Masui. The Japanese journal of anesthesiology
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A 62-year-old man with hypertension was scheduled for discectomy at L4-5 in prone position. Anesthesia was induced with propofol 70 mg, fentanyl 0.75 mg and rocuronium 40 mg and maintained with sevoflurane 0.8-2.0% in oxygen 2 l x min(-1) and nitrous oxide 2 l x min(-1). ⋯ This case achieved a complete response to quick administration of the coronary vasodilator and antiarrhythmic agent, in this case whose coronary spasm was suspected on the basis of ST elevation in the first place. We have to be careful of various initiating factors for coronary spasm each time during anesthesia as it is difficult to assess its clinical risk, especially in prone position because actual coronary flow is much lower and cardiac resuscitation is difficult in a sudden cardiac complication.
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The i-gel, which has been introduced into clinical practice in Japan in 2010, has a potential role in maintaining a clear airway during general anesthesia. ⋯ We believe that the i-gel is useful in maintaining a clear airway during general anesthesia.
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A forty-year old man hanged himself and was transported to our hospital. On arrival his consciousness was clear but he showed dyspnea, dysphagia, and oral bleeding. Tracheal intubation was attempted but was failed and emergency tracheostomy was successfully accomplished. ⋯ Orotracheal intubation was accomplished with StyletScope. It worked very well for the destroyed trachea. StyletScope is a useful device for intubation, especially in difficult airway management.
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Shoulder arthroscopy has been performed in beach-chair position. In our hospital, the postoperative complications of the airway were reported in the patients who had undergone the operation in this position (hoarseness: 4 cases, paralysis of recurrent nerve: 2 cases, arytenoids dislocation: 1 case). ⋯ The results showed that the neck bending significantly increases the intra-cuff pressure of endotrachial tube. Therefore, we conclude that it is necessary to pay attention to neck position to avoid postoperative complications of the airway in the patients who have the operation in beach-chair position.
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Case Reports
[Efficacy of continuous epidural saline infusion in cerebrospinal fluid hypovolemia: report of 5 cases].
We identified the sites of leakage by cisternography in 5 patients with cerebrospinal fluid hypovolemia and treated them by continuous epidural infusion with physiological saline solution. The results showed improvement in symptoms in all 5 patients, and lasting favorable results were obtained in 3 of them. ⋯ Adverse effects are the same as for ordinary epidural punctures. If the site of the cerebrospinal fluid leak has been specified and the treatment method is understood by the patient, we think that continuous epidural infusion with physiological saline is safe and effective method of treating cerebrospinal fluid hypovolemia.