THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA
Online ISSN : 1349-9149
Print ISSN : 0285-4945
ISSN-L : 0285-4945
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Volume 31, Issue 2
Displaying 1-27 of 27 articles from this issue
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Journal Symposium (1)
  • Spinal Cord Protection during Spinal and Major Vascular Surgeries
    Hiroki IIDA
    2011 Volume 31 Issue 2 Pages 193-201
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.193
    JOURNAL FREE ACCESS
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      For anesthesiologists it is important to maintain adequate conditions for spinal cord monitoring and to control spinal cord perfusion pressure in order to maintain microcirculation of the spinal cord, preventing exacerbation of spinal cord damage. In spine surgery, motor evoked potential (MEP) monitoring and a wake-up test will be performed to detect the intra-operative spinal cord dysfunction. MEP is inhibited by anesthetics and muscle relaxants, while the wake-up test is difficult for patients with communication difficulties. We will show here the algorithm of spinal cord monitoring in our hospital. In major vascular surgery, to understand the characteristics of reactivity of the blood vessels in the spinal cord is helpful in maintaining appropriate spinal cord circulation. However, pharmacological spinal cord protection could not adequately overcome the clinical problems of spinal protection. Since internal organ protection, such as pharmacological- and remote-preconditioning, could be useful for preventing fatal damage even in the spinal cord, its clinical introduction is expected, in addition to conventional spinal cord protection strategies.
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  • Epidural Procedures under Fluoroscopy and X-ray Study of Epidural Catheters
    Takeshi SHIMA
    2011 Volume 31 Issue 2 Pages 202-208
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.202
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      Epidural procedures under fluoroscopy can be performed safely and accurately, and allow a direct view of needle puncture sites. Therefore, these procedures are recommended for epidural catheter insertion in obese patients and those with difficult or abnormal spines. Fluoroscopic machine preparation, needle insertion under fluoroscopy and epidural catheter insertion are clearly explained. First, 0.5 ml of contrast medium is injected through the epidural catheter and an antero-posterior roentgenogram is taken to observe the longitudinal spread of the contrast medium in the cephalad and caudal directions. The position of the epidural catheter tip and spread of the contrast medium can provide information about the passage of the catheter tip through an intravascular, subdural, subarachnoid or extra-epidural space.
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Journal Symposium (2)
  • [title in Japanese]
    Michiyoshi SANUKI, Kenji SHIGEMI
    2011 Volume 31 Issue 2 Pages 209
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.209
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  • Japanese Trend of Anesthesia Information Management System (AIMS)
    Yoshimitsu SANJO, Tomonori UEDA, Koji MORITA, Yoshito SHIRAISHI, Tomie ...
    2011 Volume 31 Issue 2 Pages 210-220
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.210
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      The term ‘Anesthesia Information Management Systems’ (AIMS) has been popularized, replacing the conventional ‘Automated Anesthesia Record-keeper’ (AAR). Here, we discuss the Japanese trend of AIMS. In our survey sent to major AIMS vendors in Japan, AIMS were installed in 70% of university hospitals (10% in US, 2007). Anesthesia records, nurse records, billing, etc., can all be handled by AIMS. For the needs of operation room (OR) information management, AIMS is mostly combined with ORIMS in Japan, and functions as (OR+A) IMS = ORAIMS. The smart display of anesthetic pharmacokinetics simulation on AIMS is gaining popularity among Japanese anesthesia professionals. The Japanese Society of Anesthesiologists provides free software for perioperative information management (JSA PIMS). Using JSA PIMS as a core, we have developed an advanced extension (JSA/AE) of three times the database fields. JSA/AE is categorized as a state-of-the-art ORIMS.
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  • Strong and Weak Areas of Automated Anesthesia Record Systems
    Michiyoshi SANUKI
    2011 Volume 31 Issue 2 Pages 221-225
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.221
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      As present automated anesthesia record systems become unified and administer a range of anesthesia management-related information rather than merely recording intraoperatively, they are now referred to as Anesthesia Information Management Systems (AIMS). In order to distinguish between AIMS and what are termed ‘electronic medical record systems’, AIMS need to develop systems that assist anesthesiologists and contribute to the safety of anesthesia. To accomplish this, it is necessary to be aware of their strong and weak areas, and to elucidate an achievable objective.
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  • Development of a Clinical Information Management System for the OR, ICU and ER Using the MetaVision® System
    Katsuyuki KATAYAMA
    2011 Volume 31 Issue 2 Pages 226-234
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.226
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      MetaVision® is a clinical information management system designed for use in anesthesia, critical care, and emergency medicine. It facilitates workflow in the perioperative and acute care settings through rapid and accurate record-keeping which, in turn, enable more informed and safer clinical decision-making. Additionally, one of the system's unique features is the capacity for users to customize it for their own use.
      Since 2007, we have employed MetaVision® in our OR (12 rooms), ICU (12 beds), and ER (19 beds in our HCU and 4 beds in our initial treatment area), and during this interim have been using it to construct a comprehensive electronic recording and ordering system. Although overall we have found this system to be a very useful tool for acute care medicine, we have encountered problems in transferring records between departments and continue to struggle with them.
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  • Anesthesia Information Management System: Current Status and Vision for Future Development
    Osamu UCHIDA
    2011 Volume 31 Issue 2 Pages 235-241
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.235
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      Most modern automated anesthesia record systems are sophisticated information systems, which not only keep an anesthesia record automatically, but also handle a wide variety of data relevant to anesthetic management, and are currently called Anesthesia Information Management Systems (AIMS). With the advancement of computer and related technologies, AIMS have achieved acceptable performance for routine clinical use. However, there exists some room for improvement. Man-machine interfaces are key components of AIMS. Ubiquitous devices such as a personal digital assistant are an example of a potential man-machine interface for data entry. Data display is another target for improvement. The display of vital signs on an AIMS screen should be reformatted to that which makes full use of the characteristics of a computer and a bitmap screen. The development of methods for use of the data in an AIMS database is also important. Newer features that are currently being implemented in some AIMS include a full-time digital recording of waveform data such as ECG, and a real-time display of drug concentrations based on pharmacokinetic simulation.
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Journal Symposium (3)
  • [title in Japanese]
    Takumi NAGARO, Toyoshi HOSOKAWA
    2011 Volume 31 Issue 2 Pages 242
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.242
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  • Holistic Care - How Anesthesiologists Can Contribute : Intrathecal Analgesia in Local Communities
    Junichi IKEGAKI
    2011 Volume 31 Issue 2 Pages 243-249
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.243
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      Interest in palliative care is increasing, and the roles anesthesiologists play are expected to expand. Anesthesiologists have been contributing to palliative care in various ways; however, nerve block for cancer pain is not always straightforward for anesthesiologists who specialize in surgical anesthesia.
      Continuous intrathecal analgesia has yet to become commonplace in Japan, but is not difficult to conduct and is effective for intractable cancer pain. Therefore, we have employed it since 2001. It required the approval of the ethics committee, improvement in devices, and cooperation with the local community. Seven of 25 patients were treated at home, and some of them were able to return to work. Holistic care involves providing support for patients so they can live as normally as possible, and pain control is considered to be very important. Continuous intrathecal analgesia is an excellent analgesic method, and conducting it in the local community contributes to holistic care.
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  • Contribution to Palliative Care for Cancer Patients as Anesthesiologists
    Hiroshi UENO, Toyoshi HOSOKAWA
    2011 Volume 31 Issue 2 Pages 250-257
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.250
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      Recently, as the Japanese have become increasingly aware of the importance of palliative care for cancer patients, a large number of medical students and residents have become interested in palliative care. The easiest way to master palliative care is to be an anesthesiologist. Because anesthesiologists have various pain relief methods and sedation techniques by skillful use of anesthetic agents, such skills play an effective role in palliative care directly. On the other hand, the psychological and physical stress on doctors who take on palliative care can cause burnout, so preventive measures must be set up. If anesthesiologists doing palliative care almost develop burnout, they can temporarily work in other fields to relieve stress. Moreover, all the members of a palliative care team have to look for ways to prevent burnout.
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Journal Symposium (4)
  • [title in Japanese]
    Yoji SAITO, Ken YAMAMOTO
    2011 Volume 31 Issue 2 Pages 258
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.258
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  • IV-PCA
    Masataka YOKOYAMA
    2011 Volume 31 Issue 2 Pages 259-267
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.259
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      Epidural anesthesia and analgesia has become popular because there is a lot of evidence that proves the benefits of epidural anesthesia. However, the recent spread of antiplatelet drugs and anticoagulation therapy is starting to influence the choice of anesthesia or postoperative analgesia method. These circumstances lead to an increased number of cases receiving postoperative intravenous patient-controlled analgesia (IV-PCA). Although indications of fentanyl IV-PCA are increasing, morphine IV-PCA is still the gold standard. This article reviews the methods and side effects of IV-PCA.
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  • Today's Postoperative Epidural Analgesia
    Kosaku TOYOTA
    2011 Volume 31 Issue 2 Pages 268-274
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.268
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      Generalization of prophylaxis for postoperative venous pulmonary thromboembolism, recent introduction of ultrasound-guided peripheral nerve block and parenteral opioid administration using highly advanced IV-PCA systems have changed postoperative analgesic strategies. The indication of postoperative epidural analgesia tends to be decreasing.
      However, epidural analgesia still has the clinical advantage of superior pain control and lower postoperative respiratory complications. Additionally, recent clinical investigations have also mentioned the advantage of epidural analgesia on cancer recurrence.
      Epidural analgesia is especially useful when combined with other analgesic methods. It will provide superior postoperative management under better proven indications.
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Educational Articles
  • Efficacy of Epidural Levobupivacaine on the Treatment of Post-Operative Pain
    Tatsuo YAMAMOTO, Yoshiko OTSUKA, Tomo TOIHATA
    2011 Volume 31 Issue 2 Pages 275-281
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.275
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      Bupivacaine has a chiral center and is currently available as a racemic mixture of its two enantiomers: R (+)-bupivacaine and S (-)-bupivacaine. Levobupivacaine is a drug which consists of only S (-)- bupivacaine. One criticism of bupivacaine is its toxicity to either the central nervous system or cardiovascular system. It has been demonstrated that there is enantiomer selectivity of action with the bulk of central nervous system and cardiovascular toxicity residing with the R (+) isomer. Thus, levobupivacaine is less toxic to either the central nervous system or the cardiovascular system than bupivacaine. Moreover, levobupivacaine has reported to have less effect on motor function than bupivacaine. These characteristics of levobupivacaine are good for using post-operative pain management. Levobupivacaine is more potent than ropivacaine and has similar efficacy to ropivacaine. These data strongly suggest that levobupivacaine is a suitable epidural drug for post-operative pain management.
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  • What Are the Benefits of Short-Acting β-Blockers for Perioperative Management?
    Yasuhiro KOIDE, Kenta OKAMURA, Hideki ITO
    2011 Volume 31 Issue 2 Pages 282-291
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.282
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      Short-acting β-blockers are useful for the perioperative control of heart rate in a variety of conditions and diseases. The safe use of these drugs requires an understanding of their pharmacokinetics and the pathophysiology of patients. Myocardial ischemia can lead to a vicious cycle of deterioration. Short-acting β-blockers are immediately effective in preventing further deterioration. Refractory ventricular fibrillation after the release of aortic clamping is a new indication that may contribute to the prevention of myocardial damage. In patients with atrial fibrillation, heart-rate control or pharmacological defibrillation by short-acting β-blockers in combination with sodium channel blockers may help to prevent the development of congestive heart failure or ischemic stroke.
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Original Articles
  • Influence of Fasting Duration on Stroke Volume Variation in Patients Undergoing Pulmonary Lobectomy -Morning and Afternoon Cases-
    Harumi MIYOSHI, Hitoshi YOSHIDA, Kazuo KAMITANI, Koso MATSUURA, Riho A ...
    2011 Volume 31 Issue 2 Pages 292-297
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.292
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      We studied the influence of fasting duration on stroke volume variation (SVV) in patients undergoing pulmonary lobectomy. We enrolled 20 patients. Patients were divided into two groups: patients who underwent surgery in the morning (group A) and patients who underwent it in the afternoon (group B). The difference in fasting duration was 4 hours. We measured cardiac output (CO), cardiac index (CI) and SVV with FloTracTM. We also measured blood pressure (BP), heart rate (HR) and central venous pressure (CVP). There were no significant differences between the two groups in BP, HR, CVP, CO, CI, systemic vascular resistance (SVR) and SVV. But SVV was elevated in both groups (group A; 15.4±6.5%, group B; 18.5±6.9%), indicating hypovolemia. Preoperative fasting for 10 and 14 hours in both groups elevated SVV, but the additional 4-hour difference in the fasting duration didn't cause a further change in the SVV.
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  • Predictors of Deep Thoracic Wound Infection in Cardiac Surgery
    Takahiro NONAKA, Masafumi FUJIMOTO, Sumi OTOMO, Kengo MAEKAWA, Tomoko ...
    2011 Volume 31 Issue 2 Pages 298-304
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.298
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      Deep surgical site infection (DSSI) is a rare but serious surgical complication. We assessed the incidence and risk factors for DSSI after cardiovascular surgery. Data were analyzed on 1,212 patients who underwent consecutive cardiovascular surgeries between 2003 and 2009. DSSI was defined as a deep sternal wound infection or mediastinitis. The incidence of DSSI was 3.1% (n=37); one of these patients died during hospitalization. Univariate predictors of DSSI were being male, and having diabetes mellitus, creatinine >1.9 mg/dl, peripheral vascular disease, surgery duration >5 h, and re-exploration for bleeding. Use of bilateral internal thoracic artery grafts increased the risk of DSSI in patients undergoing coronary artery bypass grafting. Multivariate regression analysis demonstrated that significant independent predictors for DSSI were impaired renal function (odds ratio [OR], 2.1; p=0.049), duration of surgery (OR, 2.6; p=0.036), and peripheral vascular disease (OR, 2.6; p=0.021). The mean length hospital stay was significantly longer for patients with DSSI compared to patients without DSSI (80 vs. 22 days). These data suggested that a shorter procedure is important to prevent DSSI in patients with advanced systemic atherosclerosis.
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Case Reports
  • Marked Swelling of the Submandibular Gland Developing Upper Airway Obstruction after General Anesthesia
    Aki HIRAI, Kazuaki TANNGE, Kohei KAWASHIMA, Tadashi TANIOKU, Yoshio HA ...
    2011 Volume 31 Issue 2 Pages 305-308
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.305
    JOURNAL FREE ACCESS
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      Acute parotid gland swelling is a rare complication of general anesthesia and has been called ‘anesthesia mumps’. However, there have been no reports of the severe swelling of the submandibular gland after general anesthesia.
      A 67-year-old female underwent resection of brain tumor under general anesthesia with sevoflurane and remifentanil. Surgery was performed in the supine position and lasted over 10 hours. Emergence from anesthesia and extubation were uneventful. Two hours after surgery, right mandibular swelling appeared and she progressively deteriorated. Four hours after surgery, she complained of dyspnea and a cricothyrotomy using Minitrack® was performed to avoid complete upper airway obstruction.
      Computed tomography scan revealed a low-density area from right side of the glottis to the right side of the pharynx, neck and oropharynx. On the first postoperative day, she underwent a tracheotomy because the airway obstruction caused by the neck swelling had not improved. On the second postoperative day, her neck swelling gradually reduced. The rest of the postoperative course was uneventful.
      Prolonged intubation and stimulation by intubation or extubation can account for the swelling of the tongue and pharynx that leads to right submandibular duct obstruction.
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  • A Case of an Elderly Patient Who Was Re-Intubated Because of Hypercarbia Due to Subcutaneous Emphysema during Laparoscopic Cholecystectomy
    Atsushi KOTERA, Seiji KOUZUMA, Yujiro NAKAYAMA, Naoki MIYAZAKI, Kenich ...
    2011 Volume 31 Issue 2 Pages 309-313
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.309
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      The patient was a 96-year-old woman, 142 cm in height and 35 kg in weight. She was diagnosed as having acute cholecystitis, and emergent laparoscopic cholecystectomy was scheduled. The anesthetic management was done with general anesthesia combined with epidural anesthesia. About fifty minutes after the beginning of pneumoperitoneum, the level of PEtCO2 gradually elevated. Subcutaneous emphysema around the right thoracic wall was observed, but the laparoscopic procedure was continued. The range of subcutaneous emphysema was not changed, but the control of PEtCO2 by increasing minute volume and respiratory rate of ventilation was not easy. After pneumoperitoneum stopped, the level of PEtCO2 gradually decreased. After the patient was extubated, hypoventilation and coma due to hypercarbia were observed, and the patient was re-intubated.
      In the case of subcutaneous emphysema during laparoscopic procedures in elderly patients, we should pay attention to hypoventilation due to hypercarbia, because of the diminished respiratory response due to hypercarbia and the reduced clearance of the narcotics.
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  • Anesthesia Management of a Gastric Carcinoma Patient with Severe Emphysema and the Efficacy of Lung Volume Reduction Surgery (LVRS)
    Hiromi YAMASE, So SUZUKI
    2011 Volume 31 Issue 2 Pages 314-317
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.314
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      We report the efficacy of successful lung volume reduction surgery performed for improving respiratory function prior to gastric cancer resection in a patient with gastric cancer associated with severe lung emphysema. Following the procedure, the patient had favorable respiratory function and received a total gastrectomy under general anesthesia with a good post-operative outcome.
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[JAMS] Original Articles
[JACM] Journal Symposium
  • Transition and Prospects of Patient Monitoring Technology
    Hironami KUBOTA
    2011 Volume 31 Issue 2 Pages 328-333
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.328
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      Patient monitoring system had been being developed for critical care patients mainly by monitoring electrocardiograms. After that, pulse oximetry and capnometry were added and monitoring was expanded for patients in general wards or at home. One reason that usage of the patient monitor spread might be wireless technology, which is easily used by doctors. On the other hand, blood pressure, which is a major parameter of monitoring, is difficult to measure. Therefore, we hope that a device which allows real monitoring of blood pressure will be created.
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  • Technique of Dividing a Task into Various Smaller Components, Facilitated by Using the File-Link Method
    Kunio SUWA
    2011 Volume 31 Issue 2 Pages 334-340
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.334
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      This paper presents a technique of dividing a task into various smaller components. While dividing a task into smaller components is important in and of itself, using the file-link method further facilitates this concept. In writing a paper, we are unlikely to get “a one-month paper-writing vacation”, but we are likely to obtain a fifteen-minutes break every day. If we can make good use of this daily fifteen-minutes break, we may achieve writing a paper consisting of 30 components in a month, by finishing a single component every day in this daily fifteen-minutes period. To accomplish this, it is vital to make a content file for a written work consisting of these components, and then from this content file we link each list to the individual component file. By applying this file-link method, we work on a small component without losing sight of the overall task, because we have the content file available. This file-link method may be applied to various types of work to be done on a PC.
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  • How Is the Evaluation of Intravascular Volume and Fluid Responsiveness with the Swan-Ganz Catheter Used to Optimize Hemodynamics?
    Tokuhiro YAMADA
    2011 Volume 31 Issue 2 Pages 341-346
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.341
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      Swan-Ganz catheter has been effective in determining hemodynamics in critically ill patients. However, routine use has not been shown to provide benefits in morbidity and mortality, thus, an appropriate recommendation on clinical use of this catheter is required because of the potential complications. Pulmonary capillary wedge pressure (PCWP), which is an estimate of left ventricular end-diastolic pressure (LVEDP), has not been shown to predict fluid responsiveness in many goal-directed approaches, because the relationship between LVEDP and left ventricular end-diastolic volume (LVEDV) on the left ventricular compliance curve is nonlinear, and LVEDP has a smaller change under the optimum stroke volume. In contrast, LVEDP has a possibility of predicting fluid responsiveness in the condition where left ventricular compliance lowers, especially in severe aortic stenosis and hypertrophic cardiomyopathy. The Swan-Ganz catheter may be useful in the evaluation of left ventricular preload due to a greater change of LVEDP under this condition.
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  • Perfusion Index and Pleth Variability Index
    Katsuaki TANAKA
    2011 Volume 31 Issue 2 Pages 347-352
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.347
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      Perfusion index (PI) and pleth variability index (PVI) have recently been developed as monitoring parameters that can be recorded by a pulse oximeter, Radical-7TM (Masimo Corp., USA). PI is the ratio of pulsatile components to non-pulsatile components of the arterial blood flow derived from pulse oximetry, which shows the perfusion state of the finger to which a pulse oximeter is attached. PVI is a novel algorithm that allows automated and continuous calculation of respiratory variations in the pulse oximeter waveform amplitude. PVI has been reported to have the potential to predict intraoperative fluid responsiveness. Because the normal values for PI or PVI are not known, their relative changes in clinical use need to be noted. Although PI and PVI are largely influenced by the position of the probe, pain, or respiratory state, they are non-invasive and may contribute to optimization of intraoperative fluid therapy. For appropriate interpretation of PI and PVI, combined use of Radical-7TM and other monitors is important.
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  • Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured by Transpulmonary Thermodilution Technique
    Takashi TAGAMI
    2011 Volume 31 Issue 2 Pages 353-358
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.353
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      The introduction of the transpulmonary thermodilution technique has made it possible to measure extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI). Evidence appears to support the usefulness of goal-directed fluid management by parameters derived from the thermodilution technique. EVLW represents the degree and severity of pulmonary edema. The EVLW measured by this method had been validated by the gravimetric measurement of lung weight in humans and statistically normal EVLW values have been reported. The PVPI can be utilized to differentiate between cardiogenic and non-cardiogenic pulmonary edema. The values of EVLW and PVPI impact significantly on fluid management, especially for the intensivist and anesthesiologist.
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  • Rational Fluid Therapy Supported by the Physiology of Blood Volume
    Takehiko IIJIMA
    2011 Volume 31 Issue 2 Pages 359-363
    Published: 2011
    Released on J-STAGE: May 02, 2011
    DOIhttps://doi.org/10.2199/jjsca.31.359
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      Liberal infusion according to conventional calculations is reported to cause postoperative complications. It has been reported that postoperative blood volume is unrelated to in-out balance. Crystalloid has only transient volume-expanding effects. Goal-directed fluid therapy (GDT) employing SVV (stroke volume variation) and SV (stroke volume) allows us to titrate fluid therapy confirming volume-expanding effects. Recent reports showed that colloid is preferentially used according to GDT, and usage of crystalloid is limited. If the parameters of fluid response are appropriately applied, then postoperative complications could be reduced, preventing liberal infusion of crystalloid.
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