Masui. The Japanese journal of anesthesiology
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Spinal epidural hematoma following neuraxial anesthesia is a rare condition that usually presents with acute and, if any, progressive neurological symptoms including pain, sensory/motor impairment, and bladder/ rectal disturbance. Although possible pathogenesis is mainly considered to be a direct injury of Batson's venous plexus, preoperative coagulation status and anticoagulant therapy also play some role in its development. Therefore, to prevent such a disastrous complication, one must choose an appropriate anesthetic technique and monitor neurological function of the patient at a regular time interval. In addition, it is highly recommended to carefully follow the recently revised regional anesthesia guideline for the patient receiving antithrombotic or thrombolytic therapy, although we still need further understanding and investigation of the complexity around this issue.
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The innovation of ultrasound-guided regional anesthesia technique has enabled the anesthesiologist to secure an accurate needle position and to monitor the distribution of the local anesthetic in real time. However, the evidence is necessary concerning increased benefits and reduced complications compared to conventional guidance techniques. ⋯ Common complications of nerve blocks can be avoided with major principles of ultrasound-guided technique, which involves similar risk of complications and requires similar amount of knowledge for management. It is necessary to establish the recommendations for the scope of practice, teaching curriculum and the opinion for implementing the medical practice of ultrasound-guided regional anesthesia.
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Epidural anesthesia has many advantages, including block of surgical stress, postoperative pain management and prevention of postoperative complications. Therefore, we should use epidural anesthesia when indicated. However, patients with preexisting spinal stenosis or lumbar radiculopathy have higher incidence of neurologic complications after epidural anesthesia. ⋯ It is important to have measures for safety in performing epidural anesthesia at every hospital. Recently, we have many anesthetic techniques, including epidural anesthesia, remifentanil infusion, ultrasound-guided peripheral nerve blocks and intravenous PCA. Therefore, we should choose an anesthesia method based on the careful evaluation of the benefit and risk balance for the patient's safety to reduce the incidence of complications.
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To evaluate the suitability of GlideScope Ranger, endotracheal intubation was performed in 100 surgical patients undergoing general anesthesia. The time to complete intubation, percentage of glottic opening score and optimizing procedures were recorded. ⋯ It was easily handled not only by experienced anesthetists but also by novice personnel. GlideScope Ranger could be an effective aid to airway management in surgical patients.
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Kasabach-Merritt syndrome (KMS) is a rare and severe coagulation disorder caused by vascular malformations within or outside the liver. It is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, and consumption coagulopathy. We successfully managed the anesthesia for a giant hemangioma resection complicated with KMS using FloTrac/Vigileo system. ⋯ The increase of SVV and sudden decrease of APCO and SBP were recognized during surgical procedure. The SVV demonstrated marked changes in response to hemorrhage, and it was more sensitive than CVP change during operation. We conclude that SVV is an accurate predictor of intravascular hypovolemia, and it is a useful indicator for assessing the appropriateness and timing of applying fluid for improving circulatory stability during a giant hemoangioma resection.