Masui. The Japanese journal of anesthesiology
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Preoperative fasting period is required in order to reducing the risk of pulmonary aspiration which may occur during pediatric general anesthesia. Overnight fasting is still prevalent in Japan. ⋯ Cochrane Database evaluated this guideline twice in 2005 and in 2009. In this article, recent tactics of preoperative fasting in children is reviewed along the ASA guideline and the Cochrane report.
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In recent years, various perioperative patient management programs have been proposed as "Enhanced recovery after surgery program" in order to improve patient prognosis. These programs are an evidence-based approach which does not use novel drugs or novel therapeutic intervention, but uses conventional medical therapy and skill. ⋯ Specifically, early postoperative recovery will be carefully managed by evaluating clinical variables such as "postoperative pain, gut dysfunction, and immobility". These programs aim to keep the reduction of body functions as marginally as possible by minimizing surgical stress imposed on patients and then help shorten the recovery time after surgery.
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Excessive bleeding after cardiopulmonary bypass remains a major complication for cardiac surgery. The principal causes of hemostatic bleeding are related to inadequate surgical hemostasis or diluted coagulopathy. We investigated the efficacy of cryoprecipitate (Cryo) transfusion in thoracic aortic surgery with cardiopulmonary bypass. ⋯ Cryoprecipitate transfusion is an effective treatment for coagulopathy caused by dilution of coagulation factors after cardiopulmonary bypass.
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Case Reports
[Successful use of i-gel in three patients with difficult intubation and difficult ventilation].
I report successful ventilation through the i-gel and tracheal intubation through it, in patients in whom both facemask ventilation and tracheal intubation were difficult. Case 1: A 54-year-old woman, 157 cm, 60 kg, was scheduled for laparoscopic cholecystectomy. Preoperatively, neither difficult intubation nor difficult mask ventilation was predicted. ⋯ Insertion of a size 3 i-gel allowed adequate ventilation. Fiberoptic tracheal intubation through the i-gel was successful. I feel that the i-gel has a potential role as a rescue device, by allowing ventilation and tracheal intubation in patients with difficult airways.
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Although epidural blood patch (EBP) is an effective treatment for postdural puncture headache (PDPH), the adequate blood volume has not been determined. We reported two cases of EBP for PDPH after caesarean section with spinal anesthesia using ultrasound imaging with a 2-5 MHz convex probe. ⋯ In case 2, although the area of the epidural space was unchanged by 17 ml of EBP, contrast of the epidural space was altered in as a mosaic pattern. We conclude that ultrasound imaging is useful to confirm the adequate blood infusion during EBP Therefore, there is a possibility of estimating the optimal blood volume by ultrasound imaging.