Masui. The Japanese journal of anesthesiology
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The American Society of Anesthesiologists (ASA) published a clinical practice guideline of preoperative fasting in 1999. A nationwide survey conducted in Japan in 2003 reveals that many hospitals have a much longer fasting period. We conducted a similar survey in three limited areas in Japan to assess the changes in fasting practice. ⋯ Longer preoperative fasting periods are still common practice in Japanese hospitals.
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A 26-year-old woman with Ehlers-Danlos syndrome (EDS) underwent posterior spinal fusion with instrumentation for scoliosis. General anesthesia was maintained using propofol and remifentanil. The procedure was performed examining the motor evoked potential (MEP) and somatosensory evoked potential (SSEP) of the lower extremities with the patient placed in the prone position. ⋯ Brachial plexus injury is the most common among the nerve injuries resulting from intraoperative malpositioning. Patients with EDS are thought to be at high risk for the complications and it has also been reported that patients with joint hypermobility, such as that in EDS or Marfan syndrome, are highly susceptible to nerve injury. Intraoperative monitoring of the MEP and SSEP in the upper extremities should be considered for early detection and prevention of brachial plexus injury in patients with EDS who are thought to be at high risk.
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We report 2 patients for whom anesthetic management using aortic occlusion balloon catheter (AOBC) was performed thrice. A 14-year-old boy and a 43-year-old man with sacral giant cell tumor underwent tumor resection. In both patients, transcatheter arterial embolization (TAE) was performed several times before the operation. ⋯ Because the AOBC could not decrease the severity of venous hemorrhage, we expected increased hemorrhage with an increase in the extent of surgery. In addition, preoperative multiple TAE might lead to the development of collateral circulation around the sacrum and augment the amount of blood loss in that region. Although the AOBC could reduce intraoperative hemorrhage, uncontrollable bleeding may occur if the sacral giant cell tumor shows extensive dissemination.
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In our hospital, the average duration of training in intubation by the emergency medical technician training intubation was 17.9 days. Compared to other reports, our training period is shorter. ⋯ But long training period has been increasing the burden of anesthesiologists and emergency medical technicians. We report a practical method of intubation by emergency medical technician in our hospital.
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Although the cases of upper airway obstruction with ProSeal laryngeal mask airway (PLMA) during spontaneous respiration were reported, the structural comparison with other types of laryngeal mask are not known. We thus examined the relationship between upper airway obstruction and the structure of laryngeal mask. ⋯ The upper airway obstruction is caused by PLMA due to the deep bowl cup form which is distinctive design of PLMA. Bulky side cuff limits the movement of arytenoids. The bowl cup pushes up the oral cavity forward, and the supraglottic soft tissues are displaced inward because those tissues are not fixed by the thyroid cartilage. Other types of LMA listed above do not have these features. This suggests that Supreme or Classic LMA is suitable for spontaneous respiration than PLMA, and it is risky to choose PLMA for emergency airway management without knowing these features.