Open MRI Operating Room with Automatic Electronic Recording of Medical Equipment Provided by Wireless LAN - Anesthesia Care Experience of ２５ Cases in Hiroshima University Hospital

オープンMRI設置手術室で25例の麻酔を経験した。MRI設置手術室では術中にMRI画像を判断材料として手術をすすめるため，MRI画像へのノイズ混入対策が必要である。また，MRI磁場の影響で術中にモニター機器や麻酔器が誤動作を起こす可能性があるため，MRI非対応機器からの画像ノイズの遮断対策として，電子機器から発生するノイズの軽減には特殊シールドボックスやイキソルメッシュを使用し，手術室外からのノイズには手術室全体にシールド工事を行った。MRIが発生させる磁場による電子機器の誤動作・故障対策は，オープンMRIの磁場が5ガウス以下となる範囲に電子機器や手術器具を置くことで対応した。問題の克服に加えて，医療機器からのデータの無線通信により，ケーブル類をなくすことでMRI撮影時の患者移動の簡素化をはかり，安全性を高めることができた。We provided anesthesia care for 25 patients in an open MRI operating room and summarized here our experience. When surgeons use MRI during surgery, the presence of noise in the images caused by other electronic equipment in the area often hinders accurate diagnosis.　In addition, malfunction of monitoring and anesthesia equipment during surgery due to the MRI magnetic field created during an MR examination can occur. In order to prevent imaging interference affecting equipment not compatible with MRI, we utilized 2 specially prepared shield boxes and wrapped the personal computer used for coordinating the data with a mesh-like cloth made by Ixol-mesh.　In addition, we prepared a shielded operating room in order to block noise from the outside. To prevent malfunction of the surgical and electronic instruments, we kept them outside the magnetic field of 5 Gauss or lower to minimize the magnetic effect generated with MRI.　Furthermore, patient safety during MRI imaging was improved by establishing a wireless communication system to feed data from medical devices, which allowed elimination of cabling

Transition of Anesthesia Management and Anesthetics Used for 50 Years Since the Establishment of Anesthesiology Department in Hiroshima University

広島大学麻酔蘇生学教室は1967年1月に盛生倫夫が初代教授に就任し開講した。開講50周年を機に，麻酔科開設以来の麻酔管理に用いた麻酔薬の変遷を辿った。開講当初から１９８５年までは亜酸化窒素とハロタンを中心とした吸入麻酔薬の時代，1990年から2005年はエンフルラン，イソフルラン，セボフルランなどの吸入麻酔薬とフェンタニルの併用の時で，2010年からはプロポフォールとレミフェンタニルの全静脈麻酔あるいはセボフルランあるいはデスフルランとレミフェンタニル併用の時代であった。開講から1980年頃まではスキサメトニウムを主に使ったが，それ以降は非脱分極性筋弛緩薬であるパンクロニウムへ，そしてベクロニウムへ推移し，現在はロクロニウムが主流となっている。使用麻酔薬の変遷は麻酔薬の科学的な評価とそれらを使用する麻酔科医の考え方を反映していた。Department of Anesthesiology and Critical Care, Hiroshima University, started in January 1967 when Dr. Michio Morio became the first professor.　With the 50th anniversary of the establishment of the department, the transition of the anesthetics used in our long history of anesthesia care was investigated since the beginning of the department. Inhalation anesthetics was mainly used in combination with nitrous oxide and halothane from the beginning to 1985. Inhalation anesthetics such as enflurane, isoflurane, sevoflurane and intravenous fentanyl were used from 1990 to 2005, and the total intravenous anesthesia by using propofol and remifentanil was introduced and used currently. Sevoflurane or desflurane combined with remifentanil was also a mainstream since 2010.　From the beginning to 1980, suxamethonium was mainly used for muscle relaxation, followed by pancuronium thereafter and shifted to vecuronium and to rocuronium. The transition of anesthetics applied for clinical anesthesia in our department seemed to be reflecting the selection based on scientific validity

Anesthetic Management for Hemophilia A Carrier Who Underwent Caesarean Section Procedures Twice with Subarachnoid Anesthesia

Hemophilia A carriers are usually asymptomatic and their risk of bleeding when giving birth is not necessarily high, since the level of coagulation factor VIII (FVIII) increases during the perinatal period.　However, for mothers whose FVIII activity remains low, bleeding risk is increased and a Caesarean section is required when the fetus is a male. We report here anesthetic management for a hemophilia A carrier who underwent a selective Caesarean section procedure on two separate occasions during birth of male infants.　The level of FVIII was noted to be increased during the perinatal period, thus management by spinal subarachnoid anesthesia alone was used for the first childbirth and combined spinal-epidural anesthesia for the second.　FVIII remained within a normal range throughout both procedures, and no complications occurred in either the mother or the newborns.本稿の要旨は第１１９回日本産科麻酔学会学術集会（２０１５年，東京）において発表した

General Anesthesia Management Combined with Thoracic Wall Block for Mastectomy on a Patient with a History of Aortic Valve Replacement

Thoracic wall block is a useful tool for analgesia in a patient receiving mastectomy. To select an analgesic method with sufficient analgesic effect and little influence on cardiovascular dynamics is important for perioperative management of the patients whose cardiovascular dynamics are desirable to be stable. We experienced a patient who had an increased pressure gradient from the left ventricle to the aortic valve, accompanied by the sigmoid shaped ventricular septum developed after aortic valve replacement. By using pectoral nerve block and transversus thoracic muscle plane block combined with general anesthesia, we managed this patient uneventfully and safely.本論文の要旨は，日本麻酔科学会　中国・四国支部　第53回学術集会（2016年，岡山）で発表した

Examination of the Usefulness of High Flow Nasal Cannula Oxygen Therapy after Stanford Type a Acute Aortic Dissection

Stanford A型急性大動脈解離（AAD）の術後管理において，呼吸管理は重要な問題の一つである。この研究ではAAD術後患者に関する高流量鼻カニュラ（HFNC）の有用性を検討した。当院の外科手術後集中治療室においてHFNCを導入する前に呼吸管理をした患者群（導入前群：９例）とHFNC導入後にこれを用いて呼吸管理をした患者群（導入後群：７例）を対象に，後方視的に比較検討を行った。患者背景因子および術中経過に有意な群間差は認めなかったが，人工呼吸器離脱直前のPaO２/FiO２比（P/F）は導入後群で有意に低かった（導入前群：２８４±２８，導入後群：２０５±６）。人工呼吸器離脱後の経過や有害事象の発生数に有意な群間差は認めなかった。本研究では，HFNC導入によりP/Fが２００程度の患者であっても人工呼吸器からの離脱が可能であった。有害事象の発生数に両群間に差を認めなかったことから，HFNCはAADの術後に用いることができる呼吸管理法になると結論した。In this study, we retrospectively reviewed the records of patients who underwent open operation for acute aortic dissection (AAD), and assessed the clinical superiority of postoperative respiratory management with high flow nasal cannula (HFNC) in comparison with conventional management with the face mask.　PaO2/FiO2 before tracheal extubation in the HFNC group (n = 7) was 205, and which was lower than that in the conventional management group (n = 9).　The HFNC was not inferior to the conventional face mask for improvements in oxygenation, stay lengths in the surgical intensive care unit, and frequencies of adverse events.　In conclusion, we suggested that the HFNC could be an option for postoperative respiratory management of AAD.本論文の要旨は，第４４回日本集中治療医学会学術集会（２０１７年，札幌）で発表した