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ABSTRACT: A 32-year-old pregnant woman diagnosed with aplastic anemia was admitted for emergent caesarean delivery of 26th week of the gestation due to PIH (pregnancy-induced hypertension) and NRFS (non-reassuring fetal status). After compensating platelets counts to 5.3x10(4) microl-1, general anesthesia was induced with propofol and rocuronium. Anesthesia was maintained with O2 and sevoflurane until delivery and with modified-NLA after delivery. She was additionally monitored with Vigileo/FloTrac system (Edwards Lifesciences, USA) and TOF-WATCH SX (Nihon Kohden, Tokyo). After 8 minutes of operation her baby was born with the 5-minute Apgar score of 5 and the UA-pH of 7.387. It was only 2 hours and 12 minutes that the baby was born after she was admitted. The baby was tracheally intubated and transferred to NICU. Blood loss during operation was 835 g and two units of RCC was transfused. Circulatory values were kept acceptable and neuromuscular blocking was completely reversed by sugammadex and extubated in the operating room. Bleeding tendency and atonic bleeding were not observed. She survived perioperative period and was to be treated for aplastic anemia. Her baby was discharged neurologically free. We should be ready to respond to anesthetic requirement for urgent cases of aplastic anemia.
Masui. The Japanese journal of anesthesiology 12/2011; 60(12):1394-7.
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ABSTRACT: Many anesthesiologists are reluctant to depart from their traditional long fasting periods, even though many guidelines recommend that oral intake of clear fluids administered up to 2-3 hours prior to general anesthesia does not adversely affect the gastric contents. It also indicates that the application of these guidelines does not affect the incidence of pulmonary aspiration. One of the reasons why they have not changed their practices is that they wonder whether it is safe to administer clear fluids as recommended in the guidelines. In this review, we emphasize that oral rehydration therapy using clear fluids (such as OS-1, water and carbohydrate-rich beverage) is safe based on the non-invasive gastric echo examinations as many guidelines have already indicated. Oral rehydration therapy should be considered not only as an alternative to intravenous therapy for preoperative fluid and electrolyte management but also as one of the important modalities which can enhance the recovery of surgical patients.
Masui. The Japanese journal of anesthesiology 07/2011; 60(7):790-8.
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ABSTRACT: OS-1 is an oral rehydration solution that conforms with the principles of oral rehydration therapy. It may be useful for preoperative fluid management of surgical patients. While intake of clear fluids 2 hours before surgery is considered safe, it is not known if the same applies to OS-1. We therefore investigated the safety of OS-1 for preoperative patients as compared with clear fluids.
First, eight healthy adult volunteers were studied in a crossover manner. Volunteers ingested 500 ml of OS-1 or water (clear fluid). Gastric emptying time was measured using gastric ultrasonography. Gastric antral area as measured by ultrasonography correlates well with gastric volume in a close-to-linear manner. Next, we measured gastric volume of elective surgical patients who had drunk OS-1 until two hours before the induction of anesthesia.
Gastric emptying time did not differ between OS-1 and water. The stomach was emptied 30 minutes after ingestion of both OS-1 and water. The fasting stomach was identified in all patients who had drunk OS-1 before surgery.
We concluded that allowing elective surgical patients to drink OS-1 until two hours before anesthesia did not affect the volume of gastric contents.
Masui. The Japanese journal of anesthesiology 05/2011; 60(5):615-20.
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ABSTRACT: Polypregnancy is one of the major problems to both mothers and fetuses leading to poor prognosis. Even though hemodynamic parameters change greatly during pregnancy and cesarean delivery, it is unclear how blood volume (BV) and cardiac output (CO) increase during triplet pregnancy and how CO goes up and down during cesarean delivery in the cases of triplet pregnancy. We measured BV and CO by dye-densitogram analyzer (DDG-analyzer: Nihon Kohden, Tokyo, Japan) and CO by FlowTrac (Edwards Lifesciences, Irvine, USA) on three cases of triplet pregnancy. BV increased up to about 50% above that of singleton after 20 weeks of gestational age. However, there was no such tendency in CO. When they underwent cesarean delivery under combined spinal-epidural anesthesia (CSEA) or sequential-CSE (S-CSE) receiving a 10 or 12 mg intrathecal isobaric bupivacaine with 20 microg fentanyl, CO decreased in parallel with blood pressure from ten minutes after spinal anesthesia, to the start of operation and just after the birth of third fetus.
Masui. The Japanese journal of anesthesiology 04/2010; 59(4):440-5.
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ABSTRACT: Although obstetric disease is one of the major causes of disseminated intravascular coagulation (DIC), no gold standard exists. Three current criteria, the Japanese Association for Acute Medicine (JAAM) -DIC criteria, the revised Japanese Ministry of Health and Welfare (JMHW) criteria and the International Society on Thrombosis and Haemostasis (ISTH) criteria, do not clarify the usefulness in obstetric DIC. We therefore conducted a retrospective study by simulation.
We enrolled 89 cases of emergent caesarean section when platelet count decreased to below 150,000 x 10(9) x mm(-3) during 7 days from 3 days before operation to 3 days after operation from April 2004 to March 2007. We applied them and compared diagnostic rates and investigated characteristics of obstetric DIC.
After excluding 21 cases, 68 cases were examined. The number of patients diagnosed with DIC by JAAM-DIC criteria, JMHW criteria and ISTH criteria were 15 (22.1%), 5 (7.4%) and 3 (4.4%), respectively. Fifteen patients who fulfilled JAAM-DIC criteria included all 5 patients for whom DIC was diagnosed by JMHW criteria, and those 5 patients included all 3 patients for whom DIC was diagnosed by ISTH criteria.
The current study indicates that JAAM-DIC criteria can be useful but may overdiagnose the DIC.
Masui. The Japanese journal of anesthesiology 07/2009; 58(6):732-8.
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Anesthesia and analgesia 02/2007; 104(1):232. · 3.08 Impact Factor
