Masui. The Japanese journal of anesthesiology
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Review Case Reports
[Four cases of extrapyramidal reactions to epidural droperidol administration].
Continuous epidural administration of droperidol at 2.5 mg x day(-1) or less was performed in 837 patients after surgery. In 4 of these patients, an extrapyramidal reaction occurred. Patient 1 was a 10-year-old girl who developed the symptom 29 hours after the start of administration, with a total dose of 3.0 mg. ⋯ Patient 4 was a 74-year-old female in whom the symptom occurred 24 hours after the start, with a total of 1.3 mg. With respect to the age distribution, the total of 837 patients consisted of 16 patients aged 10 to 19 years, 85 patients aged 20 to 29 years, 91 patients aged 30 to 39 years, 90 patients aged 40 to 49 years, 77 patients aged 50 to 59 years, 148 patients aged 60 to 69 years, 240 patients aged 70 to 79 years, 97 patients aged 80 to 89 years, and 9 patients aged 90 to 99 years. Extrapyramidal reactions related to epidural administration may readily develop at younger ages.
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Complications related to anesthesia remain a problem. We studied the incidence of complications during anesthesia in 2688 patients who had undergone anesthesia in the University of Occupational and Environmental Health Hospital. ⋯ Complications related to anesthesia should be prevented as much as possible through anesthesiologists' efforts in protocol development and skilled assistance.
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Case Reports
[Successful management of a patient with rhabdomyolysis and marked elevation of serum creatine kinase level].
We experienced successful management of a patient with severe rhabdomyolysis by conservative treatment. A 41-year-old man developed Stanford-A-type acute aortic dissection and underwent an emergent replacement of the aortic root and arch. After the weaning from cardiopulmonary bypass, his left femoral artery was found non-pulsatile, probably due to extension of the aortic dissection, and femoro-femoral artery bypass surgery was added. ⋯ Although serum creatinine increased to 2.0 mg x dl(-1) on postoperative day (POD) 1, diuresis was maintained and the level of creatinine returned to normal on POD 6. He was extubated on POD 6 and discharged on POD 7. The early start of these combined therapies seems to have prevented acute renal failure without blood purification.
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Comparative Study
[Appropriate dose of isobaric bupivacaine with fentanyl in spinal anesthesia for cesarean section].
Spinal anesthesia combined with fentanyl is commonly used for cesarean section. We studied the appropriate dose of isobaric bupivacaine for spinal anesthesia when combined with a fixed dose of 20 microg fentanyl. ⋯ Two ml of 0.5% isobaric bupivacaine was the most appropriate dose for cesarean section, when combined with 20 microg of fentanyl.
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We report a patient who was suspected of transfusion-related acute lung injury. A 60-year-old man underwent emergency thoracotomy and hemostasis after pneumonectomy. The SpO2, decreased abruptly to 66% 90 minutes after transfusion of packed red blood cells and fresh frozen plasma. ⋯ The SPO2 returned to 100% in 3 minutes. Postoperative chest radiography showed diffuse pulmonary infiltrates. The pulmonary edema improved in 12 hours with mechanical ventilation.