Masui. The Japanese journal of anesthesiology
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New era in the prevention of venous thromboembolism (VTE) in Japan started in 2004 when the Japanese guideline for prevention of VTE was released by the editorial committee on the Japanese guideline for prevention of VTE and Japanese public health system began to cover the cost of physical prevention of VTE for hospitalized patients. The incidence of perioperative symptomatic pulmonary thromboembolism (PTE) significantly decreased in 2004 compared with 2003 and 2002 according to the results of the annual research for perioperative PTE by the Japanese Society of Anesthesiologists (3.62/10,000 cases in 2004, 4.41/10,000 cases in 2002, 4.76/10,000 cases in 2003). However, there has been no change in the mortality rate of perioperative PTE during these three years. This special issue was planned to introduce the panel discussion titled as "Up-to-date medical care for perioperative venous thromboembolism in Japan-Standardization of care for perioperative venous thromboembolism in Japan" in the 53rd annual scientific meeting of the Japanese Society of Anesthesiologists at Kobe in 2006.
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Three pregnant women with diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), received emergency cesarean section in our hospital. Considering low platelet counts, in all three patients, operations were performed under general anesthesia using sevoflurane without epidural or spinal anesthesia. Special attention was paid to management of blood pressure, especially intra-operative hypertension. ⋯ Complications of this syndrome were severe including acute renal failure, DIC, pulmonary edema, cerebral hemorrhage and liver rupture. It is reported that maternal mortality is 2-24%. In the management of pregnant women complicated with HELLP syndrome, early diagnosis and adequate therapy, including preventive therapy for complications, are necessary.