Masui. The Japanese journal of anesthesiology
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Excessive bleeding after cardiopulmonary bypass remains a major complication for cardiac surgery. The principal causes of hemostatic bleeding are related to inadequate surgical hemostasis or diluted coagulopathy. We investigated the efficacy of cryoprecipitate (Cryo) transfusion in thoracic aortic surgery with cardiopulmonary bypass. ⋯ Cryoprecipitate transfusion is an effective treatment for coagulopathy caused by dilution of coagulation factors after cardiopulmonary bypass.
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Restriction of preoperative clear liquid intake causes thirst in many patients but is followed traditionally for many years in the preoperative order by an anesthesiologist in charge. Although many anesthesiologists doubted long the efficacy of this tradition, no one has stopped. ⋯ In 2005, the report from north European countries was published and introduced the new idea "Enhanced Recovery after Surgery, ERAS" which consists of many factors. Among these factors, the enforcement of preoperative clear liquid intake was reviewed in this volume.
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Case Reports
[Automated intermittent bolus infusion for continuous sciatic nerve block: a case report].
We present two cases of severe pain due to critical limb ischemia (CLI) treated with automated intermittent bolus infusion for continuous sciatic nerve blocks. Case 1: A 32-year-old man had severe lower extremity ischemic pain due to Fontaine grade IV peripheral vascular disease. The pain did not respond to systemic analgesics. ⋯ As continuous infusion did not relieve his pain, automated intermittent with patient-controlled bolus administration was started. However even with this technique, his pain was not relieved well. In some patients whose severe pain due to CLI could not be managed well, automated intermittent bolus infusion of local anesthetics from peripheral nerve catheter may provide better analgesia than continuous infusion.
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Although epidural blood patch (EBP) is an effective treatment for postdural puncture headache (PDPH), the adequate blood volume has not been determined. We reported two cases of EBP for PDPH after caesarean section with spinal anesthesia using ultrasound imaging with a 2-5 MHz convex probe. ⋯ In case 2, although the area of the epidural space was unchanged by 17 ml of EBP, contrast of the epidural space was altered in as a mosaic pattern. We conclude that ultrasound imaging is useful to confirm the adequate blood infusion during EBP Therefore, there is a possibility of estimating the optimal blood volume by ultrasound imaging.
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Continuous epidural analgesia has become an accepted technique used in laparotomy including liver resections. Although American Society of Regional Anesthesia and Pain Medicine recommends that epidural catheter be removed with prothrombin time-international normalized ratio (PT-INR) less than 1.5, it is possible that liver surgery causes coagulation disturbances. We examined the postoperative changes in coagulation profiles of living liver donors to elucidate whether hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters or not. ⋯ Our study suggested that hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters, even in the living liver transplant donors with normal liver function.