Masui. The Japanese journal of anesthesiology
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Recent advances in prenatal diagnosis have made fetal surgery as a possible treatment for a wide variety of fetal diseases. Fetal surgeries consist of minimally invasive fetal surgery such as ultrasound guided procedure and fetoscopic surgery, open fetal surgery, and ex-utero intrapartum treatment. ⋯ For this purpose, anesthesiologists are supposed to know outlines of the fetal treatment in addition to pediatric and obstetric anesthesia, as a member of multidisciplinary team. In this review, outlines of fetal treatment will be introduced and anesthetic considerations for fetal surgeries will be discussed.
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The trial of labor analgesia in Japan dates back to the year 1929. After the foundation of the original Japan Society of Obstetric Anesthesia and Perinatology in 1961, various labor analgesia techniques were widely attempted. Some anesthetists relieved the labor pain with balanced anesthesia using intravenous (diazepam and pethidine during the 1st stage of labor, followed by pentobarbital or ketamine during the 2nd stage of labor) combined with inhalational anesthetic (methoxyflurane or enflurane), while the others tried regional anesthesia. ⋯ However, the ideal labor analgesia technique has been still controversial. We, obstetric anesthesiologists, should grope for safer and more comfortable anesthetics to the mother and fetus. In next 50 years, the standard method for labor analgesia may change to no needle system with non-placental transfer anesthetics.
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A 26-year-old G1P0 woman with past history of bronchial asthma underwent emergency cesarean section for non-reassuring fetal status under spinal anesthesia. She had not had surgery before. Thirteen minites after the start of the procedure, she started complaining of flushing and itching of her hands and mouth. ⋯ It is known that several antigens which cause latex allergy share common structures with defense related proteins of plants. It is to be noticed that, patients sensitized by those defense related proteins by plants intake, may develop latex allergy even though they are not considered to be high risk group from relevant occupational exposure and, co-morbid conditions. We should consider latex allergy as one of the causes of shock during intraoperative period even when the possibility of latex allergy seems scant.
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Comparative Study
[Comparative study of induction time using propofol bolus injection in elderly patients].
We studied the induction time using propofol bolus injection in elderly patients. ⋯ Prolonged anesthesia induction time was observed with the advancing ages.
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Although the number of maternal death in Japan has decreased especially since 1990's and its total number has reached the level of developed countries, obstetric hemorrhage is still equally important as obstetric embolism and hypertension in pregnancy as a cause of maternal death. Intrapartum abnormal bleeding is defined as hemorrhage which amounts to more than 500 ml during intrapartum period by Japan Society of Obstetrics and Gynecology (JSOG). However, according to the official register of peripartum data in Japan, the upper normal limit (mean + 1.5 SD) of the amount of hemorrhage during intrapartum period was 900 g at vaginal singleton delivery, 1600 g at singleton cesarean delivery, 1900 g at multifetal vaginal delivery and 2600 g at multifetal cesarean delivery. ⋯ Strategy of treatment for obstetric DIC and the guideline of response to obstetric critical hemorrhage are also important at such state. Level 1 and other medical devices for critical care also become strong tools for severe cases. However, the most important is adequate and prompt estimation and direction by workforce.