Masui. The Japanese journal of anesthesiology最新文献

Intravenous leiomyomatosis (IVL) is a condition in which leiomyoma originating from uterine myoma or intrauterine venous walls develops intravenously. A single-stage operation was planned by the departments of gynecology and cardiovascular surgery for a patient in which the IVL was extended across the tricuspid valve. It was possible to safely perform perioperative care with continued evaluation of the tumor position and intravascular volume through the use of transesophageal echocardiography (TEE). TEE can be useful in the intraoperative care of patients with intracardiac tumor extension as in this case.

From the mid-18th century, several different stimulations were used to attempt to resuscitate apparently dead people. These include sound, smell, and light stimulation to the ear, nose and eyes, rubbing the body surface and spirit given to the oral cavity. The most notable stimulation was use of electricity, which was initiated by better understanding of its power by Benjamin Franklin and Luigi A. Galvani. Charles Kite developed the first electrical machine to stimulate the heart, and by 1800, it was found that the most effective site for applying electricity was over the heart.

Point-of-care ultrasound (POCUS) in the diagnoses of postoperative complications is discussed. POCUS is useful in many situations such as abdominal distension, elevated liver enzymes, abdominal pain, and fever, which are the common complications encountered after surgical operations. In the patients with abdominal distention, bowel distention or ascites can be easily detected by POCUS. Occasionally, congestive liver and milk of calcium bile caused by the administration of antibiotics cause elevated liver enzymes, and both of these can also be detected by POCUS. Although there are many complications which cause abdominal pain, POCUS is useful not only for the diagnosis of intraabdominal disorders but also the .diseases of other organs including the bone and muscle. Even the presence of NOMI (non-occlusive mesenteric ischemia) can be diagnosed by contrast ultrasound using Sonazoid®. In patients with fever, US is useful not only for the diagnosis of abdominal abscess but also for the drainage. By evaluating the colon with POCUS, we can detect the pseudomembranous colitis which often is overlooked. In conclusion, POCUS is an essential tool for the proper management of postoperative patients.

Recent years have witnessed remarkable progress in the medical equipment including ultrasound devices. There has also been an increasing interest in point-of-care ultrasound in the field of perioperative medicine. This editorial outlines the basis of point-of-care ultrasound to aid anesthesiologists, focusing on how to make better use of this useful tool.

Klippel-Feil syndrome (KFS) is a complex syndrome of osseous and visceral anomalies that include the classical clinical triad of short neck, limitation of head and neck movement and low posterior hairline. It may also be associated with anomalies of the genitourinary, musculoskeletal, neurologic and cardiac systems. We experienced surgery for a case of KFS complicated with cleft palate and ankyloglossia. This boy underwent palatoplasty with a push-back method at 19 months of age, and frenumectomy at 31 months. respectively. We had to secure the field of operation and airway management involved difficult tracheal intubation. Careful postoperative care and respiratory management are also required for the patient afflicted with KFS.

Ultrasonography is useful not only for screening, but also for evaluating pathological conditions and followup because it can be performed repeatedly and noninvasively at bedside. This paper discusses the importance of the functional assessment of vascular access, as well as the examination method and points for diagnosis of venous thrombosis.

We report a case of sudden shock during caesarean section under combined spinal epidural anesthesia. The patient was a 29-year-old woman. During the operation vital signs had been almost stable until a female-baby was born. But after the delivery of the placenta, the patient developed an episode of coughing and dyspnea followed by unconsciousness and bradycardia. She was given adrenaline and intubated, appearing ventricular fibrillation on a EKG. Cardiopulmonary resuscitation was immediately started and sinus rhythm returned. Hypotension followed and a small dose of adrenaline was infused for three days. She made good progress and was discharged without significant sequela. Cardiopulmonary collapse type of amniotic fluid embolism (AFE) is doubtful in this case. The necessity of rapid and appropriate treatment for emergency obstetric cases was discussed.

Background: Endoscopy is one of the most useful clinical techniques in difficult airway management Comparing with the fibroptic endoscope, this compact device is easy to operate and can provide the clear image. In this study, we investigated its usefulness in the preoperative examination of endoscopy.

Methods: Patients undergoing oral maxillofacial surgery were enrolled in this study. We performed preoperative airway examination by electronic endoscope (The CMOS video rhino-laryngoscope, KARL STORZ Endoscopy Japan, Tokyo). The system is composed of a videoendoscope, a compact video processor and a video recorder. In addition, the endoscope has a small color charge coupled device (CMOS) chip built into the tip of the endoscope. The outer diameter of the tip of this scope is 3.7 mm.

Results: In this study, electronic endoscope was used for preoperative airway examination in 7 patients. The preoperative airway examination with electronic endoscope was performed successfully in all the patients except one patient The patient had the symptoms such as nausea and vomiting at the examination.

Conclusions: We could perform preoperative airway examination with excellent visualization and convenient recording of video sequence images with the CMOS video rhino-laryngoscope. It might be a especially useful device for the patients of difficult airways.

A 77-year-old man with paroxysmal atrial fibrillation and hypertrophic obstructive cardiomyopathy was scheduled for cervical laminoplasty. He was predicted difficult mask ventilation combined with difficult laryn- goscopy (CICV) because of short thyromental distance. After induction of general anesthesia, we attempted tracheal intubation using McGRATHO and Gum-elastic Bougie and the intubation was successful. After opera- tion, in ward, atrial fibrillation occurred. Because anti- arrhythmic agents were not effective, cardioversion was planned. While under sedation, his breathing stopped. The attending physician could not ventilate with mask and intubate with Macintosh laryngoscope. The patient went into cardiopulmonary arrest After successful intubation using McGRATH? and Gum- elastic Bougie by anesthesiologist The attending physi- cian did not recognize CICV. We should convey infor- mation of CICV surely and perform education about difficult airway management.

A 58-year-old man (height, 160.5 cm; weight 46.7 kg) underwent partial esophagectomy under general anesthesia. A resident anesthesiologist punctured the right internal jugular vein (IJV) (20 mm wide, 4.7-7.6 mm long antero-posteriorly, and 7.6 mm deep) with a 22-gauge metal puncture needle under ultrasono- graphic guidance to secure a central venous catheter (CVC) after surgery under artificial respiration. After obtaining venous blood return without an ultrasono- graphic image of the needle tip inside the IJV, the anesthesiologist advanced a flexible straight-type guidewire into the IJV without resistance. Longitudinal ultrasonography of the guidewire outside the IJV indi- cated extravasation. After withdrawing the guidewire, the anesthesiologist re-punctured the IJV. After obtain- ing blood return with two-echo enhancement inside the IJV, indicating the needle tip, the anesthesiologist advanced the guidewire without resistance and ultra- sonographically confirmed the course of the guidewire inside the IJV along the posterior wall. CVC placement was confirmed via plain radiography of the chest Even a flexible guidewire can penetrate the IJV at posterior wall if a puncture needle tip is positioned near the pos- terior wall Longitudinal ultrasonographic imaging of guidewires can help physicians avoid misplacing dila- tors.