Masui. The Japanese journal of anesthesiology
-
It has been hypothesized that the intubating laryngeal mask (ILM) has some advantages: (1) tracheal intubation is achieved with a neutral head-neck position and limited mouth opening, (2) intubation is not interfered with blood and secretion in the mouth, (3) ventilation via the device is possible, and (4) it is easy to use. Many studies have brought evidences for these points. ⋯ Degree of hemodynamic changes and incidences of postoperative airway complications are similar between the ILM and the laryngoscope. ILM-users should pay attention to these limitations when they use the ILM.
-
Case Reports
[Perioperative management using propofol in a patient with uncontrolled preoperative hyperthyroidism].
There is a risk of thyrotoxic crisis during and after surgery in patients with uncontrolled hyperthyroidism. To avoid this, suppression of sympathetic activity during the perioperative period is important. ⋯ Propofol 6 to 8 mg.kg-1.hr-1 plus 66% of nitrous oxide was not sufficient to obtain hemodynamic stability during the surgery, but propofol 3 mg.kg-1.hr-1 produced optimal sedation in the postoperative period. The results demonstrate that propofol is useful for the anesthetic management of patients with uncontrolled hyperthyroidism.
-
To determine how the education of basic life support (BLS)/advanced cardiac life support (ACLS) and emergency medicine for anesthesiologists is conducted, we performed a survey of chairpersons at university departments and newly board certified anesthesiologists in 1999. Basic and advanced life support courses for residents were provided in more than half of the anesthesiology departments that responded to this survey. ⋯ On the other hand, more than 80% of respondents considered a rotation in emergency medicine desirable as a part of anesthesia training. To improve the resuscitation skills of anesthesiologists, an urgent need to establish regular BLS/ALS courses and educational programs in emergency medicine in anesthesia training does exist.
-
Case Reports
[Anesthetic management for gastrojejunostomy in a patient with hemiplegia and recurrent laryngeal nerve palsy].
A 70-year-old man who had undergone a low anterior resection for primary rectal cancer 9 years before complained of anorexia, hemiplegia, and recurrent laryngeal nerve palsy. The anorexia was caused by duodenal stenosis due to swollen lymph nodes, the hemiplegia was caused by a metastatic brain tumor, and the recurrent laryngeal nerve palsy was caused by metastases of the cancer to the mediastinal space. ⋯ Thoracic epidural anesthesia could provide sufficient analgesia, and the operation was uneventful. In anesthetic management of an end-stage patient undergoing a palliative operation like this, we should consider the purpose of the operation, its complications, and further complications which may be induced by anesthesia in order to plan out an anesthetic regimen unlikely to lead to harmful events in perioperative period.
-
Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (ASA-PS). ⋯ The major co-existing diseases or conditions leading to critical events were heart diseases in elective anesthetics, and hemorrhagic shock in emergency anesthetics. We reconfirmed that ASA-PS is beneficial to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation of cardiovascular conditions in those with poor physical status.