Masui. The Japanese journal of anesthesiology
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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.
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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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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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A 63-year-old man with von Recklinghausen disease was transported to the emergency department for swelling and pain of his right neck. Chest X-ray and computed tomography scan showed displacement of the trachea to the left by a tumor mass. Urgent airway management was required and fiberoptic intubation in awake condition was planned. ⋯ Suddenly, his consciousness level and Sp(O2) went down, therefore surgical airway was required. Due to pre-scanning, emergency cricothyroid membrane puncture could be performed immediately without any complications. We recommend ultrasound pre-scanning for cricothyroid membrane puncture in a patient with suspected tracheal displacement.
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Case Reports
[Anesthetic management of a morbidly obese patient undergoing laparoscopic right nephrectomy].
A 41-year-old man weighing 196 kg (body mass index of 62.5 kg m2) with renal cancer was scheduled for laparoscopic right nephrectomy. On the day before surgery, we confirmed the intraoperative patient position with the patient and medical staff to prevent neurological deficit during the intraoperative period. For postoperative analgesia and prevention of respiratory complications, an epidural catheter was inserted under radiography and ultrasound guidance. ⋯ During neumoperitoneum at 12 mmHg, mechanical ventilation was achieved without hypercapnia, hypoxia or elevated airway pressure, with rate of 12 min-1, FIO2 of 0.6, PIP of 25 cmH2O and PEEP of 8 cmH2O. The surgery was completed and his trachea was extubated in the operating room. He did not develop any perioperative complications and was discharged on the 10th day after the surgery.