Five Fulbright scholars' contributions to Japanese anesthesiology.

After the signing the Peace Treaty in 1951 and Japan's political independence, the Fulbright Scholarship Program has started sending Japanese to American universities and academic institutions for clinical training and research. During the 1950s, more than two hundred physicians received the scholarship. At the time, anesthesiology was still in its infancy in Japan. However, among them, five physicians chose anesthesiology as their specialty and completed American anesthesiology residency. The Fulbright Scholarship recipients' contributions to Japanese anesthesiology during their professional career had been notable and is the subject of this article.

A Round Trip: The Japanese Contribution to the Development of Sevoflurane.

Sevoflurane was first synthesized independently by Richard Wallin and Bernard Regan at Travenol Laboratories Incorporated and Ross Terrell and Louise Croix at Airco, Inc in the late 1960s, and subsequent animal studies and a phase-1 human trial of the agent published in 1981 showed promising results. Further research in the United States was halted, however, because of concerns regarding potential nephrotoxicity and the introduction of less degradable alternatives. Interest in sevoflurane resumed in Japan when Maruishi Pharmaceutical Company, Limited (Ltd) (Maruishi) decided to continue its development in 1982. They secured approval by the Japanese Ministry of Health, Labor and Welfare for its clinical use in January 1990. Because of its low blood:gas partition coefficient and resulting rapid action, sevoflurane quickly became the anesthetic of choice of Japanese anesthesiologists. In 1992 Abbott Laboratories, now AbbVie, Inc (Abbott, North Chicago, IL) finalized a licensing agreement with Maruishi to seek the US Food and Drug Administration approval for sevoflurane sales in the United States. Approved in June 1995, sevoflurane is now marketed by Abbott in 120 countries and has been administered >120 million times. This report details the Japanese contribution to the development of sevoflurane.

The Reincarnation of Methoxyflurane.

Methoxyflurane was an inhaled agent commonly used for general anesthesia in the 1960s, but its clinical role gradually decreased in the 1970s because of reports of dose-dependent nephrotoxicity. In 1999 its manufacturer, Abbott Laboratories, discontinued distribution of methoxyflurane in the United States and Canada. Outside of North America, however, methoxyflurane has been reborn as an inhaled analgesic used for pain relief in the prehospital setting and for minor surgical procedures. First used in Australia and New Zealand, and subsequently in over thirty-seven other countries, low concentrations of methoxyflurane are administered with a hand-held inhaler which provides conscious sedation, so that patients can self-assess their level of pain and control the amount of inhaled agent. The Penthrox inhaler, originally developed in Australia after several other hand-held vaporizers were tried, is currently being used worldwide as a portable and disposable self-administered agent delivery system. Methoxyflurane-induced nephrotoxicity continues to be a major concern, but with cautious administration of recommended doses methoxyflurane has been established as a remarkably safe analgesic agent with minimal side effects for patients in need of rapid and potent pain relief.

Japanese Medical Education Reforms during the Allied Forces Occupancy; Roles Played by the Public Health and Welfare Section of the Supreme Commander for the Allied Powers.

The health and welfare of the Japanese people were of a lower standard compared to other developed countries at the end of the World War II in 1945. Crawford F. Sams, Chief, the Public Health and Welfare Section of the Supreme Commander for the Allied Powers thought that medical care in a wartom country could be improved not by building new hospitals and providing more medical equipment, but through professional education and training. He founded the Council on Medical Education to reform the Japanese medical education. The Council shaped Japanese medical education by establishing the standards for medical school education and initiating internship and a national medical licensure examination. In the early 1950s, the Unitarian Service Committee Medical Mission was invited to teach to medical school professors and students American medicine. This medical mission was also a contribution of the Public Health and Welfare Section to Japanese medical education. This article explores how Public Health and Welfare Section played vital roles in transforming Japanese medical education and postgraduate training during the occupation.

[The treasure of the American Society of Anesthesiologists: Wood Library-Museum of Anesthesiology].

The origin of the American Society of Anesthesiologists Wood Library of Museum (WLM) can be traced back to the early 1930s when Dr. Paul Meyer Wood donated his collection of books and medical devices to the New York Society of Anesthetists. The WLM's current activities go beyond collection and preservation of the historical materials and publication and sale of history-related books. The WLM publishes and sells history-related books, and provides anesthesia related materials and information to the society members, as well as the public in general. The on-going programs initiated by the WLM encourage one to study history (WLM Fellowship in Anesthesiology) and honor the established anesthesia historians (WLM Laureate of History of Anesthesia). At the annual ASA meeting, the WLM has also its own lectures and symposium sessions, such as 'Patrick Sim Forum on the History of Anesthesiology' 'Lewis H. Wright Memorial Lecture' and 'History Panel'. These activities are partly supported by a group of anesthesiologist-historians (Friends of WLM). The Japanese Society of Anesthesiologists' Museum was founded in 2011 and it is still in its infancy. In order for the museum to be fully functional, Japanese anesthesiologists will be able to learn from the well-established anesthesiology museum/libraries, such as the WLM.

[American contributions to Japanese anesthesiology--a historical view].

The origin of anesthesiology in Japan can be traced back to 1804, when Seishu Hanaoka administered anesthesia. However, the present day anesthesiology in Japan was shaped by two programs in the 1950s supported by the United States (US) Government. The first US program to influence anesthesiology in Japan was the Unitarian Service Committee (USC) Medical Mission. The USC sent three anesthesiologists; Dr. Meyer Saklad in 1950, Dr. Perry Perry Volpitto in 1951 and Dr. Joseph Artusio in 1956. The impact of the program on Japanese anesthesiology has been long-lasting. The second program was called Government Account for Relief in Occupied Area (GARIOA). Under this program, two Japanese physicians finished anesthesiology training in the US. Examining the history of our profession helps us understand the dedication and commitment of our pioneers, and prepares us to take on existing challenges to further the vision and goals set by our pioneers. The past provides us with a framework and understanding for how we pursue future opportunities and aspirations.

American anesthesiologists' contribution to post-World War II global anesthesiology: the Unitarian Service Committee's medical missions.

Beginning in 1946, the Unitarian Service Committee's Medical Mission sent 10 distinguished anesthesiologists to 13 different countries to teach anesthesiology. The details and impact of that mission are the subject of this article.

Accuracy of Anatomical Landmarks in Locating the Internal Jugular Vein Cannulation Site among Different Levels of Anesthesia Trainees.

BACKGROUND: Internal jugular vein (IJV) cannulation is a common practice procedure employed by anesthesiologists to access large central veins. The purpose of this study is to examine the accuracy of the use of superficial anatomical landmarks to locate the IJV as well as to delineate differences in accuracy at various levels of anesthesiology trainees, and staff. METHODS: We prospectively evaluated the accuracy of locating the left and right IJV on the skin surface by anesthesiology residents and board certified anesthesiologists. Twenty-four patients with body mass index (BMI) <30 and 24 morbidly obese patients with BMI > 40 were employed across all groups. Ultrasound imaging of the actual IJV course was utilized as a reference. RESULTS: Experienced operators (Third year residents and faculty) achieved better accuracy in locating the IJV compared to first and second year residents. Higher accuracy was achieved when the carotid pulse was used as a landmark compared to the sternocleidomastoid muscle, particularly for experienced operators in morbidly obese patients. Overall, there was no difference in accuracy between the right and left IJV, although medial deviation was greater on the left side. CONCLUSION: The accuracy of locating the IJV on the skin surface improved with operator experience in our anesthesiology training program. Experienced operators improved their accuracy using the carotid pulse as the external landmark. Ultrasound may be a useful tool to improve IJV localization early during training, and for cannulation of the left IJV.

Effects of hemoglobin concentration and temperature on the in vitro release of cyanide from sodium nitroprusside.

PURPOSE: This in vitro study was performed to determine whether changes in hemoglobin (Hb) concentration and temperature influenced the amount of cyanide (CN-) released from sodium nitroprusside (SNP). METHODS: Canine whole blood with a Hb concentration of 8.5 to 18.9 g·dl (5.3 to 18.9 mM) was equilibrated with SNP at either 37°C or 25°C, and CN- levels in plasma and red blood cells (RBC) were measured using the microdiffusion method. RESULTS: Changes in Hb concentration and temperature did not have any statistically significant effect on the CN- released from SNP in plasma. On the other hand, CN- levels in RBC decreased with increasing Hb concentrations. CN- levels in RBC were significantly lower at 25°C than at 37°C. CONCLUSION: Though the Hb concentration and temperature changed the amount of CN- released from SNP in RBC, the change observed was not clinically significant.