Masui. The Japanese journal of anesthesiology
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Although the number of maternal death in Japan has decreased especially since 1990's and its total number has reached the level of developed countries, obstetric hemorrhage is still equally important as obstetric embolism and hypertension in pregnancy as a cause of maternal death. Intrapartum abnormal bleeding is defined as hemorrhage which amounts to more than 500 ml during intrapartum period by Japan Society of Obstetrics and Gynecology (JSOG). However, according to the official register of peripartum data in Japan, the upper normal limit (mean + 1.5 SD) of the amount of hemorrhage during intrapartum period was 900 g at vaginal singleton delivery, 1600 g at singleton cesarean delivery, 1900 g at multifetal vaginal delivery and 2600 g at multifetal cesarean delivery. ⋯ Strategy of treatment for obstetric DIC and the guideline of response to obstetric critical hemorrhage are also important at such state. Level 1 and other medical devices for critical care also become strong tools for severe cases. However, the most important is adequate and prompt estimation and direction by workforce.
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We studied the effect of the initial loading dose of dexmedetomidine on hemodynamics in pediatric patient undergoing cardiac surgery. ⋯ Any clinical problems leading to a major increase in blood pressure were not encountered. But these results suggest that it is necessary to devise a method of administration of dexmedetomidine in consideration of the patient's condition and the drug effect in severe cases.
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Case Reports
[Landiolol hydrochloride is useful for anesthetic management of cesarean section in a patient with Basedow disease].
We report successful anesthetic management of elective cesarean section in a 30-year-old patient with Basedow disease using landiolol hydrochloride, a short-acting beta-1 adrenergic blocker of which greatest advantages are its short duration of action, rapid clearance and high beta-1 selectivity. The patient received landiolol for the prevention of aggravated tachycardia and tachyarrhythmia during cesarean section. ⋯ No severe adverse effects were observed in the infant. In conculusion, landiolol is useful for maintaining the hemodynamics stable in a pregnant woman with Basedow disease and keeping the infant safe from any adverse effect by infusion of landiolol.
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Anesthesia training system and operation theater management at St Vincent's hospital Melbourne in Australia, are very well organized, including tutorials, invitation lecture, transesophageal echocardiography conference as well as working hour, operation room, organization of comedical staffs such as nursing and technician staff, and day surgery and anesthesia. Good anesthesia training system and efficient operation theater management are necessary to establish better quality of medical services.
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Although remifentanil produces respiratory depression, its very short duration of action provides a great advantage for the control of hemodynamics during anesthesia for tracheobronchial stent insertion. We compared remifentanil with fentanyl during propofol-based anesthesea for anesthetic management for tracheobronchial stent insertion. ⋯ We conclude that the continuous infusion of low dose remifentanil with propofol produce more efficient respiratory and hemodynamic stability than the bolus infusion of fentanyl with propofol during anesthesia for tracheobronchial stent insertion.