Masui. The Japanese journal of anesthesiology
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Arrhythmogenic right ventricular cardiomyopathy is a genetic cardiomyopathy characterized by replacement of right ventricular myocardium by fibrofatty infiltrates, leading to significant ventricular arrhythmias with sudden death and right ventricular dysfunction. Elective operations should be postponed, until the arrhythmias and myocardial function are well tolerated. There has been no guideline on the anesthetic management of this serious, despite rare, disease and there are a few reports of the patients undergoing operation under either general or regional anesthesia. ⋯ It is essential to apply alpha-adrenergic agonists instead of beta-agonists for intraoperative hemodynamic support. The arrhythmias should be managed with beta-blockers or amiodarone. Adequate control of postoperative analgesia and nausea/vomiting is also important to suppress sympathetic activities.
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Comparative Study
[Safety of axillary and subclavian vein cannulation using real-time ultrasound guidance].
The safety of real-time ultrasound-guided subclavian and axillary vein cannulation as opposed to ultrasound-guided internal jugular vein cannulation has not received much attention. We retrospectively compared the safety and value of real-time ultrasound-guided cannulation in the subclavian and axillary veins with those of the landmark method. ⋯ Real-time ultrasound-guided subclavian and axillary vein cannulation is associated with a low incidence of complications similar to that of the internal jugular vein when competent individuals with appropriate training apply the technique.
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Case Reports
[Anchor Fast endotracheal tube securing device for a pediatric patient during therapeutic hypothermia].
A 5-year-old girl was admitted to our hospital after resuscitation from cardiac arrest due to near-drowning accident in a river. On admission, Glasgow Coma Scale score was 7; arterial blood pressure was 113/73 mm Hg; heart rate was 157 beats x min(-1), and percutaneous oxygen saturation was 99% on 10 l x min(-1) of oxygen. The patient was intubated with a 5.0 mm internal diameter endotracheal tube, and therapeutic hypothermia was started for neural protection. ⋯ Anchor Fast kept the tube position properly even though the patient was turned or moved. Seventy-two hours later, she was rewarmed and extubated as scheduled. Ten days after admission, she was discharged without any neurological deficits.
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The WHO Surgical Safety Checklist was published in 2008 as an attempt to decrease complications and death from surgery. This checklist was implemented and evaluated using questionnaires in an intermediate size general hospital. We attempted to confirm how the WHO checklist has been implemented and assessed as a medical safety system. ⋯ According to our questionnaires, after the adoption of our checklist, which amended the WHO Surgical Safety Checklist, positive evaluation increased significantly after one year, compared with evaluation immediately following implementation. At least one year was required for the checklist to be favorably received by anesthesiologists, surgeons and operating room nurses. We anticipate that the WHO Surgical Safety Checklist, amended to meet the circumstances of individual facilities, will be effectively implemented and firmly established.
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It has been reported that multiple puncture more than or equal to 3 times is a factor associated with the development of CVC-related complications. The present retrospective study was undertaken to evaluate the predictors and risks of multiple puncture during the insertion of CVC. ⋯ The results of the study indicate that the age less than 6 years is a significant predictor for multiple puncture during the CVC insertion.