[Anesthetic management for hip joint fracture surgery in an elderly patient with untreated polycythemia vera].

The author report anesthetic management of an elderly patient with untreated polycythemia vera undergoing hip joint fracture surgery. Hydroxycarbamide was administered for erythrocytosis and thrombocytosis before surgery. Antithrombotic treatment with warfarin, aspirin and physical therapy, was continued during perioperative period. Surgery was performed under general anesthesia with hematocrit below 50% and platelet below 500 thousand x microl(-1). Hypovolemia was avoided to prevent hemoconcentration. No complication occurred perioperatively, although a high proportion of patients with polycythemia vera are complicated with vascular occlusion and major hemorrhage.

[Anesthetic management of hip joint fracture surgery in an elderly patient with giant pulmonary artery aneurysm].

We report anesthetic management of an elderly patient with giant pulmonary artery aneurysm undergoing hip joint fracture surgery. Preoperative chest computed tomography showed a main pulmonary artery aneurysm with a maximal size of 55 mm. Surgery was performed under spinal anesthesia and adequate sedation with propofol. Continuous infusion of milrinone, phosphodiesterase 3 inhibitors, was given intravenously during anesthesia. Hypoxemia and hypothermia were avoided for the purpose of preventing an increase in pulmonary vascular resistance. Surgery was uneventful because of anesthetic management considering pulmonary hypertension.

[Preoperative NT-proBNP predicts perioperative cardiac events in hip joint fracture surgery of the elderly].

BACKGROUND: We investigated retrospectively the association between preoperative NT-proBNP and perioperative cardiac events in hip joint fracture surgery of the elderly. METHODS: We studied 137 patients aged >75 years who had undergone hip joint fracture surgery between April 2010 and March 2011. All patients were assigned to one of three groups; NT-proBNP<300 pg x ml(-1) of low risk group, NT-proBNP 300-1,800 pg x ml(-1) of medium risk group and NT-proBNP>1,800 pg x ml(-1) of high risk group. RESULTS: Intraoperative vasopressor agents were needed significantly more in high risk group than low and medium risk groups. Moreover, postoperative hypotension and congestive heart failure occurred only in high risk group. CONCLUSIONS: We demonstrated that preoperative NT-proBNP>1,800 pg x ml(-1) was related to perioperative cardiac events in hip joint fracture surgery of the elderly.

[Trial of preoperative consultation in outpatient clinic at a medium sized hospital].

BACKGROUND: Sometimes surgery is cancelled due to insufficiency of preoperative risk management by consultation of anesthesiologist on the day before surgery. We reported achievement of preoperative consultation in outpatient clinic at a medium sized hospital for three years. METHODS: Reservation to our clinic was performed by surgeons, when they judged that early consultation by anesthesiologist was needed by various reasons, for example severe complications and problem of past anesthesia. RESULTS: Among 737 surgical patients, 49 patients (6.6%) were consulted in our clinic and surgery was cancelled in 8 patients (16.3%). Among 688 patients who were not consulted in our clinic, we judged that early consultation was needed in 12 patients (1.7%) and surgery was cancelled in 2 patients. CONCLUSIONS: As preoperative consultation in outpatient clinic became appreciated, no patient was cancelled on the day before surgery. Moreover, our trial of preoperative consultation in outpatient clinic contributed to establishment of good relationship of anesthesiologists with surgeons and patients.

[Postoperative management of carotid endarterectomy with dexmedetomidine--a comparison with propofol].

BACKGROUND: We compared dexmedetomidine (DEX) with propofol (PRO) in patients requiring sedation after carotid endarterectomy (CEA) in the intensive care unit (ICU). Incidence of hyperperfusion syndrome, the sedative and analgesic properties, cardiovascular responses, and ventilation characteristics were discussed. METHODS: On arrival in the ICU, 66 patients were randomized to receive sedation with either DEX (0.2-0.7 microg x kg(-1) x hr(-1)) or PRO (1-3 mg x kg(-1) x hr(-1)) infusions. Additional analgesia was provided and patients were ventilated mechanically, if needed. RESULTS: No hyperperfusion syndrome occurred in either group. Eight patients in the DEX group required additional PRO infusions because of insufficiency for sedation. Patients receiving PRO infusions required significantly more analgesic agents and artificial ventilation than patients receiving DEX (P<0.05). Eleven patients in the PRO group required dopamine infusions because of hypotension. CONCLUSIONS: DEX is a safe and acceptable sedative agent for patients requiring sedation after CEA in the ICU; however, further studies are needed to assess the appropriate sedative doses of DEX.

[Laryngeal edema and vocal cord paralysis due to lithium battery ingestion; a case report].

We report a case of an 8-year-old boy with laryngeal edema and vocal cord paralysis due to lithium battery ingestion. He had ingested a lithium battery of a television remote controller, and was admitted to our hospital. He was suffering from wheezing and retractive respiration with crying. The foreign body was removed under general anesthesia about two hours after the ingestion. It was a 3 volt lithium battery of 20 millimeters in diameter. Endoscopy showed chemical burn of the postcricoid area and severe edema of the laryngeal arytenoids. Twelve days later we confirmed healing of edema and extubated the tracheal tube, but endoscopy showed bilateral vocal fold paralysis. He had no difficulty in breathing and eating but the vocal cord paralysis remained. Lithium batteries ingestion may cause severe airway injury in a short period because of their large size and high voltage. Immediate removal and careful management are required.