Masui. The Japanese journal of anesthesiology
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A 45 year old woman undergoing a removal of cerebral arterio-venous malformation, suffered an unexpected massive bleeding. With transfusion of plasma constituents, her hemoglobin concentration decreased to about 5 g.dl-1, but her hemodynamic parameters remained unchanged. ⋯ With rapid transfusion of concentrated red cell and whole blood, hemodynamic parameters as well as ECG change were restored to normal. With hemodilutional myocardial ischemia which is caused by acute massive bleeding, hemoglobin concentration of about 2 g.dl-1 would be critical.
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For two cases of cardiac tamponade following cardiac surgery, the approaches for pericardial drainage were determined by the transesophageal echocardiography under general anesthesia. In most cases of cardiac tamponade after cardiac surgery the pericardial effusion is regional and localized due to adhesions of pericardium. Therefore subxiphoid incision approach of pericardial drainage cannot often be accomplished. In these cases transesophageal echocardiography can image the presence, location and size of the pericardial effusion and is an available method to determine the approach of pericardial drainage.
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We anesthetized a patient who received an emergency internal carotid artery ligation. Regional cerebral oxygen saturation (rSO2) was measured with near infrared spectroscopy (NIRS) during the whole anesthetic course. The sensor was placed on the left forehead of the patient. ⋯ However, cerebral infarction in the middle cerebral artery region, the onset of which remained unclear, was revealed postoperatively, regardless of a stable rSO2 during the operation. This monitor may provide useful information regarding the cerebral circulation during the operation in such a case as the present one, but this monitor reflects only the oxygenation of the region on which the sensor was placed. Thus, we should keep in mind the limitation in detecting cerebral dysfunction using NIRS.
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Randomized Controlled Trial Clinical Trial
[Possibility of rice porridge for preoperative feeding in children].
To determine the effect of rice porridge feeding before elective surgery on preoperative gastric fluid pH, volume and starvation, a prospective study was undertaken in pediatric patients. Twenty healthy children ranged in age from 5 to 12 years were allocated randomly to either a fasted or rice porridge group. The children of fasted group (control group) were allowed to take solid food until midnight before the operation. ⋯ There were no significant differences between the two groups concerning the gastric fluid volume and pH. The patient of the study group complained of less hunger. Preoperative rice porridge feeding is a possible preoperative feeding for pediatric patients.
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Randomized Controlled Trial Clinical Trial
[Skillfulness is essential to improve venipuncture pain in combination with lidocaine containing adhesive tape].
We evaluated the effect of lidocaine containing adhesive tape (LT) on the venipuncture pain by using visual analogue scale (VAS). Patients were assigned prospectively to a control (65 cases) group and a LT (80 cases) group weekly. LT was applied 30 min before the scheduled entry into the operating room. ⋯ Smooth venipuncture was performed in 91% of those in expert group. However only 71% of venipuncture was done smoothly in the novice group. We conclude that skillful venipuncture in combination with LT is essential to reduce the venipuncture pain.