Masui. The Japanese journal of anesthesiology
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Sivelestat sodium hydrate (ELASPOL) was effective for ARDS in a fifty-year-old female patient suffering from chronic rheumatoid arthritis with acute exacerbation, after failing to respond to high dose steroid pulse therapy. In ICU, the patient had bilateral lung opacities, especially of the upper lobes, respiratory acidosis, hypercapnea (PaCO2 89 mmHg), and poor oxygenation (P/F ratio 193). High dose steroid pulse therapy had been performed, but oxygenation was not improved, and a low level of oxygenation (P/F ratio 155) persisted. ⋯ Respiratory support was terminated with P/F ratio 300. Plasma concentrations of SP-A and SP-D decreased after sivelestat administration, but concentration of KL-6 was still elevated. In this case, sivelestat was effective for ARDS in the patient not responding to steroid pulse therapy, and clinical finding and plasma concentrations of SP-A and SP-D were correlated well.
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Case Reports
[Case of circulatory depression in an obese patient in prone position during general anesthesia].
A 25-year-old man [120 kg, 180 cm (body mass index=37 kg x m(-2)] underwent laminectomy and discectomy under general anesthesia in the prone position. Hall frame was used for supporting his body. In spite of a small amount of bleeding, the patient showed metabolic acidosis and hypotension with limb cyanosis one hour after changing position. ⋯ We consider that Hall frame allows patient's abdomen to hang freely, but compresses the body more strongly than expected, especially with heavy patients. It is possible for morbidly obese patients to develop seriously inhibited circulation due to Hall frame. Prone position with careful selection of support system may prevent these complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of the effects of colloid and crystalloid solution for volume preloading on maternal hemodynamics and neonatal outcome in spinal anesthesia for cesarean section].
The role of crystalloid or colloid preloading to prevent hypotension associated with spinal anesthesia in parturients during cesarean section has recently been questioned. The aim of the current study was to investigate the effects of volume preload with either crystalloid or colloid, or with no preload on changes of maternal hemodynamics and neonatal outcomes. ⋯ In healthy patients with full-term pregnancy, volume preloading has little effect on maternal hemodynamics and neonatal outcomes, suggesting that stable perioperative management is possible with or without volume preload before spinal anesthesia. However, preloading may be needed for prevention of hypotension in emergency cases.
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Case Reports
[Anesthetic management for removal of a giant ovarian tumor by monitoring transesophageal Doppler cardiac output].
Transesophageal Doppler cardiac output was monitored in two cases for removal of a giant ovarian tumor. In case 1, cardiac output (CO) increased following the drainage of the tumor, and CO decreased following blood loss. ⋯ Cardiovascular parameters changed remarkably with the drainage of tumors and blood loss. Therefore, noninvasive Doppler cardiac output monitor was useful for rapid estimation of cardiovascular changes.
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A recent modification of the Norwood procedure involves the use of a right ventricle-to-pulmonary artery (RV-PA) shunt to provide pulmonary blood flow for patients with hypoplastic left heart syndrome (HLHS). We investigated the hemodynamics after first-stage palliation of HLHS with RV-PA shunt compared with classic Norwood procedure with subclavian-to-pulmonary artery (BT) shunt. ⋯ These results show that the RV-PA shunt provides a stable systemic circulation and abundant tissue oxygen supply. Excellent hemodynamics provided by RV-PA shunt is beneficial for infants undergoing stage I palliation for HLHS.