Masui. The Japanese journal of anesthesiology
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In Japan, over 50 thousand pulmonary artery catheters (PAC) per year were used for hemodynamic monitoring system perioperatively since 1970s. PAC provides many quantitative circulatory data, such as pulmonary capillary wedge pressure, cardiac output and continuous mixed venous oxygen saturation. On the contrary, several studies pointed out the problems of PAC and advocated the limitations of perioperative PAC monitoring in 2000s. ⋯ It is also important to use PAC in proper patients. I have also discussed other monitoring systems, such as aortic wave form analysis and central venous oxygen saturation, which were less invasive compared with PAC. I think abundant training, correct education and strict management must be employed to increase the benefit of PAC.
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A 35-year-old parturient highly suspicious of the placenta accreta/increta was scheduled for cesarean hysterectomy. She had received two cesarean sections and two intrauterine curettages. Prior to cesarean hysterectomy, 900 g of autologous blood was stored for the predictable massive bleeding. ⋯ The postoperative course was uneventful and the patient was discharged 14 days after operation. Histopathological diagnosis was placenta accreta. We successfully managed the anesthesia for cesarean hysterectomy in a parturient with placenta accreta under a combination of general anesthesia and epidural anesthesia.