Masahiko Akatsu

Current state of emergency medicine in Fukushima 4 years after the Great East Japan Earthquake

On 11 March 2011, a huge tsunami exceeding 13 m in height generated by the Great East Japan Earthquake widely damaged the Pacific coastal area of Fukushima Prefecture. The tsunami induced loss of the power supply to nuclear reactors 1–4 at the Fukushima Daiichi Nuclear Power Plant (see figure 1; F1 on map). Steam explosions of the reactor buildings ensued, and the eastern part of Fukushima Prefecture was widely contaminated by scattered radioactive materials. At that time, we were engaged in the forefront of emergency medical care at Fukushima Medical University Hospital for the victims of this disaster. Fukushima Prefecture has two nuclear power plants, and we had prepared for radiation accidents before the Great East Japan Earthquake. We learned how to measure radiation activity and decontaminate radioactive materials. However, these actions were not useful for this disaster because our training involved learning how to treat only two to three patients involved in radiation accidents in nuclear power plants. We were thus unprepared for this large-scale disaster. The most urgent problem for us was the sudden closing of hospitals around F1. We had to accept large numbers of patients from these hospitals, and many of the patients were transported with only the clothes on their backs. Because the communication system in Fukushima Prefecture completely collapsed, dozens of patients were transported by the Japan Self-Defense Force and arrived at our hospital without any information. These patients required radioactivity screening, but we could not take rapid action because of the lack of trained staff members and danger involved in handling radioactivity measuring devices. In many cases, these patients had to undergo long-distance …

Anesthetic Management of a Patient With Antimuscle-Specific Kinase Antibody-Positive Myasthenia Gravis Undergoing an Open Cholecystectomy: A Case Report.

Myasthenia gravis (MG) is an autoimmune disease characterized by the production of antibodies against the acetylcholine receptor, muscle-specific kinase (MuSK), or other proteins at the neuromuscular junction. MG with antibodies against MuSK (MuSK-MG) has been described recently. Here, we report the first case of anesthetic management of a patient with MuSK-MG undergoing an open cholecystectomy. In our case, propofol and remifentanil-based anesthesia were used for successful management without using muscle relaxants. Patients with MuSK-MG have predominantly ocular, bulbar, and respiratory symptoms that may increase the risk of aspiration. Anesthesiologists need to pay attention to perioperative respiratory failure and respiratory crisis.

Great East Japan earthquake: anesthetists in Minamisoma

changes in public health policies; mental health issues; general illness; legal problems [1]. These problems particularly affect the elderly and children. Air radiation levels have decreased through decontamination efforts, but the local population is declining. Social changes include a decrease in the number of children and able workers [2]. We are concerned about the effects of radiation on the children of hospital employees which has the potential to affect staffing levels and lead to fewer hospital beds. If the present trend continues, we will be unable to increase the number of hospital anesthesiologists and hence the number of surgeries performed. The average age of our anesthesiologists is 58.5 years at this time and is progressively increasing. We are very concerned about this situation, which amounts to a medical crisis.