Masui. The Japanese journal of anesthesiology
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The population of children undergoing successful surgery for congenital heart disease (CHD) continues to increase. Increasing number of patients with a Fontan circulation is reaching adulthood and requiring anesthesia for noncardiac surgeries. We anesthetized a patient with a Fontan circulation (9 years old) for giant internal carotid-ophthalmic artery aneurysm trapping. ⋯ Anesthetic time was 13 hr and 40 min. The patient was extubated in the operating room. We have to take into consideration that there are anatomical abnormalities and arrhythmia in the patients with a Fontan circulation.
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Parental presence during induction of anesthesia (PPIA) is widely practiced to prevent preoperative anxiety in children. However, some previous studies described parental presence is less effective than sedative premedication. The purpose of this investigation is to determine whether PPIA is not an effective prevention of preoperative anxiety using a postoperative questionnaire survey to parents. ⋯ PPIA has beneficial effects against preoperative anxiety in both children and parents.
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Comparative Study
[Relationship between postoperative neurological complications and regional cerebral oxygen saturation during retrograde cerebral perfusion].
Transient postoperative neurological disorders are common in patients undergoing aortic surgery with retrograde cerebral perfusion (RCP). We evaluated the relationship between transient postoperative neurological disorders and regional cerebral oxygen saturation (rSO2) during RCP. ⋯ The rSO2 monitor could detect the decrease of cerebral perfusion during RCP. The wide asymmetry of rSO2 was associated with transient neurological disorders, although the lowest rSO2 value and the rate of decline did not relate.
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We examined the hemodynamic responses to tracheal intubation during anesthetic induction by inhalational sevoflurane with continuous administration of remifentanil. ⋯ During sevoflurane anesthesia, remifentanil infusion at 0.5 microg x kg(-1) x min(-1) for more than 210 sec could provide the effective blocking of the sympathetic response to tracheal intubation with more than 50% probability.
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Although obstetric disease is one of the major causes of disseminated intravascular coagulation (DIC), no gold standard exists. Three current criteria, the Japanese Association for Acute Medicine (JAAM) -DIC criteria, the revised Japanese Ministry of Health and Welfare (JMHW) criteria and the International Society on Thrombosis and Haemostasis (ISTH) criteria, do not clarify the usefulness in obstetric DIC. We therefore conducted a retrospective study by simulation. ⋯ The current study indicates that JAAM-DIC criteria can be useful but may overdiagnose the DIC.