Journal of anesthesia
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Journal of anesthesia · Jan 2009
Prediction of postoperative delirium after abdominal surgery in the elderly.
Indications for the surgical treatment of elderly patients have been increasing. Postoperative central nervous system dysfunction, including delirium, is one of the most common complications in elderly surgical patients. The relationship between patient factors, including cerebral oxygen saturation, and the incidence of postoperative delirium was evaluated. ⋯ Patients' age, low preoperative kana-hiroi test score, and low preoperative rSO2 were important risk factors for postoperative delirium.
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Journal of anesthesia · Jan 2009
Case ReportsSuccessful extracorporeal membranous oxygenation for a patient with life-threatening transfusion-related acute lung injury.
A case of transfusion-related acute lung injury (TRALI) that was successfully treated with extracorporeal membranous oxygenation (ECMO) is reported. A 58-year-old male patient underwent hepatectomy, and pulmonary edema occurred after the administration of fresh-frozen plasma and packed red cells. In the postoperative period, the impaired oxygenation progressively worsened, resulting in life-threatening hypoxemia, despite vigorous treatments. ⋯ As a treatment for ARDS, ECMO does not cure the underlying disease of the lungs, however, with ECMO, TRALI, usually improves within 96 h with respiratory support. ECMO for TRALI-induced lethal hypoxemia is useful for providing time to allow the injured lung to recover. It is suggested that ECMO might be a useful option for the treatment of TRALI-induced, potentially lethal hypoxemia.
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Journal of anesthesia · Jan 2009
Case ReportsAnesthetic management of renal transplantation in a patient with familial dysautonomia.
Familial dysautonomia is an inherited disorder characterized by autonomic and sensory nervous system neuropathy resulting in extremely labile blood pressure (severe hypertension followed by hypotension). As more patients with familial dysautonomia reach adulthood due to improved medical treatment, perioperative encounters of patients with familial dysautonomia will increase. This report is the first adult case to describe an anesthetic management of kidney transplantation for an adult familial dysautonomia patient. The clinical manifestations of this disease and rationale of our anesthetic management are discussed.
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Journal of anesthesia · Jan 2009
Increased fingertip vascular tone leads to a greater fall in blood pressure after induction of general anesthesia.
General anesthesia causes peripheral vasodilation. We thus hypothesized that patients with increased peripheral vascular tone would become more hypotensive after the induction of general anesthesia compared to those without increased peripheral vascular tone. To test this hypothesis, we compared the decrease in blood pressure after anesthetic induction between patients with increased peripheral vascular tone and those without increased peripheral vascular tone. ⋯ In each patient, the peripheral vascular tone was assessed by either the fingertip skin-surface temperature (FSST) or the forearm-fingertip skin-surface temperature gradient (FFSSTG; forearm skin-surface temperature minus FSST). The decrease in blood pressure 15 min after anesthetic induction was larger in patients with an FSST of 29 degrees C or less (FSST = 27.3 +/- 1.6 degrees C; FFSSTG = 5.2 +/- 1.6C) than in those with an FSST of more than 29 degrees C (FSST = 30.8 +/- 1.0 degrees C; FFSSTG = 1.6 +/- 1.2 degrees C). In conclusion, increased fingertip vascular tone (presumably due to thermoregulatory vasoconstriction) before anesthetic induction leads to a greater fall in blood pressure after anesthetic induction.
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Journal of anesthesia · Jan 2009
Work stress and workload of full-time anesthesiologists in acute care hospitals in Japan.
The number of anesthesiologists per population in Japan is small compared with that in Europe and North America. While there is a growing concern that hard work causes anesthesiologists' fatigue and may compromise patient safety, the workload and physical stress, as well as the impact of staff support on physicians' stress have not been assessed in detail. The goal of this study was to evaluate the working environment, anesthesia workload, and occupational stress of anesthesiologists in Japan. ⋯ Our results provide a quantitative assessment of the duties of anesthesiologists and show that work stress among anesthesiologists is related to workload and other factors.