Masui. The Japanese journal of anesthesiology
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Anisocoria and abnormality of pupil- lary light reflex may indicate sight-threatening or life- threatening neurological injury. Many perioperative patients are given opioids for analgesia, and opioids produce miosis and make it hard to assess anisocoria or pupillary light reflex. This study was designed to determine the influence of induction of anesthesia on pupillary light reflex assessed by a hand-held point- and-shoot pupillometer. ⋯ Propofol and remifentanil infusion in- fluence pupillary light reflex and decreases values of NPI and CV. When using these drugs, it is necessary to perform neurologic evaluation using NPI and CV.
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Macewen, who was the first to perform tracheal intubation in a patient undergoing surgery under gen- eral anesthesia, described four people (Desault, Bou- chut, Schrötter and Trendelenburg) who had per- formed tracheal intubation (without general anesthe- sia), before Macewen. I have reanalyzed the Macewen's description and have confirmed that these descriptions are generally accurate. ⋯ I also estimated the date when they performed tracheal intubation. Through the liter- ature search, I have found several other people who performed tracheal intubation even before Desault, with different aims.
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Case Reports Historical Article
[History of Tracheal Intubation: 1. First Application of Tracheal Intubation during General Anesthesia].
The earliest report of tracheal intubation during general anesthesia was made by Sir. William Macewen (a Scottish surgeon, 1848-1924), who performed it on 5th July, 1878. ⋯ Macewen performed tracheal intubation, instead of tracheostomy, in a patient sched- uled for resection of a large epithelioma in the mouth under general anesthesia, to prevent airway obstruc- tion and aspiration of blood. In the report, he described several advantages of tracheal intubation during gen- eral anesthesia and methods with which aspiration of blood can be prevented.
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Case Reports
[Acute Subdural Hematoma due to the Breakage of an Epidural Catheter Left for a Long Time].
Breakage of an epidural catheter occurs rarely dur- ing the insertion or removal procedures. In previous reports, the broken epidural catheter fragment need not be removed in asymptomatic patients. However, late-onset neurological symptoms might occur. ⋯ Antiplatelet therapy might lead to the hematoma because this patient took an aspirin (antiplatelet drug) for over 9 years. Antiplatelet and anticoagulant therapies are likely to be a risk of hematoma. Thus, even without neurological symptoms, it is necessary to consider the removal of the epidural catheter fragment in patients on anti- platelet and anticoagulant therapy.
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The pain of skin graft site after surgery is compara- tively severe. We present three cases of combined of ultrasound-guided femoral nerve block and lateral fem- oral cutaneous nerve block that was effective for har- vesting skin grafts. ⋯ Case 3 : a 94-year-old man had split-thickness skin grafting of acrotarsium harvested from outside of the thigh under spinal anesthesia, femoral nerve block, lat- eral femoral cutaneous nerve block and sciatic nerve block. In all cases, there was no pain just after surgery, and postoperative pain was controlled well through the hospitalization with administration of oral analgesic agents.