堀田 訓久

Spinal hematoma is a rare and serious complication of neuraxial anesthesia. Risk factors for spinal hematoma during neuraxial anesthesia are anatomic abnormalities, impaired hemostasis and difficult needle placement. Japanese guideline for prevention of venous thromboembolism recommends low-dose unfractionated heparin (LDUH) to patients with moderate and high risk in perioperative period. LDUH is not contraindication for neuraxial anesthesia in this guideline. In order to reduce the risk of spinal hematoma in patients receiving heparin, it is recommended that the needle placement and catheter removal should be done when the anticoagulant effect of heparin is at the minimum. Postoperative evaluation of the neurological status is also important for early detection of a spinal hematoma.

We describe the clinical use of a new video-laryngoscope (GlideScope®, GS) in patients with a difficult airway and morbid obesity. In 4 patients with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottic opening (Cormack-Lehane grade I or II) was visualized with GS. In 2 patients, showing a Cormack-Lehane grade IV view with Macintosh direct laryngoscope, Cormack-Lehane grade II view of the glottic opening was obtained. GS also provided a good view of glottic opening in a patient with morbid obesity. GS will have a profound impact on the management of the difficult airway.

We describe a patient to whom ropivacaine 150 mg had been administered during obturator nerve blockade and developed grand mal convulsions because of inadvertent i.v. injection. Venous blood samples were taken 15, 32 and 52 min after the convulsion. The measured total plasma concentrations of ropivacaine were 4.5, 3.5 and 2.9 μg · ml-1 respectively. The peak plasma concentration at the time of the inadvertent i.v. injection was estimated to be 6.6 μg · ml-1. The patient recovered uneventfully.

Background: The anesthetic incident-reporting scheme in the department of anesthesia, Jichi Medical School Hospital, has been running for 3 years and 100 incidents have now been reported. Methods: An 'anesthetic incident' was defined as any incident related to anesthesia which either caused harm, or if uncorrected might have caused harm, to a patient. Results: There were 26 problems involving drugs, 18 airway and respiratory problems, 15 dental damages, 11 cardiovascular problems, 8 problems related epidural anesthesia, and 22 others. Conclusions: The scheme has successfully high-lighted weaknesses of the department.

A 76-yr-old male presented for leg amputation above the knee. The patient complained of dyspnea due to pulmonary embolism occurring 3 weeks before operation. In addition, the patient could not report paresthesias because he had suffered from a cerebral infarction. Anesthesia was performed with combined block of femoral, sciatic, obturator nerves and the lateral cutaneous nerve of the thigh. The nerves were anesthetized with 0.75% ropivacaine solution 31 ml by use of an electrical nerve stimulator and an insulated needle. Nerve stimulation technique is the best choice for patients who are unable to report paresthesias reliably.

A new programmable syringe infusion pump, Auto Syringe Model® AS 40 A, was evaluated for infusion of muscle relaxants, vasodilators and opioids in 4 surgical patients. Every drug mentioned above was easily adjusted according to surgical requirement in these patients. Auto Syringe Model® AS40A is light and compact. Its major advantages lie in the mechanisms for delivery of a bolus dose and autmated delivery of intermittent doses, automatic rate calculation, and the applicability to various sizes of syringes. Auto Syringe Model® AS40A was found to be very useful for intravenous infusion of drugs.