Masui. The Japanese journal of anesthesiology
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Recently, various less-invasive cardiac output monitors are used for a variety of cases. We used FloTrac system for a patient with severe dilated cardiomyopathy (LVDd/Ds = 75/62 mm, EF = 22%) and recognized its limitation. A 52-year-old woman underwent left partial mastectomy. ⋯ Its accuracy is worse with arterial wave artifact, compromise of the arterial catheter, aortic regurgitation, intense peripheral vasoconstriction, irregular pulse and severe cardiac hypofunction. Thus, its reliability is influenced by various conditions, especially in critically ill patients. FloTrac system is very useful for the management of cardiocirculatory dynamics, but we should be familiar with its limitations.
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A 59-year-old man with chronic renal failure underwent the ascending colectomy. After administration of neostigmine 2 mg, his postoperative neuromuscular recovery was good. ⋯ But we failed to reverse neuromuscular blockade and the patient fell into respiratory depression. After a chain of two operations, the administration of neostigmine in second operation requires circumspection when the effect of neostigmine administrated in the first operation is continuing, because the proper evaluation of residual neuromuscular blockade is difficult.
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We report a second case of awareness during general anesthesia with sevoflurane supplemented with fentanyl. A 58-year-old man, weighing 61 kg, underwent an 8.8-hour operation for a malignant tumor of the right mandible. ⋯ The patient became agitated in the recovery room and could recall his visual memory during the operation. We speculated contribution of visual input through the open eye and/or the effects of cranial bone oscillation during the surgery to his intraoperative awareness.
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Randomized Controlled Trial
[Preoperative intravenous administration of droperidol (1.25 mg) reduced postoperative nausea and vomiting after intrathecal morphine administration].
Intrathecal morphine (ITM) is an excellent postoperative analgesic, but may often cause postoperative nausea and vomiting (PONV). We designed this prospective, randomized and controlled study to evaluate the antiemetic efficacy of low-dose droperidol for the treatment of PONV caused by ITM. ⋯ Single intravenous administration of 1.25 mg droperidol before operation showed prophylactic efficacy in early PONV caused by ITM. The duration of droperidol action was shorter than that of ITM. Hence we recommend that droperidol should be administered more frequently or continuously in the postoperative period.
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Unrecognized esophageal intubation remains a significant cause of anesthetic morbidity. Extensive data showed that clinical signs and methods for confirming proper tracheal tube placement were not always reliable. Advancing tracheal tube into the trachea can be detected by palpating the cricoid cartilage. We evaluated the reliability of detecting tracheal intubation by cricoid palpation methods (CPM) in this study. ⋯ The CPM alone is imperfect for tracheal tube placement confirmation. Multiple methods for detecting correct tube placement should be used, since no single method has perfect reliability.