Masui. The Japanese journal of anesthesiology
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As a population ages, an increase in the number of patients with cardiac complications who undergo non-cardiac surgeries is observed. The perioperative mortality for noncardiac surgery is approximately 1-5%; approximately 20-35% of these cases are due to cardiovascular complications. Among them, perioperative myocardiac infarction/ischemia is a factor that leads to poor prognosis, and the ACC/AHA guidelines emphasize this aspect. An important task of the anesthesiologist is to accurately assess risks in patients undergoing noncardiac surgeries and avoid adverse cardiovascular events.
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Intraoperative crisis is an inevitable event to anesthesiologists. The crisis requires effective and coordinated management once it happened but it is difficult to manage the crises properly under extreme stressful situation. Recently, it is reported that the use of surgical crisis checklists is associated with significant improvement in the management of operating-room crises in a high-fidelity simulation study. ⋯ It undoubtedly predicts higher than average risk of postoperative complications and death within 30 days of surgery. Surgical Apgar score is a bridge between proper intraoperative and postoperative care. Anesthesiologists should make effort to reduce the postoperative complication and this score is a tool for it.
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Review
[Does Surgical Safety Checklist for cesarean section improve maternal and neonatal outcome?].
Surgical Safety Checklist published by WHO (World Health Organization) has been widely accepted and contributed to reduce postoperative mortality and morbidity. However, the implementation of the original checklist for cesarean section has been questioned as most of the patients for cesarean section being awake at the occasion of time out, and some patients requiring emergency cesarean section. From these points of view, modified versions of the checklist for cesarean section have been proposed. ⋯ K. published a checklist specifically for obstetric surgery, and its usefulness has been evaluated. The most important modification of the checklist seems to be adoption of classification of urgency of cesarean section by NICE (National Institute of Clinical Excellence) into the time out Surgical Safety Checklist from U. K. is introduced with its recent evaluation, and its possible adoption in Japanese hospitals will be discussed.
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Randomized Controlled Trial
[Analgesic efficacy and clinical safety of intraperitoneal instillation combined with rectus sheath block using ropivacaine for pain relief after laparoscopic gynecological surgery].
The aim of this study was to evaluate the analgesic efficacy and safety of rectus sheath block combined with intraperitoneal instillation using two doses of ropivacaine in patients undergoing laparoscopic gynecological surgery. ⋯ The present study showed that the combination of rectus sheath block with intraperitoneal instillation of ropivacaine was safe and potent enough to relieve pain after laparoscopic surgery.
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Although magnesium can potentially shorten onset time of a muscle relaxant, it is unclear whether it does shorten the onset time of rocuronium for patients in cesarean delivery (CD). Thus the purpose of this study is to compare the onset time of rocuronium in patients with or without preoperative magnesium treatment. ⋯ Magnesium did not shorten the onset time of rocuronium 0.6 mg x kg(-1) in CD patients.