[Hyperkalemia after arterial revascularization in a patient undergoing arm replantation].

A 25-year-old man was admitted for arm replantation. His left upper arm was completely amputated by conveyer belt Anesthesia was induced with propofol (80 mg), rocuronium (50 mg), remifentanil (0.15 µg x kg(-1) x min(-1)) and maintained with sevoflurane (1-2%) and remifentanil (0.1-0.3 µg x kg(-1) x min(-1)). The plastic surgeons revascularized subclavian artery quickly but blood pressure decreased to 40-50 mmHg because of massive bleeding and plasma potassium concentration reached 5.8 mEq x l(-1). Noradrenaline (0.3 µg x kg(-1) x min(-1)) and massive albumin on behalf of red blood cells were administered. After we treated hyperkalemia and hypotension, the subclavian vein was successfully revascularized. We should maintain low potassium concentration before revascularization in patients undergoing arm replantation.

[Introduction of hospital information system and anesthesia information management system into the perianesthetic practice at Osaka City University Hospital].

BACKGROUND: Recently, the hospital information systems (HIS) and anesthesia information management systems (AIMS) have been rapidly improved and have been introduced into the clinical practice in Japan drastically; however, few reports have detailed their influences on clinical practice. We here report our experience. METHODS: We introduced HIS (EGMAIN-EX, Fujitsu Co., Ltd.) in our preoperative evaluation clinic and in the postoperative care unit. AIMS (ORSYS, Philips Electronics Japan) was introduced almost only to the intraoperative management. RESULTS: It became easy for us to acquire patient's information and to share it with the medical staffs in the other departments. However, we had to invest large human resources for the introduction and maintenance of the HIS and the AIMS. CONCLUSIONS: Though AIMS is more useful in anesthetic management than HIS, it seems to be more suitable for coordination with the medical staffs in the other departments to use HIS for perioperative management than to use AIMS.