Masui. The Japanese journal of anesthesiology
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We report a 38-year-old man with Kugelberg-Welander disease who underwent triple arthrodesis for talipes equinovarus under combined spinal-epidural anesthesia supplemented with continuous intravenous infusion of propofol. There was no ventilatory disturbance, muscle weakness, or neurologic untoward event during perioperative period.
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This special issue focuses on recent advances in understanding pathogenesis and altered physiology of sepsis on cellular and molecular basis. It is recognized that remarkable advances have been made in understanding the basic cellular and molecular mechanisms of multiple organ dysfunction associated with sepsis. ⋯ Although a lot of clinical trials have been conducted, a small number of treatment or management protocols have been proven to be effective in severe sepsis. Although critical questions remain unanswered, these new insights into sepsis-associated mechanisms are likely to lead to effective treatment approaches that ultimately improve clinical outcome.
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We report a case of anaphylactic shock caused by repeated use of aprotinin. Following re-administration of aprotinin at the beginning of repeated mitral valve replacement, the patient fell into shock state probably induced by anaphylactic reactions. Immediately, bispectral index (BIS) decreased from 40 to 5, and near-infrared spectroscopy showed regional tissue oxygen saturation (rSO2) of frontal head decreasing from 64/56% (left/right) to 26/36%. ⋯ After the immediate initiation of cardiopulmonary bypass, the perfusion pressure increased to 40 mmHg, and BIS and frontal rSO2 recovered to 45 and 70/61%, respectively. The patient had no significant neurological sequela after the surgery. We conclude that parallel changes of BIS and frontal rSO2 reflect acute global cerebral ischemia, and these parameters may be useful for decision making in the treatment of shock patients.
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Although postoperative femoral neuropathy is an uncommon complication occurring after pelvic surgery, we experienced several cases of femoral nerve palsy in patients after radical prostatectomy. All cases had neither previous vascular nor peripheral nerve disease. To investigate the possible etiology, we compared the difference in age, height, body weight, body mass index (BMI), duration of surgery, and volume of bleeding in patients with or without femoral nerve palsy. ⋯ After these strategies, we found that the frequency of femoral nerve palsy had considerably decreased. Patients received physical therapy and showed nearly total neurological recovery. We report here unusual complication following major pelvic surgery, and discuss the possible etiology and some strategies for prevention of this injury.
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The incidence of a tracheal bronchus supplying the right upper lobe has been reported to be in the range of 0.1 to 3%. We encountered 3 cases with the anomaly among 200 cases of lung surgery conducted over a year at our hospital. ⋯ Patients with a tracheal bronchus may be difficult or impossible to ventilate, especially when requiring unilateral lung ventilation. Therefore, the airway must be assessed carefully by fiberoptic bronchoscopy prior to unilateral lung surgery, keeping in mind the possibility of a tracheal bronchus, in order to design a safe way to secure it safely during the surgery.