Masui. The Japanese journal of anesthesiology
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A 34-year-old obese, small-jawed and short-necked woman, had severe obstructive sleep apnea syndrome (OSAS) with bronchial asthma. A surgical removal of a lingual tumor using a laser knife was scheduled under general anesthesia with sevoflurane. A small diameter tracheal tube for laser surgery (internal diameter (ID) of 5.5 mm) was used. ⋯ After confirming that the two tubes were inserted securely, the tube for laser surgery was withdrawn. The patient's ventilation improved significantly afterwards and the extubation was performed successfully. Our method for replacing a tracheal tube seemed to be effective and safe.
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We have previously showed that surgical volume affects mortality due to intraoperative critical incidents among patients undergoing cardiac surgery, the surgery with the highest risk, using data obtained by the annual survey in 2001 conducted by the Japanese Society of Anesthesiologists (JSA). In this study, we investigated whether surgical volume affects mortality due to intraoperative critical incidents independent of the surgical site. ⋯ Surgical volume was shown to affect mortality independent of the surgical site. Hospitals with low surgical volume should pay significant attention to improving surgical outcomes. These results also suggest that centralization or regionalization should be discussed from the perspective of socio-economical problems as well as patient safety.
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A 54-year-old female patient was scheduled for retroperitoneoscopic nephrectomy. Anesthesia was induced with propofol and maintained with nitrous oxide/sevoflurane and epidural anesthesia. One hour after the start of the surgery, arterial oxygen saturation suddenly decreased from 99% to 94%. ⋯ The patient was extubated following thoracocentesis that had improved her pneumothorax and oxygenation. There is no report of pneumothorax in retroperitoneoscopic nephrectomy, as far as we know, although several cases have been reported in laparoscopic nephrectomy. We must be careful of pneumothorax in both laparoscopic and retroperitoneoscopic nephrectomy.
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Case Reports
[Anesthetic management with propofol during pheochromocytoma resection under bispectral index monitoring].
In three patients undergoing pheochromocytoma resection under propofol/fentanyl anesthesia, bispectral index (BIS) was monitored for assessment of hypnotic effect. In two patients, arterial blood concentrations of propofol were measured by high performance liquid chromatography (HPLC), and compared with those of the estimated blood concentrations. Until resection of the tumor, propofol was infused at a rate of 10 mg x kg(-1) x hr(-1). ⋯ In a patient with rapid infusion of fluid, the arterial blood concentration was lower than the estimated blood concentration (2.59 vs 3.58 microg x ml(-1)). The anesthetic depth can not be estimated accurately by hemodynamic changes in the patients undergoing pheochromocytoma resection. BIS monitoring should be recommended for adjustment of propofol dosage after pheochromocytoma resection.
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We evaluated retrospectively the effectiveness of low dose colforsin daropate hydrochloride (CDH) in 12 patients undergoing off-pump coronary artery bypass grafting (CABG). ⋯ Infusion of low dose CDH prevents the elevations of mean pulmonary artery pressure, right atrial pressure and pulmonary artery wedge pressure without reducing systolic bood pressure during coronary artery anastomosis. Cardiac output was significantly increased, and SVR as well as PVR were significantly decreased after the infusion of CDH. In patients undergoing off-pump CABG, we recommend infusion of low dose colforsin daropate hydrochloride from sternotomy to the end of coronary artery anastomosis.