Masui. The Japanese journal of anesthesiology
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In cesarean deliveries, it is important to prevent deep vein thrombosis in the lower limbs as this can result in pulmonary embolisms. Taking post-operative analgesia into account it is preferable to use an anesthesia method that allows early ambulation of patients. It is therefore necessary to use epidural anesthesia as a sole anesthesia method for cesarean deliveries. ⋯ Our findings showed that it is possible to utilize only epidural anesthesia for cesarean deliveries. Using lumbar epidural anesthesia with L1-2 puncture reduced a postoperative time to ambulation to less than 3 hours 10 minutes.
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Number of surgeries for the elderly is increasing year by year. Postoperative cognitive dysfunction, POCD, and delirium are typical failure's of higher brain function after surgery. The mechanism of POCD and delirium has been suggested to be associated with inflammation, but its details are unknown. ⋯ On the other hand, the another suspect, that propofol is safe. However, it should be recognized that these results became clear by basic research. Further clinical study is required.
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Postoperative cognitive impairment is a recognized clinical phenomenon. Previously, such clinical findings were called "adverse cerebral effects of anesthesia on old people". POCD is transient disturbance that can affect patients of any age but is more common in elderly people. ⋯ For the diagnosis of POCD, pscychometric tests are applied. Risk factors for POCD are aging, extensive invasive operations, intra and postoperative complications, and anesthetics. To reduce POCD, it is necessary to provide preoperative screening and cognitive training, minimally invasive surgery, the use of short-acting agents, meticulous anesthetic technique to prevent perioperative disturbances of homeostasis and organ ischemia, tight volume balance, and EEG monitoring.
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Postoperative cognitive dysfunction (POCD) is seen not only after cardiac surgery but also after non-cardiac surgery. POCD leads to decreased quality of life and increased mortality. ⋯ POCD is highly associated with age or inflammation in the central nerve system. Anti-inflammatory strategies including dexmedetomidine, statin or minocycline in the perioperative period may reduce incidence of POCD.
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Vallecular cysts frequently cause difficult intubation due to poor glottic visualization during direct laryngoscopy. The appropriate way of airway management and predictive factors of difficult intubation are unknown. ⋯ Because children with vallecular cysts have a risk of difficult airway, we need to prepare for difficult airway management. The cyst-diameter to patient-height ratio could be useful as a predictor of difficult intubation.