[The Influence of Tourniquet during Total Knee Arthroplasty on Perioperative Blood Loss and Postoperative Complications].

BACKGROUND: Previous studies have shown that tourniquet (TQ) during total knee arthroplasty (TKA) is associated with nerve injury and deep vein thrombosis. However, it is still not clear whether TQ which is effective in decreasing intraoperative blood loss and creating a bloodless surgical fields, is beneficial in management during and after TKA. METHODS: We compared intra- and postoperative management of patients undergoing TKA with (Group T, n = 41) and that without a TQ (Group N, n = 40) at Toyama Prefectural Central Hospital. RESULTS: The intraoperative blood loss in group T was less than that in group N, but perioperative blood loss showed no significant defference between the two groups. Pain and nerve injury between the two groups were comparable for 24 hours postoperatively. There was no significant defference in the incidence of DVT, and no pulmonary thromboembolism occurred. CONCLUSIONS: Using a TQ which could not decrease the amount of perioperative blood loss did not affect the incidences of postoperative pain, nerve injury and, risk of DVT between the two groups.

[Anesthetic Management for a Patient with Fibromyalgia].

A 22-year-old female with fibromyalgia (FM) was scheduled for tonsillectomy under general anesthesia. Her medication included pregabalin 300 mg x day(-1) and dantrolene 50 mg x day(-1). Anesthesia was maintained with sevoflurane-remifentanil-fentanyl. Intravenous injection of fentanyl 20 µg x hr(-1) and droperidol 100 µg x hr(-1) was continued for 24 hours. On the first postoperative day, she reported that she had slept well and had no pain. There are some perioperative problems in a patient with FM. Therefore, anesthetic managements for a patient with FM is worth reporting.

[Perioperative management and postoperative complication rates of patients on dual antiplatelet therapies after coronary drug eluting stent implantation].

BACKGROUND: Few studies have examined the perioperative status of dual antiplatelet therapy and postoperative thrombotic or bleeding complication rates of patients undergoing non-cardiac surgery with recent history of coronary stent implantation. METHODS: Eight patients underwent surgery with antiplatelet therapy discontinued on both pre- and post-operative period (pre/postop group); 7 patients with only post-operative discontinuation (postop group); and 2 patients with therapy maintained (maintained group). All patients had history of coronary drug eluting stent implantation within 12 months of surgery. RESULTS: Antiplatelets were discontinued 7 days before surgery and restarted on postoperative day 7 for the pre/postop group, and on postoperative day 5 for postop group. Re-exploration due to bleeding complication was required in 1 patient in the postop group. Two or more units of red cell concentrate transfusion were required in 2 pre/postop, 3 postop, and 1 maintained group patients intraoperatively. No cardiac thrombotic complications including in-hospital stent thrombosis were observed, in line with previous reports of low stent thrombosis rates in Asian patients. CONCLUSIONS: In the present study, bleeding complications requiring transfusion were frequently observed in patients with dual antiplatelet therapy undergoing non-cardiac surgery, whereas perioperative therapy discontinuation did not trigger thrombotic complications including stent thrombosis.

[Case of suspected malignant hyperthermia following local infiltration anesthesia].

A 49-year-old man with no past history of malignant hyperthermia (MH) and scheduled for hernia repair was suspected of MH after local infiltration anesthesia at other hospital. Although intravenous diazepam was not effective for increased body temperature, tachycardia, and convulsion, dantrolene was effective for these signs. However, blood test showed no abnormal finding. At our hospital, he was scheduled for hernia repair and muscle biopsy under total intravenous anesthesia. No event occurred intra- and postoperatively. The examination for muscle biopsy revealed that the function of his ryanodine receptor 1 is abnormal. The events which had occurred at other hospital were uncertain of being associated with MH.

[Examination of acute kidney injury after abdominal aortic aneurysm surgery].

BACKGROUND: Either suprarenal or infrarenal aortic clamping markedly reduces renal blood flow. This aortic clamping may cause postoperative acute kidney injury(AKI). METHODS: Fifty-four patients undergoing open abdominal aortic aneurysm (AAA) surgery were included in a retrospective study. Postoperative AKI defined as an absolute increase in serum creatinine (Cre) of more than or equal to 0.3 mg x dl(-1) or an increase in Cre of more than or equal to 50% within 48 hours after the end of the procedure. RESULTS: Thirteen patients developed AKI, but none of them required dialysis. The patients with AKI had higher preoperative Cre, longer operation, longer clamp time and more use of diuretics intra- and postoperatively. CONCLUSIONS: AKI occurred in 24.1% of patients undergoing AAA surgery. Risk factors for AKI were preoperative Cre, operation time, clamp time and use of diuretics.

[The influence of remifentanil on intra- and postoperative drug cost].

BACKGROUND: Intraoperative use of remifentanil requires much more analgesics postoperatively. Moreover, remifentanil causes intraoperative hypotension and bradycardia. METHODS: The objectives are to compare intra- and post-operative drug cost between patients who received remifentanil (Group R, n = 72) and those who received fentanyl (Group F, n = 66) during laparoscopic cholecystectomy retrospectively. RESULTS: The baseline demographics were similar between the two groups. Intraoperative drug costs were 7,782 +/- 1,579 yen in Group R and 6,235 +/- 1,037 yen in Group E Postoperative drug costs were 364 +/- 521 yen in Group R and 146 +/- 153 yen in Group E Total drug costs were 8,167 +/- 1,607 yen in Group R and 6,381 +/- 1,042 yen in Group E These reached statistical significance (P < 0.01). Length of hospital stay (days) between the two groups were comparable. CONCLUSIONS: Remifentanil anesthesia requires much more intra- and post-operative drug cost than fentanyl anesthesia for laparoscopic cholecystectomy.