Masui. The Japanese journal of anesthesiology
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For management of postoperative bladder spasm by the ureteral reimplantation, general anesthesia and epidural anesthesia are selected in many hospitals, but epidural anesthesia is not a common technique for various complications and risks. We examined whether postoperative bladder spasms can be prevented by general anesthesia combined with single shot caudal anesthesia. ⋯ General anesthesia combined with single shot caudal anesthesia suppressed postoperative bladder spasm. All patients were discharged within 3 postoperative days.
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Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia was reviewed. Common crisis which is encountered during regional anesthesia includes toxic reaction to local anesthetic drugs, allergic reaction induced by local anesthetic drugs, reaction induced by epinephrine, nerve injury, hematoma etc. Concerning peripheral nerve block, crisis encountered during brachial plexus block, interscalene block and supraclavicular block used for surgical operation of upper extremity was discussed. ⋯ Especially, epidural hematoma and epidural abcess have possibility to cause nerve defect symptoms such as motor paralysis and sensory disturbance if appropriate treatment was not started in early stage. Moreover crisis such as cauda equina syndrome and anterior spinal cord syndrome have possibility to remain permanent and hard to cure. We anesthesiologists should make efforts to prevent crisis, to detect crisis in early stage, and to treat it in early stage.
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Even a trivial increase in intracranial pressure is likely to induce cerebral ischemia, hernia, and neurogenic pulmonary edema in patients with intracranial hypertension. In this article, I have described several issues that are essential for safe perioperative management in patients undergoing neurosurgical procedures for treatment of subarachonoid hemorrhage, and intracerebral and subdural hematoma, as well as relevant information on basic physiology and pathology of the brain.
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During an abdominal surgery, life-threatening events such as severe bradycardia and massive hemorrhage may occur. Reflex bradycardia may arise with surgical manipulation of abdominal contents. Anesthetic agents such as propofol or remifentanil increase the risk of bradycardia. ⋯ When we find critical hemorrhage, we have to manage the condition in accordance with "The guideline for critical intraoperative hemorrhage" published by JSA and the Japan Society of Transfusion Medicine and Cell Therapy. The pneumoperitoneum required for laparoscopy induces physiologic changes that complicate anesthetic management and could cause CO2-subcutaneous emphysema, pneumothorax, endobronchial intubation, and gas embolism. During laparoscopy, blood pressure, heart rate, electrocardiogram, end-tidal CO2, and oxygen saturation by pulse oximetry must be continuously monitored.
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Risk management in clinical practice is an impor part of medical audit. Although, medical audit consists of monitoring, data collection, peer review and establishing standards, these four steps should be regarded as a series of cyclical process. As a general rule, this concept should be applied to any field of clinical medicine and will contribute to the development of sound quality control scheme. ⋯ Auscultation, fiber-optic visualization and proper ventilatory management (eg. lower tidal volume with dependent lung PEEP, alveolar recruitment maneuver, application of CPAP to non-dependent lung) are the recommended technique required to correct these abnormalities. When life-threatening hypoxia is imminent, we should convert to two-lung ventilation without any delay. In this regard, verbal communication between surgical teams should be kept on even ground, each playing key roles in the management of such a critical situation.