記述言語：日本語   出版者・発行元：(一社)医療の質・安全学会  

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記述言語：日本語   出版者・発行元：(一社)医療の質・安全学会  

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記述言語：日本語   出版者・発行元：(一社)医療の質・安全学会  

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記述言語：日本語   出版者・発行元：(一社)日本医療情報学会  

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記述言語：日本語   出版者・発行元：(一社)日本医療情報学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床医学リスクマネジメント学会  

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: During pandemic situations, many guidelines recommend that surgical masks be worn by both healthcare professionals and infected patients in healthcare settings. The purpose of this study was to clarify the levels and changes of oxygen concentration over time while oxygen was administered over a surgical mask. METHODS: Patients scheduled to undergo general anesthesia (n = 99) were enrolled in this study. First, patients were administered oxygen at 6 L/min via an oxygen mask over a surgical mask for 5 min. The patients removed the surgical mask and then took a 3-min break; thereafter, the same amount of oxygen was administered for another 5 min via the oxygen mask. We measured the fraction of inspired oxygen (FiO2), the end-tidal CO2 (EtCO2), and respiratory frequency every minute for 5 min, both while administering oxygen with and without a surgical mask. The FiO2 was measured at the beginning of inspiration and the EtCO2 was measured at the end of expiration. RESULTS: The FiO2 at 5 min was significantly lower when breathing with a surgical mask than that without it (mean difference: 0.08 [95% CI: 0.067-0.10]; p <  0.001). In contrast, the EtCO2 at 5 min was significantly higher when breathing with a surgical mask than that without it (mean difference: 11.9 mmHg [95% CI: 10.9-12.9]; p <  0.001). CONCLUSION: The FiO2 was lower when oxygen was administered over surgical masks than when patients did not wear surgical masks. Oxygen flow may need to be adjusted in moderately ill patients requiring oxygen administration.

DOI： 10.1186/s12871-022-01649-x

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction The use of electric health records (EHRs) has spread worldwide and has helped record huge amounts of data. However, despite accumulated data from EHRs, especially text data, the information has been underutilized. Our research questions and aims are as follows: How can an incident report system extract common themes behind incidents, good practices, improved quality, and safety based on the Safety-II/resilient healthcare approach? Methods We extracted data from the electronic incident reporting system of the Yokohama City University Medical Center between April 1, 2016 and March 31, 2018. We utilized natural language processing and text mining to extract concept categories and word patterns. We also used the incident levels as outcomes, as well as classification and regression tree analysis to obtain associated text combinations. Results A total of 17,231 cases were reported through the electronic incident reporting system in our hospital during the study period. Hospital staff has to be prepared for incidents with complex mechanisms in daily practice. The hospital staff tend to focus on individual actions rather than considering a systematic approach. Conclusion Certain combinations of professions and contents may contribute to resilient management. Studies on Safety-II management utilizing clinical information and text records are needed.

DOI： 10.7759/cureus.21528

PubMed

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記述言語：日本語   出版者・発行元：(一社)医療の質・安全学会  

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記述言語：日本語   出版者・発行元：(一社)医療の質・安全学会  

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記述言語：日本語   出版者・発行元：(株)総合医学社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Patients undergo dilatation and evacuation for abortion or miscarriage. However, bleeding is sometimes problematic. Despite reports on the association between volatile anesthetics and increased bleeding during the procedure, firm evidence is lacking. Therefore, we conducted a systematic review and meta-analysis to compare the effects of volatile anesthetics and propofol on the amount of bleeding in patients undergoing dilatation and evacuation. METHODS: We conducted a systematic search of four databases, namely PubMed, Embase, Cochrane Central Register of Controlled Trials databases, and Web of Science (Clarivate Analytics), from their respective inception to April 2021. Moreover, we searched two trial registration sites. The inclusion criterion was randomized controlled trials of patients who underwent dilatation and evacuation under general anesthesia using volatile anesthetics or propofol. The primary outcome was the amount of perioperative bleeding. The mean difference of the bleeding was combined using a random-effects model. The I2 statistic was used to assess heterogeneity. We assessed risk of bias with Cochrane domains. We controlled type I and II errors due to sparse data and repetitive testing with Trial Sequential Analysis. We assessed the quality of evidence with GRADE. RESULTS: Five studies were included in the systematic review. The amount of bleeding was compared in four studies and was higher in the volatile anesthetic group, with a mean difference of 164.7 ml (95% confidence interval, 43.6 to 285.7; p = 0.04). Heterogeneity was considerable, with an I2 value of 97%. Two studies evaluated the incidence of significant bleeding, which was significantly higher in the volatile anesthetic group (RR, 2.42; 95% confidence interval, 1.04-5.63; p = 0.04). CONCLUSION: Choosing propofol over volatile anesthetics during dilatation and evacuation might reduce bleeding and the incidence of excessive bleeding. However, the quality of the evidence was very low. This necessitates further trials with a low risk of bias. TRIAL REGISTRATION: PROSPERO (CRD42019120873).

DOI： 10.1371/journal.pone.0261494

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Intravenous lidocaine in adults undergoing general anesthesia has been shown to reduce the incidence of postoperative nausea and vomiting (PONV). However, the anti-postoperative vomiting (POV) effect of lidocaine in pediatric patients remains unclear. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of intravenous lidocaine on prevention of POV/PONV. METHODS: Six databases including trial registration sites were searched. Randomized clinical trials evaluating the incidence of POV/PONV after intravenous lidocaine compared with control were included. The primary outcome was the incidence of POV within 24 hours after general anesthesia. The incidence of POV was combined as a risk ratio with 95% confidence interval using a random-effect model. We used the I2 to assess heterogeneity. We evaluated the quality of trials using the Cochrane methodology, and we assessed quality of evidence using the Grading of Recommendation Assessment, Development, and Evaluation approach. We also assessed adverse events. RESULTS AND DISCUSSION: Six trials with 849 patients were included, of whom 433 received intravenous lidocaine. Three trials evaluated the incidence of POV, and 3 evaluated the incidence of PONV. The overall incidence of POV within 24 hours after anesthesia was 45.9% in the lidocaine group and 63.4% in the control group (risk ratio, 0.73; 95% confidence interval, 0.53-1.00; I2 = 32%; p = 0.05). The incidence of PONV within 24 hours after anesthesia was 3.73% in the lidocaine group and 4.87% in the control group (RR, 0.76; 95% CI, 0.36-1.59; I2 = 0%; p = 0.47). The quality of evidence was downgraded to "very low" due to the study designs, inconsistency, imprecision, and possible publication bias. CONCLUSION: Our meta-analysis suggests that intravenous lidocaine infusion may reduce the incidence of POV, however, the evidence quality was "very low." Further trials with a low risk of bias are necessary.

DOI： 10.1371/journal.pone.0227904

PubMed

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記述言語：日本語   出版者・発行元：(一社)医療の質・安全学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Clinical trials regarding the antishivering effect of perioperative magnesium have produced inconsistent results. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of perioperative magnesium on prevention of shivering. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and 2 registry sites for randomized clinical trials that compared the administration of magnesium to a placebo or no treatment in patients undergoing surgeries. The primary outcome of this meta-analysis was the incidence of shivering. The incidence of shivering was combined as a risk ratio with 95% CI using a random-effect model. The effect of the route of administration was evaluated in a subgroup analysis, and Trial Sequential Analysis with a risk of type 1 error of 5% and power of 90% was performed. The quality of each included trial was evaluated, and the quality of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach. We also assessed adverse events. RESULTS: Sixty-four trials and 4303 patients (2300 and 2003 patients in magnesium and control groups, respectively) were included. The overall incidence of shivering was 9.9% in the magnesium group and 23.0% in the control group (risk ratio, 0.42; 95% CI, 0.33-0.52). Subgroup analysis revealed that the incidence of shivering was lower with IV (risk ratio, 0.29; 95% CI, 0.29-0.54; Grading of Recommendation Assessment, Development, and Evaluation, moderate), epidural (risk ratio, 0.24; 95% CI, 0.13-0.43; Grading of Recommendation Assessment, Development, and Evaluation, low), and intrathecal administration (risk ratio, 0.64; 95% CI, 0.43-0.96; Grading of Recommendation Assessment, Development, and Evaluation, moderate). Only trials with low risk of bias were included for Trial Sequential Analysis. The Z-cumulative curve for IV magnesium crossed the Trial Sequential Analysis monitoring boundary for benefit even though only 34.9% of the target sample size had been reached. The Z-cumulative curve for epidural or intrathecal administration did not cross the Trial Sequential Analysis monitoring boundary for benefit. No increase in adverse events was reported. CONCLUSIONS: Perioperative IV administration of magnesium effectively reduced shivering and Trial Sequential Analysis suggested that no more trials are required to confirm that IV magnesium effectively reduces shivering.

DOI： 10.1213/ANE.0000000000004024

PubMed

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DOI： 10.1213/ANE.0000000000004024

PubMed

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記述言語：日本語   出版者・発行元：(一社)医療の質・安全学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Rett syndrome, which is a progressive, central nervous system disease that is caused by a gene mutation, is known to present with various symptoms. This case is that of a 15-year-old girl who was diagnosed with Rett syndrome at the age of 2 years. Laryngotracheal isolation under general anesthesia was planned due to recurrent aspiration pneumonia. Since the patient's nutritional status and control of convulsions were good, this was deemed an appropriate time for the surgery. Following careful preoperative evaluation of her airway, we performed oral endotracheal intubation using a video laryngoscope after rapid induction. Since postoperative pain control was important to prevent apneic attacks and convulsions, we used a multimodal analgesic regimen including carefully titrated fentanyl, acetaminophen, nonsteroidal anti-inflammatory drug, and wound infiltration with a local anesthetic. Postoperatively, the patient returned to the intensive care unit under spontaneous ventilation and followed a good course. Patients with Rett syndrome present several symptoms. Thus, several points must be considered during the preoperative evaluation, anesthetic management, and postoperative care of these patients.

DOI： 10.1186/s40981-018-0169-y

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/PTS.0000000000000232

PubMed

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記述言語：日本語   出版者・発行元：Kokuseido Publishing Co. Ltd  

Scopus

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2016/1058750

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3233/THC-130754

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1165/rcmb.2010-0092OC

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/TA.0b013e3181c4529e

Web of Science

PubMed

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記述言語：日本語  

J-GLOBAL

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記述言語：英語  

DOI： 10.1155/2015/454807

Web of Science

Scopus

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記述言語：日本語   出版者・発行元：真興交易(株)医書出版部  

J-GLOBAL

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記述言語：日本語   出版者・発行元：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

【背景】横浜市立大学附属病院手術室では，2006年まで，年に1度手術室をクローズして避難訓練を行っていた．これは主に火災を想定し職員の避難に重点を置いた訓練であった．この年，病院の災害対策マニュアル整備をきっかけに，手術室独自の災害対策マニュアル作成が行われた．このマニュアルは実際に機能するのか検証し，その不備を改善する目的で，災害に主眼を置いた訓練が企画された．<br>  【訓練の実際】［2007年］マニュアルを使用した訓練を行うため，シミュレーショントレーニングの訓練形態を初めて採用した．具体的には机上訓練を用いてマニュアル検証を行った．［2008年］前年の反省点をふまえ改正されたマニュアルを再検証し，アクションカードや災害状況報告書，そのほか災害対策の物品を整理した．［2011年］2009年，2010年は，緊急時のトレーニングをシミュレーショントレーニング法で実施した．この経験を生かし，2011年は再度地震災害をテーマに，新しい訓練法を取り入れた．［2012年］これまでの経験を生かし，もう一つの大学病院である市民総合医療センターにて，この病院の特徴をふまえた災害訓練を行った．<br>  【訓練の成果と課題】・実際に使用しなければ明らかにできないマニュアルの問題点を改善できた．／・多職種の参加者が共通認識を持つことができた．／・実際に体験することで効率よく学習でき，実際の震災時もあわてることがないよう物品の面でも精神的な面でも準備を整えられた．／・大規模な訓練の実施は時間的にもマンパワーの面でも困難であり，小規模なトレーニングを繰り返し行うことも必要であることが認識された．<br>  【結語】手術室災害トレーニングを繰り返し行い，効果的であったと思われるが，今後も継続していくために最適なトレーニング法を新たに模索する必要もあると考えられた．

DOI： 10.2199/jjsca.33.539

CiNii Books

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本臨床麻酔学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

J-GLOBAL

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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