Masui. The Japanese journal of anesthesiology
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We experienced a 55-year-old female patient who was diagnosed as femoral neuropathy after radical ovariectomy. An epidural catheter was introduced at T11-12 interspace without any problems and general anesthesia was induced and maintained. The operation ended uneventfully. ⋯ Those findings led us to diagnose with femoral neuropathy probably due to abdominal retractors or the operation itself, and insertion of epidural anesthesia could not be the cause of neuropathy. Her symptom was ameliorated with a conservative therapy after four months. We should perform fine neurological examinations when neurological complications occur, especially when we use epidural catheters, and also should have the knowledge about those complications.
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We experienced a case of dilution coagulopathy successfully treated with cryoprecipitate. A seven-month-old male infant with tetralogy of Fallot and right femoral arteriovenous fistula had undergone a modified Blalock-Taussig shunt at 63 days of age. He was scheduled to undergo complete repair of TOF and closure of femoral arteriovenous fistula. ⋯ In the present case, dilution coagulopathy occurred as a result of the combination of excessive fluid infusion due to massive bleeding and blood dilution due to CPB. Fresh frozen plasma could have been contraindicated to supplement fibrinogen because the patient's body weight was low. Cryoprecipitate, a highly concentrated source of fibrinogen, was effective for correcting fibrinogen deficit.
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Enhanced recovery after surgery (ERAS) protocols aim to improve patient care, reducing complication rates, and shortening hospital stay following colorectal surgery in Europe. In cooperation with colorectal surgeons, ERAS protocols were initially introduced in our hospital to the patients undergoing open colorectal resection in July 2010. ⋯ We, anesthesiologists as perioperative physicians, can improve key elements of perioperative care such as patients' counseling, perioperative analgesia and early mobilization by collaboration with surgeons and nurses, to facilitate postoperative recovery.
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Case Reports
[A case of bilateral recurrent laryngeal nerve palsy after thyroid surgery under intraoperative nerve monitoring].
A 66-year-old woman suffering from Basedow disease had total thyroidectomy under intraoperative monitoring (IOM) of recurrent laryngeal nerve (RLN) using Medtronic Xomed Nerve Integrity Monitor-2 (Medotronic, Mineapolice, Minesota, USA). IOM indicated a positive signal for her right RLN while the signal for her left RLN disappeared during the operation. During the surgery, surgeons identified her left RLN which was anatomically intact. ⋯ On POD3, dysfunction of her vocal cord continued, therefore, she had tracheotomy With long-term follow up, her vocal cord function returned to normal on POD37 and tracheotomy tube was removed. In conclusion, positive signals of IOM are not always correlated with proper function of vocal cord. Therefore, respiratory condition should be carefully observed during postoperative period.
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Hypotension is a common adverse effect of spinal anesthesia (SA). Preoperative fluid infusion is recommended to prevent hypotension during caesarean section. The aim of this study is to document relationship between preoperative total body water (TBW) and the amount of the vasopressors given intraoperatively and to evaluate the change of maternal body water composition (BWC). ⋯ Preoperative TBW does not affect the amount of vasopressors given during caesarean section, which suggested massive fluid infusion can not always prevent hypotension after SA. A slight changes in TBW and ECW may be induced by SA, while the exact physiological and clinical significance of these observation remains to be elucidated.