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The onset of tachyarrhythmia after the Fontan procedure (total cavopulmonary connection; TCPC) should be considered a medical emergency. Landiolol is an ultra-short-acting [beta]1-selective blocker whose effect on tachyarrhythmia after TCPC is unclear. We evaluated the efficacy and safety of landiolol for tachyarrhythmia after TCPC. Consecutive patients undergoing TCPC were enrolled from January 2007 to December 2011. Of 435 pediatric open heart surgeries, 28 patients underwent TCPC. Of the 28 patients, 13 were treated with landiolol for critical tachyarrhythmia. Excluding three patients who received landiolol during surgery, we investigated the remaining 10 patients and statistical analysis was performed without a 10-year-old patient as outlier. The median age was 4.08 years. The subjects comprised five patients with sinus tachycardia, four with junctional ectopic tachycardia and one with paroxysmal supraventricular tachycardia. The initial dose was 4.7 ± 2.3 [mu]g/kg/min, without a loading dose. Landiolol reduced the heart rate from 151.8 ± 23.2 at the start to 132.9 ± 20.0 at 1 h and 126.1 ± 24.9 at 2 h (P < 0.01 and P < 0.01, respectively), without blood pressure decrease (P = 0.235). Landiolol was effective in treating critical tachyarrhythmia without hemodynamic deterioration. We believe that landiolol is a promising option for postoperative tachyarrhythmia after the Fontan procedure., Author(s): Kentaro Miyake[sup.1] , Yoshihito Fujita[sup.2] , Saya Yoshizawa[sup.1] , Maiko Tomita[sup.1] , Mitsunori Miyazu[sup.1] , Yoshiki Sento[sup.1] , Shinichiro Yoshimura[sup.1] , Kazuya Sobue[sup.1] Author Affiliations: (1) Department of Anesthesiology [...]

Although maintaining anesthesia for myasthenia gravis (MG) with minimal muscle relaxants (MR) is common, the success rate of anesthetic management for MG without MR is not clear. We therefore retrospectively examined the success rate of anesthetic management for MG without MR among 66 consecutive cases of thymectomy for MG performed at our hospital between January 2004 and April 2010, before approval of using sugammadex. A total of 60 patients (90.9 %) were treated without MR (N group). Among the 60 cases, 17 (28.3 %) patients were not extubated in the operating room due to postoperative respiratory depression or other reasons. Therefore, the success rate of anesthetic management for thymectomy in patients with MG without treating MR was 71.7 % (43/60) [95 % confident interval (CI): 65.9-77.5 %]. The reasons for using MR included coughing at intubation in one case, bucking during surgery in two cases, and MR was considered to be safer by the attending anesthesiologist in three cases. The number of cases of impossible extubation requiring ventilation on that day was three in the N group and none in the R group. Finally, the success rate of anesthetic management for MG without MR was estimated to be 71.1 % (95 % CI: 65.9-77.5 %)., Author(s): Yoshihito Fujita[sup.1] , Satoru Moriyama[sup.2] , Satoshi Aoki[sup.3] , Saya Yoshizawa[sup.3] , Maiko Tomita[sup.3] , Taiki Kojima[sup.3] , Yukiko Mori[sup.3] , Naoko Takeuchi[sup.3] , Min-Hye So[sup.3] , Motoki Yano[sup.2] [...]

Background: The American Society of Anesthesiologists (ASA) published a clinical practice guideline of preoperative fasting in 1999. A nationwide survey conducted in Japan in 2003 reveals that many hospitals have a much longer fasting period. We conducted a similar survey in three limited areas in Japan to assess the changes in fasting practice., Methods: A written questionnaire for preoperative fasting was sent to 50 hospital in 3 prefectures., Results: The duration of fasting for liquids tends to be shorter than those in the 2003 survey. The rates of application of the ASA guideline, however, are still low specifically in adults (4.2%), which is significantly lower than those in children (17.7%), or in infants (39.0%). The reasons for noncompliance are mainly due to organizational problems associated with scheduling of operation. Most hospitals aspire to have Japanese guideline about preoperative fasting periods., Conclusions: Longer preoperative fasting periods are still common practice in Japanese hospitals.