Masui. The Japanese journal of anesthesiology
-
Review
[ECMO for the patients with severe respiratory failure associated with ARDS due to influenza].
Although the survival rate of H1N1-related severe respiratory failure following ECMO therapy was high in several countries, the rate in Japan has been low. Efforts should be made to supply suitable equipments, to train the physicians, and to establish transport system for the patient.
-
Randomized Controlled Trial
[Continuous infusion of low-dose remifentanil for palliation of pain with epidural catheterization].
To prospectively determine the safety and effectiveness of continuous infusion of low-dose remifentanil for the reduction of pain in patients for epidural catheterization. ⋯ Continuous infusion of low-dose remifentanil is a safe and effective method for palliation of pain in epidural catheterization.
-
The definition of acute respiratory distress syndrome (ARDS) by American-European Consensus Conference (AECC) in 1994 has promoted clinical and epidemiological research leading to improved survival outcome of the ARDS patients by establishing lung protective ventilation. On the other hand, no pharmacological therapy has yet proved to be effective despite substantial effort devoted to development and research. ⋯ Recently, a randomized trial and clinical experience in treating severe influenza have demonstrated favorable outcome of ECMO therapy in the management of severe ARDS. Future progress will depend on developing novel therapeutics that can ameliorate lung injury and systemic derangements and facilitate lung repair.
-
Case Reports
[A case of prolonged neuromuscular blockade possibly related to a high anti-acetylcholine receptor antibody level].
Prolonged neuromuscular blockade is a relatively common complication of general anesthesia. Some previous reports have shown that positive serum anti-acetylcholine receptor antibody (AChR Ab) might contribute to this complication. ⋯ Although this patient had mediastinal tumor diagnosed as thymic carcinoma two years before the operation, preoperative clinical evaluation was negative for myasthenia gravis (MG) and the tumor was in remission at the operation. These observations suggest that preoperative measurement of anti-AChR Ab level might be recommended for patients with mediastinal tumor regardless of symptoms of MG and that neuromuscular blocking agents should be administrated carefully in anti-AChR Ab positive patients under monitoring of the neuromuscular blockade.
-
Intensive perioperative management is required for adrenalectomy in patients with pheocromocytoma because of the unstable hemodynamics and life threatening cardiovascular disturbances due to catecholamine surge from the neuroendocrine tumors. The aim of this study was to assess the perioperative factors contributing to the hemodynamic changes during surgery in pheochromocytoma. ⋯ The decreases of blood pressure after resections of the central veins are dependent on the perioperative blood NA levels, the level of NA in the perioperative urine testig, and tumor sizes.