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general anesthesia, demonstrating its usefulness as an IV anesthetic. 2 – 4 Remimazolam was approved in Japan for use via continuous IV infusion for general anesthesia in adult patients in 2020. 5 Because remimazolam's metabolism is independent of organ (i.e., renal) function, it may be considered an appropriate agent for the anesthetic management of hemodialysis patients and may have added benefits beyond other IV anesthetics like midazolam and propofol. However, to our knowledge, there has been no report on general anesthesia using remimazolam in hemodialysis

frequency of MMA in Japan is 1:120 000. Its clinical symptoms are ketoacidosis and hyperammonemia that develops from the neonatal period to infancy and progresses to acute encephalopathy due to malnourishment, recurrent vomiting with dehydration, respiratory distress, and muscle hypotonia. Physical growth is also delayed, and intellectual disability, seizures, and stroke are common findings. In cases of severe hyperammonemia or metabolic acidosis, hemodialysis should be considered. Preventing the development of acute MMA exacerbations was critical during the anesthetic

disease, but also because there are new drugs on the market that have been shown to be highly effective in treating the disease. The people with the highest risk include those who have received clotting factor concentrates made before 1987, blood transfusions, or solid organ transplants before July 1992. Also at high risk are injection drug abusers, even those who have injected only once or at any time in the past; those who are on chronic hemodialysis; those who have had known exposure to HCV or HIV; and those who were born to mothers who were HCV positive. 1

fibrillation. He had been undergoing hemodialysis 3 times weekly for 8 years. His chronic atrial fibrillation was managed with warfarin (2.5 mg/d), which he had been taking for 4 years. Upon admission, his laboratory results included an international normalized ratio of 1.38 (normal <1.1) and an aPTT of 30.0 seconds (normal 26.9–38.1 seconds). His international normalized ratio approximated the targeted range for a hemodialysis patient with a history of chronic atrial fibrillation. Platelet aggregation test results using adenosine diphosphate, collagen, and epinephrine were

fact higher than the later-measured value. In previous reports, pacing failure due to pilsicainide poisoning have occurred at blood levels of at least 2.3 to 2.5 μg/mL, and we surmise that our patient's blood levels at the time of deterioration were close to or higher than this. 6 , 11 Therefore, it appears that although the patient's pacemaker was delivering pacing impulses, voltage-based excitement of the myocardium did not occur. Treatment for pilsicainide poisoning includes large-volume infusion, hemodialysis, sodium bicarbonate administration, and PCPS

, hemodialysis or hemodiafiltration may be necessary if the patient does not respond in several hours to these treatments. As noted previously, it is critical that treatment occur in a setting where serum ammonia levels can be monitored throughout the perioperative period. It is also important to establish a relationship where the endocrinologist can be contacted promptly if the blood ammonia levels increase substantially. Owing to the paucity of reports describing the management of sedation and anesthesia in patients with CTLN1, additional case reports and research in this

The typical daily dose for lithium is 300 mg three or four times a day and results in a therapeutic serum level of 0.4–1.2 mEq/L. Provided serum concentrations are sustained at this level, lithium is relatively free of side effects. Higher concentrations result in toxicity that is directly related to the serum concentration and may require hemodialysis in life-threatening cases. These are summarized in Table 6 . To avoid toxicity, patients must be compliant with their dosage schedule and have their serum concentrations monitored periodically