[Easy screening of outpatients for atrial fibrillation by analyzing fingertip pulse wave variation].

AIM: Atrial fibrillation (AF), which can lead to cardioembolic stroke, is often not properly diagnosed in hospital outpatient departments or medical clinics. We therefore used a pulse analysis to screen patients for AF, and examined the benefits of using this method in screening. METHODS: We performed screening of the hospital's first-visit and ambulatory patients during the afternoon in 2014 (total number, 50,875; true number, 16,356), mainly targeting patients older than 65 years of age. Among the true number of outpatients, the device was used on 5,013 patients, 8,656 times. We independently developed a pulse analysis software application which analyzed the pulse interval variation. We assessed the accuracy of this analytical method in the detection of AF. RESULTS: AF was detected in 56 patients, who were considered for or introduced to anticoagulation treatment. In their cases, the method was considered useful for detecting undiagnosed or untreated AF. This figure amounts to 0.34% of all outpatients and 1.1% of the patients who were screened in 2014. The average age was 76.9±7.7 years, 67.9% of the patients had a CHADS2 score of more than 2, half had a history of arrhythmia in the past, and 37.5% were first-visit patients. The sensitivity of the device used was 89.7%. CONCLUSIONS: Using the method described in this study, we detected asymptomatic AF in numerous patients, and demonstrated that this method is potentially useful in screening outpatients for asymptomatic AF.

[Case of general anesthesia combined with epidural anesthesia in a pregnant woman undergoing thoracotomy for spontaneous pneumothorax].

General anesthesia combined with epidural anesthesia for thoracotomy due to spontaneous pneumothorax was given to a pregnant woman at 21st week of gestation. She was premedicated intravenously with famotidine 20 mg and metoclopramide 10 mg. Mepivacaine 1% was administered through a thoracic epidural catheter. General anesthesia was induced by thiamylal 225 mg, vecuronium 8 mg and fentanyl 100 mcg, and maintained by sevoflurane, vecuronium and fentanyl. Endobronchial intubation with a 35Fr Bronchocath double-lumen tube was successful and one-lung ventilation was commenced to maintain the end-expiratory CO2 pressure at 30 to 35 mmHg with Sp(O2) remaining 100%. Ephedrine 16mg (in 4mg increments) was required to maintain systolic blood pressure above 100 mmHg. After the surgery, ropivacaine 0.2% was administered through the catheter. There were no clinical signs of fetal distress during the perioperative period. Postoperative pregnancy and delivery were uneventful. We succeeded in the anesthetic management by avoiding hypoxia, hypercapnia, hypocapnia and hypotension during the surgery.

The use of droperidol decreases postoperative nausea and vomiting after gynecological laparoscopy.

We evaluated whether or not routine prophylaxis with 2.5 mg of droperidol would efficiently prevent postoperative nausea and vomiting (PONV). Fifty-two patients scheduled for elective gynecological laparoscopic surgery were eligible for this study. Anesthesia was induced using propofol, fentanyl, and vecuronium, and maintained with sevoflurane in nitrous oxide, fentanyl, and vecuronium. Patients were randomized to one of two groups: group 1 patients (n = 23) received 2.5 mg droperidol intravenously when the surgery was started, while group 2 patients (n = 29) did not receive any droperidol. At the conclusion of the surgery, the patient was extubated on satisfactory emergence from general anesthesia. Any episodes of nausea and vomiting, rescue medications, and adverse effects were recorded until the next morning after the surgery. There were no differences in the duration of anesthesia on surgery between the groups, but the total fentanyl dose in group 1 was higher than that in group 2. Episodes of nausea and vomiting and the need for metoclopramide in group 1 were lower than in group 2, though the total fentanyl dose in group 1 was higher than in group 2. There were no differences in the need for analgesics between the groups. The use of 2.5 mg droperidol safely decreased PONV after gynecological laparoscopy.

[Ambulatory anesthesia preoperative evaluation and its effects on anesthetic care].

BACKGROUND: Adequate preoperative evaluation with sufficient informed consent from patients will lead to safe perioperative anesthetic managements. We started outpatient preoperative evaluation from October, 2002. METHODS: We investigated 1137 elective cases operated during one year after starting outpatient examination. They were compared with 1083 cases under the previous system. On requests from surgeons we examined the patients and obtained informed consents. Additional examinations and medications were ordered if necessary for adequate preoperative management. RESULTS: Eight hundred and twenty-three cases (72.4%) of 1137 elective operative cases visited our outpatient booth and 86.8% of them visited before admission for the surgery. Patients classified into ASA-PS II-III, 550 cases (66.9%), and their major complications were cardiovascular and pulmonary diseases. Two hundred and ninety seven cases (36.1%) required additional examinations following adequate preoperative management by another consultants. After the introduction of this system, the number of postponing or cancellation of operation after hospitalization was only 1.3% of elective operations. Furthermore the number of patients admitted on the day and the day before the operation significantly increased compared with those under the previous system (27.9 - 45.2%). CONCLUSIONS: Our preoperative consulting system will decrease average length of hospital stay and improve the quality control of patients before surgery.

[Evaluation of our manual for prevention of perioperative pulmonary embolism].

All patients scheduled for surgical procedures were divided into three groups depending on risk grade for pulmonary embolism (PE) in our hospital from August, 2001. Based on our experience of two PE cases after gynecologic surgery, we introduced the perioperative manual for prevention of PE from April, 2003. According to the manual criteria, we could decide indications for the physical prophylaxis or anticoagulant preventive treatment for the patients. In spite of introduction of the manual, two cases of PE occurred after femoral head prosthetic replacement for femoral head fracture patients classified low risk group in our criteria. The Japanese guideline for prevention of venous thromboembolism was published in January, 2004, but even low risk group patients were candidates for PE depending on the surgery and the situation. Even after installation of the guideline for PE, careful perioperative examination is mandatory to prevent and treat PE.