Munetaka Furuya

Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion

Upper airway obstruction resulting from overflexion fixation of the cervical spine is a rare but life-threatening complication after cervical spine surgery. There are few reports of dyspnea after a posterior cervical fusion. We present the case of a 63-year-old woman with rheumatoid arthritis who developed an upper airway obstruction immediately after an O–C4 fusion. She was reintubated with a fiberoptic scope. Revision surgery allowing the angle to return to the neutral position was performed to ameliorate the overflexion of the cervical spine fixation and the consequent upper airway obstruction. After revision surgery, the upper airway obstruction disappeared. Our experience suggests that intraoperative use of fluoroscopy and extubation with a tube exchanger are recommended to avoid this complication, especially in patients at high risk of upper airway obstruction.

Comparative effects of verapamil, nicardipine, and nitroglycerin on myocardial ischemia/reperfusion injury.

The aim of this experiment was to establish whether verapamil, nicardipine, and nitroglycerin have (1) infarct size-limiting effects and (2) antiarrhythmic effects in in vivo rabbit hearts during ischemia/reperfusion. Rabbits received regional ischemia by 30 min of left anterior descending coronary artery occlusion followed by 3 hours of reperfusion under ketamine and xylazine anesthesia. The animals were randomly assigned to the following 4 treatment groups: a control group, a verapamil group, a nicardipine group, and a nitroglycerin group. A continuous infusion of verapamil, nicardipine, or nitroglycerin was initiated 5 min prior to ischemia. Infarct size/area at risk decreased in verapamil, and nitroglycerin. The incidence of ischemia-induced arrhythmia decreased in nicardipine, verapamil and nitroglycerin. The incidence of reperfusion-induced arrhythmias decreased in verapamil and nitroglycerin. From the present experimental results, verapamil and nitroglycerin rather than nicardipine did afford significant protection to the heart subjected to ischemia and reperfusion in a rabbit model.

Application of nasal flexible laryngeal mask airway in anesthesia for oral surgery

The laryngeal mask airway has been used increasingly in clinics but is seldom applied in anesthesia for oral surgery, as the mask occupies the middle of the mouth and tends to obstruct the surgical field. Here, we report the successful placement and usage of a nasal flexible laryngeal mask airway (FLMA) in an oral surgical procedure. Fifteen patients undergoing dental procedures under general anesthesia were studied. We clinically applied a previously reported method for inserting an FLMA with some modifications. There was no significant bleeding from the intubated nostril in any of the patients. None of the patients complained of sore throat, coughing, hoarseness, or any discomfort in the nose. Although we anticipate that further refinements of the technique may be possible and that the safety of this method using a nasal FLMA needs to be assessed in a greater number of patients, in this preliminary study we provide a proof-of-principle demonstration of the efficacy of nasal LMA ventilation as a method of airway management for oral surgery.

Application of gum elastic bougie to nasal intubation.

Gum elastic bougie (GEB), a useful device for difficult airway management, has seldom been used for nasotracheal intubation. Among 632 patients undergoing dental procedures or oral surgery, GEB was used successfully in 16 patients in whom conventional nasal intubation had failed because of anatomical problems or maldirection of the tip of the tracheal tube. We recommend that GEB should be applied from the first attempt for nasal intubation in patients with difficult airways.

Perioperative management of obstructive sleep apnea with nasal continuous positive airway pressure.

The high risks associated with general anesthesia in obstructive sleep apnea syndrome (OSAS) patients have been reported. Many authors have suggested that the intraoperative administration of opioids and sedatives should be limited or avoided because these drugs selectively impair muscle activity in the upper airway. We report the case of an OSAS patient who was managed with nasal continuous positive airway pressure (NCPAP) and treated safely in spite of the use of conventional anesthetic and analgesic agents typically used for patients without OSAS. She had little pain during the perioperative period. It is suggested that NCPAP is an effective treatment for not only preventing airway obstructive apnea but for allowing the administration of anesthetic and analgesic drugs without major complications.

Effects of Lidocaine on Ischemia/Reperfusion Injury in In vivo Rabbit Hearts

Objective: The aim of this study was to investigate the cardioprotective effects of lidocaine administered at three different timings, as indexes of hemodynamics, infarct size, antiarrhythmic action, and changing activation time by electrocardiogram in in vivo rabbit hearts. Methods: Thirty two rabbits received regional ischemia by 30 min of left anterior descending coronary artery occlusion followed 3 hours of reperfusion under ketamine and xylazine anesthesia. The animals were randomly assigned to the following 4 treatment groups: a control group, a lidocaine-preconditioned group, a lidocainepostconditioned group, and a lidocaine-continuous administration group. Results: The ratio of areas at risk revealed no significant difference among all groups. Mean infarct size of the area at risk was significantly less in a lidocaine-continuous administration group than other 3 groups. The incidence of arrhythmias during myocardial ischemia was no significant difference between a control group and other 3 groups. The incidence of arrhythmias during reperfusion was no significant difference among all groups. However, lidocaine depressed the activation time which was prolonged by ischemia.

Effects of Ischemic and Sevoflurane-induced Preconditioning on Myocardial Infarction and Arrhythmias in Rabbits In Vivo

Objectives: The present study aimed to investigate whether ischemic or sevoflurane-induced preconditioning exerts infarct size limiting effects and depresses ischemia-reperfusion arrhythmias through opening of mitochondrial KATP channels in rabbits in vivo. Methods: Rabbits anesthetized with ketamine and xylazine given intramuscularly underwent 30 min of left anterior descending coronary artery (LAD) occlusion followed by 3 hrs of reperfusion. Before this, rabbits were randomized into one of five groups. Control rabbits received no intervention before 30 min LAD occlusion and 3 h reperfusion (Group-C). The ischemia-preconditioned (IP) rabbits underwent 5 min LAD occlusion followed by 10 min of reperfusion before prolonged ischemia-reperfusion (Group-IP). In the sevoflurane (S)–preconditioned group, 30 min of sevoflurane exposure at a 1.5% end-tidal concentration was followed by 15 min of washout before prolonged ischemia-reperfusion (Group-S). The selective mitochondrial KATP channel blocker, 5-hydroxy-decanoate (5-HD, 5 mg/kg) was given intravenously 10 min before ischemic preconditioning and sevoflurane exposure, respectively (Group-5-HD-IP, Group-5-HD-S). An electrocardiogram was recorded throughout the experiment via lead 2 of the standard electrocardiogram. At the end of the 3 hrs reperfusion period, area at risk (R) and infarct size (I) were measured. Results: RPP decreased in Group-5-HD-IP and Group-5-HD-S compared with Group-S at 30 min after ischemia. The ratio of R to left ventricular mass showed no significant difference among all groups. I/R values of each group were 51.6 ± 3.0% in Group-C, 33.3 ± 4.7% in Group-IP, 36.6 ± 4.8% in Group-S, 48.9 ± 5.2% in Group-5-HD-IP, 54.8 ± 4.2% in Group-Group-5-HD-S. There was no significant difference in duration of arrhythmias during myocardial ischemia and reperfusion among 5 groups. Conclusion: Ischemic preconditioning and sevoflurane-induced preconditioning exert infarct size limiting effects through opening of mitochondrial KATP channels. However, ischemic preconditioning and sevoflurane-induced preconditioning do not have antiarrhythmic effects. This suggests that the opening of mitochondrial KATP channels does not cause antiarrhythmic effects.