Masui. The Japanese journal of anesthesiology最新文献

Respiratory adverse events, such as cough, hypoxia, laryngospasm, bronchospasm and stridor, are major causes of morbidity and mortality during pediatric anesthesia. Since several studies have shown that upper respiratory tract infection is an independent risk factor for perioperative respiratory adverse events, children presenting for elective surgery with upper respiratory tract infection require a careful evaluation to decide whether or not to proceed with anesthesia. However, there are no standard guidelines to proceed with or postpone anesthesia, and thus the decision pro- cess is often based on unique institutional, patient, surgical, and social factors. Most of perioperative respira- tory adverse events can be anticipated, recognized, and treated easily, while laryngospasm and bronchospasm that can lead to oxygen desaturation and death are serious complications and their prevention and treat- ment are challenging. Anesthesiologists should be fa- miliarized with the prevention and treatment of peri- operative respiratory adverse events.

Background: Ultrasound-guided transversus ab- dominis plane (TAP) and rectus sheath (RS) blocks are peripheral nerve blocks that diminish somatic pain of the abdominal wall and are useful for postoperative analgesia. Here, we retrospectively compared the effi- cacy of ultrasound-guided TAP and RS blocks in com- bination with continuous intravenous fentanyl for postoperative analgesia of laparoscopic colectomy.

Methods: The ethics committee of our institute ap- proved the study. In our hospital, postoperative analge- sia is performed with continuous intravenous fentanyl administration at three concentrations : 12.5, 18.75, and 31.25 μg · hr⁻¹. TAP and RS blocks were applied using 30-40 ml of 0.19-0.25% ropivacaine. We selected 43 patients who underwent laparoscopic colectomy from May to October 2015. We compared the fentanyl only group (F group, n=26) and block combination group (F+B group, n=17). Statistical analysis was performed with the Mann-Whitney U test P<0.05 was considered significant Results : Patient characteristics including age, height, body weight, duration of anesthesia, and surgery did not significantly differ between the two groups. The concentration of intravenous fentanyl was significantly lower in the F+B group than in the F group (F group : 19.5±8.4μg · hr⁻¹, F+B group : 14.7?4.9 μg · hr⁻¹, P=0.02). In the present study, TAP and RS blocks significantly reduced the dose of administered fentanyl. - Conclusions : Our findings suggest that a combina- tion of TAP and RS blocks lower the dose of continu- ous intravenous fentanyl needed, and may provide better postoperative analgesia after laparoscopic colec- tomy.

The pain of skin graft site after surgery is compara- tively severe. We present three cases of combined of ultrasound-guided femoral nerve block and lateral fem- oral cutaneous nerve block that was effective for har- vesting skin grafts. Case 1 : a 32-year-old man had a split-thickness skin grafting of lateral upper arm harvested from outside of the thigh under general anesthesia, brachial nerve block, femoral nerve block and lateral femoral cutane- ous nerve block. Case 2 : a 39-year-old man had split-thickness skin grafting of lower thigh harvested from outside of the thigh under general anesthesia, femoral nerve block and lateral femoral cutaneous nerve block. Case 3 : a 94-year-old man had split-thickness skin grafting of acrotarsium harvested from outside of the thigh under spinal anesthesia, femoral nerve block, lat- eral femoral cutaneous nerve block and sciatic nerve block. In all cases, there was no pain just after surgery, and postoperative pain was controlled well through the hospitalization with administration of oral analgesic agents.

Respiratory complications are the major causes of anesthesia-related death or irreversible brain damage. Recently, the incidence and severity of bronchial asthma, obesity and sleep apnea are increasing, and because of advancement of medical care, surgery is increasingly carried out in patients with moderate or severe respiratory complications. In this special issue, preoperative assessment and treatment methods of patients with upper respiratory tract infection, bron- chial asthma, sleep apnea, deformed airways, chronic obstructive lung disease, or restrictive respiratory dis- ease are discussed, followed by anesthesia and airway management methods during anesthesia, including treatment of each respiratory disease.

Bronchial asthma is a major disease with bronchial hyperreactivity. In Japan, patients with bronchial asthma are increasing in number. Bronchospasm may be evoked by tracheal intubation, and it may increase perioperative complications. In some cases, broncho- constriction may lead to a poor outcome. The treatment of asthmatic attack and the long-term management for bronchial asthma are described in the Japa- nese Asthma Prevention and Management Guideline 2015 (JGL2015). There is no specific strategy for anesthesia in patients with bronchial asthma, but we should know its treatment and management on the basis of JGL2015. It is important that we are prepared for asthmatic attack during anesthesia, and we should consider the perioperative management for asthma patients.

We report a case of persistent dysesthesia lasting over a year in a patient after uneventful spinal anes- thesia with bupivacaine. A 67-year-old woman received spinal anesthesia for transurethral resection of bladder tumor. The surgery was performed in lithotomy position taking 20 min. Dysesthesia was found in her left lower limb postoperatively. Postoperative magnetic resonance imaging (MRI) revealed lumbar spinal canal stenosis at the L4-5 level, but she did not have any neurological deficits preoperatively. In spite of conser- vative treatment, the dysesthesia persisted for a year. We suspect that neurological symptoms were potentially caused by the interaction of local anesthetic toxicity and lumbar spinal canal stenosis. This case emphasizes the importance of thorough consultation on potential neurological complications following spinal anesthesia including the possibility for prolonged sequelae. In addition an early imaging examination during follow up is quite informative in assessing the situation appropriately.

The earliest report of tracheal intubation during general anesthesia was made by Sir. William Macewen (a Scottish surgeon, 1848-1924), who performed it on 5th July, 1878. The report, which was published in the British Medical Journal in 1880, included four cases of tracheal intubation, and in one of those, general anes- thesia was provided. Macewen performed tracheal intubation, instead of tracheostomy, in a patient sched- uled for resection of a large epithelioma in the mouth under general anesthesia, to prevent airway obstruc- tion and aspiration of blood. In the report, he described several advantages of tracheal intubation during gen- eral anesthesia and methods with which aspiration of blood can be prevented.

Hosetsu Namba (1760-1859), a practitioner at Kanagawa, Bizen (presently Okayama Prefecture) and a disciple of Rokujo Hanaoka, described in his Taisan Shinsho three cases of general anesthesia with Mafu- tsusan. They are breast cancer tumor excisions in two patients in 7 and 3 months of pregnancy, respectively, and anal fistulectomy in a patient in 3 months of preg- nancy. Their postoperative courses were uneventful, and all of them had smooth deliveries. Although Namba did not provide the exact dates of these opera- tions, it is highly likely that the patient with breast cancer in 7 months of pregnancy received the tumor excision during a period between 1815 and 1830. To the best of our knowledge, this is considered the first general anesthesia for surgery in a pregnant woman to be documented in the world literature.

Background: Recently several types of head- mounted displays are available for use in the medical field. Because head-mounted display can provide the visualized information without moving direction of eye- sight, ultrasound guided central venous cannulation might be performed more quickly and safer. One of the head-mounted type displays, Near-Eye Display (NED; NED prototype product, JCV Kenwood, Japan) was tested in ultrasound guided central venous cannulation.

Methods: Eleven experienced anesthesiologists per- formed central venous cannulation on the training sim- ulator with NED and with control method (without NED). Ultrasound real time image and operating field were recorded by video camera and analyzed to iden- tify procedure time, success rate and incidence of unintentional posterior venous wall penetration.

Results: With NED, although time required for cen- tral venous cannulation was similar to the time with standard method (31.3 ± 8.7 sec with control and 30.2 ±7.9 sec with NED, P=0.61), unintentional posterior wall penetration tended to occur less frequently (21% with control and 9% with NED, P=0.17).

Discussions and conclusions: As NED can help practitioners to have both insertion field and ultra- sound image visible without moving eyesight, NED might be a promising assist device for the ultrasound guided central venous cannulation.

A 29-year-old man suspected of having a hematopoietic malignancy was scheduled to undergo video- assisted splenectomy. Because of his good general con- dition on a preanesthetic evaluation, combined general and epidural anesthesia was selected. However, after insertion of an epidural catheter in the operating room, surgery had to be postponed due to bleeding from the catheter insertion site. The hematological examination done right after the postponement revealed hemo- phagocytic syndrome and the patient rapidly developed disseminated intravascular coagulation. This case suggested that in a patient with hematopoietic malig- nancy a hematological examination should be carried out on the day of surgery; besides, neuraxial blockade should be avoided because bleeding could be acutely induced due to changes in the patient's condition.