Masui. The Japanese journal of anesthesiology
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Patients with cardiac disease have high mortality rates, mainly owing to shock. Therefore, evaluation of cardiac function is one of the most challenging issues in the intensive and critical care unit. Cardiac point-of-care tests using ultrasound, such as focus assessed transthoracic echo (FATE) and rapid ultrasound in shock (RUSH). are useful for diagnosis and initial care of such patients. ⋯ A simple measurement method is described to evaluate the left and right ventricular function using mitral annular plane systolic excursion (MAPSE), mitral septal separation (MSS), and tricuspid annular plane systolic excursion (TAPSE). Next the RUSH protocol is discussed, which is useful for evaluation and care of patients with hypovolemic, cardiogenic, obstructive, or distributive shock. RUSH involves evaluation of the three main components : the pump (cardiac function, volume, pericardial function), the trunk (inferior vena cava, pleural fluid, lining), and the pipes (abdominal aneurysm, aortic dissection, deep vein thrombosis).
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Case Reports
Use of Sugammadex in a Patient with Myotonic Dystrophy Undergoing Laparoscopic Cholecystectomy.
A 37-year-old female patient with myotonic dystrophy was scheduled for laparoscopic cholecystectomy for gall stone under general anesthesia with continuous propofol infusion. Rocuronium was administered with careful monitoring using TOF- Watch®, measuring train-of-four count (Tc), TOF ratio (Tr), and posttetanic count The total amount of rocuronium was 70 mg ; 0.6 mg .kg⁻1 for anesthetic induction and 0.3 mg .kg⁻1 when Tc exceeded 1. When the operation was completed, Tc was 4, Tr was uncountable and she showed reaction to calling her name. ⋯ After 20 minutes of first administration of sugammadex, we extubated the tracheal tube without respiratory depression. To avoid respiratory depression, we did not use postoperative opioids. Intraoperative transversus abdominis plane block and postoperative thoracic epidural block with ropivacaine were successful for postoperative pain relief.
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Historical Article
History of Resuscitation :4. Development of Resuscitation in the Mid-18 Century-4 : External Stimulation to the Body.
From the mid-18th century, several different stimulations were used to attempt to resuscitate apparently dead people. These include sound, smell, and light stimulation to the ear, nose and eyes, rubbing the body surface and spirit given to the oral cavity. ⋯ Galvani. Charles Kite developed the first electrical machine to stimulate the heart, and by 1800, it was found that the most effective site for applying electricity was over the heart.
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Historical Article
[History of Resuscitation: 3. Development of Resuscitation in the Mid-18 Century-3: Artificial Respiration].
In the mid-18th century, resuscitation attempts started of "apparently dead" people as a result of drowning or other causes. In this article, I describe development of artificial ventilation. ⋯ Monro Secundus, Kite and Cullen attempted to ventilate via a tube which was inserted to. the mouth, nose or into the trachea. Gastric insufflation was pre- vented by a plug to the upper esophageal inlet and by cricoid pressure.
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We experienced rocuronium-induced anaphylaxis in a 62-year-old man who was scheduled for laparoscopic ileocecal excision for cecal cancer under general anes- thesia. The patient did not have a preoperative history and examinations suggestive of heart disease, or pre- disposing factors for myocardial infarction. Just after induction of anesthesia, we noticed abnormally low blood pressure and ST segment elevation on his elec- trocardiogram. ⋯ The sur- gery was performed safely with this protocol. It is likely that his symptoms in the first general anesthesia were caused by Kounis syndrome. We conclude that the basophil activation test seems to be valuable in determining the causative agent of anaphylaxis, partic- ularly when a patient does not agree to undergo skin tests.