Masui. The Japanese journal of anesthesiology
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A 45 year old woman undergoing a removal of cerebral arterio-venous malformation, suffered an unexpected massive bleeding. With transfusion of plasma constituents, her hemoglobin concentration decreased to about 5 g.dl-1, but her hemodynamic parameters remained unchanged. ⋯ With rapid transfusion of concentrated red cell and whole blood, hemodynamic parameters as well as ECG change were restored to normal. With hemodilutional myocardial ischemia which is caused by acute massive bleeding, hemoglobin concentration of about 2 g.dl-1 would be critical.
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Intraoperative transesophageal echocardiography (TEE) has a wide range of applications including monitoring of left ventricular (LV) function, evaluation of natural and prosthetic valves, detection of intracardiac thrombus, mass and vegetation, assessment of surgical repair of cardiac disease, visualization of intracardiac air, positioning of an intraaortic balloon and a coronary sinus catheter, evaluation of thoracic aortic lesions, and so on. Complications are very rare with TEE, but damage of the esophagus or stomach can occur. Gentle manipulation of the TEE probe is always required. ⋯ Assessment of RWMAs is thus very useful for diagnosis of ischemia. Although RWMAs are not always caused by acute ischemia, a new onset of RWMAs, as seen during surgery, almost certainly indicates myocardial ischemia. TEE also allows evaluation of LV diastolic function by analyzing the transmittal flow velocity.
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Randomized Controlled Trial Clinical Trial
[The effect of preoperative oral fluid intake on the volume and pH of gastric contents in elective surgical patients--a comparison of tea with apple juice].
This study aimed to investigate the effect of 150 ml of either tea or apple juice on the volume and pH of gastric contents in 40 elective surgical patients, ranging in age from 18 to 70 years. They were given diazepam 5 approximately 10 mg and roxatidine 75 mg orally 2 hours before the start of isoflurane anesthesia or modified neuroleptic anesthesia. ⋯ There was a significant difference in the gastric volume between the two groups (P < 0.05), while no significant difference in gastric pH was observed. This result suggests that apple juice is not appropriate as preoperative drink because apple juice increases gastric contents, and may cause aspiration pneumonia.
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For two cases of cardiac tamponade following cardiac surgery, the approaches for pericardial drainage were determined by the transesophageal echocardiography under general anesthesia. In most cases of cardiac tamponade after cardiac surgery the pericardial effusion is regional and localized due to adhesions of pericardium. Therefore subxiphoid incision approach of pericardial drainage cannot often be accomplished. In these cases transesophageal echocardiography can image the presence, location and size of the pericardial effusion and is an available method to determine the approach of pericardial drainage.
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Randomized Controlled Trial Clinical Trial
[Skillfulness is essential to improve venipuncture pain in combination with lidocaine containing adhesive tape].
We evaluated the effect of lidocaine containing adhesive tape (LT) on the venipuncture pain by using visual analogue scale (VAS). Patients were assigned prospectively to a control (65 cases) group and a LT (80 cases) group weekly. LT was applied 30 min before the scheduled entry into the operating room. ⋯ Smooth venipuncture was performed in 91% of those in expert group. However only 71% of venipuncture was done smoothly in the novice group. We conclude that skillful venipuncture in combination with LT is essential to reduce the venipuncture pain.