Masui. The Japanese journal of anesthesiology
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Environmental surfaces in operating rooms (e. g., tables, floors) are rarely implicated as the sources of pathogens important in the development of surgical site infections (SSIs). Nevertheless, it is important to perform routine cleaning of these surfaces to reestablish a clean environment after each operation. There are no data to support routine disinfecting of environmental surfaces or equipment between operations in the absence of contamination or visible soiling. ⋯ But they have not definitively been shown to reduce SSI rates. Many SSI prevention techniques are directed at reducing opportunities for microbial contamination of the patient's tissues or sterile surgical instruments; others are adjunctive, such as using antimicrobial prophylaxis or avoiding unnecessary traumatic tissue dissection. Optimum application of SSI prevention measures requires that a variety of patient and operation characteristics be carefully considered.
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Infectious diseases, surgical site infections (SSI) in particular are the most popular perioperative complications, and not only the treatment but also prevention is extremely important. The inappropriate use of antibiotic prophylaxis in surgical patients accelerated the development of drug-resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA) or multiple-drug resistant Pseudomonas aeruginosa (MDRP) infections. ⋯ It is important to make a distinction between prophylactic and therapeutic antibiotic administration in the perioperative period. The anti-cross infection measure with the observance of Standard Precautions is also important in infection control.
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As ultrasound beam does not penetrate the air, it has long been thought that ultrasound imaging is not useful for evaluation of the pulmonary parenchyma. However, recent studies have shown that the artifact pattern generated by the lung can be used for the diagnosis of acute respiratory failure. Lung ultrasonography can provide us important informations inside the lung in a real-time fashion. Furthermore, general application of extended ultrasonography would be of greater benefit for perioperative diagnosis and intervention.
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We managed 10 cases of propofol anesthesia with rocuronium, and recorded the time course of the neuromuscular blockade evaluated through accelerometry, as well as the estimated blood concentrations of rocuronium calculated from the administration history with a pharmacokinetic simulation analysis. Rocuronium was injected at 0.6 mg x kg(-1) initially, and the infusion rates were managed in order to maintain a twitch height at 3-10% of the control. ⋯ The time to spontaneous recovery with a twitch height of 25% and a reappearance of the fourth response in train-of-four ratio (TOF ratio) nerve stimulation was twenty minutes, even after a five-hour infusion, and was not affected by the length of the infusion. Thus, continuous infusion of rocuronium might be an effective and safe way to maintain appropriate neuromuscular blockade.
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A 53-year-old woman who had experienced symptoms of fulminant malignant hyperthermia (MH) by sevoflurane a week before and her MH muscle biopsy revealing positive later, underwent the right hemicolectomy under total intravenous anesthesia with propofol and fentanyl. The patient's body temperature increased at a rate of 0.6 degree C per 15 min from 37.5 to 39.4 degrees C, but other symptoms of MH, such as tachycardia, arrhythmia, acidemia, and hypoxemia, were obviously slight in comparison with those induced by sevoflurane. ⋯ However, it decreased to 37.8 degrees C after discontinuation of propofol and dantrorene injection again. It is well recognized that propofol is not a MH trigger, but it shoud be noted that some MH patients could experience a hypermetabolic state, such as hyperthermia, even by propofol.