Shortened cataract surgery by standardisation of the perioperative protocol according to the Joint Commission International accreditation: a retrospective observational study.

OBJECTIVES: To investigate the impact of standardisation of the perioperative protocol based on the Joint Commission International (JCI) accreditation guidelines for operating time in cataract surgery. DESIGN: Retrospective observational study. SETTING: Single centre in Japan. PARTICIPANTS: Between March 2014 and June 2016, 3127 patients underwent cataract surgery under topical anaesthesia including 2581 and 546 patients before and after JCI accreditation, respectively. PRIMARY AND SECONDARY OUTCOMES: We compared three time periods, comprising the preprocedure/surgery time (pre-PT), PT and post-PT, and total PT (TPT) of cataract surgery between patients before and after JCI accreditation, by regression analysis adjusted for age, sex and cataract surgery-associated confounders. RESULTS: The main outcomes were pre-PT, PT, post-PT and TPT. Pre-PT (19.8±10.5 vs 13.9±8.5 min, p<0.001) and post-PT (3.5±4.6 vs 2.6±2.1 min, p<0.001) significantly decreased after JCI accreditation, while PT did not significantly change (16.8±6.7 vs 16.2±6.3 min, p=0.065). Consequently, TPT decreased on average by 7.3 min per person after JCI accreditation (40.1±13.4 vs 32.8±10.9 min, p<0.001). After adjusting for confounders, pre-PT (ß=-5.82 min, 95% CI -6.75 to -4.88), PT (ß=-0.76 min, 95% CI -1.34 to -1.71), post-PT (ß=-0.85 min, 95% CI -1.24 to -0.45) and TPT (ß=-7.43 min, 95% CI -8.61 to -6.24) were significantly shortened after JCI accreditation. CONCLUSION: Perioperative protocol standardisation, based on JCI accreditation, shortened TPT in cataract surgery under local anaesthesia.

[Energy expenditure of anesthesiologists estimated from number of steps].

The physical activity can be mainly evaluated by the number of steps. We estimated the energy expenditure from the number of steps in the different job specifications of anesthesiologists using digital pedometer Walk Life CH-200 (Crecer Co, Tokyo, Japan). The average number of steps in the anesthesiologists (n = 41, 31 +/- 5 yr. old, M/F = 34/7, body mass index (BMI) 23 +/- 4 kg x m(-2)] during daily working hours was 7,778 and almost as same as the average number of steps in Japanese people for one day or manufacturer during daily working hours. The average numbers of steps in the residents (n = 26, 29 +/- 4 yr. old, M/F = 20/6, BMI 21 +/- 2 kg x m(-2)), instructors (n = 10, 35 +/- 5 yr. old, M/F = 9/1, BMI 24 +/- 4 kg x m(-2)), and supervisors (n = 5, 38 +/- 6 yr. old, M/F = 5/0, BMI 27 +/- 3 kg x m(-2)) were 7,249, 8,399, and 11,599, respectively. The number of steps in supervisor was significantly more than resident. Our present findings about the numbers of steps in the anesthesiologists were contrary to the general reports that the number of step in manager is less than laborer and the number of step decreases with aging and increasing BMI. No sex difference with the numbers of steps in anesthesiologists was contrary to the general report that the number of step in male is more than female. From our present results, the energy expenditure estimated from the number of steps in anesthesiologists, residents, instructors, and supervisors might correspond to 285, 246, 331, and 516 kcal, respectively.

[Novel assessment of intracellular calcium transient decay in cardiac muscle by curve-fitting with half-logistic function].

A decrease in intracellular calcium (Ca2+) concentration in the cardiac muscle is one of the important factors to induce myocardial relaxation. A mono-exponential (m-E) function has been used for assessing myocardial relaxation curve of isometric tension and intracellular calcium transient (CaT) decay, and the m-E time constants for the relaxation curve of isometric tension (F tau E) and CaT decay (Ca tau E) have been recognised as lusitropic indices. However, we found that a half-logistic (h-L) function fits the relaxation curve of isometric tension much more precisely than the conventional m-E function in the ferret right ventricular (RV) papillary muscle. Moreover, we demonstrated that the goodness of the h-L fits for CaT decays was superior to the goodness of the m-E fits in the rabbit RV and murine left ventricular papillary muscles. The changes in the h-L time constants for the relaxation curves of isometric tension (F tau L) and CaT decays (Ca tau L) with the different onsets were significantly smaller than the changes in F tau E and Ca tau E, respectively. The differences in the h-L non-zero asymptotes for the relaxation curves of isometric tension and CaT decays with the different onsets were smaller than the changes in the m-E non-zero asymptotes. The h-L function model characterises the amplitudes and time courses of the relaxation curve of isometric tension and CaT decay more precisely than the m-E function model, and thus F tau L and Ca tau L serve as more novel and reliable lusitropic indices. Simultaneous analysis of myocardial relaxation curve of isometric tension and CaT decay using h-L functions can become a useful method for assessment of myocardial calcium handling.

[Assessment by logistic model of hemodynamic changes during general anesthesia].

The anesthesia induction with strong anesthetic agents generally reduces blood pressure. Cardiovascular agents used during anesthesia induce hemodynamic changes. The time courses of systolic (sBP) and diastolic blood pressure (dBP) and heart rate (HR) are expressed as sigmoidal curve. We have found that the hemodynamic changes can be precisely curve-fitted with a logistic function giving non-linear curve. The four parameters of the logistic function present the first asymptote, the last asymptote, the slope at the inflection point, and the time to the inflection point. Moreover, each logistic parameter is used for the effects of drug dose, age and sex differences of subjects on the hemodynamic change. In this review, we introduce the analyses with the logistic function for the changes in sBP, and dBP during preintubation period and HR, sBP, and dBP during infusion of landiolol hydrochloride, an ultra-short-acting beta1-adrenergic receptor blocking agent, which is used for subjects with tachycardia during general anesthesia. The logistic parameters are useful for assessing the hemodynamic response during general anesthesia. The assessment method of the hemodynamic change using the logistic model contributes much to the management of anesthesia.