Masui. The Japanese journal of anesthesiology
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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 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.
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Point-of-care ultrasonography has become widely used in diagnosis and managements of patients. In the field of anesthesiology, ultrasound guided nerve blocks and central venous catheterization (CVC), and transesophageal echocardiography (TEE) have become popular. Now, ultrasound devices are familiar to anesthesiologists. ⋯ Because of less invasive technique, whole body ultrasound evaluation is suitable to use when anesthesiologists may have questions whether the patient's condition is good or not. No doubt that point-of-care ultrasonography by anesthesiologists themselves in pre-anesthesia. clinic can be the useful decision making tool of anesthesia plan. To be tomorrow's anesthesiologists, please start point-of-care pre-anesthetic ultrasonographic assessment.
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Case Reports
Use of Sugammadex in a Patient with Myotonic Dystrophy Undergoing Laparoscopic Cholecystectomy.
A 37-year-old female patient with myotonic dystrophy was scheduled for laparoscopic cholecystectomy for gall stone under general anesthesia with continuous propofol infusion. Rocuronium was administered with careful monitoring using TOF- Watch®, measuring train-of-four count (Tc), TOF ratio (Tr), and posttetanic count The total amount of rocuronium was 70 mg ; 0.6 mg .kg⁻1 for anesthetic induction and 0.3 mg .kg⁻1 when Tc exceeded 1. When the operation was completed, Tc was 4, Tr was uncountable and she showed reaction to calling her name. ⋯ After 20 minutes of first administration of sugammadex, we extubated the tracheal tube without respiratory depression. To avoid respiratory depression, we did not use postoperative opioids. Intraoperative transversus abdominis plane block and postoperative thoracic epidural block with ropivacaine were successful for postoperative pain relief.
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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. ⋯ 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.
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Historical Article
History of Tracheal Intubation :5. Use for Resuscitation in Neonates.
In the 18th century, tracheal intubation was introduced to clinical practice, mainly in patients with airway obstruction in children due to diphtheria, and in patients who were apparently dead. In this article, I describe the fourth reason for tracheal intubation :a newborn with apnea. ⋯ Jean Anne Henri Depaul (1811-1883), Heinrich Alexander Pagenstecher (1825-1889), and Alban Alphonse Ambroise Ribemont-Dessaignes (1847-1940) intubated the trachea. Tracheal intubation might have been widely performed by midwives, because Chaussier had educated them at his school.