Masui. The Japanese journal of anesthesiology
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The cholinergic ascending arousal pathway is one of the most powerful cortical activation systems. The origins of this system is from the pedunculopontine tegmentum (PPTg) and laterodorsal tegmentum (LDT), which relay their signals to the posterior hypothalamus, the basal forebrain and then the cerebral cortex. The cholinergic activation by selective agonists or cholinesterase inhibitors has been shown to produce cortical activation and induce awareness from anesthesia. ⋯ Microinjection of orexin-A into the basal forebrain induced the increases in acetylcholine release and EEG arousal through orexin-1 receptors. Furthermore, electrical stimulation of the PPTg induced the increases in acetylcholine release and EEG arousal under isoflurane anesthesia, and SB334867, an orexin-1 receptor antagonist, attenuated these arousal responses. These findings suggest that the orexinergic system may contribute to the arousal from anesthesia through the cholinergic ascending arousal pathway.
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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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Equipments for epiduroscopy consist of an epidural endoscope, video camera system, video screen, recording system and C arm X-ray system. Epidural endoscope with a diameter of 0.9 mm is inserted from the hiatus sacralis, and has been used clinically for the observation of epidural space of a lumbar vertebrae level since 1996. There are still some problems to be solved in the epiduroscope development, but its dramatic pain reduction effect has been recognized and it has been held as an attractive diagnostic tool.