Masui. The Japanese journal of anesthesiology
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The current efforts and strategies have greatly helped reduce transfusion-associated risks. Indeed, the risk of being infected by a contaminated blood unit today is lower than that thirty years ago. ⋯ Compatibility testing is designed to ensure that the patient receives the intended units of red cell concentrate (RCC) and that transfusion will be effective with minimum risk of adverse reactions. The process includes ABO and Rh typing of patients, testing recipient serum for clinically important alloantibodies, and crossmatching donor red cells with recipient serum by a technique that detects serological incompatibility.
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According to a survey of anesthesia-related critical incidents by the Japanese Society of Anesthesiologists, hemorrhage was the major cause of cardiac arrest developing in the operating room. To deal with critical hemorrhage swiftly, not only cooperation between anesthesiologists and surgeons but also the linkage of operating rooms with transfusion management divisions and the blood center is important. It is desirable for the hospital transfusion committee to prepare hospital regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these guidelines by simulated drills. ⋯ The evolving concept of hemostatic resuscitation seems to be important to prevent coagulopathy, which easily develops during massive hemorrhage. Anesthesiologists should be aware of the risk of such an emergency transfusion and procedures to be taken to switch to transfusion of the ABO-identical blood. Establishment of a hospital emergency transfusion system depends on the overall capability of the critical and crisis management systems of the hospital.
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Airway scope (AWS) is a rigid indirect laryngoscope with integrated tube guidance and can improve laryngeal exposure compared to the conventional direct laryngoscope. It is expected that the clear and improved laryngeal view obtained with AWS can eliminate the risk of esophageal intubation. We, however, experienced 3 cases of esophageal intubation out of 600 clinical cases with AWS in 15 month after its market release. ⋯ The third case was performed by an experienced laryngoscopist but it was difficult to identify the glottic opening because patient had distracted airway anatomy due to laryngeal tumor. In all cases esophageal intubation was immediately noticed and airway was secured uneventfully. We conclude that intubation under vision with improved laryngeal view is still not sufficient to prevent esophageal intubation.
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The latest revision of Japanese practical guidelines for the blood component therapy, edited by the Ministry of Health, Labour and Welfare of Japan in 2005, consisted of several crucial points including: emergency red cell transfusion for critically ill patients; the computer crossmatch; and non-erythrocyte blood component therapy based on diagnosis for coagulopathy. The guidelines issued by the Japanese Society of Anesthesiologists as well as the Japan Society of Transfusion Medicine and Cell Therapy (2008) further focused on the strategy for perioperative massive blood loss. Seven feature articles following this opening article summarizes the topics for the new frontier in perioperative blood component therapy in Japan.