Masui. The Japanese journal of anesthesiology
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Case Reports
[Severe airway obstruction relieved by sedation using sevoflurane in a pediatric patient with tracheobronchomalacia].
A 3-month-old baby with trisomy 18 syndrome was scheduled for tracheostomy under general anesthesia because of the prolonged tracheal intubation. Immediately after transferring the patient to the operating table, the patient suddenly began crying and coughing, resulting in severe hypoxia. The patient's lungs could not be ventilated by manual and positive pressure ventilation, and airway obstruction could not be relieved until the respiratory effort spontaneously decreased. ⋯ After sevoflurane administration, the sedated patient never developed the respiratory effort, and the lungs could be ventilated by manual and positive pressure ventilation without difficulty. The patient was diagnosed as tracheobronchomalacia as a result of intraoperative flexible bronchoscopy performed through tracheostomy tube, revealing significant narrowing of both the trachea and mainstem bronchus lumens. Sedation using sevoflurane may be helpful in maintaining airway patency in the pediatric patient with tracheobronchomalacia.
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We investigated changes in core temperature associated with lower extremity tourniquet (TQ) under two different ambient temperatures (1) and two different warming equipments (2) under general anesthesia combined with lumbar epidural anesthesia. ⋯ Air-forced warming maintains core temperature efficiently associated with lower extremity tourniquet.
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Uterine artery embolization (UAE) has become widely employed in Japan. Although several methods of anesthesia and analgesia are performed for UAE, pain control does not appear to be satisfactory. We report a series of UAE, successfully managed using thoracic epidural analgesia. ⋯ Several phases of severe pain are seen perioperatively in UAE. Because thoracic epidural analgesia is easily administered and the dosage of the drugs used effectively controlled, it is a practical method for perioperative pain control for UAE.
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Cor triatriatum is a rare congenital cardiac anomaly, in which left ventricular filling is impeded by obstructive membrane in the left atrium. We administered spinal anesthesia for cesarean section in a patient with cor triatriatum (type III A1) with congestive heart failure. ⋯ However, in our patient, increasing the heart rate to 80-90 beats x min(-1) was beneficial in maintaining adequate systemic blood pressure and cardiac output. Spinal anesthesia could be a method of choice for cesarean section in a patient with cor triatriatum when adequate hemodynamic monitoring is available.
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We reported previously the existence of regional discrepancies in the numbers of anesthesiologists to the general population, the numbers of all medical doctors and hospital beds in Japan. In the present study, we investigated the regional discrepancies of the numbers of anesthesiologists and hospitals with department of anesthesiology from medical facility's point of view in Japan. ⋯ There are remarkable regional discrepancies in the numbers of anesthesiologists and CTHs to the general hospitals and in the number of CTHs to the general population in Japan. We suspect that the regional discrepancies in the field of anesthesiology would influence the quality and form of corresponding clinical practice.