Masui. The Japanese journal of anesthesiology
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Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) need many blood products due to deficiency of coagulation factors. Blood transfusion therapy in patients with excessive bleeding after CPB is generally empiric. We checked and studied the fibrinogen concentration and transfusion, as well as bleeding amount in the perioperative period. ⋯ Blood transfusion therapy based on fibrinogen concentration is needed to maintain adequacy of the perioperative blood transfusion and blood conservation in cardiac surgery.
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Spinal progressive muscular atrophy (SPMA) is a rare lower motor neuron disease in which anesthetic management is often difficult as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents. A 43-year-old female patient with SPMA was scheduled to undergo laparotomy for ovarian teratoma. Her vital capacity was only 530 ml and % volume capacity was 22.2%, indicating a severe restrictive pulmonary disfunction. ⋯ Postoperative pain control was stable using continuous epidural infusion of 0.2% ropivacaine without neurological adverse effects. One day after surgery, the trachea was extubated and respiratory function did not aggravate. Despite the controversy surrounding the use of neuraxial blocks in motor neuron diseases, in this case, epidural anesthesia was useful to keep the respiratory function stable.
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Case Reports
[Anesthetic management of a patient with Klippel-Trenaunay syndrome undergoing caesarean section].
Klippel-Trenaunay syndrome (KTS) is characterized by capillary and venous malformation and hypertrophy of bone and soft tissues. A 29-year-old primigravida, who had been diagnosed of KTS by her hemangiomas and varicosities in the right leg, pubic area, rectum, vagina and lower abdominal area, was scheduled to receive caesarean section at 37 weeks gestation because vaginal delivery might cause hemorrhagic complications and extension of the venous lesions. ⋯ There were no complications such as massive hemorrhage, disseminated intravascular coagulation and deep venous thrombosis in the perioperative period. Careful anesthetic considerations for the prevention of hemorrhagic and thrombotic complications are necessary for cesarean section in a patient with KTS.
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Anesthesia for the tracheobronchial stent placement involves the risk of airway narrowing and obstruction. Controlled ventilation with relatively high airway pressure is usually used to maintain oxygenation and ventilation during anesthesia. However, controlled ventilation does not always provide tidal volume and oxygenation due to gas leakage from tracheobronchial fistula. ⋯ Anesthesia was induced with remifentanil and sevoflurane with spontaneous respiration. When inserting the rigid bronchoscope, cough reflex occurred and propofol was added to deepen the anesthesia. The stent placement was performed with general anesthesia under spontaneous respiration without any complications.
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Neuromuscular blocking drugs (NMBDs) can predispose patients with myasthenia gravis to postoperative paralysis and respiratory complications. We had a 12-year-old female patient undergoing thoracoscopic thymectomy. She had suffered from MGFA class IIa (mild systemic) myasthenia gravis for 4 months. ⋯ Intercostal nerve block with 0.2% ropivacaine was performed to relieve postoperative pain. TOF ratio was 32% at the end, when we gave 2 mg x kg(-1) of sugammadex to get 100% reversal of neuromuscular blockade in 120 seconds. There was no residual paralysis and respiratory complications postoperatively.