Masui. The Japanese journal of anesthesiology
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We anesthetized three patients with refractory atrial fibrillation undergoing the new thoracoscopic mini Maze procedure. This minimally invasive surgical procedure provides isolation and ablation of the bilateral pulmonary vein without thoracotomy or cardiopulmonary bypass, which was performed first in the United States in 2003. General anesthesia was administrated with a double lumen tracheal tube for bilateral single lung ventilation, and epidural anesthesia was also administrated. ⋯ Another patient was complicated with dextrocardia, but the procedure was successful. One other patient had no complications and the procedure was performed as planned. Certain anesthetic management is essential for this new procedure and we have to prepare for any predictable events.
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Ultrasound-guided arterial catheterization has been attempted, and its effectiveness demonstrated. We encountered 3 cases in which arterial catheterization (A-line) was difficult for the following reasons: the arterial lumen was narrow due to arteriosclerosis; the pulse of the radial artery was weak because of swelling in the arm and heart failure; and the deep artery was too hard for the needle to penetrate it. Using ultrasound guidance, arterial catheterization could be smoothly performed in all cases. Thus, ultrasound-guided arterial catheterization is effective for cases in which arterial catheterization using the usual palpation technique is difficult.
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Case Reports
[Two cases of transfusion-related acute lung injury following massive transfusion during the perioperative period].
Transfusion-related acute lung injury (TRALI) is a serious complication of transfusion of blood and blood components. TRALI is reported to be the most common cause of transfusion-associated death. TRALI has increasingly become known in the medical community. ⋯ We report two cases of TRALI after massive transfusion due to massive bleeding during cardiovascular surgery. In the perioperative period, the diagnosis of TRALI is difficult to make because of coexistence of various factors leading to hypoxia. Thus, in this report, we discuss the management of these two cases focusing upon the differential diagnosis of TRALI.
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Case Reports
[Novel echogenic needle for ultrasound-guided peripheral nerve block "Hakko type CCR"].
A novel echogenic insulated nerve block needle (CCR-needle: Echogenic Needle Type CCR; Hakko, Japan) is commercially available since 2006 in Japan. This needle has three echogenic dimples, namely corner cube reflectors (CCR) on its tip. The CCR-needle will potentially provide a significant advantage for detecting the needle tip. ⋯ Afterwards, an interscalene brachial plexus block was performed on a male patient undergoing shoulder surgery. The needle insertion procedure was the "out of plane" ultrasound-guided technique using simultaneous electrical nerve stimulation. The surgery was successfully conducted without any complications.
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Randomized Controlled Trial
[Combined intrathecal morphine and bupivacaine for elective post-caesarean pain].
Intrathecal morphine is widely used for analgesia following cesarean section in Europe and North America. In Japan analgesic method of intrathecal morphine was admitted to the insurance adjustment and it is necessary to study optimal dose of the morphine. ⋯ It is concluded that intrathecal morphine 0.1 mg gives effective analgesia with minimum side effects after cesarean section for the Japanese patients.