Masui. The Japanese journal of anesthesiology
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We present the system of nurse anesthetist (Infirmier Anesthésiste Diplômé d'Etat: IADE) in France to the community of Japanese anesthesiologists. This French system with 70 years' history is older than the Japan Society of Anesthesiologists itself. There are 7000 nurse anesthetists in France now and the number of nurse anesthetists increases by 450-500 each year. ⋯ The relationship between the certified anesthesiologist and the nurse anesthetist is marked by mutual respect, confidence and cooperation at each step of the anesthetic management, from induction to recovery of anesthesia. We believe that it is very safe for the patients to undergo anesthesia performed by nurse anesthetists under the control of certified anesthesiologists. We suggest that the introduction of the system equivalent to the French concept and improved training of nurse anesthetists can be the solution to overcome our current shortage of certified anesthesiologists in Japan.
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A 66-year-old man with severe chronic obstructive pulmonary disease (COPD) was scheduled for elective endovascular repair of an aortic abdominal aneurysm and femoral-femoral artery bypass. Because spirometry revealed marked reduction of percent forced expiratory volume in 1 second (%FEV1.0), postoperative respiratory failure was anticipated. Spinal anesthesia and no use of tracheal intubation were planned. ⋯ Additional analgesia was acquired with a total of 0.1 mg of fentanyl IV. The endovascular repair was completed uneventfully. In conclusion, spinal anesthesia combined with local anesthesia in the elbow is useful for management of endovascular repair of an aortic abdominal aneurysm in patients with severe COPD for whom postoperative respiratory failure is anticipated.
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Majority of severe anesthetic complications result from airway difficulties. Among the airway difficulties, difficult mask ventilation is a key critical condition in the currently proposed difficult airway algorithms, and is probably the most life-threatening event. ⋯ Lateral neck radiographs for patients with suspected airway difficulties may provide useful information for identification of potential patients with difficult mask ventilation. Among the parameters measured by the radiographs, I recommend anesthesiologists to measure distance between the hyoid bone and mandibular plane, which possibly reflects anatomical balance of the upper airway maintenance.
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A 79-year-old man underwent aortic arch replacement for thoracic aortic aneurysm. He had a history of smoking, coronary stenting for ischemic heart disease and replacement with artificial blood vessel for abdominal aortic aneurysm. Anesthesia was induced and maintained with midazolam, fentanyl, sevoflurane, and vecuronium. ⋯ However, as he developed compartment syndrome on the left lower limb due to reperfusion injury postoperatively, fascitomy was performed. On the 58th postoperative day, he was discharged from our hospital. Measurement by Doppler is useful for the early diagnosis of the lower leg arterial occlusion.