Masui. The Japanese journal of anesthesiology
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We report the successful combined use of continuous epidural anesthesia and transversus abdominis plane block for the management of postoperative pain following a cesarean delivery in a patient whose paralysis and pain were not well controlled after two previous cesarean deliveries. A 28-year-old female patient with no remarkable medical history was scheduled to undergo cesarean delivery at 38 weeks and 3 days of pregnancy. She had undergone cesarean deliveries twice previously, at 23 and 25 years of age. ⋯ Therefore, during the third operation, the concentration of the continuous epidural anesthesia infusion was decreased to prevent complications, and a transversus abdominis plane block was added. The patient experienced no postoperative pain and fewer complications. We think that the combined use of these blocks provided good postoperative pain control with fewer complications.
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A 19-year-old male was admitted with diabetic ketoacidosis. A central venous catheter for fluid loading and insulin administration was inserted from the right femoral vein. The catheter was placed for 4days and was removal. ⋯ The surgeon also implanted an inferior vena caval filter. The patient was weaned from ventilator assist next day and was discharged from the hospital 13 days later. This case suggests that deep vein thrombosis should be checked in diabetic ketoacidosis even after removal of a central venous catheter implanted at the femoral vein.
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Despite a drastic decline in anesthesia-related morbidity and mortality, perioperative mortality remains still high with an overall rate around 1 to 2%. To improve postsurgical outcomes ultimately, anesthesiologists should move forward to take more responsibility in the perioperative management of patients. In this issue, we selected several types of highly invasive surgical procedures and reviewed anesthesia and perioperative management for the patients undergoing these surgeries. Team approach by various professionals may facilitate organizing pre-, intra-, and postoperative care.
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We report the refinement of the simulation-based sedation training course (SEDTC) hosted by the Japanese Association of Medical Simulation, and the drafting and development of an learning goal and instructor course. In basic airway management training, we highlighted the importance of the "call for help" and oxygen supply. In card-based simulation training sessions, we posted a picture detailing recommended amounts of oxygen and the duration of its use. ⋯ Twenty-seven SEDTCs were conducted between August 2011 and March 2013 at several locations in Japan. A total of 395 medical staffs affiliated with various medical departments participated in the courses. SEDTCs may serve as a vehicle to improve the safety of sedation and analgesia.
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Comparative Study
[Difference in nitrous oxide-mediated increases in intracuff pressure between two tracheal tubes in a simulated pediatric lung model].
The purpose of this study was to compare the nitrous oxide-mediated increases in cuff pressure between a tracheal tube with a tapered cuff (Taper) or conventional high volume low pressure cuff (HVLP) utilizing a simulated pediatric lung model. ⋯ These findings suggest that the Taper may be more effective than the HVLP in preventing hyperinflation of the tracheal tube cuff in response to nitrous oxide exposure in children.