Masui. The Japanese journal of anesthesiology
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Case Reports
[Epiduroscopy in patients with chronic low back pain without remarkable findings on magnetic resonance imaging].
Two patients with chronic low back pain and sciatica failed to respond to conservative treatments. In these patients, magnetic resonance imaging (MRI) showed no remarkable findings corresponding to their symptoms. ⋯ One patient got better after two epiduroscopic procedures, and the other did not. Epiduroscopy may be an effective, minimally invasive treatment as well as examination for patients with chronic low back pain without remarkable findings on MRI.
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A 28 year-old-woman with the first and second brancheal arch syndrome was scheduled for the lift of the inferior part of the right ear. Difficult intubation was expected because of the mandibular hypoplasia. We chose a lightwand stylet for tracheal intubation. ⋯ Usually fiberoptic laryngoscopy requires more skill, more expensive equipment, and more time to prepare than the lightwand stylet technique. Moreover profuse secretions or blood in the oropharynx sometimes inhibit clear vision by fiberoptic laryngoscopy. The lightwand stylet is simple and inexpensive and it is useful for tracheal intubation in patients with difficult airway from the first and second brancheal arch syndrome.
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We experienced two cases of malignant hyperthermia (MH) triggered by sevoflurane. Case 1 was a six-year-old girl, 15.8 kg, undergoing strabismus repair. She had flat back, elevated diaphragm and high arched palate. ⋯ Postoperatively he was noted to have downslanting palpebral fissures, micrognathia, low set ears, and a single crease of the fifth finger and diagnosed as King syndrome which is reported to have association with MH. Both patients had no history of anesthesia nor abnormal family history. Both of them were rescued with dantrolene and recovered without sequelae.
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Anesthetic mortality and morbidity in Japan Society of Anesthesiologists (JSA) Certified Training Hospitals (CTH) for the year 1999 were reported as continuation of annual studies started in 1993. The JSA Committee on Operating Room Safety (CORS) sent confidential questionnaires to 774 CTH and received valid responses from 60.3% of hospitals. A total number of 793,840 anesthetics were documented. ⋯ Five major causes of all critical incidents were massive hemorrhage due to surgical procedures (20.8%), preoperative hemorrhagic shock (10.7%), surgical technique (8.0%), inappropriate airway management (5.2%) and intraoperative myocardial infarction and coronary ischemia (4.5%). Drug overdose or selection error (3.9%) and overdose of main anesthetic (2.9%) as a result of human error occupied the 7th and 10th places. As far as anesthetic management to reduce mortality and morbidity related to anesthesia is concerned, we should increase vigilance to avoid human errors in addition to improving preanesthetic preparations and assessment of cardiovascular status as well as intraoperative management of cardiovascular events.
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Case Reports
[Swelling of the tongue after intraoperative monitoring by transesophageal echocardiography].
Tongue swelling after surgery is a rare but potentially lethal postoperative complication. This is a case report of a 62-yr-old patient who developed tongue swelling after intraoperative monitoring by transesophageal echocardiography. The patient underwent replacement of the descending aorta with an interposition graft under cardiopulmonary bypass. ⋯ The tongue swelling was thought to have been caused by local mechanical compression of the tongue with the TEE probe. The tongue returned to normal size the next day. Care should be taken to prevent the occurrence of this complication during and after TEE examination under general anesthesia.