Masui. The Japanese journal of anesthesiology
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Case Reports
[Percutaneous vertebroplasty for vertebral compression fractures in the patient with acute lymphoblastic leukemia].
Percutaneous vertebroplasty (PVP) is an interventional treatment for painful vertebral compression fractures caused by osteoporosis and malignant diseases such as multiple myeloma and metastatic bone tumors. We present the first case of PVP performed on a man in his thirties with vertebral compression fractures secondary to acute lymphoblastic leukemia. PVP at T11 and L1 levels resulted in a marked improvement in refractory pain although he developed delayed pyogenic spondylitis two months after the intervention. This case suggests that PVP could be one of the useful therapeutic procedures for intractable back pain associated with vertebral compression fractures in acute lymphoblastic leukemia if we are extremely vigilant for the risk of spondylitis.
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Randomized Controlled Trial
[Effect of amino acid and glucose infusion on perioperative body temperature and postoperative infection in patients undergoing total knee arthroplasty].
We investigated whether the perioperative amino acid infusion with glucose is effective for preventing perioperative hypothermia and postoperative infection in patients undregoing total knee arthroplasty (TKA). ⋯ These results suggest that in patients undergoing TKA receiveing amino acid infusion perioperatively, thermogenic effect and prevention of postoperative infection are similar whether exogenous glucose is infused or not.
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Coagulation disorders often occur perioperatively and monitoring of blood coagulation should be fast and adequate to treat these disorders to protect patients from massive bleeding. Control of hemostasis is one of the main issues in major surgeries. Coagulation test results from a central laboratory may delay making such a perioperative decision. ⋯ Both prothrombin time (PT) and activated clotting time (ACT) are very useful and popular, but also criticized because they can be monitored only until fibrin formation. On the other hand, viscoelastic monitorings of whole blood, are able to estimate fibrin formation, clot fixation, platelet function and fibrinolysis. In this review article, among variable perioperative POCMs of blood coagulation, three thromboelastographic monitorings, such as TEG ROTEM, and Sonoclot as well as PT and ACT, are described along with their utilities and limits to examine perioperative coagulation.
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Less invasive measuring procedures for hemodynamic status and function are increasingly being used. Surgical patients are frequently undifferentiated, need accurate risk assessment and stratification, while their need for diagnosis and therapy is often time-critical. ⋯ Pulmonary artery catheters, transesophageal echocardiography, pressure pulse waveform analysis, and other less invasive monitoring techniques all are potentially effective for diagnosis and hemodynamic monitoring. This article provides information on the usefulness and limitations of recent circulatory monitoring procedures.
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It is more than 60 years since averaged somatosensory evoked potentials (SEPs) were devised. During this period, other evoked potentials including spinal cord evoked potentials and motor evoked potentials (MEPs) were developed. ⋯ The combination of these evoked potentials (multimodality monitoring) has been demonstrated to be sensitive and specific for detecting intraoperative neurologic injury during spine surgery. Although there is still a low level of evidence that intraoperative evoked potentials reduce the rate of new or worsened perioperative neurologic deficits, it is recommended to monitor MEP for thoracoabdominal aortic surgery and multimodal evoked potentials including at least spinal cord evoked potentials and MEP for spine surgery, when the spinal cord is considered to be at risk.