Masui. The Japanese journal of anesthesiology
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Among all drugs used for general anesthesia, neuromuscular blocking agents (NMBAs) seem to play a predominant role in the incidence of severe adverse reactions. The overall incidence of perioperative anaphylaxis is estimated at 1 in 10,000-20,000 anesthetic procedures, whereas it is estimated at 1 in 6,500 administrations of NMBAs. ⋯ Prick testing is advised for the diagnosis of the NMBAs responsible for an anaphylactic reaction, and intradermal testing is preferred when investing cross-reaction. The choice of the safest possible anesthetic agents should be based on the result of a rigorously performed allergologic assessment.
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Case Reports
[Suspected case of peripartum cardiomyopathy during perioperative period--a case report].
A 31-year-old primigravida was admitted for control of twin gestation and delivery. At 36-week gestation, an emergent cesarean section was performed under combined spinal-epidural anesthesia because of progression of PIH. Anesthetic course was uneventful until the operation was finished. ⋯ HELLP syndrome and DIC were also combined with PPCM, so intensive care was given to her from the 1st POD. Symptoms of heart failure were alleviated by furosemide and carperitide by the 12th POD. The EF increased to 58% on the 11th POD.
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Compression stockings are used for patients under general anesthesia to prevent occurrence of deep venous thrombosis. We report a case of allergic contact dermatitis to synthetic rubber, neoprene in compression stockings. A 53-year-old house wife had a history of sensitivity like skin eruption and disstasis to rubber products such as rubber band. ⋯ After disappearance of the skin symptoms, she was discharged from the hospital on the ninth day after the operation. Synthetic rubber, neoprene, in the upper part of compression stockings to prevent slipping down might cause allergic contact dermatitis. We should take care of occurrence of allergic contact dermatitis to synthetic rubber, neoprene in compression stockings in patients with rubber allergy.
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Both Japan Society of Blood Transfusion and Cell Therapy and Japan Society of Anesthesiologists have made a "Guideline of Management at Critical Bleeding in the Operating Room" in 2007. Since 2008, Japan Red Cross Blood Center (JRC) introduced leuko-reduction filter and diversion technique to prevent bacterial contamination. This improvement can easily introduce ABO compatible transfusion at critical situation. ⋯ When such mismatch transfusion necessarily performed, hydration therapy to protect kidney function should be applied immediately after hemostasis. 4) Red Cell Volume in a PC bag: PC in Japan have processed by single donor apheresis alone since 2004. Our results showed that each PC bag contains less than 5 mm(-3) of RBCs. If this level of RBCs caused hemolysis in ABO mismatch patient, it is too small to cause DIC or renal failure.
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The annual surveys of critical incidents in Japanese Society of Anesthesiologists (JSA)-certified hospitals in 1999-2002 demonstrated that massive and critical bleeding was the major cause of intraoperative cardiac arrest leading to poor prognosis including death and permanent brain damage. The surveys also suggested that type-specific blood transfusion and emergent O-type blood transfusions were underutilized. ⋯ Five academic societies publicized the guidelines for management of critical bleeding in obstetrics in 2010. Each hospital is expected to make institutional emergency blood transfusion guidelines on the basis of the above guidelines in order to decrease the incidence of critical bleeding and to improve the prognosis of the patients with critical bleeding.