Masui. The Japanese journal of anesthesiology
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Annual surveys conducted by the Japanese Society of Anesthesiologists repeatedly show that hemorrhage is the leading cause of life-threatening events in the operating room. ⋯ Undertransfusion may occur in 16.7-28.3% of cases of massive hemorrhage in the operating room, and the rate of emergency blood transfusion was much lower than this percentage. To avoid operation-associated deaths from hemorrhage, the improvement of hospital systems for emergency blood transfusion, including the active use of intraoperative blood salvage, should be promoted.
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A 59-year-old man with poor pulmonary functions was scheduled for thoracoscopic lung resection because of right pneumothorax. In order to preserve spontaneous breathing and prevent left pneumothorax, we selected epidural anesthesia and intravenous dexmedetomidine. We could provide appropriate sedative and antianxiety effect without respiratory depression and hemodynamic change. With its unique features, dexmedetomidine is useful for thoracoscopic surgery in a patient with poor lung functions.
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In this special issue, the topic of sex difference in the field of anesthesiology is featured. Eight subtopics are discussed including 1) sex differences in cardiovascular medicine, 2) perioperative cardiovascular management, 3) sex differences in the respiratory functions of the upper airway, 4) sex differences in the anesthetic management, 5) sex differences in pain, 6) sex differences in laboratory medicine, 7) sex differences in pharmacokinetics of anesthetics, and 8) postoperative nausea and vomiting. Although recent clinical and experimental studies have shown the existence of sex and/or gender differences in many fields of medicine, our knowledge of sex differences in anesthesiology is apparently insufficient. I believe that anesthesiologists should pay more attention to this topic to improve our daily practice of anesthesia.
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Postoperative nausea and vomiting (PONV) are two of the commonest and most distressing complications of general anesthesia and surgery. Factors affecting PONV are patient characteristics, surgical procedure, anesthetic technique, and postoperative care. Female patients have 1.5-3 times greater incidence of PONV than males, due to increased plasma progesterone levels during their menstrual cycles. ⋯ Most of published trials indicate improved prophylaxis against PONV by avoiding risk factors and/or by using effective antiemetic therapy (e. g., traditional and non-traditional antiemetics, serotonin receptor antagonists). Non-pharmacotherapy (e. g., P6 acupressure) is also important. Knowledge regarding prophylactic antiemetic therapy is necessary to management of PONV in female patients.
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Men and women have different body compositions such as fat and fluid, and hormonal environments which affect both pharmacokinetics and pharmacodynamics of anesthesia-related drugs. The knowledge on gender differences in the effects of these drugs has been accumulated. ⋯ Then, gender differences in the effects of commonly used anesthesia-related agents are discussed. Although there have not been remarkable differences demonstrated, better understanding of the difference may lead to satisfying perioperative anesthetic cares for each sex.