Masui. The Japanese journal of anesthesiology
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Control of the airway is fundamental for the safe anesthetic practice of head and neck surgery and careful assessment of airway must be undertaken preoperatively. Safe tracheal intubation method should be decided after the airway assessment. ⋯ Emergency anesthesia for neck and head surgery is most difficult. Experienced personnel and several kinds of devices for securing the airway should be gathered in the operating room before induction of anesthesia.
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The advancement of surgical and anesthetic techniques reduced cardiac morbidity and mortality. As a result, the attention has been focused on the perioperative cerebral complication, which contribute to more than 20% of perioperative deaths. Cognitive dysfunction is associated with increased medical costs, decreaged quality of life, and mortality. ⋯ The research including the control group seems to overcome these issues, but still remains to have problems. Further, patients with cardiac disease have comorbid factors to induce postoperative sequelae compared to healthy population. We describe these issues which require continued researches.
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Motor dysfunction following thoracoabdominal aortic surgery remains as one of their devastating postoperative complications. Recently, many studies have provided information for the mechanisms of ischemic spinal cord injuries and for some strategies against spinal cord ischemia in the perioperative period. Especially, advances in stimulation technique using multipulse could make intraoperative monitoring of functional integrity of motor pathways possible by recording myogenic motor evoked potentials. We summarize the strategies for spinal cord protection, including spinal cord functional monitoring and anesthetic techniques during thoracoabdominal aortic surgery.
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Antifibrinolytic therapy is effective in reducing postoperative bleeding and allogeneic transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass. Aprotinin is a bovine serine protease inhibitor which potently inhibits plasmin, and two lysine analogues, epsilon-aminocaproic acid and tranexamic acid, inhibit the activation of plasmin by binding to plasminogen. ⋯ This review article presents a current perspective on the efficacy and safety of antifibrinolytic agents based on the available basic science and clinical data. Further, the hemostatic strategies for complex cardiac surgical patients will be proposed.
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Since the strict blood glucose control by intensive insulin therapy was introduced as a life-saving maneuver, a lot of beneficial effects have been reported. The intensive insulin therapy has also been recommended in cardiac surgeries, particularly with cardiopulmonary bypass (CPB) which often induces hyperglycemia resulting from the excessive stress response. ⋯ These studies indicated that the same target level of blood glucose did not provide the beneficial outcome to all patients, and that the optimal level of blood glucose differed depending on the individual patient and care setting. In order to determine the target level for blood glucose resulting in the lowest risk-to-benefit ratio, we must take into account various factors, such as variability of blood glucose concentration, presence or absence of diabetes, care setting, and perioperative nutritional management.