Masui. The Japanese journal of anesthesiology
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We Japanese anesthesiologists can now use rocuronium as well as vecuronium. Although the onset of rocuronium is more rapid, the non-depolarizing neuromuscular blocking (NMB) agent has similar characteristics of duration and recovery compared to vecuronium. Reversal of NMB is therefore essential to recover patients safely. ⋯ Sugammadex is a novel and unique compound designed as an antagonist of rocuronium and possibly other steroid NMB agents. Sugammadex exerts its effect by forming very tight water-soluble complexes at a 1 : 1 ratio with steroid NMB agents (rocuronium>vecuronium>pancuronium). PhaseIII trials in Japan as well as Europe and the US have just been finished, and it is expected to be used clinically in the near future.
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A full stomach patient often requires a rapid sequence induction (RSI) technique to protect against gastric aspiration. Suxamethonium is the most common muscle relaxant used because it has a fast onset and a short duration. ⋯ However, it has been proved that suxamethonium creates superior intubation conditions to rocuronium in a large meta-analysis comparing intubation conditions. Once Org 25969 (sugammadex) is available to rapidly bind rocuronium and reverse its action, rocuronium may replace succinylcholine for rapid-sequence induction.
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Case Reports
[Perioperative management for cardiovascular operations in two patients with cold agglutinin disease].
Cold agglutinin (CA) reacts reversibly with red blood cells at a low temperature and may cause thromboembolism of various organs. Therefore, special consideration is required in patients with cold agglutinin disease (CAD) undergoing cardiovascular surgery requiring hypothermia. Case 1: A 71-year-old man with elevated CA was scheduled to undergo total aortic arch replacement. ⋯ However, no safety standards for perioperative management of patients with CA are clearly established. Generally, it is more important to figure out the TA and to prevent the low-temperature exposure below the TA. In cases of normothermic procedures, further consideration for cerebral and myocardial protection is important.
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Comparative Study
[Functional analysis of the smart vent compensation system and the fresh gas decoupling system].
In MIPPV mode, an anesthetic machine supplies a fixed amount of tidal volume (TV) corresponding to changes of fresh gas flow (FGF) in a certain period of time. In this research, we examined discrepancy of delivered TV and preset TV, after a change of FGF in both fresh gas decoupling system (FGDS) and smart vent compensation system(SVCS). ⋯ FDGS has a valve for closing FGF in the inspiratory phase and it makes the gas circuit over volume, but SVCS changes the volume of gas delivery to the ventilator by CPU according to FGF changes. Therefore it is assumed that the safety system of SVCS is superior to FDGS in high and low FGF.