[Significance of Multi-center Obstetrics Perioperative Team Training Including Various Medical Staffs].

We report the development of a multi-center/multispecialist obstetrics perioperative team training program. Participants were members of the team, including anesthesiologists, obstetricians, and operation nurses. A questionnaire survey was conducted prior to course participation to clarify any questions team members had. The courses included a lecture and simulation training with scenario-based discussions or the use of a simulator. Scenarios included massive bleeding during cesarean section, massive bleeding after vaginal delivery, and emergency cesarean section for premature placental abruption. After each course, participants discussed problems associated with obstetrics medical safety in the context of each theme. Simulation-based perioperative team training with anesthesiologists, obstetricians, and operation nurses may serve as a vehicle to promote perioperative obstetrics patient safety.

[The Attitudes of Anesthesiologists toward Paramedic Tracheal Intubation Clinical Training].

BACKGROUND: We performed a questionnaire survey to investigate anesthesiologist attitudes toward para- medic tracheal intubation clinical training and related issues. METHODS: Twenty-four anesthesiologists (clinical expe- rience, 18.4?12.2 years) answered a questionnaire regarding their attitudes toward paramedic clinical training and complications encountered during training. Participants were also asked about the number of cases paramedics should be required to handle for tra- cheal intubation training. RESULTS: Over 75% and 80% of anesthesiologists responded that paramedics had difficulty performing mask ventilation and stomach expansion, respectively. Moreover, roughly 25% encountered tooth injury, and 75% lip injury. Over 90% agreed that simulation train- ing before clinical training is important. The respon- dents thought 37.5 ?25.0 cases should be required for Macintosh laryngoscope training, and 20.0?13.6 cases for videolaryngoscope training. CONCLUSIONS: Our results suggest the need for improvements in paramedic clinical training, including pre-training education about perioperative medicine and operating room rules.

[Five Cases of Anesthetic Management for Emergent Hysterectomy with Postpartum Hemorrhage after Vaginal Delivery].

Anesthetic management for emergent hysterectomy with postpartum hemorrhage after vaginal delivery is often difficult due to disseminated intravascular coagu- lation (DIC). Here we discuss our experience with 5 cases (2 in-hospital, 3 transferred to our hospital) of emergent hysterectomy after vaginal delivery. Preop- erative blood loss was 4,485±4,450 [1,404-12,350] ml, and blood loss during the operation was 7,466±5,543 [2,096-15,8561 ml. A total of 35±29 [10-80] units of red blood cell concentrates, 36±32 [4-84] units of fresh frozen plasma, and 60±47 [20-120] units of platelet concentrates were administered. The primary cause of massive hemorrhage was placenta accreta in 3 cases, cervical laceration in 1 case, and amniotic fluid embo- lism in 1 case. The progression of DIC before the operation was attributed to an escalation in hemorrhage. Physicians should note that massive hemor- rhage often occurs during emergent hysterectomy after vaginal delivery and make necessary prepara- tions for appropriate perioperative management.

Comparison of mechanisms of allodynia induced by acromelic acid A between early and late phases.

We previously showed that intrathecal administration of acromelic acid A (ACRO-A) provoked tactile allodynia in mice. As well, recent studies have demonstrated that the activation of NMDA glutamate receptor-neuronal nitric oxide synthase (nNOS) pathway and glia play crucial roles in the development and maintenance of neuropathic pain. In order to clarify their involvement in ACRO-A-induced allodynia, we investigated the effects of various agents on two mouse models at early and late-phase allodynia. The agents employed were Ca(2+) channel α2δ ligands, NMDA and AMPA receptor antagonists, nNOS, and Ca(2+)/calmodulin kinase II inhibitors. When injected simultaneously with ACRO-A, all of these agents blocked allodynia in the early-phase group; however, they did not block allodynia when injected 7 days after the administration of ACRO-A in the late-phase group. In order to block glial activation, astrocytic inhibitor L-α-aminoadipate (LAA) or microglial inhibitor minocycline was administrated, and allodynia was examined on day 7. Activations of nNOS and glia in the spinal cord were histochemically examined at 1 h or 1 week after injection of ACRO-A. We found that nNOS activity increased 1 h after ACRO-A injection; however, it did not increase 1 week after ACRO-A injection. Conversely, microglial activation was observed 1 week after ACRO-A injection and was significantly inhibited with minocycline treatment. Moreover, only LAA was found to inhibit late-phase allodynia. In this study, we demonstrate that NMDA receptor activation is involved only in ACRO-A-induced tactile allodynia in the early phase, and that spinal astrocytic activation contributes to allodynia in the late phase.

[Discrepancy in the length of smoking cessation between surgeon's and anesthesiologist's records in relation to hypoxia during one-lung ventilation].

BACKGROUND: Smoking cessation before pulmonary surgery is essential for preventing respiratory complications associated with operation and anesthesia. We compared patients' smoking habits and length of smoking cessation based on respiratory surgeon's and anesthesiologist's records. METHODS: We retrospectively surveyed 68 patients who underwent elective operation under one-lung ventilation (OLV) with respect to the Brinkmann index, smoking cessation period, and incidence of hypoxia during OLV. RESULTS: Of the 68 patients, 38 had a history of smoking, with no difference in the Brinkmann index according to respiratory surgeons and anesthesiologists. Of the 38 patients, 6 had inconsistent records regarding the length of smoking cessation. The smoking cessation period was significantly longer according to respiratory surgeons (17.5 days (median)) compared to that according to anesthesiologists [2.0 days (median), P < 0.05). The incidence of hypoxia (SP(O2) < 90%) was significantly higher in these patients (4 of 6), relative to those with no discrepancy (2 of 32, P < 0.05). CONCLUSIONS: Accurate information regarding the length of smoking cessation before surgery is difficult to obtain. The incidence of hypoxia during OLV was significantly higher in patients with a discrepancy regarding the length of smoking cessation between respiratory surgeon's and anesthesiologist's records.

[Successful awake tracheal intubation in the sitting position using the Pentax-AWS Airwayscope in a patient with hypopharyngeal cancer and gastroesophageal regurgitation].

We report the successful awake tracheal intubation in a patient with hypopharyngeal cancer and gastroesophageal regurgitation with the TaperGuard Evac tracheal tube (TaperGuard) and Pentax-AWS Airwayscope (AWS). A 63-year-old man with hypopharyngeal cancer with invasion to the glottis was scheduled for total laryngectomy under general anesthesia. He had undergone thoracic esophagectomy and could not maintain supine position due to severe gastroesophageal regurgitation. To avoid vomiting after induction of anesthesia, we planned awake intubation in the sitting position with the AWS. After topical anesthesia with 8% lidocaine and infusion of fentanyl and continuous dexmedetomidine, the AWS was inserted into his mouth in the sitting position from the cranial side. The AWS allowed visualizing the glottis avoiding the cancer, leading to safe placement of the tracheal tube.

[Successful tracheal intubation through the air-Q intubating laryngeal airway in a patient with severe pharyngeal edema].

A 68-year-old man was diagnosed with severe pharyngeal edema after neck lymph node dissection for cancer of the external ear canal. He was scheduled for an emergency tracheotomy, but preoperative fiberoptic laryngoscopy revealed airway and glottic obstruction due to severe pharyngeal edema. As difficult mask ventilation and tracheal intubation were anticipated, intubation under spontaneous ventilation was performed to avoid a "can't ventilate, can't intubate" situation. The first attempt to intubate the patient using the Pentax-AWS Airwayscope with a thin Intlock resulted in failure due to hindered visualization of the glottis. Therefore, a size 3.5 air-Q intubating laryngeal airway was inserted using a bronchofiberscope to perform tracheal intubation through a laryngeal mask. Successful tracheal intubation was achieved while maintaining spontaneous ventilation. The air-Q intubating laryngeal airway can be useful in the setting of anticipated difficult mask ventilation and tracheal intubation, as in the case of severe pharyngeal edema.

Go-rei-San, a Kampo medicine, reduces postoperative nausea and vomiting: a prospective, single-blind, randomized trial.

OBJECTIVE: The objective of this study was to determine the efficacy of Go-rei-San (GRS), a Kampo medicine, in the treatment of postoperative nausea, vomiting, or both nausea and vomiting (PONV). DESIGN: The study was a randomized, controlled, single-blind study of two groups of adult female patients who were scheduled to undergo benign gynecological laparoscopic surgery under general anesthesia. Patients in each group possessed an American Society of Anesthesiologists physical status of 1 (normal, healthy patient) to 2 (patient with a mild systemic disease). Patients were randomly assigned to the GRS group or the no-intervention group. INTERVENTION: Patients in the GRS group were given 7.5 g of GRS orally the day before surgery. OUTCOME MEASURES: The primary outcome measure was the severity of nausea at 0-3 h and 0-24 h after tracheal extubation. The secondary outcome measures were the incidence of vomiting at 0-3 h and 0-24 h and the frequency of vomiting at 0-24 h. The severity of nausea was measured by the patient, who used an 11-point verbal scale to indicate her strongest nausea. RESULTS: Of the 100 female patients selected for the study, 99 completed the trial, and no adverse events occurred. The severity of nausea, frequency of vomiting, and incidence of vomiting were significantly lower in the GRS group than in the no-intervention group. CONCLUSIONS: This study suggests that GRS may be effective for the reduction of PONV.