THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

Journal Symposium (1)

Working Knowledge for Fluid Management

Hideki MIYAO

2010 Volume 30 Issue 7 Pages 917-924
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.917

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Thinking of three compartments (intracellular, interstitial, and intravascular compartment) is necessary for fluid therapy during surgery. As Hartman's solution is hypotonic, we prefer the extracellular fluids which contain sugars (except glucose), because they have high osmolarity and then high volume effect and diuretic effect. Hydroxyethyl starch (HES) is an appropriate intravascular fluid when acute fluid resuscitation is needed. When we think about colloid osmotic pressure, the characteristics of measured membrane, organ specificity of endothelium, and comprehension of pathological condition should be considered. HES has anti-inflammatory effects and can maintain proper blood viscosity and, consequently maintain peripheral microcirculation. HES70 has the lowest molecular weight among HES products and thus has the least side effects of renal function and coagulation system. Urine output is the most clinical and useful monitor for fluid management. The assessment of volume challenge using a transesophageal echocardiogram is a new idea for monitoring fluid load. The mixed venous saturation and the plasma lactate measurement are important comprehensive monitors which also offer the direction of fluid management for patients under unstable oxygen metabolism.

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Intraoperative, Salvaged, Autologous Blood Transfusion in Obstetric Surgery

Ju MIZUNO

2010 Volume 30 Issue 7 Pages 925-930
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.925

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Intraoperative, salvaged, autologous blood transfusions carried out with autotransfusion devices are commonly used for cardiovascular surgery, and also enable the treatment of massive hemorrhage in orthopedic surgery, gynecologic surgery, and so on. Such autologous transfusions can prevent potential complications of homologous blood transfusions, such as transmission of infection, immune reactions, and blood type incompatibility. A prominent concern with intraoperative autotransfusion in obstetric surgeries is the risk of transfusing salvaged blood that may be contaminated with amniotic and fetal substances which may cause amniotic fluid embolism. However, some investigators have reported that use of leukocyte depletion filters with intraoperative autotransfusion in cesarean section can guarantee complete elimination of amniotic and fetal substances and thereby prevent amniotic fluid embolism. Intraoperative autotransfusion with leukocyte depletion filters is therefore a promising technique for the treatment of profuse hemorrhage in obstetric surgery.

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ABCs of Sleep-Disordered Breathing for Anesthesiologists and Recommended Perioperative Airway Management

Shiroh ISONO, Nao IIYORI

2010 Volume 30 Issue 7 Pages 931-941
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.931

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Because of the high prevalence of obstructive sleep apnea (OSA) among surgical patients and the possible development of severe perioperative complications in these patients, basic knowledge of OSA is required for anesthesiologists. This review article presents updated pathophysiology of OSA and its clinical features, diagnosis and treatments. Perioperative airway management for patients with OSA in a university hospital is discussed.

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Journal Symposium (2)

[title in Japanese]

Toru KOMATSU, Shinichi SAKURA

2010 Volume 30 Issue 7 Pages 942
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.942

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The Present Status and the Future of Ultrasound-Guided Thoracic Paravertebral Block

Masami SATO, Gotaro SHIRAKAMI, Kiichi HIROTA, Kazuhiko FUKUDA

2010 Volume 30 Issue 7 Pages 943-951
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.943

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Thoracic paravertebral block (tPVB) is the technique of injecting local anesthetic adjacent to the paravertebral foramina, resulting in ipsilateral somatic and sympathetic nerve blockade. tPVB is effective in managing acute and chronic pain originating from the unilateral chest and abdomen. Because of its excellent analgesic properties similar to epidural block but with a lower complication rate, it is becoming popular, especially in pain management following thoracic and breast surgery. Although tPVB has a potent risk of pneumothorax, it can become a safer and more reliable technique with the introduction of ultrasound-guidance. In breast cancer surgery, monitored anesthesia care coupled with tPVB provides faster postanesthesia recovery of a higher quality than general anesthesia.

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Comparing Dual Guidance with Ultrasound and Nerve Stimulator in Combination versus Nerve Stimulator Alone for Lumbar Plexus Block and Parasacral Nerve Block in Patients Undergoing Total Knee Arthroplasty

Misako HARATO, Hiroshi ITO, Manabu AKASHI, Toru KOMATSU, Yoshihiro FUJ ...

2010 Volume 30 Issue 7 Pages 952-958
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.952

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Lumbar plexus block and parasacral block provide high quality analgesia in patients undergoing total knee arthroplasy (TKA). Both blocks used to be performed using nerve stimulator and land mark guidance (Landmark Group). Identification of the sonoanatomical structures of the parasacral nerve or lumbar plexus located deep inside the body is very difficult. However, we could identify the structures of the bone and muscle around parasacral nerve or lumbar plexus and the tip of the needle by ultrasound guidance. The quality of the nerve block could be improved by using those sonoanatomical images as landmark and nerve stimulation in combination (Dual guided Group). In this study, efficiency of the block, and block execution time were similar between the Landmark Group and Dual guided Group. One patient in Landmark Group showed blood aspiration during needle puncture when parasacral nerve block was performed, suggesting an accidental puncture of the inferior gluteal artery. Dual guided nerve block is theoretically superior as compared to the nerve block guided by the nerve stimulator alone and may prevent complications.

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Ultrasound-Guided Peripheral Nerve Blocks for Upper Abdominal Surgery - Where We Are and Where We Will Be -

Akemi SHIDO

2010 Volume 30 Issue 7 Pages 959-966
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.959

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Ultrasound-guided peripheral nerve blocks for upper abdominal surgery are being performed at our institution, mainly for those patients in whom epidural anesthesia and analgesia is contraindicated. Our limited experience shows that ultrasound-guided rectus sheath block and subcostal transversus abdominis plane block are greatly effective in eliminating postoperative abdominal somatic pain, if they are performed with sufficient knowledge of their analgesic characteristics. Development of continuous infusion techniques would further make them play a more important roles in multimodal perioperative pain management. Randomized controlled study is also necessary to compare the usefulness and effectiveness of peripheral nerve blocks with those of other analgesic methods, such as epidural analgesia and local anesthetic wound infiltration.

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Ultrasound-Guided Peripheral Nerve Blocks: Abdominal Wall Nerve Blocks for Lower Abdominal Surgery

Masato KITAYAMA, Kazuyoshi HIROTA, Yutaka SATO

2010 Volume 30 Issue 7 Pages 967-973
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.967

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I.v. opioids, such as IV-PCA, are popular methods for postoperative pain control after lower abdominal surgery. However, opioids are weakly efficacious for somatic pain and are associated with side-effects including nausea, vomiting, and respiratory depression. It is well recognized that local anesthetic techniques can improve the quality of postoperative recovery by reducing the somatic pain and opioid requirement. Recently, the spread of ultrasound-guided nerve blocks has improved the efficacy of the abdominal wall blocks, such as TAP block, for example. Ultrasound-guided nerve blocks had been innovated for perioperative management for abdominal surgery, such as gynecologic laparotomy, laparoscopy-assisted surgery and inguinal hernia. The combination of abdominal nerve blocks and opioids allows a significant reduction in postoperative analgesics requirements and intraoperative relaxation of abdominal muscles.
Further studies are warranted to establish general recommendations for the use of abdominal peripheral nerve blocks, as a part of a multimodal analgesic regimen for the quality of analgesia and patient satisfaction.

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Current Status and Future Application of Ultrasound-Guided Nerve Block for Orthopedic Surgery

Yasuhiro MORIMOTO, Yuko NOGAMI, Chie YOSHIKAWA

2010 Volume 30 Issue 7 Pages 974-979
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.974

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  Current status and future application of ultrasound-guided nerve block for orthopedic surgery are discussed.
  The advantage of ultrasound-guided nerve block for orthopedic surgery is excellent pain control after surgery. Another advantage of ultrasound-guided nerve block is analgesic effect in high-risk patients. Femur fracture surgery can be performed under femoral nerve and lateral femoral cutaneous nerve block.
  The technique of ultrasound-guided nerve block is necessary for safe and excellent anesthetic management of orthopedic surgery.

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Analgesic Effect of Continuous Intercostal Nerve Block Infusion Compared to Continuous Thoracic Epidural Analgesia

Shigeyuki SAITO

2010 Volume 30 Issue 7 Pages 980-985
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.980

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Acute post-nephrectomy pain has been controlled by continuous thoracic epidural analgesia. We evaluated the effect of a continuous intercostal nerve block to control post-nephrectomy pain compared to continuous epidural analgesia.
Analgesic effect of continuous intercostal nerve block was the same as that of continuous epidural analgesia.

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Journal Symposium (3)

[title in Japanese]

Norimasa SEO, Takao KOBAYASHI

2010 Volume 30 Issue 7 Pages 986
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.986

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Anticoagulant Thromboprophylaxis for Perioperative Venous Thromboembolism

Takao KOBAYASHI

2010 Volume 30 Issue 7 Pages 987-995
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.987

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Recently in Japan, venous thromboembolism (VT) [deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE)] has increased with the Westernization of eating habits and the aging of society. In the West, prophylactic guidelines have been discussed for many years, and, unfortunately, Japan falls far behind the West in this area. Therefore, the necessity of thromboprophylaxis in the Japanese population should be emphasized based on reliable VTE studies in Japan. We developed Japanese Guidelines for VTE prophylaxis based on the 6th ACCP guidelines in 2004. The incidence of perioperative PTE in Japan has been investigated by the Japanese Society of Anesthesiologists since 2002. The rate of perioperative PTE was estimated to be 4.76 per 10,000 operations in 2003. As we expected, it decreased to 3.61 immediately after the guidelines for thromboprophylaxis were issued and the management fee for PTE prophylaxis was covered by health insurance in April 2004. Furthermore, it decreased by half in 2006. However, mechanical prophylaxis alone is not sufficient to prevent PTE, and advanced prophylaxis using anticoagulants, such as low-molecular-weight heparin/selective Xa inhibitor along with unfractionated heparin (UFH)/vitamin K antagonists (VKA) will be essential. The advanced revised guidelines for VTE prophylaxis based on our clinical evidence will be established in the near future.

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Perioperative Venous Thromboprophylaxis Using Anticoagulants : The Viewpoint of an Anesthesiologist

Masayuki KUROIWA

2010 Volume 30 Issue 7 Pages 996-1001
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.996

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The knowledge and practice of perioperative venous thromboprophylaxis has increased among the medical practitioners in Japan after the publication of the domestic guidelines for the prevention of venous thromboembolism (VTE) in 2004; anticoagulant prophylaxis, therefore, may be considered to be the next stage in the field. Epidemiological research of perioperative symptomatic pulmonary thromboembolism conducted by researchers of the Japanese Society of Anesthesiologists revealed that anticoagulant therapy for patients with thromboprophylaxis might reduce mortality. However, some important problems regarding the perioperative use of anticoagulants, such as major bleeding after surgery, intracranial bleeding in the case of elderly patients, intestinal bleeding in the case of ulcer patients, and epidural hematoma in the case of patients under neuraxial anesthesia/analgesia, remain unsolved. Hence, it is essential to develop a protocol for the management of patients who receive perioperative administration of anticoagulants.

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Anticoagulant for Prevention of Venous Thromboembolism in Patients Undergoing Orthopaedic Surgery

Takeshi FUJI

2010 Volume 30 Issue 7 Pages 1002-1007
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1002

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Mechanical prevention of venous thromboembolism in orthopaedic surgery is performed in most hospitals. New anticoagulants, such as enoxaparin or fondaparinux, were approved in 2007 and 2008. The Japanese Orthopaedic Association has published the guideline for prevention of venous thromboembolism in orthopaedic surgery in 2008, and anticoagulant prophylaxis or intermittent pneumatic compression is recommended for total joint arthroplasty or hip fracture surgery. Since then, anticoagulant prophylaxis has been widely used for joint replacement surgery. Anticoagulant is effective for prevention of venous thromboembolism, but bleeding complications have occurred in some cases. Each case has both thrombotic and bleeding risks. Therefore, the choice of preventive methods of venous thromboembolism should be selected case-by-case with good informed consent.

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Pharmacological Thromboprophylaxis in Abdominal and Pelvic Surgery

Masato SAKON, Masataka IKEDA

2010 Volume 30 Issue 7 Pages 1008-1013
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1008

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The mechanical prophylaxis for venous thromboembolism (VTE) has been widely performed for the last 5 years. However, the mortality of perioperative pulmonary thromboembolism (PTE) is still extremely high, suggesting the necessity of pharmacological thromboprophylaxis. Under these circumstances, the reimbursement of anticoagulants like enoxaparin (low molecular weight heparin) and fondaparinux for perioperative thromboprophylaxis has recently become applicable in Japan, and the same pharmacological thromboprophylaxis can be performed as in western countries.
In Japanese clinical trials, the beneficial effect on VTE was confirmed in both enoxaparin and fondaparinux without increased risk of bleeding. The current status of thromboprophylaxis in abdominal surgery is discussed focusing mainly on the clinical results of both anticoagulants.

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Educational Articles

Postoperative Pain Management with Disposable Patient-Controlled Epidural Analgesia (PCEA) Pump: Epidural 0.2% Ropivacaine with Fentanyl Following Major Surgery

Masahiro TAKAHASHI, Aya NISHIMURA, Katsuhiro KIMOTO, Yuki TERADA, Miho ...

2010 Volume 30 Issue 7 Pages 1014-1022
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1014

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Postoperative pain management by patient-controlled epidural analgesia (PCEA) involving the administration of local anesthetics and low-dose opioids has been reported to be available to patients. Electrical PCEA pumps have high performance and are useful for postoperative pain management following major surgeries. However, their introduction and maintenance are associated with considerable costs. On the other hand, disposable PCEA pumps are not that expensive with regard to their introduction and maintenance. Furthermore, the cost of disposable PCEA pumps can be claimed from National Health Insurance agencies. Therefore, many hospitals have adopted the use of disposable PCEA pumps. However, these pumps are inferior to electrical pumps with respect to performance. We overcome these weaknesses of disposable pumps by using various ideas.
In this paper, we discuss the formulation designed by us that contains high concentrations of ropivacaine and low doses of fentanyl and the improvement in PCEA efficacy achieved by using disposable pumps.

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The Parker Spiral Endotracheal Tube: First Experience in 45 Patients

Takero ARAI, Yasuhisa OKUDA

2010 Volume 30 Issue 7 Pages 1023-1028
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1023

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The Parker spiral endotracheal tube is a new type of disposable reinforced endotracheal tube which has a flexible tip that reduces the gap between the fiberscope and the inside of the tube. It has been expected that the tube will facilitate orotracheal and nasotracheal intubation with/without a fiberscopy. The tube was used for endotracheal intubation of 45 patients by trainees and trainers to evaluate the suitability. Most trainees and trainers assessed that use of the tube is associated with more rapid success and a lower incidence during endotracheal intubation. Further systematic studies are needed for assessing the clinical implications.

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Roles of Epidural Anesthesia and Remifentanil in Intraoperative Analgesia

Yoshimi INAGAKI, Naoki MORIYAMA, Kazumi FUNAKI, Aki AOKI, Masato NAKAS ...

2010 Volume 30 Issue 7 Pages 1029-1036
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1029

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Surgical stress is well known to activate the neuroendocrine response, blood coagulability and metabolism and to reduce the immune response, thereby causing intraoperative hyperglycemia or endotherial impairment and postoperative surgical site infection. Intraoperative analgesia plays an important role in attenuating these unfavorable responses. In particular epidural anesthesia and an intravenous infusion of remifentanil are increasingly used in intraoperative analgesia due to their strong analgesic actions, which prevent activation of neuroendocrine and metabolic response systems and reduction in the immune response system, thereby providing better postoperative prognosis. Analgesia provided by the infusion of remifentanil is considered to be of a quality on par with that by epidural analgesia to maintain intraoperative homeostasis on neuroendocrine and metabolic responses under certain conditions.

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Original Articles

A Retrospective Analysis of Postoperative Pain in Patients Undergoing Cerebellopontine Angle (CPA) Tumor Removal with Propofol-Remifentanil Anesthesia

Mikiko OZAWA, Takahiro TERADA, Takashi YAMASAKI, Makoto OZAKI

2010 Volume 30 Issue 7 Pages 1037-1042
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1037

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We evaluated the effects of intraoperative remifentanil dosage on postoperative analgesic consumption in 106 patients undergoing CPA tumor removal with propofol-remifentanil anesthesia. The low-dose group was defined as total intraoperative remifentanil dosage/body weight/surgical duration <0.66μg/kg/min (n=61), and the high-dose group as ≥0.66μg/kg/min (n=45). In the low-dose group, the number of patients who required postoperative analgesics gradually decreased, while that in the high-dose group remained high from postoperative day (POD) 1 to POD 3. There were no differences in the number of patients who did not require any postoperative analgesics from POD 1 to POD 3 between the low- and high-dose groups. In addition to intraoperative high dose remifentanil, the younger patient age was a factor that prolonged the postoperative analgesic consumption.

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Case Reports

Perioperative Management of a Patient with Ehlers-Danlos Syndrome

Atsushi KOTERA, Kenichiro TAKI, Seiji KOUZUMA, Naoki MIYAZAKI, Masahir ...

2010 Volume 30 Issue 7 Pages 1043-1049
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1043

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  Ehlers-Danlos syndrome is a disease caused by connective tissue disorders. The clinical features of Ehlers-Danlos syndrome are hyperextensibility of the skin, propensity to bruise and bleed, and hyperextension of the joints. Recently we experienced perioperative management of a patient with Ehlers-Danlos syndrome.
  The patient was a 49-year-old woman who had been clinically diagnosed with Ehlers-Danlos syndrome in childhood. The patient underwent an emergent operation for recurrent right obturator hernia under general anesthesia. During the perioperative management, we encountered several problems, which were subcutaneous extravasation of intravenous fluids and muscle relaxant, prediction of difficult airway management, hypertension due to surgical stress during the operation, and severe postoperative joint pain, and the formation of new subcutaneous bleeding.
  In the perioperative management of the patient with Ehlers-Danlos syndrome, avoiding complications that arise due to their tissue fragility and hemorrhage is very important.

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Successful Sciatic Nerve Block for a Patient with Severe Coronary Artery Disease Who Underwent Arterial Thrombectomy

Hiroyuki ITO, Koshi MAKITA

2010 Volume 30 Issue 7 Pages 1050-1053
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1050

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Few studies have examined the frequency or severity of hemorrhagic complications following plexus or peripheral block in patients on anticoagulant therapy. We report successful anesthetic management by sciatic nerve block (SNB) of a patient with severe coronary artery disease who underwent lower-limb arterial thrombectomy and revascularization. A 72-year-old female with arteriosclerosis obliterans was diagnosed with acute arterial thrombosis and scheduled for emergency surgery. She had heart failure caused by three-vessel coronary artery disease and was taking anticoagulant therapy of warfarin and cilostazol. We performed SNB (popliteal approach) using a single injection of 20 ml 0.5% ropivacaine guided by ultrasound echography. There were no hemodynamic or respiratory disturbances during the operation. She had no local hematoma or neural disturbances during the clinical course, although heparin infusion was initiated perioperatively. Anesthetic management using SNB was successful. Ultrasound-guided SNB could be a useful technique in patients receiving anticoagulant therapy.

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Anesthetic Management of Severe Tracheal Stenosis Using Percutaneous Cardiopulmonary Support

Mitsuko NOUTOMI, Tomoko HARA, Yukiko SASAKI, Yoshiya MIYAZAKI, Takehik ...

2010 Volume 30 Issue 7 Pages 1054-1058
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1054

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We experienced the anesthetic management of balloon expansion in a 70-year-old woman with tracheal stenosis caused by tuberculosis. The stenotic lesion extended from the upper trachea to the carina. Based upon a CT scan, the minimum tracheal diameter was 4.8 mm and intubation through the stenotic lesion was considered to be impossible. Balloon dilation and tracheal stent placement were planned. When a balloon is expanded, the trachea becomes totally obstructed. In this case, the stenotic lesion was long and multiple trials of balloon expansion were required. Since the duration of apnea would be long, we decided to use percutaneous cardiopulmonary support (PCPS) for gas exchange. During the PCPS catheter insertion, the patient was well-sedated with dexmedetomidine and breathed spontaneously. Total intravenous anesthesia was performed after the start of PCPS. There were no problems with oxygenation and circulation under PCPS. After balloon dilation, we decided to continue artificial ventilation for a few days because bleeding and edema were observed within the trachea. We intubated a microlaryngeal tube (ID 6 mm) through the stenotic lesion. The tip of the tube was placed just above the carina. We began artificial ventilation and terminated the PCPS. Three days later, tracheal stents were placed under dexmedetomidine infusion and local anesthesia.

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Airway Managements for Unanticipated Difficult Mask Ventilation in a Child with Treacher Collins Syndrome

Hidetomo NIWA, Masayuki NISHIMURA, Futoshi KIMURA, Hitoshi YOSHIDA, Ta ...

2010 Volume 30 Issue 7 Pages 1059-1064
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1059

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Difficulty in maintaining the airway including tracheal intubation is often encountered in patients with Treacher Collins syndrome (TCS) due to their characteristic facial deformity. We report a case of difficult intubation under general anesthesia in a child with Treacher Collins syndrome with unanticipated difficult ventilation by anesthetic mask. A 7-year-old girl with TCS underwent removal of the preauricular sinus. Nasal continuous positive airway pressure was administered to her while she slept, as she was expected to be difficult to ventilate by anesthetic mask and tracheal intubation. However, we assumed that assisted ventilation by anesthetic mask would be possible. Therefore, at first, a laryngeal mask airway-ProSeal^® (PLMA) was placed under assisted ventilation. Fiberoptic scope-guided tracheal intubation was then performed through the PLMA. However, when rapid anesthetic induction with sevoflurane was performed, we had difficulty with the assisted ventilation but managed to continue to ventilate her with assistance without hypoxia. Although we successfully managed her using this airway strategy, we believe that the airway management in this case needs to be discussed.

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[JARMA] Journal Symposium

[title in Japanese]

Hideki KOMATSU

2010 Volume 30 Issue 7 Pages 1067-1075
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1067

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Death Associated with Medical Practice from the Viewpoint of Forensic Medicine

Hirotaro IWASE

2010 Volume 30 Issue 7 Pages 1076-1079
Published: 2010
Released on J-STAGE: February 07, 2011

DOIhttps://doi.org/10.2199/jjsca.30.1076

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In Japan, the role of the interface between the law and medicine has been underestimated. It may be related to problems such as death associated with medical practice. If a doctor feels stress about the judicial intervention in a death associated with medical practice and wants to improve the stress, one way is to exclude the judicial process from the field of medicine, which is difficult to be realized. However, there is another way to stop the reckless activity of the judicial authorities and make them act properly. It is now commonly accepted that not only medical doctors but also the judicial world makes mistakes, and judiciary reforms have taken place recently. With this opportunity, doctors and the judicial world should reexamine the role of the interface between law and medicine and reconsider expert medical opinions to establish the proper judicial system.

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