Masui. The Japanese journal of anesthesiology
-
Recent advances in prenatal diagnosis have made fetal surgery as a possible treatment for a wide variety of fetal diseases. Fetal surgeries consist of minimally invasive fetal surgery such as ultrasound guided procedure and fetoscopic surgery, open fetal surgery, and ex-utero intrapartum treatment. ⋯ For this purpose, anesthesiologists are supposed to know outlines of the fetal treatment in addition to pediatric and obstetric anesthesia, as a member of multidisciplinary team. In this review, outlines of fetal treatment will be introduced and anesthetic considerations for fetal surgeries will be discussed.
-
The trial of labor analgesia in Japan dates back to the year 1929. After the foundation of the original Japan Society of Obstetric Anesthesia and Perinatology in 1961, various labor analgesia techniques were widely attempted. Some anesthetists relieved the labor pain with balanced anesthesia using intravenous (diazepam and pethidine during the 1st stage of labor, followed by pentobarbital or ketamine during the 2nd stage of labor) combined with inhalational anesthetic (methoxyflurane or enflurane), while the others tried regional anesthesia. ⋯ However, the ideal labor analgesia technique has been still controversial. We, obstetric anesthesiologists, should grope for safer and more comfortable anesthetics to the mother and fetus. In next 50 years, the standard method for labor analgesia may change to no needle system with non-placental transfer anesthetics.
-
Environmental surfaces in operating rooms (e. g., tables, floors) are rarely implicated as the sources of pathogens important in the development of surgical site infections (SSIs). Nevertheless, it is important to perform routine cleaning of these surfaces to reestablish a clean environment after each operation. There are no data to support routine disinfecting of environmental surfaces or equipment between operations in the absence of contamination or visible soiling. ⋯ But they have not definitively been shown to reduce SSI rates. Many SSI prevention techniques are directed at reducing opportunities for microbial contamination of the patient's tissues or sterile surgical instruments; others are adjunctive, such as using antimicrobial prophylaxis or avoiding unnecessary traumatic tissue dissection. Optimum application of SSI prevention measures requires that a variety of patient and operation characteristics be carefully considered.
-
Infectious diseases, surgical site infections (SSI) in particular are the most popular perioperative complications, and not only the treatment but also prevention is extremely important. The inappropriate use of antibiotic prophylaxis in surgical patients accelerated the development of drug-resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA) or multiple-drug resistant Pseudomonas aeruginosa (MDRP) infections. ⋯ It is important to make a distinction between prophylactic and therapeutic antibiotic administration in the perioperative period. The anti-cross infection measure with the observance of Standard Precautions is also important in infection control.
-
As ultrasound beam does not penetrate the air, it has long been thought that ultrasound imaging is not useful for evaluation of the pulmonary parenchyma. However, recent studies have shown that the artifact pattern generated by the lung can be used for the diagnosis of acute respiratory failure. Lung ultrasonography can provide us important informations inside the lung in a real-time fashion. Furthermore, general application of extended ultrasonography would be of greater benefit for perioperative diagnosis and intervention.