Masui. The Japanese journal of anesthesiology
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We report drug errors during anesthesia. The data were retrieved from the incident reports in a period of June 2000 to June 2003 at the Department of Anesthesiology, Fukuoka University Hospital. ⋯ Errors in dosage were five, and wrong route of administration in one. There were no serious sequelae in the 18 patients.
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To avoid the neurological deficits after neurosurgical procedures, awake craniotomy applying intraoperative awake functional brain mapping has been employed. Anesthesia for awake craniotomy requires particular attention to airway management, control of seizures and measures for decreasing the anxiety of the patients. We investigated the current status of anesthetic management for awake craniotomy in Japan to establish a standard procedure for safe anesthesia. ⋯ The first experience of awake craniotomy was in 1996 in Japan and since then most of the institutes have experienced only three or fewer cases. Airway management, control of nausea and vomiting, stable awakening during functional mapping and control of seizures were pointed out as problems during awake craniotomy. Based on the present results, our experience and the information from previous investigations, standard anesthetic management for awake craniotomy in our country will be documented.
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Case Reports
[Successful anesthetic management of two high-risk elderly patients using propofol-remifentanil].
This report deals with anesthetic management using remifentanil in high-risk elderly patients with many complications such as arteriosclerosis and obstructive lung disease other than the disease which was the object of operation. Case 1; an 87-year-old woman with complete left bundle branch block and aortic valve stenosis was scheduled for cholecystectomy, intestinal tract incision and gallstone extraction. Case 2; a 79-year-old woman with obstructive lung disease was scheduled for sigmoidectomy and cholecystectomy. ⋯ They received epidural anesthesia 30 minutes before the remifentanil discontinuance. After remifentanil is discontinued, they had little pain. Elderly patients considered at high-risk were treated under total intravenous anesthesia with remifentanil and propofol.
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Case Reports
[Hypoxemia during cesarean section due to massive pleural effusion in a patient with preeclampsia].
We report hypoxemia during cesarean section in a 33-year-old woman with preeclampsia. She developed generalized body weight increase, severe proteinuria and decrease of platelets at week 33 of gestation. Cesarean section was scheduled under general anesthesia. ⋯ Massive left pleural effusion was detected and chest drainage was performed, and oxygenation was improved. Accumulation of pleural effusion tends to be over-looked because many parturients with pleural effusion do not complain of dyspnea. Physicians should pay attention to pleural effusion in parturients, especially those with risk factors such as preeclampsia, generalized body weight increase and administration of beta stimulant.
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Case Reports
[Successful nasal intubation using airway scope with gum elastic bougie in a case of difficult airway].
AWS (Airway Scope, Pentax, Tokyo), a new videolaryngoscope, was originally designed to facilitate oral laryngoscopy and tracheal intubation. We describe a successful case of nasal intubation with a combination of AWS and GEB (gum elastic bougie). A 50-year-old man with a past history of difficult intubation was scheduled to undergo subtotal esophagectomy. ⋯ Oral insertion of AWS showed full view of the glottis and nasal insertion of GEB was easily advanced into the trachea through an endotracheal tube, allowing tracheal intubation while utilizing GEB as a stylet. No complication occured in this case. In conclusion, nasal intubation using AWS combination with GEB is useful for patients with difficult airways and is easy to perform.