[Use of StyletScope in a patient with airway injury].

A forty-year old man hanged himself and was transported to our hospital. On arrival his consciousness was clear but he showed dyspnea, dysphagia, and oral bleeding. Tracheal intubation was attempted but was failed and emergency tracheostomy was successfully accomplished. Tracheoplasty was soon scheduled under general anesthesia because of subcutaneous emphysema. An ordinary laryngoscope could not give a view of the larynx at all. Orotracheal intubation was accomplished with StyletScope. It worked very well for the destroyed trachea. StyletScope is a useful device for intubation, especially in difficult airway management.

[Effect of the music-therapy under spinal anesthesia].

BACKGROUND: Since no pre-medication has been widely accepted especially in spinal anesthesia, anesthesiologists should manage the control of patient's anxiety during surgery. Instead of sedatives, we have been using music-therapy during spinal anesthesia. Bispectral index monitoring (BIS) is used as one of the sedation indices in spinal anesthesia. The aim of this study was to assess the music-therapy on reducing anxiety of patients under spinal anesthesia using BIS and interview type psychology test, State Trait Anxiety Inventory (STAI). METHODS: Fifty-eight ASA physical status I-II patients scheduled for spinal anesthesia, were randomly allocated into M group (music group, n=29) or C group (control, n=29). BIS, EMG, and SQI of both groups were obtained continuously with computer system. Patients in M group listened to music by head phone and those in C group were left free under ordinary operating theater environment. Trait Anxiety Inventory (STAI-TA) score was obtained preoperatively for property-based anxiety and the State Anxiety Inventory (STAI-SA) score was obtained postoperatively for condition-based anxiety. Time averaged BIS scores (pre-surgery, during-surgery and post-surgery period)were obtained during operation. RESULTS: Time averaged BIS values of M and C group in pre-surgery period, during-surgery period, and post-surgery period were 95.3+/-0.4 vs 95.8+/-0.4 (NS), 87.6+/-7.5 vs 95.1+/-2.8 (P<0.01) and 96.0+/-0.4 vs. 96.2+/-0.4 (NS), respectively. Post-surgery STAI-SA was 29.7+/-7.2 in M group vs 38.8+/-10.3 in C group (P<0.01) while pre-surgery STAI-SA scores of both groups were not different. CONCLUSIONS: Music-therapy reduced BIS value and was effective to reduce patient's anxiety during spinal anesthesia.

Gender differences between predicted and measured propofol C(P50) for loss of consciousness.

OBJECTIVE: To investigate gender differences in the effective dose of 50% for loss of consciousness (C(P50LOC)) for propofol using Diprifusor, the most commonly used target-controlled infusion system. DESIGN: Prospective, randomized, comparative study. SETTING: University-affiliated hospital. PATIENTS: 50 ASA physical status I and II patients, aged 20 to 50 years, scheduled for minor surgery. INTERVENTIONS: Patients were randomized into two groups of 25 patients each. A target-controlled infusion of propofol (Diprifusor) was maintained at a predetermined target concentration. After a 10-minute steady state, blinded investigators evaluated patients' consciousness using verbal commands. The propofol test concentration was predetermined using a modified version of Dixon's up-and-down method (starting at 2.5 mug/mL; step size of 0.1 microg/mL). MEASUREMENT: Predicted and measured C(P50LOC) values and bispectral index (BIS) were obtained by averaging the crossover midpoint (ie, consciousness to unconsciousness). Those values were analyzed by unpaired t test: P < 0.05 was considered significant. RESULTS: The predicted C(P50LOC) for men was 2.14 +/- 0.10 microg/mL, which was lower than that for women, 2.55 +/- 0.11 microg/mL (P < 0.0001). No significant difference was found for measured C(P50LOC) in men (2.37 +/- 0.41 microg/mL) and in women (2.30 +/- 0.28 microg/mL) or for BIS measurements. CONCLUSION: Predicted C(P50LOC) by Diprifusor for men tended to be underestimated; that for women tended to be overestimated. Our data support a review of Diprifusor (Astra Zeneca, Osaka, Japan) pharmacokinetic parameters to avoid awareness during operation, particularly for women.

[Newly developed BONFILS Retromolar Intubation Fiberscope for difficult airway].

Battery powered BONFILS Retromolar Intubation Fiberscope (BRIF) is a nonflexible fiberscope having the same curvature as the Macintosh laryngoscope for difficult airway. We used this device in two patients; A 65-year-old man with small chin and a 35-year-old man with neck spinal cord injury. Two trials of orotracheal intubation were accomplished easily in 20 seconds. We conclude that BRIF is useful for orotracheal intubation in patients in whom neck extension is contra-indicated.