Masui. The Japanese journal of anesthesiology
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There are still legal and ethical problems relating to the refusal of blood transfusion due to religious belief of Jehovah's Witness patients. Since general consensus about the anesthetic management of these patients has not been established, the "Guidelines for refusal of blood transfusion on religious grounds" was proposed by the joint committee including Japanese Society of Anesthesiologists in February 2008. The principle of the guideline is that if a patient, who refuses blood transfusion even at cost of life, is 18 years old or above and competent to understand the medical treatment and the adverse effects due to bloodless medicine, doctors may plan and complete bloodless surgery. ⋯ In other cases, the policy of life-saving blood transfusion should be explained to the patients. If a bloodless surgery is planned, precise perioperative strategies to avoid blood loss have to be carried out with the cooperation of all the physicians who care the patient. Anesthesiologists should be carefully prepared for the possible law suits that might lead to unexpected outcomes.
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Randomized Controlled Trial Comparative Study
[Remifentanil provides fast recovery and hemodynamic stability in laryngomicrosurgery anesthesia].
Stressful procedures such as intratracheal intubation and direct laryngoscopy in very short operations make anesthetic management for laryngomicrosurgery difficult. This study was conducted to evaluate which anesthetic agent, remifentanil or fentanyl, is suitable in anesthesia for laryngomicrosurgery. ⋯ Remifentanil provided faster recovery and hemodynamic stability. Therefore, remifentanil seems to be more suitable than fentanyl in anesthesia for laryngomicrosurgery.
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Case Reports
[Anesthetic management of an adult patient with Fontan circulation for laparoscopic surgery].
Advances in the surgical and medical management of children with congenital heart disease have decreased the mortality of these patients. As a result, more patients are surviving into adulthood and are presenting for noncardiac surgery. We experienced a case of anesthetic management of an adult patient with Fontan circulation for laparoscopic surgery. ⋯ Throughout the operation, including the period of pneumoperitoneum, the hemodynamic status remained stable, and adequate oxygenation and ventilation were maintained. The surgery ended uneventfully, and the trachea was extubated in the operating room. In anesthetic management of patients with Fontan circulation for laparoscopic surgery, it is important to understand the physiology of the circulation, and consider the influence of the pneumoperitoneum on the hemodynamics.
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To determine the learning process in endotracheal intubation using the Macintosh laryngoscope, we investigated time needed for instrumentation and rate of erroneous esophageal intubation. ⋯ Two month training course for anesthesia management in our institution seems to be insufficient for learning skills in endotracheal intubation. It is most likely to require 6 months to acquire the sufficient skill in endotracheal intubation.
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Multicenter Study
[Long-term efficacy and safety of pregabalin in patients with postherpetic neuralgia: results of a 52-week, open-label, flexible-dose study].
The efficacy of pregabalin was demonstrated in a randomized double-blind placebo-controlled 13-week trial in 371 Japanese patients with postherpetic neuralgia (PHN). In this study, we evaluated the long-term efficacy and safety of pregabalin for relief of PHN. ⋯ These results suggest that long-term treatment of pregabalin may be beneficial in patients with PHN.