Masui. The Japanese journal of anesthesiology最新文献

Macewen, who was the first to perform tracheal intubation in a patient undergoing surgery under gen- eral anesthesia, described four people (Desault Bou- chut, Schrötter and Trendelenburg) who had per- formed tracheal intubation (without general anesthe- sia), before Macewen. Literature search indicates that tracheal intubation had been performed before Desault (ca. 1790), with different aims. In this article, I describe several people who developed tracheal intuba- tion for cardiopulmonary resuscitation of the drowned: Alexander Monro Secundus (tracheal intubation was estimated to be performed during 1767-1774), William Cullen (1767-1774), Charles Kite (1784-1786) and Edward Coleman (1786-1791).

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. In this article, I describe the background for this movement (which was likely to be related to a fear of being buried alive and of being dissected alive). I also describe a historical development of rescue methods of drowned people.

Ultrasound guidance has become the standard tech- nique for brachial plexus block. Evidence has been accumulating that the ultrasound-guided brachial plex- us block can provide various advantages such as shorter block performance time, fewer needle passes, reduced incidence of vascular puncture, increased suc- cess rate, and rapid sensory block onset when compared with the conventional nerve localization tech- niques. Real-time ultrasound visualization during the procedure can reduce the amount of local anesthetics and the incidence of complications. Brachial plexus block has a strong analgesic effect with minimal effect on the cardiorespiratory and gastrointestinal systems. Therefore, ultrasound-guided brachial plexus block is a valuable regional anesthetic technique for upper ex- tremity surgery.

Patients undergoing abdominal surgery can experi- ence severe pain due to the abdominal wall incision. Epidural anesthesia has been considered as the gold standard for perioperative analgesia in abdominal sur- gery. However, currently, many patients receive pro- phylactic anticoagulation therapy preoperatively with potential complications. For such cases, while epidural anesthesia is contraindicated, the use of ultrasound- guided peripheral nerve block is increasing. In abdomi- nal surgery, ultrasound-guided rectus sheath block and transversus abdominis plane block are commonly used for perioperative analgesia. The use of ultrasound ren- ders these block techniques safe and reliable. Cur- rently, a new abdominal peripheral nerve block, qua- dratus lumborum block, is gaining attention because it is thought to have a wider range of analgesia and a longer duration of effect As the analgesic properties of these blocks are limited in extent and duration, it is important to select the appropriate approach. Ultrasound-guided abdominal trunk block can con- tribute to perioperative multimodal analgesia.

A 97-year-old woman with severe back pain was transferred to our hospital. She was able to perform activities of daily living independently and had no neu- rological deficit or dementia before her admission. Con- trast-enhanced computed tomography revealed a rup- ture in the descending aorta and thrombosed type A aortic dissection. We carefully explained the need for and the risks associated with surgery to the patient and her family. After an informed consent had been obtained, she was taken to the operating room for an emergency surgery. Anesthetic management was uneventful. Trans- esophageal echocardiography was useful to evaluate her cardiac function and aortic dissection. We per- formed replacement of the total aortic arch and descending aorta successfully. On the 55th postopera- tive day, she was transferred to another hospital to undergo further physical therapy. The total hospital- ization cost was nearly 9.8 million yen. The medical cost was high in our case. In cases of nonagenarians who require an emergency cardiac surgery, we should consider the patients' age, preoperative activities of daily living, and postoperative quality of life when making decisions on surgery. The patient in our case needed to be carefully treated for airway and swallow- ing management in the early perioperative period.

Tranexamic acid (TA), an antifibrinolytic agent, is commonly used in cardiac surgery with cardiopulmo- nary bypass to reduce bleeding. We report two cases of convulsive seizures after cardiac surgery with chronic kidney disease on hemodialysis. The two patients underwent aortic valve replacement, one for aortic valve regurgitation and another for aortic valve stenosis, with cardiopulmonary bypass uneventfully. A total dose of 8 g of TA was administered intravenously; 4 g during and 4 g after cardiopulmonary bypass. Both patients developed two episodes of gener- alized convulsive seizures post-operative day 1, which were suppressed by administration of diazepam intra- venously. The blood test, brain CT and electroenceph- alogram revealed no significant abnormalities. They were discharged without any neurological complica- tions. The high dose of TA was considered to have caused the seizures, since in previous reports the use of TA during surgery was associated with increased risk for postoperative seizures. It was demonstrated that approximately 40 to 70% of TA is excreted in the urine following intravenous administration. We posit that this might have led to excessive serum concen- tration of TA in our patients. Therefore, the dosage of TA should be decreased judiciously in patients with chronic kidney disease especially on hemodialysis to prevent postoperative seizures.

Regional anesthesia for lower limb surgery not only provides satisfactory analgesia, but also improves the overall postoperative outcome with less postoperative nausea and vomiting by decreasing the opioid con- sumption, encouraging early postoperative mobility. Therefore, high-quality anesthesia and postoperative analgesia accelerate the rehabilitation process and shorten the hospital stay. In the past decade, ultra- sound-guided lower extremity peripheral nerve blocks have become popular in Japanese hospitals. This tech- nique enables the visualization of thee target nerve structures, controlles needle movement and the spread of injected local anesthetic solution in a real real-time manner, and this has been adapted not only for tradi- tional blocks, but also in "new approach" blocks such as adductor canal blocks, depending solely on ultra- sound images. In the decades to come, we hope to obtain more established evidence supporting the utility of ultra- sound-guided techniques for lower extremity nerve blocks based on high-quality clinical studies. These findings may support the development of sustained- release formulation local anesthetics and new devices or techniques in the future.

Ultrasound-guided nerve blocks (UGNBs) have been gaining popularity since 2000 in Japan. This is not only because ultrasound technology has developed recently but also because remifentanil has become available in 2006 with the risk of opioids for recurrence of cancer after surgery shown in 2006. Thus, UGNBs have been employed widely in the anesthesiology field, and anes- thesiologist have tried to reduce consumption of opioid during perioperative periods by using UGNBs, non- steroidal anti-inflammatory drugs, acetoaminophen and so on; that is, multi-modal analgesic technique. In a special issue of this month, experts discuss the efficacy and use of UGNBs for the upper extremities, thorax, abdomen, and lower extremities. In these articles, they will highlight the data on clinical outcome for UGNBs and discuss specific limitations of UGNB. The articles will help readers to know much more about the future direction of UGNBs.

Erythropoietic protoporphyria (EPP) is a hereditary disease resulting from a deficiency in ferrochelatase required for haem synthesis system. We describe the anesthetic management of a 51-year-old man with EPP undergoing open reduction and internal fixation of patella fracture. Spinal anesthesia was induced with bupivacaine. The surgery was performed without any complications. No skin symptom was observed periop- eratively. Spinal anesthesia with bupivacaine can be safe for an EPP patient.

We anesthetized a patient with Rett syndrome pre- senting intense breath holdings and severe aerophagia for dental treatment The patient had shown an intense breath holding plunging into hypoxia during slow induction with sevoflurane in previous anesthesias. Therefore, we chose rapid sequence induction with intravenous propofol and rocuronium and intubated orally. The length of glottis to tracheal bifurcation was shorter than average patient After a gastric tube was inserted and the content was aspirated, the orotracheal tube was changed to nasotracheal one. When she recovered from anesthesia at the quite deep stage, her saliva poured from nose and orally and began severe aerophagia. Once again, deep depth of anesthesia was kept, and we minimized stimulations for her. By. this approach, anesthesia was achieved uneventfully. In this case, she had signs of early-awakening from anesthesia.