Masui. The Japanese journal of anesthesiology
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Central venous catheterization is a procedure with a high success rate. However, life-threatening complications are occasionally caused by mechanical injury during the catheterization process. ⋯ We herein review and discuss the mechanical complications previously reported to have occurred in association with central venous catheterization. Comprehensive knowledge about various complication-inducing factors, the ability to make a quick and accurate diagnosis of such complications, and sufficient skill to prevent worsening of these complications can thus help patients from suffering lethal complications due to central venous catheterization.
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Central venous catheterization is essential for the anesthetic management of operations for congenital heart diseases. We prospectively examined the usefulness of ultrasonography in internal jugular vein catheterization in infants. ⋯ Internal jugular vein cannulation guided by ultrasonography can be performed safely and quickly in pediatric patients.
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The cholinergic ascending arousal pathway is one of the most powerful cortical activation systems. The origins of this system is from the pedunculopontine tegmentum (PPTg) and laterodorsal tegmentum (LDT), which relay their signals to the posterior hypothalamus, the basal forebrain and then the cerebral cortex. The cholinergic activation by selective agonists or cholinesterase inhibitors has been shown to produce cortical activation and induce awareness from anesthesia. ⋯ Microinjection of orexin-A into the basal forebrain induced the increases in acetylcholine release and EEG arousal through orexin-1 receptors. Furthermore, electrical stimulation of the PPTg induced the increases in acetylcholine release and EEG arousal under isoflurane anesthesia, and SB334867, an orexin-1 receptor antagonist, attenuated these arousal responses. These findings suggest that the orexinergic system may contribute to the arousal from anesthesia through the cholinergic ascending arousal pathway.
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The Japanese Society of Anesthesiologists (JSA) survey of critical incidents in the operating room and other reports have shown that pediatric patients undergoing anesthesia are at an increased risk. Purpose was to examine the state of pediatric anesthesia in Japan. This might clarify the role of children's hospitals for pediatric anesthesia, and the relationship between critical incidents and volume of pediatric anesthetic procedures. ⋯ Almost all JSA Certified Training Hospitals conducted pediatric anesthesia, although only 15.6% of them had an annual pediatric anesthetic volume of more than 200. It was suggested that general pediatric anesthesia was conduced safely in JSA Certified Training Hospitals, even if they had a low annual pediatric anesthetic volume. The exception was newborn anesthetic procedures : the mortality was high in hospitals with an annual newborn anesthetic volume of less than 12. Analysis of critical incidents in the operating room failed to show the superiority of children's hospitals in comparison with the university hospitals and other hospitals. Collecting and analyzing data including the patients without critical incidents are required for further analysis.
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Case Reports
[Combination of spinal and inhalation anesthesia for nephrectomy in a cirrhotic patient].
We report a 75-year-old man with the liver cirrhosis of Child-Pugh B who underwent nephrectomy. Preoperative serum examination revealed increases in GOT, GPT, LDH and total bilirubin, decreases in cholinesterase and albumin, and prolongation of prothrombin time. ⋯ The surgery was completed uneventfully in 2.5 hours. Post-operative pain control was satisfactory and hepatic dysfunction did not deteriorate in the postoperative period.