Masui. The Japanese journal of anesthesiology
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The concept and the definition of CKD proposed by The National Kidney Foundation (USA) have been there for 10 years. The Japanese Society of Nephrology also has conducted the education and the spread of CKD. Consequently, in 2009 the newly introduced dialysis patients reached the ceiling in number in Japan. Definition, diagnosis, grading and the treatment of CKD published in 2012 by The Japanese Society of Nephrology were reviewed in this article.
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To avoid perioperative cardiac complications and deterioration of renal function in chronic kidney disease (CKD), anesthesiologists are required to manage respiration and circulation properly. Three mechanisms are considered to worsen renal function during inappropriate mechanical ventilation; first, hypercapnia or hypoxemia, second, unstable systemic hemodynamic, and third, systemic inflammatory mediators derived from pulmonary biotrauma. Many circulatory problems are present in CKD patients, for example, hypertension, cardiac hypertrophy, cardiomyopathy, ischemic heart disease, arterial sclerotic valve disease, salt and water retention etc. ⋯ Appropriate hemodynamic monitoring, including direct arterial pressure, left ventricular preload, intravascular volume and cardiac output could be helpful for anesthesiologists to manage CKD patients safely. In the area of CKD and anesthesia, there is lack of evidence in respiratory and circulatory strategies. Prospective studies in these aspects are required in the future.
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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.
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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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Historical Article
[The first labor analgesia with drug was performed in late Meiji Period (1868-1912). Hypnosis also attracted attention as a method of labor analgesia in mid-Meiji Period].
Ether or chloroform, was in use for ambulatory surgery after 1861 in Japan. An inhalational anesthetic, especially chloroform, was administered for cesarean section in early Meiji Period (from 1868) up to 1897. ⋯ However, it is uncertain whether inhalational anesthetic had been utilized for vaginal deliveries before 1903. There is evidence that hypnosis had attracted attention as a method of labor analgesia around that time.