Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of a patient with severe subcutaneous and mediastinal emphysema due to pertussis infection].
A 20-month-old girl, with respiratory failure due to severe subcutaneous and mediastinal emphysema, was scheduled to undergo percutaneous drainage of emphysema and induction of extracorporeal membrane oxygenation. Paroxysm, a symptom of the infection of Bordetella pertussis, was the cause of emphysema. In patients with severe neck subcutaneous emphysema, management of difficult airway is the most important safety issue in the practice of anesthesia. ⋯ Combined with propofol and midazolam, pethidine was an effective agent for safe anesthetic induction because it produces less respiratory depression compared to other opiate analgesics. In conclusion, this case demonstrates the importance of prediction of and preparation for difficult airway. Furthermore, anesthesiologists should consider the optimization of anesthesia to avoid progression of emphysema.
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Few studies have examined the perioperative status of dual antiplatelet therapy and postoperative thrombotic or bleeding complication rates of patients undergoing non-cardiac surgery with recent history of coronary stent implantation. ⋯ In the present study, bleeding complications requiring transfusion were frequently observed in patients with dual antiplatelet therapy undergoing non-cardiac surgery, whereas perioperative therapy discontinuation did not trigger thrombotic complications including stent thrombosis.
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Living-donor liver transplantation has become a standard and effective treatment for end stage liver disease patients. As a result of remarkable progress in immunosuppressive drugs, surgical device, anesthetics, and appropriate perioperative management, liver-transplanted patients may experience fewer complications, shorter length of ICU stay, and a better overall outcome. However, unexpected perioperative complications remain substantial. ⋯ And third, in postoperative period we should perform strict monitoring and focus on infection prophylaxis, early weaning from mechanical ventilation, appropriate administration of fluid and transfusion, maintaining renal function and preservation of graft function. Appropriate knowledge and understanding of perioperative management in liver transplantation are required to improve patient's outcome. Furthermore, it is important for performing liver transplantation to boost mutual understanding and trust in the medical team including health-care providers.
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Thoracic surgery developed remarkably in tandem with anesthetic management and post-operative intensive care since 1990. The innovations in these fields include wide spread use of one-lung ventilation, advances in clarification of pathophysiology of postoperative acute lung injury as well as its treatment, initiation of lung protective ventilation strategy, advancement of chest physiotherapy, and wide use of non-invasive ventilation in the last two decades. ⋯ Under the influence of this new lung protective ventilation strategy, perioperative managements such as setting of tidal volume changed drastically in nearly ten years. The purpose of this article is to review the innovations and the transitions in anesthetic management and post-operative intensive care in thoracic surgery, and to propose up-to-date peri-operative respiratory strategies for patients undergoing thoracic surgery, especially pneumonectomy.
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Comparative Study
[Shift of the i-gel position after chest compression: comparison of fixation methods using Durapore tape, Multipore tape, or a fixation strap].
The i-gel (Intersurgical, Wokingham, U.K.) is a newly developed, non-inflatable supraglottic device characterized by its soft, gel-like, and transparent mask made of thermoplastic elastomer. Although i-gel can be useful in emergency airway management during chest compression, the instability after insertion remains a problem. ⋯ A fixation strap may be useful in stabilizing the inserted position of i-gel during cardiopulmonary resuscitation.