Masui. The Japanese journal of anesthesiology
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Axillary veins (AxV) are increasingly selected instead of the subclavian veins (SCV) for safe and successful catheterization in adults using ultrasound echo although quite rarely in children. The diameters and depths of the pediatric internal jugular veins (IJV) are well known but those of pediatric AxV are unfamiliar even to anesthesiologists. We evaluated the diameters and the depths of the AxV and IJV in children undergoing cardiac surgery. ⋯ The diameters of the AxV are about 0.6 times and the depths are about 1.5 times those of the IJV and it seems difficult to use AxV for pediatric CVC from the standpoint of venous diameters and depths.
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A 64-year-old man was diagnosed to have a tracheal tumor 2 cm proximal to the carina. He was scheduled for tracheal resection and reconstruction with omentopexy. An epidual tube was placed at the level of T5-6. ⋯ After the operation, he was extubated under anesthesia without coughing. No pain was complained during postoperative course. Epidural anesthesia combined with TAPB provided sufficient postoperative analgesia, especially in tracheal resection and reconstruction with omentopexy.
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A 32-year-old pregnant woman diagnosed with aplastic anemia was admitted for emergent caesarean delivery of 26th week of the gestation due to PIH (pregnancy-induced hypertension) and NRFS (non-reassuring fetal status). After compensating platelets counts to 5.3x10(4) microl-1, general anesthesia was induced with propofol and rocuronium. Anesthesia was maintained with O2 and sevoflurane until delivery and with modified-NLA after delivery. ⋯ She survived perioperative period and was to be treated for aplastic anemia. Her baby was discharged neurologically free. We should be ready to respond to anesthetic requirement for urgent cases of aplastic anemia.
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The author joined the emergency health operation of the International Red Cross for Haiti earthquake as one of Japanese Red Cross delegates for about one month in May, 2010. Althought I was not expected to offer the skills and experiences as an anesthesiologist, but those of a general practicing, I learned many valuable things from seeing local people, especially about the characteristic diseases and symptoms after disasters caused by living in the camp which was not an ideal environment to be in so long. It is difficult to know much about such typical problems through our usual work as an anesthesiologist. If we want to join these kinds of mission, we have to have some extra knowledge for helping people after such disasters.
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Amyotrophic lateral sclerosis (ALS) is a degenerative disease involving motor neurons. The anesthetic problem is increased susceptibility to non-depolarizing muscle relaxants and the feasibility of spinal and epidural anesthesia. An 86-year-old man with ALS underwent colostomy to the ileus. ⋯ Post-operative course was uneventful. Our anesthetic management of ALS patient using sugammadex was successful. Further evidence is required to establish appropriate use of sugammadex for ALS patients.