Masui. The Japanese journal of anesthesiology最新文献

Alpha-1 antitrypsin deficiency (AATD) is an inherited disorder affecting the lung, liver, and rarely skin. The most frequent features of AATD consist of chronic lung disorders related to protease-antiprotease imbalance in the respiratory system, to which lung transplantation is frequently indicated. We describe a case of aortic dissection in a 55-year-old male who underwent left single lung transplantation for respiratory failure due to AATD-related emphysema. Extracorporeal membrane oxygenation (ECMO) was indicated during the procedure, and an arterial cannula was placed into the descending aorta and a venous cannula was placed into the right femoral vein. Bronchial and vascular anastomoses were finished without any problems and ECMO was weaned off However, transesophageal echocardiography carried out at the end of the operation showed a dissected descending aorta. Alpha-1 antitrypsin (AAT) is the major serum inhibitor of seine proteinases, which enzymatically destroys collagen and elastin. Degeneration of connective tissues, in particular elastic tissues, is established in AATD, and decreased stiffness of the aorta due to degradation of elastic fibers has also been reported in AATD. In this patient, reduced AAT activity might have boosted the enzymatic destruction of his arterial walls, leading to enhanced vulnerability to aortic dissections.

A 37-year-old female patient with myotonic dystrophy was scheduled for laparoscopic cholecystectomy for gall stone under general anesthesia with continuous propofol infusion. Rocuronium was administered with careful monitoring using TOF- Watch®, measuring train-of-four count (Tc), TOF ratio (Tr), and posttetanic count The total amount of rocuronium was 70 mg ; 0.6 mg .kg⁻1 for anesthetic induction and 0.3 mg .kg⁻1 when Tc exceeded 1. When the operation was completed, Tc was 4, Tr was uncountable and she showed reaction to calling her name. Then sugammadex 2 mg .kg⁻1, rapidly antagonized the neuromuscular block, such that the Tr recovered to 100% but tidal volume was 250 ml in 3 minutes. Additional dorsage of sugammadex, 2 mg .kg⁻1, was required for tidal volume to recover to 530 ml. After 20 minutes of first administration of sugammadex, we extubated the tracheal tube without respiratory depression. To avoid respiratory depression, we did not use postoperative opioids. Intraoperative transversus abdominis plane block and postoperative thoracic epidural block with ropivacaine were successful for postoperative pain relief.

We report an 87-year-old woman who presented with unexpected systolic anterior motion (SAM) of the mitral valve after the induction of general anesthesia. She was receiving medication for hypertension and cerebral infarction. There were no abnormal findings on her preoperative transthoracic echocardiography (TTE) examination. After the induction of general anesthesia, she presented with refractory hypotension. We performed TTE and diagnosed SAM of the mitral valve. Her hemodynamic state was improved by fluid infusion and administering intravenous phenylephrine. After the surgery, we performed a morphologic assessment of the patient's heart using TTE. We found a thick basal interventricular septum and a small distance from the mitral coaptation point. to the septum. This case shows that SAM of the mitral valve can occur in a patient without preoperative cardiac abnormalities. SAM of the mitral valve should be considered in the differential diagnosis of refractory hypotension, particularly in elderly patients. Perioperative TTE is a useful tool for the rapid diagnosis and treatment of hemodynamic instability.

The evaluation of the lung has usually been considered off-limits for ultrasound, because ultrasound energy is rapidly dissipated by air. Lung ultrasound is not useful for the evaluation of the pulmonary parenchyma and the pleural line. However ultrasound machines have become more portable, with decreased start-up time, while simultaneously providing improved image quality and ease of image acquisition. Additionally, lung ultrasound is highly accurate for the diagnosis of pneumothorax, hemothorax. pleural effusions, pulmonary edema (cardiogenic or noncardiogenic), interstitial syndrome, and pneumonia. These factors make lung ultrasound suitable for operating rooms, intensive care units, and emergency departments. Adequate interpretation of lung ultrasonographic findings, including artifacts, requires some training and experience. Since lung ultrasound abnormalities, however, are well defined and easy to recognize, learn and reproduce, operator dependence is minimal. So let's try lung ultrasound! In this article, the author will discuss the examination method for adequate lung ultrasonographic images, lung ultrasonographic findings and signs, leading to the diagnosis.

A 32-year-old pregnant woman with verapamil sensitive ventricular tachycardia underwent elective caesarean section. She received catheter ablation for frequent tachycardia, but ventricular tachycardia appeared. In the operating room, a defibrillator pad was placed on her chest for external defibrillation, with A-line in a left radial artery. General anesthesia was started with rapid sequence induction. The anesthetic course was uneventful, and the infant showed no complication during the perioperative period. General anesthesia can be considered as safe anesthetic management for caesarean section in a patient with verapamil sensitive ventricular tachycardia.

Patients with cardiac disease have high mortality rates, mainly owing to shock. Therefore, evaluation of cardiac function is one of the most challenging issues in the intensive and critical care unit. Cardiac point-of-care tests using ultrasound, such as focus assessed transthoracic echo (FATE) and rapid ultrasound in shock (RUSH). are useful for diagnosis and initial care of such patients. The author will introduce first a basic FATE protocol of how to scan from position 1-4, including subcostal 4-chamber, apical 4-chamber, parasternal long and short axis, and pleural scanning. A simple measurement method is described to evaluate the left and right ventricular function using mitral annular plane systolic excursion (MAPSE), mitral septal separation (MSS), and tricuspid annular plane systolic excursion (TAPSE). Next the RUSH protocol is discussed, which is useful for evaluation and care of patients with hypovolemic, cardiogenic, obstructive, or distributive shock. RUSH involves evaluation of the three main components : the pump (cardiac function, volume, pericardial function), the trunk (inferior vena cava, pleural fluid, lining), and the pipes (abdominal aneurysm, aortic dissection, deep vein thrombosis).

In the 18th century, tracheal intubation was introduced to clinical practice, mainly in patients with airway obstruction in children due to diphtheria, and in patients who were apparently dead. In this article, I describe the fourth reason for tracheal intubation :a newborn with apnea. Until the mid-18th century, delivery was performed only by midwives, and mouth-to-mouth resuscitation was "secretly" performed by them (midwives' secret). In the mid-18th century, obstetricians started to be involved in the delivery, and in 1750's, Benjamin Pugh (1715-1798) and William Smellie (1697-1763) might have intubated the tracheas of neonates with apnea Since 1790's, Paul Scheel (1773-1811), Frangois Chaussier (1746-1828), James Blundell (1791-1878). Jean Anne Henri Depaul (1811-1883), Heinrich Alexander Pagenstecher (1825-1889), and Alban Alphonse Ambroise Ribemont-Dessaignes (1847-1940) intubated the trachea. Tracheal intubation might have been widely performed by midwives, because Chaussier had educated them at his school.

Point-of-care ultrasonography has become widely used in diagnosis and managements of patients. In the field of anesthesiology, ultrasound guided nerve blocks and central venous catheterization (CVC), and transesophageal echocardiography (TEE) have become popular. Now, ultrasound devices are familiar to anesthesiologists. In pre-anesthetic patient risk evaluation, the sonographic results of transthoracic echocardiography (TTE) or the examination of deep venous thrombus are often helpful for anesthesia planning. Both examinations usually have been performed by sonographer. However, the ultrasonographic assessment of neck vessels, lung condition with diaphragm function are still less familiar among anesthesiologists. Here, we have introduced a series of pre-anesthetic whole body ultrasound evaluation of the patients. Because of less invasive technique, whole body ultrasound evaluation is suitable to use when anesthesiologists may have questions whether the patient's condition is good or not. No doubt that point-of-care ultrasonography by anesthesiologists themselves in pre-anesthesia. clinic can be the useful decision making tool of anesthesia plan. To be tomorrow's anesthesiologists, please start point-of-care pre-anesthetic ultrasonographic assessment.

In the past ultrasound identification of the airway structure was rather difficult However, recent advancement of the high frequency linear type transducer allows us to visualize airway structure easily. Accordingly, now we have difficult airway society guideline 2015. resuscitation guideline 2015, and Australia and New Zealand Intensive Care Society guidelines for percutaneous dilatational tracheostomy which recommend use of ultrasound in airway management Airway ultrasound is an emerging technique for all physicians, and the author introduces perioperative evaluation of the airway via sonography, the PEAS protocol.