Masui. The Japanese journal of anesthesiology
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Case Reports
[A successful weaning from mechanical ventilation by diaphragmatic plication for unilateral diaphragmatic paralysis].
A patient with unilateral diaphragmatic paralysis (UDP) after cardiac surgery, commonly extubated without any troubles, encounters a serious fetal respiratory complication in a rare case. We had a case of a 68-year-old man under long term mechanical ventilation (MV) because of UDP and phrenic nerve injuries after the replacement of the ascending aorta. After this operation he suffered from mediastinal infection and needed MV for a few days. ⋯ The patient was successfully weaned from MV on the 4th postoperative day of the right DP. Pulmonary function test was improved dramatically. In a case of long term MV due to UDP, DP can be one of effective treatments.
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We experienced anesthetic management for a patient with platypnea-orthodeoxia syndrome. This syndrome is relatively uncommon and accompanies dyspnea and hypoxemia on changing to a sitting or standing from recumbent position. A 75-year-old man with the syndrome underwent atrial septal defect closure on cardiopulmonary bypass. ⋯ The perioperative and postoperative course was uneventful, except for hypoxemia during induction. Although the exact mechanisms of platypneaorthodeoxia remains to be solved, right-to-left shunt by an anatomical abnormality and by change of the atrial septum is considered one of the hypoxic mechanisms. We suggest that it is necessary to prevent right-to-left shunt and hypoxemia in anesthetic management of a patient with platypneaorthodeoxia syndrome.
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A 41-year-old woman with single atrium and single ventricle at 6 weeks of gestation was scheduled for dilation and evacuation of the fetus. The PaO2 was 39 mmHg, while she was breathing room air. Dilatation of the uterine cervical canal was performed under spinal anesthesia using 2.0 ml of 0.5% hyperbaric bupivacaine one day before dilatation and evacuation of the fetus. ⋯ However, intravenous fentanyl was needed during the procedure. There was no cardiovascular or respiratory complication after anesthesia and surgery. The patient was discharged on the next day.
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Review Case Reports
[Intraoperative coronary spasm in patients without a history of anginal chest pain].
We report three cases of intraoperative coronary spasm that developed during non-cardiac surgical procedures. None of the patients had a history of anginal chest pain. The presumed contributing factors were: 1) suction of the trachea during general anesthesia, 2) hyperventilation and hypotension during induction of general anesthesia, and 3) hyperventilation during neuroanesthesia. ⋯ Some of common intraoperative conditions such as hyperventilation, hypotension, and inadequate depth of anesthesia, were reported to be potent precipitating factors for coronary spasm. In recent years, a larger proportion of surgical patients have coronary risk factors. Careful anesthetic management is required to prevent intraoperative coronary spasm even in patients without a history of coronary artery disease.
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Randomized Controlled Trial Clinical Trial
[The effects of patient-controlled epidural analgesia with background infusion after abdominal surgery].
Although patient-controlled epidural analgesia (PCEA) is widely known to provide good pain control after abdominal surgery, it has not been popular in Japan. We evaluated the effects of PCEA with background infusion after major abdominal surgery. ⋯ PCEA with background infusion could improve the management of postoperative pain, and adequate program of PCEA is important to reduce postoperative pain and its side effects.