Masui. The Japanese journal of anesthesiology最新文献

Background: The purpose of this study was to compare the perioperative management of aortic valve replacement combined with coronary artery bypass grafting (AVR+CABG) and transcatheter aortic valve implantation combined with off-pump coronary artery bypass grafting (TAVI+OPCAB).

Methods: A retrospective analysis was performed on patients who had undergone either AVR+CABG or TAVI+OPCAB for AS and CAD in Osaka Univer- sity Medical Hospital from January to October, 2014.

Results: AVR+CABG was performed in 11 pa- tients (group A) and TAVI+OPCAB was performed in 4 patients (group T) in this period. The patients in group T was significantly older than the patients in group A. There were no significant differences in other background factors. Procedure time and postoperative mechanical ventilation time were shorter in group T than in group A. Postoperative recovery was signifi- cantly faster in group T than in group A.

Conclusions: TAVI+OPCAB is less invasive than AVR+CABG and an effective treatment for high risk patient with AS and CAD.

We report the development of a multi-center/multi- specialist perioperative team development training program about respiratory surgery. Participants were members of the team, including anesthesiologists, respiratory surgeons, and operation nurses. A ques- tionnaire survey was conducted prior to course partici- pation to clarify any questions team members had. The courses included a lecture and simulation training with scenario-based discussions or the use of a simulator. Scenarios included massive bleeding during pulmonary artery damage, intractable hypoxia during one lung ventilation, and severe hypotension accompanied with hypoxia after tracheal extubation. We also discussed the best method for preoperative smoking cessation for better surgery outcome. After each course, participants discussed problems associated with perioperative medi- cal safety of respiratory surgery in the context of each theme. Simulation-based perioperative team training with anesthesiologists, respiratory surgeons, and opera- tion nurses may serve as a vehicle to promote periop- erative obstetrics safety.

We experienced two cases of large gynecological tumor resection with co-existing deep vein thrombo- embolism (VTE) and pulmonary thromboembolism (PTE). Despite perioperative anticoagulation, one of the two patients developed dyspnea with massive PTE postoperatively, although the other patient did not have any postoperative complications. To prevent fatal mas- sive PTE, temporary inferior vena cava (IVC) filter might have been effective during perioperative period in these cases. Since there are wide variations among institutes regarding the perioperative application of temporary IVC filters for patients with co-existing VTE and/or PTE before surgery, guidelines or recom- mendations for appropriate usage of perioperative IVC filter are necessary.

Background: Patients with mobile teeth are at an increased risk of tooth injury related to tracheal intu- bation. Although the presence/absence of mobile teeth is confirmed through interviews during preoperative visits, patients are frequently unaware of the presence of such teeth. In our facility, dental consultation is pro- vided for all patients undergoing thoracoscopically- assisted surgery as part of the management of oral hygiene. This study examined the presence/absence of mobile teeth reported by patients during preoperative visits and those identified on dental consultation, focus- ing on the inconsistency between them.

Methods: Patients who had undergone thoraco- scopically-assisted surgery in our facility between Janu- ary and October 2014 were retrospectively studied. Tooth mobility was evaluated using the Miller index.

Results: Among the 76 (46 males and 30 females) patients aged 36 to 88 (mean: 67.8), mobile teeth were identified on dental consultation in 13 and reported during preoperative visits by 8.

Conclusions: Based on this findings, it may be nec- essary to pay sufficient attention when inserting tubes even when mobile teeth have not been reported by patients during preoperative visits.

We present a case of massive air inflow into the left ventricle from the right ventricle through a small intraventricular shunt detected by transesophageal echocardiography (TEE). This case suggests that TEE plays an important role in the right ventricle-pulmo- nary artery conduit re-replacement.

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. It was already rec- ognized in the mid-18th century that early initiation of artificial ventilation was the main factor for successful resuscitation. The oldest remaining record of mouth-to- mouth resuscitation performed was on November 11th 1732, by William Tossach, and John Fothergill in Edin- burgh, and this encouraged lay people to do this pro- cedure. 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.

We report a case of well leg compartment syndrome (WLCS) in both legs after robot-assisted laparoscopic prostatectomy (RALP). A 65-year-old man underwent surgery for prostate cancer. He was placed in the lithotomy position and both his legs were protected with elastic stockings and intermittent pneumatic com- pression to prevent deep vein thrombosis during sur- gery. After surgery, he complained of pain in both calves. Movement and sensory disorder along with swelling were found in both legs. Computed tomogra- phy of the legs showed damage to the soleus and gas- trocnemius muscles of both legs. The creatinine phos- phokinase level had increased to 10,560 IU · l⁻¹. The patient was diagnosed with WLCS in both legs and underwent conservative treatment. Symptoms in both legs started to improve from the next day. The right leg swelling receded within 10 days, while the left leg swelling receded 67 days after surgery. WLCS in the legs after RALP is a rare but severe complication requiring early diagnosis and intervention. To prevent WLCS, it is important that we recognize this disease as a potential complication after RALP.

This is a case report of a patient who died from acute aortic dissection after awake intubation. An 86-year-old woman with neck abscess causing dyspnea and hypertension was scheduled for a tracheotomy. Awake intubation was chosen and fentanyl 150 μg was injected first Immediately after intubation using a McGRATH® scope, her blood pressure increased to 205/157 mmHg and about 5 minutes after induction following intubation, end-tidal CO₂ suddenly decreased. Aortic dissection was found with transesophageal echocardiography, and soon after, the electrocardio- gram of the patient showed an asystole. The patient was confirmed dead after effort to resuscitate. Chest CT revealed the wide range of aortic dissection from the aortic arch to the abdominal aorta. Hemodynamic change occurs at the time of intuba- tion, and its change is greater in elderly and those with hypertension. Furthermore, an interrelation between apnea and aortic dissection or large diameter of aneu- rysms has been reported. Therefore, anesthesia for elderly, especially those with hypertension, requires greater attention to their hemodynamic changes.

Atrial arrhythmia is an important prognostic factor in patients undergoing the Fontan operation. Although catheter ablation is considered to be a curative treat- ment the anatomical constraints produced by extra- cardiac total cavopulmonary connection make it diffi- cult to insert catheters towards the right atrium. Mag- netic navigation systems enable safer catheter delivery to the target site in such cases. Catheter ablation was carried out under the guidance of a magnetic naviga- tion system after the Fontan conversion operation in a 39-year-old female patient with persistent atrial tachy- cardia for the first time in Japan. During a 3-hr period of atrial tachycardia (AT), the patient's hemodynamic status was severely compromised ; her systemic blood pressure fell below 80 mmHg, and her central venous pressure increased to 26 mmHg. After the termination of AT, the patient's hemodynamic status was normal- ized without any complications. The procedure was successful, and the patient was discharged as sched- uled. The number of catheter ablation procedures in patients with arrhythmia after the Fontan procedure is expected to increase as patients with complex congen- ital heart defects are surviving longer. It is important to clarify the issues associated with this procedure and establish a safe anesthetic management strategy based on hemodynamic data.

Von Recklinghausen disease is an autosomal domi- nant neurocutaneous disorder, characterized by cuta- neous neurofibromas, accompanied by café-au-lait spots. We report a case of a 51-year-old man with von Recklinghausen disease who had been operated on for thoracic and spinal neurofibroma. Exploratory thoracotomy was performed under general anesthesia combined with epidural anesthesia. After tracheal intubation with spiral tube, one lung ventilation was performed using blocker tube. General anesthesia was maintained by inhalation of oxygen, air, and desflurane and the continuous infusion of remifentanil. The opera- tive course was uneventful. The patient emerged from general anesthesia smoothly, and was extubated safely. There was no neurological abnormality after operation. Preoperative evaluation of airway status and neuro- logical findings are essential in the anesthetic management of the patient with von Recklinghausen disease. This case suggests that we must take the complication into account for anesthetic management and select the appropriate anesthetic method by routine preoperative estimation. It is of great importance that anesthesiologists evaluate the airway status and neurological find- ings of patients with von Recklinghausen disease.