Masui. The Japanese journal of anesthesiology
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Enhanced recovery after surgery (ERAS) protocols aim to improve patient care, reducing complication rates, and shortening hospital stay following colorectal surgery in Europe. In cooperation with colorectal surgeons, ERAS protocols were initially introduced in our hospital to the patients undergoing open colorectal resection in July 2010. ⋯ We, anesthesiologists as perioperative physicians, can improve key elements of perioperative care such as patients' counseling, perioperative analgesia and early mobilization by collaboration with surgeons and nurses, to facilitate postoperative recovery.
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Case Reports
[A case of bilateral recurrent laryngeal nerve palsy after thyroid surgery under intraoperative nerve monitoring].
A 66-year-old woman suffering from Basedow disease had total thyroidectomy under intraoperative monitoring (IOM) of recurrent laryngeal nerve (RLN) using Medtronic Xomed Nerve Integrity Monitor-2 (Medotronic, Mineapolice, Minesota, USA). IOM indicated a positive signal for her right RLN while the signal for her left RLN disappeared during the operation. During the surgery, surgeons identified her left RLN which was anatomically intact. ⋯ On POD3, dysfunction of her vocal cord continued, therefore, she had tracheotomy With long-term follow up, her vocal cord function returned to normal on POD37 and tracheotomy tube was removed. In conclusion, positive signals of IOM are not always correlated with proper function of vocal cord. Therefore, respiratory condition should be carefully observed during postoperative period.
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Hypotension is a common adverse effect of spinal anesthesia (SA). Preoperative fluid infusion is recommended to prevent hypotension during caesarean section. The aim of this study is to document relationship between preoperative total body water (TBW) and the amount of the vasopressors given intraoperatively and to evaluate the change of maternal body water composition (BWC). ⋯ Preoperative TBW does not affect the amount of vasopressors given during caesarean section, which suggested massive fluid infusion can not always prevent hypotension after SA. A slight changes in TBW and ECW may be induced by SA, while the exact physiological and clinical significance of these observation remains to be elucidated.
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The "BURP" maneuver (back, upward, right lateral, pressure) improves the visualization of the larynx for experienced anesthesiologists during orotracheal intubation in patients with difficult airway. We investigated whether this maneuver has same efficacy for inexperienced residents in anesthesiology. ⋯ We concluded that "BURP" maneuver was effective even for inexperienced residents. More than two months were required for the residents to develop laryngoscopy skill.
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Ketamine is associated with an increase in the bispectral index (BIS) values that can lead to an overdose of hypnotic agents. We investigated the effect of ketamine on BIS values during general anesthesia with a target-controlled infusion (TCI) of propofol and infusion of remifentanil. ⋯ Under stable propofol and remifentanil anesthesia, a small dose of ketamine did not increase the BIS value over the next 15 min.