Masui. The Japanese journal of anesthesiology
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Case Reports
[Severe airway obstruction relieved by sedation using sevoflurane in a pediatric patient with tracheobronchomalacia].
A 3-month-old baby with trisomy 18 syndrome was scheduled for tracheostomy under general anesthesia because of the prolonged tracheal intubation. Immediately after transferring the patient to the operating table, the patient suddenly began crying and coughing, resulting in severe hypoxia. The patient's lungs could not be ventilated by manual and positive pressure ventilation, and airway obstruction could not be relieved until the respiratory effort spontaneously decreased. ⋯ After sevoflurane administration, the sedated patient never developed the respiratory effort, and the lungs could be ventilated by manual and positive pressure ventilation without difficulty. The patient was diagnosed as tracheobronchomalacia as a result of intraoperative flexible bronchoscopy performed through tracheostomy tube, revealing significant narrowing of both the trachea and mainstem bronchus lumens. Sedation using sevoflurane may be helpful in maintaining airway patency in the pediatric patient with tracheobronchomalacia.
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To protect the spinal cord during thoracoabdominal aortic aneurysm repair, motor evoked potentials (MEP) monitoring and cerebrospinal fluid drainage are often employed. Herein, we report a case, where intraoperative diminishment of motor evoked potentials was accompanied by multiple cerebral infarction. A 63-year-old man underwent elective surgery for both thoracoabdominal aortic aneurysm and abdominal aortic aneurysm. ⋯ On the postoperative day 4, when we stopped the cerebrospinal fluid drainage and propofol administration, his level of consciousness was poor and brain CT revealed multiple cerebral infarction. On the postoperative day 30, he was discharged from an intensive care unit with complications of hemiplagia and paraplegia. Although cerebrospinal fluid drainage may be recommended to protect spinal cord during thoracoabdominal aortic aneurysm repair, we should consider performing brain CT to exclude a risk of brain herniation secondary to cerebrospinal fluid drainage if there is a possibility of cerebral incidents.
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Although anesthetics have been often used clinically, the mechanisms of action of anesthetics have not yet been clarified. Recently, major advances have been made in our understanding of the physiology and pharmacology of G-protein-coupled receptor (GPCR)-mediated signaling. ⋯ Given that known GPCRs are targets for anesthetics, these oGPCRs may represent a rich group of receptor targets for anesthetics. This review highlights the effects of anesthetics on Gq-coupled receptors, and discusses whether GPCRs other than Gq-coupled receptors, and proteins that convey GPCR signals are also targets for anesthetics.
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We investigated changes in core temperature associated with lower extremity tourniquet (TQ) under two different ambient temperatures (1) and two different warming equipments (2) under general anesthesia combined with lumbar epidural anesthesia. ⋯ Air-forced warming maintains core temperature efficiently associated with lower extremity tourniquet.
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Historical Article
[New study on the history of anesthesiology--(11) three Japanese doctors who observed William TG Morton's ether anesthesia at the Gross Clinic in 1860].
In January of 1860 the Tokugawa Shogunate dispatched a group of Japanese mission headed by Masaoki Niimi, the first ambassador, to Washington D. C. to exchange ratification of Japan-United States treaty of commerce and amity. On May 22nd the ratification was approved. ⋯ In Philadelphia three Japanese medical doctors visited Jefferson Medical College to observe an operation of lithotomy by Dr Samuel D Gross, professor of surgery. Ether was given by Dr William TG Morton, the man that had succeeded in the public demonstration of ether anesthesia at Massachusetts General Hospital in Boston on October 16, 1846. The doctors might have brought new information on ether anesthesia to Japan, but they only left few traces of providing the information to medical professionals in Japan.