Masui. The Japanese journal of anesthesiology
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Comparative Study
[Appropriate dose of isobaric bupivacaine with fentanyl in spinal anesthesia for cesarean section].
Spinal anesthesia combined with fentanyl is commonly used for cesarean section. We studied the appropriate dose of isobaric bupivacaine for spinal anesthesia when combined with a fixed dose of 20 microg fentanyl. ⋯ Two ml of 0.5% isobaric bupivacaine was the most appropriate dose for cesarean section, when combined with 20 microg of fentanyl.
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Review Case Reports
[Four cases of extrapyramidal reactions to epidural droperidol administration].
Continuous epidural administration of droperidol at 2.5 mg x day(-1) or less was performed in 837 patients after surgery. In 4 of these patients, an extrapyramidal reaction occurred. Patient 1 was a 10-year-old girl who developed the symptom 29 hours after the start of administration, with a total dose of 3.0 mg. ⋯ Patient 4 was a 74-year-old female in whom the symptom occurred 24 hours after the start, with a total of 1.3 mg. With respect to the age distribution, the total of 837 patients consisted of 16 patients aged 10 to 19 years, 85 patients aged 20 to 29 years, 91 patients aged 30 to 39 years, 90 patients aged 40 to 49 years, 77 patients aged 50 to 59 years, 148 patients aged 60 to 69 years, 240 patients aged 70 to 79 years, 97 patients aged 80 to 89 years, and 9 patients aged 90 to 99 years. Extrapyramidal reactions related to epidural administration may readily develop at younger ages.
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Complications related to anesthesia remain a problem. We studied the incidence of complications during anesthesia in 2688 patients who had undergone anesthesia in the University of Occupational and Environmental Health Hospital. ⋯ Complications related to anesthesia should be prevented as much as possible through anesthesiologists' efforts in protocol development and skilled assistance.
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Case Reports
[Successful management of a patient with rhabdomyolysis and marked elevation of serum creatine kinase level].
We experienced successful management of a patient with severe rhabdomyolysis by conservative treatment. A 41-year-old man developed Stanford-A-type acute aortic dissection and underwent an emergent replacement of the aortic root and arch. After the weaning from cardiopulmonary bypass, his left femoral artery was found non-pulsatile, probably due to extension of the aortic dissection, and femoro-femoral artery bypass surgery was added. ⋯ Although serum creatinine increased to 2.0 mg x dl(-1) on postoperative day (POD) 1, diuresis was maintained and the level of creatinine returned to normal on POD 6. He was extubated on POD 6 and discharged on POD 7. The early start of these combined therapies seems to have prevented acute renal failure without blood purification.
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[Critical events in the operating room among 1,440,776 patients with ASA PS 1 for elective surgery].
The Japanese Society of Anesthesiologists (JSA) survey of critical incidents in the operating room has shown that preoperative complications are the leading causes of critical incidents, and affect the occurrence, severity and outcome of critical incidents which are due to causes other than preoperative complications. Causes of critical events in the operating room were examind in patients for elective surgery with American Society of Anesthesiologists physical status (ASA PS) 1. ⋯ Even in elective patients with good physical status, non-lethal incidents were not rare, and lethal incidents were also reported. We should pay significant attention to the following findings, and take some measures to overcome these problems especially related to human factors. Firstly, SM badly harmed some operative patients. Secondly, coronary vasospasm and pulmonary embolism were the main causes of death due to IP. Thirdly, drug administration and airway/ventilation management were the major causes of critical incidents totally attributable to AM. Human factors were responsible for 70.6% of critical incidents and 71.1% of deaths.