Masui. The Japanese journal of anesthesiology
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Among all drugs used for general anesthesia, neuromuscular blocking agents (NMBAs) seem to play a predominant role in the incidence of severe adverse reactions. The overall incidence of perioperative anaphylaxis is estimated at 1 in 10,000-20,000 anesthetic procedures, whereas it is estimated at 1 in 6,500 administrations of NMBAs. ⋯ Prick testing is advised for the diagnosis of the NMBAs responsible for an anaphylactic reaction, and intradermal testing is preferred when investing cross-reaction. The choice of the safest possible anesthetic agents should be based on the result of a rigorously performed allergologic assessment.
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The annual surveys of critical incidents in Japanese Society of Anesthesiologists (JSA)-certified hospitals in 1999-2002 demonstrated that massive and critical bleeding was the major cause of intraoperative cardiac arrest leading to poor prognosis including death and permanent brain damage. The surveys also suggested that type-specific blood transfusion and emergent O-type blood transfusions were underutilized. ⋯ Five academic societies publicized the guidelines for management of critical bleeding in obstetrics in 2010. Each hospital is expected to make institutional emergency blood transfusion guidelines on the basis of the above guidelines in order to decrease the incidence of critical bleeding and to improve the prognosis of the patients with critical bleeding.
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Case Reports
[Suspected case of peripartum cardiomyopathy during perioperative period--a case report].
A 31-year-old primigravida was admitted for control of twin gestation and delivery. At 36-week gestation, an emergent cesarean section was performed under combined spinal-epidural anesthesia because of progression of PIH. Anesthetic course was uneventful until the operation was finished. ⋯ HELLP syndrome and DIC were also combined with PPCM, so intensive care was given to her from the 1st POD. Symptoms of heart failure were alleviated by furosemide and carperitide by the 12th POD. The EF increased to 58% on the 11th POD.
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We report a case of awake intubation utilizing Pentax-AWS Airwayscope in semi-sitting position. A 74-year-old man with myasthenia gravis and cervical disc hernia was scheduled for distal gastrectomy under general anesthesia. ⋯ With fentanyl bolus administration and lidocaine spray for laryngotracheal anesthesia, we performed awake intubation in semi-sitting position with AWS from cranial side. The patient did not buck during intubation and no hemodynamic change was observed.