Masui. The Japanese journal of anesthesiology
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Brachial plexus injury has often occurred secondary to malposition of the patient during general anesthesia. We have experienced median nerve injury following laparoscopic sigmoidectomy. A 61-year-old man with diabetes and hypertension received laparoscopic sigmoidectomy under general and epidural anesthesia. ⋯ We suspect that his right median nerve injury was caused by compression and stretching of the brachial plexus in head down position, right lateral tilt table, use of shoulder brace, laparoscopy, abduction of the upper arm, and extension of the elbow. In laparoscopic operation in head down position, we should avoid using the shoulder brace to minimize the risk of brachial plexus injury. The arms should be approximated to the sides as nearly as possible and the elbows should be gently flexed to unload the median nerve and relieve tension on the brachial plexus.
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We report a case showing a bispectral index (BIS) value "10" during anesthesia maintained with propofol. Vital signs of the patient including blood pressure and heart rate were stable and the depth of anesthesia was considered as adequate. The serum concentration of propofol measured later was 2.5 and 2.2 microg ml(-1) when BIS indicated 10 and 35, respectively. The age of patient was 81 and the BIS values in elderly might decrease in accordance with the reduction of brain function.
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Early detection of complications after craniotomies are important and remifentanil may be beneficial for that purpose because of the short and constant context-sensitive half time. To examine the efficacy of remifentanil in neuroanesthesia, we investigated hemodynamic properities and recovery from anesthsia in craniotomies. ⋯ Remifentanil is suitable for neuroanesthesia because of the hemodynamic stability and quick recovery from anesthesia.
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The Airway Scope (AWS) is a new videolaryngoscope which consists of an optical system and a single-use blade. The blade of the device is designed according with the pharyngeal anatomy, and thus the AWS is expected to have a role in the management of difficult airway. ⋯ The AWS provides a view of the glottis with Cormack-Lehane grade 1 and resulted in successful intubation in the 15 patients. The AWS is useful for the management of difficult airway.
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The pain associated with spinal puncture is severe, and the memory of this uncomfortable procedure often deters patients from undergoing the procedure again. Therefore, it is important to make the patient as comfortable as possible when this procedure is performed. ⋯ In the patients aged <70 years, intravenous administration of 0.023-0.044 mg x kg(-1) of midazolam was very effective in preventing a bad memory concerning the spinal-tap procedure; however, it is important to note that the number of side effects associated with this procedure increases in patients aged > or =60 years.