Masui. The Japanese journal of anesthesiology
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Review Case Reports
[Intraoperative coronary spasm in patients without a history of anginal chest pain].
We report three cases of intraoperative coronary spasm that developed during non-cardiac surgical procedures. None of the patients had a history of anginal chest pain. The presumed contributing factors were: 1) suction of the trachea during general anesthesia, 2) hyperventilation and hypotension during induction of general anesthesia, and 3) hyperventilation during neuroanesthesia. ⋯ Some of common intraoperative conditions such as hyperventilation, hypotension, and inadequate depth of anesthesia, were reported to be potent precipitating factors for coronary spasm. In recent years, a larger proportion of surgical patients have coronary risk factors. Careful anesthetic management is required to prevent intraoperative coronary spasm even in patients without a history of coronary artery disease.
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Hypothermia occurs due to body heat redistribution between core and peripheral tissues as well as imbalance between heat loss and production. Perioperative hypothermia not only induces offensive shivering and prolongation of anesthetic recovery but also increases blood loss and incidence of surgical wound infection, increasing postoperative morbidity. ⋯ Anesthesiologists should have knowledge of the characteristics of the various kinds of fluid warmer currently available and use them appropriately according to surgical procedures and the patient's position. It was reported recently that administration of amino acid can prevent intraoperative hypothermia, possibly by increasing the heat production in the body.
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Randomized Controlled Trial Clinical Trial
[The effects of patient-controlled epidural analgesia with background infusion after abdominal surgery].
Although patient-controlled epidural analgesia (PCEA) is widely known to provide good pain control after abdominal surgery, it has not been popular in Japan. We evaluated the effects of PCEA with background infusion after major abdominal surgery. ⋯ PCEA with background infusion could improve the management of postoperative pain, and adequate program of PCEA is important to reduce postoperative pain and its side effects.
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Cardiovascular events are one of the most critical perioperative complications. The purpose of this study is to investigate the clinical characteristics, effective treatments, and clinical outcome of intraoperative coronary spasm through a review of the published literature. ⋯ Intraoperative coronary spasm may develop in patients with no history of chest pain. Some of the intraoperative conditions themselves are potent vasoconstricting factors. Once coronary spasm occurs, immediate administration of a full dose of coronary dilators is recommended.
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Case Reports
[Transient increase of bispectral index in a patient with bronchoconstriction after endotracheal intubation].
A 62-year-old woman (148 cm, 48.5 kg) with a history of bronchial asthma underwent an emergency appendectomy. Ten days before the operation she developed symptoms of wheezing while under asthma medication. An endotracheal tube (7 mm) was inserted after the induction of general anesthesia with intravenous injection of fentanyl 100 micrograms, propofol 100 mg and vecuronium 10 mg under Sellick's maneuver. ⋯ Upon completion of the operation, the endotracheal tube was removed without any events. The patient gave no sign of awareness during the operation. When severe bronchoconstriction prevents the absorption of anesthetics from the lung alveoli, additional intravenous anesthetics should be administered to maintain stable amnesia.