Masui. The Japanese journal of anesthesiology
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We experienced anesthetic management for six cases of the Batista operation and measured cardiac function before and after cardiopulmonary bypass (CPB) with transesophageal echocardiography. In the successful three patients, left ventricle ejection fraction and ejection time were maintained over 25% and 200 msec after CPB, respectively. In the other three resulting in implantation of left ventricular assist device, ejection fraction remained below 20% and ejection time under 200 msec after CPB. Intraoperative transesophageal echocardiography may be useful not only for monitoring of cardiac function but also for the prediction of prognosis.
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We experienced a case of stump pain relieved by continuous intravenous ketamine infusion therapy. A 59-year-old male had his left first through fourth toes amputated because a giant iron plate at work fell on his left foot fifteen years ago. Thereafter he had refractory spontaneous burning pain and night pain on his stump. ⋯ Thereafter stump pain was relieved to the level of VAS 20 mm. Therefore we diagnosed his stump pain as central pain of neuropathic origin. We suspect that continuous intravenous infusion of ketamine, a noncompetitive blocker of N-methyl-D-aspartic acid receptor, might be an effective and useful alternative treatment in a patient with refractory stump pain.
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Measuring arterial lactate concentration is a prompt, easy and relatively non-invasive way to estimate tissue oxygen metabolism. We evaluated whether perioperative levels of the arterial lactate concentrations can reflect the general severity of a pediatric patient's condition. A consecutive series of 112 patients, aged 5 days to 17 years (median age: 12 months), admitted to our pediatric intensive care unit (PICU) following cardiac surgery under cardiopulmonary bypass were studied. ⋯ Hyperlactemia greater than 2.2 mmol.l-1 at D1 predicted death with a sensitivity of 82% and a specificity of 72%. The measurement of early postoperative lactate levels, reflecting postoperative ability to eliminate intraoperative hyperlactemia, is a better way of assessing the severity of a pediatric patient's condition following cardiac surgery. The ideal time to measure early postoperative lactate levels should be determined by further research.
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Huge laryngeal cyst is rare, but may cause difficulty or inability in tracheal intubation during induction of general anesthesia. A 69-year-old patient was scheduled for laryngomicroscopic cystectomy. In this patient, we examined two methods of oro-tracheal intubation either with rigid laryngoscopy or flexible fiberscopy using transnasal fiberoptic monitoring. ⋯ Postoperative respiratory management under intubating state was necessary because of bleeding, airway edema, and deviation of the larynx after tumor resection. We reported anesthetic management of a patient with epiglottis gigantic cyst occupying the laryngopharyngeal airway. It is a rare tumor leading to difficulty of induction of anesthesia and necessitating postoperative intubated respiratory care.
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Lidocaine adhesive tape (Penles; Wyeth Lederle Japan, Ltd, Tokyo, Japan) is placed for pain relief prior to puncturing a vein with a needle. We investigated the optimal time interval from application of Penles to vein puncture by measuring current perception threshold (CPT) levels with a Neurometer, by which it was possible to measure the extent of nerve block in a non-invasive and quantitative manner with 3 electrical stimulus rates (2000 Hz, 250 Hz, and 5 Hz). ⋯ However, CPT levels tended to decrease 12 hours after application, regardless of the stimulus rate. From the result, we conclude that Penles provides maximum benefit when applied 6 hours prior to vein puncture.