Masui. The Japanese journal of anesthesiology
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From 1994 to June 2001, 15 parturients weighing more than 100 kg underwent cesarean section at our institution. Their medical and anesthetic records were reviewed retrospectively. They consisted of 10 primiparous and 5 multiparous patients. ⋯ All the patients gave live births. Intraoperative complications included hypotension (n = 6) and nausea (n = 3). All of them were free from the morbid postoperative complications except wound dehiscence occurring in four patients.
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We report anesthetic management of a patient suspected of malignant hyperthermia with difficult tracheal intubation. A 64-year-old man was scheduled for a fixation of humerus bone fractures in prone position. He had a history of difficult tracheal intubation due to masseter spasm, and his niece was suspected to be malignant hyperthermia. ⋯ Trials for tracheal intubation failed whenever using a standard laryngoscope, a bronchofiberscope, a laryngeal mask airway or an intubating laryngeal mask airway. Resecting the epiglottic elevating bar of an intubating laryngeal mask airway enabled fiberoptic tracheal intubation. No symptom suggesting malignant hyperthermia developed.
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Deteriorated neurological outcome is not rare after major surgeries. With aging of the surgical population in Japan, an increasing frequency of perioperative cerebral ischemia is expected. To avoid neurological deterioration after surgery and general anesthesia, especially in high-risk patients, it is important to provide appropriate CNS-oriented anesthesia management. ⋯ Among these inhalational anesthetics, isoflurane has been most extensively studied regarding neuroprotection against cerebral ischemic insult. Although no clinical outcome trials have been performed, both in vivo and in vitro studies have consistently shown that the isoflurane provides neuroprotection. However, it is also suggested that factors such as sympathetic reactivity, brain temperature, anesthetic dosage, timing of anesthetic administration, and co-administration of nitrous oxide might affect the neuroprotective effect of isoflurane.
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Biography Historical Article
[Ralph Milton Waters and 75 years of professionalism in anesthesiology].
This short biography introduces Ralph Waters to Japanese speaking people. Meeting in Madison in June 2002, "Ralph Waters and Professionalism in Anesthesiology A Celebration of 75 Years", is also reported briefly. ⋯ After the end of the World War II, however, Japan sent a number of students to the United States including many who received the training in anesthesiology in the departments headed by the disciples of Waters or in the departments under the strong influence of Waters' philosophy. Therefore, it is probably true to say that Japanese anesthesiology today owes much to Waters' teaching.
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Case Reports
[Anesthetic management for cesarian section in a patient with mitral stenosis and severe pulmonary hypertension].
Mitral stenosis is one of the complicating cardiac diseases during pregnancy. We experienced cesarean section in a patient with mitral stenosis and severe pulmonary hypertension (94/41 mmHg). ⋯ A baby (BW:1880 g) was intubated because of tachypnea although Apgar scores were 6-8-8. The anesthetic course of the patient was uneventful.