Masui. The Japanese journal of anesthesiology
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Case Reports
[Effect of bolus propofol administration on muscle evoked potential (MsEP) during spine surgery].
Intraoperative monitoring of descending pathways by means of muscle evoked potential (MsEP) is a reliable method to monitor spinal cord motor function, but MsEP is readily affected by anesthetics. We monitored MsEP evoked by repetitive transcranial electrical stimulation of the motor cortex in 30 patients receiving spine surgery. Total intravenous anesthesia was maintained with propofol and fentanyl without any muscle relaxant. ⋯ The amplitude of MsEP decreased slightly by bolus propofol administration, but the latencies showed no significant change with propofol under the same condition. We consider that total intravenous anesthesia with propofol and fentanyl without muscle relaxants is compatible with the recording of MsEP evoked by high frequency repetitive electrical transcranial stimulations. When MsEP is monitored during spine surgery, anesthetic condition should be controlled carefully in order to maintain a stable blood concentration of propofol and thus to assure the reliability of MsEP measurements.
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Case Reports
[A case of awareness during propofol anesthesia using bispectral index as an indicator of hypnotic effect].
A 77-year old, woman weighing 44 kg with mild liver dysfunction underwent lower abdominal surgery. Anesthesia was induced with propofol 60 mg and fentanyl 0.1 mg. Tracheal intubation was facilitated with vecuronium 8 mg, and the lungs were ventilated with 33% oxygen in air. ⋯ On discharge from the operating room the patient declared that she had been awake. She had heard voices and felt the surgeon working, but had suffered no pain. The BIS is a useful indicator for hypnotic effect, but this case demonstrates that awareness might occur even when BIS value indicates adequate hypnotic state.
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Case Reports
[A case of central retinal artery occlusion after anterior posterior fusion of the lumbar spine].
We report a case of central retinal artery occlusion after anterior-posterior fusion of the lumbar spine. The patient suddenly lost his vision of the right eye in the ICU just after the end of long procedure for anterior-posterior fusion of the lumbar spine. The patient was diagnosed as having central retinal artery occlusion, and treated successfully with treatments including immediate administration of urokinase and PGE1, stellate ganglion block, and hyperbaric oxygen therapy. ⋯ Central retinal artery occlusion is a rare but very serious complication during and after supine surgery with prone position. It is very important for us to be aware of its possible occurrence. We have to diagnose and treat, as soon as possible, the vision loss after the spine surgery.
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Clinical Trial
[A clinical evaluation of blind orotracheal intubation using Trachlight in 511 patients].
We used Trachlight for blind orotracheal intubation (ordinary tracheal tube or Portex Blueline in 305 cases, and reinforced tube or Mallinckrodt Safety-Flex in 206 cases) for general anesthetic procedures, and evaluated its technical features along with related complications. With ordinary tubes, 93% of the patients could be intubated successfully at the first attempt. Unsuccessful intubation even at the third attempt occurred in 3 patients (1%). ⋯ One patient developed minor tracheal bleeding probably due to injury of the mucosa. The elevation of the blood pressure at intubation with this device was not as high as that by direct laryngoscopy. We conclude that Trachlight leads to intubation with a high success rate, and that care should be taken not to damage the tracheal mucosa by blind insertion.
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We report two cases of anesthetic management with monitoring by near-infrared spectroscopy in patients with renal cell carcinoma and with adrenal cortical carcinoma, who had tumor thrombus invading into the inferior vena cava. In inferior vena caval reconstruction, extracorporeal circulation such as veno-veno bypass or cardiopulmonary bypass is frequently required. The hemodynamic unstability under extracorporeal circulation may lead to severe cerebral damage, especially in elderly patients. ⋯ However, these decreased oxygenated hemoglobin was restored rapidly at the end of extracorporeal circulation. Both patients showed no post-operative neurological complication. We concluded that near-infrared spectroscopy, which is continuous and non-invasive monitoring of cerebral oxygenation status, is one of the useful monitors during extracorporeal circulation.