Masui. The Japanese journal of anesthesiology
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Oral rehydration therapy before surgery may be useful for elderly patients in perioperative management especially induction of general anesthesia, as they cannot preserve water in the body sufficiently. In elderly patients oral rehydration therapy is favorable to intravenous hydration as in younger patients. However, if swallowing is impaired or there are risks for aspiration, gastric emptying rate is decreased; gastroesophageal reflux disease is pointed out; cognitive function is disordered; or delirium has appeared, oral rehydration therapy should be carefully considered. It may be necessary to provide preoperative oral rehydration therapy to high risk elderly patients when they are hospitalized and they should be watched for taking oral rehydration solution soon by hospital nurses.
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Excessive bleeding after cardiopulmonary bypass remains a major complication for cardiac surgery. The principal causes of hemostatic bleeding are related to inadequate surgical hemostasis or diluted coagulopathy. We investigated the efficacy of cryoprecipitate (Cryo) transfusion in thoracic aortic surgery with cardiopulmonary bypass. ⋯ Cryoprecipitate transfusion is an effective treatment for coagulopathy caused by dilution of coagulation factors after cardiopulmonary bypass.
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Continuous epidural analgesia has become an accepted technique used in laparotomy including liver resections. Although American Society of Regional Anesthesia and Pain Medicine recommends that epidural catheter be removed with prothrombin time-international normalized ratio (PT-INR) less than 1.5, it is possible that liver surgery causes coagulation disturbances. We examined the postoperative changes in coagulation profiles of living liver donors to elucidate whether hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters or not. ⋯ Our study suggested that hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters, even in the living liver transplant donors with normal liver function.
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Restriction of preoperative clear liquid intake causes thirst in many patients but is followed traditionally for many years in the preoperative order by an anesthesiologist in charge. Although many anesthesiologists doubted long the efficacy of this tradition, no one has stopped. ⋯ In 2005, the report from north European countries was published and introduced the new idea "Enhanced Recovery after Surgery, ERAS" which consists of many factors. Among these factors, the enforcement of preoperative clear liquid intake was reviewed in this volume.
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Although epidural blood patch (EBP) is an effective treatment for postdural puncture headache (PDPH), the adequate blood volume has not been determined. We reported two cases of EBP for PDPH after caesarean section with spinal anesthesia using ultrasound imaging with a 2-5 MHz convex probe. ⋯ In case 2, although the area of the epidural space was unchanged by 17 ml of EBP, contrast of the epidural space was altered in as a mosaic pattern. We conclude that ultrasound imaging is useful to confirm the adequate blood infusion during EBP Therefore, there is a possibility of estimating the optimal blood volume by ultrasound imaging.