Masui. The Japanese journal of anesthesiology
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Perioperative mortality and morbidity in Japan for the year 2000 were studied retrospectively. Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 Certified Training Hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to the age group. ⋯ Its mortality rate in each group was 0.00, 0.00, 0.21, 0.14, 0.06, 0.04, or 0.00. There were eleven cases of death or vegetative state due to anesthetic management, like improper management of airway and overdose of anesthetics. Some of them were preventable with the anesthesiologists' effort in protocol development and skilled assistance.
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We experienced four cases of craniotomy in which motor evoked potential (MEP) and somatosensory evoked potential (SEP) were monitored alternately. Anesthesia was induced with propofol and fentanyl, and it was maintained with continuous infusion of propofol. ⋯ We could obtain the largest amplitude of MEP using five consecutive stimuli of which duration and frequency were 0.5 milliseconds and 500 Hz, respectively. Anesthetic management using propofol and fentanyl is useful for craniotomy with monitoring of MEP and SEP.
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Case Reports
[Two cases of intraoperative awareness during intravenous anesthesia with propofol in morbidly obese patients].
We experienced two cases of intraoperative awareness during intravenous anesthesia with propofol and fentanyl in morbidly obese patients. The rates of propofol infusion were calculated according to the adjusted body weights, or reduced intentionally as obese patients are generally believed to require lower doses of propofol compared with non-obese patients. Our postoperative analysis by simulations using the anesthesia records showed that, when the simulation was based on real body weight, the blood/effect-site concentrations of propofol in both patients would have been below the necessary levels to keep the patients unconscious during the operation, but when the simulation was based on adjusted body weight, those concentrations might have been within the necessary range to maintain an adequate hypnotic level. We propose that the rate of propofol infusion should be the same in obese and non-obese patients and should be calculated according to the real body weight not to the adjusted body weight.
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The purpose of this investigation was to determine whether elimination of premedication before general anesthesia affects preoperative anxiety. ⋯ We conclude that elimination of premedication does not increase anxiety in comparison with patients receiving sedatives, but makes patients feel comfortable by way of preoperative conversation. Elimination of premedication also makes ambulatory entrance possible, both improving safety with respect to patient identification and reducing the demand on nursing.
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A 43-year-old man (166 cm, 53.5 kg) with cerebral palsy on maintenance hemodialysis underwent a right nephrectomy for gross hematuria under combined spinal-epidural anesthesia (CSEA) with sedation. The patient suffered from hemiplegia, speech disturbance and low intelligence (approximately 6 years and 8 months). Following premedication with midazolam 4 mg, he was calm and cooperative. ⋯ Three hours after surgery, sleep was induced by brotizolam 0.25 mg orally. We accomplished a giant nephrectomy under CSEA with sedation in a patient with cerebral palsy receiving hemodialysis. Sufficient premedication using midazolam was profitable for CSEA in mental-retarded patient.