Masui. The Japanese journal of anesthesiology
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A 47-year-old female was scheduled for ulnar osteotomy under general anesthesia combined with brachial plexus block. She had a history of symptomatic epilepsy due to subarachnoid hemorrhage. Immediately after giving 100 mg bolus of propofol to the patient, she developed generalized convulsion similar to a grand mal. ⋯ After that no further convulsive attack occurred. Although it has been known that propofol has anticonvulsive properties, there have been several reported cases of seizure following the administration of propofol. Further studies are needed to clarify the mechanism of seizure induced by propofol in the patients with epilepsy.
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A survey of unexpected cardiac arrests, excluding those associated with cardiac surgery, that had occurred during anesthesia and surgery in the period 1980-1999 was conducted. There was no significant difference between the number of such cardiac arrests that occurred in the 1980 s (29/36,159, 0.080%) and the number in the 1990 s (33/37,643, 0.088%). According to the classification by Keenan et al., there were 3 cases (0.0083%) in the 80 s and 4 cases (0.0106%) in the 90 s that occurred due to anesthetic management. ⋯ This increase seems to be due to an increase in the number of severe and multiple injuries and an increase in complicated major surgery. The increase in number of cases due to preoperative conditions also depends on coronary spasm and cardiac conduction insufficiency. Taking into consideration the improvement in intraoperative monitoring and the development of novel anesthetics in the 90 s, greater efforts should be made by anesthesiologists to reduce the incidence of cardiac arrest due to anesthetic management, and preoperative evaluation of surgical patients needs to be reconsidered.
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Finding appropriate endotracheal tube position in children is important, because the trachea length of a child is shorter than that of an adult, and the position of the endotracheal tube is easy to be altered by head position, rotary movements, and flexion as well as extension. We confirmed the correct depth of the endotracheal tube by transillumination method using the Trachlight device in children. Twenty children were intubated orally with a rigid laryngoscope according to the distance of the formula height/10 + 5 cm at the lips. ⋯ The distance between the carina and the tube tip measured by chest radiography was more than 1 cm. Trachlight device was simple and reliable to ensure the appropriate endotracheal tube position in children. We consider that the appropriate depth of the endotracheal tube using any of 4.5, 5.0 or 5.5 mm tube size is 1.5 cm beyond the point the bright light of the Trachlight disappears.
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Historical Article
[Notes about two paintings in the Francis A. Countway Library of Medicine].
Two interesting mural-sized oil paintings hang in the Francis A. Countway Library of Medicine in Boston. One is "The First Operation Under Ether" painted by Robert C. ⋯ On the other hand, "The First Successful Kidney Transplantation" was planned by the three doctors who were themselves involved in the memorable operation. The painter, Joel Babb, began to recreate the scene after he had been handed some sketches and photos of the event and several photos of the participants. In this case, it seems that authenticity was the main consideration.
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Case Reports
[Efficiency of bispectral index in anesthetic management of a patient with hypothyroidism].
A 72-year-old, female patient with severe hypothyroidism underwent tracheostomy using deltopectral flap. During the anesthetic management, we assessed the hypnotic level using the bispectral index and regulated the dose of general anesthetics to maintain the bispectral index at about 50. ⋯ Although the anesthetic requirement for patients with hypothyroidism is generally thought to be decreased, there is no practical index by which we can estimate the optimal dose of anesthetic agents for these patients. This case report shows that the assessment of the hypnotic level by the bispectral index can be utilized as an efficient index to determine the optimal dose of general anesthetics for patients with hypothyroidism.