Journal of Anesthesia最新文献

Malignant hyperthermia (MH) is a rare, life-threatening inherited disorder triggered by volatile inhalational anesthetics and/or the depolarizing muscle relaxant suxamethonium. In susceptible individuals, calcium release from the sarcoplasmic reticulum in the skeletal muscle becomes abnormally accelerated, leading to a hypermetabolic state. Early signs of MH include unexplained hypercarbia (end-tidal carbon dioxide > 55 mm Hg), tachycardia, and muscle rigidity, particularly in the masseter. Rapid increases in core temperature (> 0.5 °C/15 min, with temperatures often exceeding 40 °C) are typical. With progression, respiratory and metabolic acidosis, arrhythmias, cola-colored urine (myoglobinuria), elevated serum potassium, and tented T-waves may develop, potentially leading to cardiac arrest or multiorgan failure. The Japanese Society of Anesthesiologists' guidelines for the management of MH in 2025 (Japanese version) emphasize the importance of early recognition and immediate intervention. The essential steps include discontinuing triggering agents, administering intravenous dantrolene (initially 1-2 mg/kg), aggressive cooling of the body, and managing complications, such as hyperkalemia and acidosis. On the basis of international standards, a higher initial dose of dantrolene is recommended. Preoperative assessment of MH risk should include history taking for anesthetic complications, a family history suggestive of MH susceptibility, signs of congenital myopathies, and careful anesthetic planning using non-triggering agents. Genetic testing and muscle biopsy may aid in the diagnosis but are not definitive in all cases. The Japanese translation of these guidelines has been posted on the following website: https://anesth.or.jp/files/pdf/guideline_akuseikounetsu . pdf.

Background: One-lung ventilation (OLV) is an essential technique in thoracic surgery, and double-lumen endobronchial tubes (DLTs) are commonly used. While right-sided DLTs are useful in specific situations, few studies have investigated the prevalence of their use. This study aimed to investigate the current practice of OLV and right-sided DLT usage among anesthesiologists in Japan.

Methods: A nationwide cross-sectional survey was conducted in September 2024, targeting 1444 hospitals certified by the Japanese Society of Anesthesiologists. Questionnaires were mailed to anesthesiology departments, inquiring about OLV practices, right-sided DLT usage, challenges, and desired improvements. Responses were collected via postal mail or web, and data were analyzed using descriptive statistics and Chi-square tests.

Results: A total of 768 institutions responded (response rate: 53.2%). Among 761 valid responses, 74.9% performed OLV, and DLTs were the most frequently used device (94.7%). Approximately half (45.8%) of the institutions performing OLV reported never using right-sided DLTs. Frequently recognized challenges included insertion difficulty, positioning difficulty, and unfamiliarity, and 42.1% of institutions expressed a willingness to increase the use of right-sided DLTs if these challenges were resolved. Institutions with a higher annual volume of OLV cases tended to use right-sided DLTs more frequently, but the proportion of institutions unfamiliar with right-sided DLTs was not associated with the number of OLV cases performed.

Conclusion: OLV is widely practiced in Japan, primarily using DLTs, while the use of right-sided DLTs is limited. Concerns over technical difficulties and complications may hinder the use of right-sided DLTs.

The global healthcare sector accounts for approximately 4.4% of the total greenhouse gas emissions, with anesthesiology contributing disproportionately through volatile anesthetic agents whose global warming potentials range from 130 (sevoflurane) to 2540 (desflurane). This narrative review examines the environmental implications of contemporary anesthetic practice and evaluates evidence-based strategies for sustainable anesthesia delivery. Desflurane has a global warming potential approximately 20-fold greater than sevoflurane, making it the most environmentally damaging volatile anesthetic in clinical use. Total intravenous anesthesia (TIVA) produces substantially lower emissions at approximately 0.4 kg CO₂-equivalent/h, compared with 3.1-3.8 kg CO₂-equivalent/h for volatile-based techniques. Low-flow anesthesia techniques may reduce volatile agent consumption by 50-75% without compromising patient safety. Current evidence suggests that sustainable anesthesia practices can substantially reduce environmental impact while maintaining optimal patient safety. Strategies such as eliminating desflurane use, implementing low-flow techniques, and increasing TIVA utilization represent immediately implementable interventions with established safety profiles and demonstrated economic benefits. Implementation in diverse healthcare settings, including Asian contexts, requires tailored approaches considering regional practice patterns and resource availability.

Background: Surgical smoke produced by the use of an electrosurgical unit may have a negative effect to patients and healthcare workers in the operating room, but studies on this problem are insufficient.

Methods: In 100 situations in which patients were undergoing four types of surgery under general anesthesia, the count of airborne particles (in 1.415 L) was measured using a particle counter to see possible differences at the patients and at the anesthesiologists, during different types of surgery, and at several locations.

Results: The airborne particles during the use of an electrosurgical unit were significantly higher than before its use, both at the patient's head (median: 56/L vs 3,514/L; 95%CI for the median difference: 769-7,699/L) and at the anesthesiologist's position (230/L vs 6,907/L; 95%CI for the median difference: 2,945-13,196/L) (p < 0.0001). The airborne particles were significantly higher during cardiovascular surgery than during open abdominal surgery (median difference in increase: 8,439/L), significantly higher during open abdominal surgery than during head and neck surgery (2,654/L), and significantly higher during head and neck surgery than during laparoscopic surgery (1,442/L) (all p < 0.0001), and were high anywhere in the operating room and even outside the operating room door (always > 2,000/L).

Conclusions: During the use of an electrosurgical unit, both the patients and healthcare workers are at increased risk of being exposed to high concentrations of airborne particles derived from surgical smoke.