Masui. The Japanese journal of anesthesiology最新文献

Here we report successful anesthetic management of emergency thrombectomy for a patient with undiag- nosed polycythemia vera. A 67-year-old man com- plained of numbness of the right lower limb and was diagnosed with acute artery obstruction. Emergency thrombectomy was scheduled. Preoperative blood exam revealed hemoglobin 21.0 g · dl⁻¹ (hematocrit, 63.4%). During central venous catheter placement, we con- firmed high backflow blood viscosity; blood was diluted with plasma substitute. Hemoglobin was main- tained at 14-15 g · dl⁻¹ with continuous administration of plasma substitute. On re-perfusion of the right lower limb, potassium increased to 7.6 mEq · ml⁻¹, which responded to calcium carbonate, GI therapy, and furo- semide. Surgery was uneventful and the patient was diagnosed with polycythemia vera postoperatively. As perioperative management of polycythemia vera is challenging, particularly in undiagnosed and untreated cases, efforts should be made to avoid further throm- bosis and cardiac events.

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. I have reanalyzed the Macewen's description and have confirmed that these descriptions are generally accurate. I have found that the main aim of tracheal intubation in reported cases was to prevent airway obstruction. I also estimated the date when they performed tracheal intubation. Through the liter- ature search, I have found several other people who performed tracheal intubation even before Desault, with different aims.

Catheter ablation is a common treatment for ar- rhythmia and the number of procedures is increasing. Takatsuki General Hospital introduced a remote mag- netic navigation system into clinical practice for the first time in Japan. This system produces- magnetic flux density of 0.08-0.1 Tesla. Catheter ablation is usu- ally performed under deep sedation at our facility ; however, general anesthesia is needed in some cases. Although many cases of general anesthesia for MRI have been reported, there has been no report of gen- eral anesthesia under the unique environment of a weak magnetic field. We use MRI-certified equipment such as an anesthesia machine and a patient monitor in the heart rhythm center. There is no contraindication for the selection of anesthetic agents. Analgesia, depending on pain or burning sensation by ablation, and immobilization are required. Anesthesiologists must be aware that there are some differences in gen- eral anesthesia in the MRI room compared with the heart rhythm center, including the environmental set- ting, limitations in the use of certain medical equipment and procedure-related knowledge.

Background: Several reports have examined meth- ods to control pain after a laparoscopic cholecystec- tomy (LC) and have shown regional anesthesia to be an effective method. We had been performing LC using simple general anesthesia (G); however, in 2013, we adapted a rectus sheath block (RSB), and in 2014, we used a combination of RSB and a subcostal transversus abdominis plane block (TAPB) on the right side. We report on the transition from G to regional anesthesia in LC and its effect on postoperative pain.

Methods: We anesthetized three groups of patients undergoing LC. Group 1 received G (n =32) ; group 2 received RSB (n=28); and group 3 received a combination of RSB and TAPB (n=31). Patients used the numeric rating scale (NRS) to record their levels of postoperative pain, and the scores were compared for each group.

Results: No significant differences were noted in NRS scores between the G and RSB groups; however, the scores in the RSB group tended to be lower. NRS scores were significantly lower in the RSB-TAPB group than in both the RSB and G groups.

Conclusions: This study showed that the combina- tion of RSB-TAPB effectively controlled pain after LC and lowered NRS scores.

Background: The McGRATH® MAC (McGRATH) laryngoscope is a newly developed video device, which enables us to perform tracheal intubation minimally invasive. The aim of this study is to evaluate and com- pare the hemodynamic changes triggered by intuba- tion using either the McGRATH or the Macintosh laryngoscope.

Methods: Thirty-seven patients, between 20 and 42 years of age with ASA status I or II, were randomly assigned to two groups : the McGRATH (n=19) or the Macintosh laryngoscope (n=18). Anesthesia was induced with fentanyl 2 μg · kg⁻¹, propofol 2 mg · kg⁻¹, sevoflurane 2%, and rocuronium 0.6 mg · kg⁻¹. We recoded the hemodynamic changes (blood pressure, heart rate) every minute up to 5 minute after intuba- tion. We also recoded the time needed to complete the tracheal intubation. In all cases, the same certified anesthesiologist performed tracheal intubation. Data were presented as mean ± SD. Statistical analyses were performed using the t-test for comparisons of the patients' demographic data, blood pressure, and heart rate between groups.

Results: There were no significant differences in two groups regarding age, weight, height, and sex. Comparing the average time needed to complete the tracheal intubation, the McGRATH group took longer than Macintosh group (40.5 ± 15.3 seconds vs. 29.4? 4.73 seconds, P=0.01). There was no significant differ- ence in blood pressure and heart rate just before tra- cheal intubation. The McGRATH laryngoscope had a significantly lower value than the Macintosh laryngo- scope in systolic pressure (101.2?7.9 vs. 111 ?16.8 mmHg, P=0.03) and heart rate (71.5?9.9 vs. 79.7? 12.3 mmHg, P=0.02) at one minute after tracheal intu- bation.

Conclusions: The McGRATH laryngoscope is less invasive for hemodynamic parameters than the Macin- tosh laryngoscope. These findings suggest that the McGRATH laryngoscope may enable us to perform tracheal intubation less invasively.

We report a case of a 34-year-old pregnant woman with fibromyalgia (FM) who underwent cesarean sec- tion under general anesthesia. The patient was taking duloxetine and pregabalin for FM, as well as several anti-depressants due to severe depression. To avoid the exacerbation of FM by spinal anesthesia, we decided to perform cesarean section under general anesthesia. After a crash induction with propofol and rocuronium, tracheal intubation was performed using the Pentax- AWS Airwayscopeo. The procedure was completed uneventfully. Postoperatively, the patient received an ultrasound-guided transverse abdominal plane block and a continuous intravenous fentanyl infusion to relieve pain. No FM exacerbation was noted.

Go-rei-san is a Japanese traditional medicine that is used to treat motion sickness, nausea, and vomiting. We report here four patients for whom Go-rei-san was effective in treating pain associated with intractable trigeminal neuralgia. Three patients could not continue carbamazepine due to drug-induced rash, liver damage, and gastrointestinal injury, and suffered from pain. One patient experienced severe dizziness upon combination treatment with pregabalin and carbamazepine. All patients exhibited symptoms of water poisoning on their tongues. All patients experienced significant pain relief without major complications after daily adminis- tration of 7.5 g Go-rei-san. Our findings suggest that Go-rei-san can effectively alleviate pain associated with intractable trigeminal neuralgia without major compli- cations.

Background: Perioperative coronary artery spasm (GAS) is one of the serious complications leading to circulatory collapse. Here we retrospectively examined the impact of CAS and discussed its prevention strate- gies.

Methods: Reports of intraoperative CAS were iden- tified by using the PubMed and by manually searching the Journal of Japan Society for Clinical Anesthesia (2001-2015). Analyses were performed on 51 patients who developed CAS and had had no history of isch- emic heart disease.

Results: Of the 51 analyzed patients, 19 developed circulatory collapse. In these patients, the rate of early administration of a sufficient dose of a coronary vasodi- lator was low, and they tended to have prolonged and/ or recurrent attacks. Among them, two patients may have had a problem due to the dosage and/or admin- istration method for coronary vasodilator, despite early administration. In addition, we found that a combina- tion of general anesthesia and epidural block may have contributed to the collapse. In three cases, it was diffi- cult to identify the predictors of circulatory collapse.

Conclusions: Awareness of CAS and vigilant moni- toring are crucial for preventing circulatory collapse. When a transient ST-segment change indicates possi- ble CAS, adequate dosages of a coronary vasodilator should be promptly administered.

In 1846, Ryoan Imamura joined the Gassuido school in Osaka, which was a branch of the Shunrinken school in Hirayama, Kishu. At that time the Gassuido school was presided by Nanyo Hanaoka, the son-in-law of Sei- shu Hanaoka. It remains unknown how long Imamura studied surgery at the school. In 1862, Imamura published a book titled Iji Keigen, wherein he disclosed the prescription of "Mafutsusan". Every disciple of the Hanaoka's schools was sternly asked not to leak the secrets of the prescription. In the background of his divulgence, there may have been the circumstances in which he had a deliberate intension to insist on the significance of traditional Kampo medicine, coping with emerging Western medicine.

A sixteen-year-old female patient with congenital aortic stenosis underwent Ross procedure. We monitored bilateral regional cerebral saturation of oxygen (rcSO₂) on the forehead at the right and left of the midline. After aortic and bicavel cannulation, cardiopulmonary bypass was instituted. On the mor- row of aortic cross clamping, the rcSO₂ fell from approximately 55% to below 30%. We searched the cause of this phenomenon, and detected that the tip of aortic cannula was inserted to the left subclavian artery. After repositioning, the bilateral rcSO₂ increased to above 65%. We felt keenly that the monitoring of rcSO₂ is useful to recognize corrective adjustment of the cannula ori- entation, and the avoidance of cerebral hypoperfusion during the cardiopulmonary bypass period.