Masui. The Japanese journal of anesthesiology
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Case Reports
[Airway Management Utilizing an air-Q blocker in a Patient with Motor Neuron Disease and Soft Palate Paralysis].
A 67-year-old woman suffering from hoarseness or dysphagia was diagnosed with motor neuron disease. She was scheduled for laparoscopic cholecystectomy under general anesthesia for suspected gallbladder cancer. She was concerned about the exacerbation of her hoarseness or dysphagia from tracheal intubation. ⋯ Sealing pressure was over 20 cmH2O and mechanical ventilation was performed uneventfully during artificial pneumoperitoneum. We were able to deflate the stomach and perform tracheal suction via the inner hole of the air-Q. Following the operation, the patient developed neither hoarseness nor pharyngeal pain.
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Interscalene brachial plexus block (ISBPB) complications depend usually on the dose administered. ⋯ The use of low-volume ultrasound-guided ISBPB is associated with less respiratory depression and hemidiaphragmatic paralysis.
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Here, we report the development of a simulation-based perioperative training course. Participants were anesthesiologists and operating room nurses. Three different courses were held with different themes, such as airway management, circulation management and central venous management. ⋯ At the end of each course, participants discussed problems associated with medical safety in the context of each theme. Participants commented not only on changes in their views regarding individual technical or non-technical improvements, but also on general medical safety in the operating room. Our findings suggest that simulation-based perioperative team training may serve as a vehicle to promote operating room safety.
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Historical Article
[Did Seikyo Sugita Perform Two Surgical Operations under Ether Anesthesia in 1855?].
Although Seikyou Sugita is said to have provided ether anesthesia for two surgical oprations in 1855 including the scur resection of burned fingers of a man and the resection of a breast cancer of a woman. The details of his administration of the drug were not known because he did not describe these cases at all. According to Treatise on Inhalation of Ether written in 1863 by Shinryo Tsuboi, Sugita failed to provide successful general anesthesia using ether for these patients. The ether he used was prepared by Ryuho Shima, and the failures were likely to be due to impure nature of the agent.
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Malignant hyperthermia occurred 10 hours after surgery in a 72-year-old man who had received emergency laparoscopic cholecystectomy for severe acute cholecystitis with cholelethiasis. He had a high fever (39.4 degrees C) with liver damage before surgery. Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane and epidural block using ropivacaine. ⋯ He had hypoxic brain damage, but was dischanged from the hospital after tracheostomy on the 150th hospital day. From his clinical course, especially decrease in body temperature by dantrolene, he was suspected to have developed malignant hyperthermia. We should consider malignant hyperthermia when patient had a severe high fever postoperatively.