待ちぼうけ、待ちぼうけ。GW3日目せっせと術前回診へ。。。
晴天に恵まれた前半のGW、いかがお過ごしでしたか？
私は明日の術前回診のために大学へ。明日は小児外科の担当のため、間もなく戻ってくる
予定の外出中のお母様を待つことに・・・ところが、予定時間をかなり過ぎても姿は見えず。
なんと、新宿駅で”デモ隊”に巻き込まれて身動きがとれなかったそうです！
予想外の理由で(ﾉﾟ⊿ﾟ)ﾉびっくり！！
だいぶ時間はかかったものの、患児のお母様は病院にたどり着きました。
術前回診は無事終了しましたとさ。めでたしめでたし。
2013年4月30日火曜日
Hand Free and Central Site Pulse Oximetery
Assurance® - Overview
Assurance Biosense is focused on creating a simple, single-point-of-contact sensor that can reliably monitor critical parameters for all patients and provide clinicians an early warning of impending events.
The Assurance® Alar Sensor is the next generation of pulse oximetry. The sensor is placed on the fleshy part of the side of the nose. This region has the same central blood supply as the brain. The alar site provides a strong, reliable signal, even when it is difficult to get a signal at the extremities.
The Assurance® Alar Sensor is the next generation of pulse oximetry. The sensor is placed on the fleshy part of the side of the nose. This region has the same central blood supply as the brain. The alar site provides a strong, reliable signal, even when it is difficult to get a signal at the extremities.
Assurance Biosense, Inc. is a wholly-owned subsidiary of Xhale, Inc.
2013年4月24日水曜日
Anesthesiology News - µ-Opioid Receptors Impaired in Fibromyalgia Patients, Study Shows
Anesthesiology News - µ-Opioid Receptors Impaired in Fibromyalgia Patients, Study Shows
µ-Opioid Receptors Impaired in Fibromyalgia Patients, Study Shows
by Alice Goodman
Washington—Impaired functioning of the brain’s ability to process pain stimuli may negatively affect how people with fibromyalgia experience pain, according to new research. The research also shows that abnormal pain signal processing is associated with reduced opioid receptor binding, and these findings suggest that the brain’s normal pain-inhibiting processes malfunction in fibromyalgia patients.
This study is the first to demonstrate the connection between μ-opioid receptor binding and the brain’s response to the pain of fibromyalgia, said lead investigator Richard Harris, PhD, assistant professor in the Department of Anesthesiology and research assistant professor in the Department of Internal Medicine, University of Michigan, in Ann Arbor. “In fibromyalgia patients, the main inhibitory mechanisms are not working correctly, specifically the opioid receptors within the brain,” he reported at the 2012 annual meeting of the American College of Rheumatology (abstract 2450).
The investigators used functional magnetic resonance imaging to measure changes in blood flow in the brains of 18 female patients with fibromyalgia after they received a painful stimulus, administered to the thumb in varying intensity, and measured by the Short-Form McGill Pain Questionnaire. The researchers also measured μ-opioid receptor binding by positron emission tomography scanning. None of the patients had received opioids prior to the study, which was conducted between 2008 and 2012. The study cohort received acupuncture and placebo acupuncture for reduction of pain before and after the tests for the brain’s response to pain and the binding of μ-opioid receptors.
A negative correlation was seen between the change in blood oxygenation level–dependent (BOLD) signal and the μ-opioid receptor binding in several regions of the brain involved in processing and controlling pain. These included the right posterior insula (R= –0.82; P=0.0004), left medial insula (R= –0.82; P=0.0003), left orbital frontal cortex (R= –0.75; P=0.0004) and right amygdala (R= –0.68; P=0.002).
Positive correlations also were found in the right dorsolateral prefrontal cortex (R=0.66; P=0.003), posterior cingulate (R=0.62; P=0.006) and the right putamen (R=0.72; P=0.0008).
“When opioid receptor binding went down, the evoked brain pain response went up in key brain regions that are involved in pain processing, such as the insula and amygdala,” Dr. Harris said. He proposed two possible explanations: either the receptors were downregulated or activating the receptors caused pain.
Dr. Harris found the study results to be somewhat paradoxical. “We found that fibromyalgia patients either have too few receptors in their brains, or the receptors themselves, when they get activated, are causing pain instead of lessening pain. It is possible that opioids are not the best treatment for fibromyalgia and may even worsen symptoms,” he added.
“This study may explain why patients with fibromyalgia do not respond to narcotics,” said Kathryn Dao, MD, associate director of rheumatology research at Baylor Research Institute, in Dallas. “Further studies would help define if the same aberration in the pain signaling pathway is responsible for other chronic pain conditions.”
This study is the first to demonstrate the connection between μ-opioid receptor binding and the brain’s response to the pain of fibromyalgia, said lead investigator Richard Harris, PhD, assistant professor in the Department of Anesthesiology and research assistant professor in the Department of Internal Medicine, University of Michigan, in Ann Arbor. “In fibromyalgia patients, the main inhibitory mechanisms are not working correctly, specifically the opioid receptors within the brain,” he reported at the 2012 annual meeting of the American College of Rheumatology (abstract 2450).
The investigators used functional magnetic resonance imaging to measure changes in blood flow in the brains of 18 female patients with fibromyalgia after they received a painful stimulus, administered to the thumb in varying intensity, and measured by the Short-Form McGill Pain Questionnaire. The researchers also measured μ-opioid receptor binding by positron emission tomography scanning. None of the patients had received opioids prior to the study, which was conducted between 2008 and 2012. The study cohort received acupuncture and placebo acupuncture for reduction of pain before and after the tests for the brain’s response to pain and the binding of μ-opioid receptors.
A negative correlation was seen between the change in blood oxygenation level–dependent (BOLD) signal and the μ-opioid receptor binding in several regions of the brain involved in processing and controlling pain. These included the right posterior insula (R= –0.82; P=0.0004), left medial insula (R= –0.82; P=0.0003), left orbital frontal cortex (R= –0.75; P=0.0004) and right amygdala (R= –0.68; P=0.002).
Positive correlations also were found in the right dorsolateral prefrontal cortex (R=0.66; P=0.003), posterior cingulate (R=0.62; P=0.006) and the right putamen (R=0.72; P=0.0008).
“When opioid receptor binding went down, the evoked brain pain response went up in key brain regions that are involved in pain processing, such as the insula and amygdala,” Dr. Harris said. He proposed two possible explanations: either the receptors were downregulated or activating the receptors caused pain.
Dr. Harris found the study results to be somewhat paradoxical. “We found that fibromyalgia patients either have too few receptors in their brains, or the receptors themselves, when they get activated, are causing pain instead of lessening pain. It is possible that opioids are not the best treatment for fibromyalgia and may even worsen symptoms,” he added.
“This study may explain why patients with fibromyalgia do not respond to narcotics,” said Kathryn Dao, MD, associate director of rheumatology research at Baylor Research Institute, in Dallas. “Further studies would help define if the same aberration in the pain signaling pathway is responsible for other chronic pain conditions.”
2013年4月17日水曜日
新入りです。よろしく。
手術室の隣の麻酔科控室に新しい・・・ハンガーラックが届きました。
控室、地味にリニューアル！！
新入局の先生が増え、かける白衣も倍増。
今までのハンガーラック、お疲れ様～。
皆さま、整理整頓を忘れずに☆
控室、地味にリニューアル！！
新入局の先生が増え、かける白衣も倍増。
今までのハンガーラック、お疲れ様～。
 |
| 組立終了～ |
麻酔科ゴルフコンペ☆
今日は年に２回開かれる麻酔科ゴルフコンペ☆通称、野村（教授）杯。
今回は、栃木県にあるロペ倶楽部で。
ゴルフ場としてはめずらしく和風の建物。
 |
ロペ倶楽部☆
|
お天気にも恵まれ、気持ちいいゴルフができました！
次回はまた秋に！ |
| 野村教授とコースでぱちり☆ |
2013年4月14日日曜日
2013年4月13日土曜日
新年度最初の総合医局会
4月13日 医局長も変わり、新しい人も入り、医局員がいろいろ入れ替わって初めての総合医局会が開催されました。
説明会は新しいPCAポンプです。新しい機械がすぐに入るのが当医局の特徴でもあります。普通新しい機械が入るまでは、審査やら前の機械を廃止するやら手続きが多いものです。
学会などでしか新しいものに触れられず、『あれがあったら便利なのになー』で終わってしまいがちです。新しいPCAポンプはスマホのような見た目で、PCで入れ方を調節するのだとか。なので、汎用性があり、プログラムを組むことで今後の麻酔トレンドの変化に対応しうる仕様になっておりました。
次は新入医局員の紹介です。麻酔経験のある先生1名、後期研修医8名（1名は緊急をかけていたので欠席）、ICU専属の先生1名と、多くの入局者が4月から入ってくださいました。それぞれ自己紹介をしていただきましたが、バックグラウンドがかぶらないんですね。派閥がない。これは麻酔科のある他大学にはない特徴ではないでしょうか。おかげで顔と名前は一致しても出身大学がなかなか覚えられません。みなさん、よろしくおねがいします。
最後は抄読会と海外留学報告、学会の優秀演題発表でした。抄読会では、神経ブロックにおける効果の程度や効き始める時間の差に関する論文を紹介。また、ブロックに用いる薬は2剤を混合して使うケースがありますが、その際の中毒閾値の低下などについて分かりやすく説明してくださいました。海外留学報告ではサンフランシスコに留学され、脳動脈瘤と肥満細胞に関する研究をされていたW先生から、動物実験を成功させていった過程や海外のオペ室の話など、普段聞けない話を効かせて頂きました。
F先生の集中治療学会の優秀演題発表は、ARDSとAKIの関係を統計学的に解析したもので、かなり面白い内容でした。最優秀演題が演者から聞けるなんて贅沢な医局会ですね。
総合医局会は月一回の頻度で行われ、長い時もあってちょっと疲れもするのですが、貴重な話を聞けるのも事実なので、毎月少しだけ楽しみにしています。
でも、できれば録画して2倍速くらいで聞きたいな！ 切実に思う練士Kでした。
2013年4月7日日曜日
Lady's Day?
嵐の土曜、晴天の日曜、週末いかがお過ごしでしたか？
当科日曜の当直メンバー4人は、女性のみ。
女子医大といえども、当直が全員女性の日は珍しいです。
こんな日の昼食は・・・
ハンバーガー♪♪
当科日曜の当直メンバー4人は、女性のみ。
女子医大といえども、当直が全員女性の日は珍しいです。
こんな日の昼食は・・・
ハンバーガー♪♪
 |
| 空箱です。。。 |
F先生とK先生から素敵な差し入れを頂きました！！
 |
| 元祖いちご大福。F先生御馳走様です！ |
 |
| ANA機内限定品。K先生御馳走様です！ |
そして夕飯は・・・
インドカレー♪♪ |
| 女子が大好きタピオカドリンク付！ナンは3種類です。 |
力強いレディース当直でした♡
2013年4月4日木曜日
Anesthesiology News - Focus on Anemia May Alter Transfusion Practices
Anesthesiology News - Focus on Anemia May Alter Transfusion Practices
New York—Blood transfusions have been among the most commonly performed invasive procedures in the United States, with a significant percentage occurring perioperatively to treat anemia.
Now, there is a movement within anesthesiology to change the way anemia is managed in patients undergoing elective surgery. During a session at the 2012 PostGraduate Assembly in Anesthesiology (PGA), a panel of blood conservation specialists within the profession said that, given the risks associated with blood transfusion, it is time for a “new paradigm.”
“There is a long tradition of accepting anemia as a relatively harmless problem that can be easily corrected with transfusion,” said Aryeh Shander, MD, chief of the Departments of Anesthesiology, Critical Care Medicine, Pain Medicine and Hyperbaric Medicine at Englewood Hospital and Medical Center, in Englewood, N.J. “Transfusion for many of us is the default. That has to change.”
Studies have shown that anemia in the surgical setting is associated with significant morbidity and mortality, and the PGA panelists saw a clear need to address the condition within this patient population. However, they noted, blood transfusions carry significant risks, and too often these complications are poorly understood by clinicians—and therefore improperly explained to patients.
For example, according to session moderator Linda J. Shore-Lesserson, MD, professor of anesthesiology and chief of cardiothoracic anesthesiology at Montefiore Medical Center, in New York City, inflammatory events and infection are among the well-known risks associated with transfusion. But mortality, renal damage and lung dysfunction also may occur—some of which may be the result of the age of the blood being transfused, she said. Although the advent of citrate-phosphate-dextrose-adenine-1 has enabled blood banks to store red blood cells for up to 42 days, Dr. Shore-Lesserson said this “may be too long.”
“There is evidence that there is a linear if not geometric increase in the levels of cell lysis and oxidative injury markers as you store blood for longer periods of time,” Dr. Shore-Lesserson continued. “What is the effect clinically? If there is an effect, it is going to be difficult to measure in prospective, randomized trials. And given that in our country and in our world blood-banking procedures are really not equipped to limit the blood supply to younger units of blood, I think it’s worth taking the time to really investigate this question further. To say that you need to only transfuse units that are 14 days [old] or younger would be catastrophic [to] our blood supply and may not be worthy of the outcomes we are looking for. However, it is clear that there is morbidity associated with blood transfusion.”
Although the risk for infection—including HIV and hepatitis C—associated with transfusion is well understood, the leading cause of transfusion-related mortality in the United States is transfusion-related acute lung injury (TRALI; Table). And TRALI is “underreported and underrecognized,” said Ian J. Welsby, MD, associate professor of anesthesiology and critical care at Duke University Medical Center, in Durham, N.C.
Dr. Welsby told the audience at PGA that although mitigation strategies from the American Association of Blood Banks and the National Heart, Lung, and Blood Institute have reduced the incidence of TRALI since the mid-2000s, the complication—like all pulmonary infusion reactions—remains a serious problem. As a result, he said, all clinicians involved in the management of a case that involves a transfusion must report any incident of TRALI and similar complications so that the blood supplier is aware and can take precautions, such as quarantining donor sources, against future episodes.
Avoiding Transfusions by … Transfusing
The panelists agreed that the goal for treating patients undergoing elective surgery should be to prevent transfusion without incurring risk for anemia. Another panelist, Keyvan Karkouti, MD, associate professor of anesthesiology and health policy, management, and evaluation, at the University of Toronto, Canada, has explored a possible alternative approach: prophylactic transfusion.
Dr. Karkouti and his team published a study in Anesthesiology (2012;116:613-621) that found that prophylactic transfusions of red blood cells may reduce anemia and limit the need for additional transfusions. The trial found that anemic patients—those with hemoglobin levels of 10 to 12 g/dL—undergoing cardiac surgery with cardiopulmonary bypass who received prophylactic transfusions one to two days before surgery were less likely to experience perioperative anemia and erythrocyte transfusions (P=0.0002).
Dr. Shander said Dr. Karkouti’s study indicates that when it comes to anemia, clinicians are missing an “opportunity to diagnose an underlying disease that carries significant morbidity and mortality before these patients enter the surgical arena.” Studies have found that prophylactic transfusion is used in only 25% to 50% of anemic patients who “could have been treated preemptively prior to elective surgery,” Dr. Shander added.
Dr. Shander is president of the Society for the Advancement of Blood Management, which is working with the American Society of Anesthesiologists to develop new criteria for the diagnosis and treatment of anemia in patients undergoing elective surgery and position anesthesiologists as the “gatekeepers” in the management of these patients.
“We can debate whether or not the best approach is transfusion or treatment with erythropoiesis-stimulating agents, but if the therapy is directed, correct and implemented at the right time it is the safest option for the patient,” Dr. Shander said. “Anemia is a burden that is not well defined, and part of the burden is lack of knowledge we have. Transfusion is only one treatment among many available. Preoperative detection and diagnosis of anemia reduces both the risk of transfusion as well as risks of anemia.”
Focus on Anemia May Alter Transfusion Practices
by Brian P. Dunleavy
New York—Blood transfusions have been among the most commonly performed invasive procedures in the United States, with a significant percentage occurring perioperatively to treat anemia.Now, there is a movement within anesthesiology to change the way anemia is managed in patients undergoing elective surgery. During a session at the 2012 PostGraduate Assembly in Anesthesiology (PGA), a panel of blood conservation specialists within the profession said that, given the risks associated with blood transfusion, it is time for a “new paradigm.”
“There is a long tradition of accepting anemia as a relatively harmless problem that can be easily corrected with transfusion,” said Aryeh Shander, MD, chief of the Departments of Anesthesiology, Critical Care Medicine, Pain Medicine and Hyperbaric Medicine at Englewood Hospital and Medical Center, in Englewood, N.J. “Transfusion for many of us is the default. That has to change.”
Studies have shown that anemia in the surgical setting is associated with significant morbidity and mortality, and the PGA panelists saw a clear need to address the condition within this patient population. However, they noted, blood transfusions carry significant risks, and too often these complications are poorly understood by clinicians—and therefore improperly explained to patients.
For example, according to session moderator Linda J. Shore-Lesserson, MD, professor of anesthesiology and chief of cardiothoracic anesthesiology at Montefiore Medical Center, in New York City, inflammatory events and infection are among the well-known risks associated with transfusion. But mortality, renal damage and lung dysfunction also may occur—some of which may be the result of the age of the blood being transfused, she said. Although the advent of citrate-phosphate-dextrose-adenine-1 has enabled blood banks to store red blood cells for up to 42 days, Dr. Shore-Lesserson said this “may be too long.”
“There is evidence that there is a linear if not geometric increase in the levels of cell lysis and oxidative injury markers as you store blood for longer periods of time,” Dr. Shore-Lesserson continued. “What is the effect clinically? If there is an effect, it is going to be difficult to measure in prospective, randomized trials. And given that in our country and in our world blood-banking procedures are really not equipped to limit the blood supply to younger units of blood, I think it’s worth taking the time to really investigate this question further. To say that you need to only transfuse units that are 14 days [old] or younger would be catastrophic [to] our blood supply and may not be worthy of the outcomes we are looking for. However, it is clear that there is morbidity associated with blood transfusion.”
Although the risk for infection—including HIV and hepatitis C—associated with transfusion is well understood, the leading cause of transfusion-related mortality in the United States is transfusion-related acute lung injury (TRALI; Table). And TRALI is “underreported and underrecognized,” said Ian J. Welsby, MD, associate professor of anesthesiology and critical care at Duke University Medical Center, in Durham, N.C.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Avoiding Transfusions by … Transfusing
The panelists agreed that the goal for treating patients undergoing elective surgery should be to prevent transfusion without incurring risk for anemia. Another panelist, Keyvan Karkouti, MD, associate professor of anesthesiology and health policy, management, and evaluation, at the University of Toronto, Canada, has explored a possible alternative approach: prophylactic transfusion.
Dr. Karkouti and his team published a study in Anesthesiology (2012;116:613-621) that found that prophylactic transfusions of red blood cells may reduce anemia and limit the need for additional transfusions. The trial found that anemic patients—those with hemoglobin levels of 10 to 12 g/dL—undergoing cardiac surgery with cardiopulmonary bypass who received prophylactic transfusions one to two days before surgery were less likely to experience perioperative anemia and erythrocyte transfusions (P=0.0002).
Dr. Shander said Dr. Karkouti’s study indicates that when it comes to anemia, clinicians are missing an “opportunity to diagnose an underlying disease that carries significant morbidity and mortality before these patients enter the surgical arena.” Studies have found that prophylactic transfusion is used in only 25% to 50% of anemic patients who “could have been treated preemptively prior to elective surgery,” Dr. Shander added.
Dr. Shander is president of the Society for the Advancement of Blood Management, which is working with the American Society of Anesthesiologists to develop new criteria for the diagnosis and treatment of anemia in patients undergoing elective surgery and position anesthesiologists as the “gatekeepers” in the management of these patients.
“We can debate whether or not the best approach is transfusion or treatment with erythropoiesis-stimulating agents, but if the therapy is directed, correct and implemented at the right time it is the safest option for the patient,” Dr. Shander said. “Anemia is a burden that is not well defined, and part of the burden is lack of knowledge we have. Transfusion is only one treatment among many available. Preoperative detection and diagnosis of anemia reduces both the risk of transfusion as well as risks of anemia.”
2013年4月1日月曜日
新年度、始まる！！！
今日から、2013年度、始まりました！！
当科では本日10人の新しい仲間が来てくれました！
来月からはさらに1人仲間が増えます！
新しい環境で慣れないことも多いでしょうが、ここにいる誰もが最初はとまどったり、
困ったりしました・・でも、皆の暖かいサポートで今では楽しく仕事ができています。
新しく来てくれた先生方も、ご心配なく♪
今朝の新年度最初の医局会では、新入局員の自己紹介に始まり、尾崎主任教授と野村教授の激励など、スタートにふさわしいものになりました。。。
当科では本日10人の新しい仲間が来てくれました！
来月からはさらに1人仲間が増えます！
新しい環境で慣れないことも多いでしょうが、ここにいる誰もが最初はとまどったり、
困ったりしました・・でも、皆の暖かいサポートで今では楽しく仕事ができています。
新しく来てくれた先生方も、ご心配なく♪
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