[Anesthesia for four pediatric patients with difficult airway in whom airway scope was useful for Intubation].

In the field of pediatric anesthesia, devices to solve difficult airway are scant compare to devices for adult difficult airways. We report successful use of an Airway Scope with a pediatric blade in four children with difficult airways. Difficult tracheal intubation had been predicted in all the children, and two had history of difficult intubation. Tracheal intubation using an Airway Scope was always easy. We conclude that the Airway Scope with a pediatric blade is potentially useful in children with difficult airways.

[Use of the airway scope for rapid sequence induction in the emergency operation].

Rapid sequence intubation is a common procedure in emergency patients at risk for pulmonary gastric aspiration. However, in some of these cases may accompany a difficult airway. The Airway Scope (AWS) has been shown to be useful for difficult airway. We used AWS for rapid sequence intubation in 19 such patients. All patients were successfully intubated without any complication. We believe that AWS is a useful device for rapid sequence intubation.

[Anesthetic management for surgery of the ankle joint fracture in a patient with Ebstein's anomaly].

The authors describe the successful anesthetic management of a patient with Ebstein's anomaly and Wolff-Parkinson-White syndrome who underwent repair for foot joint fracture. Anesthesia was provided by combined spinal-epidural block to minimize hemodynamic changes which cause an increase in right-to-left shunt and hypoxemia. We estimated hemodynamic status using radial arterial pressure, central venous pressure and ECG from the start of anesthesia. During anesthesia, his vital signs were unchanged to any significant degree. The recovery was rapid and the postoperative course was uneventful.

[Case of peripartum cardiomyopathy developed after an emergency cesarean section--a case report].

A 28-year-old woman was admitted because of pregnancy induced hypertension at 35 weeks of gestation with twin babies. The premature labor had been inhibited for 2 weeks with ritodrine (100 microg min(-1) continuous infusion). At 37 weeks of gestation, an emergency cesarean section was carried out under combined spinal epidural anesthesia. After the delivery, oxytocin 5 units was injected to the uterine muscle and methylergometrin 0.2 mg was given intravenously to induce uterine contraction. One hour after the operation, she developed severe pulmonary edema. An echocardiography showed diffuse hypokinesis of the left ventricle with ejection fraction of 23%. She was diagnosed as having peripartum cardiomyopathy by cardiologist. The patient's condition improved in a few days but the abnormal cardiac function continued for two months.

[Anesthetic management of 7-9th total spondylectomy for severe scoliosis].

Patients with scoliosis are at a great risk of perioperative problems including excessive blood loss, respiratory and circulatory failure, postoperative pain, malignant hyperthirmia and particularly, spinal cord damage. A case of a 22-year-old girl undergoing 7-9th total spondylectomy for severe scoliosis is presented. To avoid spinal cord damage, we employed deep anesthesia, wake-up test with BIS and postoperative pain management. After the surgery, the patient was transferred to ICU under deep anesthesia and controlled ventilation. The patient had no postoperative motor or sensory deficit, but further experience is needed.

[Effects of olprinone hydrochloride in patients undergoing off-pump coronary artery bypass grafting].

BACKGROUND: Olprinone hydrochloride (OLP) is a new phosphodiesterase III inhibitor with positive inotropic and vasodilator properties. It is characterized by strong inotropic effect and relatively weak vasodilating effect. Although the method for administration of OLP has been reasonably optimized, no studies have examined the administration mode for patients with off-pump coronary artery bypass grafting (OPCAB). METHODS: After the start of the operation, 12 patients received OLP 0.2 microg x kg(-1) x min(-1) (OLP group) and 14 patients received normal saline (control group). Catecholamines were concomitantly administered to maintain systolic pressure > or = 100 mmHg and cardiac index (CI) > or = 2.5 l x min(-1) x m(-2). Hemodymanic parameters were measured after induction of anesthesia, at the administration of heparin, immediately after coronary artery anastomosis, at the end of the operation, and 3 h and 6 h after the operation. RESULTS: Systolic and mean arterial pressures did not differ between the two groups. CI was significantly increased, and SVRI was significantly decreased after administration of heparin, immediately after coronary artery anastomosis, at the end of the operation and 3 h after the operation in the OLP group. OLP reduced the number of patients requiring dopamine and dobutamine compared with the control group. CONCLUSIONS: The study showed that OLP administrated during OPCAB may have improved hemodynamics in patients for OPCAB.