Masui. The Japanese journal of anesthesiology
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Palliative care prevents and relieves total pain of patients and their families and improves their quality of life. The author describes the work of anesthesiologists in palliative care unit as ward staffs. The need for palliative care units is increasing and new palliative care units are being established throughout Japan. ⋯ Anesthesiologists manage the patients who need to be sedated for relief of refractory sufferings by sedative drugs in palliative care unit It is important that we anesthesiologists walk alongside the patients when they need to be heard in the end of life stage. We expect that it is a key point to palliate spiritual pain of the patients. I hope many young anesthesiologists serve as capable members in the palliative care unit in the future.
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World Health Organization has proposed that palliative medicine should be applied early in the course of the malignant diseases. Regrettably, however, palliative care has been usually provided to patients with the advanced stage of cancer, as terminal care. Recently, palliative medicine begins at the time when patients are diagnosed with cancer. In response to changes in clinical settings of palliative medicine, anesthesiologists, with substantial experience in interdisciplinary pain management, can utilize their advantages in providing palliative medicine to cancer patients: 1) use of opioid analgesics; 2) considering the biopsychosocial model of pain; 3) helping patients live as actively as possible until death; and 4) helping the family cope with the patient's illness and their own bereavement.
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We report here a case of rocuronium-induced anaphylactic shock in a 41-year-old woman. She was scheduled for partial hepatectomy due to liver metastasis of a pheochromocytoma. Anesthesia was induced with propofol, remifentanil, and rocuronium. ⋯ A skin test also showed cross-reactivity between rocuronium and vecuronium. Therefore, we did not use any neuromuscular agent for the subsequent surgery, which was completed uneventfully. Determining the drug responsible for anaphylaxis helps to prevent recurrence of anaphylaxis.
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Governmental policies recommend the palliative care at home for cancer patients. However, there are some barriers to discharge cancer patients from the hospital who want to receive end-of-life care at their homes. Anesthesiologists whose main job is to perform general anesthesia in the operating theater usually have little contact with general practitioners giving community palliative care. So it is important to communicate each other to make opportunities to discuss an organized system and care plan for these patients, and to improve information transfer.
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The aim of Japanese Society of Anesthesiologists is to provide safe and comfortable medical care through biological management in emergency and intensive care using pain management and palliative medical care to deal with disease and surgery. Thus, in addition to the fields of intensive care medicine and emergency medicine, anesthesiologists have been expected to play an important role in the field of palliative medicine. Recently, anesthesiologists have been becoming professors and heads in the field of palliative medicine at many university hospitals in Japan. ⋯ It is appropriate at any age and at any stage of a serious illness and can be provided along with curative treatment. Palliative care is also appropriate for patients from the point of diagnosing a serious illness--not just for the end of life. Anesthesiologists should show more leadership in the field of such palliative medicine in Japan.