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The COVID-19 pandemic is ongoing as of September 2022. Since January 2020 when the first case was reported in Japan, the medical community faced a variety of problems both domestically and internationally. It is meaningful to review the impact of COVID-19 from an anesthesiologist's perspective to clarify our policy for future infectious disease outbreaks. In this year's Journal of Anesthesia (JA) symposium, five experts who were deeply involved in the COVID-19 response reviewed the past 2.5 years and made recommendations for potential future pandemics. Anesthesiologists are specialists in airway management and their role in intubating patients with COVID-19 has received much attention. However, they have also played an important backup role in intensive care as critical care physicians and must be more involved in critical care in regular (non-pandemic) times to properly fulfill this role. It is especially important for the Japan Society of Anesthesiologists and JA to quickly disseminate accurate information on unknown infectious diseases to the medical community and wider society. Therefore, it is important to promptly publish papers that are quality-assured through peer review., Author(s): Kanji Uchida [sup.1], Osamu Nishida [sup.2], Hiroshi Morimatsu [sup.3], Takahisa Goto [sup.4], Yutaka Oda [sup.5], Takashi Asai [sup.6] Author Affiliations: (1) grid.26999.3d, 0000 0001 2151 536X, Department of Anesthesiology, [...]

Recently published case reports relating to anesthesia in patients with coronavirus disease (COVID-19) were reviewed. The diagnosis of COVID-19 was confirmed by positive results of reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Numerous reports handled emergency cesarean delivery. Primary symptoms and laboratory data of pregnant women with COVID-19 were similar to those of non-pregnant patients. Although the mortality rate is reported to be high after surgery in patients with COVID-19, cesarean delivery was successfully performed under regional anesthesia in most cases and postoperative course was favorable both in the parents and newborns. There is no direct evidence of vertical mother-to-child transmission of SARS-CoV-2; however, a diagnosis of COVID-19 was made in a newborn two hours after delivery from a pregnant woman with COVID-19, based on the increased immunoglobulin levels and deranged liver function, suggesting that its possibility cannot be completely eliminated. Emergency cerebral shunt reconstruction was performed repeatedly in an eight-month-old boy with COVID-19. The tracheal tube was removed in the operating room after surgery and postoperative course was uneventful. All the procedures should be performed in isolated operating rooms with medical staff with level-3 personal protection to ensure the safety of patients and health care providers., Author(s): Yutaka Oda [sup.1] Author Affiliations: (1) Department of Anesthesiology, Osaka City Juso Hospital, , 2-12-27, Nonaka-kita, Yodogawa-ku, 532-0034, Osaka, Japan Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly [...]

Purpose To characterize the clinical features and outcome of patients treated at a specialized hospital for coronavirus disease 2019 (COVID-19). Methods We retrospectively reviewed the symptoms on admission, treatment, and outcome of a total of 300 patients with mild (peripheral oxygen saturation (SpO.sub.2) [greater than or equal to] 96%), moderate I (93% < SpO.sub.2 < 96%), moderate II (SpO.sub.2 [less than or equal to] 93%) and severe (requiring admission to the ICU or mechanical ventilation) COVID-19. Results Median age was 53 (interquartile range [IQR] 33-72) years and 57% was male. The number of patients with mild, moderate I, II and severe condition was 85, 138, 61 and 16, respectively. Common presenting symptoms were cough (n = 71), loss of taste (42), loss of smell (39), fever [greater than or equal to] 37.5 °C (36). Dyspnea was observed only 21 cases; 57 reported no symptoms on admission. Favipiravir, ciclesonide, dexamethasone, and heparin were administered in 106, 168, 65, and 38 patients, respectively, but not remdesivir. The median duration of hospitalization was 10 (7-15) days. All patients with mild and moderate I severity were discharged. Among the 77 patients classified as moderate II or severe, 3 were transferred to tertiary hospitals for further treatment on the day of admission. The respiratory condition worsened in 21 patients; 18 required transfer to tertiary hospitals 3 (median) days after admission and 3 died. Conclusion Respiratory condition recovered in 92%; whereas it worsened in 7% and the mortality rate was 1%. The ratios of male patients, of patients with diabetes mellitus in those with the decreased respiratory condition, were significantly higher than recovered., Author(s): Yutaka Oda [sup.1], Satoshi Shiraishi [sup.2], Motoko Shimada [sup.1], Osamu Kurai [sup.3] Author Affiliations: (1) Department of Anesthesiology, Osaka City Juso Hospital, , 2-12-27 Nonaka-kita, Yodogawa-ku, 532-0034, Osaka, Japan [...]

Purpose We examined the hypothesis that 1 minimum alveolar concentration (MAC) of desflurane and sevoflurane provides different depth of anesthesia. Methods One hundred and twenty young (20-30 years), middle-aged (31-65 years), and elderly (66-80 years) patients were randomly allocated to receive either desflurane or sevoflurane (n = 20, each group). General anesthesia was induced with propofol 2 mg/kg bolus and remifentanil 0.25 [micro]g/kg/min, which was stopped after tracheal intubation. Maintenance of anesthesia was started with an end-tidal concentration of desflurane or sevoflurane at age-adjusted 1 MAC and maintained for 10 min, followed by 1-min assessment of bispectral index (BIS), 95% spectral edge frequency (SEF95), and amplitude of the electroencephalogram taken at 10-s intervals. Results BIS and SEF95 in patients receiving 1 MAC desflurane were significantly lower than those receiving 1 MAC sevoflurane including all age groups [35 (29, 39) vs. 41 (38, 49); 12.53 (10.99, 13.95) Hz vs. 14.42 (12.99, 17.17) Hz median (25, 75 percentile), respectively, P < 0.001 for both]. Both BIS and SEF95 in young patients were lower than in middle-aged and elderly patients receiving either desflurane or sevoflurane (P < 0.001 for both). There were no differences in amplitude between patients receiving desflurane and sevoflurane. Conclusions BIS as well as SEF95 were lower in patients receiving 1 MAC desflurane than those receiving 1 MAC sevoflurane, suggesting that desflurane provides higher depth of anesthesia than sevoflurane at 1 MAC., Author(s): Shinya Kanazawa [sup.1] , Yutaka Oda [sup.1] , Chika Maeda [sup.1] , Ryu Okutani [sup.1] Author Affiliations: (Aff1) 0000 0004 1764 9308, grid.416948.6, Department of Anesthesiology, Osaka City General [...]

Author(s): Yutaka Oda[sup.1] Author Affiliations: (1) Department of Anesthesiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, 534-0021, OsakaJapan Introduction With the development of ultrasound-guided regional anesthetic techniques, peripheral nerve block [...]

Many education critics, teachers, and parents have lamented the recent poor achievement scores of Japanese school-age children, and have sought the reasons for the decline. Some critics, including the Minister of Education, Culture, Sports, and Science and Technology, blame the practice known as yutori-kyoiku (literally translated as "relaxed-education"), initiated in 2002, which cut the school week from six days to five days and slashed curriculum content by 30 percent. At first glance, this debate does not seem to affect kindergarten or preschool education directly. However, some critics make kindergarten the scapegoat for poor school performance, saying that kindergarten education overemphasizes free play. Thus, this article provides an overview of the history of kindergarten education in Japan, focusing on the development of curriculum content and practice. The authors illustrate the current Japanese kindergarten curriculum and prospects for the future.

PHACE syndrome is a neurocutaneous syndrome characterized by the association of large cutaneous hemangiomas and the cardiac and cerebral vascular anomalies. We report a 6-year-old female with PHACE syndrome presented with left facial hemangiomas, cystic lesion in the cerebral posterior fossa, coarctation of the aorta, aplasia of the left vertebral artery and stenosis of the left internal carotid artery. Surgical repair of the aorta with left heart bypass under beating heart was scheduled. We monitored regional cerebral oxygen saturation (rS[O.sub.2]) with infrared spectroscopy in order to detect cerebral hypoperfusion. A decrease of rS[O.sub.2] ipsilateral to the cerebrovascular anomalies occurred during anastomosis of the aorta, which was treated by reducing the flow rate of left heart bypass and by increasing the inhalational oxygen concentration. As children with PHACE syndrome are frequently accompanied with cerebrovascular anomalies and at a risk of cerebral hypoperfusion, prevention of cerebral hypoperfusion is crucially important during general anesthesia. Keywords Coarctation of the aorta * Dandy-Walker syndrome * Left heart bypass * PHACE syndrome * Regional cerebral oxygen saturation, Introduction PHACE syndrome (1) is a coined acronym consisting of the initial letters of the following features: posterior fossa brain malformations, hemangiomas on face, anomaly of the cerebral arteries, coarctation [...]

Background It has been nearly 15 years since the effectiveness of intravenous lipid emulsion in resuscitation from bupivacaine-induced cardiac arrest was reported by Weinberg et al. [1]. Despite the outstanding [...]

Purpose Despite numerous studies examining the effect of lipid emulsion on bupivacaine-induced cardiac toxicity, few studies have examined its effect on central nervous system (CNS) toxicity of local anesthetics. We investigated the effect of lipid emulsion on the CNS and cardiac toxicity of bupivacaine and levobupivacaine in awake, spontaneously breathing rats. Methods Male Sprague-Dawley rats were randomly allocated to control-bupivacaine (CB), control-levobupivacaine (CL), lipid-bupivacaine (LB), and lipid-levobupivacaine (LL) groups (n = 8 in each group). After infusion of saline (CB and CL groups) or 20% lipid emulsion (LB and LL groups) for 5 min, bupivacaine (CB and LB groups) or levobupivacaine (CL and LL groups) was administered IV at 1 mg/kg/min. Cumulative dose of anesthetics and their plasma concentrations at the onset of convulsions and cardiac arrest were measured. Results The doses of bupivacaine for inducing convulsions and cardiac arrest in the LB group (8.8 ± 1.7 and 10.2 ± 1.5 mg/kg, respectively) were significantly larger than those in the CB group (5.9 [+ or -] 1.1 and 7.1 ± 1.3 mg/ kg, respectively, p < 0.001 for both). The doses of levobupivacaine for inducing convulsions and cardiac arrest in the LL group (10.0 ± 2.0 and 13.7 ± 3.6 mg/kg, respectively) were significantly larger than those in the CL group (7.7 ± 1.6 and 9.4 [+ or -] 2.4 mg/kg, p = 0.03 and p = 0.02, respectively). Plasma concentrations of bupivacaine at the onset of convulsions and cardiac arrest in the LB group (12.9 ± 2.9 and 41.4 ± 5.2 µg/ml, respectively) were significantly higher than those in the CB group (7.9 ± 1.2 and 21.6 [+ or -] 3.3 µg/ml, respectively, p < 0.001 for both). Plasma concentrations of levobupivacaine at the onset of convulsions and cardiac arrest in the LL group (17.5 ± 1.5 and 47.6 ± 6.1 µg/ml, respectively) were significantly higher than in the CL group (10.9 ± 2.2 and 29.2 ± 3.5 µg/ml, respectively, p < 0.001 for both). Conclusions Lipid emulsion decreased CNS and cardiac toxicity of both bupivacaine and levobupivacaine. Keywords Bupivacaine * Levobupivacaine * Central nervous system toxicity * Cardiac toxicity * Lipid emulsion, Introduction The effect of lipid emulsion on local-anesthetic-induced cardiac toxicity has been extensively studied [1]. Most of those studies employed anesthetized, mechanically ventilated animal models [2-4]. One reason for this [...]

Purpose We compared the insertion performance of the pediatric size 1.5-3 i-gel airway device with that of the ProSeal laryngeal mask airway (PLMA) in anesthetized children in a prospective, randomized, controlled manner. Methods We included 134 children, aged 3 months to 15 years, scheduled for elective surgery under general anesthesia. They were randomly divided into the i-gel and the PLMA groups according to the airway device used. The primary outcome variable was oropharyngeal leak pressure. Other outcome variables were ease of insertion, required time for insertion, fiberoptic view, and first-attempt and overall success rates. Results There were no differences in the ease of insertion, insertion time, or leak pressure between the devices. Fiberoptic view was significantly better with the i-gel than with the PLMA (P = 0.002). The view was significantly better with the sizes 2, 2.5, and 3 i-gel than with the size 1.5 i-gel (P = 0.02, 0.004 and 0.002, respectively), and the view was significantly better with the sizes 2.5 and 3 PLMA than with the size 1.5 PLMA (P = 0.02 and 0.005, respectively). The first-attempt success rates were 94 and 97 % in the i-gel and the PLMA groups, respectively; the success rates including the second attempt were 100 % in both groups. No children developed side effects requiring treatment with either device. Conclusion Both the pediatric i-gel and the PLMA were successfully inserted in children. The fiberoptic view was better with the i-gel than with the PLMA. Keywords Airway * Device * Intubation * i-gel * ProSeal laryngeal mask airway * Pediatrics, Introduction The pediatric i-gel (Intersurgical, Wokingham, Berkshire, UK) is a new single-use, latex-free supraglottic airway device for children [1]. It is a smaller model of the i-gel device used in [...]

Author(s): Yutaka Oda [sup.1] Author Affiliations: (1) Department of Anesthesiology, Osaka City Juso Hospital, 2-12-27, Nonaka-kita, Yodogawa-ku, 533-0034, Osaka, Japan Rocuronium has become the neuromuscular blocking agent of first choice [...]

The tertiary and quaternary structures of 0.19 alpha-amylase inhibitor (0.19 AI) from wheat kernel were investigated by X-ray analysis. The crystal structure was refined by simulated annealing using diffraction data to 2.06 angstroms resolution. The tertiary structure of 0.19 AI was compared with that of the bifunctional alpha-amylase/trypsin inhibitor from ragi seeds (RBI). Results showed that the arrangements of the major alpha-helices of 0.19 AI, RBI and hydrophobic protein from soybean are similar while the conformations of the remaining residues differ significantly.