[Ultrafast-track Anesthesia (UFTA) in the Operating Room and the Anesthetic Management for Off-pump Coronary Artery Bypass (OPCAB)].

Currently, the immediate extubation in the operating room is necessary for the patients undergoing off-pump coronary artery bypass (OPCAB). To achieve UFTA, anesthesiologists should control general anesthesia. We report the case series of UFTA for the patients undergone OPCAB at our hospital. Forty patients receiving OPCAB between April 2012 and April 2014 were retrospectively analyzed. We divided the patients into those extubated in the operating room (Extubation group) and those not (Intubation group). The extubation criteria included adequate revascularization, adequate hemostasis, ratio between Pa(O2) and FI(O2) more than 250, body temperature above 36 degrees C, stable hemodynamics without noradrenaline, without IABP, and normal postoperative chest X-ray. Twenty-three patients (70% of the scheduled and 20% of the emergency patients) were included in our criteria and could be extubated in the operating room. One patient was re-intubated due to asthma attack following extubation in the operating room. The sucess rate of immediate extubation was 95.7% by our criteria. There were no significant differences in age, sex, BMI, duration of anesthesia, and amount of hemorrhage between the 2 groups. We believe that UFTA for OPCAB patients may be possible under carefull decision by extubation criteria.

[Extended resection for a huge retroperitoneal malignant paraganglioma-a case report].

A 74-year-old man was transferred to our institute because of a huge abdominal tumor in April 2012. Computed tomography (CT) showed the presence of a huge retroperitoneal tumor, 20 cm in diameter. The tumor directly infiltrated the right kidney, the liver, and the inferior vena cava. Obstruction of the hepatic hilum and right hydronephrosis in the near future was predicted, and therefore, immediate surgical intervention was selected. Extracorporeal circulation was essential for complete tumor removal. The tumor was removed en bloc together with the right lobe of the liver, the right kidney, the ileocecal portion, and the retrohepatic vena cava. Histopathological examination indicated a diagnosis of paraganglioma. Two months after surgery, CT showed a recurrent lesion at the resected surface of the pelvic cavity. Additional radiotherapy was ineffective, and the patient died 6 months after surgery.

Intraoperative fluorescence imaging system for on-site assessment of off-pump coronary artery bypass graft.

OBJECTIVES: The aim of this study was to evaluate the intraoperative fluorescence imaging (IFI) system in the real-time assessment of graft patency during off-pump coronary artery bypass graft. BACKGROUND: Intraoperative fluorescence imaging is an intraoperative angiography-like imaging modality using fluorescent indocyanine green excited with laser light. Recently, assessment of graft patency using the IFI system was introduced into clinical use. The feasibility and efficacy of IFI technology in off-pump coronary artery bypass graft has not been systematically compared with other conventional diagnostic modalities. METHODS: Patients undergoing off-pump coronary artery bypass graft received IFI analysis, intraoperative transit time flowmetry, and postoperative X-ray angiography. In off-line IFI analysis, the graft washout was classified based on the number of heartbeats required for indocyanine green washout: fast washout (15 beats). RESULTS: A total of 507 grafts in 137 patients received IFI analysis. Of all the IFI analyses, 379 (75%) grafts were visualized clearly up to the distal anastomosis. With regard to anastomosis location, anterior location was associated with a higher percentage of fully analyzable images (90%). More than 80% of images were analyzable, irrespective of graft type. Six grafts with acceptable transit time flowmetry results were diagnosed with graft failure by IFI, which required on-site graft revision. All revised grafts' patency was confirmed by post-operative X-ray angiography. Conversely, 21 grafts with unsatisfactory transit time flowmetry results demonstrated acceptable patency with IFI. Graft revision was considered unnecessary in these grafts, and 20 grafts (95%) were patent by post-operative X-ray angiography. Compared with slow washout, fast washout was associated with a higher preoperative ejection fraction, use of internal mammary artery grafts, and anterior anastomosis location. CONCLUSIONS: The IFI system enables on-site assessment of graft patency, providing both morphologic and functional information. This technique may help reduce procedure-related, early graft failures in off-pump bypass patients.