2014年4月24日木曜日

新入局員歓迎会 2014!!


今年度も女子医大麻酔科は11名という多くの新入局員を迎えました!

4月は異動・入局・退局のため大学の雰囲気ががらりと変わります。
(現在出向中の私にとってはその雰囲気が味わえず残念ではありますが。。)

 
先日、5月に控えている日本麻酔科学会の予演会後、
四谷三丁目の一軒家レストランにて新入局員歓迎会が開かれました。



40人近い医局員とスペシャルゲストのちびっ子たちも参加してくれて
大変盛り上がりました。










11名の新入局員の自己紹介が続き、
まだまだ全員の細かいところまでは覚えられていませんが、
とっても意欲のある素晴らしい先生方ばかりです。

そしてその日は3次会まで続き、夜はふけていったのでした




 


今後ともどうぞよろしくお願いいたします

2014年4月18日金曜日

<日本臨床麻酔学会メールマガジン> 第13号

☆★――――――――――――――――――――――★☆
    <日本臨床麻酔学会メールマガジン> 第13号
☆★――――――――――――――――――――――★☆

日本臨床麻酔学会から第13号(2014年4月号)メルマガのお届けです。

==============================
日本臨床麻酔学会広報委員会提供のメールマガジンをお届けいたします!
なんとこのメールマガジンの登録者数が600名を超えました!
これからも是非どんどん皆様の周りに宣伝していただき、登録者数を増やしていきたいです!

さて、今号は、耳寄りな情報がたくさんあります。

まず、「2014年度 企業後援研究奨励賞 募集のお知らせ」です。
MSD賞とクーデック賞があり、どちらも賞金が50万円出ますので、
下記のURLにて詳細情報を得て、どしどし応募なさって下さい。
更に日本臨床麻酔学会としての研究助成金1件40万の募集も行っています。
なおこれらの申請書提出の締切期日は年次大会一般演題締め切り日となっています。
  http://jsca.umin.jp/

次いで、第34回日本臨床麻酔学会の学術大会が今年秋の
11月1日から3日間にわたってグランドプリンスホテル新高輪 国際館パミールにて
開催されますが、その一般演題受付が開始されました。
演題登録締め切りは、2014年6月14日(土)24:00までで、
オンラインにて抄録受付を行っていますのでふるって応募下さい。
  http://meetingnavi.com/jsca2014/

チャンスは前髪をつかまなくてはあっという間に逃げ去るかもしれません。
後ろ髪をひいていたのでは間に合いません。
皆さまもこのメールマガジンで先んじたニュースを捉え、演題登録や研究奨励賞に
どしどし応募なさって下さい。
==============================

/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\
本メールマガジンの解除はこちらから
https://secure01.red.shared-server.net/www.waaint.co.jp/jsca_mm/
==============================================================
【配信元】日本臨床麻酔学会 広報委員会

本メールにお心当たりのない方は、
お手数ですが<mailto:jsca@waaint.co.jp>までご連絡下さい。
日本臨床麻酔学会
http://jsca.umin.jp/

2014年4月11日金曜日

Anesthetic Choice for TKA Cases Tied to Board Certification

Anesthesiology News - Anesthetic Choice for TKA Cases Tied to Board Certification



Anesthetic Choice for TKA Cases Tied to Board Certification
by Ajai Raj
image
The choice to use regional anesthesia rather than general anesthesia for total knee arthroplasty correlates strongly with an anesthesiologist’s board-certification status, new research shows.

The study found that, compared with their board-certified counterparts, non–board-certified anesthesiologists were more likely to use general anesthesia than neuraxial anesthesia or peripheral nerve blocks. A growing body of evidence shows that neuraxial anesthesia leads to better outcomes for patients than general anesthesia in joint replacement procedures, although the authors of the latest study cautioned that this is not universally agreed on.

Previous studies also suggested that the disparity in treatment choices might exist between board-certified and non–board-certified practitioners. None, however, had been conducted on such a large scale.

“The results are what we had hypothesized, but there are many factors that can contribute to the decision regarding the anesthetic technique,” said Peter M. Fleischut, MD, assistant professor in the Department of Anesthesiology at NewYork-Presbyterian Hospital/Weill Cornell Medical College, in New York City, and a co-author of the study. “For example, in this dataset non–board-certified anesthesiologists tended to take care of older patients” with a higher American Society of Anesthesiologists (ASA) surgical status.

The results do not warrant drawing any conclusions about individual practitioners based on their board certification status, but rather raise questions about these larger-scale practice patterns that merit further investigation, according to the researchers, who presented their findings at the ASA’s 2013 annual meeting (abstract 1001).

Emerging Findings From AQI

The study is one of the first to use data in the National Anesthesia Clinical Outcomes Registry (NACOR), collected by the Anesthesia Quality Institute (AQI). Researchers examined approximately 97,000 NACOR records for patients who underwent total knee arthroplasty surgery between 2010 and 2013 in which the anesthesiologist’s board certification status was available. Board-certified anesthesiologists attended to 82% of these patients. Board-certified anesthesiologists provided general anesthesia for this procedure less frequently than non–board-certified anesthesiologists (36% vs. 62%, respectively). Board-certified anesthesiologists used either neuraxial or regional anesthesia in 41% of the procedures, whereas non–board-certified anesthesiologists used these techniques 21% of the time.

Regardless of why a given anesthesiologist might choose general over regional anesthesia for a knee replacement procedure, patients are entitled to care that leads to the best possible outcomes, said Stavros Memtsoudis, MD, PhD, clinical professor of anesthesiology and of public health at Weill Cornell Medical College, and the study’s senior author.

Dr. Memtsoudis said previous work, including a recent study of his own published inAnesthesiology (2013;118:1046-1058), found that using regional anesthesia for total knee replacements is associated with better outcomes, including decreased blood loss, lower risk for blood clots, fewer organ-specific complications and decreased mortality.

“These population-based database studies that we provide don’t really allow us to establish a causal relationship. We can’t account for all covariates that may play a part when it comes to outcomes,” Dr. Memtsoudis said. “What I always clarify is that our data provide information on associations. Thus, we can conclude that patients who received a neuraxial anesthetic in this cohort did better across a wide range of outcomes.

“However, can we conclusively say that it was because of the neuraxial anesthetic? Not for sure; it may be, for example, that the performance of neuraxial anesthetics is a marker of a certain type of practice in a certain hospital,” he added. “For example, it may reflect that staff at these hospitals may be better trained to care for a particular patient group, they may be more involved, or may be part of a comprehensive perioperative practice that overall promotes better outcomes. Therefore, the question regarding what factors may contribute to the specific practice pattern is something we are looking into right now.”

Dr. Memtsoudis and his colleagues will be publishing a study in Regional Anesthesia and Pain Medicine assessing whether neuraxial anesthesia is equally effective in reducing complications in patient subpopulations of different age and comorbidity burden.

“From a patient perspective, it may not matter as much if the effects are due to cause or represent just an association,” Dr. Memtsoudis said. “Because if a patient chooses a place that provides neuraxial anesthesia for their cases, and they know that it is associated with better outcomes, then patients may not care whether it’s because neuraxial anesthesia is a marker of better care, or it’s because of the neuraxial anesthetic itself that better outcomes are achieved.”

Perhaps more significant than the findings regarding practice patterns, at least from a research perspective, were the methods used to conduct this study, Dr. Fleischut said.

“The most significant feature of this study was the large volume of data available to test the proposed hypothesis. As with other big data studies, having a wealth of information available permits an accurate identification of factors contributing to the outcome under investigation,” he said. In addition, the benefit of AQI data is that the data are from so many practices and providers throughout the country, even if some data are missing.”

Richard Dutton, MD, MBA, executive director of the AQI, agreed, saying that NACOR opens up valuable opportunities for anesthesiologists to better understand and examine practice patterns in their discipline.

“The whole purpose of NACOR is to inform us about ourselves—what we do and how we do it,” Dr. Dutton said. “And this was a particular study that demonstrated a substantial variability in practice. I think we’re going to see a lot more studies showing that variations in practice have important consequences for patients.”

John Laur, MD, MS, medical director of the ambulatory surgery center at the University of Iowa Hospitals and Clinics in Iowa City, said he expects the study to generate some valuable hypotheses. For instance, smaller hospitals may hire nurse anesthetists rather than anesthesiologists, for financial reasons, or the non–board-certified anesthesiologists in the study may be recent graduates who are unfamiliar with the use of neuraxial anesthesia.

“One thing about these large database studies is that the methodology continues to improve for using them appropriately,” Dr. Laur said. “I think that people do need to understand the caveats of these types of studies, in that they’re more for helping to create understanding of possible causes that we could design a more thorough study to look into.”

EROS Program Hastens Post-Labor Discharge

Anesthesiology News - EROS Program Hastens Post-Labor Discharge—And Moms Love It



by Michael Vlessides
San Francisco—He may be the god of love in Greek mythology, but when it comes to elective cesarean deliveries, EROS is all business.
Indeed, a British research group has found that its Enhanced Recovery in Obstetric Surgery (EROS) program significantly reduces length of stay in the hospital while keeping women satisfied with their care. The researchers stressed, however, that a multidisciplinary approach is critical to the success of EROS.
“A few of us got together and realized we’ve got the perfect obstetric population for enhanced recovery: They’re young, motivated to get home and have support once they leave the hospital,” said Daniel Abell, MBChB, consultant anesthetist at King’s College Hospital, in London. “So there didn’t seem to be any reason why we shouldn’t be doing this.”
Given that enhanced recovery programs have been successfully applied to many specialties throughout the world in recent years (see Anesthesiology News, October 2013, page 1), Dr. Abell and his colleague, Saju Sharafudeen, MD, helped introduce the EROS program—a protocol-driven pathway—at King’s in June 2012. EROS aims to reduce length of stay by educating patients about their hospitalization, reducing starvation times for both solids and liquids, removing urinary catheters within six hours of anesthesia and promoting early mobilization.
What To Expect When You’re Expecting
image
Daniel Abell, MBChB
“One of the biggest issues we’ve faced has been managing expectation and disseminating information,” Dr. Abell told Anesthesiology News. “Because if they come in expecting to stay for four or five days, they’re going to stay for four or five days, no matter what you do.”
To help determine the efficacy of EROS, the researchers compared data collected before and after the initiation of the program. Collected data included patient demographics; details about the surgery and anesthesia; urinary catheter removal times; time to first mobilization after regional anesthesia; rates of readmission and recatheterization; and length of stay in the hospital.
As Dr. Abell reported at the 2013 annual meeting of the American Society of Anesthesiologists (abstract 2102), 60 women underwent elective cesarean deliveries at the institution; 45 of them were included in the EROS pathway (Table 1). When compared with 60 women who did not go through the enhanced recovery protocol, the women in the EROS group had significantly shorter lengths of stay and time to early mobilization (Table 2).
Table 1. Patient Selection Criteria
InclusionExclusion
Patient consentPatient refusal
Uncomplicated elective cesarean delivery patientsHigh risk for perioperative obstetric complications
Minimal comorbiditiesUnanticipated complications with surgery or anesthetic
Uncomplicated surgery and anestheticUnanticipated mother or baby outcomes
Supportive home and social circumstancesDiabetes or similar complex medical/psychosocial conditions
Agreement among midwife, surgeon and anesthetist that inclusion is appropriateLack of social support
Table 2. Women in EROS Program Enjoyed Better Outcomes

Pre-EROSEROS Patients
(P Value)
Time to
mobilization
22.01±6.12 h9.9±5.05 h
(<0.001)
Time to
catheter removal
21.95±5.84 h6.71±6.2 h
(<0.001)
Time to first
spontaneous void
25.38±5.5 h12.64±6.2 h
(<0.001)
Hospital length
of stay
3.3±2.94 d1.7±0.85 d
(<0.001)
EROS, Enhanced Recovery in Obstetric Surgery
Although recatheterization rates were higher in the EROS group (13.3%) than in the non-EROS patients (0%), the seven-day readmission rate was lower (2.2% vs. 8.3%, respectively. All patients were followed up on days 1 and 7 postsurgery, and 90% said they “agreed or “strongly agreed that pain control was adequate to undertake routine tasks.
Nearly every woman (97.8%) who received EROS care said they would recommend the program to a friend and would undergo the same program for any future cesarean deliveries. The researchers said they received no reports of problems with mobilization, urination and visits to the patients’ general practitioners.
Much of the program’s success stems from education and a willingness to examine preexisting care patterns, Dr. Abell said. “Now our patients get an information booklet, a thorough preoperative briefing on their hospital stay and a phone call the day before their operation, all of which tell them about their stay and how they can get back to normal as quickly as possible.
“And now we’re really doing all the things that we should have been doing all along,” he added. “In the hospital setting, things often go on for years, and nobody actually looks at [them]. For example, we had a traditional policy where the urinary catheter didn’t come out until the morning after the C-section. The women would be sitting in their beds, completely fine, but they weren’t going to move because they still had the catheter in. So now we pay attention to the little things, and it’s made all the difference in the world.”
Scott Segal, MD, professor and chair of anesthesiology at Tufts University School of Medicine, in Boston, noted that these results might not have widespread applicability in the United States, where there are minimum lengths of stay for new mothers. “Since the [President Bill] Clinton administration, it’s been federal law that mothers cannot be required to be discharged earlier than two days after a normal vaginal delivery and four days after a cesarean delivery,” said Dr. Segal, who was not involved in the U.K. study.
“These investigators started at a baseline of 3.3 days [in the hospital]—already shorter than the U.S. standard—and reduced it to 1.7,” he continued. “It would be interesting to know if the women discharged earlier wanted to go or would have stayed longer if they had been given the opportunity. Nonetheless, the fact that they could show discharge readiness this early might reduce health system costs, but might also require incentives for women to accept early discharge, or change in federal law.”

2014年4月9日水曜日

春の野村杯

毎年恒例、春の野村杯が今年もロペ倶楽部で4月6日に開催されました。
雨の予報でしたが、当日は晴れ渡りとっても気持ちのいい1日でした。



ゴルフ初心者も大歓迎のコンペですが、優勝者はスコア70台!優勝賞品ルンバ。羨ましい~
その他ドライバーやヨナナスや豪華賞品多数。参加者全員が景品をもらえます。
レディース優勝の景品はフットマッサージャー、錬士賞は教授セレクトのとってもかわいいバッグでした。すでに毎日愛用させていただいています♪



次回は秋です。幹事はM岡先生(補佐?錬士H)です!詳細は後日。
さらに多くのご参加をお待ちしております。
最後に主催の教授と1枚✩


2014年4月8日火曜日

はじまりの用意は、はじまりじゃない



最近知った、コピーライターの糸井重里さんの言葉です。

「はじまりの用意は、はじまりじゃないですからね。
 はじまりの用意ばかりしていると、
 はじまらない癖がついてしまいます。」


たしかに、そういう面ってありますよね。
用意周到な準備を、と思っていたのが、いつのまにか「はじめない」言い訳になってしまう。

医療、わたしたちのたずさわる麻酔管理も、患者さんに還元されて初めて意味があるわけで。
術前評価とかを含めた、いわゆる術前の準備、麻酔計画・・・
これらも常に、実際の麻酔管理を行うための、はじめるための準備なわけで。

あたりまえといえばあたりまえですが、深いなーと一人うなずく今日この頃です。





2014年4月5日土曜日

m3.comに取材されました


トップページにもありますが、先日、m3.com 「研修病院ナビ」の取材を受けました。

尾崎主任教授の考えをはじめ、うちの医局員の生の声を掲載して頂きました。

それぞれの立場で、共感して読んで頂けるとありがたいです。
掲載ページは下記アドレスになります。

https://career.m3.com/kenshunavi/ikyoku/twmu/anesthesiology

ちなみに、取材に答えた唯一の男性医局員。彼だけ写真がありませんでした・・・・
紙面の問題か、見た目の華やかさの問題か・・・・(^^;

2014 東京女子医大麻酔科 新入医局員 歓迎会は4月19日だ!

2014 日麻予演会プログラム    2016419日   第2別館大会議室
13:00 Drug information (昼食付き)&連絡事項
13:45頃から、1演題 質疑応答を含め、10分、高橋/小野先生は15分(Power Point
円滑に歓迎会を移行するために、事前に医局Dellにデータを移してください
座長
タイトル
演者
共同演者

岩出
25,906症例によるSurgical Apgar Scoreの検討
荻原
木下真帆、清水敬介、森岡宣伊、尾崎眞

13:45
14:15
持続坐骨神経ブロックの鎮痛効果の比較検討~0.2%ロピバカイン vs 0.375%ロピバカイン~
西坂
前知子、春山直子、嵐朝子、篠原恵、山﨑隆史

 
全身麻酔薬による発達期マーモセット中枢神経系への影響
宮島
小田桐紗織2、石橋英俊3、一戸紀孝4、関口正幸2、尾崎眞1

森岡
14:15
14:45
研修医による直接喉頭鏡(マッキントッシュ直接喉頭鏡)とビデオ喉頭鏡(McGrathMAC)を用いた気管挿管の成功率ならびに合併症に関する検討
高橋
糟谷祐輔、庄司詩保子、永井美玲、市川喜之、尾崎眞

双胎妊娠子宮による大動脈,下大静脈圧迫に対する傾斜角度の影響-単胎妊娠との比較
小野
高木、樋口、尾崎

樋口
14:50
15:30
小児症例におけるMcGrath MACビデオ喉頭鏡とMacintosh型喉頭鏡の比較
廣岡
虻川有香子、深田智子、広木公一、尾崎眞

ラットの実験について
虻川
垣花、須加原、広木、尾崎眞

小児麻酔 小児麻酔 麻酔管理
中山
水原敬洋、宮本義久、水野好子、三輪高明、何廣頤

脊髄くも膜下麻酔の効果が得られず全身麻酔に移行した一例
浅越
廣岡、高木、西川、樋口、尾崎

月曜日
ネオスチグミン,スガマデクスの追加投与を要したロクロニウム使用症例の検討
高木
尾崎眞

18時から新入医局員歓迎会:Farefax Grill
11名の新しい仲間を大歓迎しよう!!!

2014年4月2日水曜日

Comparison of the glidescope®, flexible fibreoptic intubating bronchoscope, iPhone modified bronchoscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study


Langley and Mar Fan BMC Anesthesiology 2014, 14:10
http://www.biomedcentral.com/1471-2253/14/10

Abstract
Background: Smart phone technology is becoming increasingly integrated into medical care.
Our study compared an iPhone modified flexible fibreoptic bronchoscope as an intubation aid and clinical teaching tool with an unmodified bronchoscope, Glidescope® and Macintosh laryngoscope in a simulated normal and difficult airway scenario.

Methods: Sixty three anaesthesia providers, 21 consultant anaesthetists, 21 registrars and 21 anaesthetic nurses attempted to intubate a MegaCode Kelly™ manikin, comparing a normal and difficult airway scenario for each device.
Primary endpoints were time to view the vocal cords (TVC), time to successful intubation (TSI) and number of failed intubations with each device. Secondary outcomes included participant rated device usability and preference for each scenario. Advantages and disadvantages of the iPhone modified bronchoscope were also discussed.

Results: There was no significant difference in TVC with the iPhone modified bronchoscope compared with the Macintosh blade (P = 1.0) or unmodified bronchoscope (P = 0.155). TVC was significantly shorter with the Glidescope compared with the Macintosh blade (P < 0.001), iPhone (P < 0.001) and unmodified bronchoscope (P = 0.011). 
The iPhone bronchoscope TSI was significantly longer than all other devices (P < 0.001). There was no difference between anaesthetic consultant or registrar TVC (P = 1.0) or TSI (P = 0.252), with both being less than the nurses (P < 0.001).
Consultant anaesthetists and nurses had a higher intubation failure rate with the iPhone modified bronchoscope compared with the registrars. Although more difficult to use, similar proportions of consultants (14/21), registrars (15/21) and nurses (15/21) indicated that they would be prepared to use the iPhone modified bronchoscope in their clinical practice. The Glidescope was rated easiest to use (P < 0.001) and was the preferred device by all participants for the difficult airway scenario.

Conclusions: The iPhone modified bronchoscope, in its current configuration, was found to be more difficult to use compared with the Glidescope® and unmodified bronchoscope; however it offered several advantages for teaching fibreoptic intubation technique when video-assisted bronchoscopy was unavailable.