Lateral position does not cause an interhemicerebral difference of cerebral hemodynamic in healthy adult volunteers.

Cerebral perfusion is maintained at a consistent value irrespective of changes in systemic blood pressure or disease-induced changes in general physical condition. This regulatory mechanism is effective despite postural changes, working even during changes in posture, such as those from sitting to standing or from the head-down to the head-up position. However, no study has addressed changes in perfusion separately in the left and right cerebral hemispheres, and there has been no specific investigation of the effect of the lateral decubitus position on perfusion in each hemisphere. Surgery, particularly respiratory surgery, is often performed with the patient in the lateral decubitus position, and since intraoperative anesthesia may also have an effect, it is important to ascertain the effect of the lateral decubitus position on perfusion in the left and right cerebral hemispheres in the absence of anesthesia. The effects of the lateral decubitus position on heart rate, blood pressure, and hemodynamic in the left and right cerebral hemispheres assessed by regional saturation of oxygen measured by near-infrared spectroscopy were investigated in healthy adult volunteers. Although the lateral decubitus position causes systemic circulatory changes, it may not cause any difference in hemodynamic between the left and right cerebral hemispheres.

The clinical utility of genetic testing for t(8;16)(p11;p13) in congenital acute myeloid leukemia.

Acute myeloid leukemia (AML) with t(8;16)(p11;p13) is known to have very poor prognosis in adults. In contrast, the prognosis is not clear in pediatric patients and chemotherapy is generally started immediately in cases of congenital leukemia because of its association with hyperleukocytosis and poor prognosis. This study reports a case of congenital AML where chemotherapy was discontinued after detection of a MOZ-CBP fusion, which remains in remission without additional treatment. This article stresses the importance of examination for the presence of the MOZ-CBP fusion at diagnosis to inform treatment decisions in congenital AML.

[Epidural anesthesia for five caesarian sections in patients with placenta previa percreta combined with placenta accreta].

We gave anesthesia for five cases of caesarian section in patients with placenta previa percreta combined with placenta accreta. Five caesarian sections were performed under epidural anesthesia and placentae remained in the uterus. After surgery, they were transferred to the angiography room and received uterine arterial embolization (UAE). They were given the diagnosis of the placenta accreta. However, during anesthesia in patients with placenta accreta, incomplete separation of the placenta causes atonic bleeding. And, uncleanliness of the abrasive degree may lead to difficulty in a prediction of bleeding, and control of hemodynamics is difficult. In the caesarian section of the placenta accreta, UAE prevents excessive bleeding during the operation and FloTrac monitor makes it easy to control hemodynamics.

[Case of caesarean section using Cell Savers5+ in a patient with the placenta accreta associated with massive hemorrhage].

Placenta accreta which occurs as a complication of total placenta previa is comparatively rare. And the diagnosis of placenta accreta before the caesarean section (C-section) is difficult. We experienced an extremely difficult anesthesia management of placenta accrete because of critical hemorrhage during C-section. We used self-blood collection device Cell Saver5+ (Haemonetics Japan Ltd, Tokyo) for the massive bleeding of 25,500 ml. The Cell Saver could be used to treat life threatening bleeding in C-section without any side effects, although it is thought that the use of the self-blood collection device during C-section had the danger of the amniotic fluid embolism and fetal red cell ontamination. It is necessary to consider using the Cell Saver in the obstetrical operation for life-saving medical treatment in response to unexpected massive bleeding.

[Report of an inquiry about epidural anesthesia for abdominal aortic aneurysm surgery in Japan].

BACKGROUND: Recently there are growing number of patients suffering from the abdominal aortic aneurysm (AAA), and we have many occasions to anesthetize these patients under coagulation therapy as well. Moreover, the risk of epidural hematoma increases when the operation of the AAA is performed with epidural technique because the operation is usually done with perioperative heparinization. For these reasons, we investigated the current situations of clinical practice in Japan in terms of the epidural anesthesia for AAA surgeries. METHODS: The questionnaires were sent to all 998 Japanese Society of Anesthesiologists certified training hospitals in October 2005, anonymously asking about current practices concerning AAA cases, anesthetic managements, use of epidural anesthesia and the experience of any complications. Fifty one per cent of the total questionnaires were returned and 94% of them could be analyzed. Seventeen per cent of responders were from university institutes or university related hospitals and 75% of them were from general hospitals of secondary critical care centers. RESULTS: This survey showed that the operations of AAA were done at 308 (64% of the responders) hospitals and the total number of AAA surgeries carried out was estimated to be 6,321 the last year. This figure was very close to the number announced by Japan Society of Cardiothoracic Surgeons. The epidural anesthesia was routinely used for AAA surgeries with general anesthesia in 224 hospitals (64%), but it was not used in 51 hospitals (14%). The standard protocol for the application of epidural anesthesia had been installed in 56% of hospitals and mostly in 187 hospitals (as several answers can be chosen). The epidural catheters were inserted the day before operation. There were 113 hospitals in which less than 2 hours was required from epidural puncture to heparinization, but in 141 hospitals it took more than 12 hours. However, on the contrary, many anesthetists answered that the risk of the epidural hematoma had been the cause of not routinely using the epidural anesthesia in AAA operations. We had 30 hospitals in which epidural hematoma had occurred in the cases not limited to AAA surgery and 17 cases of them resulted in severe complications afterwards. CONCLUSIONS: This investigation clarified the current situations of the clinical practice in Japan of the use of epidural anesthesia for AAA surgeries.