Masui. The Japanese journal of anesthesiology
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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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Peripheral nerve block (PNB) is now widely performed in operating room by anesthesiologists. PNB is associated with multiple benefits compared to general anesthesia, but we should consider the complications of PNB. ⋯ Ultrasound guided PNB has become very popular now, and it has many potential advantages, such as direct visualization of nerves and anatomical structures, and direct and indirect visualization of spread of local anesthetics during injection with the possibility of repositioning the needle in case of maldistribution of local anesthetic. The half of these complications can be prevented by use of ultrasound guided PNB.
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The "Guideline for Management of Critical Bleeding in Obstetrics" was implemented by five obstetrics-related societies in April 2010 to improve management strategies and outcomes of massive bleeding in obstetrics. Besides emergency transfusion replacing acute blood loss, the Guideline contains a flow chart of instructions for autologous blood transfusion in obstetric patients with rare blood types, irregular antibodies, or with an increased risk and/or history of massive bleeding. In this chapter, based on the characteristics of bleeding in the field of obstetrics, indication, contraindication, patient selection, preparation, and pitfalls regarding actual practices of autologous blood transfusion are detailed in terms of efficacy and limitations. The pros and cons of autologous blood transfusion are discussed together with the feasibility of intra/post-operative blood salvage and hemodilutional autologous blood transfusion during bleeding to reduce the total amount of transfusion and thereby improve the outcome of critical bleeding in obstetrics.
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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.