Masui. The Japanese journal of anesthesiology
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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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Tracheobronchopathia osteochondroplastica is a rare benign disease, with difficult airway for intubation because the trachea and bronchia are narrow and transformed. We experienced one lung ventilation for a patient with the lung cancer associated with the tracheobronchopathia osteochondroplastica. ⋯ We could actually manipulate the blocker balloon very easily and maintain complete one lung ventilation maintaining SpO2 well. Coopdech bronchial blocker is useful for one lung ventilation in a patient with difficult airway such as tracheobronchopathia osteochondroplastica.
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A case of accidental total spinal anesthesia was presented. A 47-year-old woman was scheduled for a total abdominal hysterectomy. ⋯ Therefore propofol was administered again until the recovery of sufficient spontaneous breathing confirmed approximately 3 hours following administration of ropivacaine, and patient was extubated. No neurologic deficits could be detected.
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We experienced a case of epidural hematoma caused by coagulopathy 3 days after surgery. A 72-year-old man, who had undergone a total gastrectomy, suffered from nausea and vomiting by ileus. He underwent repair of ileus under general anesthesia with thoracic epidural anesthesia. ⋯ After a discussion with orthopedic consultants, we selected a conservative therapy rather than surgical removal of the hematoma. Thoracic epidural hematoma disappeared two months after surgery, but motor paralysis requiring rehabilitation remained. In conclusion, when patients have not eaten anything for a few days and antibiotics with an NMTT sidechain has been administered, care must be taken to prevent vitamin K deficiency and coagulopathy.