診療・研究からの働きかけ
現在の多忙な日常診療業務では，研究を実施するモチベーションを高めるのはなかなか難しい．しかし，そのためにも慣れた日常業務に疑問を感じ突き詰めるような気づきが重要となってくる．そのきっかけに，臨床と基礎研究に携わった私の経験が，研究実施のために役に立てば幸いである．最初の臨床研究は日常臨床の疑問点解決のために開始し，その後の研究は自身の周辺環境を活用していくことで実施してきた．基礎研究では脆弱な脳に与える麻酔薬の影響を，筋肉と術後認知機能の関連性を通して探っている．これらから，研究のハードルは決して高いわけではないことを伝えたい．...
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| Published in | 日本臨床麻酔学会誌 Vol. 44; no. 4; pp. 419 - 427 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
15.07.2024
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.44.419 |
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| Abstract | 現在の多忙な日常診療業務では，研究を実施するモチベーションを高めるのはなかなか難しい．しかし，そのためにも慣れた日常業務に疑問を感じ突き詰めるような気づきが重要となってくる．そのきっかけに，臨床と基礎研究に携わった私の経験が，研究実施のために役に立てば幸いである．最初の臨床研究は日常臨床の疑問点解決のために開始し，その後の研究は自身の周辺環境を活用していくことで実施してきた．基礎研究では脆弱な脳に与える麻酔薬の影響を，筋肉と術後認知機能の関連性を通して探っている．これらから，研究のハードルは決して高いわけではないことを伝えたい． |
|---|---|
| AbstractList | 現在の多忙な日常診療業務では，研究を実施するモチベーションを高めるのはなかなか難しい．しかし，そのためにも慣れた日常業務に疑問を感じ突き詰めるような気づきが重要となってくる．そのきっかけに，臨床と基礎研究に携わった私の経験が，研究実施のために役に立てば幸いである．最初の臨床研究は日常臨床の疑問点解決のために開始し，その後の研究は自身の周辺環境を活用していくことで実施してきた．基礎研究では脆弱な脳に与える麻酔薬の影響を，筋肉と術後認知機能の関連性を通して探っている．これらから，研究のハードルは決して高いわけではないことを伝えたい． |
| Author | 合谷木 徹 |
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| Copyright | 2024 日本臨床麻酔学会 |
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| DOI | 10.2199/jjsca.44.419 |
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| References | 4) Goyagi T, Nishikawa T：Oral clonidine premedication enhances the quality of postoperative analgesia by intrathecal morphine. Anesth Analg 82：1192-1196, 1996 11) Horikoshi Y, Goyagi T, Kudo R, et al.：The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery：A randomized controlled clinical trial. J Clin Anesth 38：111-116, 2017 19) Savitz SI, Erhardt JA, Anthony JV, et al.：The novel beta-blocker, carvedilol, provides neuroprotection in transient focal stroke. J Cereb Blood Flow Metab 20：1197-1204, 2000 14) Goyagi T, Goto S, Bhardwaj A, et al.：Neuroprotective effect of sigma（1）-receptor ligand 4-phenyl-1-（4-phenylbutyl）piperidine（PPBP）is linked to reduced neuronal nitric oxide production. Stroke 32：1613-1620, 2001 16) Goyagi T, Toung TJK, Kirsch JR, et al.：Neuroprotective δ-opioid receptor agonist BRL 52537 attenuates ischemia-evoked nitric oxide production in vivo in rats. Stroke 34：1533-1538, 2003 26) Goyagi T, Tobe Y, Nishikawa T：Long-term and spatial memory effects of selective β1-antagonists after transient focal ischaemia in rats. Br J Anaesth 109：399-406, 2012 36) Scisciola L, Fontanella RA, Surina, et al.：Sarcopenia and cognitive function：Role of myokines in muscle brain cross-talk. Life（Basel） 11：173, 2021 20) Standefer M, Little JR：Improved neurological outcome in experimental focal cerebral ischemia treated with propranolol. Neurosurgery 18：136-140, 1986 29) Umehara S, Goyagi T, Nishikawa T, et al.：Esmolol and landiolol, selective beta1-adrenoreceptor antagonists, provide neuroprotection against spinal cord ischemia and reperfusion in rats. Anesth Analg 110：1133-1137, 2010 25) Goyagi T, Horiguchi T, Nishikawa T, et al.：Post-treatment with selective β1 adrenoceptor antagonists provides neuroprotection against transient focal ischemia in rats. Brain Res 1343：213-217, 2010 28) Goyagi T, Horiguchi T, Nishikawa T, et al.：Neuroprotective effects of selective β-1 adrenoceptor antagonists, landiolol and esmolol, on transient forebrain ischemia in rats； a dose-response study. Brain Res 1461：96-101, 2012 3) Goyagi T, Nishikawa T：The addition of epinephrine enhances postoperative analgesia by intrathecal morphine. Anesth Analg 81：508-513, 1995 6) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication reduces the awakening concentration of isoflurane. Anesth Analg 86：410-413, 1998 23) Latchaw JP, Little JR, Slugg RM, et al.：Treatment of acute focal cerebral ischemia and recirculation with d-propranolol. Neurosurgery 16：18-22, 1985 12) Nemoto A, Mizuno K, Goyagi T：The effect of tranexamic acid administration on perioperative bleeding in patients undergoing knee or hip arthroplasty：a single-centre retrospective study. Turk J Anaesthesiol Reanim 48：142-147, 2020 15) Alkayed NJ, Goyagi T, Joh HD, et al.：Neuroprotection and P450 2C11 upregulation after experimental transient ischemic attack. Stroke 33：1677-1684, 2002 10) Goyagi T, Sato T, Horiguchi T, et al.：The effect of nitrous oxide on the intraocular pressure in patients undergoing abdominal surgery under sevoflurane and remifentanil anesthesia. Open J Anesthesiol 6：85-90, 2016 8) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication enhances postoperative analgesia by epidural morphine. Anesth Analg 89：1487-1491, 1999 9) Nitta R, Goyagi T, Nishikawa T：Combination of oral clonidine and intravenous low-dose ketamine reduces the consumption of postoperative patient-controlled analgesia morphine after spine surgery. Acta Anaesthesiol Taiwan 54：14-17, 2013 13) 合谷木徹，梅原志乃，西川俊昭：肩関節手術後疼痛に対するエコーガイド下持続腕神経叢ブロックの有効性． ペインクリニック 30：203-207，2009 17) Goyagi T, Bhardwaj A, Koehler RC, et al.：Potent δ1-receptor ligand 4-phenyl-1-（4-phenylbutyl）piperidine provides ischemic neuroprotection without altering dopamine accumulation in vivo in rats. Anesth Analg 96：532-538, 2003 21) Capraro JA, Reedy DP, Latchaw JP, et al.：Treatment of acute focal cerebral ischemia with propranolol. Stroke 15：486-491, 1984 5) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication enhances the pressor response to ephedrine during spinal anesthesia. Anesth Analg 87：1336-1339, 1998 30) Goyagi T：The additional oxygen as a carrier gas during long-duration sevoflurane exposure ameliorate the neuronal apoptosis and improve the long-term cognitive function in neonatal rats. Brain Res 1678：220-230, 2018 7) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication reduces induction dose and prolongs awakening time from propofol-nitrous oxide anesthesia. Can J Anaesth 46：894-896, 1999 31) Goyagi T：Erythropoietin reduces neurodegeneration and long-term memory deficits following sevoflurane exposure in neonatal rats. Neurotox Res 36：817-826, 2019 35) Severinsen MC, Pedersen BK：Muscle-organ crosstalk：The emerging roles of myokines. Endocr Rev 41：594-609, 2020 24) Goyagi T, Kimura T, Nishikawa T, et al.：Beta-adrenoreceptor antagonists attenuate brain injury after transient focal ischemia in rats. Anesth Analg 103：658-663, 2006 34) Yang TR, Luo K, Deng X, et al.：Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy：a systematic review and meta-analysis. World J Emerg Surg 17：36, 2022 2) 合谷木徹，木原真一，佐藤重仁ほか：小児セボフルレン麻酔で深麻酔下と覚醒下で抜管したときの呼吸器合併症の比較．麻酔 44：1242-1245，1995 33) Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C, et al.：Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer：a systematic review and meta-analysis. Int J Colorectal Dis 36：1077-1096, 2021 37) Nemoto A, Goyagi T：Tail suspension is useful as a sarcopenia model in rats. Lab Anim Res 37：7, 2021 1) 合谷木徹，佐藤重仁：小児硬膜外麻酔が「覚醒時気管内チューブ耐性ハロセン濃度」に及ぼす影響．麻酔 44：338-341，1995 38) Nemoto A, Goyagi T, Nemoto W, et al.：Low Skeletal muscle mass is associated with perioperative neurocognitive disorder due to decreased neurogenesis in rats. Anesth Analg 134：194-203, 2022 27) Goyagi T, Nishikawa T, Tobe Y：Neuroprotective effects and suppression of ischemia-induced glutamate elevation by β1-adrenoreceptor antagonists administered before transient focal ischemia in rats. J Neurosurg Anesthesiol 23：131-137, 2011 32) Goyagi T：Dexmedetomidine reduced sevoflurane-induced neurodegeneration and long-term memory deficits in neonatal rats. Int J Dev Neurosci 75：19-26, 2019 18) Chen TY, Goyagi T, Toung TJK, et al.：Prolonged opportunity for ischemic neuroprotection with selective kappa-opioid receptor agonist in rats. Stroke 35：1180-1185, 2004 22) Little JR, Latchaw JP Jr, Slugg RM, et al.：Treatment of acute focal cerebral ischemia with propranolol. Stroke 13：302-307, 1982 |
| References_xml | – reference: 32) Goyagi T：Dexmedetomidine reduced sevoflurane-induced neurodegeneration and long-term memory deficits in neonatal rats. Int J Dev Neurosci 75：19-26, 2019 – reference: 18) Chen TY, Goyagi T, Toung TJK, et al.：Prolonged opportunity for ischemic neuroprotection with selective kappa-opioid receptor agonist in rats. Stroke 35：1180-1185, 2004 – reference: 38) Nemoto A, Goyagi T, Nemoto W, et al.：Low Skeletal muscle mass is associated with perioperative neurocognitive disorder due to decreased neurogenesis in rats. Anesth Analg 134：194-203, 2022 – reference: 5) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication enhances the pressor response to ephedrine during spinal anesthesia. Anesth Analg 87：1336-1339, 1998 – reference: 15) Alkayed NJ, Goyagi T, Joh HD, et al.：Neuroprotection and P450 2C11 upregulation after experimental transient ischemic attack. Stroke 33：1677-1684, 2002 – reference: 31) Goyagi T：Erythropoietin reduces neurodegeneration and long-term memory deficits following sevoflurane exposure in neonatal rats. Neurotox Res 36：817-826, 2019 – reference: 7) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication reduces induction dose and prolongs awakening time from propofol-nitrous oxide anesthesia. Can J Anaesth 46：894-896, 1999 – reference: 17) Goyagi T, Bhardwaj A, Koehler RC, et al.：Potent δ1-receptor ligand 4-phenyl-1-（4-phenylbutyl）piperidine provides ischemic neuroprotection without altering dopamine accumulation in vivo in rats. Anesth Analg 96：532-538, 2003 – reference: 22) Little JR, Latchaw JP Jr, Slugg RM, et al.：Treatment of acute focal cerebral ischemia with propranolol. Stroke 13：302-307, 1982 – reference: 23) Latchaw JP, Little JR, Slugg RM, et al.：Treatment of acute focal cerebral ischemia and recirculation with d-propranolol. Neurosurgery 16：18-22, 1985 – reference: 2) 合谷木徹，木原真一，佐藤重仁ほか：小児セボフルレン麻酔で深麻酔下と覚醒下で抜管したときの呼吸器合併症の比較．麻酔 44：1242-1245，1995 – reference: 12) Nemoto A, Mizuno K, Goyagi T：The effect of tranexamic acid administration on perioperative bleeding in patients undergoing knee or hip arthroplasty：a single-centre retrospective study. Turk J Anaesthesiol Reanim 48：142-147, 2020 – reference: 28) Goyagi T, Horiguchi T, Nishikawa T, et al.：Neuroprotective effects of selective β-1 adrenoceptor antagonists, landiolol and esmolol, on transient forebrain ischemia in rats； a dose-response study. Brain Res 1461：96-101, 2012 – reference: 1) 合谷木徹，佐藤重仁：小児硬膜外麻酔が「覚醒時気管内チューブ耐性ハロセン濃度」に及ぼす影響．麻酔 44：338-341，1995 – reference: 19) Savitz SI, Erhardt JA, Anthony JV, et al.：The novel beta-blocker, carvedilol, provides neuroprotection in transient focal stroke. J Cereb Blood Flow Metab 20：1197-1204, 2000 – reference: 3) Goyagi T, Nishikawa T：The addition of epinephrine enhances postoperative analgesia by intrathecal morphine. Anesth Analg 81：508-513, 1995 – reference: 10) Goyagi T, Sato T, Horiguchi T, et al.：The effect of nitrous oxide on the intraocular pressure in patients undergoing abdominal surgery under sevoflurane and remifentanil anesthesia. Open J Anesthesiol 6：85-90, 2016 – reference: 33) Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C, et al.：Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer：a systematic review and meta-analysis. Int J Colorectal Dis 36：1077-1096, 2021 – reference: 29) Umehara S, Goyagi T, Nishikawa T, et al.：Esmolol and landiolol, selective beta1-adrenoreceptor antagonists, provide neuroprotection against spinal cord ischemia and reperfusion in rats. Anesth Analg 110：1133-1137, 2010 – reference: 35) Severinsen MC, Pedersen BK：Muscle-organ crosstalk：The emerging roles of myokines. Endocr Rev 41：594-609, 2020 – reference: 13) 合谷木徹，梅原志乃，西川俊昭：肩関節手術後疼痛に対するエコーガイド下持続腕神経叢ブロックの有効性． ペインクリニック 30：203-207，2009 – reference: 6) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication reduces the awakening concentration of isoflurane. Anesth Analg 86：410-413, 1998 – reference: 11) Horikoshi Y, Goyagi T, Kudo R, et al.：The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery：A randomized controlled clinical trial. J Clin Anesth 38：111-116, 2017 – reference: 26) Goyagi T, Tobe Y, Nishikawa T：Long-term and spatial memory effects of selective β1-antagonists after transient focal ischaemia in rats. Br J Anaesth 109：399-406, 2012 – reference: 8) Goyagi T, Tanaka M, Nishikawa T：Oral clonidine premedication enhances postoperative analgesia by epidural morphine. Anesth Analg 89：1487-1491, 1999 – reference: 37) Nemoto A, Goyagi T：Tail suspension is useful as a sarcopenia model in rats. Lab Anim Res 37：7, 2021 – reference: 9) Nitta R, Goyagi T, Nishikawa T：Combination of oral clonidine and intravenous low-dose ketamine reduces the consumption of postoperative patient-controlled analgesia morphine after spine surgery. Acta Anaesthesiol Taiwan 54：14-17, 2013 – reference: 16) Goyagi T, Toung TJK, Kirsch JR, et al.：Neuroprotective δ-opioid receptor agonist BRL 52537 attenuates ischemia-evoked nitric oxide production in vivo in rats. Stroke 34：1533-1538, 2003 – reference: 20) Standefer M, Little JR：Improved neurological outcome in experimental focal cerebral ischemia treated with propranolol. Neurosurgery 18：136-140, 1986 – reference: 30) Goyagi T：The additional oxygen as a carrier gas during long-duration sevoflurane exposure ameliorate the neuronal apoptosis and improve the long-term cognitive function in neonatal rats. Brain Res 1678：220-230, 2018 – reference: 21) Capraro JA, Reedy DP, Latchaw JP, et al.：Treatment of acute focal cerebral ischemia with propranolol. Stroke 15：486-491, 1984 – reference: 34) Yang TR, Luo K, Deng X, et al.：Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy：a systematic review and meta-analysis. World J Emerg Surg 17：36, 2022 – reference: 36) Scisciola L, Fontanella RA, Surina, et al.：Sarcopenia and cognitive function：Role of myokines in muscle brain cross-talk. Life（Basel） 11：173, 2021 – reference: 24) Goyagi T, Kimura T, Nishikawa T, et al.：Beta-adrenoreceptor antagonists attenuate brain injury after transient focal ischemia in rats. Anesth Analg 103：658-663, 2006 – reference: 25) Goyagi T, Horiguchi T, Nishikawa T, et al.：Post-treatment with selective β1 adrenoceptor antagonists provides neuroprotection against transient focal ischemia in rats. Brain Res 1343：213-217, 2010 – reference: 4) Goyagi T, Nishikawa T：Oral clonidine premedication enhances the quality of postoperative analgesia by intrathecal morphine. Anesth Analg 82：1192-1196, 1996 – reference: 27) Goyagi T, Nishikawa T, Tobe Y：Neuroprotective effects and suppression of ischemia-induced glutamate elevation by β1-adrenoreceptor antagonists administered before transient focal ischemia in rats. J Neurosurg Anesthesiol 23：131-137, 2011 – reference: 14) Goyagi T, Goto S, Bhardwaj A, et al.：Neuroprotective effect of sigma（1）-receptor ligand 4-phenyl-1-（4-phenylbutyl）piperidine（PPBP）is linked to reduced neuronal nitric oxide production. Stroke 32：1613-1620, 2001 |
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| Title | 診療・研究からの働きかけ |
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