Masui. The Japanese journal of anesthesiology
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Perioperative fluid management for cases with severely compromised cardiac function undergoing major non-cardiac surgery remains a challenge. Dynamic parameters such as stroke volume variation (SVV) and cardiac index obtained by arterial pulse contour analysis may not be sufficient for fluid optimization because individualized optimal parameter values are difficult to determine in cardiac patients. We report two cases of abdominal surgery with severe pre-existing impairment of cardiac function (ejection fraction < 30%) complicated by severe pulmonary and renal dysfunction. ⋯ In Case 2, cardiac index and stroke volume index remained unchanged despite the decrease of SVV after colloid bolus infusion. Infusion of dobutamine was useful for maintaining the ScvO2 above 75% in a rather hypovolemic state (SVV of 10-15%). Our cases suggest that the use of central venous oxygen saturation together with arterial pulse contour analysis may aid decision-making for individualized fluid optimization and use of inotropics in severely compromised cardiac patients undergoing major abdominal surgery.
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Anaphylaxis during anesthesia is a rare but life-threatening event. Sugammadex is a recently introduced drug that was specifically designed for the reversal of rocuroium and vecuronium-induced neuromuscular block. ⋯ Initial management consisted of fluid administration and intermittent i.v. ephedrine, epinephrine, and hydrocortisone. The patients made uncomplicated recovery and were discharged.
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Comparative Study
[Bladder temperature versus tympanic temperature in patients undergoing abdominal aortic aneurysm surgery].
Inaccurate measurements of body temperature might be associated with complications during the perioperative period. We conducted a retrospective cohort study to compare the bladder temperature and the tympanic membrane temperature in patients undergoing open repair of abdominal aortic aneurysm. ⋯ The tympanic membrane might be a reliable site for core body temperature measurement in abdominal aortic aneurysm surgery patients.
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We describe a case of dextran-induced anaphylactic shock during general anesthesia. A 34-year-old woman was scheduled for partial hepatic resection under general anesthesia. General anesthesia was induced with intravenous remifentanil, thiamylal and rocuronium, and was maintained with oxygen, air, sevoflurane and remifentanil. ⋯ The patient's blood pressure and oxygen saturation immediately improved, and the operation was resumed. No postoperative complications were evident, and the postoperative course was uneventful. Although low molecular weight dextran is often used as plasma expander or to prevent thromboembolism, it can cause severe hypotension or bronchospasm during general anesthesia.
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The endovascular repair of thoracic aortic aneurysm and abdominal aortic aneurysm has become a promising alternative for open surgical graft replacement. The benefits of EVAR include less invasiveness, no need for cardiopulmonary bypass or differential lung ventilation, less blood loss, shorter hospital stay and reduced perioperative morbidity and mortality. ⋯ Previous abdominal aortic aneurysm repair, prolonged hypotension, severe atherosclerosis of the thoracic aorta, injury to the external iliac artery, and more extensive coverage of the thoracic aorta by the graft are reported to be the risk factors for paraplegia after TEVAR. In such cases, strategies to protect the spinal cord from ischemia including lumbar cerebrospinal fluid drainage should be taken.