[Anesthesic management of a patient with Stickler's syndrome].

Stickler's syndrome is a connective-tissue disease of autosome dominant inheritance. This report concerns a 3-year-old girl with Stickler's syndrome who underwent arthroplasty under general anesthesia. After slow induction of anesthesia with an inhalation anesthetic, neither a oropharyngeal airway nor a laryngeal mask airway fitted her, and mask ventilation and endotracheal intubation became difficult. Endotracheal intubation was performed not with a muscle relaxant but under deep anesthesia. Care should be taken when planning anesthesia for a case of this syndrome because airway management is often difficult and emergency surgery for detached retinas might be required.

[Delayed subarachnoid migration of an epidural catheter: a case report].

We often experience migration of an epidural catheter into an undesirable space. Migration of an epidural catheter into the subarachnoid space is a potentially lethal complication. Although almost all migrations of epidural catheters have been reported to occur at insertion of the catheter, we experienced a case of catheter migration into the subarachnoid space two days after its insertion. The symptoms caused by this migration were motor paralysis in the lower extremities and sensory disturbance of the trunk. Neurological and hemodynamic changes in a patient who is undergoing continuous epidural infusion of local anesthetics should be monitored carefully.

[Anesthetic management of four cases of craniotomy with alternate monitoring of motor and somatosensory evoked potentials].

We experienced four cases of craniotomy in which motor evoked potential (MEP) and somatosensory evoked potential (SEP) were monitored alternately. Anesthesia was induced with propofol and fentanyl, and it was maintained with continuous infusion of propofol. Intermittently, propofol and fentanyl were administered as needed. Inhalation of 66% nitrous oxide did not prolong latency, but significantly reduced the amplitude of MEP. We could obtain the largest amplitude of MEP using five consecutive stimuli of which duration and frequency were 0.5 milliseconds and 500 Hz, respectively. Anesthetic management using propofol and fentanyl is useful for craniotomy with monitoring of MEP and SEP.

[Anesthetic management of a patient with Evans syndrome--benefit of perioperative hemodilutional autologous blood transfusion].

The combination of idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia is termed Evans syndrome. We experienced the anesthetic management of a patient with this syndrome undergoing laparoscopic splenectomy. After induction of general anesthesia using thiamylal, fentanyl and vecuronium, hemodilutional autologous transfusion was employed to minimize the immune hemolytic process against the transfused blood throughout the surgical procedure. The anesthetic course was uneventful, and neither massive hemorrhage nor any complications related to bleeding occurred. We therefore recommend the use of hemodilutional autologous transfusion for the anteshetic management of patients with Evans syndrome.

[Orotracheal intubation using a Styletscope in a patient with restricted opening of the mouth].

We used a Styletscope (FSS) for endotracheal intubation in a 61-year-old man with restricted mouth opening. The degree of mouth opening was only 1.5 cm. The FSS was passed through an oral RAE endotracheal tube and used as a guide for insertion of the tube. After induction of anesthesia using propofol and vecuronium, orotracheal intubation was accomplished promptly and smoothly using this scope. The Styletscope is a useful device for orotracheal intubation in patients with restricted mouth opening.

[Anesthetic management of a patient with hereditary spastic paraplegia].

We experienced the anesthetic management of a 39 year-old-male with hereditary spastic paraplegia (HSP) associated with pain due to pes cavus. He underwent orthomorphia ostectomy and tenodesis. Preoperative neurological examination revealed that he had slight dementia, symptoms of the pyramidal tract, lower limb bathyhypesthesia, and neurogenic bladder in addition to spastic paraplegia, and he was diagnosed as having combined type of HSP. Spinocerebellar degeneration is often accompanied with this type of HSP. To avoid the use of muscle relaxants and narcotics, we tried to induce anesthesia with inhalation of nitrous oxide (N2O), oxygen and sevoflurane (sevo). A laryngeal mask (LM) was inserted at the expiratory concentration of sevo 3.5%. Anesthesia was maintained by N2O, oxygen and sevo (2-3%) under spontaneous respiration. The patient recovered from anesthesia after the end of surgery, and the LM was removed smoothly. The patient's respiratory condition was stable, and no problems were found in the postoperative period.

[A survey on cardio-pulmonary resuscitation knowledge of the nursing staff in the Asahikawa Medical College Hospital].

We surveyed the knowledge of the 66 nursing staffs on cardio-pulmonary resuscitation (CPR) and compared the results with that of 53 students of the Department of Nursing of the Asahikawa Medical College. The average scores of the test among the nursing staffs and the student nurses were 61 points and 54 points, respectively. Although a significant difference in the percentage of total correct answers was demonstrated between the two groups, the rate of correct answers of the observation items was high, whereas that of skill items was comparatively low in each group. The "Ability" defined as an indicator of capability of practicing CPR of the nursing staffs was 17% and that of the student nurses was 0%. Our results show that the CPR knowledge of both the nursing staffs and the student nurses was not sufficient, indicating the necessity of CPR education for both nursing staffs and student nurses.

[Anesthetic management for elective cesarean section due to placenta previa in a patient with moyamoya disease].

We report the anesthetic management of a 31-year-old female patient with moyamoya disease using general anesthesia combined with epidural anesthesia for a cesarean section due to placenta previa. Epidural anesthesia with 10 ml of 2% lidocaine was first used. Then general anesthesia was induced with thiamylal 200 mg and succinylcholine 60 mg just before starting operation and was maintained with 60% nitrous oxide in oxygen. After the delivery, propofol was administered at 3-5 mg.kg-1.hr-1. Except for temporary hypotension due to massive bleeding, systolic blood pressure was maintained between 100 and 120 mmHg. Arterial carbon dioxide tension was maintained at about 40 mmHg. Intracranial blood velocity and regional oxygen saturation were also measured to monitor cerebral blood flow. There was no postoperative pain, and no postoperative neurological defects. On the basis of these findings, it was concluded that general anesthesia combined with epidural anesthesia for elective cesarean section due to placenta previa is effective for perioperative management of a patient with moyamoya disease.