Masui. The Japanese journal of anesthesiology
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Preoperative oral hydration is an important component of "enhanced recovery after surgery" strategies. This was originally developed for patients undergoing colon surgery. The Obstetric Anesthesia Practice Guideline issued by American Society of Anesthesiologists states that intake of minimum amount of clear fluid 2 hours prior to surgery may be safe. ⋯ Moreover, some articles suggest that oral hydration may improve utero-placental perfusion. Therefore, we have to balance risks and benefits of oral hydration in parturients. Further investigations are needed among this specific subgroup of patients in order to establish the safe application of preoperative oral hydration.
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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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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.
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Effect of epidural anesthesia is affected by catheter tip position. Migration of an epidural catheter is known and several methods were reported to secure fixation of the catheter, but there were no gold standard method to fix it. ⋯ We conclude that fixation of epidural catheter by only Tegaderm can not be a gold standard even if circular loop and record label are used.