Perioperative Stage Research Articles

未破裂脳動脈りゅうに対する血管内治療を含めた治療方針

We investigated the indications for endovascular treatment of unruptured cerebral aneurysms based on the natural history reported in ISUIA and our treatment results. At Nagoya University hospital and affiliated hospitals over 7 years we treated or attempted embolization for 383 unruptured aneurysms, including 301 asymptomatic and 82 symptomatic ones. Among them, 326 were treated with embolization and 57 were left untreated due to the high risks involved. Ruptures during the follow-up occurred in 2 symptomatic cases without treatment. We experienced 28 technical complications including 9 hemorrhagic, 14 ischemic and 4 others at the intra- and perioperative stage, in addition to 14 recanalizations at the delayed stage. The rate of morbidity associated with procedure was 4.0%. There was a high risk of hemorrhagic complications from a tiny anterior communicating artery aneurysm and ischemic complications in the middle cerebral, basilar-tip, and vertebral dissecting aneurysms with a hypoplastic posterior inferior cerebellar artery. As for the symptomatic aneurysms, although 72 patients had a good outcome, symptoms due to mass effects did not improve in 19 cases and worsened in 7. Particularly large paraclinoid aneurysms with visual symptoms showed a reduced possibility of symptom improvement. Although embolization has proved highly effective for the treatment of unruptured aneurysms, the treatment decision should take into account the relevant guidelines, including those for surgical option and observation. Abbreviations: ISUIA: International Study of Unruptured Intracranial Aneurysms

Intracranial tumoural haemorrhage – a report of 58 cases

In order to study the computerized tomographic (CT) appearances and clinical characteristics of intracranial tumoural haemorrhage (ITH), we analyzed retrospectively fifty-eight patients with ITH and reviewed the literature. As a result, 91% patients had acute or subacute onset and 26% manifested haemorrhage as their first symptoms. CT scanning indicated that intratumoural bleeding occurred in 23 cases, bleeding into parenchyma 18 cases, subarachnoid space 6 cases, ventricle 3 cases and subdural space 8 cases. Thirty-eight patients had emergency operations and the others had selective operations. Both tumours and haematomas were removed all together in all patients. Fifty-five patients were cured or improved and three died during the perioperative stage in our series. Among the patients with ITH, there were 21 metastatic tumours, 19 gliomas, 10 meningiomas, 6 pituitary adenomas, 1 melanoma and 1 acoustic neurilemoma. The onset of most ITH resembled that of cerebrovascular diseases. The location of ITH and the CT appearances of ITH varied in different cerebral tumours. Radical removal of brain tumours with haemorrhage is an effective treatment for ITH, which can greatly decrease the perioperative mortality rate and improve the prognoses of patients.

Exploration of Syndrome Differentiation patterns in coronary heart disease patients during Peri-Operative stage of coronary artery bypass graft

Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG).Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored.Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation.Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.

Perceptual phenomena after unilateral arm amputation: a pre-post-surgical comparison

Painful and non-painful phantom phenomena occur frequently after amputations but are rarely investigated in the perioperative stage. The goal of the present study was the assessment of phantom phenomena, pain and changes in primary somatosensory cortex prior to and after upper limb amputation. Two patients who suffered from metastatic carcinoma were examined 2 days prior to and 7 days after the amputation of an arm using comprehensive psychometric assessments and neuroelectric source imaging. Both patients reported phantom limb pain that was similar to their pre-amputation pain. In one patient, reorganization of the mouth area into the deafferented hand area took place immediately after the amputation. In the other patient reorganization had occurred prior to the amputation possibly related to non-use of the arm several years prior to the amputation.

552 Participation of the intact hemisphere of the brain in the recovery of the somatic sensibility after unilateral injury

Painful and non-painful phantom phenomena occur frequently after amputations but are rarely investigated in the perioperative stage. The goal of the present study was the assessment of phantom phenomena, pain and changes in primary somatosensory cortex prior to and after upper limb amputation. Two patients who suffered from metastatic carcinoma were examined 2 days prior to and 7 days after the amputation of an arm using comprehensive psychometric assessments and neuroelectric source imaging. Both patients reported phantom limb pain that was similar to their pre-amputation pain. In one patient, reorganization of the mouth area into the deafferented hand area took place immediately after the amputation. In the other patient reorganization had occurred prior to the amputation possibly related to non-use of the arm several years prior to the amputation.

手術侵襲を防御する麻酔管理 周術期における血しょうサイトカインおよびＮＯｘ濃度の変動 メチルプレドニゾロン療法の有用性

手術侵襲を防御する麻酔管理 周術期における血しょうサイトカインおよびＮＯｘ濃度の変動 メチルプレドニゾロン療法の有用性

周術期の輸血 適正輸血の実際 術中の赤血球補充は全血か濃厚血か？

周術期の輸血 適正輸血の実際 術中の赤血球補充は全血か濃厚血か？

周術期の輸血 適正輸血の実際 術前希釈式自己血輸血の普及上の問題点

周術期の輸血 適正輸血の実際 術前希釈式自己血輸血の普及上の問題点

周術期の輸血 適正輸血の実際 輸血後ＧＶＨＤとその対策

周術期の輸血 適正輸血の実際 輸血後ＧＶＨＤとその対策

Educational and support needs of patients and their families awaiting cardiac surgery

OBJECTIVE: To identify and explore the learning and support needs of patients and families during the waiting period before cardiac surgery. DESIGN: Prospective, cross-sectional cohort survey design. SETTING: University-affiliated tertiary cardiovascular care center in mideastern Canada. SUBJECTS: One hundred forty-seven patients currently on the cardiac surgery waiting list, and 125 family members of these patients. OUTCOME MEASURES: Needs Inventory for Patients who Wait. INTERVENTION: All patients were sent a survey for themselves and one for a family member that included: a demographic profile, subjective questionnaire, and the Needs Inventory for Patients who Wait. The survey was to be completed and returned to the investigators. RESULTS: The return rates were 77% (113) for patients, and 70% (87) for family members. For patients and their family members, item rankings were highly correlated for areas in which they wanted information ( r = 0.84), and for areas that caused them the most concern ( r = 0.91). Family members were also concerned about caring for the patient before and after surgery. The number of weeks on the waiting list (< 1 month to > 6 months) did not change the concerns of patients and family. CONCLUSIONS: This survey identifies some of the educational and support needs of patients undergoing cardiac surgery and their family members. Patients are concerned about their health and survival until the surgical procedure, as well as about the success of the procedure. Families share patients concerns and have an additional concern regarding how to support the patient during the perioperative stage. The needs identified by patients and their families in this survey were found to be stable over time, and within the realm of nursing practice to address.

ウリナスタチンによる腎機能障害患者の周術期の腎機能管理

ウリナスタチンによる腎機能障害患者の周術期の腎機能管理

周術期における医事紛争，医療事故と麻酔科医の民事・刑事責任 神奈川県における医事紛争について

周術期における医事紛争，医療事故と麻酔科医の民事・刑事責任 神奈川県における医事紛争について

周術期における医事紛争，医療事故と麻酔科医の民事・刑事責任 医事紛争の日米における比較とわが国の麻酔事故

周術期における医事紛争，医療事故と麻酔科医の民事・刑事責任 医事紛争の日米における比較とわが国の麻酔事故

周術期における医事紛争，医療事故と麻酔科医の民事・刑事責任 麻酔事故における法的責任

周術期における医事紛争，医療事故と麻酔科医の民事・刑事責任 麻酔事故における法的責任

周術期に於ける医事紛争，医療事故と麻酔科医の民事・刑事責任 大阪府医師会に於ける麻酔事故の分析と処理方法について

周術期に於ける医事紛争，医療事故と麻酔科医の民事・刑事責任 大阪府医師会に於ける麻酔事故の分析と処理方法について

肝切除術周術期でのＩＣＧ薬物動態の変化

肝切除術周術期でのＩＣＧ薬物動態の変化