In this retrospective study, we examined the risk factors for discontinuation of intravenous patient-controlled analgesia（IVPCA）. Cases treated with fentanyl using PCA pump with continuous and bolus dosing after total hip arthroplasty were collected. Of the 268 patients analyzed, 95 patients discontinued IVPCA. Causes of IVPCA discontinuation were postoperative nausea and vomiting in 94 patients and suspected extrapyramidal symptoms in 1 patient. Logistic regression analysis showed that age, Apfel score≧3 and dose of fentanyl≧0.35μg/kg/h were risk factors for discontinuation of IVPCA.

We report a case of generalized tonic seizures following a total en bloc spondylectomy. The case was that of a 61-year-old man with no history of seizures and no major problems noted under previous general anesthesia. Preoperative examination, including blood tests, showed only atrial fibrillation. A total en bloc spondylectomy（TES）was planned. The operation time was 5 hours and 14 minutes, during which no problem with bleeding and circulatory and respiratory dynamics was observed. After the operation, the patient was admitted to the ICU after extubation for postoperative management. Generalized tonic seizure suddenly developed 20 minutes after entering the ICU. The seizure disappeared after intravenous diazepam injection. Head CT showed high absorption in the right Sylvian fissure and cerebellar tent margin. The MRI excluded cerebral infarction and thrombosis. The patient was extubated two days after the operation, and no other notable findings such as seizures were observed. The most probable cause of the seizures, in this case, was thought to be intracranial hemorrhage due to low CSF pressure, which is one of the complications of spinal surgery.

A case of malignant hyperthermia was experienced in a chronic care hospital where only dental anesthesiologists managed anesthesia. The patient was a 21-year-old male. He was referred for extraction of an impacted tooth with severe vomiting reflex and many dental problems. The malignant hyperthermia was detected early and successfully treated. Action cards prepared in advance were helpful. The patient was able to be treated by trained medical staff only, and we reaffirmed the importance of avoiding confusion on an emergency call.

We report a case in which an emergency cesarean section and hysterectomy were safely performed after the insertion of an arterial occlusion balloon（OB）in a woman with placenta percreta after premature rupture of the membrane. The patient was a woman in her 30s. Her water broke at 27 weeks and 4 days of pregnancy, and she was rushed to hospital. Close examination revealed a placenta percreta. The following day, a cesarean section was performed under a combined spinal-epidural anesthesia with OB, followed by induction of general anesthesia and a total hysterectomy. Hemorrhage was 4,000 mL including urine and amniotic fluid, but the intraoperative hemodynamics were stable and the postoperative course was good. Placenta percreta carries a high risk of massive hemorrhage, so how to respond to such an event and the method of anesthesia to be used should be considered in the managing of such cases.

We experienced anesthesia for an emergency caesarean section at 34 weeks’ gestation with a sudden drop in SpO₂ with orthopnoea. Due to the difficulty of the supine position, we administered general anesthesia. Postoperative transthoracic echocardiography revealed a left ventricular ejection fraction of 30% and a diagnosis of severe heart failure due to peripartum cardiomyopathy. The patient required temporary left ventricular assist treatment with Impella^TM. However, a post-operative CT scan incidentally revealed a pheochromocytoma, and after medical treatment, a laparoscopic adrenalectomy was performed. In cases of perinatal hypocontractility and cardiac failure, anesthetists should consider the possibility of pheochromocytoma in patient assessment and anesthetic management.

A previous report revealed that preoperative anxiety in children is correlated with cooperativeness at the time of anesthesia induction, and the psychological preparation may be effective. In this study, a child-oriented video explaining anesthesia was created and integrated into a social humanoid robot made by Softbank Robotics Corp（“Pepper”）.

Patients were divided by age（3-5 and 6-10 years）. Differences in preoperative anxiety （mYPAS-SF： modified Yale Preoperative Anxiety Scale-Short Form）and cooperation（Frankl’s Behavior Rating Scale and VAS： Visual Analogue Scale）between the groups that watched the “Pepper video”（P-group）and the group that watched the traditional parent video（V-group）were prospectively evaluated.

There were no significant intergroup differences in mYPAS-SF and VAS scores. However, among children aged 6-10 years, Frankl Behavior scores were significantly higher in the P-group（p＝0.004）.In children aged 6-10 years, explaining anesthesia to the affected children suggested that they may be more cooperative during anesthesia induction. Additional research is needed on differential responses within pediatric age ranges.

One of the missions of a learned society is to train high-quality, reliable board-certified specialists. We, the Japanese Society of Anesthesiologists, impose written, oral, and practical examinations on senior residents for qualification. Through these examinations, we evaluate cognitive, affective, and psychomotor domains listed in Bloom’s taxonomy. Speaking of “Education”, it is undesirable to adhere only to evaluation, and providing continuing education opportunities for the residents to facilitate their achieving the required level for a certified Anesthesiologist is essential. Society’s education system entrusts this to each training program, and it doesn’t provide residents with opportunities to ensure their achievements before they take the exams. The Society has to provide training sessions for the residents to heighten their capacity, especially in affective and psychomotor domains, through sessions focusing on a formative evaluation.

Anesthesia monitoring generally calculates statistical anesthesia depth indices by multivariate analysis of a database, mainly based on frequency analysis, but there is a problem that age groups and drug types not included in the database are not taken into account. On the other hand, the ultimate target of anesthesia monitoring is metaphysical consciousness, including pain, but the enormous flow of information through the cortical network that gives rise to consciousness is supported by the complex behavior of neural oscillatory dynamics. Recently, in the field of clinical anesthesia, attempts have begun to quantify anesthetic effects based on the complexity, stability, and randomness of cerebral neuro-dynamics, which reflect cortical information processing. In order to build a unified anesthesia monitoring system, further research on appropriate complexity evaluation methods is needed.

Frontal electroencephalogram（EEG）, widely used in processed EEG monitors, can be used to identify gradual changes in the anesthetic effect. However, misdiagnosis can still occur because EEG monitoring of anesthesia is affected by other factors besides anesthetics. This article discusses the impact of various drugs used in clinical anesthesia/sedation on EEG monitoring of anesthesia, based on both a review of the current literature and the author’s personal experience.

Informed consent is based on the principle that the patient or patient’s family is the subject, and the physician should provide sufficient information and guarantee the patient’s right to self-determination. Conveying such information requires time and an environment that allows the patient to understand, and asking the patient to sign a consent form immediately after the explanation should be avoided as much as possible.

Nevertheless, there is a limit to the amount of information that can be provided by a physician in a hospital setting within a limited time. On the other hand, video can provide a homogeneous and complete explanation that is not dependent on the competence, experience, or workload of the physician, and can be viewed as many times as necessary until the patient or patient’s family fully understands the information. Better understanding leads to increased trust and patient satisfaction, and greater patient satisfaction can improve the safety of medical staff in emergency situations.

The level of anxiety, understanding, satisfaction and explanation time for pamphlet-based pre-operative explanation（Group P）and video-based pre-operative explanation（Group V）were compared at three points：before the explanation, after the explanation, and after the operation/delivery. The study was conducted on 22 patients who were scheduled to undergo caesarean section or were likely to undergo caesarean section. In both groups, there was a decreasing trend in the level of anxiety from before the explanation to after the operation and delivery. There were no differences in patient understanding and satisfaction between the two groups. The explanation time was significantly shorter in Group V than Group P（5.3 minutes vs 18.2 minutes）.

The year 2022 marks the 150th anniversary of the opening of the Kyoto Ryobyoin, which evolved into the Kyoto Prefectural University of Medicine. In November 2022, lectures honoring Ferdinand Adalbert Junker von Langegg（Junker）were held at the annual meeting of the Japan Society for Clinical Anesthesia. This paper is an amalgamation of these lectures.

Junker qualified in Vienna, worked as a general physician, surgeon and obstetrician and gynaecologist in London, Berlin, Kyoto, Leipzig and Vienna, and also spent time as an army doctor during some of these travels, before returning to the country of his birth, Austria, at the end of his career.

Junker stayed in Japan from 1872 to 1876. Junker contributed to the modernization of medical care as the first foreign doctor and teacher at Kyoto Ryobyoin Hospital. Junker was the only anesthesiologist among the “hired foreigners” employed to change Japan into a modern country during the Meiji Restoration. Junker’s inhaler, which he developed in 1867, has been improved and used for generations. Junker’s career was very unusual for the time and still presents many unanswered questions.

As the second part of a three-part series, this article describes Junker’s career up to his arrival at the Kyoto Ryobyoin Hospital, including the development of Junker’s inhaler, as well as his education and treatment at the hospital after he arrived in Kyoto.