Journal of anesthesia
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Journal of anesthesia · Feb 2011
Case ReportsA case of intraoperative coronary artery spasm in a patient with vascular disease.
A 66-year-old man with a history of longtime smoking, untreated hypertension, hyperlipidemia, and impaired glucose tolerance but no history of myocardial infarction or angina pectoris was scheduled for right aortofemoral bypass and thromboembolectomy for arteriosclerosis obliterans with right common iliac and right popliteal arterial thrombus. Epidural anesthesia and general anesthesia were administered without obvious ECG changes. Just after skin incision, ST elevation in leads II and V5 and a short run of ventricular tachycardia with frequent premature ventricular contractions (PVCs) were recorded on the ECG monitor, and the patient's blood pressure suddenly decreased within a few seconds. ⋯ Transesophageal echocardiography (TEE) showed basal to mid- and anteroseptal to inferior wall motion hypokinesis that gradually returned to normal during observation. Even in patients without coronary disease but with systemic arteriosclerosis, it is important to consider the possibility of perioperative CAS and not to overlook ECG changes. Immediate diagnosis and treatment are essential.
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Journal of anesthesia · Feb 2011
Case ReportsAssessment of intraoperative motor evoked potentials for predicting postoperative paraplegia in thoracic and thoracoabdominal aortic aneurysm repair.
Monitoring motor evoked potentials (MEPs) has been recognized as a highly reliable method to detect intraoperative spinal cord ischemia (SCI) in aortic repair. However, the data regarding the sensitivity and specificity of MEPs for predicting postoperative paraplegia are limited. We retrospectively assessed the value of intraoperative MEP amplitudes for predicting postoperative paraplegia. ⋯ Monitoring MEPs had relatively high sensitivity and acceptable specificity, with the cutoff point set at 75% decrease of the baseline MEP, for predicting paraplegia and paraparesis. Because of the small sample in our study, further investigations would be necessary to investigate an adequate cutoff point that could predict postoperative paraplegia.
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Journal of anesthesia · Feb 2011
Protocol-based noninvasive positive pressure ventilation for acute respiratory failure.
Noninvasive positive pressure ventilation (NPPV) has been suggested to be associated with adverse outcomes in emergency patients with acute respiratory failure (ARF), possibly because of a delay in tracheal intubation (TI). We hypothesized that protocol-based NPPV (pNPPV) might improve the outcomes, compared with individual physician-directed NPPV (iNPPV). ⋯ The present study suggests that pNPPV is effective and likely to improve the mortality rate of emergency patients with ARF.
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Journal of anesthesia · Feb 2011
Awareness during anesthesia: the results of a questionnaire survey in Japan.
We planned a survey to evaluate the current incidence and risk factors of intraoperative awareness. ⋯ The most surprising finding of this study is that total intravenous anesthesia (TIVA) was used in 21 of the 24 (88%) cases of definite and possible awareness. Although the incidence of intraoperative awareness was compatible with the previous studies, meticulous care should be taken when anesthesia is performed by TIVA for high-risk patients. The results of this survey should be verified, as well as further continuous survey and prospective study, because this study was performed by an anonymous questionnaire survey conducted over only 1-year period.