Masui. The Japanese journal of anesthesiology
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Various kinds of evidence-based checklists and guidelines aimed at patient safety in the perioperative period are becoming popular in the clinical setting. These include WHO guidelines on surgical patient safety, surgical-crisis checklists, checklist for preventing major complications associated with cesarean delivery, NICE guidelines for surgical site infection, guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis, appropriateness criteria for stress echocardiography and so on. ⋯ When we use the guidelines and checklists correctly, we could see what is happening in a patient and what to do next for the patient leading us to correct diagnosis and appropriate treatment. Thus, evidence-based practice will be established in the near future in the perioperative period.
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As a population ages, an increase in the number of patients with cardiac complications who undergo non-cardiac surgeries is observed. The perioperative mortality for noncardiac surgery is approximately 1-5%; approximately 20-35% of these cases are due to cardiovascular complications. Among them, perioperative myocardiac infarction/ischemia is a factor that leads to poor prognosis, and the ACC/AHA guidelines emphasize this aspect. An important task of the anesthesiologist is to accurately assess risks in patients undergoing noncardiac surgeries and avoid adverse cardiovascular events.
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Case Reports
[Anesthetic management of a patient with moyamoya disease undergoing mitral valve repair].
Moyamoya disease is the result of progressive steno-occlusive changes in the internal carotid arteries followed by formation of bilateral abnormal vascular networks. The disease may present with cerebral ischemia causing cerebral hemorrhage in the perioperative period. There are few reports of cardiac surgeries in patients with moyamoya disease, and the management during cardiopulmonary bypass for moyamoya disease has not been established. ⋯ We maintained the perfusion flow of CPB above 3.0 l x min(-1) x m(-2) and the mean perfusion pressure above 70 mmHg. In addition, we used the pulsatile perfusion assist with intraaortic balloon pumping to maintain cerebral circulation. Postoperative course was uneventful without apparent neurologic deficit, and she was discharged from hospital on 10th postoperative day.
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Case Reports
[Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster].
A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. ⋯ Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess.
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Rapid onset of a muscle relaxant is required for general anesthesia with rapid sequence induction technique. Although a high dose of rocuronium was demonstrated to achieve the rapid onset in non-pregnant persons, it is still unknown whether this is true in women during late pregnancy. The purpose of this study is to compare the onset time of high dose rocuronium between pregnant and non-pregnant women. ⋯ The onset time of high dose of rocuronium in pregnant women was significantly shorter than that of non-pregnant women.