Passive exercise of the lower limbs and trunk alleviates decreased intestinal motility in patients in the intensive care unit after cardiovascular surgery.

[Purpose] The purpose of this study was to clarify the effects of passive exercise of the lower limbs and trunk (PELT) in ICU patients after cardiovascular surgery with decreased bowel motility. [Subjects and Methods] Ten ICU patients with clinically-apparent decreased bowel motility during the period of April to July 2016 were enrolled this study. Bowel sounds (BS) for 5 minutes at rest and 5 minutes after PELT were recorded through an electronic stethoscope. A frequency analysis was performed and the BS before and after PELT were compared. In addition, the percent change in BS before and after PELT was determined, and the relationship between the percent change in BS and individual parameters (invasiveness of surgery, inflammation, nutrition, renal function) was examined. [Results] Average BS (integral value) for 5 minutes before and after PELT were 63.1 ± 41.3 mVsec and 115.0 ± 57.8 mVsec, respectively; therefore, BS was significantly increased by PELT. When compared to patients at rest, a significant increase was found 0-4 minutes after PELT. None of the individual parameters was significantly correlated with the percent change. [Conclusion] PELT can increase the bowel motility of ICU patients with decreased bowel motility.

[Uncrossmatched type O red blood cell transfusion and cell saver autologous blood transfusion effective for intraoperative massive bleeding].

We experienced rapid and massive bleeding in a 57-year-old woman undergoing resection of ovarian tumor metastasis. One hour after the start of operation, blood loss increased due to adhesion of the tumor. The blood hemoglobin level decreased from 11.7 to 4.6 g x dl(-1). Since available matched homologous blood had been consumed, we transfused type O uncrossmatched red blood cells followed by cell saver autologous blood. For the treatment of uncontrollable hyperkalemia and metabolic acidosis, continuous hemodiafiltration was started. A total of 66 U of red blood cells, 48 U of FFP, and 40 U of platelets were transfused intraoperatively. No neurological deficit, pulmonary edema, renal failure, or hemolysis was found postoperatively.

[Conscious sedation and amnesic effect of intravenous low-dose midazolam prior to spinal anesthesia].

BACKGROUND: The pain associated with spinal puncture is severe, and the memory of this uncomfortable procedure often deters patients from undergoing the procedure again. Therefore, it is important to make the patient as comfortable as possible when this procedure is performed. METHODS: We administrated a low-dose (1-2.5 mg) of midazolam intravenously several minutes before conducting a spinal-tap in 200 patients undergoing elective surgery of the lower limb. The dose of midazolam used was based on the patient's age and weight, and we investigated remaining of a memory concerning the spinal-tap procedure and side effects of midazolam at the end of surgery. RESULTS: Memory of the spinal-tap procedure remained in 14.0%, 1.9%, and 32.7% of the patients who had received benzodiazepine preoperatively and in 25.0%, 40.0%, and 60.9% of the patients who hadn't received benzodiazepine preoperatively in the age group <60, 60-70, and > or =70 years, respectively. No patient experienced severe respiratory depression, but an excessive sedation or restlessness was experienced in 1.6%, 4.8%, and 5.2% of the patients. CONCLUSIONS: In the patients aged <70 years, intravenous administration of 0.023-0.044 mg x kg(-1) of midazolam was very effective in preventing a bad memory concerning the spinal-tap procedure; however, it is important to note that the number of side effects associated with this procedure increases in patients aged > or =60 years.

[Anesthetic management for wake-up test during reconstruction surgery of the anterior crucial ligament].

BACKGROUND: Seven patients were subjected to intraoperative wake-up tests during reconstruction surgery of the anterior crucial ligament (ACL) to measure the tension of the reconstructed ligament. METHODS: The patients were of 18 to 28 of age with ASA physical status 1. Anesthesia was maintained with nitrous oxide-sevoflurane-fentanyl or propofol-fentanyl under orotracheal intubation. RESULTS: Patients anesthetized with nitrous oxide-sevoflurane-fentanyl did not perform smoothly in the wake-up test because of restless or delayed emergence from anesthesia, and two of them experienced intraoperative awareness. On the other hand, all patients anesthetized with propofol-fentanyl performed smoothly, and no patient experienced intraoperative awareness. CONCLUSIONS: Propofol-fentanyl is better than nitrous oxide-sevoflurane-fentanyl as the method of anesthesia for wake-up tests of ACL reconstruction surgery.