Masui. The Japanese journal of anesthesiology
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Malignant hyperthermia (MH) is a potentially fatal complication of general anesthesia following exposure to a depolarizing muscle relaxant and/or volatile anesthetics. MH is inherited as autosomal dominant and is thought to result from disordered Ca2+ regulation by the sarcoplasmic reticulum of the skeletal muscle. ⋯ It is difficult to diagnose by usual examinations preoperatively. Therefore, early detection, prompt treatment, discontinuation of triggering agents, and sufficient administration of dantrolene are needed.
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The number of epileptic patients scheduled to receive anesthesia and operation is not small. The management of anesthesia for epileptic patients requires caution and prudence. ⋯ Drug interactions of anticonvulsants and muscle relaxants or opioids and other drugs are also to be considered. Volatile anesthetics and intravenous anesthetics have both anticonvulsant and convulsive properties, although the convulsive properties of clinical doses of these anesthetics are permissible.
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Difficult airway management (DAM) including cannot intubate and cannot ventilate (CICV), and difficult mask ventilation is a life threatening issue during anesthesia care. Although American Society of Anesthesiologists (ASA) has presented the guideline for this purpose, it is still not available in this country. We as a specialist for airway management should be prepared this trouble any time by equipping a laryngoscope, fiberoptic bronchoscope, and novel devices such as Airway Scope and Airtraq.
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Comparative Study
[The direction and the position of epidural catheter tips inserted 5 cm or 7 cm cephalad did not differ].
Epidural catheter insertion is a common procedure in gynecological surgeries. At a previous study, we investigated the catheter's direction and position, inserted 7cm cephalad from T12-L1, with postoperative plain X-P using picture archiving communication system (PACS). 74% of the catheters advanced in cephalad direction and 71.4% of the catheter tips stayed within one vertebra from the puncture level. We estimated that the catheters were too long to advance straight. Then, we planned another prospective study to compare the catheter advanced 7 cm or 5 cm regarding its direction and tip position. ⋯ The direction and the position of epidural catheter inserted 5 cm or 7 cm cephalad did not differ.
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There are still legal and ethical problems relating to the refusal of blood transfusion due to religious belief of Jehovah's Witness patients. Since general consensus about the anesthetic management of these patients has not been established, the "Guidelines for refusal of blood transfusion on religious grounds" was proposed by the joint committee including Japanese Society of Anesthesiologists in February 2008. The principle of the guideline is that if a patient, who refuses blood transfusion even at cost of life, is 18 years old or above and competent to understand the medical treatment and the adverse effects due to bloodless medicine, doctors may plan and complete bloodless surgery. ⋯ In other cases, the policy of life-saving blood transfusion should be explained to the patients. If a bloodless surgery is planned, precise perioperative strategies to avoid blood loss have to be carried out with the cooperation of all the physicians who care the patient. Anesthesiologists should be carefully prepared for the possible law suits that might lead to unexpected outcomes.