Masui. The Japanese journal of anesthesiology
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We report a case of accidental epidural injection of vecuronium during cholecystectomy in a 55-year-old man (63 kg, 158 cm). Following 3 ml of lidocaine 1% as an epidural test dose, inadvertent epidural (T7-8) injection of vecuronium 4.25 mg instead of ropivacaine occurred. After immediate removal of the syringe containing vecuronium, 10 ml of ropivacaine 0.375% was injected epidurally. ⋯ There was no memory of back pain during epidural vecuronium injection. There was no postoperative respiratory insufficiency or neurological disorder. We suspect the duration of action of epidural vecuronium is approximately twice that of intravenous injection and becomes prolonged with higher doses and advanced age.
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In Japan, the number of medical staff charged with criminal liability has been increasing since 2000, and this medico-legal trend seems to be promoting topics of medical risk management in government, academic meetings and individual hospital. A survey conducted by the Japanese Society of Anesthesiologists (JSA) has been widely accepted among JSA-certified training hospitals, and its denominator has exceeded one million since 2001. The purpose of this investigation is to examine changes in the incidence of life-threatening events in the operating theater between 2001 and 2005 based on the data of the surveys. ⋯ The incidence of life-threatening events in the operating room and mortality due to these events seemed to have decreased during the recent five years, probably because of progress in risk management in JSA-certified training hospitals. The decrease was obvious in the recent two years. However, the results should be interpreted cautiously, because the response rate to the questionnaire in 2005 was the lowest. To confirm this trend, we should perform a follow-up survey for 2006 and continue the survey. The reasons for the deterioration in the recovery rate from cardiac arrest should also be examined.
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Brugada syndrome has been known as one of the causes of sudden death due to ventricular fibrillation. We experienced anesthetic management of seven patients with ECG showing Brugada syndrome before surgery, even though they had no symptoms nor family history. All of them showed no problems through-out the operation. ⋯ For preoperative evaluation of patients with Brugada syndrome-like ECG, it is important to ask them their experience of syncope and family history. Ultrasonic cardiography and Holter ECG recording should be done. External defibrillator should be prepared and parasympathetic dominant condition must be avoided during the anesthetic management.