Masui. The Japanese journal of anesthesiology
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The GlideScope videolaryngoscope is a new device for endotracheal intubation, which provides a view of the glottis without alignment of the oral pharyngeal and tracheal axes. The purpose of this study was to evaluate the performance of the GlideScope in patients. ⋯ The GlideScope was easily handled not only by experienced anesthetists but also by novice personnel. The GlideScope seems to be a novel device in routine and difficult airway management.
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We described how modern neuroscience has elucidated what is sleep and its implication, and also reviewed histological and current trends in search of sleep mechanism from view of neurocirculatory or hormonary basis studies. We conclude that anesthesia and sleep share some neuronal structure in their action and mechanism of anesthesia could be elucidated through sleep study. In addition, anesthesia-related sleep disturbance must be settled to serve satisfied quality of life of patients and to save economic and medical resources.
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Case Reports
[Electromyographic activity increases the bispectral index up to 98 during anesthesia].
We report the patients who developed sudden unpredicted increases of bispectral index (BIS) value during sevoflurane and fentanyl anesthesia. After the epidural catheter placement, anesthesia was induced with propofol and fentanyl, and muscular relaxation was obtained by vecuronium for tracheal intubation. Anesthesia was maintained with 1-1.5% sevoflurane, intermittent administration of fentanyl and epidural infusion of ropivacaine. ⋯ At first, the BIS was decreased with small dose of supplemental anesthetics, but finally, it was up to 98 and the depth of anesthesia could not be assessed by BIS value. Because slight shivering was found in the patient immediately after emergence, electromyographic activity might have falsely elevated the BIS excessively. No clear recall or explicit memory during operation was observed after anesthesia, but anesthesiologists might better pay much more attentions to unpredictable changes of anesthetic depth during anesthesia.
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We report two cases of anesthetic management for emergency cesarean sections and craniotomies in patients with intracranial hemorrhage. Case 1: A 32-year-old woman at 33 weeks gestation suffered from subarchnoid hemorrhage due to the rupture of cerebral aneurysm. Case 2: A 38-week-pregnant woman aged 32 developed intracerebral hematoma resulting from ruptured arteriovenous malformation. ⋯ After deliveries, isoflurane was changed to propofol and prostaglandin E1 was infused to control blood pressure and to avoid uterine atonic bleeding. Uneventful anesthetic course resulted in both the mothers and the fetuses surviving. It is important to develop good relationships among the specialists for the management of pregnant woman with intracranial hemorrhage.
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We experienced differential lung ventilation using laryngeal mask airway (LMA) and a bronchial blocker tube for a patient with unanticipated difficult intubation. A 27-year-old man was diagnosed as the left spontaneous pneumothorax and scheduled for bulla excision with video-assisted thoracic surgery. Because of failure in tracheal intubation of the usual double lumen tube, we inserted LMAProseal #4 and accomplished differential lung ventilation using a bronchial blocker tube through LMA. This method will be effective in differential lung ventilation of the patient with difficult airway.