Masui. The Japanese journal of anesthesiology
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Recently there are growing number of patients suffering from the abdominal aortic aneurysm (AAA), and we have many occasions to anesthetize these patients under coagulation therapy as well. Moreover, the risk of epidural hematoma increases when the operation of the AAA is performed with epidural technique because the operation is usually done with perioperative heparinization. For these reasons, we investigated the current situations of clinical practice in Japan in terms of the epidural anesthesia for AAA surgeries. ⋯ This investigation clarified the current situations of the clinical practice in Japan of the use of epidural anesthesia for AAA surgeries.
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Motor dysfunction following thoracoabdominal aortic surgery remains as one of their devastating postoperative complications. Recently, many studies have provided information for the mechanisms of ischemic spinal cord injuries and for some strategies against spinal cord ischemia in the perioperative period. Especially, advances in stimulation technique using multipulse could make intraoperative monitoring of functional integrity of motor pathways possible by recording myogenic motor evoked potentials. We summarize the strategies for spinal cord protection, including spinal cord functional monitoring and anesthetic techniques during thoracoabdominal aortic surgery.
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The advancement of surgical and anesthetic techniques reduced cardiac morbidity and mortality. As a result, the attention has been focused on the perioperative cerebral complication, which contribute to more than 20% of perioperative deaths. Cognitive dysfunction is associated with increased medical costs, decreaged quality of life, and mortality. ⋯ The research including the control group seems to overcome these issues, but still remains to have problems. Further, patients with cardiac disease have comorbid factors to induce postoperative sequelae compared to healthy population. We describe these issues which require continued researches.
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Myocardial ischemic preconditioning is a procedure giving powerful protection against myocardial ischemia and infarction. Clinical application of this property to anesthesia might improve anesthetic management of patients with cardiac diseases. ⋯ In addition, diabetes mellitus and hyperglycemia may abolish the protective effect of preconditioning by impairing K(ATP). From point of view of clinical application of preconditioning, anesthetic maintenance with volatile anesthetics instead of intravenous anesthetics, such as propofol, and administration of nicorandil throughout perioperative period, is recommended to patients with heart diseases and control of blood glucose is useful to maintain the protective effect of preconditioning.
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Antifibrinolytic therapy is effective in reducing postoperative bleeding and allogeneic transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass. Aprotinin is a bovine serine protease inhibitor which potently inhibits plasmin, and two lysine analogues, epsilon-aminocaproic acid and tranexamic acid, inhibit the activation of plasmin by binding to plasminogen. ⋯ This review article presents a current perspective on the efficacy and safety of antifibrinolytic agents based on the available basic science and clinical data. Further, the hemostatic strategies for complex cardiac surgical patients will be proposed.