Masui. The Japanese journal of anesthesiology
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Comparative Study
[Comparison of vecuronium doses in general anesthesia administered with remifentanil or fentanyl].
It is recommended to minimize neuromuscular blocker administration during general anesthesia for the efficacy of operating room utilization and potential hazards of unintended awareness during anesthesia. ⋯ Anesthesia with remifentanil reduces requirement of vecuronium dose greater than with fentanyl, while it does not affect the emergence time from anesthesia.
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A 15-year-old boy with subarachnoid hemorrhage was planned for emergency cerebral aneurysm clipping under general anesthesia. He had different blood pressure between the upper limbs and we found coarctation of the aorta at left subclavian artery bifurcation in the preoperative angiography. To prevent re-rupture of cerebral aneurysm and ischemia of abdominal organs, we monitored arterial blood pressure in bilateral radial arteries and non-invasive blood pressure in the left thigh, and his blood pressure was maintained within 120-150 mmHg of systolic pressure in the right radial artery and 50-70 mmHg of mean arterial pressure in the left radial artery and the left thigh during general anesthesia. The preoperative period elapsed uneventfully and the patient was planned for repair of coarctation of the aorta after discharge.
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Surgeons, anesthesiologists, nurses and paramedical staffs constitute a team dedicated to the welfare of the surgical patients. We have to understand that good results depend on good teamwork. ⋯ Seven subtopics; (1) usefulness and problems of pre- and post-operative anesthesia evaluation clinic, (2) communication at the time of the operating room emergency outbreak, (3) cooperative structures in blood transfusion departments for massive intraoperative hemorrhage, (3) collaboration between anesthesiologists and psychiatrists in the management of modified electroconvulsive therapy (mECT), (5) the role of the pharmacist in the management of the operating room, (6) the importance of perioperative oral care, and (7) anesthesiologists playing a pivotal role in the enhanced recovery after surgery program, are presented and discussed in detail. It should be emphasized that good teamwork arises from mutual respect.
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In recent years, specific approaches for perioperative patient management have been proposed based on the clinical evidence from various studies. The approaches are called "Enhanced recovery after surgery program", focusing on the early recovery of patients after surgery as the primary endpoint. ⋯ In the practice, anesthesiologists provide stress-free treatment to patients in various situations, the surgically-associated reduction of various functions in patients, and help shorten the recovery period. In the program, anesthesiologists are responsible for making important decisions and play a pivotal role in the perioperative management team.
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The number of the patients with psychiatric disease is increasing. Ministry of Health, Labour and Welfare eventually added psychiatric disease to the conventional four major disorders making it fifth biggest illness in July, 2011. Since mECT is assuming a important role in the treatment of various psychiatric diseases, we have more cases in which anesthesia management is required. Anesthesiologists must collaborate with psychiatrists to perform safe ECT and understand indication, procedure and how to use the treatment device for ECT.