Masui. The Japanese journal of anesthesiology
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A 38-year-old female, at 38-week gestation, was scheduled for cesarean section under epidural anesthesia. After the delivery, it was found that she had been diagnosed as myotonic dystrophy by the other physician and the neonate was a floppy infant indicating hereditary neuromuscular diseases. ⋯ We previously had given her general anesthesia for two times with nitrous oxide, isoflurane and vecuronium for her to undergo emergency operations, left salpingectomy under laparoscopy due to unruptured tubal pregnancy at 34 years of age and cesarean section due to liver function disorder indicating HELLP syndrome at 36 years of age. Although many problems have been described about the perioperative management in patients with myotonic dystrophy, she was safely managed for each operation.
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To make the public aware of the risks of anesthesia, we prepared an explanatory note composed of 634 Japanese characters or of 248 English words. The incidences of fatal anesthetic complications over a five-year period in 2,358,642 anesthetics in 741 Certified Training Hospital belonging to the Japanese Society of Anesthesiologists were cited in the explanatory note. Patients were asked to read and sign the explanatory note prior to agreeing to surgery. ⋯ Thereafter, responsible anesthesiologists visit and evaluate patients, and explain common as well as specific anesthesia risks to each patient. A survey by mailing questionnaires regarding this explanatory note and anesthesia risks sent to patients, who had read and signed the explanatory note, revealed that the patients were generally satisfied with the content of the explanatory note. This system may help patients, surgeons and anesthesiologists to recognize anesthesia risks on the same basis.