Masui. The Japanese journal of anesthesiology
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We report on the development of a simulation-based sedation training course (SEDTC). Participants were doctors and medical staff, such as operating room nurses. During the course, we identified issues that medical staff confront in the operating room (OR). ⋯ At the end of the course, participants discussed problems associated with sedation and provided input regarding sedation safety. Participants commented not only on changes in their views regarding sedation, but also on general medical safety in the OR. Our findings suggest that the SEDTC may serve as a vehicle to promote safety with respect to sedation and analgesia.
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Case Reports
[Awake intubation with landiolol and dexmedetomidine in a patient with anxiety neurosis].
We report a successful case of awake intubation in a patient with anxiety neurosis via continuous administration of landiolol and dexmedetomidine. A 52-year-old woman weighing 46.8 kg with anxiety neurosis experienced postoperative bleeding after left-side thyroidectomy and was scheduled for emergent hemostasis under general anesthesia Due to swelling of the neck, we anticipated a difficult airway and decided to perform awake intubation. ⋯ After 10 minutes, her shivering disappeared, and she agreed to undergo awake intubation, which was performed with the Pentax-AWS Airwayscope and thin Intlock blade. The patient bucked slightly during intubation but hemodynamic changes were minimal.
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Case Reports
[Case of respiratory arrest during intraoperative magnetic resonance imaging (iMRI) for awake craniotomy].
We had a neurosurgical patient who developed apnea during iMRI. She was suspected of obstructive sleep apnea. The tumor had a risk of motor aphasia, and therefore awake craniotomy with iMRI was planned. ⋯ Awake craniotomy could be challenging because of unsecured airway with risks of vomitting, epileptic attacks or unstable level of consciousness. It is considered that the patient monitoring becomes more difficult when iMRI is performed because the patient's face cannot be obsereved directly. We should remember that conscious level as well as respiration pattern may change during operation.
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We conducted a retrospective analysis of the intraoperative lactate level and its association with patients' outcome in adult cardiac surgery patients requiring cardiopulmonary bypass. ⋯ Increased lactate concentrations after weaning from CPB were significantly and independently associated with ICU free survival days at POD 28. This finding may be important to physicians in managing patients undergoing cardiac surgery using CPB.
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We report a case of successful procedural sedation using dexmedetomidine (DEX) in a 68-year-old woman undergoing left gasserian ganglion block for intractable trigeminal neuralgia. DEX was chosen to provide an effective sedation and clear communication about the injection of drugs or thermocoagulation. After 15 minutes of DEX administration at 0.8 microg x kg(-1) x hr(-1), nerve block needle insertion was bearable. ⋯ High-frequency thermocoagulation elicited tolerable radiating pain with minimum vital sign change. She was comfortable and had no communication difficulty under DEX sedation. DEX sedation for interventional pain management during procedures such as gasserian ganglion block may be useful.