The non-profit organization, Patient Safety for Anesthesia, was founded in Apr. 2004, to promote the understanding of anesthesia.
  First, we talked to people through lectures and consultation in open symposiums, to promote the idea of safety. Everyone should learn about their surgery and disease and select the therapy together with their doctor. br>  Second, members of this NPO offer to hospitals their art of anesthesia, philosophy and guidance for young doctors. br>  Third, the NPO is trying to increase the number of anesthesiologists through providing a scholarship fund and showing the way of practicing. br>  All these activities are supported by the volunteers of this organization.

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  Skills required in anesthetic management of neurosurgery include ; 1) familiarity with recent topics in neuroanesthesia, 2) techniques for neuroprotection using mild hypothermia and anesthetic agents, and 3) neuromonitoring. With recent evidence in the literature, treatment strategies have been changing for cerebral aneurysm and intracerebral hemorrhage. Efficacy and the limitations of intraoperative neuroprotection by mild hypothermia and anesthetic agents should be recognized. Monitoring techniques to determine motor function, language areas, and epileptic focus are also required and anesthetic management during such monitoring may be one of the most important clinical challenges.

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  The most widely used obstetric anesthesia in Japan is for cesarean section. For the anesthesia, reliable skill is necessary for the safe practice with less risk. One has to insert the needle in the correct place and choose the appropriate anesthetic mixture on the basis of knowledge of maternal anatomical and physiological changes, or maternal background to establish the anesthesia. Especially, combined spinal-epidural anesthesia, which is used for more than half of the cesarean sections in 60% of Japanese hospitals, is not simply a combination of spinal and epidural anesthesia. One has to consider the interaction of these two anesthetic methods.

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  The image of anesthesiologists prevalent among high school students is mainly that created by the media, such as television, magazines and cartoons. This image is often quite different from reality, as the “voice” of anesthesiologists does not directly reach the general population.
  Anesthesiologists have traditionally been regarded as playing only minor roles in medical practice. In a famous Japanese medical novel, SHIROI KYOTOU, written by Toyoko Yamazaki in 1963, anesthesiologists were not featured at all, although there were many surgical scenes in this book. For a long time, mass media has sensationalized anesthesia as one of the major causes of medical accidents ; the only anesthesia-related news that was published by the media was that of anesthetic accidents, resulting in the creation of a negative image in the minds of the public about anesthesia and anesthesiologists.
  Recently, the role of anesthesiology in surgical practice has become more prominent, with the media, too, portraying a more positive and accurate image of anesthesiologists. This media attention could well be the platform that we anesthesiologists need to create a more realistic understanding of anesthesia among high school students as well as the general public.
  We anesthesiologists should further this understanding by attempting to provide accurate information about ourselves, using non-technical terminology that is easily understood by the public.

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  The number of Japanese anesthesiologists is gradually increasing but the shortage is still apparent in comparison with the number of surgeons. We aimed to ask medical students from the 1st to the 4th grade how they thought about medicine and their favorite medical fields. It was found that internal medicine was the most attractive subject and pediatrics and gynecology were more appealing than anesthesiology (among 172 students, only 6 students had an interest in anesthe-siology) . We assume that an effective educational system is the most important for acquiring good candidates, and we have to make greater efforts to help the Japanese public understand what anesthesiology is.

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  The objective of the anesthesiologist in planning the preoperative care of pediatric patients is to ensure, as much as possible, that the potentially adverse psychological effects of anesthesia and surgery are minimized. For children, the two greatest advantages of outpatient surgery are the reduction in both separation anxiety and nosocomial infections. In a well-organized program it should not be necessary to separate parents and children having strong anxiety during the induction of anesthesia in operating room. It has been almost 7 years since we began ambulatory anesthesia for pediatric patients undergoing the repair of inguinal hernia. We introduce the system of ambulatory anesthesia in Wakayama Medical University Hospital.

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  Establishing oneself, social status and pride as anesthesiologists are the most important issues which cannot be ignored when anesthesiologists open private clinics to work as anesthesiologist in other surgical hospitals. Anesthesiologists are the patient's life support in the perioperative medical care team, not assistants to the surgeons. Mutual understanding between anesthesiologists and surgeons and their independence are fundamentally important. The only and best way to provide medical care with clear responsibility is opening a private anesthesia clinic approved by the Health Insurance Law and start Attending typed private practice as an expert. I will introduce the current conditions of Attending typed private practice using the example of the Karashima Anesthesiology Clinic. My personal opinions on the way of life and professional liability of an anesthesiologist are also described. Furthermore, “Plan for a centralized anesthesiology medical institution” which I propose as the future image of Attending typed private practice is explained.

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  Landiolol and esmolol are short-acting β₁-adrenoceptor antagonists that can be used for the treatment of supraventricular tachyarrhythmia during surgery in Japan. We conducted research on landiolol, and we found that (1) high intravenous doses of landiolol blunt acute hyperdynamic responses during electroconvulsive therapy without altering seizure activity, (2) intravenous landiolol shortens the time to loss of consciousness by vital capacity rapid inhalation induction, and (3) intravenous landiolol reduces the minimum alveolar concentration (MAC) of sevoflurane in adults. These results suggest that we will be able to put those newly confirmed properties (e. g., the effect on the central nervous system and the effect of the reduction of anesthetic requirements) of β₁ blockers such as landiolol and esmolol to practical and clinical use in future, but further investigation is needed.

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  A medical accident due to negligence is called “medical malpractice” . In a medical dispute, the patient goes to court and this is a “medical lawsuit” . In medical malpractice, the criminal responsibility, civil responsibility and administrative penalties become a problem. A total of 1,110 cases of civil acts were filed in 2005. 405 judgments were passed, and the patients won in 39.5% of the cases. Since 1999 there have been 89 criminal judgments for doctors, nurses and co-medical staff because of medical malpractice. The construction of a medical safety control system is needed and the medical risk management is an important task. Learning the specific cases, watching videos and/or enacting near-miss cases, we expect that many people will pay attention to the improvement of high-risk situations.

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  Recently some guidelines for pulmonary embolism and deep venous thrombosis (DVT) have been established. We screened perioperative generation of DVT using femoral vein ultrasonography (US) . 62 patients who underwent an operation of 2 hours or more during the period from December 2003 to February 2004 were included in this study. Abnormalities were detected in two of 62 patients who displayed the symptoms of DVT before the surgery. These two patients were excluded from the evaluation.

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  A questionnaire survey was carried out to clarify the career obstacles for female anesthesiologists. The questionnaire was sent in January 2001 to 331 female and 300 male anesthesiologists. The questionnaire asked for information on personal and professional demographics, gender inequity, responsibilities of child caretaking, and expectations of childcare responsibilities for women. The results showed that 39.5% of female and 46.4% of male anesthesiologists felt that there were greater childcare responsibilities for women than for men, which made the domestic responsibilities of female anesthesiologists great. The systems needed to keep female anesthesiologists working are part-time works, more support systems for childcare, and earning equities accounted by practice characteristic and rank.

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  Perioperative hypothermia increases the possibility of post-operative complications. We report a clinical experience of bronchopulmonary lavage in a patient with pulmonary alveolar proteinosis who underwent general anesthesia three times. Our findings suggest that amino acid infusion can help prevent perioperative hypothermia. We conducted different lung lavages and administered infusion solution drugs on the same alveolar proteinosis patient and examined the patient's body temperature change. The advantage of volume controlled lung lavage (VCLL) was lowered body temperature while massive pulmonary lavage (MPL) had superior treatment effects. By administering amino acid infusion, perioperative hypothermia was prevented with MPL while superior treatment effects were also achieved during this procedure. We have found that amino acid infusion can effectively prevent hypothermia in anesthesia management for pulmonary lavage.

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  A 88-year-old man was scheduled for ventral hernia repair. His preanesthetic chest X-ray had not revealed airway abnormality. Anesthesia was induced with propofol and maintained with sevoflurane and nitrous oxide and oxygen. The operation was finished uneventfully. Immediately the tracheal tube was extubated, arterial oxygen saturation measured by pulse oximeter decreased to 70%, and he developed respiratory effort and stridor. Chest X-ray after reintubation showed tracheal arcuation with a shift to the right side, and we found tracheal stenosis by bronchofiberscopy. The oxygenation was improved by putting him into the sitting position, and the tracheal tube was removed the following day.
  Intra-abdominal hypertension induced by repair of hernial sac might cause tracheal arcuation. However, the contributions of advanced age and obesity cannot be denied. We should be alert for intra-abdominal pressure and airway management during the repair of ventral hernia.

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  In our hospital peripheral nerve blocks have been widely used together with general anesthesia for surgery of the lower extremities, although this is not common elsewhere. The author preferentially utilized any combination of femoral nerve block, lateral femoral cutaneous nerve block, and anterior approach or parasacral sciatic nerve block.
  Because of the multiple advantages of peripheral nerve blocks, which include minimal hemodynamic alterations, comfortable emergence with superb postoperative analgesia, no urinary retention, and minimal risk of hematoma after perioperative anticoagulant therapy, they will be a useful alternative to neuraxial anesthesia for compromised patients with dementia, pain, bedsores or coagulopathy.
  The availability will be recognized as an option for secure anesthesia of the lower extremities if the advancement of equipment and the opportunity for regional anesthesia training increase at the same level as the West.

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