Masui. The Japanese journal of anesthesiology
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In cesarean deliveries, it is important to prevent deep vein thrombosis in the lower limbs as this can result in pulmonary embolisms. Taking post-operative analgesia into account it is preferable to use an anesthesia method that allows early ambulation of patients. It is therefore necessary to use epidural anesthesia as a sole anesthesia method for cesarean deliveries. ⋯ Our findings showed that it is possible to utilize only epidural anesthesia for cesarean deliveries. Using lumbar epidural anesthesia with L1-2 puncture reduced a postoperative time to ambulation to less than 3 hours 10 minutes.
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Number of surgeries for the elderly is increasing year by year. Postoperative cognitive dysfunction, POCD, and delirium are typical failure's of higher brain function after surgery. The mechanism of POCD and delirium has been suggested to be associated with inflammation, but its details are unknown. ⋯ On the other hand, the another suspect, that propofol is safe. However, it should be recognized that these results became clear by basic research. Further clinical study is required.
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Postoperative cognitive dysfunction (POCD) is seen not only after cardiac surgery but also after non-cardiac surgery. POCD leads to decreased quality of life and increased mortality. ⋯ POCD is highly associated with age or inflammation in the central nerve system. Anti-inflammatory strategies including dexmedetomidine, statin or minocycline in the perioperative period may reduce incidence of POCD.
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A male patient in his thirties was scheduled to undergo adenotonsillectomy due to dyspnea from bilateral tonsillar hypertrophy. He was morbidly obese (body mass index 56 kg x m(-2)) with severe obstructive sleep apnea syndrome (OSAS), and thus was evaluated with extreme risk for difficult ventilation and intubation. We planned awake intubation via video-assisted laryngoscopy and fiberoptic bronchoscopy under dexmedetomidine sedation, and the intubation was successfully performed. ⋯ On postoperative day 1, he started walking with no need of sedative drugs. On day 4, after confirmation of minimal oropharyngeal swelling, tracheal cannulae was removed, and no further complications were observed in his postoperative course. We conclude that careful preoperative evaluation of the airway, retention of spontaneous breathing via awake intubation, and preventive tracheotomy for postoperative airway management are important points in perioperative management of a morbidly obese patient with severe obstructive sleep apnea syndrome.
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This study was designed to determine postoperative pain levels after ear, nose, and throat (ENT) surgery, and also to examine whether intraoperative fentanyl use during ENT surgery enhances the quality of postoperative pain control. ⋯ Prevalence of moderate to severe postoperative pain after ENT surgery was approximately 28%. Intraoperative fentanyl use was not associated with a decreased incidence of moderate to severe postoperative pain, but was significantly associated with PONV.