Masui. The Japanese journal of anesthesiology
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Review Comparative Study
[Properties and clinical implications of middle molecular weight low substitution hydroxyethyl starch solution].
In this review article, the properties and clinical implications of middle molecular weight low substitution hydroxyethyl starch (HES) solution are summarized. This preparation shows larger volume effect and longer duration compared to the currently available low-molecular weight HES solution and will be available in the near future in Japan. Effects on renal function and coagulation system are supposedly dependent on the persistence of larger HES molecule in the body and this middle molecular weight low substitution HES preparation may be advantageous to the older HES preparation due to its rapid metabolism. This preparation has been successfully used in the goal-directed fluid management in the early recovery program after surgery and will offer several advantages in fluid management when introduced in Japan.
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There are growing interests in perioperative preventation of surgical site infection, since the World Health Organization has published surgical safety checklist with the slogan "safe surgery saves lives" in 2008. According to the surgical safety checklist, the surgical team needs to check whether antibiotic prophylaxis has been given within 60 minutes of skin incision. In this study, we investigated whether anesthesiologists in our institution completed the administration of antibiotics before skin incision. ⋯ Anesthesiologists should have knowledge on the preventation of surgical site infection especially on antibiotic prophylaxis, because it starts in the operating room.
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Comparative Study
[Intraoperative body temperature changes and short-term outcomes of open and minimally invasive esophagectomy].
Esophagectomy is a highly invasive procedure, and recently the use of minimally invasive esophagectomy (MIE) via thoracoscopy and laparoscopy increased, since this technique possibly enhances the recovery and outcomes of the patient compared with open esophagectomy (OE). However there is little data about intraoperative changes in body temperature during OE and MIE. ⋯ Our study showed that the intraoperative temperature during MIE tended to decrease compared with OE, but the short-term outcomes were comparable.
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Case Reports
[Refractory headache after epidural catheter placement in a girl in whom epidural blood patches were ineffective].
A 12-year-old girl who had received epidural catheter placement for an orthopedic surgery developed postural headache on postoperative day (POD) 1 which resolved in 24 hours. She was discharged on POD 6 but readmitted on POD 16 for headache accompanied by nausea and photophobia. On POD 17 and 35 she received epidural blood patches (EBPs) with 15 ml and 20 ml of autologous blood, respectively and her headache disappeared shortly after the second EBP. ⋯ Headache gradually and completely disappeared on the POD 200. It took more than 100 days for her to regain her usual life. In conclusion, in adolescents whose symptoms and atypical, psychosomatic disorder should be taken into consideration as a differential diagnosis and a referral to a specialist is important.