Masui. The Japanese journal of anesthesiology
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A 79-year-old man underwent aortic arch replacement for thoracic aortic aneurysm. He had a history of smoking, coronary stenting for ischemic heart disease and replacement with artificial blood vessel for abdominal aortic aneurysm. Anesthesia was induced and maintained with midazolam, fentanyl, sevoflurane, and vecuronium. ⋯ However, as he developed compartment syndrome on the left lower limb due to reperfusion injury postoperatively, fascitomy was performed. On the 58th postoperative day, he was discharged from our hospital. Measurement by Doppler is useful for the early diagnosis of the lower leg arterial occlusion.
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Objective structured clinical examination: OSCE is now widely used in educational scene in medical schools before medical students start their clinical training. However, the utility of OSCE on BLS education has not been confirmed yet. The effect of OSCE on BLS education was examined using questionnaires. ⋯ OSCE improved medical students' knowledge of BLS, but did not contribute to prevent forgetting for a long time. Thus, reeducation in BLS is still necessary for students after passing OSCE.
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Comparative Study
[Fentanyl shows different effects by administration routes on bispectral index during spinal anesthesia in patients undergoing cesarean section].
Spinal anesthesia using a local anesthetic with fentanyl has been reported to induce sedation. We previously reported that the bispectral index (BIS) value was significantly decreased by spinal anesthesia using only bupivacaine and fetanyl after cesarean delivery. In the present study, we studied the effect of different fentanyl administration routes on BIS values during spinal anesthesia for cesarean section. ⋯ The BIS value was significantly decreased only by intrathecal fentanyl for cesarean section.
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Comparative Study
[Evaluation of the sedation level with propofol with electroencephalographic Entropy in comparison with bispectral index monitor].
Entropy, a newly available electroencephalographic monitor, demonstrates two parameters, response entropy (RE) and state entropy (SE). The aim of this study is to compare RE and SE with bispectral index (BIS) during anesthetic induction with propofol. ⋯ Response entropy and SE can provide similar information as BIS about the sedation level with propofol.
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We experienced anesthetic management using dexmedetomidine for awake coronary artery bypass grafting (ACAB) in a patient with cerebrovascular and lung diseases. Epidural anesthesia was performed using only local anesthetics, and narcotics were not administered for epidural anesthesia or general anesthesia. The patient complained of discomfort when the surgical maneuver reached the superior extremity of the sternum and when pneumothorax occurred. ⋯ Hemodynamics was stable in the intraoperative period, although the plasma concentration of dexmedetomidine calculated by pharmacokinetic simulation analysis, exceeded 1.6 ng x ml(-1). Aggravation of cerebrovascular or lung disease did not occur in the perioperative period. Dexmedetomidine may be useful for ACAB.