Masui. The Japanese journal of anesthesiology
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Case Reports
[Use of dexmedetomidine in a critically ill patient with hyperactive delirium: a case report].
A 28-year-old male after a traffic accident was hospitalized with the abdominal pain. The abdominal CT showed deep hepatic injury. We immediately performed emergency transcatheter arterial embolization (TAE) and observed him in the ICU. ⋯ Postoperative delirium has been reported to be less with DEX compared to other sedatives. Recent studies have revealed that delirium is one of the most frequent complications and an independent risk factor for prognosis in the ICU patients. DEX may be effective for controlling delirium and provide sufficient sedation without respiratory adverse effects in patients in the ICU.
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A 54-year-old man (height 155 cm, weight 49 kg) was scheduled for retroperitoneoscopic nephrectomy. He had a history of schizophrenia that had been controlled with propericiazine 10 mg and bromperidol 3 mg daily for 34 years. After induction of anesthesia, 1% mepivacaine 5 ml was administered via an epidural catheter. ⋯ Surgery was cancelled and he was extubated 45 minutes later without any complications. These findings suggest that caution must be exercised when combining general and epidural anesthesia for patients on long-term major tranquilizers. In the event of refractory hypotension, the use of direct-acting vasoconstrictors such as noradrenaline or vasopressin should be considered.
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Case Reports
[Anesthetic management of hip joint fracture surgery in an elderly patient with giant pulmonary artery aneurysm].
We report anesthetic management of an elderly patient with giant pulmonary artery aneurysm undergoing hip joint fracture surgery. Preoperative chest computed tomography showed a main pulmonary artery aneurysm with a maximal size of 55 mm. ⋯ Hypoxemia and hypothermia were avoided for the purpose of preventing an increase in pulmonary vascular resistance. Surgery was uneventful because of anesthetic management considering pulmonary hypertension.
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The risk of accidental removal of a central venous catheter is a major concern in anesthesia and intensive care. We hypothesized that the force required to remove a fixed catheter depends on the size of the catheter (diameter) or use of a dry or wet catheter. ⋯ The force required for the accidental removal of dry catheters was greater than that required for the accidental removal of wet catheters, regardless of catheter diameter. Therefore, it is essential to use dry catheters and fixtures to prevent accidental removal of central venous catheters.
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Randomized Controlled Trial Comparative Study
[Comparison of the Supreme Laryngeal Mask Airway(SLMA), single use, with the reusable Proseal Laryngeal Mask Airway(PLMA) in anesthetized adult Japanese patients].
Supreme laryngeal mask airway (SLMA) is a single use, new supraglottic airway device with anatomically designed curved airway conduit. It has second channel for gastric tube insertion. We compared the performance of the SLMA with that of the Proseal LMA (PLMA), the older reusable LMA, during anaesthesia in spontaneously breathing adult patients. ⋯ Our result indicated that SLMA can be inserted faster without inserting one's finger into patient oral cavity. Leak pressure was lower but acceptable for clinical use in spontaneously breathing anesthetized adult patients.