Masui. The Japanese journal of anesthesiology
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We report the anesthetic management of microlaryngeal surgery in children using tubeless total intravenous anesthesia (TIVA) without endotracheal intubation under spontaneous breathing. In 9 patients (median age : 4.9 yr. range 1 months-14 years, body weight : 17 kg, range 3-61 kg), 19 procedures were performed with TIVA using propofol and remifentanil. The median time from the start of TIVA to rigid laryngoscope insertion was 11 minutes. ⋯ Three children were found apneic after a bolus administration of remifentanil or after increasing the rate of remifentanil infusion accompanied with desaturation and their tracheae were intubated. The spontaneous respiration technique using TIVA without intubation provides an excellent view of the operative field while allowing stable anesthesia. Further studies are required to establish the optimal dose of propofol and remifentanil and the timing of rigid laryngoscope insertion.
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Participation in the American Heart Association advanced cardiac life support provider course is a prerequisite for taking the anesthesiology specialist examination in Japan. The course teaches fundamental resuscitation methods for different types of cardiac arrest. ⋯ Main contents of the course included circulation management, airway management central venous catheters, and pain clinic-related complications. ALS-OP simulation training may be beneficial for educating anesthesiologist and promoting perioperative patient safety.
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We report a case of sudden head-tilt difficulty after induction of general anesthesia which was postoperatively diagnosed as ossification of the posterior longitudinal ligament. A 42-year-old man weighing 115 kg was scheduled for emergent laparoscopic appendectomy for acute appendicitis. ⋯ Following mask ventilation with jaw-thrust maneuver, we successfully performed tracheal intubation using the Pentax-AWS Airwayscope. After surgery, he was diagnosed with ossification of the posterior longitudinal ligament by an orthopedist.
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The laryngeal tube (LT ; Smiths Medical, Minnesota, U. S. A) is an inflatable supraglottic device for emergency airway management such as during chest compression, the instability after insertion remains a problem. ⋯ A fixation neck tape may be useful in stabilizing the inserted position of LT during cardiopulmonary resuscitation.
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Intraoperative neurophysiological monitoring has been increasingly utilized for many neurosurgical procedures as well as for spine and aortic surgery. The recent advances in monitoring devices and anesthesia techniques have improved the reliability and accuracy of intraoperative neurological monitoring. In this issue, we review the basic principle, methods, and clinical application of several modalities of neurological monitoring to detect neural tissue ischemia and the direct physical injury to the specific neural pathway during surgical procedures. ⋯ Evidence for the efficacy of the monitoring varied with surgical procedures, but has been well validated in some procedures. Anesthesiologists can contribute to the reliability and efficacy of neurophysiological monitoring by maintaining good physiological homeostasis and stable levels of anesthesia during the surgical procedure. With appropriate knowledge and experience, the anesthesiologist should work together with the neuromonitoring staff and surgeon to ensure neurological safety for the patient during and after surgery.