Masui. The Japanese journal of anesthesiology
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Epidural anesthesia and spinal anesthesia are very popular anesthetic techniques used for surgery in elderly patients. Aging i s associated withanatomical changes and a loss of functional reserve in all organ systems. ⋯ However, previous studies have demonstrated only a slight effect of age on the anesthetic levels as well as the reduction in functions with these blocks. In elderly patients, both anesthetic techniques have been shown to decrease intraoperative blood loss, perioperative cardiac ischemic events, post-operative hypoxic episodes and arterial and venous thrombosis, and so forth.
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A 26-year-old woman with ovarian tumor underwent bilateral oophorectomy. Pre-operative examination showed massive ascites, obvious edema of the lower extremities and absence of pleural effusion. Immedi- ately after removal of massive ascites during the operation, sudden deterioration of SpO2 appeared. ⋯ After the operation we recognized left sided massive pleural effusion on the chest X-ray picture, and we drained it. However, the next day we recognized right side massive pleural effusion. We suspect that the fluid pooled in the lower extremities shifted to produce pleural effusion for some reason or other.
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Coronary artery bypass graft surgery in patients with immune thrombocytopenic purpura (ITP) refractory to preoperative medical therapy accompanies an increased risk of bleeding perioperatively. In the ITP patient without responding to intravenous immunoglobulin and corticosteroids, we performed combined off-pump coronary artery bypass grafting with splenectomy to minimize the risk of intraoperative bleeding and cardiac ischemia. Using platelets infusion, we successfully managed the patient without major bleeding and ischemic events.
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TruViewEVO2 videolaryngoscope (Truphatek, Israel) is a modified version of the Truphatek 1. We used this device in four patients with difficult airways. A 77-year-old obese woman, scheduled for nasal surgery, had short neck and small jaw. ⋯ A full view of the glottis was obtained when the TruView was used, and the trachea was easily intubated. In another two patients, in whom laryngoscopy with a Macintosh blade had failed, and in one patient with limited mouth opening, the TruView allowed us to see the glottis and to intubate the trachea without difficulty. Therefore, we believe that the TrueViewEVO2 videolaryngoscope is useful in patients with difficult airways.
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The objective of this study was to investigate the effects of posture after spinal anesthesia with 2% lidocaine and 0.5% isobaric bupivacaine in parturients undergoing caesarean section and to demonstrate our modified combined spinal epidural (CSE) method. ⋯ Our modified CSE method can provide beneficial effects on full term pregnant women by preventing hypotension due to spinal anesthesia.