Masui. The Japanese journal of anesthesiology
-
A 55-year-old man was transferred to our hospital with spontaneous esophageal rupture. An emergency operation of mediastinum drainage by thoracotomy was performed. On postoperative day 8, he had new abcesses located at the upper mediastinum around the esophagus, and required another operation. ⋯ Intraoperative and post-operative hemodynamics was stable. His respiratory condition improved, and he was weaned from V-V ECMO. Unfortunately, postoperative day 11, he died because of sudden intrathoracic bleeding from the thoracic aorta which might have been infected by the severe mediastinitis.
-
Incident rates of cardiac arrest are reported as being from 0.54 to 17.5 per 10,000 (0.54-17.5/10,000) spinal anesthesia patients. In our hospital, four cases of cardiac arrest occurred in 903 spinal and combined spinal and epidural anesthesia patients over 15 months (44.3/ 10,000). ⋯ All patients recovered without any side effects. The conditions suspected of causing strong bradycardia leading to cardiac arrest are thought to be maintained parasympathetic activity, lack of blood volume before anesthesia, rapid progress of spinal blockade, decreased blood return to the heart by high spinal blockade (T4) and protective cardiac parasympathetic reflex (Bezold-Jarisch reflex).
-
Case Reports
[Left internal jugular venipuncture in real-time ultrasound-guided pediatric central venous cannulation].
The right internal jugular vein (IJV) is usually selected for pediatric central venous cannulation (CVC); however, the left is rarely selected. We investigated cases of CVC through left IJVs from Apr to Nov of 2011. ⋯ After three failed attempts through the right IJVs in three patients (3.7%), of 2 to 9 months of age out of the 82 patients, 24 G puncture needles were successfully inserted through left IJVs with the first attempt. One of the three patients, of 9 months of age with a persistent left superior vena cava, had a thinner 2.6-mm-wide right IJV and a thicker 8.3-mm-wide left IJV It was difficult but successful to insert a 0.018-inch guidewire in another patient due to a steep 90 degree angle between the left IJV and the brachiocephalic vein.
-
Goal directed therapy (GDT) is applied during the initial resuscitation of sepsis, known as early goal directed therapy (EGDT). Recent studies in major abdominal surgery suggested that anesthetic management with GDT may decrease morbidity and hospital stay. We have utilized GDT in major invasive surgery such as pancreatoduodenectomy in November 2009. ⋯ Anesthetic management with goal-directed therapy, may have contributed to shorter postoperative hospital stay.
-
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.