Masui. The Japanese journal of anesthesiology
-
A 74-year-old female patient underwent a coil embolization for an unruptured cerebral aneurysm. A routine anesthetic protocol was devised as there was no risk of a difficult airway. ⋯ We changed the stylet to a Parker Flex-IT™ Stylet (Parker Medical, CO, USA), which can be freely curved by pushing the sum button on the top of the stylet. As a result, easy intubation was possible, and the DLT was maneuvered at a proper angle while examining the vocal cords by using the Parker Flex-IT™ Stylet In conclusion, when a McGRATH® MAC laryngoscope cannot be operated freely in the oral cavity owing to a limited oral opening, we can instead intubate easily and effectively by using a combination of a Parker Flex-IT™ Stylet and the McGRATH® MAC video laryngoscope.
-
Non-invasive positive pressure ventilation (NPPV) reduces the incidences of ventilator-associated pneumonia, the duration of ICU stay and the mortality rate compared with conventional respiratory management of the patients with acute respiratory failure (ARF). Recently, helmet NPPV equipment became available. Because of the high tolerability, the helmet seems to be the best NPPV interface when prolonged and continuous assistance is needed. In this study, we analyzed several factors related to failure of helmet NPPV in ARF patients in intensive care unit (ICU), retrospectively. ⋯ Helmet NPPV improved oxygenation in ARF patients immediately after induction of NPPV. Although there were no significant predictable parameters of unsuccessful NPPV before induction of NPPV, a lot of excretion of sputum might be suggested as a risk factor.
-
Biography Historical Article
[Seishu Hanaoka Did Not Describe His Anesthetic as Tsusensan--A Misunderstanding of the Terms Mafutsusan and Tsusensan].
It is widespread even among medical professionals as well as medical historians that the formal term of the general anesthetic that Hanaoka developed is Tsusensan and its alias name is Mafutsusan. Hanaoka himself, however, described it as Mafutsusan in his Nyugan Chikenroku, the case report of the first breast cancer excision under general anesthesia with the anesthetic, and a large number of his disciples all used the term Mafutsusan to denote the anesthetic in their manuscripts. The description of Tsusensan has not been found in the documents written in the Edo period, and this name is detected only in the epitaph of Hanaoka. Consequently, we should refer to Hanaoka's anesththetic as "Mafutsusan, another name Tsusensan" instead of "Tsusensan, another name Mafutsusan."
-
We report a case of epidural hematoma in an elderly patient with normal coagulability and without difficulty in epidural catheterization. A 76-year-old man with a history of cervical myelopathy was scheduled for gastrojejunostomy under combined epidural and general anesthesia. He had normal bleeding time, coagulation test results, and platelet count. ⋯ On the second postoperative day, MRI of the spine demonstrated a hematoma-like lesion, and severe thoracic and lumbar spinal canal stenosis. Severe vertebral deformation, especially in cases of the elderly, is a potential risk for epidural hematoma after epidural catheterization, because a small hematoma may compress the spinal cord. A careful preoperative evaluation whether to perform epidural catheterization and postoperative observation are required for elderly patients with severe vertebral deformation.
-
Case Reports
[A Case of Epidural Hematoma after Removal of Epidural Catheter in a Patient with Coagulation Disorder].
A 75-year-old man with abdominal aortic aneurysm underwent Y-graft replacement under combination of general anesthesia and epidural anesthesia. Although we inserted an epidural catheter at first attempt from T11-12, nurse cut the epidural catheter accidently. We re-inserted from the same place. ⋯ After one hour, he could move leg but had numbness of the left leg. MRI revealed epidural hematoma from T8 to T10. Although the cause of epidural hematoma remains unclear, we should have proposed to check anticoagulant data when catheter was pulled out from epidural space.