Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Postoperative nausea and vomiting caused by epidural infusion following gynecological laparoscopic surgery: fentanyl and ropivacaine versus ropivacaine alone].
Patients who undergo gynecological laparoscopic surgery often begin to eat and ambulate soon after surgery. However, postoperative nausea and vomiting (PONV) can postpone recovery. ⋯ We found that PCEA with ropivacaine alone resulted in a significantly lower incidence of PONV and did not disturb eating and ambulation following gynecological laparoscopic surgery, as compared to patients who received CEA.
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A 34-year-old obese, small-jawed and short-necked woman, had severe obstructive sleep apnea syndrome (OSAS) with bronchial asthma. A surgical removal of a lingual tumor using a laser knife was scheduled under general anesthesia with sevoflurane. A small diameter tracheal tube for laser surgery (internal diameter (ID) of 5.5 mm) was used. ⋯ After confirming that the two tubes were inserted securely, the tube for laser surgery was withdrawn. The patient's ventilation improved significantly afterwards and the extubation was performed successfully. Our method for replacing a tracheal tube seemed to be effective and safe.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intraoperative autonomic nervous activities and postoperative analgesia when general anesthesia was applied using an opioid combination].
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Case Reports
[Anesthetic management with propofol during pheochromocytoma resection under bispectral index monitoring].
In three patients undergoing pheochromocytoma resection under propofol/fentanyl anesthesia, bispectral index (BIS) was monitored for assessment of hypnotic effect. In two patients, arterial blood concentrations of propofol were measured by high performance liquid chromatography (HPLC), and compared with those of the estimated blood concentrations. Until resection of the tumor, propofol was infused at a rate of 10 mg x kg(-1) x hr(-1). ⋯ In a patient with rapid infusion of fluid, the arterial blood concentration was lower than the estimated blood concentration (2.59 vs 3.58 microg x ml(-1)). The anesthetic depth can not be estimated accurately by hemodynamic changes in the patients undergoing pheochromocytoma resection. BIS monitoring should be recommended for adjustment of propofol dosage after pheochromocytoma resection.
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We have previously showed that surgical volume affects mortality due to intraoperative critical incidents among patients undergoing cardiac surgery, the surgery with the highest risk, using data obtained by the annual survey in 2001 conducted by the Japanese Society of Anesthesiologists (JSA). In this study, we investigated whether surgical volume affects mortality due to intraoperative critical incidents independent of the surgical site. ⋯ Surgical volume was shown to affect mortality independent of the surgical site. Hospitals with low surgical volume should pay significant attention to improving surgical outcomes. These results also suggest that centralization or regionalization should be discussed from the perspective of socio-economical problems as well as patient safety.