Masui. The Japanese journal of anesthesiology
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We report 3 patients who developed a sudden unpredicted increase in bispectral index (BIS) value during propofol and fentanyl anesthesia. The patients were induced with propofol 2-mg.kg-1 and fentanyl 2-micrograms.kg-1 and muscle relaxation was obtained by vecuronium 0.12-mg.kg-1. During induction of anesthesia, BIS value went down to below 50 in all three cases, and anesthesia was maintained by continuous infusion of propofol at a rate of 5 mg.kg-1.hr-1 and intermittent administration of fentanyl. ⋯ The serum concentration of propofol was approximately 2.5 micrograms.ml-1. All patients were successfully treated with increasing the infusion rate of propofol and additional administration of fentanyl. No clear recall or explicit memory during operation was observed after anesthesia, but, anesthesiologists might have to pay more attention to unpredictable changes of anesthetic depth during propofol anesthesia using target controlled infusion.
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Case Reports
[Fiberoptic intubation via laryngeal mask airway under general anesthesia in the patients with halo vest].
Since 1991, we gave anesthesia to 155 patients with halo vest. All of 128 whose airways could be kept patent by laryngeal mask airway (LMA) were successfully intubated fiberoptically via LMA using the tube exchange catheter under general anesthesia. Four patients developed airway obstruction during the induction of anesthesia, two of whom were awakened and subsequently intubated by awake fiberoptic intubation. ⋯ Even less experienced residents can intubate easily and safely without assistance. However, we must carefully diagnose and select the patient whose airway can be kept patent under general anesthesia. The motionless pictures of the intubation procedures can be seen on the web site: www.hosp.go.jp/~kobe/.
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Historical Article
[New study on the history of anesthesiology--(9) a brief history of "N2O Study Society"].
In Japan nitrous oxide has been manufactured since 1955 at the request of General Headquarters of the Allied Forces. Two years later in 1957, a manufacturer built a small society for the study and popularization of nitrous oxide anesthesia as well as general anesthesia. The society gave more than twenty seminars for this purpose in various cities in a period of 8 years from 1957 until 1965. ⋯ Yamamura of Tokyo University and other professors of anesthesiology gave their lectures on basic science of nitrous oxide anesthesia and demonstrated its use for surgical patients. In July 1962, a fatal accident of explosion during ether anesthesia occurred in a hospital in Tokyo, in which a 25-year-old male died due to combustion and explosion triggered by electrical cauterization during surgery of pulmonary empyema. This accident facilitated and accelerated rapid and wide spread of nitrous oxide anesthesia as well as anesthesiology in general in Japan.
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After induction of spinal anesthesia, thoracic epidural pressure and left saphenous venous pressure were monitored and recorded during supine hypotensive syndrome in 8 pregnant patients who underwent elective cesarean section. ⋯ The synchronous increase in both pressures was late after the hypotension probably because sympathetic block with spinal anesthesia inhibited vasoconstriction of the lower extremity, a factor to compensate for supine hypotensive syndrome. Only collateral flow via epidural venous plexus emptying into azygos system could not compensate for decreased venous return to the right atrium from obstructed inferior vena cava, and differences in the degree of compression of the inferior vena cava by gravid uterus would affect the recovery from supine hypotension.
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Case Reports
[Anesthetic management for laparoscopic surgery in a patient with Charcot-Marie-Tooth disease].
A 50-year-old woman was scheduled for laparoscopic cholecystectomy under general anesthesia. She was suffering from Charcot-Marie-Tooth (CMT) disease for 21 years, and implanted with a permanent pacemaker for IIIrd degree AV block. ⋯ Neuromuscular blockade was not used because of the presence of peripheral neuropathy and respiratory muscle weakness. We suggest that sevoflurane anesthesia might be useful for anesthetic management of CMT patient with a risk of postoperative respiratory failure.