Masui. The Japanese journal of anesthesiology
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The number of surgical operations performed has been reported to have a relation with surgical morbidity and mortality. In Japan, however, the relationship between surgical load and outcome has not been elucidated. ⋯ The yearly number of operations has been shown to affect mortality rate due to intraoperative critical incidents among patients for cardiac surgery in Japan. Hospitals with a small number operations should pay significant attention to improving surgical outcome. These results also suggest that centralization or regionalization of cardiac surgery should be discussed from the socio-economical points as well as patient safety.
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Randomized Controlled Trial Clinical Trial
[Combined use of intrathecal morphine and diclofenac suppository for postoperative analgesia after caesarean section].
Intrathecal morphine for postoperative analgesia after caesarean section has been used in Europe and North America, but its use is not common in Japan. ⋯ Intrathecal morphine 0.05 mg and diclofenac suppository 50 mg given every 8 hours produced effective postoperative analgesia with minimum side effects after caesarean section.
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Case Reports
[A case of emergency surgery in a patient with bronchial asthma under continuous spinal anesthesia].
A 78-year-old male, observed for bronchial asthma, underwent two emergency operations within eight days. The first operation was performed under general anesthesia with tracheal intubation. Anesthesia was maintained by sevoflurane-oxygen and continuous infusion of propofol in combination with epidural injection of lidocaine. ⋯ He needed ventilatory support for three days for status asthmatics. The second operation was performed under continuous spinal anesthesia using hypobaric tetracaine and hyperbaric bupivacaine. No ventilatory support was necessary after the operation and he was discharged uneventfully.
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Case Reports
[A case of acute pneumococcal meningitis treated with spinal drainage and vancomycin administration].
A 25-year-old woman complaining of general fatigue, headache, high fever, and nuchal rigidity, was admitted. She was diagnosed as pneumococcal meningoencephalitis after the cell culture of cerebrospinal fluid (CSF). Despite the administration of vancomycin (VCM), she fell into a coma without amelioration of the symptom. ⋯ The lumbar drainage at the L 4-5 level and the intrathecal administration of VCM were performed to improve the mal-circulation of CSF. After the procedure, the cell count of CSF showed a significant decrease and her consciousness level was recovered gradually. The patients with pneumococcal meningitis may occasionally require the lumbar drainage with the intrathecal administration of appropriate antibiotics, in case they fail to show response to the conventional therapy.
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Case Reports
[Cardiac arrest during emergency cesarean section due to peripartum cardiomyopathy--a case report].
A 23-year-old woman at 35 weeks of gestation was scheduled for emergency cesarean section because of preeclampsia. Anesthesia was induced with thiopental 250 mg, and her trachea was intubated following administration of vecuronium 7 mg. Anesthesia was maintained with oxygen and sevoflurane (0.5%). ⋯ She was transferred to the intensive care unit of our university hospital. She was diagnosed as having peripartum cardiomyopathy from her history and echocardiography. She was discharged from the hospital with only slight disturbance of consciousness two months after surgery.