Masui. The Japanese journal of anesthesiology
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We experienced a case of 82-years-old-man who developed anaphylactic shock immediately after admin- istration of sugammadex. He was scheduled for ventral hernia surgery. Anesthesia was induced by propofol, rocuronium and remifentanil, and maintained with des- flurane, remifentanil and intermittent rocuronium. ⋯ His respiratory state was stable and he was extubated. After administration of methylpredniso- lone, he was transferred to the surgical ward and showed no troubles thereafter. Anaphylaxis caused by sugammadex is a rare event However, considering the high frequency of sugamma- dex use in Japan, we should always keep the possibil- ity of anaphylactic shock caused by sugammadex in mind during daily general anesthetic management.
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Antidepressants are used for treatment of not only major depression but also for treatment of neuropathic pain. In guidelines for pharmacological treatment of neuropathic pain, tricyclic antidepressants and sero- tonin noradrenaline reuptake inhibitors are listed as the first line choice and second line choice, respectively. However, antidepressants act on several kinds of neu- ronal receptors, resulting in various adverse effects. In this article, we review common adverse effects of anti- depressant drugs and the prevention and treatments of these adverse effects.
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We reviewed the anesthesiology training in the United States from the viewpoint of Japanese Anes- thesiologists. The Accreditation Council for Graduate Medical Education (ACGME) strictly supervises anes- thesiology residency programs in the U. S. ⋯ Continuing medical education should be mandatory for each re- newal with recertification examination. Second, the number of residents and the quality of each program should be strictly supervised by a third party. Lastly, we should encourage residents to seek subspecialty training and more research experience to become bet- ter anesthesiologists.
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A 60-year-old male patient with left hilar lung cancer was scheduled to undergo left pneumonectomy or left sleeve lower lobectomy. Preoperative computer tomographic and bronchoscopic examinations revealed that the bronchus (B1) to the right apical segment (S1) was a tracheal bronchus (TB) originating from the trachea approximately 10 mm above the carina. Because the left main bronchus was to be dissected, a right-sided double-lumen tube (DLT) was selected to completely protect the right lung from spillage of secretions or cancer cells from the left lung. ⋯ Although the upper half of the blue bronchial cuff appeared above the tracheal carina, OLV through the two bronchial lumen openings could be achieved due to a specific, slanted doughnut shape of the blue bronchial cuff and the location of the abnormal branch (B1) approximate to the carina. Left pneumonectomy using successful OLV was completed safely without hypoxemia or hypercapnea. Our experience indicates that management of OLV for patients with a thoracheal bronchus needs special considerations of the exact location of the TB and intra-lobar micro-airway communications, in addition to types of scheduled surgical procedures.
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Fibrinogen replacement therapy is effective for attaining perioperative hemostasis in critical bleeding due to acquired hypofibrinogenemia. By simulating the fibrinogen level and fibrin polymerization, we compared the effect of fibrinogen replacement therapy using cryoprecipitate or fibrinogen concentrate versus the effect of fresh frozen plasma. ⋯ In the simulation model, which combines the fibrinogen level and fibrin polymerization, cryoprecipitate and fibrinogen concentrate effectively normalize the fibrinogen level and fibrin polymerization, compared to fresh frozen plasma. The fibrinogen concentrate also demonstrated efficacy in treating hypofibrinogenemia in clinical patients. The combined simulation model is useful in assessing the efficacy of fibrinogen replacement therapy by cryoprecipitate or by fibrinogen concentrate.