Masui. The Japanese journal of anesthesiology
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We report a case of ventilation failure due to supraglottic air leakage with the use of uncuffed tracheotomy tube. A 4-year-old girl with 22q11.2 deletion syndrome after tracheotomy due to tracheomalacia developed left caudate bleeding and was admitted urgently. She required mechanical ventilation but suffered from a supraglottic air leakage which prevented adequate ventilation via a tracheostomy site. ⋯ The supraglottic air leakage was not detected under mandatory mechanical ventilation following seal of the connector of the LMA with a piece of tape. The respiratory condition of the patient improved gradually. The use of an LMA may be useful to stop or significantly decrease the air leak.
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Generally, anesthesiologists believe that patients with Eisenmenger syndrome (ES) undergoing noncardiac surgery have significant risks of perioperative morbidity and mortality. Because of the recent strides in medical care, these patients often require anesthesia. ⋯ She had no adverse perioperative events, and was discharged the next day. Patients with ES have increased risks with general anesthesia for noncardiac surgery, but the risk of morbidity and mortality seems to be less than previously thought.
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Perioperative complications are prevalent among current smokers. Smoking cessation program is covered by national insurance for patients who meet certain criteria in Japan. We established a smoking cessation program in a preoperative clinic of our anesthesia department in July 2010. ⋯ Smoking cessation program is effective when offered to patients right before surgery. Preoperative anesthesia clinic may be one of the most suitable opportunities for the program.
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Review
[Perioperative management after non-cardiac surgery in patients with chronic kidney disease].
The number of patients with chronic kidney disease (CKD) continues to increase all over the world for the past ten years. It follows that we have more CKD patients with various complications who need perioperative management in Japan. ⋯ Safe comprehensive anesthetic management is required in order not to aggravate the preoperative CKD. In this review, we will take up some recent topics and novel concept in association with noncardiac surgery for the perioperative management of CKD patients.
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Chronic kidney disease (CKD), defined by abnormalities in kidney function or damage stable for more than three months, is a relatively common disease in Japan. A high prevalence of pain-associated disease is reported in the CKD population. ⋯ Furthermore, certain analgesics can increase the risk of acute kidney injury and they should be avoided in CKD patients. The aim of this article is to review the considerations needed for pain management in CKD patients.