Masui. The Japanese journal of anesthesiology
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We report a second case of awareness during general anesthesia with sevoflurane supplemented with fentanyl. A 58-year-old man, weighing 61 kg, underwent an 8.8-hour operation for a malignant tumor of the right mandible. ⋯ The patient became agitated in the recovery room and could recall his visual memory during the operation. We speculated contribution of visual input through the open eye and/or the effects of cranial bone oscillation during the surgery to his intraoperative awareness.
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Recently, various less-invasive cardiac output monitors are used for a variety of cases. We used FloTrac system for a patient with severe dilated cardiomyopathy (LVDd/Ds = 75/62 mm, EF = 22%) and recognized its limitation. A 52-year-old woman underwent left partial mastectomy. ⋯ Its accuracy is worse with arterial wave artifact, compromise of the arterial catheter, aortic regurgitation, intense peripheral vasoconstriction, irregular pulse and severe cardiac hypofunction. Thus, its reliability is influenced by various conditions, especially in critically ill patients. FloTrac system is very useful for the management of cardiocirculatory dynamics, but we should be familiar with its limitations.
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Retroperitoneal laparoscopic surgery has recently become a common procedure for urological fields. We investigated the incidence of respiratory complications and their background during retroperitoneal laparoscopic surgical procedures performed in the kidney position. ⋯ Respiratory complications, such as atelectasis or pneumomediastinum, occurred in more than half of the patients after urological retroperitoneal laparoscopic surgical procedures in the kidney position. Careful perioperative management and postoperative CXR examinations are essential for early detection of such potentially life-threatening complications.
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Case Reports
[Case report of endotracheal intubation using AirWay Scope (Pentax-AWS) in a Forestier's disease patient].
A Forestier's disease patient was scheduled for endoscopic mucosal resection under general anesthesia, because of his hypoxic episode during gastric endoscopy. Endotracheal intubation was planned while awake, because he was suspected as a case of difficult airway. ⋯ The procedure was successful with no complications. AWS seems to be a useful device for endotracheal intubation in Forestier's disease.
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Case Reports
[Case of spinal anesthesia for pyrolomyotomy in a former preterm infant with chronic lung disease].
A former premature infant (1,795 g) with chronic lung disease underwent pyrolomyotomy under spinal anesthesia. She had been managed with artificial ventilation for 2 months after birth and had developed chronic lung disease. She showed frequent apnea with desaturation several times per day and 21 x min(-1) of oxygen had been administered. ⋯ After we confirmed the anesthesia level up to T5, surgery was commenced. She was managed with mask CPAP to prevent deasaturation under spontaneous respiration during surgery. She required nasal-CPAP to prevent apnea after surgery and she was transferred back to the referred hospital on the 3rd postoperative day without any sequela.