Masui. The Japanese journal of anesthesiology
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Living-donor liver transplantation has become a standard and effective treatment for end stage liver disease patients. As a result of remarkable progress in immunosuppressive drugs, surgical device, anesthetics, and appropriate perioperative management, liver-transplanted patients may experience fewer complications, shorter length of ICU stay, and a better overall outcome. However, unexpected perioperative complications remain substantial. ⋯ And third, in postoperative period we should perform strict monitoring and focus on infection prophylaxis, early weaning from mechanical ventilation, appropriate administration of fluid and transfusion, maintaining renal function and preservation of graft function. Appropriate knowledge and understanding of perioperative management in liver transplantation are required to improve patient's outcome. Furthermore, it is important for performing liver transplantation to boost mutual understanding and trust in the medical team including health-care providers.
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Thoracic surgery developed remarkably in tandem with anesthetic management and post-operative intensive care since 1990. The innovations in these fields include wide spread use of one-lung ventilation, advances in clarification of pathophysiology of postoperative acute lung injury as well as its treatment, initiation of lung protective ventilation strategy, advancement of chest physiotherapy, and wide use of non-invasive ventilation in the last two decades. ⋯ Under the influence of this new lung protective ventilation strategy, perioperative managements such as setting of tidal volume changed drastically in nearly ten years. The purpose of this article is to review the innovations and the transitions in anesthetic management and post-operative intensive care in thoracic surgery, and to propose up-to-date peri-operative respiratory strategies for patients undergoing thoracic surgery, especially pneumonectomy.
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Comparative Study
[Shift of the i-gel position after chest compression: comparison of fixation methods using Durapore tape, Multipore tape, or a fixation strap].
The i-gel (Intersurgical, Wokingham, U.K.) is a newly developed, non-inflatable supraglottic device characterized by its soft, gel-like, and transparent mask made of thermoplastic elastomer. Although i-gel can be useful in emergency airway management during chest compression, the instability after insertion remains a problem. ⋯ A fixation strap may be useful in stabilizing the inserted position of i-gel during cardiopulmonary resuscitation.
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Case Reports
[One-lung ventilation using dexmedetomidine in an emphysema patient with pneumothorax due to metastatic lung cancer].
We report a case of double-lumen tube intubation and intraoperative one-lung ventilation under spontaneous breathing with continuous dexmedetomidine administration. A 61-year-old man developed pneumothorax due to multiple metastatic cancer, had multiple bilateral bullae, and underwent bullae resection under general anesthesia. An epidural catheter was placed at T8-9. ⋯ The patient was under one-lung ventilation with spontaneous breathing during the operation. There were no complications from one-lung ventilation and the patient was extubated in the operating room. One-lung ventilation, which preserves spontaneous breathing, under dexmedetomidine sedation is considered effective for preventing barotrauma in patients with multiple metastatic cancer.
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A 67-year-old woman with rheumatoid arthritis was scheduled for lumbar anterior fusion (L5-S1). The patient had undergone several major operations on the cervical to the lumbar spine. Cervical spine movement was severely restricted, the mouth opening was limited (inter-incisor distance 3 cm), and the jaw was small (thyro-mental distance 2 cm). ⋯ At the second attempt at fiberoptic intubation a rapidly swollen larynx was observed and awake intubation was abandoned. Fiberoptic intubation could be perfomed after induction of general anesthesia. This case indicates that, although awake fiberoptic intubation is regarded as the safest and the most reliable method, this may also be associated with severe airway obstruction.