Masui. The Japanese journal of anesthesiology
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We report a case of paroxysmal supraventricular tachycardia (PSVT) that occurred during video-assisted thoracoscopic (VATS) lobectomy in a patient with concealed Wolff-Parkinson-White (WPW) syndrome. A 59-year-old man with lung cancer was scheduled for VATS lobectomy under general anesthesia. After inserting a thoracic epidural catheter, general anesthesia was induced with intravenous administration of propofol. ⋯ An electrophysiological study performed after hospital discharge detected concealed WPW syndrome, which had contributed to the development of atrioventricular reciprocating tachycardia. Concealed WPW syndrome is a rare, but critical complication that could possibly cause lethal atrial tachyarrhythmias during the perioperative period. In the present case, cardioversion using adhesive electrode pads briefly terminated PSVT in a patient with concealed WPW syndrome.
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After the operation, early postoperative ambulation has been recommended for thromboprophylaxis. As more anticoagulant drugs have become available, hemorrhagic complication of epidural anesthesia is the focus of attention. Recently, the spread of ultrasound-guided nerve block has improved the efficacy of the transversus abdominis plane block Therefore, we compared transversus abdominis plane block with epidural anesthesia regarding postoperative numerical scale in patients undergoing gynecological surgery. ⋯ No significant difference in postoperative NRS between two groups in this survey suggests that TAPB in combination with appropriate postoperative pain service is useful in patients contraindicated to epidural puncture.
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Delayed discharge from ICU to the general ward can exert an adverse effect. We researched whether patients are discharged smoothly from our ICU to the general ward. ⋯ We need to investigate further the reasons why delayed discharge occurred. It is im portant that patients are discharged from the ICU to the general ward properly. Delayed discharge can delay the recovery and expose the patient to multi-resistant microorganisms. We studied whether patients are discharged smoothly from the ICU to the general ward.
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A 74-year-old man with ruptured thoracoabdominal aortic aneurysm was scheduled for open surgical repair under partial cardiopulmonary bypass. He had a history of diabetes mellitus and a concomitant renal dysfunction, requiring regular intermittent hemodialysis. To maintain electrolytes, acid base as well as water balance within adequate ranges, we planned to use continuous hemodiafiltration (CHDF) during the surgery because there was a high incidence of bolus transfusion to deal with massive bleeding in these surgeries. ⋯ Heparin was administered just before the partial car diopulmonary bypass. There was no evidence for thromboembolic complications due to CHDF use. In conclusion, we successfully managed electrolytes as well as acid base balance, and hydration of a patient with chronic renal failure by using CHDF during open graft repair of ruptured thoracoabdominal aortic aneurysm.