Masui. The Japanese journal of anesthesiology最新文献

A tracheal tube can be safely replaced by using a tube exchanger (TE). However, only a thin TE can be used to replace a double-lumen tracheal tube (DLT) with a standard single-lumen tracheal tube (SLT). We successfully replaced a DLT to a SLT by inserting an Aintree Intubation Catheter® (AIC) over a TE in two cases. The AIC (diameter : 19 Fr, overall length : 56 cm) is mainly used for the replacement of various supra- glottic apparatuses using a SLT. In our cases, an AIC with an internal diameter of 4.7 mm was placed over a thin TE with an external diameter of 3.7 mm (11 Fr) to increase the support, and the difference between the SLT with an internal diameter of 7.5 mm and an AIC with an external diameter of 6.3 mm (19 Fr) was decreased, resulting in smooth replacement of the tubes. Even for those cases in which tube replacement might be difficult, acute administration of oxygen could be provided using an AIC with a larger internal lumenthan TE. In conclusion, replacement of a DLT with a SLT i safe and useful through the concomitant use of an AI( and a TE.

Background: Postoperative nausea and vomiting (PONV) is a common complication of general anesthe- sia. The aim of this study was to determine whether the use of nasogastric (NG) tube can decrease the incidence of PONV in patients undergoing positive- pressure ventilation using LMA SupremeTM (SLMA).

Methods: We retrospectively examined the medical records of 176 patients who had undergone orthopedic surgery under general anesthesia. SLMA was inserted after the induction of anesthesia, and positive-pressure ventilation was continued during the operation. Intra- operative NG tube was used in 89 patients (N group) but not in 87 patients, who served as the control group (C group). The incidence of PONV during 24 hours after the operation and the amount of postoperative oral intake were compared between the two groups.

Results: There were no significant differences in the incidence of postoperative nausea (10.1% vs 10.3%) and vomiting (4.5% vs 4.6%) between the N group and the C group. Both groups received 'similar amount of postoperative oral intake.

Conclusions: We conclude that using NG tube does not reduce the risk of PONV in patients undergoing positive-pressure ventilation using SLMA.

Background: In our hospital, thoracoscopic surgery in the prone position for esophageal cancer has been performed since 2013. To assess the invasiveness of thoracoscopic esophagectomy in the prone position, we conducted a retrospective observational study after IRB approval.

Methods: After some patients were removed for procedural reasons, 21 patients of thoracoscopic esoph- agectomy (group A, thoracoscopy group) were com- pared with 28 patients with thoracotomic esophagec- tomy (group B, thoracotomy group). We examined : operation time, amount of bleeding, percentage of blood transfused patients, intraoperative fluid balance, length of time from the end of operation to extubation, length of stay in intensive care unit (ICU) and hospital, and long-term intubation rate (> 72 hr).

Results: The thoracoscopy group showed less bleeding (mean, group A, 560 g ; group B, 1,243 g, P< 0.01), a lower percentage of blood transfused patients (group A, 14% ; group B, 64%, P<0.01), lower intra- operative fluid balance (median, group A, 3,046 ml ; group B, 4,215 ml, P<0.05), shorter length of stay in ICU (mean, group A, 2.4days ; group B, 3.7days, P< 0.01) and lower long-term intubation rate (>72 hr) (group A, 0% ; group B, 32%, P<0.01) than those of the thoracotomy group.

Conclusions: This study showed that the thoraco- scopic esophagectomy in the prone position is poten- tially less invasive than thoracotomic surgery. Further study based on a larger number of patients is required to confirm this finding.

With recent changes in surgical procedures and perioperative management, there has been a growing interest in peripheral nerve blocks of the trunk in patients undergoing thoracic and breast surgery. Tho- racic truncal blocks include paravertebral, pecs, intercostal, and retrolaminar blocks. Previous studies have demonstrated that paravertebral block provides similar analgesic effects and better hemodynamic stability compared with epidural analgesia. In addition, the results of several studies suggest that paravertebral block may improve long-term outcomes such as pre- vention of chronic pain and decrease in recurrence or metastasis after breast cancer surgery. Pecs blocks are novel ultrasound-guided blocks intended to provide analgesia of the anterior chest wall while avoiding seri- ous complications associated with epidural anesthesia and paravertebral block. The novel ultrasound-guided techniques for intercostal nerve blocks have also been reported. Although some case series support that these pecs and intercostal nerve blocks appear to be safe and effective, prospective randomized studies to confirm their clinical usefulness are lacking. Whether to con- duct these thoracic truncal blocks or not will become a standard clinical practice for thoracic and breast sur- gery is yet to be determined.

Mirror syndrome is a rare obstetric condition where a mother "mirrors" the edema of her hydropic fetus and placenta. We present the successful resolution of mirror syndrome following fetoscopic laser photocoag- ulation for twin to twin transfusion syndrome (TTTS). A 36-year-old woman was pregnant with monocho- rionic twins. She was diagnosed with TTTS at the 23rd week of pregnancy and transported to our hospi- tal by ambulance for treatment Her human chorionic gonadotropin serum concentration was 144,437 IU - ml'. Fetoscopic laser photocoagulation was performed under local anesthesia with dexmedetomidine. How- ever, her restlessness disturbed the procedure and conversion to general anesthesia was required, which facilitated successful completion of the surgical proce- dure. Postoperatively, her vital signs were stable, and after 30 min, the saturation decreased to 80%. She was intubated, sedated with propofol, and transported to the intensive care unit A transthoracic ultrasound examination showed no cardiomyopathy. A chest X-ray suggested pulmonary edema. Pulmonary edema disap- peared immediately, and she was extubated after 36 hr. Postoperatively, the twins had a good prognosis. There are several reports of mirror syndrome after fetoscopic laser photocoagulation for TTTS. Recovery from mirror syndrome can improve following the reso- lution of fetal hydrops in TTTS using fetoscopic laser photocoagulation.

In the mid-18th century, a growing number of peo- ple started to attempt resuscitation of "apparently dead" people as a result of drowning or other causes, and humane societies were established in Holland, Brit- ain, and other European countries. In this article, I describe a history of those humane societies and pro- vide an extensive list of literature related to resuscita- tion published from the mid-18th century to 1820's.

Increasing healthcare costs have pressured govern- ment finances and threatened the sustainability of the national health insurance program introduced by the government, namely the Diagnosis Procedure Combi- nation/Per-Diem Payment System (DPC/PDPS) estab- lished in 2003, a prospective payment system for inpa- tients as part of changes to the provider reimburse- ment system to ensure the long-term sustainability of the healthcare insurance program. Under the DPC/ PDPS system, anesthesiologists can help reduce medi- cal costs by applying peripheral nerve blocks (PNB), because many databases have verified that they improve surgical outcomes and reduce hospital stays. These outcomes confer a considerable advantage upon healthcare insurance, demand for which has surged due to rapid population aging and significant progress in medicine. The present study compares general and neuraxial anesthesia to determine the advantages of PNB in terms of reducing medical costs.

A 44-year-old woman (body mass index 32) with myotonic dystrophy was admitted for bilateral para- thyroidectomy. Her risk of post-operative respiratory complications was high due to respiratory muscle weakness (%VC 52.8%) and high sputum volume. Difficulties in surgery were anticipated under local anesthesia due to obesity and bilateral tumors. There- fore, general anesthetic management without muscle relaxant was selected and early extubation conducted to prevent respiratory complications. She was extubated 1 hour after surgery in the intensive care unit (ICU) and F10₂ 0.6, 10 l · min⁻¹ oxygen mask was administrated. Paco₂ gradually increased (54 mmHg 15 minutes later, 61 mmHg 2 hours later after extubation). A high flow nasal can- nula was administered to facilitate CO₂ elimination, and Paco₂ decreased to 46 mmHg after 4 hours. An intra- pulmonary percussive ventilator was administered for the purpose of sputum discharge which facilitated effi- cient expectoration of sputum. She was discharged from the ICU on postoperative day (POD) 1 and from hospital on POD 6 without complications.

Background: Although dexamethasone is widely used to prevent postoperative nausea and vomiting (PONV) in both adults and children, the evidence in children is mainly from minor, short surgical proce- dures such as tonsillectomy and strabismus surgery.

Methods: In this study, we reviewed medical re- cords of patients who had undergone posterior correc- tion and fusion surgery for adolescent idiopathic scoio- sis at our institution and evaluated the effect of dexa- methasone on PONV prophylaxis.

Results: Four of 11(36%) patients who had received prophylactic dexamethasone and 26 of 33 (79%) pa- tients who had not received dexamethasone developed PONV during the first 72 hours of surgery (OR 0.15 [95% CI : 0.04-0.681, P=0.02). Without dexametha- sone, 76% patients developed PONV within 24 hr of surgery. Although the incidence gradually declined, 24% of patients still developed PONV even later than 48 hr after surgery. In contrast the incidence of PONV during the first 24 hr in patients who had received dexamethasone was 36%, and none of them experi- enced PONV after 24 hr.

Conclusions: The results of this study suggest that dexamethasone is effective in reducing PONV in chil- dren and adolescents undergoing posterior correction and fusion surgery for scoliosis. A randomized con- trolled trial is needed to confirm the findings of this study.

Peripheral nerve block became popular with the advance of the ultrasonic diagnostic equipment, and became one of the essential procedures in anesthesia. For the further development of this method, we have to learn the past and identify problems in this course. We have outlined the history of the peripheral nerve block and described the development of the method. Furthermore, we verified the recent change in periph- eral nerve block by searching the literature and exa- min the background. Lastly, we pointed out problems of the current peripheral nerve block and described its new application and its ideal future course.