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 33, Issue 1
Displaying 1-29 of 29 articles from this issue
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Invited Lecture
  • Japanese Guidelines for Adult Asthma
    Ken OHTA
    2013 Volume 33 Issue 1 Pages 001-009
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.001
    JOURNAL FREE ACCESS
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      The treatment of adult asthma based on the Japanese guidelines (JGL2009) is summarized as follows : 1) adult asthma cannot be cured, so the goal of treatment is to maintain the state of control ; 2) long-term management consists of 4 therapeutic steps ; 3) use of inhaled corticosteroids (ICS) is recommended at all 4 steps, i.e. from a low dose at step 1 to a high dose at step 4 ; 4) selection of a step depends on the severity of asthma for asthmatics without medication ; 5) therapy is adjusted in uncontrolled patients even with some therapy in order to control their asthma ; and 6) management for asthmatics with chronic obstructive pulmonary disease (COPD) is described to improve the prognosis of aged patients who comprise the majority of fatal asthma cases, and to reduce asthma deaths to zero.
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Symposium (1)
  • [title in Japanese]
    Ichidai KUDOH, Masato KATO
    2013 Volume 33 Issue 1 Pages 010
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.010
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  • Choice of Anesthesia Method or Analgesics May Affect the Long-term Outcome of Cancer Patients after Surgery
    Ichidai KUDOH
    2013 Volume 33 Issue 1 Pages 011-016
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.011
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      Choice of anesthesia method or analgesics may affect the long-term outcome of cancer patients after surgery. I present here 12 papers documenting long-term metastasis, cancer recurrence, and survival rates after various cancer surgeries. Five showed statistical significance, while 7 did not. Most studies were retrospective and some were small-scale. To properly address this issue, a large, prospective, randomized, controlled trial (RCT) needs to be conducted.
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  • Effects of Perioperative Glycemic Control on Morbidity and Mortality Related to Surgery
    Takayuki KITAMURA
    2013 Volume 33 Issue 1 Pages 017-024
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.017
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      Maintenance of the energy demand/supply balance is essential for an uneventful clinical course in patients undergoing surgery. Thus, adequate control of glucose metabolism in the perioperative period is definitely important. Recent studies suggest that hyperglycemia in the perioperative period is a risk factor for mortality and morbidity related to surgery, but a standard protocol for perioperative glycemic control has not been established. There are several factors that modify glucose metabolism in the perioperative period. Perioperative nutritional management alters glucose metabolism; for example, energy demand/supply imbalance associated with preoperative fasting results in remarkable changes in glucose metabolism. Surgical stress results in stress-induced hyperglycemia. Furthermore, intraoperative glucose metabolism is modified by anesthetic management. Aerobic glucose metabolism is not always guaranteed during surgery, since oxygen demand/supply imbalance induces anaerobic glucose metabolism. In addition, ischemia/reperfusion is accompanied by some kind of surgical procedure. The underlying mechanisms by which these factors modify glucose metabolism have not been sufficiently elucidated. Further studies are required to understand glucose metabolism in the perioperative period and to establish a standard protocol for perioperative glycemic control, which can contribute to improving surgical prognosis.
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  • Temperature Management in Perioperative and Critically Ill Patients and Associated Patient Outcomes
    Yasufumi NAKAJIMA
    2013 Volume 33 Issue 1 Pages 025-031
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.025
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      A prospective, randomized outcome study published in a major medical journal in the second half of the 1990s showed a relationship between perioperative mild hypothermia and patient morbidity along with a subsequent increase in medical costs. In recent studies, however, researchers have mostly focused on the beneficial effects of hypothermia and reported the clinical application and outcomes of therapeutic hypothermia.
      Fever is associated with an increased length of stay in the intensive care unit (ICU) for general ICU patients and increased mortality in certain patient groups, such as patients with central nervous system injury. However, the question of whether fever in neurologically normal critically ill patients should be treated using non-steroidal anti-inflammatory drugs or cooling methods remains unresolved because few randomized clinical trials have investigated this issue.
      Large multicenter studies and laboratory investigations on temperature management should be conducted in perioperative and critically ill patients in order to (1) determine how to prevent distribution hypothermia and associated outcomes, (2) develop protocols and methods for predictiing the efficacy of therapeutic hypothermia, (3) determine the suitability of fever treatment for neurologically normal critically ill patients and the associated outcomes, and (4) develop non-invasive methods for core temperature measurement.
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Symposium (2)
  • [title in Japanese]
    Tatsuo YAMAMOTO, Kazuo HIGA
    2013 Volume 33 Issue 1 Pages 032
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.032
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  • Clinical Use of Duloxetine for Chronic Pain Patients
    Hiroki IIDA, Shigemi MATSUMOTO
    2013 Volume 33 Issue 1 Pages 033-040
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.033
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      Duloxetine (DLX) is an important drug for the treatment of neuropathic pain, especially painful diabetic neuropathy, and is classified as a first or second line therapy in some guidelines. In Japan, DLX is the only antidepressant approved to treat neuropathic pain at present. In the United States, DLX has also been approved by the FDA for the treatment of fibromyalgia and musculoskeletal pain such as osteoarthritis and chronic low back pain. Most adverse effects of DLX are mild to moderate in severity, and the drug is well tolerated by most patients. In addition, DLX appears to have minimal effects on body weight in the majority of patients, and is therefore acceptable for patients when effects on weight are considered in the selection of a medication. While some degree of pain relief would be expected to accompany improvement of mood for antidepressants, DLX evidently exerts a direct analgesic effect independent of its antidepressant effect. This drug is highly effective in reducing several types of pain while not producing the wide spectrum of side effects noted with other treatment regimens. We also describe here how we use DLX in our outpatient clinic.
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  • The Clinical Usefulness of Tramadol
    Koji KAWAI
    2013 Volume 33 Issue 1 Pages 041-050
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.041
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      Tramadol is an opioid analgesic which is prescribed worldwide. Hydrochloride oral and injectable formulations have been approved for cancer pain and postoperative pain (injection only) in Japan. In addition, tablets combining tramadol with acetaminophen have been administrated for non-cancer pain and post-tooth-extraction pain. Tramadol acts as a μ-opioid receptor agonist and inhibits the reuptake of serotonin and norepinephrine. Regarding the management of cancer pain, it is placed on the second step of the World Health Organization analgesic ladder. Tramadol is gradually coming into use as a relatively safe and less addictive drug among opioid analgesics for both cancer and non-cancer pain.
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  • Tricyclic Antidepressants for Neuropathic Pain
    Kazuhiko HIRATA, Kazuo HIGA, Kazunori HIROTA, Rumie WAKASAKI, Shiho SH ...
    2013 Volume 33 Issue 1 Pages 051-055
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.051
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      Recent guidelines for the treatment of neuropathic pain have listed tricyclic antidepressants as first line drugs. Among tricyclic antidepressants, amitriptyline and nortriptyline are established drugs for the treatment of neuropathic pain. However, tricyclic antidepressants do not seem to be used properly by Japanese physicians who treat patients with neuropathic pain. In patients using trycyclic antidepressants, the dose should be increased in patients who experience no pain relief or side-effects. The starting dose of amitriptyline/nortriptyline should be 10 or 20 mg/day. Thereafter, it should be gradually increased until pain is relieved or moderate to severe side-effects prevent further increase in the dose. Tricyclic antidepressants should be taken before bed time to avoid daytime sleepiness, even if the dose is large.
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  • Clinical Aspect of Narcotics for Medical Use
    Shigeru SAEKI, Hitoshi MIZUTANI, Setsuro OGAWA
    2013 Volume 33 Issue 1 Pages 056-063
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.056
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      In recent years, narcotics for medical use (NMU) have been used for patients with non-cancer neuropathic pain. NMU are classified as the third stage drugs according to “Guidelines for the pharmacologic management of neuropathic pain” edited by the Japan Society of Pain Clinicians. NMU which are indicated only for cancer pain (Ex: fentanyl patch) have come to be used for non-cancer neuropathic patients, therefore the frequency of NMU use can be expected to increase in the future. Although NMU including oxycodone, morphine and fentanyl have been reported to be effective for patients with non-cancer pain in foreign literature, none have been approved for non-cancer pain by Japanese health insurance. We should consider screening patients before prescribing NMU to determine the risk of abuse and should conduct sufficient follow up while prescribing them.
      On the other hand, patients prescribed NMU may wish to travel abroad for sightseeing, so physicians who prescribe NMU should be aware of official procedures for going abroad while carrying NMU.
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Lectures
  • “Ineffective” Sugammadex and “Over Effect” Sugammadex
    Shunichi TAKAGI
    2013 Volume 33 Issue 1 Pages 064-069
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.064
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      “Ineffective” sugammadex may result in residual curarization, while “over effect” sugammadex may cause a problem with reintubation.
      Residual curarization will occur even if sugammadex is used. We should consider the possibility of residual curarization in cases of elderly patients, relatively small doses of sugammadex and anesthesia with sevoflurane. A good balance is necessary between sugammadex and rocuronium when reintubation is needed. The onset of efficacy of rocuronium may be late in the presense of shock or renal insufficiency.
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Original Articles
  • Exploring Measures for Preventing Postoperative Nausea and Vomiting Associated with Postoperative Opioid Analgesia-Usefulness of a Combined Diphenhydramine and Diprophylline Preparation (Travelmin® Injection)
    Seiji MIYAHARA, Daigo TAJI
    2013 Volume 33 Issue 1 Pages 070-074
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.070
    JOURNAL FREE ACCESS
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      We compared the efficacy of prevention of postoperative nausea and vomiting (PONV) using a combined diphenhydramine + diprophylline preparation (combined DD preparation) with that obtained using droperidol. Data from 249 patients (both men and women) who received continuous intravenous fentanyl infusion for postoperative analgesia were retrospectively analyzed. In both men and women, the suppression of PONV was significantly more marked with administration of combined DD preparation than droperidol. Furthermore, treatment with the combined DD preparation reduced the symptoms of vestibular stimulation (e.g., dizziness and floating sensation) often observed after droperidol treatment. Combined DD preparation also exerted excellent prophylactic effects in non-smoking women who had undergone inhalational anesthesia (a known high-risk group for PONV). Combined DD preparations are not expensive and are less likely to induce adverse reactions, so these preparations may be promising as alternatives for preventing PONV associated with administration of opioid analgesia.
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  • Perioperative Risk Factors Associated with Pressure Ulcer in the Park Bench Position
    Mine YOSHIMURA, Osamu NAGATA, Michihiro KOHNO, Takashi YAMASAKI, Tomok ...
    2013 Volume 33 Issue 1 Pages 075-083
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.075
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      Perioperative pressure ulcers tend to occur in a specific location. However, there are few reports that have studied risk factors for perioperative pressure ulcers associated with a particular position. Therefore, we retrospectively investigated 21 potential risk factors for perioperative pressure ulcers associated with neurosurgery in the park-bench position by using logistic regression analysis and factor analysis.
      Pressure ulcers occurred in 20 of 66 cases. Surgery that lasted more than six hours (P=0.013), hidropoiesis (P=0.048), and high core temperature at the end of the operation were significantly associated with a higher risk of pressure ulcers. As a result of this study, we have started to manage patients without hidropoiesis to prevent the perioperative development of pressure ulcers.
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Case Reports
  • A Case of Acromegalic Patient with Usefulness of Nasal Ventilation during Anesthetic Induction
    Hiroyuki NISHI, Itaru GINOZA, Hiroshi IHA, Iwao NAKAHARA, Manabu KAKIN ...
    2013 Volume 33 Issue 1 Pages 084-087
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.084
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      The incidence of difficult mask ventilation and intubation is higher in patients with acromegaly than in normal patients. In the present case with acromegaly, nasal-mask ventilation, but not combined oral-nasal mask ventilation, was able to provide effective ventilation during anesthetic induction. The reason was that positive pressure during nasal mask ventilation was generated only in the nasopharynx, and the pressure gradient between the nasopharyngeal and oropharyngeal cavities was able to overcome the effect of gravity on the soft tissues like the tongue enlargement, and then provide patent airway.
      During anesthetic induction of general anesthesia in an acromegaly patient, nasal mask ventilation is more effective than combined oral-nasal mask ventilation.
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  • A Case of Compartment Syndrome after Prolonged Lithotomy Position
    Seiko YOSHIMURA, Kazuhiro MIZUMOTO
    2013 Volume 33 Issue 1 Pages 088-091
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.088
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      A 51-year-old man was scheduled for laparoscopic rectectomy. He ran marathons and his lower limbs were muscular. After induction of general anesthesia, the patient was maintained at lithotomy position with Trendelenburg. During the operation, which lasted about ten hours, the hemodynamic parameters of the patient were stable. After awaking, the patient complained of pain in his left calf. On the day after the operation, the patient was diagnosed with compartment syndrome, so a fasciotomy was immediately performed. The patient suffered from nociceptive pain and neuropathic pain, but four months later he was able to walk by himself and left the hospital. In this case, the main cause of compartment syndrome appeared to be prolonged lithotomy position with Trendelenburg. In the case of lithotomy position for a long period, the patient should be managed keeping the risk of compartment syndrome in consideration.
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  • A Case of Local Anesthetics-Induced Toxicity after Transversus Abdominis Plane Block
    Satoshi IDENO, Yoshiki NAKAJIMA, Kaoru WATANABE
    2013 Volume 33 Issue 1 Pages 092-095
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.092
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      Transversus Abdominis Plane (TAP) Block is an effective method of providing postoperative analgesia in patients undergoing cesarean delivery. We report a patient who developed local anesthetics-induced toxicity after TAP block. A 20-year-old woman was scheduled for cesarean delivery and admitted one day before surgery. Cesarean delivery was performed under spinal anesthesia and TAP block (1% lidocaine 20 ml, 0.75% ropivacaine 20 ml) was done after the surgery. 30 minutes after TAP block, she complained of dizziness, visual disturbance and dysarthria at the obstetric ward. We diagnosed local anesthetics-induced toxicity. As she received 500 ml of colloid infusion, her symptoms were diminished 3 hours after TAP block. TAP block can induce local anesthetics-induced toxicity, especially when administered after surgery. Local anesthetics-induced toxicity may be dangerous after cesarean delivery because of the difficulty of distinguishing it from eclampsia.
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  • Anesthetic Management Using Extracorporeal Membrane Oxygenator in Three Cases of Tracheotomy
    Shiho ITO, Atsushi FUJIWARA, Sunji CHO
    2013 Volume 33 Issue 1 Pages 096-100
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.096
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      Tracheotomy was performed safely under the volatile induction and maintenance of anesthesia with extracorporeal membrane oxygenator in three patients with dyspnea due to tracheal infiltration of cervical malignant tumor (thyroid cancer), cervical abscess and acute epiglottitis. Airway obstruction is likely to occur in the induction phase of general anesthesia for tracheotomy in patients with severe tracheostenosis. Careful airway management is a prerequisite to avoid airway obstruction in these patients. We consider airway management under extracorporeal membrane oxygenator to be useful in general anesthesia of patients with severe tracheostenosis.
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  • Anesthetic Management of a Heart Transplant Recipient Undergoing Ascending Aortoplasty with a Homograft Patch
    Chiho OTA, Satoshi SHIBUTA, Takahiko KAMIBAYASHI, Satoshi HAGIHIRA
    2013 Volume 33 Issue 1 Pages 101-105
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.101
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      A 16 year-old male heart transplant recipient underwent aortoplasty with a homograft patch for pseudoaneurysm of the ascending aorta with extracorporeal circulation (ECC). The patient had undergone cardiac transplantation 5 months before for dilated cardiomyopathy. During this procedure, a piece of an arterial cannula was accidentally left in. Subsequently, this piece developed a pseudoaneurysm due to infection. He had not developed significant transplant complications. His physical status was satisfactory and the preoperative laboratory data were within normal limits apart from anemia (Hb 7.2 g/dl). General anesthesia was induced and maintained with propofol, remifentanil and rocuronium.
      The circulatory system was maintained satisfactorily during the peri-operative period by ensuring sufficient fluid preloading in order to maintain adequate cardiac output from the denervated heart.
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  • A Case Report：Acute Subdural Hematoma Secondary to Spinal Anesthesia for Cervical Cerclage at the 27th Week of Pregnancy
    Hiroko NISHIHARA, Mako KOSAKA, Yasuhiko HARAGUCHI, Motoshi TANAKA, Kat ...
    2013 Volume 33 Issue 1 Pages 106-109
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.106
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      We report a case of acute subdural hematoma occurring subsequent to spinal anesthesia during pregnancy.
      A 22-year-old pregnant woman received cervical cerclage in the 27th week of pregnancy at a maternity clinic. Spinal anesthesia was performed with a 21 gauge Quincke needle. She began to complain of a severe headache and nausea immediately after the operation. On postoperative day 4, she lost consciousness when she tried to stand and walk. She was transferred to our hospital, where an emergency CT scan revealed acute subdural hematoma on the left side accompanied by midline shift of ventricles. Emergency craniotomy was conducted while monitoring fetal heart rate and uterine contraction. She recovered completely after craniotomy and delivered vaginally in the 32nd week of gestation without problems.
      Acute subdural hematoma is a very rare complication related to dural puncture. After dura mater was punctured, leakage of cerebrospinal fluid to the epidural space may have led to intracranial hypotension syndrome. This may have displaced the cerebral tissue and vessels downward and torn bridging vein as a result. We suspect that the large-bore needle triggered this course. We also discuss the management of neuroanesthesia in pregnant women.
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[JAMS] Keynote Lecture
  • Management in the University Hospital and Education Using Medical Simulators
    Chikara TASHIRO
    2013 Volume 33 Issue 1 Pages 112-116
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.112
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      The cost of purchasing medical simulation equipment for training purposes was calculated as a percentage of the total education and training expenses at our university hospital. The average annual amount spent on purchasing simulation equipment was ¥ 8.7 million (4.9%). CPR trainers comprised the highest proportion of the total amount, followed by suture/endoscopic surgery-related simulators. CPR trainers were purchased by various departments such as the post-graduate training center, emergency center, anesthesiology, pediatrics, and medical safety units. Management and maintenance of the simulator equipment is currently handled by individual departments, creating a need for a centralized database and management system supervised by a designated administrator. Medical fees should be reevaluated to provide a stable revenue base to support such systems at other teaching hospitals.
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[JAMS] Educational Lecture
  • Utility of Pentax-AWS Airwayscope® for Emergency Tracheal Intubation during Cardiopulmonary Resuscitation
    Nobuyasu KOMASAWA, Ryusuke UEKI, Yoshiroh KAMINOH
    2013 Volume 33 Issue 1 Pages 117-123
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.117
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      The Pentax-AWS Airwayscope® (AWS;Hoya, Tokyo, Japan) is a new rigid video laryngoscope for tracheal intubation which provides a non-sightline view of the airway. Increasing evidence indicates that the AWS may be suitable for tracheal intubation in various clinical settings of difficult airways. During cardiopulmonary resuscitation, rescuers should minimize the interruption of chest compressions even for tracheal intubation. Furthermore, environmental factors in emergency situations make tracheal intubation more difficult. Here, we discuss the utility of AWS for emergency tracheal intubation from clinical reports and simulation studies.
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[JAMS] Symposium
  • [title in Japanese]
    Takeshi NOMURA
    2013 Volume 33 Issue 1 Pages 124-125
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.124
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  • To Enhance Effectiveness of Response to Emergency Situations Following Earthquakes, Tsunamis, and Nuclear Disasters
    Jiro SHIMADA, Choichiro TASE, Yasuhiko TSUKADA, Arifumi HASEGAWA, Yuki ...
    2013 Volume 33 Issue 1 Pages 126-130
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.126
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      From the immediate aftermath of the 2011 Tohoku earthquake and tsunami and the ensuing Fukushima Daiichi nuclear disaster, Fukushima Medical University Hospital urgently needed to operate as both a core disaster hospital and a secondary radiation emergency hospital.
      The disaster drills and emergency simulation training that had been undertaken to prepare for such a scenario proved to be immensely helpful. However, due to the fact that the disaster caused much more damage than expected, putting that preparation perfectly into practice was impossible. In any disaster, it is important to collect human intelligence. Therefore, simulating the collection of human intelligence is necessary in order to supplement drills and training and improve rapid response following a disaster.
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  • An Experience of Fire in the Operating Room and Crisis Management in the Future
    Ryusuke UEKI, Nobuyasu KOMASAWA, Yukari OKANO, Tsuneo TATARA, Yoshiroh ...
    2013 Volume 33 Issue 1 Pages 131-136
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.131
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      Preparation for and response to fires in the operating room are two of the most important aspects of a hospital's crisis control system. An operating room has the three factors necessary for a fire: ignition source, oxygen, and fuel. Therefore we have to recognize that fires can easily occur in the operating room. Because it is difficult to move a patient under general anesthesia immediately, all staff should always be aware of risk management for operating room fires and make efforts to prevent them. Moreover, it is important not to overlook early signs, so that even if a fire breaks out, it can be extinguished in its first stages. In addition, fire emergency drills are the basis for disaster management and should include the possibility of a power failure, stopping of the oxygen supply, planning an evacuation route and confirming the chain of command.
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  • Response of Surgical Center Following a Train Accident on JR Fukuchiyama Line : A Instructive Subject for the Future
    Yoko FUJIMOTO
    2013 Volume 33 Issue 1 Pages 137-141
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.137
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      In disaster situations, the university hospital must be ready to function as a disaster response base, rendering emergency treatments including surgeries on multiple trauma patients in addition to everyday activities. We reviewed the 2005 JR Fukuchiyama line derailment accident from the view-point of the operating room nursing supervisor and analyzed the shortcomings of the response. The 2008 surgical medical practice guidelines of the Japanese Association of Operative Medicine included the train accident as a case study. One of the problems highlighted was that information regarding the numbers and severity of injured patients in need of emergency surgical procedures was constantly changing. Therefore it is important that we remain in constant contact with emergency medical care centers where staff perform triage and initial treatment as well as coordinate with all surgical departments.
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  • Our Hospital Experienced a Sudden Electrical Power Outage
    Yuichi YASUE, Nao HAMABE, Yuki HIUGE, Shunji SONODA, Kiyokazu KAGAWA, ...
    2013 Volume 33 Issue 1 Pages 142-147
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.142
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      In December 2010, our hospital experienced a sudden electrical power outage caused by a fire at an electrical substation. It took approximately an hour and 40 minutes for the electricity supply to be restored during which time our emergency power was sufficient and most medical devices in the hospital functioned as designed. However it was 1 hour before information as to the cause of the outage and projected restoration time was available. In addition, the elevator system was rendered inoperable, creating complications for the care of a post-operative patient. The incident also highlighted the importance of coordinating emergency power availability, maintaining adequate fuel storage and managing equipment down time due to restarts related to the switch to emergency power. Our experience highlights the need to develop effective strategies to prepare for and deal with sudden power outages.
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[JACM] Symposium
  • Importance of Postoperative Respiratory Complications in Perioperative Accidents
    Miyuki YOKOTA, Ryozo MORINO, Makoto SEKI, Tsutomu OSHIMA
    2013 Volume 33 Issue 1 Pages 150-155
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.150
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      Ensuring medical safety is a basic and important roles of anesthesiologists. Summary reports from the third study of anesthesia-related mortality and morbidity are as follows : 1) Post-operative mortality rate (within 30 days) by critical accidents is 5.56 per 10,000 cases as a whole, 2) Anesthesia-related mortality rate is 0.10 per 10,000 cases, 3) The mortality rate tends to decrease in general.
      CCP (Closed Claims Project) reported that airway trouble and drug-related problems such as drug misuse and/or overdose were the main causes of the accidents.
      The development of devices used for airway management has recently made it comparatively safe to intubate, but it is still difficult to avoid accidents. In particular, the reports highlight the importance of postsurgical airway and breathing monitoring and respiratory care.
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  • Respiratory Depression Caused by Residual Neuromuscular Block
    Takahiro SUZUKI, Miki KASAI, Yusuke YAMAMOTO, Satomi NOMOTO, Mitsuhisa ...
    2013 Volume 33 Issue 1 Pages 156-160
    Published: 2013
    Released on J-STAGE: March 12, 2013
    DOIhttps://doi.org/10.2199/jjsca.33.156
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      Clinical symptoms suggesting severe residual neuromuscular block such as diminished ability to breathe deeply and hold examiner's hands tight may occasionally be missed by anesthesiologists before tracheal extubation. Instead, unrecognized mild residual neuromuscular block defined as train-of-four (TOF) ratios between 0.7 and 0.9 may be clinically important and potentially cause upper airway obstruction. To prevent respiratory depression caused by residual neuromuscular block, it is essential to objectively evaluate the depth of neuromuscular block, administer an optimum dose of sugammadex and finally verify adequate recovery to a TOF ratio of 0.9.
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