Masui. The Japanese journal of anesthesiology
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Although magnesium can potentially shorten onset time of a muscle relaxant, it is unclear whether it does shorten the onset time of rocuronium for patients in cesarean delivery (CD). Thus the purpose of this study is to compare the onset time of rocuronium in patients with or without preoperative magnesium treatment. ⋯ Magnesium did not shorten the onset time of rocuronium 0.6 mg x kg(-1) in CD patients.
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Case Reports
[Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster].
A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. ⋯ Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess.
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Various kinds of evidence-based checklists and guidelines aimed at patient safety in the perioperative period are becoming popular in the clinical setting. These include WHO guidelines on surgical patient safety, surgical-crisis checklists, checklist for preventing major complications associated with cesarean delivery, NICE guidelines for surgical site infection, guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis, appropriateness criteria for stress echocardiography and so on. ⋯ When we use the guidelines and checklists correctly, we could see what is happening in a patient and what to do next for the patient leading us to correct diagnosis and appropriate treatment. Thus, evidence-based practice will be established in the near future in the perioperative period.
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As a population ages, an increase in the number of patients with cardiac complications who undergo non-cardiac surgeries is observed. The perioperative mortality for noncardiac surgery is approximately 1-5%; approximately 20-35% of these cases are due to cardiovascular complications. Among them, perioperative myocardiac infarction/ischemia is a factor that leads to poor prognosis, and the ACC/AHA guidelines emphasize this aspect. An important task of the anesthesiologist is to accurately assess risks in patients undergoing noncardiac surgeries and avoid adverse cardiovascular events.
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The World Health Organization (WHO) launched the Safe Surgery Saves Lives campaign in 2007 to improve safety of surgical care in the world. As a part of the campaign, the first edition of the Surgical Safety Checklist was created through an international consultative process in 2008 and the second edition was published in the WHO Guidelines for Safe Surgery 2009. ⋯ In this article we gave an outline of WHO Surgical Safety Checklist and WHO Guidelines for Safe Surgery 2009, and reviewed the evidence of the guidelines and checklist. Finally we presented the evidence indicating the efficacy of the WHO Surgical Safety Checklist, which included the pilot study attached in the guidelines showing that its use markedly decreased complications in patients undergoing noncardiac surgery in eight diverse international hospitals.