Masui. The Japanese journal of anesthesiology
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Clinical Trial
[Effect of preoperative treatment with recombinant human erythropoietin in patients undergoing hemodilutional autologous transfusion].
This study evaluated whether a combination of recombinant human erythropoietin (rHuEPO) and hemodilutional autologous transfusion could reduce homologous blood transfusion in 37 patients who underwent elective urological surgery. A single dose of 6000 IU rHuEPO was administered 2 weeks before operation to patients whose preoperative hemoglobin was less than 12.0 g.dl-1 (8.5-12.0 g.dl-1) (EPO group, n = 15) and compared these with control subjects whose preoperative hemoglobin was more than 12.0 g.dl-1 (non-EPO group, n = 22). Both hemoglobin and hematocrit levels after administration of rHuEPO in the EPO group increased significantly to the same levels as in those in the non-EPO group and remained at these levels. ⋯ The mean surgical blood loss was 1330 g in the EPO group and 1120 g in the non-EPO group. No homologous blood transfusion was required in 80 percent of the cases in both groups: however, homologous transfusions were added to 3 cases in the EPO group and 4 cases in the non-EPO group whose surgical blood loss was over 2500 g. We conclude that the combination of preoperative rHuEPO treatment and hemodilutional autologous transfusion can reduce homologous transfusion during surgery in anemic patients.
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A 77-year-old female was scheduled for an exploratory laparotomy under nitrous oxide-oxygen-neurolept anesthesia. At the time of admission to the operating room, the rectal temperature was 36.0 degrees C. From the beginning of operation, the body temperature dropped slowly despite constant efforts of warming with a blanket and warm intravenous fluids. ⋯ When the rectal temperature rose to 32.9 degrees C one hour after the rewarming, cardioversion was performed again and spontaneous heart beat was observed. As soon as the rectal temperature rose to 34.0 degrees C, CHF was stopped. Her consciousness recovered 2 hours and 10 minutes after cardiopulmonary resuscitation, we conclude that rewarming with CVVH can be an effective method of cardiopulmonary resuscitation in a patient suffering cardiac arrest due to hypothermia.
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We studied the relationship between quantity of microbubble retained in the left heart and neuropsychologic alterations after surgery in 21 patients undergoing cardiac surgery including cardiopulmonary bypass. The neuropsychologic change was evaluated by three kinds of psychological test, which mainly analyzed memory and cognition. ⋯ Since most of the microbubbles were detected during the unclamping of aorta and the weaning from cardiopulmonary bypass, a technical improvement of the surgical procedures could reduce them. We think that transesophageal echocardiography is useful for monitoring microbubbles during operation.
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Twenty six gauge pencil point spinal needles and an adaptor for the fixation of the spinal needle were developed for combined epidural/spinal anesthesia on an experimental basis and applied on 110 patients. The length of the spinal needles was either 11.7 cm or 13 cm. Fifty out of 110 patients were punctured with the 11.7 cm needle and then were divided into 2 groups. ⋯ On the other hand, when a 13 cm spinal needle was employed, it often did not remain in place during drug injection. This problem could be solved, however, by using an adaptor with which the spinal needle was fixed firmly on the epidural needle at the point of dural puncture. The incidence of the post dural puncture headache was 1.7% (1 out of 60 patients).
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Case Reports
[Subdural catheterization uncovered by severe hypotension during epidural plus general anesthesia].
We experienced three cases of accidental subdural catheterization during epidural combined with general anesthesia. In each case, epidural catheterization was performed before induction of general anesthesia. Aspiration through the catheter and a response to a test dose were negative. ⋯ It is often difficult to identify subdural placement of an epidural catheter under general anesthesia since signs of massive sensory blockade are masked by general anesthesia. In each case, we suspected malpositioning of the catheter by severe hypotension due to sympatholysis which was difficult to treat. Subdural catheterization is a complication of epidural anesthesia that probably occurs more frequently than previously recognized and is usually unpredictable during general anesthesia.