Masui. The Japanese journal of anesthesiology
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Case Reports
[Case of large vein perforation caused by pumping using central venous catheter revealed by postoperative CT].
A 72-year-old woman, 157 cm in height and weighing 45 kg, was scheduled for emergency surgery for acute abdomen suggestive of gastrointestinal perforation. During the procedure, a triluminal central venous catheter (CVC) was inserted via the left internal jugular vein; venous blood could be aspirated separately through its lumens. On attempting blood transfusion, we noticed that the opening of one the CVC lumen tips was blocked and blood pumping was thus performed to achieve rapid transfusion. ⋯ After the intraoperative blood vessel perforation, the condition may have been aggravated by steroid use, amyloidosis, and blood vessel fragility, ultimately presenting the extravascular findings observed on CT. We thus believe that in cases where CVC is inserted via the left internal jugular vein, blood pumping in particular is believed to be dangerous. Although the risks of blood vessel perforation when using CVC are relatively low, the possibility of unexpected complications should be borne in mind.
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Williams syndrome is characterized by the triad of supravalvular aortic stenosis (SAS), mental retardation and elfin facies. Generally, difficult airway is expected in patients with Williams syndrome by characteristic face. A 26-year-old female with Williams syndrome was scheduled for abdominal myomectomy under general anesthesia. ⋯ After induction of anesthesia, anesthetic course was uneventful. According to the most previous clinical reports in patients with Williams syndrome in Japan, mask ventilation and tracheal intubation were performed easily contrary to preoperative airway assessment. In view of SAS, mental retardation, airway deformity and airway assessment in previous clinical reports, we should select the optimal strategy for airway management in patients with Williams syndrome.
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Randomized Controlled Trial
[Effect of pentazocine on the bispectral index during nitrous oxide-sevoflurane anesthesia].
The effect of pentazocine on the bispectral index (BIS) has not been reported. In this study, we have examined whether pentazocine alters the bispectral index during nitrous oxide-sevoflurane anesthesia. ⋯ We observed that intravenous pentazocine caused a significant increase in BIS under nitrous oxide-sevoflurane anesthesia. The depth of sedation should be assessed carefully using a bispectral index monitor when pentazocine is used together.
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Randomized Controlled Trial Comparative Study
[Influence of tidal volume on functional residual capacity during general anesthesia].
Ventilation with lower tidal volume improves outcome in acute respiratory distress syndrome (ARDS). However, it is questionable if ventilation strategy using lower tidal volumes created for patients with ARDS can be transferred to healthy patients undergoing general anesthesia. We assessed the effects of ventilation with lower tidal volumes and conventional tidal volumes on functional residual capacity (FRC) and Pa(O2)/FI(O2) (P/F) ratio in patients undergoing general anesthesia for upper abdominal surgery. ⋯ Lower tidal volumes are better than conventional tidal volumes in view of airway pressure and lung protective strategy during general anesthesia.
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Randomized Controlled Trial Comparative Study
[Effect of different perioperative analgesic methods on postoperative cognitive dysfunction in elderly patients undergoing upper abdominal surgery].
We investigated whether the early postoperative cognitive dysfunction (POCD) was affected by different perioperative analgesia methods using intravenous remifentanil or epidural ropivacaine in the elderly undergoing major upper abdominal surgery. ⋯ Perioperative analgesia using intravenous remifentanil and epidural ropivacaine showed no significant difference in the incidence of early POCD after upper abdominal surgery in elderly patients.