Masui. The Japanese journal of anesthesiology
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Cardiovascular surgery is constantly progressing. However, the prevalence of central nervous system injury is greater after operations on the aortic arch than after other types of aortic or cardiac surgery. ⋯ Several different methods are currently being used to protect them during operations on the aortic arch. This thesis is organized about the protection methods for these procedures.
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Case Reports
[Case of cerebral salt wasting syndrome with difficulty in controling excessive urine volume].
Symptoms of hyponatremia and diuresis due to cerebral salt wasting syndrome (CSWS) are often observed after aneurysmal subarachnoid hemorrhage (SAH). Inadequately treated CSWS is known to work as a trigger of symptomatic vasospasm in SAH patients. Therefore, it is indispensable to detect and treat CSWS as early as possible in ICU. ⋯ Recent studies revealed that hyponatremia and hypovolemia following SAH might be caused by exaggerated secretion of natriuretic peptides. Experimental studies showed that the administration of vasopressin and desmopressin cause excessive secretion of natriuretic peptides under the circumstance of volume expansion in rats. We infer that the administration of vasopressin and desmopressin to our patient deterionated natriuresis in CSWS as in the previous experimental findings.
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Brain hypothermia therapy has been expected to lead to good neurological outcome in acute brain insults. There are a few positive results which have been proven by multicenter randomized clinical trials (RCT) in the cardiopulmonary arrest (CPA) in patients with ventricular fibrillation. ⋯ For brain hypothermia therapy to become an effective method for acute brain insults, indications, brain oriented intensive cares and biomarkers for the therapy must be established. RCT in acute brain insults beside CPA victims are needed in the near future.
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We review some anesthesiologist's curriculum and demographic characteristics in France to the community of Japanese anesthesiologists. To become a certified anesthesiologist and an intensive care physician currently requires six years' medical education, passing national medical examination, and five years' special training as an intern of anesthesiology and intensive care. This educational course was started in 1984. ⋯ The anaesthesiologist often works in a team with a nurse anaesthetist. The number of certified anesthesiologists in France is larger than that in Japan. Management of anesthesia in France seems to have an advantage in manpower.
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Basic and clinical investigations have been performed, focusing on the mechanism of ischemic brain and spinal cord injuries, and preventive measures against ischemic insults such as drug therapy, hypothermia, maintenace of blood flow to brain and spinal cord, preconditioning, and no use of high dose fentanyl. In this special issue, five experts have provided new relevant information concerning brain and spinal cord protection. Further research in brain and spinal cord protection will contribute to better understanding of ischemic central nervous system injuries and to the establishment of novel therapies for protection of central nervous system.