Blood transfusion, colloid therapy and the possible saving of albumin volumes during surgery: data analysis of the survey for certified hospitals of the Japanese Society of Anesthesiologists.

PURPOSE: Third-generation hydroxyethyl starch (HES) 130/0.4 has a larger dose limitation (up to 50 mL/kg/day) than HES 70/0.5 (up to 1000 mL/day) which has been used in Japan for 40 years. The aim of this study was to survey the current intraoperative blood transfusion and volume therapy and to predict the possible reduction of intraoperative albumin consumption assuming further replacement by HES 130/0.4 using data obtained from a survey by the Japanese Society of Anesthesiologists (JSA), although HES130/0.4 was not launched in Japan during this survey period. METHODS: In a JSA survey conducted at JSA-certified hospitals, 12,856 patients with a certain amount of blood loss were analyzed for 1 month (April, 2012). The patients were divided into two groups-group A included patients aged ≥11 years and group B included patients aged <10 years. The possible lower volume of intraoperative albumin was calculated assuming that HES 130/0.4 was used up to a dose of 50 mL/kg. RESULTS: Blood loss (total 15,111 L; 15,057 L in group A and 54 L in group B) was treated with allogeneic transfusion (total 7970 L; 7893 L in group A and 77 L in group B) and auto-transfusion (total 1777 L; 1771 L in group A and 6 L in group B) in both groups (n = 11,670 and 119). Albumin (total 1391 L; 1376 L in group A and 15 L in group B), and HES 70/0.5 (total 7645 L; 7638 L in group A and 7 L in group B) were used in both groups (n = 10,850 and 116). Five percent and 4.4 % albumin (total 1189 L; 1180 L in group A and 9 L in group B) could be replaced by HES 130/0.4 if HES 130/0.4 had been used up to a dose of 50 mL/kg. CONCLUSION: Blood loss (15,111 L) was replaced with allogeneic transfusion (53 %), auto-transfusion (12 %), albumin (9 %) and HES 70/0.5 (51 %) during surgery in April 2012. The predicted volume of 5 and 4.4 % albumin saved during this 1-month period if HES 130/0.4 had been used up to a dose of 50 mL/kg was 1189 L (86 % of actual amount used).

[Effect of the music-therapy under spinal anesthesia].

BACKGROUND: Since no pre-medication has been widely accepted especially in spinal anesthesia, anesthesiologists should manage the control of patient's anxiety during surgery. Instead of sedatives, we have been using music-therapy during spinal anesthesia. Bispectral index monitoring (BIS) is used as one of the sedation indices in spinal anesthesia. The aim of this study was to assess the music-therapy on reducing anxiety of patients under spinal anesthesia using BIS and interview type psychology test, State Trait Anxiety Inventory (STAI). METHODS: Fifty-eight ASA physical status I-II patients scheduled for spinal anesthesia, were randomly allocated into M group (music group, n=29) or C group (control, n=29). BIS, EMG, and SQI of both groups were obtained continuously with computer system. Patients in M group listened to music by head phone and those in C group were left free under ordinary operating theater environment. Trait Anxiety Inventory (STAI-TA) score was obtained preoperatively for property-based anxiety and the State Anxiety Inventory (STAI-SA) score was obtained postoperatively for condition-based anxiety. Time averaged BIS scores (pre-surgery, during-surgery and post-surgery period)were obtained during operation. RESULTS: Time averaged BIS values of M and C group in pre-surgery period, during-surgery period, and post-surgery period were 95.3+/-0.4 vs 95.8+/-0.4 (NS), 87.6+/-7.5 vs 95.1+/-2.8 (P<0.01) and 96.0+/-0.4 vs. 96.2+/-0.4 (NS), respectively. Post-surgery STAI-SA was 29.7+/-7.2 in M group vs 38.8+/-10.3 in C group (P<0.01) while pre-surgery STAI-SA scores of both groups were not different. CONCLUSIONS: Music-therapy reduced BIS value and was effective to reduce patient's anxiety during spinal anesthesia.