Masui. The Japanese journal of anesthesiology
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Before emergency medical technicians are licensed to perform prehospital endotracheal intubation, they must undergo training in the operating room setting. We investigated the incidence of cases of difficult intubation classified as Cormack & Lehane grade III or IV, because such cases are considered inappropriate for training emergency medical technicians. ⋯ Patients with grade I or II view of larynx with a Macintosh blade was only 91%. In order to prepare for unexpected case of difficult intubation, it is necessary to take various measures such as having instructors perform laryngoscopy.
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We report severe hypotension after induction of general anesthesia in a patient receiving an angiotensin II receptor antagonist and an alpha-blocker. A 50-year-old man with diabetes mellitus who had been treated with candesartan cilexetil and doxazosin was scheduled for vitreous surgery. ⋯ Repeated injections of intravenous ephedrine could not raise the blood pressure. After discontinuation of both drugs, although he developed hypotension after induction of anesthesia with propofol and fentanyl, hypotension was mild and responded promptly to intravenous ephedrine.
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We experienced four cases of anesthesia for hip fracture reduction in patients with severe heart failure, where anesthesia was attempted with combined paravertebral lumbar plexus and parasacral sciatic nerve block instead of spinal anesthesia. The anesthesia was successful without any sequelae. The patients' characteristics are as follows. ⋯ Eight ml of 0.25% bupivacaine was injected. During the anesthesia, propofol was injected for light sedation. Although this combined nerve block is difficult to perform compared with spinal anesthesia, this could be applicable for hip fracture reduction anesthesia, especially in patients with severe heart failure.
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Difficult Airway Management (DAM) is one of the most important skills for medical practice, especially for anesthesiologists. A seminar of DAM was held in the 51 st annual meeting of Japan Society of Anesthesiologists. It consisted of a 60-minute lecture about ASA difficult airway management algorithm, and a 120-minute hands-on training session using a mid-fidelity human simulator. ⋯ The questionnaire revealed that the most popular technique for DAM was insertion of laryngeal mask airway (ILMA). Otherwise the invasive techniques were difficult to be experienced in the clinical practice. We suspected that the DAM seminar was useful, especially for the invasive technique without substitute training methods under clinical situation.
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Comparative Study
[Evaluation by undergraduate medical students of clinical clerkships in the department of anesthesiology--comparison with the evaluation in previous fiscal year].
Clinical Clerkships in the Department of Anesthesiology were evaluated by undergraduate medical students and compared with other clinical departments and those of previous fiscal year 2003. ⋯ Reevaluation of the educational program in our department based on the results of the survey is essential for improvement of the program, and further provision of chances, especially for physical examinations, is also needed for undergraduate students in the program by including palliative medical care program.