[Acupuncture treatment for a patient with prolonged consciousness disturbance after a brain tumor surgery].

Acupuncture has long been applied as a therapeutic technique in China, Japan, Korea and other countries. Recently, its application began to be extended to the treatment of neural disorders. We experienced a 13-year-old boy with prolonged consciousness disturbance after a pineal tumor surgery and muscle contracture of lower extremity by long-term recumbency. We applied him acupuncture treatment for 4 months which was effective to alleviate these symptoms. Repeated IMP SPECT showed improvement of the cerebral blood flow (CBF) during the course of acupuncture therapy. Acupuncture was effective to improve prolonged coma after a brain surgery and also muscle contracture by long-lasting recumbency. CBF showed a slight increase along with the recovery of consciousness suggesting a strong relevance between CBF and improvement of these symptoms.

[Acupuncture treatment for a patient with diffuse axonal injury--report no. 2].

Acupuncture has been applied as a therapeutic technique in China, Japan and East Asia. Recently, its application is extended to treat neural injuries. We describe a 26-year-old man with consciousness disturbance and intense muscle spasticity of extremities due to severe diffuse axonal injury (DAI) in whom acupuncture treatment for 1 month was effective to alleviate these symptoms remarkably. We also investigated the cerebral blood flow two times by 123I-IMP SPECT in acupuncture period. Acupuncture treatment may be effective to improve consciousness disturbance and intense spasticity of DAI and to modulate cerebral blood flow.

[Acupuncture treatment for a patient with diffuse axonal injury].

Acupuncture has been used as a therapeutic technique in China, Japan and East Asia. Recently, it is used to treat neural injuries. We describe a 6-year-old boy with consciousness disturbance and heavy muscle spasticity of extremities due to severe diffuse axonal injury (DAI) in whom acupuncture treatment for 6 months alleviated these symptoms remarkably. Acupuncture treatment may be effective to improve consciousness disturbance and heavy spasticity of DAI.

[Incidence and characteristics of perioperative pulmonary thromboembolism in Japan in 2004].

BACKGROUND: The incidence of perioperative pulmonary thromboembolism (PTE) is reported not to be low in Japan. The aim of this study is to investigate the incidence and characteristics of perioperative PTE in Japan in 2004. METHODS: A questionnaire was mailed to 960 institutions registered as the teaching hospitals of the Japanese Society of Anesthesiologists (JSA). The survey details included age, sex, type of surgery, and risk factors of patients operated in 2004. RESULTS: Effective responses were received from 642 institutions (66.9%) of 960 institutions. A total of 409 cases of perioperative PTE were reported from 245 institutions (25.5% of the institutions responded). The incidence of perioperative PTE was 3.62 per 10,000 cases. Cardiac arrest occurred at the onset in 65 cases (15.9%). Of the patients, 150 (36.7%) had malignancy; 142 (34.7%) were obese; and 121 (29.6%) were bed-ridden (> 4 days). In 273 cases (66.7%), the patients were over 60 years of age. PTE was found to be more frequent in females than in males (males, 147 cases; females, 259 cases). The types of surgery resulted in perioperative PTE with high frequency were "spinal surgery" (6.95 per 10,000 cases) and "limbs and/or hip joint surgery" (9.79 per 10,000 cases). Eighty-nine patients (21.8%) died from perioperative PTE. CONCLUSIONS: The incidence of perioperative PTE was not low and its mortality was high in Japan in 2004. In particular, the incidence of perioperative PTE was found to be high in females, the elderly, patients with malignancy, and patients who had undergone orthopedic surgery.

[Critical incidents during regional anesthesia in Japanese Society of Anesthesiologists-Certified Training Hospitals: an analysis of responses to the annual survey conducted between 1999 and 2002 by the Japanese Society of Anesthesiologists].

BACKGROUND: Recently, a national survey in France including 35,439 patients who had received spinal anesthesia showed that the incidences of cardiac arrest and mortality associated with spinal anesthesia were 2.5 and 0.8 per 10,000 anesthetics, respectively. In this study, we investigated these values using data obtained from annual surveys conducted by the Japanese Society of Anesthesiologist (JSA). METHODS: Since 1994, JSA has conducted annual surveys concerning critical incidents in the operating theater by sending confidential questionnaires to JSA-certified training hospitals, then collecting and analyzing the responses. We investigated critical incidents associated with regional anesthesia using data from annual surveys between 1999 and 2002. The questionnaire was identical in each survey conducted during these years. The total number of anesthetics available for this analysis was 3,855,384, of which spinal anesthesia, combined spinal-epidural anesthesia and epidural anesthesia were performed in 409,338, 146,282, and 69,001 patients, respectively. In patients receiving regional anesthesia, 628 critical incidents including 108 cardiac arrests, and 45 subsequent deaths were reported. The causes of critical incidents were classified as follows: totally attributable to anesthetic management, due mainly to intraoperative pathological events, preoperative complications, and surgical management. IP consists of coronary ischemia including coronary vasospasm not suspected preoperatively, arrhythmias including severe bradycardia, pulmonary thromboembolism, and other conditions. Mortality was determined by postoperative day 7. Statistical analysis was performed by chi-square test and Mann-Whitney test. A p value less than 0.05 was considered significant. RESULTS: The incidences of cardiac arrest and mortality due to all etiologies were 1.69 and 0.76 with spinal anesthesia, 1.78 and 0.68 with combined spinal-epidural anesthesia, and 1.88 and 0.58/10,000 anesthetics with epidural anesthesia, respectively. The incidences of cardiac arrest and mortality due to anesthetic management were 0.54 and 0.02 with spinal anesthesia, 0.55 and 0.00 with combined spinal-epidural anesthesia, and 0.72 and 0.14/10,000 anesthetics with epidural anesthesia, respectively. These values did not significantly differ among regional anesthesia. Death attributable to anesthetic management was reported in 2 patients: both patients were classified as ASA-PS 3 E, and developed cardiac arrest; one due to inadvertent high spinal anesthesia with spinal anesthesia, and the other due to local anesthetic intoxication with epidural anesthesia. Anesthetic management and intraoperative pathological events comprised 33 and 43% of cardiac arrests, respectively. The distribution of causes of death was as follows: anesthetic management, 5%; intraoperative pathological events, 34%; preoperative complications, 35%; surgical management, 26%. Among the causes of anesthetic management-induced critical incidents, inadvertent high spinal anesthesia was the leading cause of cardiac arrest in spinal and combined spinalepidural anesthesia: 90% of arrests occurred in patients with ASA-PS 1+2; 88% in patients below 65 years of age; 45 and 25% in patients undergoing hip or lower extremities surgery, and cesarean section, respectively. Among the causes of intraoperative pathological event-induced critical incidents, pulmonary thromboembolism was the leading cause of cardiac arrest in spinal and combined spinal-epidural anesthesia: 59% of arrests occurred in patients with ASA-PS 1+2; 81% in patients above 66 years of age; 91% in patients undergoing hip or lower extremity surgery. CONCLUSIONS: The incidence of cardiac arrest and mortality associated with spinal anesthesia in Japan was shown to be in the same order as in France by analyzing a larger population. In patients with good ASA-PS, critical incidents occurred more often under regional anesthesia than under general anesthesia. Inadvertent high spinal anesthesia should be carefully avoided. We should also pay much attention to subclinical deep vein thrombosis in patients who were scheduled for hip or lower extremity surgery, and tourniquet- or bone cement-associated pulmonary embolism in these patients.

Changes in plasma total and ionized magnesium concentrations and factors affecting magnesium concentrations during cardiac surgery.

The purpose of this study was to measure blood total and ionized magnesium concentrations ([TMg] and [Mg(2+)], respectively) and to investigate factors that might be affecting their changes during cardiac surgery using hypothermic cardiopulmonary bypass. Eight patients were examined. All the patients received diuretics and predeposited autologous blood during surgery. No drugs containing Mg(2+) were administered. Nine blood samples and eight urine samples were collected from the pre-induction period to the end of surgery. Hematocrit, [TMg], [Mg(2+)], plasma concentrations of calcium ([Ca(2+)]), creatinine, parathyroid hormone (PTH), urinary concentrations of TMg, and creatinine were measured, and the fractional excretion of Mg (FEMg) was calculated. Both [TMg] and [Mg(2+)] decreased significantly in the prebypass period and remained significantly depressed thereafter. The ionized fraction of magnesium ([Mg(2+)]/[TMg]) was decreased during the postbypass period. Hematocrit decreased significantly from the prebypass period, and FEMg increased significantly after aortic cross-clamping. In conclusion, hemodilution and renal loss were main causes of hypomagnesemia, and citrate in predeposited autologous blood may contribute to the decrease in [Mg(2+)]/[TMg] in the postbypass period. These results suggest that magnesium supplementation under close monitoring of [Mg(2+)] should be required during cardiac surgery.

[Combined block of femoral, sciatic, obturator nerves and lateral cutaneous nerve block with ropivacaine for leg amputation above the knee].

A 76-yr-old male presented for leg amputation above the knee. The patient complained of dyspnea due to pulmonary embolism occurring 3 weeks before operation. In addition, the patient could not report paresthesias because he had suffered from a cerebral infarction. Anesthesia was performed with combined block of femoral, sciatic, obturator nerves and the lateral cutaneous nerve of the thigh. The nerves were anesthetized with 0.75% ropivacaine solution 31 ml by use of an electrical nerve stimulator and an insulated needle. Nerve stimulation technique is the best choice for patients who are unable to report paresthesias reliably.