Masui. The Japanese journal of anesthesiology
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Determination of end-tidal carbon dioxide pressure (PET(CO2)) is effective to confirm adequate ventilation, because arterial to end-tidal carbon dioxide tension difference (deltaa-ET(CO2)) does not change normally during operation. But deltaa-ET(CO2) may change during laparoscopic surgery, because peritoneal insufflation of CO2 will increase CO2 production and reduce functional residual volume. Changes in deltaa-ET(CO2) were reported in laparoscopic cholecystectomy with cardiovascular complication, but there is controversy about how deltaaET(CO2) will change in more complicated and long laparoscopic surgery. In this prospective study, we examined changes in deltaa- ET(CO2) during laparoscopic colorectal surgery. ⋯ In laparoscopic colorectal surgery, Pa(CO2) should be checked for at least the first 60 minutes to confirm adequate ventilation.
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Case Reports
[Case of traumatically bleeding shock patient rescued by using an aortic occlusion balloon catheter during surgery].
A 55-year-old (163 cm, 70 kg) man with traumatic intra-abdominal bleeding underwent emergency operation. The patient was in a state of hemorrhagic shock with 82 mmHg of systolic blood pressure (SBP) at hospital arrival. His condition became severer within about 1 hr, and tracheal intubation and mechanical ventilation were consequently started in the ambulatory emergency room. ⋯ The evelation of SBP and decrease of bleeding dose were secured by aortic occlusion. Thereby the source of bleeding could be detected and surgical procedure could be finished with survival of the patient. The insertion of AOBC for the surgical patient with intra-abdominal hemorrhagic shock may be advantageous for uncontrollable bleeding.
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Case Reports
[Prolonged paralysis after long-term administration of vecuronium in the intensive care unit].
A 51-year-old woman with renal failure requring hemodialysis received a total of 446 mg of vecuronium over a period of 4 days to help mechanical ventilation and developed generalized muscle weakness after its discontinuation. It took 2 wks to wean her from mechanical ventilation and 3 wks for her to be able to walk. ⋯ We believe that the cause is the accumulation of vecuronium and active metabolites due to renal failure. The case suggests that we should minimize the duration of neuromuscular block in patients with renal failure by aggressive use of sedatives and analgesics and the optimization of ventilator settings.
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In order to evaluate the analgesic efficacy of low dose epidural bupivacaine infusion with and without morphine after caesarean section we performed combined spinal-epidural anesthesia (CSEA) using needle through needle method. Three different epidural analgesic regimens were compared retrospectively. ⋯ A 2.1 ml x hr(-1) infusion of epidural bupivacaine has no analgesic effect after caesarean section under CSEA using NTN method.
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The incidence of perioperative pulmonary thromboembolism (PTE) is reported not to be low in Japan. The aim of this study is to investigate the incidence and characteristics of perioperative PTE in Japan in 2004. ⋯ The incidence of perioperative PTE was not low and its mortality was high in Japan in 2004. In particular, the incidence of perioperative PTE was found to be high in females, the elderly, patients with malignancy, and patients who had undergone orthopedic surgery.