Masui. The Japanese journal of anesthesiology
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During an abdominal surgery, life-threatening events such as severe bradycardia and massive hemorrhage may occur. Reflex bradycardia may arise with surgical manipulation of abdominal contents. Anesthetic agents such as propofol or remifentanil increase the risk of bradycardia. ⋯ When we find critical hemorrhage, we have to manage the condition in accordance with "The guideline for critical intraoperative hemorrhage" published by JSA and the Japan Society of Transfusion Medicine and Cell Therapy. The pneumoperitoneum required for laparoscopy induces physiologic changes that complicate anesthetic management and could cause CO2-subcutaneous emphysema, pneumothorax, endobronchial intubation, and gas embolism. During laparoscopy, blood pressure, heart rate, electrocardiogram, end-tidal CO2, and oxygen saturation by pulse oximetry must be continuously monitored.
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We describe the risk management of pediatric anesthesia. The most important risk management of pediatric anesthesia is airway and temperature management. ⋯ The management of patients' temperature, including control of room temperature should be taken into consideration. In addition, careful attention should be paid not to introduce air bubbles in any lines, especially in patients with congenital heart diseases.
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Control of the airway is fundamental for the safe anesthetic practice of head and neck surgery and careful assessment of airway must be undertaken preoperatively. Safe tracheal intubation method should be decided after the airway assessment. ⋯ Emergency anesthesia for neck and head surgery is most difficult. Experienced personnel and several kinds of devices for securing the airway should be gathered in the operating room before induction of anesthesia.
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Arrhythmia during general anesthesia occurrs occasionally as a result of the effect of inhalation anesthetic agent on cardiac conduction. We experienced a case of atrioventricular junctional rhythm (AVJR) during maintenance of general anesthesia with sevoflurane. A 61-year-old woman with normal preoperative electrocardiogram was scheduled for right total knee arthroplasty and autologous iliac crest bone graft under general and epidural anesthesia. ⋯ After discontinuation of sevoflurane at the end of the operation, isorhythmic dissociation returned to sinus rhythm. Sevoflurane could induce atrioventricular conduction disturbance leading to isorhythmic dissociation of AVJR. We should be aware that hypotension can result from isorhythmic dissociation during sevoflurane anesthesia.
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Case Reports
[Total intravenous anesthesia with propofol and remifentanil for a patient with myotonic dystrophy].
A 54-year-old woman, complicated with myotonic dystrophy, underwent laparoscopic cholecystectomy for cholelithiasis. The patient was given total intravenous anesthesia using propofol, remifentanil and vecuronium, combined with epidural anesthesia using ropivacaine. ⋯ The postoperative course was uneventful. The anesthesia with remifentanil is extremely useful for patients with myotonic dystrophy.