Masui. The Japanese journal of anesthesiology
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Perioperative fluid management for cases with severely compromised cardiac function undergoing major non-cardiac surgery remains a challenge. Dynamic parameters such as stroke volume variation (SVV) and cardiac index obtained by arterial pulse contour analysis may not be sufficient for fluid optimization because individualized optimal parameter values are difficult to determine in cardiac patients. We report two cases of abdominal surgery with severe pre-existing impairment of cardiac function (ejection fraction < 30%) complicated by severe pulmonary and renal dysfunction. ⋯ In Case 2, cardiac index and stroke volume index remained unchanged despite the decrease of SVV after colloid bolus infusion. Infusion of dobutamine was useful for maintaining the ScvO2 above 75% in a rather hypovolemic state (SVV of 10-15%). Our cases suggest that the use of central venous oxygen saturation together with arterial pulse contour analysis may aid decision-making for individualized fluid optimization and use of inotropics in severely compromised cardiac patients undergoing major abdominal surgery.
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We report three cases of continuous wound infiltration (CWI) for postoperative analgesia in upper abdominal surgery using the multi-holed epidural catheter. Ropivacaine 0.2% at a rate of 8 ml x hr(-1) was administered through the catheters after surgery. Intravenous-patient controlled analgesia was used as a rescue. ⋯ The consumption of rescue morphine was little and no side effect of morphine was observed. CWI is an easy procedure and is indicated in the patients with hemostatic abnormality and a difficulty in the epidural anesthesia. CWI was an effective technique for postoperative pain control in the upper abdominal surgery patients.
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Case Reports
[Anesthetic machine leakage from vaporizer by external force derived from keyboard of electronic medical records].
We experienced the leakage from the vaporizer of the anesthetic machine despite the normalities on performing the initial leak test. The vaporizer of the anesthetic machine was compressed by computer keyboard of EMR which caused a leak from vaporizer. After computer keyboard and the vaporizer were set at normal position, the leak stopped.
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Comparative Study
[Is nitrous oxide useful for laryngeal mask airway insertion under 8% sevoflurane?].
The usefulness of nitrous oxide for laryngeal mask airway insertion under 8% sevoflurane anesthesia was investigated. ⋯ Nitrous oxide shortened induction time, decreased hemodynamic changes, but did not increase postoperative nausea, vomiting and headache when used for anesthesia induction with 8% sevoflurane to insert laryngeal mask airway.