[Perioperative management for cesarean section in a patient with pulmonary thromboembolism due to deep venous thrombosis].

It has been estimated in Japan that Western-life style increases maternal mortality because of pulmonary thromboembolism (PTE). We report a 29-year-old primipara who suffered PTE due to deep venous thrombosis (DVT) in her 29th weeks' gestation. Except for slight tachypnea, she was relatively stable. Anticoagulation with heparin was started immediately. The retrievable inferior vena cava filter (IVC-F) was inserted. Four hours before surgery with discontinuation of heparin, the cesarean section was performed under general anesthesia. We used transesophageal echocardiography, a pulmonary artery catheter and end tidal CO2 monitoring for early detection and rapid management of recurrent PTE. She had no trouble during operation and her baby was born without serious symptoms. After recovery from anesthesia, she was admitted to the intensive care unit. Heparin was restarted after confirmation of hemostasis. On the 3rd postoperative day, we started thrombolytic therapy with urokinase which was tapered off during a week. Heparin was switched to warfarine gradually. On the 10th postoperative day, IVC-F could not be removed because of remaining DVT. She was discharged on daily warfarine. We experienced the perioperative management for cesarean section at 29 weeks' gestation following PTE due to DVT.

[Cesarean section in a patient with severe mitral stenosis after mitral valve replacement].

A 30-year-old woman with mitral stenosis after mitral valve replacement was scheduled for cesarean section at 28 weeks and 6 days of pregnancy. Cesarian section was decided at a conference of obstetrics, cardiac surgery, neonatology and anesthesiology. Anesthesia was successfully managed with epidural block and pulmonary arterial pressure monitoring. During operation, blood pressure was controlled by dopamine, milrinone and phenylephrine. Patient did not develop cardiac insufficiency perioperatively. Cardiac function deteriorated gradually and reoperation of mitral valve replacement was performed 2 months later.

[Anesthetic management of renal transplantation for a 15-year-old girl with cerebral palsy].

A 15-year-old girl with severe cerebral palsy underwent renal transplantation. It was difficult to anastomose blood vessels because her inferior limbs were contracted. The clamp time was 67 minites. After unclamping, blood pressure fell down from 120/60 to 80/50 mmHg, and CVP fell down from 6 to 3 mmHg. First flow of urine from the donor kidney was noticed 9 hours after unclamping. We regarded difficulty of the operation for cerebral palsy and insufficient infusion as the cause of the late first flow of urine. Two weeks later, there was enough urine flow, and renal function became better. Recently, it is thougt optimal to perform renal transplantations of children who have chronic renal insufficiency and end-stage renal disease. However, there are few reports of renal transplantations for children with cerebral palsy, and there is no guideline for them. Therefore, we anesthesiologists, also have to further examine anesthetic management for each case.

[Epidemiological study of hepatitis B and C in 34,336 patients operated at Hiroshima Prefectural Hospital during the period from 1993 to 2000].

BACKGROUND: We have many chances to deal with blood transfusion in the operation room, and it is important for us to pay more attention to prevent hospital infection. METHODS: We surveyed epidemiologically the prevalence of hepatitis B virus surface antigen (HBV) and hepatitis C virus antibody (HCV) in 34,336 patients operated at Hiroshima Prefectural Hospital from April 1993 through March 2001. RESULTS: The prevalence of HBV seropositivity was 1.8% in total, 1.6% in scheduled, and 2.5% in emergent cases. The prevalence of HCV seropositivity was 7.1% in total, 6.8% in scheduled, and 8.0% in emergent cases. Prevalences of both of them in emergent cases were higher than scheduled. The prevalence of HBV was highest (3.4%) in patients with age of 40's, and the prevalence of HCV increased with age. The prevalences of HBV and HCV were highest (4.5% and 19.0%) in the division of surgery and dialysis-kidney disease center. CONCLUSIONS: It is important to carry out standard precautions for all patients to prevent hospital infection. Furthermore, we should pay attention to emergent operative cases and operative cases in dialyzed patients.