Masui. The Japanese journal of anesthesiology
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Biography Historical Article
[Sir Humphry Davy, the discoverer of anesthetic action of nitrous oxide--Davy and poets of British Romanticism and inhalation of laughing gas by his friends].
In "Dove Cottage", the old house of the poet laureate William Wordsworth (1770-1850) in Grasmere, England, there is a portrait of Sir Humphry Davy (1778-1829). In 1804, Wordsworth invited his young friend to his home. Davy's works in the field of chemistry are well known. ⋯ But he has chosen the way of chemist. The author found some facts from literatures and received some information by courtesy of the Wordsworth Trust, Centre for British Romanticism. Davy's life and his works were introduced chronologically.
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To evaluate the present status of blood transfusion during operation in our hospital, we retrospectively analyzed the amount of preoperative preparation & intraoperative use of homologous blood and the circumstances of autologous blood transfusions. The amount of prepared blood was 4,505 units of which 1,187 units were transfused; the mean cross matched-to-transfused (C/T) ratio was 3.8. ⋯ Preoperative blood donation (PBD) and intraoperative autologous blood transfusion (IAT) were performed in 74 cases (47.4%) and 55 cases (35.3%), respectively, of all 156 blood-transfused cases, and the operations were performed without homologous blood transfusion in 88.0% of PBD cases and 67.3% of IAT cases respectively. We are sure that the introduction of MSBOS will lead to a more efficient use of autologous blood, and that we should use homologous blood transfusion techniques so far as is possible to avoid autologous blood transfusion.
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Clinical Trial
[Cervival spine movement during light-guided orotracheal intubation with lightwand stylet (Trachlight)].
We assessed the degree of movement of the cervical spine (C-spine) during light-guided orotracheal intubation using a lightwand stylet (Trachlight). Twenty ASA 1-2 patients were studied. Following induction of anesthesia and obtaining muscle relaxation, the cross-table lateral radiograph of C-spine was taken before and during the intubation with Trachlight. ⋯ The results showed that delta C1-occiput was larger and delta C1 + C5 was smaller with Trachlight than with conventional or McCoy laryngoscopy we had previously reported. We concluded that light-guided intubation technique using Trachlight needed less movement of the C-spine in contrast to direct laryngoscopy. We believe that Trachlight is an easy, alternative and beneficial device for patients in whom cervical spine movement is limited or undesirable.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Effect of epidural pressure gradient on buprenorphine flux through the dural hole after combined spinal-epidural anesthesia--comparison between bolus injection and continuous infusion].
Combined spinal-epidural anesthesia is a useful technique. However, there has been no attempt to investigate the risk of epidural opioid, especially buprenorphine, flux through the dural hole. The purpose of this study was to compare the effect of epidural buprenorphine administered across the dura into subarachnoid space, between two different methods of administration; bolus injection (Group I) and continuous infusion (Group II). ⋯ It indicates that the increase of nausea and vomiting is predominantly determined by a high rate of flux into subarachnoid space and only partly determined by blood concentrations. In contrast to continuous infusion, the drug movement through the dural hole may increase by bolus injection due to its higher pressure. We recommend careful injection of epidural buprenorphine such as by continuous infusion with low pressure after combined spinal-epidural anesthesia.
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Case Reports
[Anesthetic management involving difficult intubation in a child with Gaucher disease].
Gaucher disease is the most common of the glycolipid storage disorders caused by the deficiency of glucocerebrosidase, an enzyme which hydrolyzes glucocerebroside to glucose and ceramide. Accumulation of the substrate leads to multiorgan dysfunction involving the brain, spleen, liver, lymph node and bone marrow. In anesthetic management, gastroesophageal reflux leading to recurrent aspiration, pancytopenia and airway difficulties due to trismus, neck extension and upper airway infiltration with glucocerebroside must be considered. ⋯ Then, we used this special mask for the next time. Tracheal intubation was much safer by using this mask for fiberoptic intubation. In Gaucher disease, preoperative assessment of airway difficulties and preparation for this situation are necessary and anesthesiologist must be concerned about aspiration and airway difficulties.