Masui. The Japanese journal of anesthesiology
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A 26-year-old woman with Ehlers-Danlos syndrome (EDS) underwent posterior spinal fusion with instrumentation for scoliosis. General anesthesia was maintained using propofol and remifentanil. The procedure was performed examining the motor evoked potential (MEP) and somatosensory evoked potential (SSEP) of the lower extremities with the patient placed in the prone position. ⋯ Brachial plexus injury is the most common among the nerve injuries resulting from intraoperative malpositioning. Patients with EDS are thought to be at high risk for the complications and it has also been reported that patients with joint hypermobility, such as that in EDS or Marfan syndrome, are highly susceptible to nerve injury. Intraoperative monitoring of the MEP and SSEP in the upper extremities should be considered for early detection and prevention of brachial plexus injury in patients with EDS who are thought to be at high risk.
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Randomized Controlled Trial Comparative Study
[Effect of landiolol and combined use of landiolol and olprinone on hemodynamics in patients undergoing off-pump coronary artery bypass grafting].
Beta blockers are frequently used to reduce cardiac oxygen demand in off-pump coronary artery bypass grafting (OPCAB). However, significant bradycardia or negative inotropic effects are seen on occasion. We hypothesized that combined use of landiolol (L), an ultra short-acting beta blocker, and olprinone (O), a phosphodiesterase 3 inhibitor, is useful because it can increase cardiac index and prevent tachyarrhythmia even during dislocation of the heart in OPCAB. ⋯ Combined use of landiolol and olprinone increases cardiac index and decreases systemic vascular resistance index during OPCAB.
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The aim of this study was to evaluate the suitability of the C-MAC videolaryngoscope for the tracheal intubation especially by novice personnel. ⋯ The C-MAC videolaryngoscope is a useful device in education of endotracheal intubation by novice personnel.
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We experienced an anesthetic management with rocuronium and neurostimulator for a surgical patient with amyotrophic lateral sclerosis. A 61-year-old man was scheduled for intrathecal baclofen pump implantation as treatment for his spasticity under general anesthesia. After oxygenation and totally intravenous induction with propofol and remifentanil, we administered 10 mg of rocuronium repeatedly monitoring with neurostimulator. ⋯ We could confirm his stable and adequate respiration and trachea was extubated without reversal of rocuronium. In the postanesthesia care unit, he showed no discomfort and was returned to the ward. His symptoms did not deteriorate postoperatively and he was discharged on the 36th postoperative day.
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The American Society of Anesthesiologists (ASA) published a clinical practice guideline of preoperative fasting in 1999. A nationwide survey conducted in Japan in 2003 reveals that many hospitals have a much longer fasting period. We conducted a similar survey in three limited areas in Japan to assess the changes in fasting practice. ⋯ Longer preoperative fasting periods are still common practice in Japanese hospitals.