Masui. The Japanese journal of anesthesiology
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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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Rapid onset of a muscle relaxant is required for general anesthesia with rapid sequence induction technique. Although a high dose of rocuronium was demonstrated to achieve the rapid onset in non-pregnant persons, it is still unknown whether this is true in women during late pregnancy. The purpose of this study is to compare the onset time of high dose rocuronium between pregnant and non-pregnant women. ⋯ The onset time of high dose of rocuronium in pregnant women was significantly shorter than that of non-pregnant women.
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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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Various kinds of evidence-based checklists and guidelines aimed at patient safety in the perioperative period are becoming popular in the clinical setting. These include WHO guidelines on surgical patient safety, surgical-crisis checklists, checklist for preventing major complications associated with cesarean delivery, NICE guidelines for surgical site infection, guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis, appropriateness criteria for stress echocardiography and so on. ⋯ When we use the guidelines and checklists correctly, we could see what is happening in a patient and what to do next for the patient leading us to correct diagnosis and appropriate treatment. Thus, evidence-based practice will be established in the near future in the perioperative period.
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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.