Tsuyoshi Isosu

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 for ascending aorta replacement in a patient who refused autologous transfusion for religious reasons.

We report on the anesthetic management of a 69-year-old female Jehovah’s Witness undergoing cardiopulmonary bypass to replace the ascending aorta; the patient refused transfusion of stored autologous or allogeneic blood products for religious reasons. The strategy involved preoperative hematopoiesis with recombinant human erythropoietin and iron, intraoperative acute normovolemic hemodilution, the use of a cell-saver system, administration of high-dose tranexamic acid, controlled hypotension, avoidance of low body temperature, simplification of the surgery, and lower blood dilution during cardiopulmonary bypass.

Life-threatening urethral hemorrhage after placement of a Foley catheter in a patient with uroseptic disseminated intravascular coagulation due to chronic urinary retention induced by untreated benign prostatic hyperplasia

A 77‐year‐old man with severe septic disseminated intravascular coagulation following urinary infection was transported to our hospital. He had developed urinary retention induced by untreated prostatic hyperplasia. Immediate drainage with a Foley catheter was successfully carried out, but the hematuria progressed to life‐threatening hemorrhage.

THE EFFECT OF OBESITY ON DOSE OF DEXMEDETOMIDINE WHEN ADMINISTERED WITH FENTANYL DURING POSTOPERATIVE MECHANICAL VENTILATION - RETROSPECTIVE

We carried out a retrospective investigation on the effect of obesity on dexmedetomidine (DEX) requirements when administered with fentanyl (FEN) during mechanical ventilation after major surgeries. After Institutional Review Board approval, 14 obese patients with a body mass index (BMI) ≥ 30 kg/m(2) and the same number of non-obese patients with similar backgrounds to the obese patients were selected from medical records. Doses of DEX in the first 48 h or until the end of sedation or extubation were calculated for comparison. In addition to comparison of dosing between the groups, associations between total body weight (TBW), BMI, and lean body mass (LBM) values and doses of DEX (mcg/h), between BMI and various indices (i.e., amount per TBW per hour and amount per LBM per hour) of DEX doses, and between above indices of DEX and FEN doses were also examined. There were no significant differences in DEX dose indices between the groups. However, DEX requirements (mcg/h) were significantly increased with TBW (kg) (r = 0.51, P = 0.003), BMI (r = 0.49, P = 0.006) and LBM (kg) (r = 0.42, P = 0.02), which might have enhanced the DEX metabolism with physiological changes with obesity. These findings will be beneficial for future clinical pharmacological analysis of DEX.