphological alteration of Mψs during angiogenesis demonstrated that M2-like Mψs induced excessive angiogenesis through the direct cell-cell interaction with endothelial cells, possibly mediated by CD163.
  • Shirai T; Kitaura A; Uehara K; Uchida T; Fuyuta M; Iwamoto T; Hiramatsu K; Nakao S
    JA Clinical Reports 4 (1) 44 - 44 2018 [Refereed]
     
    BACKGROUND: Parkinson's disease (PD) patients often suffer from cardiac sympathetic denervation, a hallmark of which is orthostatic hypotension. Denervation supersensitivity to sympathomimetic drugs is also seen in such patients, and this phenomenon is important and can be sometimes dangerous. CASE PRESENTATION: A 65-year-old male underwent gastrojejunostomy. The patient had severe PD and did not exhibit metaiodobenzylguanidine (MIBG) accumulation in his heart, which was indicative of cardiac sympathetic nerve denervation. When 8 mg of ephedrine was administered intravenously, an unexpectedly large increase in blood pressure was observed. The phenomenon recurred when 4 mg of ephedrine was administered again, and nicardipine was required to suppress the patient's blood pressure. CONCLUSIONS: Denervation supersensitivity is not as well recognized as other complications seen in PD patients, but anesthesiologists should be aware of it because sympathomimetic drugs can have excessively strong effects in patients with the condition.
  • Seishi Kimura; Shinichi Nakao; Atsuhiro Kitaura; Tatushige Iwamoto; Kei Houri; Mayuka Matsushima; Shinichi Hamasaki
    PLOS ONE PUBLIC LIBRARY SCIENCE 12 (12) e0188555  1932-6203 2017/12 [Refereed]
     
    QTc interval prolongation is a serious diabetic complication and increases mortality rate. Hyperglycemia inhibits the rapid component of delayed rectifier potassium channel currents (Ikr) and prolongs the QTc interval on electrocardiograms. Sevoflurane also inhibits the Ikr and causes QTc interval prolongation. In fact, torsade de pointes occurred in a patient with poorly controlled diabetes mellitus during sevoflurane anesthesia. We enrolled 74 patients, including 37 normoglycemic patients (glycated hemoglobin [HbA1c]: <6.5%) (NG group) and 37 chronically hyperglycemic patients (HbA1c: >= 6.5%) (HG group). Anesthesia was induced with 2 mg/kg propofol and 0.3 mu g/kg/min remifentanil, and maintained with 2% sevoflurane in 40% O-2 and 0.2-0.3 mu g/kg/min remifentanil. The QT interval and Tp-e interval (from the peak to the end of the T wave) were measured before and at 5, 10, 30, 60, 90, and 120 min after the administration of sevoflurane and adjusted for the patient's heart rate (QTc and Tp-ec, respectively). P-values of <0.05 were considered statistically significant. The QTc and the Tp-ec intervals of the two groups did not differ significantly before the administration of sevoflurane. The QTc interval gradually increased with time in both groups and was significantly longer than the baseline value at 10 min after the administration of sevoflurane in both groups. The QTc interval of the HG group was significantly longer than that of the NG group at 90 min and 120 min after the administration of sevoflurane. The Tp-ec interval was not affected by sevoflurane in either group. We have demonstrated that sevoflurane significantly prolongs the QTc interval, and that the extent of the prolongation is significantly greater in chronically hyperglycemic patients than in normoglycemic patients. Although Tp-ec is not affected by sevoflurane, it should be noted that the simultaneous blockade of potassium channels would increase the risk of arrhythmias.
  • Atsuhiro Kitaura; Shinichi Nakao; Shinichi Hamasaki; Kei Houri; Takatoshi Tsujimoto; Seishi Kimura; Mayuka Matsushima
    JA clinical reports Springer Science and Business Media LLC 3 (29) 29  2017/05 [Refereed]
  • Atsuhiro Kitaura; Tatsushige Iwamoto; Shinichi Hamasaki; Mayuka Shiba; Yasuhiro Shiokawa; Shinichi Nakao
    Japanese Journal of Anesthesiology Kokuseido Publishing Co. Ltd 65 (2) 157 - 159 0021-4892 2016/02 [Refereed]
     
    A 69-year-old male patient with esophageal cancer underwent video assisted subtotal esophagectomy after neoadjuvant chemotherapy and radiation (50 Gy). Adhesion between esophagus and the aorta was so severe that the aortic arch was damaged and massive bleeding occurred during manipulation of the esophagus. However, as we had expected and prepared for the incident we successfully managed it and emergency thoracic endovascular aortic repair could be performed by cardiac surgeons immediately. Preanesthetic careful consideration and preparation for surgical incidents are necessary for anesthesiologists.
  • 周術期の血糖管理の重要性（誌上抄読会）
    岩元辰篤; 濱崎真一; 辻本宣敏; 北浦淳寛; 法里慧; 高岡敦; 月本翔太; 青木理沙; 中尾慎一
    臨床麻酔 40 1549 - 1553 2016 [Invited]
  • Masaki Fuyuta; Shinichi Nakao; Atsuhiro Kitaura; Tatsushige Iwamoto; Shinichi Hamasaki; Shouhei Iwasaki; Takashi Kurita
    JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA W B SAUNDERS CO-ELSEVIER INC 29 (6) 1533 - 1536 1053-0770 2015/12 [Refereed]
     
    Objective: To evaluate the preoperative prevalence of each type of J-wave syndrome electrocardiographic pattern and its association with perioperative cardiac events. Design: Retrospective study. Setting: Single hospital university study. Participants: The study evaluated 930 patients who underwent gynecologic, abdominal, neurosurgical, orthopedic, and urologic surgeries. Interventions: Preoperative standard 12-lead electrocardiogram (ECG) monitoring was performed, and each type of J-wave syndrome ECG pattern types 1, 2, and 3 and Brugada syndrome-type was evaluated. Incidence of perioperative cardiac events was investigated up to 1 year postoperatively using an electronic medical record system. Measurements and Main Results: Data from 789 patients were included in the final study. Of these, 16 patients (2.0%) had J-wave syndrome: 7 patients (0.9%) had type-1 patterns; 5 patients (0.6%) had type-2 patterns; 2 patients (0.3%) had type-3 patterns; and 2 patients (0.3%) had Brugada syndrome-type ECG patterns. A J-point elevation >= 0.2 mV, which is considered to be more dangerous, was found in only 2 patients with Brugada syndrome-type ECG patterns, both of whom suffered perioperative lethal arrhythmias. Conclusion: Patients with J-wave syndrome ECG patterns, even dangerous patterns, are not necessarily associated with a higher risk of perioperative cardiac events. However, Brugada syndrome type ECG patterns should be carefully monitored. (C) 2015 Elsevier Inc. All rights reserved.

Books etc

  • 明日からの臨床麻酔が広がるレミマゾラムQ＆A
    稲垣 喜三; 山蔭 道明; 中島 芳樹 (ContributorQ21．何を指標にして投与量を調節したらよいか)克誠堂出版 2022/05 9784771905627
  • 麻酔偶発症AtoZ
    北浦淳寛; 中尾慎一 (Joint work)文光堂 2017/06
  • わかりやすい麻酔科学－基礎と実践
    中尾慎一 (Contributor腹部緊急手術の麻酔)株式会社 中山書店 2014/12

Conference Activities & Talks

  • A Retrospective Comparative Study of Anesthesia with Remimazolam and Remifentanil Versus Anesthesia with Dexmedetomidine and Remifentanil for Transcatheter Aortic Valve Replacement  [Not invited]
    Atsuhiro Kitaura; Hiroatsu Sakamoto; Shinichi Hamasaki; Yasufumi Nakajima
    Anesthesiology 2023 annual meeting  2023/10
  • Remimazolam in the anesthesia of endvascular procedure  [Invited]
    北浦 淳寛
    JSCVA 2023  2023/09
  • レミマゾラムの低心機能患者における活用  [Invited]
    北浦 淳寛
    ムンディファーマ全身麻酔領域リモート講演会  2023/05
    Download
  • TAVIの循環管理を可視化する  [Invited]
    北浦 淳寛
    エドワーズライフサイエンス株式会社ウェビナー（プロフェッショナルはこう考える～周術期血圧はどう管理すべきか  2022/12
    Download
  • Relationship Between Brain Deep White Matter Lesions And Perioperative Cognitive Function In Tavi  [Not invited]
    Atsuhiro Kitaura; M.D.,Ph.D; Seishi Kimura; M.D.,Ph.D; Hiroatsu Sakamoto, M.D; Shinichi Nakao; M.D.,Ph.D
    Anesthesiology 2022 annual meeting  2022/10
  • TAVI麻酔における当院の取り組み～手術室滞在時間短縮と速やかな覚醒を目指して～  [Invited]
    北浦 淳寛
    日本循環制御医学会第43回総会  2022/07
  • 先天性QT延長症候群1型患者に対する外科的大動脈弁置換術の麻酔経験  [Not invited]
    岡本 健; 北浦 淳寛; 中尾 慎一
    日本心臓血管麻酔学会第25回学術大会  2020/09
  • The Greater Response to Ephedrine in Patients with Parkinson’s Disease  [Not invited]
    Atsuhiro Kitaura, M.D; Seishi Kimura; M.D.,Ph.D; Takashi Mino; No Degree; Shinichi Nakao; M.D.,Ph.D
    Annual Meeting of American Society of Anesthesiologists 2019  2019/10
  • Unusually Large Ephedrine-induced Blood Pressure Increases Due To Cardiac Sympathetic Denervation Supersensitivity In A Patient With Parkinson’s Disease  [Not invited]
    Atsuhiro Kitaura, M.D; Kei Houri, M.D; Shinichi Hamasaki, M.D; Shinichi Nakao; M.D.,Ph.D
    Annual Meeting of American Society of Anesthesiologists  2018/11
  • Prolonged complete atrioventricular blockinduced by insertion of a pulmonary arterial catheter in a patient with complete left bundle block  [Not invited]
    Kitaura A; Houri K; Hamasaki S; Nakao S
    Annual Meeting of American Society of Anesthesiologists  2017/10
  • Cardiac arrest caused by hypopotassemiafollowing insulin administration  [Not invited]
    Kitaura A; Houri K; Iwamoto T; Kimura; SNakao S
    Annual Meeting of American Society of Anesthesiologists  2017/10
  • インスリン投与後の低カリウム血症により生じた心停止（症例報告）  [Not invited]
    北浦淳寛; 法里 慧; 濱﨑真一; 辻本宜敏; 岩元辰篤; 中尾慎一
    日本心臓血管麻酔学会  2017/09
  • 肺動脈カテーテル挿入により完全房室ブロックを呈した完全左脚ブロックの1症例  [Not invited]
    法里 慧; 北浦淳寛; 濱﨑真一; 辻本宜敏; 中尾慎一
    日本心臓血管麻酔学会第22回学術大会  2017/09
  • 拡張型心筋症による低心機能を呈した維持透析患者に対する腹臥位手術の麻酔経験（症例報告）  [Not invited]
    北浦淳寛; 法里 慧; 濱﨑真一; 辻本宜敏; 鎌本洋通; 中尾慎一
    日本心臓血管麻酔学会第22回学術大会  2017/09
  • パクリタキセルによる急性腎近位尿細管障害から低K血症となり，筋力低下によって低酸素血症をきたした1 症例  [Not invited]
    北浦淳寛; 法里慧; 濱﨑真一; 岩元辰篤; 塩川泰啓; 中尾慎一
    第44回日本集中治療学会学術集会  2017/03
  • Sevoflurane Causes Greater QTc Interval Prolongation in Diabetic Patients Than in Non-diabetic Patients  [Not invited]
    Atsuhiro Kitaura; Shinichi Nakao; Seishi Kimura; Mayuka Matsushima; Kei Houri; Tatsushige Iwamoto
    Annual Meeting of American Society of Anesthesiologists 2016  2016/10
  • High-dose propofol suppresses intrinsic His-ventricular conduction in humans.  [Not invited]
    Houri K; Nakao S; Matsusima M; Kimura S; Kitaura A; Hamasaki S; Takai N; Iwamoto T; Fuyuta M
    Annual Meeting of American Society of Anesthesiologists 2016  2016/10
  • １回拍出量変化率が鎖骨下動脈狭窄側と非狭窄側とで同調性を示した1症例  [Not invited]
    北浦淳寛; 塩川泰啓; 濱﨑真; 一法里慧; 湯上晋太郎; 中尾慎一
    第61回日本集中治療医学会近畿地方会  2016/07
  • セボフルランが糖尿病患者の心電図QT間隔に及ぼす影響  [Not invited]
    木村誠志; 松島麻由佳; 北浦淳寛; 法里慧; 濱﨑真一; 中尾慎一
    日本麻酔科学会第63回学術集会  2016/05
  • 終末糖化産物（AGEs）はマクロファージによる血管内皮細胞の管腔形成を促進する  [Not invited]
    濱﨑真一; 小堀宅郎; 北浦淳寛; 丹羽淳子; 髙橋英夫
    第89回日本薬理学会年会  2016/03
  • M2マクロファージによる血管新生促進作用に対するIL-18の影響  [Not invited]
    小堀宅郎; 濱﨑真一; 北浦淳寛; 加藤貴史; 丹羽淳子; 髙橋英夫
    第89回日本薬理学会年会  2016/03
  • 呼吸機能低下のため周術期管理に難渋した肺部分切除術症例  [Not invited]
    北浦淳寛; 塩川泰啓; 岩崎昌平; 稲森雅幸; 白井達; 中尾慎一
    2015/11
  • カテコラミン誘発性多型性心室頻拍患者の麻酔経験  [Not invited]
    濱﨑真一; 岩元辰篤; 北浦淳寛; 法里 慧; 藤田明子; 中尾慎一
    日本麻酔学会第60回関西支部学術集会  2015/09
  • Tp-eが延長した先天性QT延長症候群3型の1例  [Not invited]
    北浦淳寛; 濱﨑真一; 岩崎昌平; 法里慧; 藤田明子; 中尾慎一
    日本麻酔学会近畿地方会  2015/09
  • PERM患者に対する麻酔経験  [Not invited]
    岩崎昌平; 白井 達; 北浦淳寛; 濱﨑真一; 森本昌宏; 中尾慎一
    日本麻酔学会第60回関西支部学術集会  2015/08
  • 早期再分極症候群患者の周術期発生頻度と心血管系イベント  [Not invited]
    北浦淳寛; 冬田昌樹; 濱崎真一; 中尾慎一
    第62回日本麻酔科学会  2015/05
  • 華岡派と地域医療 ―華岡派、中村順助の事例―  [Not invited]
    岩元辰篤; 濱﨑真一; 岩崎昌平; 北浦淳寛; 平松謙二; 中尾慎一
    日本麻酔科学会第62回学術集会  2015/05
  • 前胸筋ブロック後に気胸をきたした1症例  [Not invited]
    岩元 辰篤; 打田 智久; 湯浅 あかね; 上原 圭司; 白井 達; 木村 誠志; 岩崎 昌平; 北浦 淳寛; 濱﨑 真一; 中尾 慎一
    日本区域麻酔学会第2回学術集会  2015/04
  • 呼吸機能低下のため周術期管理に難渋した肺部分切除術症例  [Not invited]
    北浦淳寛; 塩川泰啓; 岩崎昌平; 稲森雅幸; 白井 達; 中尾慎一
    2014/11
  • Perioperative Cardiac Events in a Patient With Each Type of Electrocardioqraphic  [Not invited]
    Fuyuta M; Kitaura A; Inamori M; Kamamoto H; Iwamoto T; Hamsaki S; Iwasaki S; Nakao S
    Annual Meeting of American Society of Anesthesiologists  2014/10
  • Stiff-person syndromeの麻酔経験例  [Not invited]
    南 菜穂子; 平松 謙二; 吉岡 清行; 北浦 淳寛; 岩崎 昌平; 中尾 慎一
    日本麻酔学会第60回関西支部学術集会  2014/09
  • 薬剤師の手術室常駐および薬剤ミキシング業務介入の有用性の検討  [Not invited]
    北浦 淳寛; 塩川 泰啓; 白井 達; 岩崎 昌平; 稲森 雅幸; 中尾 慎一
    日本麻酔学会第60回関西支部学術集会  2014/09
  • ブルガタ症候群患者の上室性頻拍（性不整脈）による心停止  [Not invited]
    稲森 雅幸; 塩川 泰啓; 北浦 淳寛; 冬田 昌樹; 湯上 晋太郎; 岩元 辰篤; 中尾 慎一
    第41回日本集中治療医学会学術集会  2014/02
  • 術後2日目に硬膜外カテーテルを抜去後一過性の神経症状を呈した症例の検討  [Not invited]
    北浦 淳寛; 平松 謙二; 濱﨑 真一; 南 奈穂子; 岩元 辰篤; 冬田 昌樹; 中尾 慎一
    日本臨床麻酔学会第33回大会  2013/11  石川県金沢市  日本臨床麻酔学会第33回大会
  • 動脈塞栓除去カテーテルを用いた乳児一側気管支ブロック症例  [Not invited]
    北浦 淳寛; 塩川 泰啓; 冬田 昌樹; 稲森 雅幸; 湯上 晋太郎; 中尾 慎一
    第58回日本集中治療医学会近畿地方会  2013/07  大阪市  第58回日本集中治療医学会近畿地方会

MISC

Awards & Honors

  • 日本麻酔科学会 第62回日本麻酔科学会最優秀演題賞
     早期再分極症候群患者の周術期発生頻度と心血管系イベント 
    受賞者: 北浦淳寛;冬田昌樹;濱崎真一;中尾慎一

Research Grants & Projects

  • 日本学術振興会：科学研究費助成事業
    Date (from‐to) : 2024/04 -2027/03 
    Author : 北浦 淳寛
  • 日本学術振興会：科学研究費助成事業 若手研究
    Date (from‐to) : 2020/04 -2023/03 
    Author : 北浦 淳寛
     
    糖尿病における免疫機能変化について、糖化最終産物（Advanced Glycation end-products; AGEs）とマクロファージの機能に着目した研究を現在研究調書に記載した計画に基づき遂行中である。本年度までに、研究計画書の１）マクロファージによるLPS取り込み、２）AGEsの作用メカニズムおよび、３）LPS取り込みによる細胞死の機序については予定通り研究が進行した。１）については、マウス単球由来のセルラインである（RAW264.7)を用いたin vitro の研究で、マクロファージはCD14を介してLPSをエンドサイトーシスにより取り込むことを確認した。そして、CD14以外の主要なLPSやAGEsに関与すると報告のある受容体（TLR ファミリー、スカベンジャー受容体、RAGE等）についても検討を行い、それらがマクロファージのLPS取り込みに影響を与えていないことも確認した。さらに、LPSを取り込んだマクロファージはCXCL10等のインターフェロンを産生し、免疫細胞の誘導に関与することが確認された。2)に関しては、AGEsの中で特に生理活性が高く糖尿病の病因の１つとして考えられているグリコールアルデヒド由来のAGEであるAGE3を用いた研究を行った。この研究により、AGE3はマクロファージによるLPS取り込みを抑制することが発見された。AGE3のLPS取り込み抑制のメカニズムは未だ完全には確認できていないが、種々の検討によりRAGEが関与してい ることは明らかとなった。これまでの成果は学術論文としてPLOS ONEに掲載された。現在、モデルマウスを用いた実験系の確立に取り組んでいる。また、in vitro実験の副産物として、AGE3が内皮細胞の血管新生を促進する可能性があることが明らかになった。そのため、こちらについてもヒト内皮細胞を用いたin vitroでの新たに実験系を構築し、検討を進めている。
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research
    Date (from‐to) : 2017/04 -2020/03 
    Author : KITAURA Atsuhiro
     
    In diabetic patients, perioperative blood glucose control does not provide a sufficient postoperative prognosis improving effect. Therefore, we think that an approach to chronic etiology is necessary, and it is attracting attention as a cause of diabetic complications, but we focus on advanced glycation end-product (AGEs) whose mechanism of action has not been fully elucidated. did. Based on the results of our previous studies, we hypothesized that AGEs inhibit M2 polarization of macrophages, prolong wound healing mechanism, and induce postoperative organ damage.

Committee Membership

  • 2022/09 - Today   Japanese society of cardiovascular anesthesiologists   Academic Committee Member

Other link

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