Masui. The Japanese journal of anesthesiology
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We should take care of the occurrences of apnea and hypopnea after emergence from general anesthesia in the children with sleep apnea syndrome (SAS) due to an increase in sensitivity to opioid agonists given for previous recurrent hypoxia. Preoperative assessment for SAS with apnea hypopnea index (AHI), oxygen desaturation index (ODI), and minimum artery oxygen saturation by pulse oxymetry (lowest SpO2) obtained from polysomnography (PSG) test could help to predict the postoperative respiratory depression. In perioperative management in the children with SAS who are candidates for adenotonsillectomy, the dose of opioid agonists during anesthesia maintenance for purpose of postoperative analgesia and sedation should be reduced; postoperative respiratory and circulatory management with monitoring of respiratory movement of the thoracoabdominal part, and electrographic (ECG) and SpO2 monitoring should be continued intensively under long-term oxygen administration; and airway management, nasal continuous positive airway pressure (nCPAP), and artificial ventilation should be prepared for the occurrence of postoperative respiratory depression.
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Case Reports
[A case of an unexpected difficult nasal intubation, caused by hypertrophied lingual tonsil].
We experienced a case of unexpected difficult nasal intubation due to lingual tonsil hyperplasia. A 43-year-old man was scheduled for pharyngoplasty because of sleep apnea syndrome. After induction of general anesthesia, Macintosh laryngoscopy failed to expose his glottis by two experienced anesthesiologists. ⋯ Ventilation and oxygenation were maintained throughout the procedure. A FOB guided intubation under general anesthesia is often difficult, because identification of glottis is interfered by deviated pharyngeal tissue and epiglottis, which are affected by the use of muscle relaxants. At present, a selective relaxant binding agent, sugammadex, is available in anesthesia, to reverse the effect of non-depolarizing muscle relaxant and to restore spontaneous breathing in this situation.
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Biography Historical Article
[The first labor analgesia with drug was already performed in late Meiji-Period (1868-1912): trace of opioid-scopolamine which was used in Akiko Yosano, back to its origins].
There have been some records of labor analgesia with intravenous or rectal anesthetics in early Showa-period (1926-1989). However, the author found that labor analgesia had been already attempted for some women in late Meiji-period (1868-1912). One of agents used was pantopon, a water-soluble opioid without serious respiratory depression as morphine. ⋯ They also reported that this combination also conferred excellent analgesic effects without any serious complications in the mother and fetus. This combination was originally used for general surgery with inhaled anesthesia at that period. It remains uncertain how Japanese doctors got pantopon scopolamine from Germany.
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After introducing "BOKUTOH enhanced recvery after surgery (ERAS)" protocol for colorectal surgery in our hospital, the hospital stay after surgery was reduced from 10 days to 7. However, the patients' quality of life (QOL) throughout the perioperative period was not quantified. We assessed the QOL of these patients by using QoR-40J and SF-36v2J (Japanese versions of QoR-40 and SF-36v2) questionnaires. ⋯ Under "BOKUTOH ERAS" protocol management, patients who had had colorectal surgery were able to recover their QOL within 6 days. Thus, leaving hospital by 7 days after surgery was appropriate to our patients.
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Ultrasound guided neuraxial block or central venous puncture is now becoming popular in our anesthesia practice to reduce the risk of complications. Pneumothorax is a rare, but possible complication related to these interventions even if the ultrasound is used. However, the pneumothorax itself can also be diagnosed by the ultrasound. We therefore examined the efficacy of ultrasound for diagnosing pneumothorax during lung surgery requiring one lung ventilation. ⋯ Among six ultrasonic lung findings, lung sliding and M-mode procedure are most useful as screening methods of differentiating a pneumothorax.