THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

Journal Symposium (1)

Spinal Anesthesia —Brush up—

Hideyuki HIGUCHI

2009 Volume 29 Issue 7 Pages 749-757
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.749

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Baricity of a drug delivered via the subarachnoid space greatly affects the onset and spread of spinal anesthesia. Hyperbaric bupivacaine, which contains glucose, is heavier than water and cerebrospinal fluid, and the spread of spinal anesthesia using hyperbaric bupivacaine is significantly affected by gravity. Plain bupivacaine, which does not contain glucose, is heavier than water and lighter than cerebrospinal fluid. When intrathecal injection of plain bupivacaine is performed at L2/3 or L3/4, the range of the cephalad spread is great. On the other hand, when the injection is made at L4/5, the range of the cephalad spread is less than that at L2/3 or L3/4, and the spread of anesthesia is suitable for hip surgery in elderly patients.

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Combined Spinal Epidural Anesthesia (CSEA)

Reiko TAKAHASHI

2009 Volume 29 Issue 7 Pages 758-763
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.758

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CSEA offers the advantages of both spinal and epidural anesthesia: rapid onset, deep level of anesthesia and postoperative pain therapy. The technique of CSEA is divided between the single segment technique and the double segment technique. The extension of sensory block by epidural injection may have been explained by the epidural volume effect. Using this mechanism, CSEA provides many potential advantages. The analgesic level of CSEA is dependent on both spinal analgesia and epidural anesthesia. Informed of the features and the disadvantages of spinal analgesia, epidural anesthesia, and CSEA, we must use them properly.

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Child and Medical Treatment

Junichi SHOJI

2009 Volume 29 Issue 7 Pages 764-770
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.764

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In addition to the disease itself, medical treatment causes anxiety and distress in children and their parents. Anxiety and distress in children may differ by age, temperament, relationship with parents, coping style, and previous experiences with such treatment, and so on. In this paper I first describe recent developments in child psychology, in particular newborn competence, child temperament, attachment and cognitive development. I then remind medical practitioners, including anesthesiologists, to pay attention when treating children on mental health issues, because in Japan the mental health of children with diseases does not fully understood. Medical practitioners must care children respectfully.

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Child Development and Perception of Anesthesia
—Collaboration with Anesthesiologists and Child Life Specialist—

Megumi AIYOSHI

2009 Volume 29 Issue 7 Pages 771-779
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.771

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A child's developmental issues and previous medical experience affects his anxiety toward surgery and behavior during anesthesia induction. In our hospital, anesthesiologists and surgical nurses use developmentally appropriate language and create a non-threatening environment to minimize the child's psychological stress. The medical staff also collaborates with a child life specialist to provide individualized support for a child having a surgery. Developmentally appropriate and individualized support reduces a child's anxiety and pain, and moreover, provides mastery over one's experiences in having the operation.

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Difficult Airway Management (DAM) Standard

Masashi NAKAGAWA

2009 Volume 29 Issue 7 Pages 780-787
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.780

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The American Society of Anesthesiologists revised the practice guidelines for management of the difficult airway in 2003, and the Difficult Airway Society released guidelines for management of unanticipated difficult intubation in 2004. Both guidelines mainly described how to manage cases of unanticipated difficult intubation after typical anesthesia induction.
In the face of difficult laryngoscope cases after anesthesia induction, several maneuvers should be tried to optimize the laryngoscopic view, such as head extension, changing the laryngoscope blade, and BURP. Moreover, these guidelines recommend use of guide introducer for tracheal intubation, especially the gum elastic bougie (GEB) . In cases when ventilation via mask is in adequate or intubation after several direct laryngoscopic attempts is unsuccessful, laryngeal mask is recommended using for securing airway.
The usefulness of both GEB and laryngeal mask were analyzed using a simple strategy as follows: the GEB and the intubating laryngeal mask were proposed as the first and second steps in the case of failed laryngoscope-assisted tracheal intubation, respectively. This strategy was able to secure an airway in 95% of unanticipated difficult airway cases.
I think that the DAM standard is the minimum requirement for airway management for anesthesiologists, that is, they have to be familiar with using GEB and laryngeal mask in case of failure of a direct laryngoscopic attempt.

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Journal Symposium (2)

[title in Japanese]

Hirotsugu OKAMOTO

2009 Volume 29 Issue 7 Pages 788
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.788

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Pharmacokinetics and Pharmacodynamics

Hidefumi NAKAMURA

2009 Volume 29 Issue 7 Pages 789-796
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.789

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Children are not small adults, and the pharmacokinetics and pharmacodynamics (PK/PD) of a drug in children are often different from those in adults. Therefore, efficacy, safety and dosage should be carefully evaluated in every age group that will most likely benefit from the drug. Although there is a certain degree of accumulated knowledge in developmental pharmacology that is briefly described in this paper, it is still difficult to accurately estimate the PK/PD of drugs in children. Therefore, clinical trials should be conducted on each drug. Many drugs which are approved in the EU and/or the US are still off-labeled in Japan because of the lack of clinical trial data in Japanese children. There have been several critical actions taken by the Ministry of Health, Labour and Welfare to promote pediatric drug development, and physicians, governments and industries must work together to further promote pediatric drug development.

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Anesthesia for School-Aged Children and Adolescents :
A Current Concept in Pediatric Anesthesia-Consideration for Growth and Development

Yuichiro TODA, Tatsuo IWASAKI, Kazuyoshi SHIMIZU, Kiyoshi MORITA

2009 Volume 29 Issue 7 Pages 797-802
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.797

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At birth, the maturation process of the kidney and liver is not complete. Full function is not attained until the first or second year of life. What happens to the neurological and psychological development of children and how does it affect their handling of the peri-operative period? It is easy to imagine that children will feel anxious or stressed when they are informed that they are to have a surgical procedure. Postoperative abnormal or maladaptive behavior is relatively common in pediatric anesthesia, especially when children feel stressed or frightened. An anesthetic intervention to reduce these unfavorable complications should be considered. For instance, premedication, parental presence during induction, alternative induction methods and postoperative pain management may help allay anxiety. Anesthesiologists should aim to minimize psychological stress in the child who is undergoing an anesthetic or surgical procedure.

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Educational Articles

hANP as a New Diuretic for Perioperative Use

Takeshi YOKOYAMA, Rie HOSOI, Kanta KIDO

2009 Volume 29 Issue 7 Pages 803-808
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.803

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Oliguria is a major problem during anesthesia, and renal-dose dopamine or furosemide is often used to maintain urine volume during general anesthesia. But both drugs have serious side effects and their renoprotective effect has been doubtful. Human atrial natriuretic peptide (hANP) is a 28-amino-acids peptide exhibiting various biological functions including renal protection and diuresis according to the water balance. Exogenous administration of hANP may increase urine volume and prevent acute renal failure after surgery. However, the recommended dose of hANP (0.1 micro-g/kg/min) may induce hypotension and anesthetic management may be difficult. Our investigation revealed the effects of low-dose hANP (0.01 micro-g/kg/min) on perioperative urine volume, blood pressure and renal function in patients undergoing orthopedic surgery. Continuous intravenous infusion of hANP at 0.01 micro-g/kg/min was started after induction of anesthesia, and was continued for 20 hours. No hypotension was observed during surgery. However, urine volume was twice that of the control group, except in patients with hypovolemia. Electrolytes did not change significantly during surgery. In addition, hemoglobin concentration was also maintained, while it significantly decreased in the control group. hANP might be an ideal diuretic for patients undergoing elective surgery.

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Review Articles

Perioperative Management of Hemostasis and Thrombosis in Cardiovascular Anesthesia

Mutsuhito KIKURA, Yoshiki ISHIGURO

2009 Volume 29 Issue 7 Pages 809-814
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.809

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In cardiovascular surgery patients, recent important topics in perioperative management of coagulation are the risk reduction of abnormal bleeding caused by the contact activation of the fibrinolytic system due to inflammatory responses during extracorporeal circulation, and decreases in the number and function of the platelets and coagulation factors, and the risk reduction of perioperative arterial thrombosis. In this review, we discuss the recently advocated cell-based model, the mechanisms of perioperative arterial thrombosis and the perioperative hemostasis management with anti-plasmin agents in cardiovascular surgery patients. Perioperative management of hemostasis and thrombosis are difficult areas, but very important and challenging topics in cardiovascular anesthesia.

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Original Articles

The Use of Oral Rehydration Therapy for Preoperative Fluid and Electrolyte Management

Hideki TANIGUCHI, Toshio SASAKI, Hisae FUJITA

2009 Volume 29 Issue 7 Pages 815-823
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.815

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We conducted a pilot study to investigate the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. The study was conducted in 20 surgical patients, and these patients consumed an oral rehydration solution before general anesthesia. Patient self-assessment of ORT was conducted by a questionnaire survey. In addition, we conducted a follow-up survey on the 1,078 surgical patients who received ORT in the following 12 months to assess the safety of ORT. ORT was received favorably by the patients, and the results of this study suggest that ORT is safe and useful for preoperative fluid and electrolyte management, if used in selected patients and conditions.

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Can We Evaluate Pain with Pain Vision^®, a Device for Quantitative Analysis of Perception and Pain? :
A Feasibility Study of Pain in Herpes Zoster Patients

Norimasa MAEKAWA, Masahiro MORIMOTO, Mitsuo MORIMOTO, Tomohisa UCHIDA, ...

2009 Volume 29 Issue 7 Pages 824-828
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.824

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We evaluated pain caused by herpes zoster with the perception and pain quantitative analysis device “Pain Vision^®” before and after treatment including epidural block, stellate ganglion block and iontophoresis. We studied 18 patients with herpetic pain and postherpetic neuralgia, and examined the change in the visual analogue scale (VAS) and pain degree measured by Pain Vision^® before and after treatment. VAS and pain degree were both found to decrease significantly following treatment. However, a correlation between VAS and pain degree could not be found. Therefore, the evaluation of pain by Pain Vision^® can be used as an index of therapeutic gain, but is not thought to be related to VAS.

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Case Reports

Extracorporeal Membrane Oxygenation for Anesthetic Management of Whole-Lung Lavage in a Patient with Pulmonary Alveolar Proteinosis

Hidekazu IMAI, Kenta FURUTANI, Chieko SHIBUE, Takeshi SAITO, Hiroshi B ...

2009 Volume 29 Issue 7 Pages 829-834
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.829

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A 58-year-old woman presented with severe hypoxemia. Chest radiography showed patchy infiltrates in both lungs. A diagnosis of pulmonary alveolar proteinosis (PAP) was made. The patient needed whole-lung lavage (WLL) , and the support of extracorporeal membrane oxygenation (ECMO) was required during this procedure because of severe hypoxemia (PaO₂ 38mmHg, breathing ambient air) . We performed the ECMO-assisted left WLL without fatal hypoxemia. It is suggested that ECMO support enables PAP patients with severe hypoxemia to maintain good oxygenation during aggressive WLL and results in early patient recovery.

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Successful Internal Jugular Venipuncture Using the Ultrasound-guided Posterior Approach: A Report of 2 Difficult Cases

Joho TOKUMINE, Kota KAMIZATO, Koji TERUYA, Tatsuya FUCHIGAMI, Rumiko K ...

2009 Volume 29 Issue 7 Pages 835-840
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.835

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Internal jugular venipuncture is performed using the anatomic landmark technique or ultrasound-guided technique. The approach of the landmark technique is classified as anterior, lateral (central) , or posterior depending on the position of the puncture site in relation to the sternocleidomastoid muscle.
We experienced 2 difficult cases of internal jugular venipuncture. Case 1: The doctor in charge could not perform internal jugular venipuncture using the lateral approach of the landmark technique. Ultrasound examination revealed that the internal jugular vein was not present in the Sedillot triangle. Internal jugular venipuncture was then performed using the posterior approach of the ultrasound-guided technique, and this helped in the selection of the most appropriate puncture site and needle direction. Case 2: Ultrasound examination revealed that the internal jugular vein was overlying the common carotid artery in the Sedillot triangle. Therefore, internal jugular venipuncture was performed using the posterior approach of the ultrasound-guided technique in order to prevent arterial puncture.
Internal jugular venipuncture using the ultrasound-guided technique is advantageous in that the most appropriate puncture site and needle direction can be selected in terms of patient safety.

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A Case of Paraganglion Tumor Discovered for Abnormal Hypertension during TUR-BT Surgery

Tomohiro TANAKA, Kentaro IMAGAWA, Ryotaro KAYO, Sunji CHO

2009 Volume 29 Issue 7 Pages 841-844
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.841

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A 58-year-old female with renal failure, who had complained of hematuria, was diagnosed with a bladder tumor by preoperative examination. At that time, there were no significant changes, and she was scheduled for TUR-BT under general anesthesia. Immediately after the tumor was touched with the electric scalpel, her BP increased remarkably. The operation was discontinued and these hemodynamic changes were treated with nicardipine. Pathologic examination identified the tumor as a paraganglion tumor.

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Short Communications

A Case of Difficult Endotracheal Intubation Due to Laryngeal and Upper Tracheal Frontal Protrusion
Induced by Hard Abscess after Anterior Cervical Spinal Fusion Surgery

Asahiko KASAMA

2009 Volume 29 Issue 7 Pages 845-847
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.845

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A 60-year-old man underwent cervical laminoplasty and anterior fixation for cervical spondylotic myelopathy 9 months prior. He was admitted to undergo plate removal because of discomfort in the right side of the throat. At the time of anesthesia induction, the larynx showed sufficient distensibility to allow the smooth insertion of a standard 8.5-mm tracheal tube down to a position approximately 2 cm below the glottis ; however, the tube could not be advanced further. An attempt to screw an 8-mm spiral tube into the trachea failed. Finally, we were able to insert a 7-mm spiral tracheal tube. Preoperative cervical X-ray showed that the larynx and the upper trachea had been compressed anteriorly, presumably by soft tissue. However, the plate was firmly encapsulated together with an abscess, and this hard capsule-like tissue seemed to have been the cause of the intubation difficulties.

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Brief Reports

Training Effects of Cricothyroidotomy with Pig Larynxes

Hiroyuki NAKAO, Yoshiroh KAMINOH, Masashi NAKAGAWA, Takeshi NOMURA, Ak ...

2009 Volume 29 Issue 7 Pages 848-854
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.848

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A study was conducted on some problems in training on usage of the method found in the education course from the Japanese Association for Medical Simulation when making an incision in the cricothyroid membrane.
[Methods] After being instructed through simulation in the method of making an incision in the cricothyroid membrane, the lecture attendees engaged in training using a pig larynx, where the membrane was incised and spread.
[Results] Variations in the feel for and individual differences in the characteristics of living organisms could be experienced, and a check of dissection technique was carried out. Misplacement of the intubation tube into the space between the intratracheal membrane and the tracheal wall was also found.
[Discussion] Practical know-how can be learned from the pig larynx, although crisis situations can be arranged in a virtual simulation. The proper use of the training materials that correspond to the training objective and the performance of practical training are necessary.

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Autologous Peripheral Blood Mononuclear Cell Implantation for Therapeutic Angiogenesis in a Patient with Buerger's Disease

Shinji KAWAHITO, Akio ISEKI, Hiroshi KITAHATA, Tamotsu KANBARA, Tetsuy ...

2009 Volume 29 Issue 7 Pages 855-859
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.855

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We describe herein the successful treatment by therapeutic angiogenesis of a patient with ischemic ulcers and pain of the fingers due to Buerger's disease. A 49-year-old man suffering from Buerger's disease was presented for this novel procedure. Under general anesthesia with sevoflurane, autologous peripheral blood mononuclear cells were manually injected to the ischemic hands. The procedure was completed without any serious complications. The symptoms in his fingers were improved after implantation. However, we had to perform implantation three times due to recurrences. Thus, because autologous peripheral blood mononuclear cell implantation is easier than conventional therapy, and has a lower risk of complications, we recommend this procedure as the therapy of choice in the acute pain phase of Buerger's disease.

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[JAMS] Brief Reports

The Induction of a New Simulation Recording System for Medical Education

Hisao MATSUSHIMA, Seiki KOZU

2009 Volume 29 Issue 7 Pages 862-866
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.862

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Medical training using a simulation system is quite essential for both medical students/residents and co-medical personnel. Debriefing after completing simulation training is important for self-advancement, and debriefing with a recording system is recommended. This lecture, however, may be time-consuming and requires a separate room. Therefore, aggressive debriefing using our original recording system has been brought since 2002. We developed a new recording system for the purpose of more effective training in 2007. This new system makes it much easier to point out mistakes, and is suggested to be more effective for the trainers.

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[JARMA] Journal Symposium

The Fundamental Principles of Criminal Law with Particular Focus on Negligence

Atsushi YAMAGUCHI

2009 Volume 29 Issue 7 Pages 869-879
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.869

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The lecture describes the fundamental principles of criminal law with particular focus on negligence. Generally, health care providers are most concerned with negligence, which is a crime under Japanese law. The purpose of criminal law is to protect the interests of society through deterrence of wrongdoings. Criminal law ordinarily imposes punishment on individuals who intentionally engage in conduct that violate the rights of others. Negligence is an exception in which punishment is imposed despite the absence of intent. Because intent is not an element, negligence has an inherent tendency to be interpreted broadly. The key question, therefore, is how to define the scope of the crime. Negligence requires a breach in two types of duties: a duty to foresee the consequence, which must be reasonably foreseeable, and a duty to avoid the consequence, which must be reasonably avoidable. The “principle of trust” plays an important role in defining what is reasonably avoidable. The criminal liability of a supervisor, which often becomes an issue in team-based medical practice, is limited under the “principle of trust.”

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Protection from Criminal Lawsuit

Sadato GOTO

2009 Volume 29 Issue 7 Pages 880-889
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.880

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A medical accident becomes the object of a criminal lawsuit. A doctor or a nurse may assume a lot of responsibility in a case of a simple clinical mistake. When a clinical handling becomes an object of a criminal lawsuit, the problem will become difficult. It took a long time to investigate the Oono Hospital and Kyorin College cases. In these cases, defense attorneys are opposed to the public prosecutor on the clinical findings and handlings.
If your case becomes criminal, your protection will begin with a consultation with a defense attorney. The base of your protection is the truth and your level of clinical standards. A protocol from the interview room, which is not visible by private citizens, has a very important role in court. It is very important for you to do well in the interview room for protection against police officers.

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Activity Report from the Adhoc Medical Safety Working Group in Japanese Society of Anesthesiologists: In Reaction to the Governmental Draft Proposals for the Investigation Committee of Accidental Deaths during Medical Practice

Norimasa SEO, Shigeho MORITA, Miyuki YOKOTA, Atsuko KIUCHI, Hirokazu S ...

2009 Volume 29 Issue 7 Pages 890-896
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.890

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The Ministry of Health, Labour and Welfare (MHLW) proposed drafts for the investigation committee of accidental deaths during medical practice through review meetings. The adhoc medical safety working group (WG) in the Japanese Society of Anesthesiologists (JSA) was organized to evaluate those drafts and comments in review meetings and to propose action plans to the administrative board of the JSA. The WG proposed the original plan of public comment on the third draft by MHLW to the administrative board of the JSA. The WG also proposed and co-hosted urgent public meeting programs for medical safety during the meeting of Japanese Intensive Care Medicine in Tokyo and the JSA in Yokohama. The purpose of the public meetings was to discuss together how to stop destroying the health-care system and shuffling patients in crisis around hospitals. To establish medical safety, the most important issue is that doctors and patients collaborate together to deal with medical adverse events. In conclusion, the WG will continue to support the establishment of the investigation committee by improving professional autonomy and the medical safety system with high-quality medical knowledge.

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A Case of Ventilation Error Due to Malfunction of Scavenging System for Anesthetic Gases

Satoki INOUE, Tomohiro MATSUDA, Yasunobu KAWANO, Masahiko KAWAGUCHI, H ...

2009 Volume 29 Issue 7 Pages 897-900
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.897

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A 67-year-old male was scheduled for prostatectomy. Prior to induction, the anesthesia machine was inspected according to the guidelines of the Japanese Society of Anesthesiologists. Manual ventilation was performed successfully except that a gradual increase in the circuit pressure was noticed. When ventilation was conducted mechanically after intubation, abnormal thoracic movement was observed. Expiratory pressure increased gradually with concomitant deterioration of thoracic movement. We found that the problem was caused by the occlusion of the scavenging system due to a twist in the circuit. We assumed that the relocation of the anesthesia machine caused this trouble.

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The Proformas of the No-fault Compensation System :Considerations Regarding the “Obstetrical Medical Care Compensation System”

Miyuki YOKOTA, Makoto SEKI, Yoshiyasu HIRATA

2009 Volume 29 Issue 7 Pages 901-904
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.901

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The objectives of the “obstetrical medical care compensation system” lie in the following three points: 1) to compensate the economic burden of families with children who developed cerebral paralysis (CP) in association with the accouchement, 2) causal analysis and prevention of future CP, and 3) prevention of conflicts, early settlement, and improvement in the quality of obstetrical medical care.
[Considerations] 1) Scope of compensation: it is highly possible that there are exclusion criteria and that many CP children will not be subject to compensation. 2) Regarding the agreement: the administrative procedures of each medical institution will increase. Misunderstandings that all patients and families will receive compensation may occur, and furthermore, there is concern that disputes will increase. 3) Insurance fee collection and time of payment of compensation will require further consideration.
[Summary] At present, the establishment of a no-fault compensation system is required. There is little scope for objections regarding its general concept. However, it is worthwhile to examine the “obstetrical medical care compensation system” after narrowing down the plan for this system.

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Discussion Concerning Public Comments: For the Third Version of the Draft on Clarification of the Causes and Prevention of Fatal Medical Malpractice Incidents in the Goal of Medical Practice Safety, Submitted by the Ministry of Health, Labour and Welfare

Atsuko KIUCHI, Miyaji KYAKUNO, Kazumasa EHARA, Shuichi NOSAKA, Norimas ...

2009 Volume 29 Issue 7 Pages 905-910
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.905

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In April 2008, the Ministry of Health, Labour and Welfare submitted the third draft on clarification of the causes and prevention of fatal medical malpractice incidents in the goal of medical practice safety, and subsequently called for public comments on the draft. Fifty-eight associations and 404 individual persons responded by the end of June 2008. Those responders included thirty-nine academic or medical societies. Six of those societies supported the draft but the rest of those opposed or required amendments. Ninety-five percent of individual persons opposed or required amendments. The supporters of the draft pointed out the large room for improvement. This third draft has many unsolved problems, which suggests the need for further in-depth discussion in the future.

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The Comparison of Instructive Documents on Conducting Anesthesia Between Two University Hospitals

Fumihiko SHIMADA, Shuichi NOSAKA

2009 Volume 29 Issue 7 Pages 911-914
Published: November 13, 2009
Released on J-STAGE: December 17, 2009

DOIhttps://doi.org/10.2199/jjsca.29.911

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We compared instructive documents on anesthesia practices for patients between Essen University of Germany and Shiga Medical University Hospital in Japan. The documents from the German hospital include a questionnaire concerning private insurance and ambulatory surgery, whereas those of the Japanese hospital do not. These differences are considered to be the reflection of the medical insurance system and the prevalence of ambulatory surgeries between these two countries. Moreover, the German one describes items in detail on each intervention, whereas the Japanese one does not.

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