Masui. The Japanese journal of anesthesiology
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In order to evaluate cerebral oxygenation and perfusion during deep hypothermic circulatory arrest (DHCA) and selective cerebral perfusion (SCP), continuous measurement of regional cerebral oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) was performed. Two patients undergoing aortic arch surgery performed under DHCA and SCP were studied. 1) Circulatory arrest produced a continuous decrease in rSO2. Introduction of SCP increased rSO2 to even above the pre-circulatory arrest level (reperfusion hyperoxia). 2) During SCP, changes in rSO2 correlated well with the naso-pharyngeal temperature, SCP flow rate, and level of carbon-dioxide insufflation to SCP. 3) These changes in rSO2 paralleled with those of jugular venous hemoglobin saturation (SjO2) measured simultaneously, although SjO2 frequently exhibited artifacts. We conclude that rSO2 measurement may be a non-invasive and continuous measure in the evaluation of cerebral oxygenation and perfusion during DHCA and SCP.
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During perioperative period, plasminogen abnormality can result in unusual or unexplained clotting that occurs spontaneously or after minor trauma. However, there has been no report on perioperative anticoagulation therapy and monitoring in patients with hereditary plasminogen abnormality undergoing cardiac surgery. We performed a successful perioperative anticoagulation therapy and monitoring of a patient with hereditary plasminogen abnormality undergoing cardiac surgery. ⋯ When the patient was admitted to ICU, anticoagulation therapy was started immediately. During perioperative period, no episode suggesting thrombosis was observed. In conclusion, we consider that this successful anticoagulation therapy and monitoring during CPB has been achieved by use of Hepcon/HMS.
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[Analysis of postoperative shivering following the deliberate mild hypothermia during neurosurgery].
We induced deliberate mild hypothermia in 96 patients who underwent intracranial operations using a water blanket and a convective device blanket. The lowest temperature measured at the tympanic membrane during mild hypothermia was adjusted to 34.5 degrees C. The patients were divided into two groups in respect to the occurrence of postoperative shivering, and the relationship between the perioperative parameters and the occurrence of postoperative shivering was evaluated. ⋯ Urinary output was significantly larger in SV than in NSV. Tympanic membrane, nasopharyngeal, and rectal temperatures at the end of surgery and nasopharyngeal, rectal, and peripheral temperatures just after the extubation were significantly lower in SV than in NSV. These results suggest that sufficient rewarming of both the core and peripheral temperatures is important to prevent the postoperative shivering following the mild hypothermic therapy in neurosurgical patients, especially in young patients.
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We previously reported that ketamine analgesia in acute pain was produced by the activation of the monoaminergic descending inhibitory system. Recent studies have confirmed that the NMDA receptor antagonists attenuate the hyperalgesia in neuropathic pain. In this study, we investigated the suppressive effects of a clinically available NMDA antagonist, ketamine, and the mechanisms of its effects on neuropathic pain in rats with peripheral mononeuropathy. ⋯ The CCI rats showed increased NE and 5HT concentrations on both ligated and unligated sides of spinal dorsal horn, compared with shamoperated rats. IP ketamine (50 mg.kg-1) in the CCI rats did not boost the spinal NE or 5HT levels. These results indicate that the anti-hyperalgesic effect of ketamine is derived from a direct action on the spinal cord, but not from the activation of monoaminergic descending inhibitory systems.
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An emergency call system has been used to summon specialists for cardiopulmonary resuscitation in Kumamoto University Hospital since 1986. Many improvements have been made to the system since it was established. We performed a prospective evaluation of calls made during the period from April 1, 1996 to March 31, 1997. ⋯ Some of the phone numbers in this system are similar to the emergency call number. Thus many of the emergency calls were probably caused by administrative officers who misdialed. We are proposing to change this emergency call number.