THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

Invited Lecture

Unexpected Lethal Arrhythmias during General Anesthesia (Brugada Syndrome, QT Prolongation Syndrome, and Coronary Artery Spasm) : How to Treat and Prevent Them

Shinichi NAKAO, Masaki FUYUTA, Yasuhiro SHIOKAWA

2014 Volume 34 Issue 1 Pages 001-010
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.001

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Anesthesiologists sometimes encounter unexpected lethal arrhythmias during general anesthesia with no apparent causes such as hemodynamic changes or electrolyte abnormalities. Although the treatment of the ultimate lethal arrhythmia, such as cardiac arrest, remains the same, the management of these patients must sometimes be different so as to prevent the appearance of lethal arrhythmias, depending on the etiology of the arrhythmias. We present here three cases of lethal arrhythmias that we experienced : ventricular fibrillation (VF) by Brugada syndrome, R on T type premature ventricular contractions by secondary QT interval prolongation, and VF by coronary artery spasm, and review how to treat and prevent them.

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Mechanical Complications and Catheter Related Blood Stream Infection with Central Venous Catheterization

Tomoko YOROZU

2014 Volume 34 Issue 1 Pages 011-016
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.011

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To reduce mechanical complications of central venous catheterization (CVC), we initiated a five-strategy program at Kyorin University Hospital : 1) standardization of the informed consent ; 2) establishment of certification for CVC insertion ; 3) obligation to submit an observation record with every CVC insertion ; 4) revision of the manual for CVC insertion methods ; and 5) implementation of continuing education courses for safety management of CVC. A practical skill tests was required of junior residents. The outcome (four years after starting the 5 point program) showed overall mechanical complications occurred in 3.12% of insertion cases in our hospital. With regards to catheter related blood stream infection, we strongly recommended 0.5% chlorhexidine alcohol solution as a skin disinfectant of the CVC site, expecting an immediate effect and durable protection according to the CDC 2011 guidelines. We also considered the availability of these products in Japan. Following on the achievements of Dr. Pronovost, we strive to employ effective measures to prevent CVC insertion complications under strong leadership. We must build a culture that attaches great importance to safety management in invasive medical care.

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Symposium (1)

[title in Japanese]

Yuji MORIMOTO

2014 Volume 34 Issue 1 Pages 017
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.017

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Neonatal Anesthesia Causes Long-term Disturbances of Hippocampal Synaptic Plasticity

Rui KATO, Kaori TACHIBANA, Yosuke UCHIDA, Toshikazu HASHIMOTO, Koichi ...

2014 Volume 34 Issue 1 Pages 018-024
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.018

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Recent studies have pointed out that exposure of neonates to anesthetic agents causes acute widespread neurodegeneration and long-lasting neurocognitive dysfunction in rodents. Although acute toxic effects of sevoflurane on cellular viability in the hippocampus have been reported in some studies, little is known about the effects of neonatal anesthesia on long-term hippocampal synaptic plasticity, which has been implicated in the processes of neurocognitive function. We examine the long-term influences of neonatal exposure of pentobarbital, propofol, and sevoflurane on hippocampal synaptic plasticity in rats by using electrophysiological methods. Our data revealed that these agents cause suppression of long-term potentiation (LTP) induction in hippocampal CA1 region lasting into the post-growth period. This persistent change in synaptic plasticity after neonatal anesthesia may be one of the mechanisms underlying anesthetics-induced neurocognitive dysfunctions.

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The Present State of Postoperative Cognitive Dysfunction

Toru GOYAGI

2014 Volume 34 Issue 1 Pages 025-031
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.025

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Postoperative cognitive dysfunction (POCD) is known to be a significant problem after surgery, but its pathophysiology has not been fully elucidated. The etiology of POCD is unknown, but there is emerging evidence associated with POCD. The incidence of POCD in elderly patients is higher than in middle-aged patients. The risk factors of POCD are increasing age, duration of surgery, preoperative complications, lower educational level, and so on. Although the incidence of POCD is not associated with the type of surgery and anesthesia, postoperative pain may affect the incidence of POCD. Since the pathogenesis of POCD is multifactorial, we must understand these factors better in order to decrease the incidence of cognitive decline after anesthesia and surgery.

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Discussion of Postoperative Cognitive Dysfunction: Findings from Clinical and Experimental Research

Takashi KAWANO

2014 Volume 34 Issue 1 Pages 032-037
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.032

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Postoperative cognitive dysfunction (POCD) is a long-term brain function disorder that can occur after anesthesia and surgery. It has been reported that POCD can significantly decrease quality of life as well as exacerbate a long-term prognosis in patients after surgery. Aging, low educational background, medical history of cerebrovascular disorders, and preoperative cognitive impairment are known risk factors of POCD. The etiology of the POCD is not established, but its development is thought to be associated with multiple factors including general anesthetics, analgesia, and surgical invasion. At this time, there is no specific treatment for POCD. In this issue, we discuss POCD based on the results of recent clinical and experimental research.

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Symposium (2)

[title in Japanese]

Keiko KINOUCHI, Jun OHATA

2014 Volume 34 Issue 1 Pages 038
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.038

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Perioperative Pain Management Using Peripheral Nerve Block in Pediatric Patients

Chihiro SEKIJIMA

2014 Volume 34 Issue 1 Pages 039-045
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.039

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Local anesthesia is an effective technique for perioperative pain management. In pediatric patients, local anesthesia is performed under general anesthesia, so it is not likely to be performed frequently outside of pediatric institutions where suitable devices or techniques are available. We performed local anesthesia procedures under general anesthesia for perioperative pain management in pediatric patients and developed and introduced an ultrasound-guided brachial plexus nerve block technique for perioperative pain management. Because pediatric patients differ from adult patients in age and build, we came up with various ideas to provide a suitable method. In addition we introduced an infra-orbital nerve block technique that uses ultrasound pre-scanning.

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Abdominal Wall Blocks in Pediatric Regional Anesthesia

Noriko MIYAZAWA

2014 Volume 34 Issue 1 Pages 046-054
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.046

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Abdominal wall blocks, including ilioinguinal-iliohypogastric nerve block, rectus sheath block, and transverse abdominal plane blocks, are effective regional anesthetic methods to provide sufficient analgesia in abdominal surgery. Recently, the ultrasound guided technique has been proven to be more effective than the traditional landmark technique in intraoperative and postoperative analgesia. Because of their usefulness for day-care surgeries and laparoscopic surgeries, we have more opportunity to do these blocks. Performance of blocks under general anesthesia is considered to be the standard of care in pediatrics. Complications of regional blocks with proper technique and patient-choice are rare according to the surveys in France and the UK. In this survey, morbidity for peripheral blocks was six times lower than for neuraxial blocks, and peripheral blocks were chosen more often rather than neuraxial blocks.
Local anesthetic overdose should be avoided following maximum dose guidelines. Overdose may happen more often in pediatric than in adult patients. Proper education and training is essential for beginners. They should master sufficient techniques using the phantom model to visualize the needle tip during its progression into the tissues and keep the ultrasound probe in a stable position without unintentional movement in the case of real patients.

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The Efficacy of Ultrasound Echograms for Caudal, Thoracic and Lumbar Epidural Anesthesia in Pediatric Patients

Yukako ABUKAWA, Koichi HIROKI, Makoto OZAKI

2014 Volume 34 Issue 1 Pages 055-058
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.055

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Ultrasound-guided caudal epidural analgesia is a standard technique performed in the United States. However, this technique is rarely employed in Japan because of the time and costs associated with its use. In pediatric patients, it is easy to find the anatomical landmarks. However, we believe that an ultrasound-guided technique would be useful for patients with anatomical anomalies and help avoid the need for intravenous injections and spinal dysraphism. We also discuss the use of ultrasound-guided epidural catheter insertion in children. The utility of ultrasound echograms for local anesthesia is likely to increase in the future. We believe that ultrasound-guided analgesia will become standard in Japan like cervical venipuncture.

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Pediatric Spinal Anesthesia Combined with General Anesthesia

Mineto KAMATA

2014 Volume 34 Issue 1 Pages 059-065
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.059

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Every anesthesiologist should have the expertise to perform spinal anesthesia. Although pediatric spinal anesthesia is an easy and effective technique, it is not popular in Japan. Spinal anesthesia provides highly effective anesthesia, analgesia, and sympathetic and motor blocks in the lower body. Spinal anesthesia may cause the same adverse effects in children as have been reported in adults. In children, higher doses of local anesthetics are required, and they are associated with a shorter duration of action and increased hemodynamic stability compared to adults even with high blocks. The benefits of pediatric spinal anesthesia are most evident in pediatric day-case surgery. In our institution, spinal anesthesia is mostly used for laparoscopic percutaneous extraperitoneal closure.
The puncture must be performed at the L4-L5 or L5-S1 spaces to prevent spinal injuries. It is important to understand the anatomy of the spinal canal when spinal anesthesia is induced. Recently, ultrasound imaging has been used more frequently to measure the depth of the subarachnoid space and locate the conus medullaris. Patients should be selected carefully, assessing the risks and benefits of pediatric spinal anesthesia in each individual case.

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Review Articles

Depth of Anesthesia and Long-term Outcome : Involvement of Immune System

Kei INOUE, Toru IGARASHI, Shizuko KOSUGI, Takeshi SUZUKI, Nobuyuki KAT ...

2014 Volume 34 Issue 1 Pages 066-074
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.066

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Recent investigations have demonstrated that the depth of anesthesia is associated with long-term outcome in postoperative patients. Owing to their suppressive effects on immune cells such as lymphocytes and neutrophils, volatile anesthetics can contribute to modulating long-term outcomes. While volatile anesthetic-induced immunosuppressive effects can improve outcomes, possibly by modulating inflammatory responses, they pose potential risks in patients with cancer and other patients susceptible to infection. In this review, we discuss the link between depth of anesthesia and long-term outcome, focusing on the effects of volatile anesthetics on host immunity and immune cell function.

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Original Articles

Current Situation of Preoperative Autologous Blood Donation in Cardiac Surgery

Noriko TAKAI, Yoshio YAMAMOTO, Tatsushi NAKAGAWA, Yae YOKOYAMA, Shigek ...

2014 Volume 34 Issue 1 Pages 075-080
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.075

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Preoperative autologous blood donation is known to be effective in scheduled cardiac surgery. We investigated the state of preoperative autologous blood donation before elective cardiac surgery in Japan and examined related problems at hospitals.
Autologous blood donation before cardiac surgery was carried out at about half of hospitals with cardiovascular specialists. We found that standards for autologous blood donation differed among facilities and that the evidence for these standards was unclear. The outstanding reason some hospitals did not carry out preoperative blood donation was a shortage of manpower. The visibility of certified nurses for autologous blood donation was low. In order to increase the prevalence of effective autologous blood donation, we should improve support systems for the blood donation and build an evidence-based standard for blood donation.

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Case Reports

A Case of the Inner Metallic Tube of a Reusable Bite Block Falling into the Bronchus

Misa KAJITANI, Sakurako MIWA, Kikuko SUGA, Wataru TAKAYAMA, Takeshi SU ...

2014 Volume 34 Issue 1 Pages 081-085
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.081

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This is a case of a 35-year-old male after cardiopulmonary resuscitation (CPR) by unknown origin, in which the inner metallic tube of a reusable type bite block unexpectedly fell into the bronchus during intensive care management. Most reusable bite blocks contain inner metallic tubes that have a rubber coating, which is easily damaged by biting and recurring sterilization, creating the possibility of the inner metallic tube delaminating. We report this incident with some discussions.

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A Case Report of Pulmonary Edema 2 Postoperative Days after Early Successful Treatment of Amniotic Fluid Embolism

Shoko YAMAGISHI, Shingo IRIKOMA, Sotaro KOKUBO

2014 Volume 34 Issue 1 Pages 086-089
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.086

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There are two types of amniotic fluid embolism (AFE) : cardiopulmonary collapse and atonic bleeding with disseminated intravascular coagulation. We experienced a case with amniotic fluid embolism (atonic bleeding with DIC type). A 42-y.o. parturient underwent cesarean section due to progressive PIH. We chose CSEA for cesarean section. Unexpected atonic bleeding occurred, which we diagnosed as AFE and treated with massive blood transfusion. Hysterectomy was not necessary. On the second day after operation the patient developed pulmonary edema and was admitted to the ICU. We should be aware of the potential for cytokine storms after early successful treatment of AFE.

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Successful Resuscitation of Maternal Cardiac Arrest by Perimortem Cesarean Section (PCS) : a Case Report

Yukako OURA, Motoshi TANAKA, Masahiro SHIMIZU, Hideki TAKEI, Katsuo TE ...

2014 Volume 34 Issue 1 Pages 090-094
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.090

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A congenitally healthy 27-year-old female with MD (monochorionic diamniotic) twin pregnancy, gravida 1, para 0 was admitted to our institution for preeclampsia and preterm labor at 31 weeks gestational age. The patient was treated with ritodrine hydrochloride and magnesium sulfate, but developed pulmonary edema at 32 weeks gestational age. An emergency cesarean delivery was scheduled and the patient was transferred to the operating room. At that time, she was alert, but had dyspnea, orthopnea, and tachypnea. After we transferred her from the stretcher to the operating table, she suddenly lost consciousness and her pulse was not palpable. We started cardiopulmonary resuscitation immediately. At the same time, we ordered the obstetricians to promptly deliver the babies by cesarean section. Four minutes after maternal cardiac arrest, we started the cesarean section and identified spontaneous circulation. One minute after starting the surgery, both babies were delivered, and maternal vital signs became stable. After the surgery, the mother and the babies recovered steadily, and were successfully discharged home without any neurological sequelae.
Anesthesiologists should be aware of cardiopulmonary resuscitation of pregnant women and the concept of perimortem cesarean section（PCS）to improve their success rate in the treatment of cardiac arrest during pregnancy.

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[JAMS] Original Articles

Evaluation of Nasotracheal Intubation with the Airway Scope^® in Airway Training Manikin

Takeshi SUGIURA, Emi OOUCHIDA, Hiroyuki HIRATE, Hajime ARIMA, Hiroshi ...

2014 Volume 34 Issue 1 Pages 095-100
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.095

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The Airway Scope^® (AWS) has recently been introduced for nasotracheal intubation (NTI). The objective of this study was to determine the traits of NTI with AWS in a manikin. Methods : An experienced anesthetist inserted AWS orally, then inserted an endotracheal tube (ETT) through the nose into the glottis of the manikin (AirSim Multi^®). We evaluated the success rate of intubation (Rs) at head tilt angles of 50, 30, 10, and -10 degrees (groups I, II, III, and IV, respectively) below horizontal. We also assessed the effects of the direction of insertion (±30, 90, 180 degrees clockwise) and different types of ETT. Results : Under the support of AWS, Rs was significantly lower in group IV (0/20) than in the other groups (18-20/20). In group I, revolving the tube decreased Rs at angles of +90 degrees (8/10) and +180 degrees (3/10). There was no difference in Rs among the four types of ETT in all groups. Conclusions : The AWS could move the glottis in an anatomically inappropriate manner in the head-flexional position, resulting in the failure of NTI, but it provided successful NTI in the head-extended position. The rotation of ETT could facilitate adjustment of the tip movement.

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[JAMS] Brief Reports

Comparison of LMA Supreme^®, air-Q^® and i-gel^® for Airway Management during Chest Compression under Cervical Stabilization : a Manikin Study

Hanako KOHAMA, Nobuyasu KOMASAWA, Ryusuke UEKI, Yoshiroh KAMINOH, Shin ...

2014 Volume 34 Issue 1 Pages 101-104
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.101

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We compared the utility of LMA Supreme^® (Supreme), air-Q^® (air-Q), and i-gel^® (i-gel) for airway management during chest compression under cervical stabilization in manikin simulation. Sixteen short term trainees in our anesthesia department inserted these three devices in a manikin under cervical stabilization with or without chest compression. The success rate of ventilation or insertion time with Supreme, air-Q and i-gel did not change with chest compression. There was no significant difference between the three devices in success rate or insertion time with or without chest compression. Newly developed supraglottic devices such Supreme, air-Q and i-gel may be useful for emergency airway management during chest compression under cervical stabilization.

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[JACM] Educational Lecture

Intraoperative Monitoring of Motor Evoked Potential : Methodology and Pitfalls

Masahiko KAWAGUCHI, Hironobu HAYASHI, Ryuichi ABE

2014 Volume 34 Issue 1 Pages 106-116
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.106

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Intraoperative monitoring of motor evoked potential (MEP) has been conducted to prevent postoperative motor deficits in patients undergoing craniotomy for cerebral aneurysm and brain tumor, spine/spinal surgery and thoracoabdominal aortic aneurysm surgery. During craniotomy, selection of transcranial or direct cortical electrical stimulation and intensity of stimuli are important determinants for successful MEP monitoring. During spine/spinal surgery, MEP recording may be occasionally difficult in patients with preoperative motor dysfunction or scoliosis, so techniques to augment MEP amplitude such as post-tetanic MEP may be applied. During thoracoabdominal aortic aneurysm surgery, careful anesthetic management is essential, because the induction of hypothermia and cardiopulmonary bypass with aortic clamping can markedly affect MEP responses. Proper interpretation of intraoperative MEP changes during thoracoabdominal aortic aneurysm surgery is crucial. We describe the methodology and pitfalls of MEP monitoring and anesthetic management during MEP monitoring.

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Transcutaneous PCO₂ Monitor : History, Principles and Clinical Applications

Sohei KAGAWA

2014 Volume 34 Issue 1 Pages 117-123
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.117

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The measurement in PCO₂ of the skin surface by means of Stow-Severinghaus electrode is described as the transcutaneous PCO₂. End tidal PCO₂, nasal end tidal PCO₂ and PaCO₂ are compared with the values of transcutaneous PCO₂. The transcutaneous PCO₂ is best fitted with PaCO₂ value in all methods. Time constant of the transcutaneous PCO₂ measurement is approximately 4 min. Skin temperature of 42 degrees is tolerated for 12 hours after preheated 45 degrees for 15 min. The values of transcutaneous PCO₂ are delayed 1 to 2 min after PaCO₂.

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The Basic Interpretation of Surface Electrocardiography : From the Viewpoint of Myocardial Action Potentials

Yoshifumi TANAKA

2014 Volume 34 Issue 1 Pages 124-132
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.124

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Body surface electrocardiograms can be measured easily and anyone who memorizes characteristic ECG patterns can make an accurate diagnosis. Automatic diagnosis software has also be improved greatly and can make diagnoses with 80% or high accuracy these days. Moreover, many AEDs which combine automatic diagnosis software with DC counter shock are available at public facilities for emergency measures.
However there is no textbook on why ECG patterns become such a waveform from the viewpoint of abnormal myocardial action potentials. The author has found that right hand electrode detects extracellular potential in endocardium and the left foot electrode detects the extracellular potential of epicardium, hence it will be set to surface electrocardiogram if the epicardial potential is subtracted from the endocardial potential. The results of CPU simulation showed good agreement with many pathological modifications of extracellular epicardial potentials.

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[JACM] Symposium

Utility of Prehospital 12-lead Electrocardiogram Transmission System in Emergency Care

Migaku KIKUCHI, Hiroshi NONOGI

2014 Volume 34 Issue 1 Pages 133-138
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.133

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Recent resuscitation guidelines recommend prehospital 12-lead electrocardiogram (ECG) transmission to evaluate patients before arrival at hospital. Percutaneous coronary intervention can then be performed to facilitate the care of patients, especially those with ST elevation myocardial infarction (STEMI). We developed a mobile telemedicine system (MTS) to transmit 12-lead ECG and other parameters including video from ambulances to hospitals. We recently used a handheld wireless 12-lead ECG transmission system (WES) which transmitted the ECG to a smart phone using Bluetooth technology. The ECG was converted to a JPEG and sent to an email address. The influences of road turbulence, body movements and high speed driving were investigated and did not affect ECG interpretation. When we used the MTS for patients including those with STEMI, door-to-balloon time was 30 minutes shorter than with the non-MTS group. When we used the MTS or WES for 80 patients including those with STEMI, a successful case showed onset-to-balloon time of 120 minutes even though transportation time was longer than 40 minutes. These systems can improve early diagnosis and door-to-balloon time for STEMI patients. Implementation may improve care of patients with acute coronary syndrome, including prehospital emergency care.

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[JACM] Panel Discussion

Static Blood Volume and Dynamic Blood Volume

Takehiko IIJIMA

2014 Volume 34 Issue 1 Pages 139-144
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.139

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The mean circulating blood volume (BV) for surgical patients in Japan was 82.3 ± 14.8 mL/kg, based on clinical data from eight university hospitals. This value varies considerably among individuals, ranging from approximately 50 mL/kg to 100 mL/kg, suggesting a large physiological capacity to control circulating BV depending on the individual's condition. This value can be described as the “static blood volume.” In contrast, SVV (stroke volume variation) is derived from arterial wave analysis and reflects the venous return, which is fundamentally different from static BV. SVV can be controlled by vasoactive treatment : for example, vasoconstrictors augment the venous return and reduce SVV independently of static BV. Since SVV represents venous return, which directly controls cardiac output, SVV could also be described as “dynamic BV.” These two distinct values (static BV and dynamic BV) should not be confused when selecting an intervention, optimal volume load, or the use of a vasoconstrictor. The latter can be controlled not only by volume load, but also by vasoconstriction. Furthermore, vasoconstriction may be more effective for controlling dynamic BV. The use of a conventional volume load (achieved using crystalloid) to control SVV would lead to an unnecessary fluid load. Thus, SVV should be interpreted properly.

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[JACM] Lecture

Safety Management of Clinical Monitoring Equipment

Noriaki ONO

2014 Volume 34 Issue 1 Pages 145-150
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.145

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Clinical monitoring equipment is used everywhere in hospitals, including the ICU/CCU, operating theater, wards, treatment rooms, hemodialysis center and so on. Although this equipment is used to assist in the recovery and maintenance of patients' health, harm may be inflicted on patients if it is used incorrectly or is defective. In this paper, the causes of and countermeasures to 1) electric shock, 2) burns, 3) noise interference, 4) alarm problems and 5) power failures are surveyed.

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Considerations Regarding Monitored Anesthesia Care under Endoscopic Sedation : Endoscopic Procedure Rooms Currently at Risk

Toshiyasu SUZUKI

2014 Volume 34 Issue 1 Pages 151-160
Published: 2014
Released on J-STAGE: February 26, 2014

DOIhttps://doi.org/10.2199/jjsca.34.151

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With recent innovations in endoscopic technology, an increasing number of surgeries, typically endoscopic submucosal dissections (ESD), are being performed in endoscopic procedure rooms. Although analgesia and sedation are essential during ESD, adverse events induced by analgesics and sedatives including respiratory depression, hypoxemia, and respiratory arrest have been increasing. Physicians in charge of monitored anesthesia care (MAC) in endoscopic procedure rooms are not anesthesiologists. More often, staff not concurrently performing the surgery execute this task and are not familiar with measures to be taken when a patient's condition suddenly changes. Early detection of respiratory depression is especially imperative. Physicians who plan to take part in MAC in the future need to have pharmacologic knowledge of sedatives and analgesics, need to be able to accurately judge physiological responses to levels of sedation/anesthesia, and need to be familiar with anesthetic procedures and emergency measures. Furthermore, respiration of patients under endoscopic sedation should be managed from the perspectives of both ventilation and oxygenation in addition to SpO₂ by using the Acoustic Respiration Rate (RRa), which enables continuous monitoring of respiratory rate.

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