THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA
Online ISSN : 1349-9149
Print ISSN : 0285-4945
ISSN-L : 0285-4945
Search
Advanced search
OR
Browse
Search
Volume 32, Issue 7
Displaying 1-27 of 27 articles from this issue
Show all abstracts
    • |<
    • <
    • 1
    • >
    • >|
Invited Lecture (1)
  • Nitric Oxide and Cardiovascular Disease: Novel Evidence Obtained from a Genetically Manipulated Animal
    Masato TSUTSUI
    2012 Volume 32 Issue 7 Pages 835-841
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.835
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Nitric oxide (NO) is synthesized by three different NO synthase (NOS) isoforms, including neuronal (nNOS), inducible (iNOS), and endothelial NOS (eNOS). The roles of the NOS system in vivo have been extensively investigated in pharmacological studies with non-selective NOS inhibitors such as L-NAME and L-NMMA. However, because the NOS inhibitors possess multiple non-specific actions, the authentic roles of the NOS system in our body still remain to be fully elucidated. To address this important issue, we have successfully developed genetically manipulated mice in which all three NOS genes are totally disrupted. While the triply n/i/eNOS-/- mice were unexpectedly viable and appeared normal, their survival and fertility rates were markedly reduced as compared with wild-type mice. Intriguingly, the triply n/i/eNOS-/- mice spontaneously developed acute myocardial infarction accompanied by severe coronary arteriosclerotic lesions. Furthermore, the triply n/i/eNOS-/- mice manifested metabolic syndrome, dyslipidemia, and diastolic heart failure. These results provide the first evidence that genetic disruption of all NOS genes causes a variety of cardiovascular diseases in mice in vivo, demonstrating a critical role for the endogenous NOS system in the pathogenesis of cardiovascular disorders.
    View full abstract
    Download PDF (1359K)
Invited Lecture (2)
  • Perioperative Blood Glucose Control in Patients with Diabetes
    Moritoki EGI
    2012 Volume 32 Issue 7 Pages 842-850
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.842
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Diabetes mellitus is one of the most common diseases in the developed world. The relationship between hyperglycemia and outcomes was altered by the presence of diabetes. Biological adjustment to chronic hyperglycemia might explain this phenomenon. In patients with diabetes admitted to ICU, there was a significant interaction between pre-existing hyperglycemia and association between acute glucose control and mortality. These observations generate the hypothesis that glucose levels considered safe and desirable in other patients might be undesirable in patients with chronic hyperglycemia. Until high level evidence is available, a slightly higher target (150-200 mg/dL) might be recommended in patients with poor chronic glucose control.
    View full abstract
    Download PDF (877K)
Symposium
  • [title in Japanese]
    Toshiyuki OKUTOMI
    2012 Volume 32 Issue 7 Pages 851
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.851
    JOURNAL FREE ACCESS
    Download PDF (137K)
  • Risk Management in Obstetric Anesthesia : JSA's Approach
    Eiichi INADA
    2012 Volume 32 Issue 7 Pages 852-857
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.852
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Obstetric hemorrhage remains the major cause of maternal death in Japan. Life-threatening critical hemorrhage during labor or postpartum occurs in approximately 1 in 300 pregnant women. Risk factors include cesarean delivery, multiple pregnancy, placenta previa, and giant myoma uteri. Pregnant women without these risk factors occasionally experience critical hemorrhage. Characteristics of obstetric hemorrhage include 19 massive hemorrhage with blood loss greater than circulatory blood volume, 2) tendency to develop obstetric disseminated intravascular coagulation (DIC) with moderate blood loss, 3) difficulty in estimating blood loss because of the risk of internal hemorrhage, and 4) the need for urgent supplementation of fibrinogen. To improve perinatal management, the Japanese Society of Anesthesiologists (JSA) and four other academic societies established “Guidelines for Management of Critical Hemorrhage in Obstetrics” in 2010. The guidelines recommend preoperative blood donation in the parturient with risk factors, the use of shock index to assess the status of bleeding, the early use of fresh frozen plasma to supply fibrinogen, and development of emergency blood transfusion codes. It is desirable to develop an institutional manual to deal with obstetric critical hemorrhage and run drills.
    View full abstract
    Download PDF (1130K)
  • Cardiopulmonary Resuscitation Related with Pregnancy
    Rie KATO
    2012 Volume 32 Issue 7 Pages 858-865
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.858
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      In addition to giving anesthetics to pregnant/puerperal women in the operating room, anesthesiologists may have several roles to play in reducing maternal death. One is to resuscitate a pregnant/puerperal woman in case of cardiac arrest. Several modifications to standard adult cardiopulmonary resuscitation are needed for pregnant/puerperal women. They include uterine left displacement, a cephalad shift of chest compression point, early and careful establishment of airway, consideration of intravenous fluid load and consideration of perimortem cesarean section. Defibrillation and medications are given in the same manner as in other adult patients. Successful perimortem cesarean section requires immense and elaborate preparation, to which anesthesiologists should make an important contribution.
    View full abstract
    Download PDF (1072K)
  • Safety of Delivery Can be Improved by Promoting Epidural Labor Analgesia
    Hiroyuki SUMIKURA
    2012 Volume 32 Issue 7 Pages 866-870
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.866
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      We believe that the safety of delivery can be improved by promoting epidural labor analgesia by following reasons. A pre-partum evaluation of parturient requiring labor analgesia by anesthesiologist makes it possible to treat urgent cesarean section without being rushed. A parturient having an epidural catheter for labor analgesia can avoid general anesthesia even in the case of urgent cesarean section. The presence of obstetric anesthesiologists in a delivery ward can improve the safety of delivery of all parturients in the ward, and an greater number of obstetric anesthesiologists can provide better quality of education in obstetric anesthesia.
    View full abstract
    Download PDF (454K)
Panel Discussion
  • [title in Japanese]
    Toshiyasu SUZUKI, Atsuhiro SAKAMOTO
    2012 Volume 32 Issue 7 Pages 871
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.871
    JOURNAL FREE ACCESS
    Download PDF (159K)
  • What is the Optimal Device for Ultrasound-guided Central Venous Catheterization? -Effects of the Device on Blood Vessels-
    Mitsumasa MATSUDA
    2012 Volume 32 Issue 7 Pages 872-882
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.872
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Since 1994, our institution has used Safe guide®, a minimally invasive central venous catheterization kit, constantly making modifications to the device to ensure patient safety and reduce the stress of operators performing catheter insertion. With recent recommendations to use an ultrasound-guided procedure and metal needles for central venous catheterization, certain problems such as venous collapse and posterior vessel wall penetration have been observed during ultrasound-guided catheterization. This has led to a renewed recognition of the usefulness of Safe guide®, which is minimally invasive to the blood vessels. In this paper, we describe the structural characteristics of intravenous needles used in clinical practice, describe the processes used in the development and modification of Safe guide®, and discuss the optimal device for ultrasound-guided catheterization based on the findings obtained during this procedure.
    View full abstract
    Download PDF (5744K)
  • Environment and Education of Central Venous Catheter at Nippon Medical School Hospital
    Takaya TSUESHITA
    2012 Volume 32 Issue 7 Pages 883-889
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.883
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Central venous catheterization at the clinical site has been widely used for various purposes for many years. In most cases, the procedure has been safely performed, but fatal cases due to complications have also been reported. Although there has been much discussion regarding puncture techniques such as the conventional landmark method and echoguided method, which has attracted attention in recent years, there has been little discussion of safety management and education in central venous puncture techniques.
      Based on our experience establishing a working group on central venous catheterization at this hospital, environment, education, and safety management in central venous catheterization were considered.
    View full abstract
    Download PDF (1632K)
  • Can Ultrasound-guided Central Vein Catheterization be Considered Evidence-based?
    Joho TOKUMINE
    2012 Volume 32 Issue 7 Pages 890-896
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.890
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Ultrasound-guided central vein catheterization (US-CVC) is expected to become the new standard method for central vein catheterization, considering the accumulated evidence for its high success rate and low complication rate. Recently, however, there have been an increasing number of reports of complications related to US-CVC.
      Therefore, I have reevaluated the evidence for US-CVC. I have focused on the anatomical landmark techniques (AL-CVC) that have been used in the major evidence-based studies for central vein catheterization. The analysis showed that the procedures used for AL-CVC can be classified into several types of approaches and have not been standardized. Furthermore, some of these studies have not described the procedure in detail. The analysis suggests that these studies have some bias for US-CVC versus AL-CVC.
      If an operator performing AL-CVC has the basic anatomical knowledge required to successfully perform the procedure and avoid complications, it should be possible to obtain results that are as good as those obtained using US-CVC. If an operator performing US-CVC feels that the procedure is simple because of the involvement of ultrasonography and does not take adequate precautions, the procedure might fail in spite of the evidence available.
    View full abstract
    Download PDF (474K)
  • Facilitation of Ultrasound-guided Internal Jugular Vein Catheterization in Children and Infants
    Hiroshi SASANO, Masato MORITA, Takafumi AZAMI, Yoshito FUJITA, Kazuya ...
    2012 Volume 32 Issue 7 Pages 897-905
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.897
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      A recent meta-analysis has shown that ultrasound-guided internal jugular vein (IJV) catheterization has no effects on either success rate or complications during IJV access in children and infants. Based on the conclusion of this analysis, ultrasound-guide does not facilitate catheterization directly, suggesting the need for better training of operators or other additional measures.
      In this paper, we introduce a novel “skin traction method (STM)”, in which the puncture point of the skin over the IJV is stretched upwards with several pieces of surgical tape in the cephalad and caudal directions with the aim of facilitating catheterization of the IJV. Furthermore, we show the characteristics of the needle tip shape during real-time ultrasound-assisted guidance.
    View full abstract
    Download PDF (1358K)
Lectures
  • Improved ICU Care with a Respiratory Support Team and Use of Dexmedetomidine
    Masaaki SAKURAYA, Kenichi YOSHIDA, Yujiro MAEOKA, Tomoki SHOKAWA, Akih ...
    2012 Volume 32 Issue 7 Pages 906-912
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.906
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      An RST (Respiratory Support Team) was established at our hospital in January of 2011. We attempt to participate in critical care, including sedation and mechanical ventilation, for almost all patients in the ICU. We cooperate with a wide variety of health care providers through the RST to improve management of mechanical ventilation and sedation. We attempt to minimize deep sedation by using the RASS (Richmond Agitation Sedation Scale) and to reduce the duration of mechanical ventilation by using SBTs (Spontaneous Breathing Trials). By using dexmedetomidine, it is easier to make conscious patients comfortable and to manage sedation during SBTs. We initiate rehabilitation earlier, compared with the previous standard of care, and we can conduct rehabilitation without significant adverse events. Our aim going forward is to reduce delirium and to improve the prognosis of critically ill patients.
    View full abstract
    Download PDF (609K)
Original Articles
Case Reports
  • Anesthesia Management Using Desflurane in a Patient with Stiff Person Syndrome
    Kei ENOHATA, Maiko HASEGAWA-MORIYAMA, Tamotsu KUNIYOSHI, Sumikazu ISOW ...
    2012 Volume 32 Issue 7 Pages 919-922
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.919
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      We present a case with Stiff Person syndrome undergoing laparoscopic gastrostomy with general anesthesia using desflurane. Under continuous intravenous infusion of remifentanil 0.2-0.5 μg/kg/min, appropriate levels of BIS (40-60), muscle relaxation, analgesia and hemodynamics were maintained during the surgery. Although continuous infusion of fentanyl at 25 μg/hr was performed in the postoperative period, delayed awakening, prolongation of muscle relaxant effects, and autonomic disorder/dysfunction were not observed. We conclude that desflurane was safely used in this patient with Stiff Person syndrome.
    View full abstract
    Download PDF (315K)
  • A Case of Rocuronium-induced Coronary Vasospasm : “Kounis Syndrome”
    Hosun NARITA, Masahiro KANAZAWA, Shuhei TETSU, Satoko ANDO, Haruo FUKU ...
    2012 Volume 32 Issue 7 Pages 923-928
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.923
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      We encountered a patient who developed rocuronium-related anaphylaxis due to coronary vasospasm noted as an incipient manifestation. The patient was to receive an internal carotid endarterectomy, and after introduction of anesthesia with remifentanil, propofol and rocuronium, ST elevation was observed on electrocardiogram followed by a severe circulatory collapse state. Treatment for the circulatory collapse was immediately initiated, and subsequently, generalized skin flushing appeared, suggestive of drug-induced anaphylaxis. The subsequent skin test results led to a diagnosis of rocuronium-induced anaphylaxis. The development of anaphylaxis after coronary vasospasm as an incipient manifestation, the absence of respiratory symptoms and the delayed appearance of skin symptoms were clinical characteristics noted in the present case. As the heart is a target organ for anaphylaxis, it is considered important to monitor patients carefully for anaphylaxis complicated by myocardial ischemia, which is called Kounis syndrome.
    View full abstract
    Download PDF (775K)
  • Anesthetic Management of VATS in a Pregnant Woman with Spontaneous Pneumothorax
    Mio IMAISHI, Aiko SHIBAYAMA, Yousuke SHIGA, Kohso INADA
    2012 Volume 32 Issue 7 Pages 929-933
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.929
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      A 37-year-old woman in the 30th gestational week developed left-sided spontaneous pneumothorax. Although a chest tube was placed after admission, dyspnea and hypoxia continued. At the 1st day of admission, therefore, video-assisted thoracoscopic surgery (VATS) bullectomy was performed under general anesthesia. The postoperative course was successful, and the patient was discharged on the 7th day. At the 38th gestational week, she delivered a healthy normal infant. There is no universal guideline for spontaneous pneumothorax in pregnant women. Conservative treatment is recommended in many cases during pregnancy. However we consider VATS to be an acceptable procedure at an early stage if hypoxia had been continued.
    View full abstract
    Download PDF (1087K)
  • A Case of Idiopathic Thrombocytopenic Purpura Recognized after Surgery
    Atsuko HARA, Taro NAGATA, Akiko INOUE, Etsuko KANNA, Takako MATSUKADO, ...
    2012 Volume 32 Issue 7 Pages 934-937
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.934
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      An 81-year-old female patient with surgical ciliated cyst underwent endoscopic radical sinus surgery. After the surgery, the patient experienced excessive nose bleeding and isolated thrombocytopenia (1.2×104 platelets/μL). Her platelet count decreased continuously despite transfusion of platelets. She was suspected to have idiopathic thrombocytopenic purpura (ITP) and was administered gamma globulin and steroids, which caused her platelet count to return to the normal range. In most patients, ITP can be managed safely by preoperative procedures. In this case, however, an acute onset of critical thrombocytopenia occurred in the perioperative period. Because acute onset ITP is a cause of severe bleeding, early diagnosis and effective treatment are essential.
    View full abstract
    Download PDF (400K)
  • Efficacy of Intraoperative Transesophageal Echocardiography for Thoracoscopic Surgery in a Pediatric Patient with a Mediastinal Mass
    Toshio ITABASHI, Izumi HAMAYA, Hiroyuki MITONO
    2012 Volume 32 Issue 7 Pages 938-942
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.938
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      We report a 3-year-old girl who underwent thoracoscopic surgery to remove an anterior mediastinal mass measuring 10 cm compressing the left main bronchus and left ventricle. For intraoperative circulation monitoring, we used transesophageal echocardiography (TEE). Intraoperatively, when blood pressure fell rapidly, TEE allowed the surgeon to identify a mass compressing the heart and we were able to respond immediately. Moreover, we could easily distinguish the boundary of the tumor and cardiovascular organization using TEE, although thoracoscopic screening was not feasible. TEE contributed not only to identifying respiratory and circulatory changes but to enhancing the safety of the operation. It was considered to be important to prepare TEE to allow its immediate application when searching for the cause of cardio-respiratory collapse, which can occur suddenly after anesthesia induction.
    View full abstract
    Download PDF (1189K)
  • Three Cases of Dysphagia after Posterior Cervical Spine Surgery Secondary to Cranial Nerve Palsy
    Michiko HIRAYAMA, Koichi NISHIKAWA
    2012 Volume 32 Issue 7 Pages 943-947
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.943
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Dysphagia is well recognized as a complication of anterior cervical spine surgery. On the other hand, there are only a few reports of dysphagia in patients who underwent posterior cervical spine surgery. We report three cases who developed dysphagia and dysarthria, possibly secondary to cranial nerve palsy. These patients, who were scheduled for posterior cervical laminoplasty, were managed with general anesthesia in the prone position. Postoperatively, they were found to have dysphagia and dysarthria. Cranial MRI assessments of these patients showed no abnormality. We concluded that these patients were suffering from peripheral hypoglossal and vagal nerve palsy. This nerve damage could have been caused by extension due to wound retractor, ischemia of nutrient artery, and/or stretching with hyperextension of the neck. These neurogenic disorders recovered completely from 2 weeks to 3 months postoperatively. Anesthesiologists should be aware that such complications may occur during posterior cervical spine surgery and that evaluating swallowing function preoperatively and postoperatively is very important.
    View full abstract
    Download PDF (429K)
[JAMS] Brief Reports
  • Evaluation of Laryngeal Mask Supreme® and Laryngeal Tube Utility for Airway Management during Cardiopulmonary Resuscitation：a Manikin Study
    Hanako KOHAMA, Nobuyasu KOMASAWA, Ryusuke UEKI, Motoi ITANI, Shinichi ...
    2012 Volume 32 Issue 7 Pages 948-952
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.948
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      The AHA-ACLS 2010 guidelines suggest using supraglottic devices (SGD) such as laryngeal masks (LMA) as alternatives to tracheal intubation during CPR. We compared the performance of the LMA-Supreme® (Supreme; Laryngeal Mask Company, Henley-on-Thames, UK) and the laryngeal tube (LT; VBM Medizintechnik, Sulz, Germany) with or without chest compression utilizing a manikin. 18 novice doctors who had less than a year of experience with anesthesia participated. Without chest compression, all participants succeeded with the Supreme, and 17/18 participants did so with the LT (no significant difference; n.s.). During chest compression, 17/18 participants succeeded with the Supreme, and 17/18 succeeded with the LT (P < 0.05). Insertion time was not significantly lengthened by chest compression in either the Supreme or LT trial (Supreme; 7.2±2.7 sec → 7.5±1.6 sec, LT; 7.3±1.9 sec → 7.6±1.6 sec). SGD such as LMA or LT may be useful not only for physically difficult airways, but also for emergency airway management during CPR.
    View full abstract
    Download PDF (1299K)
[JARMA] Special Lecture
  • Do Not Judge Human Errors: “Punishing Culture” May Damage Safety Culture
    Shigeru HAGA
    2012 Volume 32 Issue 7 Pages 954-960
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.954
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      When an accident which harms someone or damages something occurs in this country, the police start an investigation, identify the individuals responsible, and send them to criminal court. This paper describes some recent court cases concerning accidents caused by human error, and posits that judging errors by their consequences will damage rather than contribute, to public safety. From the lessons of the Tohoku earthquake in 2011, we have learned the importance of flexible reactions - responses that are not written in a manual or those that may go against prescribed rules - to situations as they occur. One component of the safety culture is the “flexible culture”, closely related to resilience engineering, which is a noteworthy paradigm in human factors. We conclude that a “just culture”, where practitioners including healthcare professionals are not punished based on the consequences of human error, is the basis for the flexibility and resilience of both organizations and practitioners.
    View full abstract
    Download PDF (641K)
[JARMA] Educational Lecture
  • Management and Medical Safety in the University Hospital
    Chikara TASHIRO
    2012 Volume 32 Issue 7 Pages 961-965
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.961
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      In the FY 2010 revision of the medical service fee system, both the number of medical safety points and the DPC functional evaluation factor were increased slightly. The safety management fee for maintenance and inspection of life-support equipment had been firstly established, while anesthesia machine was excluded. In addition a fee for drug information systems, a safety management fees were introduced for treatment planning and for maintenance and inspection of radiation therapy machines.
      In the hospital of Hyogo College of Medicine, FY 2010 revenue excluding non-medical income and room rate difference totaled ¥27.6 billion (¥20.1 billion hospitalization & outpatient of ¥7.5 billion), of which safety management fee accounted ¥30,630,000 (0.11% of medical income). The infection control fee accounted for ¥19,720,000.
      If one takes into account labor costs of full-time staff of four faculty members (each one pharmacist-nurse, two office-staffs) and concurrently serving staff, medical safety education and training expenses, attorney consulting fees, and liability insurance premiums, the management fee for medical safety in the Japanese medical service fee system is not high enough.
    View full abstract
    Download PDF (410K)
[JARMA] Symposium
  • What Questioned in Criminal Trial and Behavior of the Anesthesiologist
    Kenji YASUFUKU
    2012 Volume 32 Issue 7 Pages 966-973
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.966
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Since it is usually diverse and “nonlinear” in nature, causation between a medical practice and its result may be difficult to predict. In most responses after medical accidents, however, responsibility in the case tends to be pursued from a “retrospective” view with serious consequences in the face of and with insufficient understanding of the diversified and “nonlinear” nature of the medical procedure. Every judicial trial, whether criminal or civil, should seek the truth only for the sake of pursuing responsibility in the case, rather than seek for the truth itself. In the case of “Ohno-Hospital”, therefore, disputes in the anesthesiology points were not questioned in the process, whereas some disputes on management after serious bleeding were left behind. To cite from the case, I believe there should have been enough human support by the whole hospital as well as a staff in the operating room. An anesthesiologist, those who may control patient's consciousness, must be asked its behavior as a “patient's agent” only representing patient's will.
    View full abstract
    Download PDF (594K)
  • What is the Proper Way to Report Medical Accident Investigations? : Lessons from the Accident Report of Fukushima Prefectural Ono Hospital
    Kazumasa EHARA
    2012 Volume 32 Issue 7 Pages 974-979
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.974
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      According to recent news, a criminal investigation of clinical staff was initiated in relation to medical accident reports. We were shaken to hear the news that an obstetrician at the Fukushima Prefectural Ono Hospital was investigated and arrested by the police as a criminal suspect.
      We analyzed these medical accident reports and discussed why these reports created problems.
    View full abstract
    Download PDF (565K)
[JARMA] Original Articles
  • Analysis of Incident and Accident Reports in Anesthesia Practice
    Yukimasa YASUMOTO, Hiroshi TANAKA, Shinsuke KYOGOKU, Sadami HABASHITA, ...
    2012 Volume 32 Issue 7 Pages 980-984
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.980
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      Anesthesia is a medical practice with very high risks. We analyzed 41 cases of incidents and accidents in anesthesia practice in 2009 and 2010 and introduce measures to prevent serious accidents. Accidents over level 3a accounted for 9 cases (22%). Two of these accidents involved anesthetic apparatus, 1 drug administration, 1 tube trouble, and 5 abrupt change after induction. Updating of anesthetic apparatus and better start-up inspection and maintenance are needed to prevent serious medical problems caused by accidents in anesthetic apparatus. Drug administration accidents involved mis-administration and mistakes in administration routes. It is important to urge anesthesiologists to visually confirm the drug indication just before administration and avoid verbal indication of the drug. Accidents after induction of anesthesia were very serious. Preoperative condition of high-risk patients should be carefully discussed by surgeons and anesthesiologists. A medical team approach involving the department in charge and related departments is very useful for preventing serious accidents.
    View full abstract
    Download PDF (351K)
  • Status of Criminal Prosecution of Medical Malpractice in Operating Rooms
    Atsuko KIUCHI, Kazumasa EHARA, Norimasa SEO, Shuichi NOSAKA, Wataru MI ...
    2012 Volume 32 Issue 7 Pages 985-993
    Published: 2012
    Released on J-STAGE: February 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.32.985
    JOURNAL FREE ACCESS
    Show abstractHide abstract
      This study investigated 83 cases of criminal prosecution involving medical malpractice (including 25 medical lawsuits for surgical errors) between 1999 and 2009. Of the accidents that occurred in operating rooms, 44% of lawsuits were filed in district courts, and 84% of physicians were sued.
      Of the total number of medical lawsuits for surgical errors, 11 (44%) were filed in municipal courts, and the number of requests for a court trial was higher than that of summary indictments compared to all criminal prosecution cases. Eighty-nine percent of medical malpractice lawsuits involved the prosecution of physicians for surgical errors.
      When the accidents were reviewed by cause, 21 cases (84%) were not related to simple malpractices, but were due to malpractice related to the quality of medical care. Three recent accidents in which physicians were found not guilty were related to quality of medical care. Physicians had to struggle many years to obtain verdicts of “not guilty.”
    View full abstract
    Download PDF (754K)
Erratum
    • |<
    • <
    • 1
    • >
    • >|
feedback
 Top