Masui. The Japanese journal of anesthesiology
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Today many aspects of neuromuscular block should adequately be assessed. Post-tetanic count is applied for evaluating intense neuromuscular block and double burst stimulation for residual neuromuscular block. However, very profound neuromuscular block can not be evaluated using the post-tetanic count, and in addition, adequate level of recovery from neuromuscular block can not be identified using the double burst stimulation. Post-tetanic burst and double burst stimulation are thought to be useful for quantifying intense and residual block, respectively.
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Intraoperative transesophageal echocardiography (TEE) has a wide range of applications including monitoring of left ventricular (LV) function, evaluation of natural and prosthetic valves, detection of intracardiac thrombus, mass and vegetation, assessment of surgical repair of cardiac disease, visualization of intracardiac air, positioning of an intraaortic balloon and a coronary sinus catheter, evaluation of thoracic aortic lesions, and so on. Complications are very rare with TEE, but damage of the esophagus or stomach can occur. Gentle manipulation of the TEE probe is always required. ⋯ Assessment of RWMAs is thus very useful for diagnosis of ischemia. Although RWMAs are not always caused by acute ischemia, a new onset of RWMAs, as seen during surgery, almost certainly indicates myocardial ischemia. TEE also allows evaluation of LV diastolic function by analyzing the transmittal flow velocity.
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Most general anesthetics, opioids, sedatives and local anesthetics perturb thermoregulatory responses. Accordingly the core temperatures triggering sweating, thermoregulatory vasoconstriction and shivering are varied in perioperative periods. Redistribution hypothermia is a quite common phenomenon during not only general anesthesia but epidural/spinal anesthesia. ⋯ However, obtaining effective decrease of core temperature is sometimes difficult because of thermoregulatory vasoconstriction. Subsequently, vasodilation therapy with appropriate drugs is now under investigation. Hypothermia per se causes critical complications in patients, and the maintenance and warming method to maintain normothermia is important in perioperative period.