Masui. The Japanese journal of anesthesiology
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A 77-year-old man scheduled for coronary artery bypass grafting underwent left superficial temporal artery-middle cerebral artery anastomosis (STA MCA). Before anesthesia, we planned to insert an intraaortic balloon pump as a perioperative circulatory assist. In addition, a fiberoptic catheter was inserted in the proximity of the right jugular bulb to monitor jugular venous oxygen saturation (Sjv(O2)) as an index of the balance between cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2). ⋯ Sjv(O2) is normally approximately 55-75%. If Sjv(O2) is < 50%, therapy (s) directed at increasing CBF and/or decreasing CMRO2 should be initiated. Sjv(O2) monitoring can be used to determine the minimal blood pressure that should be maintained to avoid cerebral ischemia in the case of STA-MCA.
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A 31-year-old female, with 22 weeks of pregnancy, presented with sudden onset of severe headache. CT scan showed diffuse subarachnoid hemorrhage. A cerebral angiogram showed dissecting aneurysm of right cerebral artery. ⋯ The patient underwent percutaneous tansluminalangioplasty coil and intraarterial injection of fasudil hydrochloride under local anesthesia. The consciousness recovered fully and the paralysis was improved. The patient delivered the baby by Caesarean sections under combined spinal and epidural anesthesia at 36 weeks without any problems with both the mother and baby.
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Previous reports indicate that Prader-Willi syndrome may present various problems during anesthesia and the perioperative period. We retrospectively investigated anesthesia records of 10 patients (2 adults and 8 children) who were diagnosed to have Prader-Willi syndrome, and who had an operation under anesthesia. Three patients had small mouths, small jaws or both. ⋯ Difficult tracheal intubation occurred in one patient. No other major problems occurred. We conclude that the incidence of problems during anesthesia and postoperative period in patients with Prader-Willi syndrome would be less than previously considered.
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We report a successful awake tracheal intubation in an emergency patient with acute exacerbation of aortic stenosis using the Pentax-AWS Airwayscope (AWS). An 83-year-old woman was admitted to our emergency department for severe dyspnea due to exacerbation of aortic stenosis. Her Sp(O2) was 92-93% even after administration of 10 l x min(-1) oxygen through a reservoir-attached face mask. ⋯ The AWS allowed for visualization of the glottis and safe placement of the tracheal tube. Sufficient spontaneous ventilation was maintained during interventions with minimum vital sign changes. Awake intubation in the sitting position with the AWS may be helpful in resolving cardiovascular crisis in patients unable to maintain the supine position.
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Randomized Controlled Trial
[Effectiveness of local cooling and lidocaine administration for prevention of pain upon injection of propofol].
Propofol is commonly used for induction and maintenance of anesthesia, but pain at the site of intravenous injection is a clinical problem. We studied the effectiveness of local cooling and pretreatment with lidocaine for prevention of injection pain of propofol. ⋯ The results suggest that cooling and pretreatment with lidocaine reduce the incidence of pain upon propofol injection.