Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of hip joint fracture surgery in an elderly patient with giant pulmonary artery aneurysm].
We report anesthetic management of an elderly patient with giant pulmonary artery aneurysm undergoing hip joint fracture surgery. Preoperative chest computed tomography showed a main pulmonary artery aneurysm with a maximal size of 55 mm. ⋯ Hypoxemia and hypothermia were avoided for the purpose of preventing an increase in pulmonary vascular resistance. Surgery was uneventful because of anesthetic management considering pulmonary hypertension.
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There are abundant cases of obstetric emergencies demanding prompt intervention. Emergency cesarean sections are classified into stable, urgent and immediate surgeries, although there is significant overlap between three groups. Stable emergency cesarean sections are performed in patients with stable maternal and fetal physiology, but who need surgery before unstability occurs. ⋯ In the event of sustained fetal bradycardia caused by placental abruption, cord prolapse, uterine rupture etc, delivery by immediate cesarean section within 25 minutes improve long-term neonatal neurologic outcome. Although cardiopulmonary arrest in pregnancy is very uncommon, peripartum cesarean section should be considered within 5 minutes not only for maternal resuscitation but for neonatal survival. Only a well-coordinated teamwork of all involved specialities will guarantee optimal prognosis of mother and fetus.
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The annual incidence of aneurysmal subarachnoid hemorrhage (SAH) is approximately 20 per 100,000/ year in Japan, and it is suggested that approximately 40% of SAH patients have poor outcome. Rebleeding after SAH and delayed cerebral vasospasm are the most important causes of poor outcomes. Particularly, rebleeding significantly worsened the outcome, therefore, its prevention is of utmost importance. ⋯ At present, surgical clipping remains the method of choice in Japan. However, there has been growing acceptance that the efficacy of endovascular treatment is comparable to that of surgical treatment, suggesting endovascular treatment should be considered in suitable patients with ruptured cerebral aneurysms. In this report, we describe the proceedures for the standard management of SAH, in particular, treatment of ruptured cerebral aneurysm and selection of treatment measures, according to the Japanese guidelines for the management of aneurysmal subarachnoid hemorrhage.
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Comparative Study
[Comparison of continuous cardiac output measurement methods: non-invasive estimated CCO using pulse wave transit time and CCO using thermodilution].
esCCO (estimated continuous cardiac output, Nihon Kohden, esCCO) is a new cardiac output measurement system which uses pulse wave transit time to calculate cardiac output continuously and non-invasively. One of the most commonly used methods to monitor cardiac output is continuous cardiac output CCO (Edwards Lifesciences) which has an accuracy equivalent to that of thermodilution method. ⋯ This result suggests that esCCO could be used to measure cardiac output accurately and non-invasively in different cases.
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Comparative Study
[Influence of intraoperative fentanyl and remifentanil infusion on early postoperative oral intake after general anesthesia].
There is no reports on influence of intraoperative fentanyl and remifentanil infusion on ability of oral intake after short stay surgery under general anesthesia. ⋯ With or without the use of remifentanil, greater the amount of fentanyl used, greater the percentage of patients unable to eat. Amount of fentanyl used in R group was significantly less than in group NR; however the difference in percentage of patients unable to eat supper was not observed.