Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of laparotomy for a patient with amyotrophic lateral sclerosis: a case report].
Amyotrophic lateral sclerosis (ALS) is a disease involving motor neurons. There are two major problems in anesthetic management for patients with motor neuron diseases; prolongation of the effect of non-depolarizing muscle relaxant, and controversy about a use of neuraxial block. We describe the anesthetic management of laparotomy for a patient with ALS by general anesthesia alone. ⋯ The patient emerged from general anesthesia smoothly, and was extubated without any complications. For the postoperative pain management, we administered opioids intravenously, providing good analgesia. The postoperative course was uneventful, and there was no exacerbation of neurological signs and symptoms of ALS.
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Intravenous leiomyomatosis (IVL) is an uncommon neoplasm characterized by the growth of a benign-looking smooth muscle tumor into the venous system. Intracardiac extension of this tumor is rare and may be misdiagnosed as right atrial myxoma unless the extracardiac part of the tumor is fully evaluated. ⋯ Intraoperative transesophageal echocardiography (TEE) revealed that the tumor had an extracardiac origin, resulting in tumor removal from the heart chamber and a part of the inferior vena cava (IVC) under circulatory arrest. When the findings of no attachment of the tumor to the interatrial septum or the right atrial wall and the tumor extension through the IVC are obtained by TEE examination, IVL should be considered as a differential diagnosis.
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The Pentax-AWS videolaryngoscope (Tokyo, Japan) has been used successfully to intubate the trachea in patients with difficult airways. We report the use of the Pentax-AWS for tube exchange in a patient with difficult airway. In a 57-year-old man scheduled for laminectomy of the cervical spines, tracheal intubation of a reinforced tube was accomplished with a great difficulty. ⋯ Under the video image, the cuff of the reinforced tube was deflated, and a tube exchanger was introduced through the polyvinylchloride tube into the trachea, alongside the reinforced tube. The reinforced tube was removed, and the new tube was advanced over the exchanger into the trachea. We suggest that the Pentax-AWS is useful for tube exchange, as one can continuously confirm the entire course of exchange and can detect and rectify any possible problems, such as difficulty in advancing an endotracheal tube over the exchanger.
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Comparative Study
[Training of internal jugular vein cannulation: comparison of landmark method with ultrasound-guided method].
We compared training of internal jugular vein cannulation with ultrasound-guided method and that with landmark method in a group of 10 residents and that of 10 staffs. Cannulation was increasingly successful with both methods as the training proceeded, and with increasingly less time and fewer number of punctures. There was no statistically significant difference in time or in number of punctures with ultrasound-guided method between the groups. Ultrasound-guided method needed fewer number of punctures than those with landmark method in both groups.
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We examined the effect of landiolol hydrochloride, a selective beta1-adrenoreceptor antagonist, on the incidence of atrial fibrillation(AF). ⋯ Landiolol hydrochloride is effective for the preventionof AF and it is safe without causing a severe decrease in blood pressure and bradycardia in high risk patients.