Masui. The Japanese journal of anesthesiology
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Hypothermia occurs due to body heat redistribution between core and peripheral tissues as well as imbalance between heat loss and production. Perioperative hypothermia not only induces offensive shivering and prolongation of anesthetic recovery but also increases blood loss and incidence of surgical wound infection, increasing postoperative morbidity. ⋯ Anesthesiologists should have knowledge of the characteristics of the various kinds of fluid warmer currently available and use them appropriately according to surgical procedures and the patient's position. It was reported recently that administration of amino acid can prevent intraoperative hypothermia, possibly by increasing the heat production in the body.
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Cardiovascular events are one of the most critical perioperative complications. The purpose of this study is to investigate the clinical characteristics, effective treatments, and clinical outcome of intraoperative coronary spasm through a review of the published literature. ⋯ Intraoperative coronary spasm may develop in patients with no history of chest pain. Some of the intraoperative conditions themselves are potent vasoconstricting factors. Once coronary spasm occurs, immediate administration of a full dose of coronary dilators is recommended.
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Case Reports
[Transient increase of bispectral index in a patient with bronchoconstriction after endotracheal intubation].
A 62-year-old woman (148 cm, 48.5 kg) with a history of bronchial asthma underwent an emergency appendectomy. Ten days before the operation she developed symptoms of wheezing while under asthma medication. An endotracheal tube (7 mm) was inserted after the induction of general anesthesia with intravenous injection of fentanyl 100 micrograms, propofol 100 mg and vecuronium 10 mg under Sellick's maneuver. ⋯ Upon completion of the operation, the endotracheal tube was removed without any events. The patient gave no sign of awareness during the operation. When severe bronchoconstriction prevents the absorption of anesthetics from the lung alveoli, additional intravenous anesthetics should be administered to maintain stable amnesia.
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Case Reports
[Anesthetic management of a patient with olivopontocerebellar atrophy using heart rate variability (HRV)].
A 65-year-old woman with olivopontocerebellar atrophy (OPCA), manifested with cerebellar ataxia mainly, with coexisting impairment of the autonomic nervous system function, and extrapyramidal symptoms, was scheduled for cholecystectomy. With no premedication, anesthesia was induced with sevoflurane and maintained with 1-1.5% of sevoflurane and 66% of nitrous oxide mixed with oxygen. Heart rate variability (HRV) calculated from ECG was used for a monitor of the autonomic nervous system activity. ⋯ We considered that the patient might have postganglionic sympathetic nerve hypersensitivity against inotropic agents. When her blood pressure decreased temporarily after the induction of anesthesia, a bolus dose of ephedrine 1 mg wa given intravenously, which stimulated the sympathetic nervous system indirectly, and could increase her blood pressure. Hypotension during anesthesia in a patient with OPCA with severe autonomic nervous failure was successfully treated by a minimal dose of ephedrine.
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The effect of inhalation induction with sevoflurane on left ventricular(LV) function has not been evaluated in adults. We assessed the effect of inhalation induction with sevoflurane on left ventricular systolic and diastolic function in adult patients using transthoracic echocardiography. ⋯ During inhalation induction with sevoflurane in adult patients, sevoflurane caused negative inotropic effects, but preserved LV diastolic function.