Masui. The Japanese journal of anesthesiology
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Coagulation disorders often occur perioperatively and monitoring of blood coagulation should be fast and adequate to treat these disorders to protect patients from massive bleeding. Control of hemostasis is one of the main issues in major surgeries. Coagulation test results from a central laboratory may delay making such a perioperative decision. ⋯ Both prothrombin time (PT) and activated clotting time (ACT) are very useful and popular, but also criticized because they can be monitored only until fibrin formation. On the other hand, viscoelastic monitorings of whole blood, are able to estimate fibrin formation, clot fixation, platelet function and fibrinolysis. In this review article, among variable perioperative POCMs of blood coagulation, three thromboelastographic monitorings, such as TEG ROTEM, and Sonoclot as well as PT and ACT, are described along with their utilities and limits to examine perioperative coagulation.
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The goals of monitoring are to improve the safety of perioperative care and to improve patient's outcome. Various invasive and non-invasive monitors are currently used. ⋯ We must continue to improve the functions of monitors. The existence of a well-trained competent anesthesiologist at bedside is essential to integrate all the information gained by five senses, the monitors, blood tests and close communication with surgeons on top of deep understanding of the patient's preoperative status.
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We describe a case of an esophageal injury caused by insertion of a transesophageal cardiac echo probe in a 66-year-old man with an aberrant right subclavian artery, who was scheduled for Bentall surgery for aortic regurgitation and annuloaortic ectasia. Preoperative CT scan showed an aberrant right subclavian artery compressed from the back of the esophagus. General anesthesia was induced with midazolam and fentanyl, and maintained with midazolam, remifentanil and fentanyl. ⋯ GIF on the postoperative day 16 revealed that ulcers had healed. Transesophageal echo probe insertion is potentially hazardous in a patient with an aberrant right subclavian artery. Although aberrant right subclavian artery is rare, transesophageal echocardiography should be performed with extreme caution.
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Case Reports
[Percutaneous vertebroplasty for vertebral compression fractures in the patient with acute lymphoblastic leukemia].
Percutaneous vertebroplasty (PVP) is an interventional treatment for painful vertebral compression fractures caused by osteoporosis and malignant diseases such as multiple myeloma and metastatic bone tumors. We present the first case of PVP performed on a man in his thirties with vertebral compression fractures secondary to acute lymphoblastic leukemia. PVP at T11 and L1 levels resulted in a marked improvement in refractory pain although he developed delayed pyogenic spondylitis two months after the intervention. This case suggests that PVP could be one of the useful therapeutic procedures for intractable back pain associated with vertebral compression fractures in acute lymphoblastic leukemia if we are extremely vigilant for the risk of spondylitis.
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The role of various monitors contributing to achieving and standardizing safety has been increasing in the management of general anesthesia. In particular, sufficient oxygenation is one of the most basic requirements to ensure the safety of patients under general anesthesia. In this report, pulse oximetry, mixed venous oxygen saturation, and central venous oxygen saturation are reexamined as monitors, based on evaluation of the respiratory system and tissue oxygenation, in order to evaluate their usefulness in measurements. Regarding pulse oximeters, the models with added functions are introduced, and in this article mixed venous and central venous oxygen saturation, the early goal-directed therapy (EGDT) and the core of the Surviving Sepsis Campaign (SSC) guidelines from 2008, are examined.