Masui. The Japanese journal of anesthesiology
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Case Reports
[Early application of the lung protective ventilation strategy at different stages in two ARDS patients].
We experienced 2 patients with acute respiratory distress syndrome (ARDS) from pneumonia after intervention for subarachnoidal hemorrhage. We applied lung protective ventilation strategy (LPVS) on both cases: a tidal volume less than 6 ml x kg(-1) ideal body weight and PEEP at 10-15 cmH2O. Although etiology and degree of hypoxia were very similar in two patients when ARDS was diagnosed, clinical course was quite different. ⋯ In contrast, another patient in whom LPVS had been started on the 16th day of ARDS required mechanical ventilation of 219 days. PaCO2 during LPVS with permissive hypercapnia in the latter patient increased up to 161 mmHg but no adverse effect was observed. These cases suggest that early application of the LPVS may be important to improve respiratory outcomes of ARDS patients.
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Case Reports
[Epidural hematoma caused after epidural catheterization for the coronary artery bypass graft: a case report].
Epidural hematoma is a rare complication of epidural anesthesia, but once this severe complication has occurred, without early decompressive procedure, it may cause permanent neurologic disorder. Especially, the patients with hemostatic disorder have a higher risk of epidural hematomas. We report a patient who recovered immediately from neurological symptoms resulting from epidural hematoma formed by epidural catheterization on the day before coronary artery bypass. Epidural hematoma as a complication of epidural anesthesia is discussed.
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Case Reports
[Accidental severance of epidural catheter used in a patient with postoperative delirium].
A 79-year-old man with an abdominal aortic aneurysm had a lumbar epidural catheter inserted for postoperative pain control of bypass graft surgery with continuous epidural analgesia. Five days after the operation, we noticed that forced traction by the patient with delirium had led to the catheter tip being separated and left behind in his body. The remaining portion of the catheter was detected using a lateral lumbar roentgenogram and CT imaging, and it was later removed surgically. We conclude that it was necessary to change the method of analgesia in this patient, since it was difficult to maintain the epidural catheter.
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We experienced a case of postoperative intravenous sedation with propofol during intermittent hemodialysis (HD), and investigated the correlation between the clinical sedation level based on bispectral index scale (BIS) together with Ramsay score, and the serum concentration of propofol. One adult oral cancer patient (carcinoma of the lower gingiva) with end-stage renal dysfunction needing HD was selected for this study. The day after operation, HD was commenced under intravenous sedation with propofol. ⋯ According to BIS and Ramsay score, sedation level decreased lineally for 1 hour after commencement of HD. In contrast, serum propofol concentration incresed from 1.71 microg x ml(-1) to 2.21 microg x ml(-1). Total serum concentration of propofol was enhanced during HD because of dialytic dehydration, but, according to BIS and Ramsay scores, the possibility was suggested that the fraction of albmin-unbound propofol with pharmacological activities was eliminated or absorbed by membrane during HD.
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Wrong drugs, overdose of drugs, and incorrect administration route remain unsolved problems in anesthetic practice. We determined the incidence and outcome of drug administration error in the operating room of Japanese Society of Anesthesiologists Certified Training Hospitals. ⋯ We should increase awareness that drug administration is generally performed with limited objective monitoring, although "To error is human". Increased vigilance is required to avoid drug administration error in the operating room. Additional anesthesia resident education, adequate supervision, and improved organization are necessary. Bar-coding technology might be useful in preventing drug administration error.