Masui. The Japanese journal of anesthesiology
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A 14-yr-old boy with hypertrophic obstructive cardiomyopathy, undergoing percutaneous transluminal septal myocardial ablation suffered dissection of the left main coronary artery during the procedure. Sixty minutes after absolute ethanol administration, he was transferred to the operating room for emergency coronary artery bypass grafting, mitral valve replacement and cardiomyectomy. Transesophageal echocardiography (TEE) findings after the induction of anesthesia were: general hypokinesis, mitral regurgitation 1+, left ventricular outflow tract pressure gradient of 11 mmHg and no blood flow in the left anterior descending coronary artery. ⋯ Systolic BP was maintained 90-120 mmHg with norepinephrine (0.2-0.3 micrograms x kg(-1) x min(-1)) and the patient could be successfully weaned from CPB with cardiac index 2.0 and mixed venous oxygen saturation 59%. On the 2nd postoperative day (POD), he was weaned from IABP and ventilator. On the 6 th POD, he was discharged from the ICU.
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We evaluated the effect of landiolol, a novel ultra-short-acting receptor-selective blocker, on bispectral index scale (BIS). ⋯ This study suggests that landiolol does not affect BIS in OPCAB surgery patients under fast-track cardiac anesthesia.
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Many complications after spinal anesthesia have been reported, but diplopia is rare. We had four cases of diplopia in 794 cases of spinal anesthesia in three years at Nara Medical University Hospital. These 4 cases were not characterized by any major factors including gender, age, or anesthetic choice. ⋯ Lack of concern regarding the possibility of post-spinal diplopia among medical staffs might be common because this incidence is really rare. However, we need to know the possibility of this neurological sequel after spinal anesthesia. We would like to propose that the informed consent regarding spinal anesthesia should include the possibility of this complication and anesthesiologists should perform intensive neurological examinations after spinal anesthesia concerning post-spinal diplopia.
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We describe successful anesthetic management of three morbidly obese patients, using inhalation induction with high concentrations of sevoflurane. In morbidly obese patients, reduced airway space of the pharynx can cause upper airway obstruction after the induction of general anesthesia and may explain difficult mask ventilation. ⋯ In inhalation induction with sevoflurane, the incidence of transient apnea is lower and the control over depth of anesthesia is easier as compared with intravenous induction. Therefore, sevoflurane may be an excellent induction agent in morbidly obese patients with a potentially difficult airway.
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Pulmonary thromboembolism (PTE) is increasingly recognized as a significant perioperative complication in Japan. A recent study reported that the incidence was 0.32 patients per 10,000 people per year in Japan. The aim of this investigation is to elucidate the incidence and characteristics of perioperative pulmonary thromboembolism in Japan. ⋯ The incidence of perioperative PTE is not low in Japan and is 13 times higher than the rate observed in the general population. The use of thromboprophylaxis should be considered in patients with risk factors.