Masui. The Japanese journal of anesthesiology
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Myasthenia gravis (MG) is an autoimmune disease. The MG patients undergoing extended thymectomy under general anesthesia are at risk for postoperative complications, such as respiratory insufficiency and crisis (cholinergic and myasthenic). We evaluated the preoperative predictive factors, which are important for postoperative respiratory control. ⋯ This finding suggests that Fuchu Hospital Scoring System, duration of myasthenia and preoperative anti-acetylcholine receptor antibody are valuable for MG patients undergoing extended thymectomy as preoperative predictive factors. These factors are important for postoperative respiratory control.
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Case Reports
[Use of dexmedetomidine in a critically ill patient with hyperactive delirium: a case report].
A 28-year-old male after a traffic accident was hospitalized with the abdominal pain. The abdominal CT showed deep hepatic injury. We immediately performed emergency transcatheter arterial embolization (TAE) and observed him in the ICU. ⋯ Postoperative delirium has been reported to be less with DEX compared to other sedatives. Recent studies have revealed that delirium is one of the most frequent complications and an independent risk factor for prognosis in the ICU patients. DEX may be effective for controlling delirium and provide sufficient sedation without respiratory adverse effects in patients in the ICU.
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A 54-year-old man (height 155 cm, weight 49 kg) was scheduled for retroperitoneoscopic nephrectomy. He had a history of schizophrenia that had been controlled with propericiazine 10 mg and bromperidol 3 mg daily for 34 years. After induction of anesthesia, 1% mepivacaine 5 ml was administered via an epidural catheter. ⋯ Surgery was cancelled and he was extubated 45 minutes later without any complications. These findings suggest that caution must be exercised when combining general and epidural anesthesia for patients on long-term major tranquilizers. In the event of refractory hypotension, the use of direct-acting vasoconstrictors such as noradrenaline or vasopressin should be considered.
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A 34-year-old woman, who had had atonic bleeding six years ago, had selective cesarean section under CSEA. On the operation, atonic bleeding occurred and persisted. Though we used uterine contracting agents (oxytocin, ergometrine), the bleeding volume exceeded 2,000 ml and the examination revealed Hb 5.9 g x dl(-1), Ht 19%. ⋯ In 2010, guideline for obstetric critical hemorrhage was published. The guideline recommends the importance of observing the perioperative change of vital sign (e. g. shock index) and obstetric DIC score. In the obstetric critical hemorrhage, we should take proper and prompt actions in accordance with this guideline.
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We conducted a retrospective study to evaluate the effectiveness of intravenous patient-controlled analgesia (IVPCA) in the early postoperative period after upper abdominal gastrointestinal surgery. We also evaluated the postoperative effects of intraoperative analgesic dosage in patients after this surgery. ⋯ The results of this study suggest that the effects of intraoperative analgesics may not be significant. Patients who had received the above mentioned anesthetic regimen intraoperatively also required full postoperative analgesia as well.