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Background. We previously reported a tele-anesthesia system that connected Sado General Hospital (SGH) to Yokohama City University Hospital (YCUH) using a dedicated virtual private network (VPN) that guaranteed the quality of service. The study indicated certain unresolved problems, such as the high cost of constantly using a dedicated VPN for tele-anesthesia. In this study, we assessed whether use of a best-effort system affects the safety and cost of tele-anesthesia in a clinical setting. Methods. One hundred patients were enrolled in this study. We provided tele-anesthesia for 65 patients using a guaranteed transmission system (20 Mbit/s; guaranteed, 372,000 JPY per month: 1 JPY = US$0.01) and for 35 patients using a best-effort system (100 Mbit/s; not guaranteed, 25,000 JPY per month). We measured transmission speed and number of commands completed from YCUH to SGH during tele-anesthesia with both transmission systems. Results. In the guaranteed system, anesthesia duration was 5780 min (88.9 min/case) and surgical duration was 3513 min (54.0 min/case). In the best-effort system, anesthesia duration was 3725 min (106.4 min/case) and surgical duration was 2105 min (60.1 min/case). The average transmission speed in the best-effort system was 17.3 ± 3.8 Mbit/s. The system provided an acceptable delay time and frame rate in clinical use. All commands were completed, and no adverse events occurred with both systems. Discussion. In the field of tele-anesthesia, using a best-effort internet VPN system provided equivalent safety and efficacy at a better price as compared to using a guaranteed internet VPN system. [ABSTRACT FROM AUTHOR]

The aim of this study was to reveal the effect of anesthesiologist’s mental workload during induction of general anesthesia. Twenty-two participants were categorized into anesthesiology residents (RA group, n=13) and board certified anesthesiologists (CA group, n=9). Subjects participated in three simulated scenarios (scenario A: baseline, scenario B: simple addition tasks, and scenario C: combination of simple addition tasks and treatment of unexpected arrhythmia). We used simple two-digit integer additions every 5 seconds as a secondary task. Four kinds of key actions were also evaluated in each scenario. In scenario C, the correct answer rate was significantly higher in the CA versus the RA group (RA: 0.370 ± 0.050 versus CA: 0.736 ± 0.051, p<0.01, 95% CI −0.518 to −0.215) as was the score of key actions (RA: 2.7 ± 1.3 versus CA: 4.0 ± 0.00, p=0.005). In a serious clinical situation, anesthesiologists might not be able to adequately perform both the primary and secondary tasks. This tendency is more apparent in young anesthesiologists. [ABSTRACT FROM AUTHOR]

We studied the use of tele-anaesthesia between Sado General Hospital (SGH) located on Sado Island and Yokohama City University Hospital (YCUH) located in mainland Japan. The two sites were connected via a virtual private network (VPN). We investigated the relationship between the bandwidth of the VPN and both the frame rate and the delay time of the tele-anaesthesia monitoring system. The tool used for communication between the two hospitals was free videoconferencing software (FaceTime), which can be used over Wi-Fi connections. We also investigated the accuracy of the commands given during teleanaesthesia: any commands from the anaesthetist at the YCUH that were not carried out for any reason, were recorded in the anaesthetic records at the SGH. The original frame rate and data rate at the SGH were 5 fps and approximately 18 Mbit/s, respectively. The frame rate at the transmission speeds of 1, 5 and 20 Mbit/s was 0.6, 1.6 and 5.0 fps, respectively. The corresponding delay time was 12.2, 4.9 and 0.7 s. Twenty-five adult patients were enrolled in the study and tele-anaesthesia was performed. The total duration of anaesthesia was 37 hours. All 888 anaesthetic commands were completed. There were 7 FaceTime disconnections, which lasted for 10 min altogether. Because no commands needed to be given during the FaceTime disconnection, the telephone was not used. The anaesthesia assistance system might form part of the solution to medical resource shortages. [ABSTRACT FROM PUBLISHER]

Background: Surgical site infection is a major perioperative issue. The morbidity of surgical site infection is high in major digestive surgery, such as pancreaticoduodenectomy. The comprehensive risk factors, including anesthetic factors, for surgical site infection in pancreaticoduodenectomy are unknown. The aim of this study was to investigate the perioperative and anesthetic risk factors of surgical site infection in pancreaticoduodenectomy., Methods: This was a retrospective cohort study conducted in a single tertiary care center. A total of 326 consecutive patients who underwent pancreaticoduodenectomy between January 2009 and March 2018 were evaluated. Patients who underwent resection of other organs were excluded. The primary outcome was the incidence of surgical site infection, based on a Clavien-Dindo classification of grade 2 or higher. Multivariable logistic regression analysis was performed to investigate the association between surgical site infection and perioperative and anesthetic factors., Results: Of the 326 patients, 116 (35.6%) were women. The median age was 70 years (interquartile range; 64-75). The median duration of surgery was 10.9 hours (interquartile range; 9.5-12.4). Surgical site infection occurred in 60 patients (18.4%). The multivariable analysis revealed that the use of desflurane as a maintenance anesthetic was associated with a significantly lower risk of surgical site infection than sevoflurane (odds ratio, 0.503; 95% confidence interval [CI], 0.260-0.973). In contrast, the duration of surgery (odds ratio, 1.162; 95% CI, 1.017-1.328), cerebrovascular disease (odds ratio, 3.544; 95% CI, 1.326-9.469), and ischemic heart disease (odds ratio, 10.839; 95% CI, 1.887-62.249) were identified as significant risk factors of surgical site infection., Conclusions: Desflurane may be better than sevoflurane in preventing surgical site infection in pancreaticoduodenectomy. Cerebrovascular disease and ischemic heart disease are potential newly-identified risk factors of surgical site infection in pancreaticoduodenectomy., Competing Interests: The authors have declared that no competing interests exist.

In isolated area in Japan, only one anesthesiologist must often do new anesthetic techniques such as ultrasound-guided procedures without receiving any teaching. One solution to this problem may involve teleanesthesia, by which experienced anesthesiologists teach novices in remote places, by utilizing information communication technologies. FaceTime™ (Apple, USA), which provides 120p of the resolution and 30 frames per second (fps) is an application of free visual communications using iPod Touch™, iPhone™ or iPad™ (Apple, USA). We investigated the delay time, the loss of the frames and the picture quality of iPad (as the device in the teaching site) in combination with iPod Touch, iPhone4 or iPhone5 (as the device in the isolated site) during FaceTime. At the operating rooms in Sado General Hospital (SGH) located in Sado Island (population; approximately 60,000), Japan, an anesthesiologist prepared 3 mobile devices (iPod Touch, iPhone4 or iPhone5). He called the other anesthesiologist at Yokohama City University Hospital (YCUH; approximately 300 km apart) by FaceTime using 1 of 3 mobile devices. The anesthesiologist at YCUH received the FaceTime call using iPad. After the connection was established, the display of the same cervical ultrasound image at SGH was sent to YCUH to evaluate the distinctness visually. Then we measured the delay time of every second (n = 60) and the loss of the frames (total frames = 30 fps × 60 s = 1,800) in each device for a minute. P < 0.01 was statistically significant. The quality of the pictures on the iPad display sent from iPhone5 was distinctly the best visually. The delay time of iPhone5 was significantly longer than the others (iPod Touch; 0.14 ± 0.02 s, iPhone4; 0.13 ± 0.02 s, iPhone5; 0.19 ± 0.03 s), but clinically acceptable. The loss of the frames of iPhone5 (20; 1.1%) was significantly less than the others (iPhone4; 900, 50.0%, iPod Touch; 902, 50.1%). To teach anesthetic techniques in remote place by FaceTime, iPhone5 as the devise in isolate site was optimum compared with iPod Touch and iPhone4.