Masui. The Japanese journal of anesthesiology
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Bispectral index (BIS) monitoring has been used since the 1990 s, and many studies on BIS monitoring have demonstrated its usefulness and safety. Currently, BIS monitoring has become indispensable for observation of patients under general anesthesia. However, we observed the development of postoperative skin lesions in 13 patients (11 female and 2 male; age range, 14-76 years) resulting from contact with the BIS electrodes between May 2012 and April 2013. ⋯ The skin lesions resolved within 1 week without scaring following the application of a steroid-containing ointment. Although the occurrence of such skin complications is rare, some patients may experience postoperative anxiety because skin lesions caused by BIS electrodes are noticeable. Therefore, both the usefulness of BIS monitoring and the potential skin complications should be explained to patients preoperatively prior to obtaining patient consent.
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The use of epidural anesthesia for ablominal aortic replacement surgery may be problematic because of the amount of heparin used during the procedure, which places the patient at increased risk of epidural hematoma. We evaluated its benefits, risks, postoperative outcomes and costs. ⋯ Epidural anesthesia during abdominal aortic replacement facilitated more rapid extubation, but did not appear to influence other aspects of patient recovery or ICU costs.
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Case Reports
[Successful Subarachnoid Phenol Block Therapy in a Patient with Pelvic Tumor-related Rectal Tenesmus].
We report a successful case of subarachnoid phenol block therapy in a patient with refractory rectal tenesmus caused by metastatic breast cancer. A 50-year-old woman with pelvic metastasis of breast cancer had the constant desire for defecation and anal discomfort, although analgesics including opioids relieved her from low abdominal and anal pain. Computed tomography revealed rectal invasion of metastatic breast cancer and the diagnosis of tumor-related rectal tenesmus was made. ⋯ Subarachnoid phenol block in the sitting position, which was neurolytic saddle block and expected to inhibit rectal reflex, was performed and her symptom was dramatically relieved. The effect of the block continued until she died 19 days after. To our knowledge, we first report subarachnoid phenol block therapy for a patient with pelvic-tumor related rectal tenesmus.
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We have noticed the possibility that preoperative spirometry may discover latent COPD patients. When COPD is discovered before operation, we can start to treat COPD promptly. Consequently, the better perioperative care is given to COPD patients. On discharge, patients are referred to their family doctors, so that they can receive COPD treatment. ⋯ Latent COPD patients can be discovered by preoperative spirometry.
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MAC is often required for pediatric examinations outside of operating room. It is difficult to conduct MAC for pediatric population safely. ⋯ This proposal consists of six parts; 1. informed consent 2. pre-sedation patient assessment, 3. back-up team for emergency, 4. pre-sedation NPO, 5. patient monitoring, and 6. post-sedation care. Anesthesiologists are expected to play supervisor roles of sedation operation to make the sedation environment safe, even though they can not conduct sedation by themselves.