Masui. The Japanese journal of anesthesiology
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A morbidly obese patient, with a body mass index of 43 kg m(-2), was scheduled to undergo open reduction and internal fixation (ORIF) to his left fibular fracture under general anesthesia in the lateral position. Before the induction of general anesthesia the patient positioned himself comfortably in right lateral. General anesthesia was induced with intravenous propofol and remifentanil infusions. ⋯ As soon as he awoke, LMA was removed in the lateral position. The patient turned to the supine position himself and was discharged to general ward. We consider our method, the induction of general anesthesia and the LMA insertion in the lateral position, was a selectable option to a morbidly obese patient who underwent an operation in the lateral position.
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Intraoperative hypothermia causes several unfavorable events such as surgical site infection and cardiovascular events. Therefore, during anesthesia, temperature is routinely regulated, mainly by using external heating devices. Recently, oral amino acid intake and intravenous amino acid or fructose infusion have been reported to prevent intraoperative hypothermia during general and regional anesthesia. ⋯ According to the protocol, anesthesiologists play an important role in both intraoperative and perioperative management. Management of optimal body temperature by preoperative fluid management alone may be difficult. To this end, preoperative fluid management and nutrient management strategies such as preoperative oral fluid intake and carbohydrate loading have the potential to contribute to the prevention of intraoperative hypothermia.
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Continuous epidural analgesia has become an accepted technique used in laparotomy including liver resections. Although American Society of Regional Anesthesia and Pain Medicine recommends that epidural catheter be removed with prothrombin time-international normalized ratio (PT-INR) less than 1.5, it is possible that liver surgery causes coagulation disturbances. We examined the postoperative changes in coagulation profiles of living liver donors to elucidate whether hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters or not. ⋯ Our study suggested that hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters, even in the living liver transplant donors with normal liver function.
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Case Reports
[Automated intermittent bolus infusion for continuous sciatic nerve block: a case report].
We present two cases of severe pain due to critical limb ischemia (CLI) treated with automated intermittent bolus infusion for continuous sciatic nerve blocks. Case 1: A 32-year-old man had severe lower extremity ischemic pain due to Fontaine grade IV peripheral vascular disease. The pain did not respond to systemic analgesics. ⋯ As continuous infusion did not relieve his pain, automated intermittent with patient-controlled bolus administration was started. However even with this technique, his pain was not relieved well. In some patients whose severe pain due to CLI could not be managed well, automated intermittent bolus infusion of local anesthetics from peripheral nerve catheter may provide better analgesia than continuous infusion.
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Restriction of preoperative clear liquid intake causes thirst in many patients but is followed traditionally for many years in the preoperative order by an anesthesiologist in charge. Although many anesthesiologists doubted long the efficacy of this tradition, no one has stopped. ⋯ In 2005, the report from north European countries was published and introduced the new idea "Enhanced Recovery after Surgery, ERAS" which consists of many factors. Among these factors, the enforcement of preoperative clear liquid intake was reviewed in this volume.