目的：本研究の目的は，終末期がん患者とその家族に対する看護師のケアを評価するための看取りケア尺度を開発し，その信頼性と妥当性を検討することである． 方法：自由記述調査から得られたデータと文献検討に基づき，看取りケア尺度原案を作成した．内容妥当性の検討から尺度原案を修正し，49項目の看取りケア尺度原案修正版を作成した．4施設の看護師562名を対象とする質問紙調査を実施し，尺度の信頼性と妥当性を検討した． 結果：主因子法－プロマックス回転による探索的因子分析の結果，22項目5因子が抽出され，第Ⅰ因子から順に，【悔いのない死へのケア】【癒しと魂のケア】【苦痛緩和ケアの保証】【情報提供と意思決定のケア】【有効なケアの調整】と命名された．また，共分散構造分析による検証的因子分析を実施した結果，探索的因子分析で得られた仮説モデルの適合度が確認された．尺度の信頼性については，Cronbach's α係数0.91（下位尺度0.67～0.83），再テスト法による信頼性係数0.74で確認された．基準関連妥当性については，家族支援とダイイング・ケア項目，看護師の自律性尺度，終末期医療に携わる看護師の患者ケアに対する満足度尺度で確認され，構成概念妥当性については，既知グループ技法で確認された． 結論：看取りケア尺度は終末期がん患者とその家族に対するケアの質向上において，有用な尺度であることが示唆された．

Key Clinical Message: Remimazolam is a new benzodiazepine sedative and has the characteristic of causing minimal effects on circulation. This case indicates that it can be considered as an option for anesthesia management of patients with decreased cardiac function. Some patients who undergo cardiac surgery have reduced cardiac function, which can often make anesthesia management difficult owing to severe hypotension at the time of anesthesia induction. Therefore, it is important to select drugs that cause minimal circulatory depression. On the other hand, in 2020, the use of remimazolam, a short‐acting benzodiazepine sedative, was approved in Japan, and reports of its use in various patients have been increasing. This drug has the characteristic of causing minimal effects on circulation. We here report the safe use of remimazolam in the anesthesia management of a patient with decreased cardiac function who was diagnosed as having angina pectoris. The patient was a 73‐year‐old man scheduled for coronary artery bypass graft (CABG) surgery. Remimazolam was used for sedation purposes during anesthesia induction. During surgery, there were no significant hemodynamic changes and the patient remained in stable cardiovascular condition. Our present case indicates that remimazolam can be considered as an option for anesthesia management in CABG for patients with decreased cardiac function.

Transesophageal echocardiography (TEE) is a necessary diagnostic tool for cardiac surgery, including for intraoperative evaluation of the morphology and function of each structure. On the other hand, many complications caused by insertion and manipulation of the TEE probe have been reported, such as gastrointestinal injuries and hematoma, as well as esophageal perforation. Here, we report a case in which a large submucosal esophageal hematoma was found on the fourth postoperative day after surgery using TEE for mitral regurgitation. The patient was an 81-year-old man who underwent mitral valve replacement for mitral regurgitation. On the fourth postoperative day, anorexia and blood-tinged sputum were observed. A computed tomography (CT) scan of the chest displayed a giant esophageal submucosal hematoma. When performing TEE, to avoid complications, it is important to handle the TEE probe with care and to avoid leaving the device at the same site for long periods of time.

Coronary angina due to low estrogen is relatively common around menopause, with almost no reports associated with the menstrual cycle or anesthetic management at younger ages. The patient was a 22‐year‐old woman who had developed ventricular fibrillation due to coronary spasm, resulting in cardiopulmonary arrest. She was resuscitated, and underwent ICD implantation. As her symptoms appeared at specific times during her menstrual cycle, she was diagnosed as having menstrual‐associated coronary spasm, and started taking estrogen/progesterone medication. An endometrial ablation was scheduled for endometrial hyperplasia that was caused by the medicine. The surgery was scheduled in consideration of the patient's menstrual cycle, and general anesthesia was selected as the method of anesthesia. The surgery and perioperative management were uneventful, and her postoperative course was favorable. Our case is the first to our knowledge of general anesthesia performed on a patient with menstrual‐associated coronary spasm.

Experience of general anesthesia in a patient with menstrual-associated coronary spasmAya Kawachi, Saho Sudo, Yusuke Ishida and Koichi NakazawaDepartment of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan

Anesthesia using remimazolam during coronary artery bypass surgery in a patient with decreased left ventricular functionShingo Narumi, Yusuke Ishida, Sae Igarashi, Shunya Sekiguchi, Aya Kawachi, and Mikiko TominoDepartment of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, JapanCorresponding author: Yusuke IshidaDepartment of AnesthesiologyTokyo Medical University6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, JapanTel.: +81-03-3342-6111; Fax: +81-03-5381-6650Email: yishida14anes@gmail.com