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

We report the development of a multi-center/multi- specialist perioperative team development training program about respiratory surgery. Participants were members of the team, including anesthesiologists, respiratory surgeons, and operation nurses. A ques- tionnaire survey was conducted prior to course partici- pation 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 pulmonary artery damage, intractable hypoxia during one lung ventilation, and severe hypotension accompanied with hypoxia after tracheal extubation. We also discussed the best method for preoperative smoking cessation for better surgery outcome. After each course, participants discussed problems associated with perioperative medi- cal safety of respiratory surgery in the context of each theme. Simulation-based perioperative team training with anesthesiologists, respiratory surgeons, and opera- tion nurses may serve as a vehicle to promote periop- erative obstetrics safety.

Preoperative Oral Administration of Kikyo-To, a Kampo Medicine, Alleviates Postoperative Sore Throat: A Prospective, Double-Blind, Randomized Study.

OBJECTIVES: This study aimed to determine the efficacy of Kikyo-To (KKT), a Kampo medicine, in treating postoperative sore throat and nausea. DESIGN: This randomized, controlled, double-blind study was conducted among two groups of women who were scheduled to undergo benign surgery under general anesthesia. All patients had a physical status of 1 (normal, healthy patient) or 2 (patient with a mild systemic disease), according to the American Society of Anesthesiologists criteria. Patients were randomly assigned to the KKT group or the placebo (control) group. INTERVENTION: Before surgery, the KKT group received KKT (5.0 g) mixed with jelly, while the placebo group received only jelly. Patients and the evaluator were blinded to the treatment status. OUTCOME MEASURES: At 0, 3, and 24 hours after anesthesia recovery, an investigator (also blinded to the treatment status) recorded the incidence and severity (using the Numeric Rating Scale [NRS]) of sore throat and nausea. RESULTS: The incidence of sore throat was significantly lower in the KKT group than in the control group immediately after surgery (p < 0.05). The severity of sore throat on the NRS was significantly lower in the KKT group than in the control group immediately and 3 hours after surgery (p < 0.05). In contrast, the incidence and severity of nausea did not differ significantly between the two groups. CONCLUSIONS: KKT administration before general anesthesia did not alleviate postoperative nausea but effectively decreased the incidence and severity of postoperative sore throat in women undergoing benign surgery.

[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.

[Airway Management Utilizing an air-Q blocker in a Patient with Motor Neuron Disease and Soft Palate Paralysis].

A 67-year-old woman suffering from hoarseness or dysphagia was diagnosed with motor neuron disease. She was scheduled for laparoscopic cholecystectomy under general anesthesia for suspected gallbladder cancer. She was concerned about the exacerbation of her hoarseness or dysphagia from tracheal intubation. We therefore decided to perform airway management by using supraglottic device air-Q blocker, through which a gastric tube could be inserted. We first passed the gastric tube through the outer blocker hole and inserted it into the esophagus using Magill forceps. The air-Q blocker was placed position under the guidance of a McGrath videolaryngoscope. Sealing pressure was over 20 cmH2O and mechanical ventilation was performed uneventfully during artificial pneumoperitoneum. We were able to deflate the stomach and perform tracheal suction via the inner hole of the air-Q. Following the operation, the patient developed neither hoarseness nor pharyngeal pain.

[Simulation-based Perioperative Team Training in the Operating Room].

Here, we report the development of a simulation-based perioperative training course. Participants were anesthesiologists and operating room nurses. Three different courses were held with different themes, such as airway management, circulation management and central venous management. The courses included a lecture and simulation training with scenario-based discussions or a simulator. At the end of each course, participants discussed problems associated with medical safety in the context of each theme. Participants commented not only on changes in their views regarding individual technical or non-technical improvements, but also on general medical safety in the operating room. Our findings suggest that simulation-based perioperative team training may serve as a vehicle to promote operating room safety.

Preventive Effect of Preoperative Administration of Hange-Shashin-To on Postoperative Sore Throat: A Prospective, Double-Blind, Randomized Trial.

OBJECTIVES: The present study aimed to determine the efficacy of Hange-Shashin-To (HST), a Kampo medicine, in treating postoperative sore throat and nausea. DESIGN: This randomized, controlled, double-blind study was conducted among two groups of adult female patients who were scheduled to undergo benign laparoscopic surgery under general anesthesia. All patients in each group had a physical status of either 1 (normal, healthy patient) or 2 (patient with a mild systemic disease), according to the American Society of Anesthesiologists. Patients were randomly assigned to either the HST group or the placebo (control) group. INTERVENTION: Before surgery, the HST group received HST (5.0 g) mixed with jelly, while the placebo group received only jelly. Patients and the evaluator were blinded to the treatment status. OUTCOME MEASURES: At 0, 3, and 24 hours after anesthesia recovery, an investigator (also blinded to the treatment status) recorded incidence and severity using the Numeric Rating Scale for sore throat and nausea. RESULTS: Incidence and severity of sore throat were significantly lower in the HST group than in the control group immediately and 3 hours after surgery (p<0.05). In contrast, incidence and severity of nausea did not differ significantly between the HST and control groups. CONCLUSIONS: HST administration before general anesthesia did not alleviate postoperative nausea, but effectively decreased the incidence and severity of postoperative sore throat in female patients undergoing laparoscopic surgery.

[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.

[Case with postoperative acute angle-closure glaucoma].

A 59-year-old man who had undergone biopsy of cervical lymph node under general anesthesia developed an attack of acute angle-closure glaucoma the night after the surgery. He had had no eye symptoms before. He complained of visual disorder, nausea, eye pain, and dizziness after the surgery. His intraocular pressure in the right eye was high (69 mmHg), and an ophthalmologist diagnosed it as acute angle-closure glaucoma. Dropping lotion in the eyes and the intravenous administration were not effective. His intraocular pressure decreased immediatery after laser iridotomy, and his symptoms improved. When the symptoms of eye pain and visual impairment appeared after the surgery, we should take acute angle-closure glaucoma into consideration and treat it as soon as possible.

[Effect of continuous intravenous infusion of flurbiprofen axetil and tramadol hydrochloride for postoperative pain management of laparoscopic colectomy].

BACKGROUND: In this study, we evaluated the efficacy of continuous intravenous infusion of flurbiprofen axetil (FA) combined with tramadol hydrochloride (TH) for postoperative pain control after laparoscopic colectomy. METHODS: Fifty patients scheduled for laparoscopic colectomy were randomly assigned to one of the following three groups : the saline group which received saline, the FA alone group which received FA 4 mg kg-1 . 24hr-1, and the FA plus TH group which received FA 4 mg kg-1 . 24 hr-1 and TH 2 mg kg-1 . 24 hr-1 intravenously after bolus injection of FA 50 mg immediately before the end of the operation. We examined the pain scores at 4 and 24 hr, and postoperative analgesic medication use during 0-4, 4-24, and 24-48 hours. RESULTS: Although no significant difference was observed among pain scores for these three groups, the FA plus TH group required the lowest dose of analgesic medication. For lower abdominal incision, the FA plus TH group required the least analgesic medication in 4-48 hr. No significant difference concerning analgesic medication was observed among the three groups for upper abdominal incision. CONCLUSIONS: Continuous intravenous injection of FA plus TH is more effective than FA alone for postoperative pain management after laparoscopic colectomy.

[Anesthetic management of laser surgery using PCPS for tracheal tumor].

Primary tracheal cancer is extremely rare, but critical tracheal stenosis is seen in many cases. Although laser resection or stent placement is performed under general anesthesia, anesthetic management for tracheal tumor is extremely difficult in terms of airway management. We report a 65-year-old woman scheduled to undergo bronchoscopic laser surgery and insertion of Dumon stent for tracheal tumor which severely obstructed the upper airway. Anesthesia was maintained with propofol, fentanyl and dexmedetomidine. Percutaneous cardiopulmonary support (PCPS) was established via the femoral artery and vein prior to induction of anaesthesia. Tumor resection was performed, but the stent placement was cancelled because a rigid bronchoscope could not be inserted due to difficult laryngeal exposure. Tracheostomy was then performed after weaning from PCPS. Although desaturation due to unsuccessful venous drainage and difficult ventilation by laryngeal edema during the operation and tracheal obstruction by a clot after the operation was observed, the patient's clinical condition improved. In cases of severe tracheal stenosis, airway obstruction by hemorrhage, secretion and laryngeal edema, etc. occur easily. Therefore, some kind of measures should be taken for the operation and a number of precautions must be taken during the perioperative period.

[Changes in palmar skin blood flow, perfusion index and temperature during endoscopic thoracic sympathectomy].

BACKGROUND: In endoscopic thoracic sympathectomy (ETS), it is required to perform accurate cautery of the sympathetic trunk. Monitoring of palmar skin blood flow and temperature has been used to assess the efficacy of ETS. This study investigated whether Perfusion Index (PI) is useful in assessing palmar skin blood flow and temperature in ETS. METHODS: We studied 5 patients (1 man, 4 women) with palmar hyperhidrosis who had undergone a total of 10 ETS procedures. We measured skin blood flow, temperature and PI during ETS and evaluated the results. RESULTS: Significant correlations were found between increases in skin blood flow and PI after ETS in cases with the palmar skin temperature just before ETS of below 35 degrees C. CONCLUSIONS: In these cases, we can substitute increases in PI with increases in skin blood flow during ETS.

[Management of intraoperative systolic anterior motion of the mitral valve after valve plasty: a case report].

We report a case of intraoperative systolic anterior motion (SAM) of the mitral valve after mitral valve plasty (MVP). A 53-year-old man underwent MVP for mitral regurgitation (MR). MVP was carried out uneventfully. We weaned the patient from cardiopulmonary bypass (CPB) with continuous administration of catecholamines and a vasodilator. However, after the weaning from CPB, transesophageal echocardiography (TEE) detected moderate MR with left ventricular outflow tract obstruction (LVOTO) due to SAM. LVOTO and SAM gradually disappeared after the reduction of catecholamines and volume loading. He was transferred to the intensive care unit postoperatively and extubated 18 hours after operation. Transthoracic echocardiography after operation revealed disappearance of MR. He was discharged from the hospital on postoperative day 15 without complications. We successfully managed MR with LVOTO due to SAM by reduction of catecholamines and volume loading.

[Three cases of acute pulmonary thromboembolism diagnosed by transesophageal echocardiography].

We report 3 cases of acute pulmonary thromboembolism (PTE) diagnosed by transesophageal echocardiography (TEE). In all these cases, cardiovascular state of the patient was unstable and therefore computerized tomography and catheterization of the pulmonary artery for diagnosis of PTE could not be performed. TEE was useful for diagnosis of acute PTE. All three patients passed away eventually and we had a difficult experience for treatment of acute PTE. We should take various measures against deep vein thrombosis for prevention of acute PTE.

[Relationship between seizure duration and bispectral index during modified electroconvulsive therapy].

BACKGROUND: The relationship between seizure duration and bispectral index (BIS) has not been studied well in modified electroconvulsive therapy (mECT). METHODS: We studied the changes in BIS and recorded the seizure duration during mECT under propofol and suxamethonium anesthesia. We examined the relationship between seizure duration and BIS. RESULTS: The BIS value immediately before turning on the electricity correlated with seizure duration. The range of BIS values that caused effective seizure duration were 53.6-58.8. CONCLUSIONS: Our study shows the possibility of determining the moment of application of electricity in mECT by using BIS values.