Masui. The Japanese journal of anesthesiology
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We experienced acute myocardial infarction due to coronary artery spasm after caesarean section. A 41-year-old multigravida woman with no previous cardiac history or coronary risk factor developed acute myocardial infarction after caesarean section, and was successfully resuscitated with emergency percutaneous transluminal coronary angioplasty. Acute myocardial infarction during pregnancy and postpartum period is a rare event, but could be associated with high mortality if it occurs. It is necessary to consider the possibility of acute myocardial infarction and provide early diagnosis and treatment by multidisciplinary team when a pregnant woman complains of retrosternal chest pain.
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Case Reports
[Anesthetic management of combined lung volume reduction surgery and off-pump coronary artery bypass grafting].
A 54-year-old man with severe emphysema and stenosis of coronary artery was scheduled for combined surgery of lung volume reduction and an off-pump coronary artery bypass grafting. His FEV1.0 was 600 ml and %FEV1.0 was 18%. Coronary angiography showed 99% stenosis of the left anterior descending artery. ⋯ A laryngeal mask airway was replaced with an endotracheal tube after surgery to avoid bucking during extubation, and this was removed after recovery from anesthesia successfully. No complications were observed during anesthesia. Lung volume reduction surgery after coronary reconstruction by off-pump coronary artery bypass grafting may be beneficial for patients with emphysema and ischemic heart disease.
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A 45-year-old woman underwent radical neck clipping for cerebral aneurysm under isoflurane anesthesia. Her preoperative examination revealed elevated body temperature which had been normal on admission. Her body temperature increased up to 40.3 degrees C during anesthesia and surgery, and it showed a downward trend at the end of surgery. ⋯ According to the diagnostic criteria for malignant hyperthermia by Larach and his colleague, malignant hyperthermia was somewhat less than likely in our case. The clinical course of the patient also suggested that a possibility of malignant hyperthermia was considerably low. The authors conclude that perioperative hyperthermia in our case must have derived from central hyperthermia following subarachnoid hemorrhage, and that postoperative increases in serum CK and Mb levels might have resulted from acceleration of sympathetic nervous system by subarachnoid hemorrhage.
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Case Reports
[Difficult airway management during emergency tracheostomy in a patient with severe rheumatoid arthritis].
We experienced difficult airway management in a 65-year-old woman with acute dyspnea due to bilateral recurrent nerve palsy suffering from severe rheumatoid arthritis for fifty years. Her cervical spine was ankylosed and could not be extended at all. Tracheostomy was planned under local anesthesia because of difficulty of endotracheal intubation, possibility of airway obstruction and laryngeal edema. ⋯ A rigid tracheal tube could not be inserted through the tracheal incision and SpO2 decreased to 81%. We inserted a percutaneous cricothyroidotomy cannula through the tracheal incision and superimposed HFJV on her spontaneous ventilation. Assisting the ventilation in this way finally, a spiral endtracheal tube was inserted and her oxygenation became stable.
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In scheduled surgery, drinking is generally restricted for 6-8 hours before operation to avoid aspiration pneumonia induced by aspiration of residual gastric contents. However, the restriction is hard for patients and also there is no evidence of reduction of such a risk. We examined the correlation between water intake and residual gastric content. ⋯ Intake of clear water until two hours before surgery has been shown to be safe and contribute to patients' satisfaction.