Masui. The Japanese journal of anesthesiology
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Although magnesium can potentially shorten onset time of a muscle relaxant, it is unclear whether it does shorten the onset time of rocuronium for patients in cesarean delivery (CD). Thus the purpose of this study is to compare the onset time of rocuronium in patients with or without preoperative magnesium treatment. ⋯ Magnesium did not shorten the onset time of rocuronium 0.6 mg x kg(-1) in CD patients.
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We investigated whether sugammadex could reverse neuromuscular blockade induced by rocuronium in patients for cesarean delivery treated with magnesium sulfate preoperatively. ⋯ Sugammadex could reverse rocuronium-induced neuromuscular blockade in a dose-response manner even in the patients treated with magnesium sulfate.
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Various kinds of evidence-based checklists and guidelines aimed at patient safety in the perioperative period are becoming popular in the clinical setting. These include WHO guidelines on surgical patient safety, surgical-crisis checklists, checklist for preventing major complications associated with cesarean delivery, NICE guidelines for surgical site infection, guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis, appropriateness criteria for stress echocardiography and so on. ⋯ When we use the guidelines and checklists correctly, we could see what is happening in a patient and what to do next for the patient leading us to correct diagnosis and appropriate treatment. Thus, evidence-based practice will be established in the near future in the perioperative period.
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The World Health Organization (WHO) launched the Safe Surgery Saves Lives campaign in 2007 to improve safety of surgical care in the world. As a part of the campaign, the first edition of the Surgical Safety Checklist was created through an international consultative process in 2008 and the second edition was published in the WHO Guidelines for Safe Surgery 2009. ⋯ In this article we gave an outline of WHO Surgical Safety Checklist and WHO Guidelines for Safe Surgery 2009, and reviewed the evidence of the guidelines and checklist. Finally we presented the evidence indicating the efficacy of the WHO Surgical Safety Checklist, which included the pilot study attached in the guidelines showing that its use markedly decreased complications in patients undergoing noncardiac surgery in eight diverse international hospitals.
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Case Reports
[Anesthetic management of a patient with moyamoya disease undergoing mitral valve repair].
Moyamoya disease is the result of progressive steno-occlusive changes in the internal carotid arteries followed by formation of bilateral abnormal vascular networks. The disease may present with cerebral ischemia causing cerebral hemorrhage in the perioperative period. There are few reports of cardiac surgeries in patients with moyamoya disease, and the management during cardiopulmonary bypass for moyamoya disease has not been established. ⋯ We maintained the perfusion flow of CPB above 3.0 l x min(-1) x m(-2) and the mean perfusion pressure above 70 mmHg. In addition, we used the pulsatile perfusion assist with intraaortic balloon pumping to maintain cerebral circulation. Postoperative course was uneventful without apparent neurologic deficit, and she was discharged from hospital on 10th postoperative day.