It has previously been reported that central venous-to-arterial partial pressure difference of carbon dioxide（dCO₂：Difference of PCO₂）is a parameter for systemic perfusion and that increased dCO₂ is occasionally observed in critical conditions. We retrospectively investigated perioperative dCO₂ of 15 patients with emergency surgery for bowel obstruction and found increased dCO₂ in all patients. In 6 patients with strangulation obstruction which did not require intestinal resection, significant decrease in increased dCO₂ was found between pre-operative and abdominal closure sampling points, and significant decrease was also found between pre-operation and next day of operation. There were no significant differences in lactate level and central venous O₂ saturation（ScvO₂）. These results suggested that dCO₂ may be a supplementary parameter for reflecting the change of systemic perfusion during the perioperative period especially in patients with strangulation obstruction.

A 76-year-old male with diabetes mellitus was scheduled to undergo laparoscopic distal partial gastrectomy. He twice underwent endoscopic submucosal dissection（ESD）for early gastric cancers before surgery. After induction of anesthesia, endotracheal intubation was performed. There were no foreign bodies in the oral cavity during endotracheal intubation. We suctioned about 200 mL of gastric contents from the nasogastric tube. Nevertheless, the stomach was still expanded. The surgeons made an incision in part of the stomach and then aspirated and scraped out about 700 g of gastric contents. The operation finished successfully. Due to two wide ESDs and diabetes mellitus, delayed gastric emptying and unexpected full stomach occurred. Fortunately, aspiration did not occur, but this case sounded serious alarm bells for anesthesiologists.

A 55-year-old man was resuscitated from ventricular fibrillation during two previous general anesthesia procedures. We performed open reduction and internal fixation followed by removal of a bony foreign body for right ulnar olecranon fracture under general anesthesia. Preoperative evaluation revealed possible long QT syndrome on electrocardiogram and vasospastic angina on cardiac catheterization with three positive branches on acetylcholine stress test. General anesthesia was induced with propofol, fentanyl, and rocuronium, followed by supraclavicular brachial plexus block and maintenance with propofol and remifentanil without inhaled anesthetics. Nicorandil was infused perioperatively to prevent coronary spasm, PaCO₂ was maintained at 39-43 mmHg, and systolic blood pressure was maintained above 100 mmHg perioperatively. The patient was discharged on schedule without experiencing any major complications. Our perioperative management may have reduced the risk of ventricular fibrillation caused by vasospastic angina or long QT syndrome.

We report the case of a 39-year-old woman（gravida 5, delivery 4）who developed acute transverse myelitis following cesarean section. Elective cesarean section was performed at 38 weeks and 4 days of gestation under combined spinal-epidural anesthesia. Both anesthetic procedures were uneventful and the patient did not have severe electric shock-like pain. The day after the operation, the patient was able to stand, but she later developed sensory, motor, and autonomic dysfunction. Based on several examinations, a diagnosis of acute transverse myelitis was made, and steroid pulse therapy and rehabilitation were initiated. Neurological recovery was slow, but the patient was discharged two months after surgery.

Acute transverse myelitis is a rare condition that can cause neurological sequelae. Therefore, careful observation of neurological progress after regional anesthesia is recommended.

Contralateral partial lung resection after pneumonectomy is very rare because perioperative mortality is high. There is therefore no definite criteria for performing surgery or for which surgical procedure should be chosen. Thoracoscopic surgery is preferable to thoracotomy in terms of postoperative respiratory function and postoperative respiratory complications. To preserve postoperative respiratory function, partial lung resection after pneumonectomy is particularly important. Airway managements of lung collapse is necessary to secure surgical fields for thoracoscopic surgery. Thoracoscopic surgery after pneumonectomy requires paticularly difficult airway management and is challenging for anesthesiologists. In this case report, we describe the usefulness of a bronchial blocker in thoracoscopic partial lung resection of left upper lobe in a patient who received right pneumonectomy.

Background：Conservative treatment of carpometacarpal joint arthrosis requires patients to understand their own condition. However, patients may discontinue their treatment due to a lack of information and communication with their attending physician.

Case：The patient was a 50-year-old woman who presented with severe pain in her right thumb 2 years before her first outpatient visit. She received analgesics and a therapeutic orthosis and was instructed not to move excessively. More than a year later, she became mistrustful of her attending physician because her symptoms did not improve. She therefore stopped visiting the clinic and consulted our department. We performed ultrasonography, explained the condition to the patient while showing her the ultrasound images, and administered an ultrasound-guided intra-articular injection. She understood her condition and was able to manage her pain with continued use of analgesics and a therapeutic orthosis and thumb stretching.

Discussion： The patient was able to understand her own medical condition after receiving an explanation while viewing her ultrasound images. Ultrasound images were a useful communication tool between the attending physician and patient.

Since the 1970s, the concept of Advance Care Planning（ACP）has been advocated, mainly in the United States, with an emphasis on understanding and sharing the decision and preference of patients and surrogate decision makers against medical intervention and care at the end of life through the process of discussions, not for making Advance Directive. Anesthesiologists as well as oncologists have many opportunities to get involved in the initiation of ACP.

Respiratory management is crucial to sustain life in perioperative patients. Under surgical anesthesia, however, adequate respiratory management can be difficult.

Here, I present methods of lung protective ventilation for acute respiratory distress syndrome which can be applied to respiratory management during perioperative anesthesia. In addition, I describe the extubation guideline prepared for safe extubation. This guideline may facilitate extubation in difficult cases after surgical anesthesia. Lastly, I discuss devices available for perioperative anesthesia management.

To improve the prognosis of patients, knowledge and devices in intensive care medicine can be utilized in respiratory management during perioperative anesthesia.

Hemodynamic management is very important not only for critically ill patients in intensive care units（ICUs）but also for anesthetic management during major surgery. Understanding hemodynamic management of critically ill patients can be beneficial for anesthetic management. Extensive data exists on effective methods of hemodynamic management for critically ill patients, and these methods can also be applied to anesthetic management during major surgery. The efficacy of non-invasive hemodynamic monitors has been presented in many clinical trials, so invasive hemodynamic monitors such as pulmonary artery catheters have been replaced with non-invasive monitors. There is increasing data available on blood pressure targets and timing of initiation of catecholamines in critically ill patients. Since administration of beta-blockers has been shown to improve the prognosis of septic shock patients in a randomized clinical trial, the use of beta-blockers in major surgery might be beneficial. Recent clinical trials have shown that goal-directed therapy, with efficacy reported in septic shock patients for the first time, reduces postoperative complications. Anesthesiologists should be updated about recent advances and developments in research on the management of critically ill patients in ICUs to improve anesthetic hemodynamic management during major surgery.

Postoperative intensive care for critically ill patients begins in the operating room. Catheters are placed in the operating room and brought to the intensive care unit. Therefore, infection control during the procedure plays an important role in postoperative intensive care. In this article, we discuss recent reports on hand hygiene, infection control for stopcocks, and infection control during catheter insertion, especially for insertion of an arterial catheter. Although perioperative infection control has a significant impact on postoperative intensive care, it is relatively easy to reduce the risk by taking the right measures. Perioperative infection control measures that take into account postoperative intensive care are desirable.

We reported the effect of prophylactic pentazocine administration on opioid-induced pruritus after cesarean section under spinal anesthesia using opioids（Anesth Analg 124； 1930-1934：2017）. There were additional requests from the reviewer（Statistical Editor）when the paper was submitted initially. In particular, the reviewer required statistical methods based on the characteristics of data and commented on the method of their notation. We present the kind of statistical analysis that was pointed out in the process from first submission to publication of our paper using the actual submitted paper.

Cochrane risk of bias has been widely used to assess bias in randomized controlled trials. The revised version of Cochrane Risk Bias 2.0（RoB 2.0）was published in 2018. There are five domains：1）bias resulting from the randomization process；2）bias due to deviation from intended intervention；3）bias due to lack of outcome data；4）bias in measurement of results； and 5）bias in the selection of reported results. The inclusion of signalling questions within each region of the domain is an important feature of RoB2 that aims to elicit information relevant to the risk assessment of bias. It can also determine the overall risk of bias.

Repeated-measures analysis of variance（ANOVA）has been conventionally used for analyzing measurements of the same subjects that are taken repeatedly through time, but its application needs to be cautious. There are a number of constraints especially when correlation can arise on the same subjects, the outcome variable is binomial or count data, or missing data is present. In the current review, the author highly recommends state-of-the-art statistical methods including generalized estimating equation（GEE）, generalized linear mixed model（GLMM）, and multiple imputation.

We collected information on criminal trials regarding medical practice from legal journals and other sources between 1950 and 2017. Among 127 individuals for whom trials were requested, 23 individuals or approximately 18％ were found to be not guilty.

The most common occupation among the 23 individuals who were found not guilty was doctor, and many of these individuals were involved in surgery or other treatments. Regarding causes of the accidents in which the 23 individuals were involved, 5 individuals committed an obvious error, and the accidents of the remaining 18 individuals were related to the quality of medical practice. In the trials related to the quality of medical practice, mistakes in the indictment by the prosecution regarding who made what error were recognized during the trials.

There were 3 individuals who were found to be guilty in the first trial but not guilty on appeal. The longest time from the date when the accident occurred to the date when innocence was confirmed was more than 11 years.

It is important to convince prosecutors that medical practices were performed correctly by ensuring that all medical practices are recorded accurately.

The Japan Obstetric Compensation for Cerebral Palsy was launched in 2009 to halt a deteriorating trend in the perinatal care delivery system. The framework of the system was proposed by the leading political party, which assigned the Japan Council for Quality Health Care as the operating organization. The system handles monetary compensation, investigation and prevention. Compensation is provided on no-fault basis. It has published approximately 2,800 investigative reports that were delivered both to childbirth facilities and family. A questionnaire survey on investigations found that investigation reports were favorably accepted both by childbirth facilities and families. The system has been hailed in Japanese society and reviewed twice for expanding eligibility for compensation. The new criteria will be applied to childbirth that takes place in January 2022 and thereafter. It is hoped that the system will produce knowledge and expertise for improving perinatal care in a continued manner.

In the medical setting, human error refers to “originally expected treatment opportunities impaired by the cognition, judgment, and behavior of medical personnel, patients, and their family members.” This paper tried to understand the reason for human error from the standpoint of the information processing that is the basis of our behavior. First, focusing on the characteristics of attention and thinking habits（cognitive bias）, we examine the mechanism by which beliefs, misunderstandings, and lack of attention occur. Next, we address communication issues that are important for working as a team on the issue of human error. We hope this paper will provide an opportunity to understand the characteristics of one’s own cognition and behavior and to reconsider the events experienced in the practice field on a daily basis from the perspective of human information processing.

We examined criminal cases and administrative punishment related to anesthesia and surgery.

There were 8 cases of 10 persons who were brought to trial, and 19 cases of 22 persons who had to go through the brief procedure.

In addition, there were multiple defendants in 4 of the 27 cases.

All cases of administrative punishment were published, but not all criminal cases could be obtained.