Masui. The Japanese journal of anesthesiology
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The incidence of postoperative paralysis after thoracic and thoracoabdominal aortic operations has decreased, but is still high in comparison with other operations. The analysis of the mechanism involved in the ischemic tolerance of the spinal cord could contribute to the protection of the spinal cord from ischemia. The identification of the Adamkiewicz artery and the predictive factors for postoperative paralysis in the preoperative period, the use of motor evoked potential, several adjuncts to keep the spinal cord circulation, the stabilization of the hemodynamics with good oxygenation, and hypothermia contribute to the prevention of the spinal cord ischemia. ⋯ Among the anesthetic drugs, narcotics might exacerbate the motor function after the spinal cord ischemia. The analgesic drugs which do not aggravate the spinal cord dysfunction would be expected. Good cooperation of surgeons and anesthesiologists greatly contributes to the finding of the spinal cord ischemia during this operation.
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Case Reports Comparative Study
[Unanticipated endotracheal tube displacement in a short-neck patient with a history of chronic rheumatoid arthritis: a comparison of three kinds of endotracheal tubes].
Endotracheal tubes are known to have a risk of being displaced at neck extension or flexion or rotation. However, the displacement seldom causes clinical problems. An 74-year-old patient suffering from chronic rheumatoid arthritis underwent debridement in the infected knee under general anesthesia. ⋯ Therefore, we compared the hardness of the three popular endotracheal tubes. We found the hardness of HLE was higher than the others. This might be one of the reasons for dangerous displacement of the endotracheal tube in our case.
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Case Reports
[A survival case of cardiac arrest resuscitated initially by several anesthesiologists in an airport].
We experienced a case of cardiac arrest in a man near the boarding gate area in an airport. An anesthesiologist witnessed the onset of his cardiac arrest. Three anesthesiologists undertook cardiopulmonary resuscitation until the arrival of the emergency medical service crew. ⋯ The patient regained consciousness before hospitalization. Airport employees should be trained in techniques of basic life support in order to be able to resuscitate patients who have suffered cardiac arrest in an airport. Medical emergency kits equipped in airplanes should be made available for use in cases of cardiac arrest occurring near a boarding gate in an airport.
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The prediction of the hypnotic states is useful to maintain the adequate anesthesia. During propofol anesthesia, the respiratory depression has been documented in a dose-dependent manner. Therefore, we investigated whether the respiratory depression under the spontaneous breathing reflected the estimated effect site propofol concentrations (Cp) in a dose-dependent fashion. ⋯ We concluded that the respiratory parameters during spontaneous breathing were useful indices to predict the changes in the effect site propofol concentrations and to maintain the adequate anesthetic levels.
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Respiratory disturbance occurs sometimes after anterior cervical fusion. This is often a result of upper airway obstruction due to prevertebral soft tissue swelling. ⋯ After starting to ventilate through Mini-Trach II, respiratory disturbance disappeared soon and respiration improved markedly. Mini-Trach II is an effective device to use in patients with post-operative respiratory disturbance due to prevertebral soft tissue swelling.