From the mid-18th century, several different stimulations were used to attempt to resuscitate apparently dead people. These include sound, smell, and light stimulation to the ear, nose and eyes, rubbing the body surface and spirit given to the oral cavity. The most notable stimulation was use of electricity, which was initiated by better understanding of its power by Benjamin Franklin and Luigi A. Galvani. Charles Kite developed the first electrical machine to stimulate the heart, and by 1800, it was found that the most effective site for applying electricity was over the heart.

In the 18th century, tracheal intubation was introduced to clinical practice, mainly in patients with airway obstruction in children due to diphtheria, and in patients who were apparently dead. In this article, I describe the fourth reason for tracheal intubation :a newborn with apnea. Until the mid-18th century, delivery was performed only by midwives, and mouth-to-mouth resuscitation was "secretly" performed by them (midwives' secret). In the mid-18th century, obstetricians started to be involved in the delivery, and in 1750's, Benjamin Pugh (1715-1798) and William Smellie (1697-1763) might have intubated the tracheas of neonates with apnea Since 1790's, Paul Scheel (1773-1811), Frangois Chaussier (1746-1828), James Blundell (1791-1878). Jean Anne Henri Depaul (1811-1883), Heinrich Alexander Pagenstecher (1825-1889), and Alban Alphonse Ambroise Ribemont-Dessaignes (1847-1940) intubated the trachea. Tracheal intubation might have been widely performed by midwives, because Chaussier had educated them at his school.

Klippel-Feil syndrome (KFS) is a complex syndrome of osseous and visceral anomalies that include the classical clinical triad of short neck, limitation of head and neck movement and low posterior hairline. It may also be associated with anomalies of the genitourinary, musculoskeletal, neurologic and cardiac systems. We experienced surgery for a case of KFS complicated with cleft palate and ankyloglossia. This boy underwent palatoplasty with a push-back method at 19 months of age, and frenumectomy at 31 months. respectively. We had to secure the field of operation and airway management involved difficult tracheal intubation. Careful postoperative care and respiratory management are also required for the patient afflicted with KFS.

A 37-year-old female patient with myotonic dystrophy was scheduled for laparoscopic cholecystectomy for gall stone under general anesthesia with continuous propofol infusion. Rocuronium was administered with careful monitoring using TOF- Watch®, measuring train-of-four count (Tc), TOF ratio (Tr), and posttetanic count The total amount of rocuronium was 70 mg ; 0.6 mg .kg⁻1 for anesthetic induction and 0.3 mg .kg⁻1 when Tc exceeded 1. When the operation was completed, Tc was 4, Tr was uncountable and she showed reaction to calling her name. Then sugammadex 2 mg .kg⁻1, rapidly antagonized the neuromuscular block, such that the Tr recovered to 100% but tidal volume was 250 ml in 3 minutes. Additional dorsage of sugammadex, 2 mg .kg⁻1, was required for tidal volume to recover to 530 ml. After 20 minutes of first administration of sugammadex, we extubated the tracheal tube without respiratory depression. To avoid respiratory depression, we did not use postoperative opioids. Intraoperative transversus abdominis plane block and postoperative thoracic epidural block with ropivacaine were successful for postoperative pain relief.

We report a case of sudden shock during caesarean section under combined spinal epidural anesthesia. The patient was a 29-year-old woman. During the operation vital signs had been almost stable until a female-baby was born. But after the delivery of the placenta, the patient developed an episode of coughing and dyspnea followed by unconsciousness and bradycardia. She was given adrenaline and intubated, appearing ventricular fibrillation on a EKG. Cardiopulmonary resuscitation was immediately started and sinus rhythm returned. Hypotension followed and a small dose of adrenaline was infused for three days. She made good progress and was discharged without significant sequela. Cardiopulmonary collapse type of amniotic fluid embolism (AFE) is doubtful in this case. The necessity of rapid and appropriate treatment for emergency obstetric cases was discussed.

Intravenous leiomyomatosis (IVL) is a condition in which leiomyoma originating from uterine myoma or intrauterine venous walls develops intravenously. A single-stage operation was planned by the departments of gynecology and cardiovascular surgery for a patient in which the IVL was extended across the tricuspid valve. It was possible to safely perform perioperative care with continued evaluation of the tumor position and intravascular volume through the use of transesophageal echocardiography (TEE). TEE can be useful in the intraoperative care of patients with intracardiac tumor extension as in this case.

We report an 87-year-old woman who presented with unexpected systolic anterior motion (SAM) of the mitral valve after the induction of general anesthesia. She was receiving medication for hypertension and cerebral infarction. There were no abnormal findings on her preoperative transthoracic echocardiography (TTE) examination. After the induction of general anesthesia, she presented with refractory hypotension. We performed TTE and diagnosed SAM of the mitral valve. Her hemodynamic state was improved by fluid infusion and administering intravenous phenylephrine. After the surgery, we performed a morphologic assessment of the patient's heart using TTE. We found a thick basal interventricular septum and a small distance from the mitral coaptation point. to the septum. This case shows that SAM of the mitral valve can occur in a patient without preoperative cardiac abnormalities. SAM of the mitral valve should be considered in the differential diagnosis of refractory hypotension, particularly in elderly patients. Perioperative TTE is a useful tool for the rapid diagnosis and treatment of hemodynamic instability.

A 32-year-old pregnant woman with verapamil sensitive ventricular tachycardia underwent elective caesarean section. She received catheter ablation for frequent tachycardia, but ventricular tachycardia appeared. In the operating room, a defibrillator pad was placed on her chest for external defibrillation, with A-line in a left radial artery. General anesthesia was started with rapid sequence induction. The anesthetic course was uneventful, and the infant showed no complication during the perioperative period. General anesthesia can be considered as safe anesthetic management for caesarean section in a patient with verapamil sensitive ventricular tachycardia.

Alpha-1 antitrypsin deficiency (AATD) is an inherited disorder affecting the lung, liver, and rarely skin. The most frequent features of AATD consist of chronic lung disorders related to protease-antiprotease imbalance in the respiratory system, to which lung transplantation is frequently indicated. We describe a case of aortic dissection in a 55-year-old male who underwent left single lung transplantation for respiratory failure due to AATD-related emphysema. Extracorporeal membrane oxygenation (ECMO) was indicated during the procedure, and an arterial cannula was placed into the descending aorta and a venous cannula was placed into the right femoral vein. Bronchial and vascular anastomoses were finished without any problems and ECMO was weaned off However, transesophageal echocardiography carried out at the end of the operation showed a dissected descending aorta. Alpha-1 antitrypsin (AAT) is the major serum inhibitor of seine proteinases, which enzymatically destroys collagen and elastin. Degeneration of connective tissues, in particular elastic tissues, is established in AATD, and decreased stiffness of the aorta due to degradation of elastic fibers has also been reported in AATD. In this patient, reduced AAT activity might have boosted the enzymatic destruction of his arterial walls, leading to enhanced vulnerability to aortic dissections.

Point-of-care ultrasonography has become widely used in diagnosis and managements of patients. In the field of anesthesiology, ultrasound guided nerve blocks and central venous catheterization (CVC), and transesophageal echocardiography (TEE) have become popular. Now, ultrasound devices are familiar to anesthesiologists. In pre-anesthetic patient risk evaluation, the sonographic results of transthoracic echocardiography (TTE) or the examination of deep venous thrombus are often helpful for anesthesia planning. Both examinations usually have been performed by sonographer. However, the ultrasonographic assessment of neck vessels, lung condition with diaphragm function are still less familiar among anesthesiologists. Here, we have introduced a series of pre-anesthetic whole body ultrasound evaluation of the patients. Because of less invasive technique, whole body ultrasound evaluation is suitable to use when anesthesiologists may have questions whether the patient's condition is good or not. No doubt that point-of-care ultrasonography by anesthesiologists themselves in pre-anesthesia. clinic can be the useful decision making tool of anesthesia plan. To be tomorrow's anesthesiologists, please start point-of-care pre-anesthetic ultrasonographic assessment.

In the past ultrasound identification of the airway structure was rather difficult However, recent advancement of the high frequency linear type transducer allows us to visualize airway structure easily. Accordingly, now we have difficult airway society guideline 2015. resuscitation guideline 2015, and Australia and New Zealand Intensive Care Society guidelines for percutaneous dilatational tracheostomy which recommend use of ultrasound in airway management Airway ultrasound is an emerging technique for all physicians, and the author introduces perioperative evaluation of the airway via sonography, the PEAS protocol.

Ultrasonography is useful not only for screening, but also for evaluating pathological conditions and followup because it can be performed repeatedly and noninvasively at bedside. This paper discusses the importance of the functional assessment of vascular access, as well as the examination method and points for diagnosis of venous thrombosis.

Point-of-care ultrasound (POCUS) in the diagnoses of postoperative complications is discussed. POCUS is useful in many situations such as abdominal distension, elevated liver enzymes, abdominal pain, and fever, which are the common complications encountered after surgical operations. In the patients with abdominal distention, bowel distention or ascites can be easily detected by POCUS. Occasionally, congestive liver and milk of calcium bile caused by the administration of antibiotics cause elevated liver enzymes, and both of these can also be detected by POCUS. Although there are many complications which cause abdominal pain, POCUS is useful not only for the diagnosis of intraabdominal disorders but also the .diseases of other organs including the bone and muscle. Even the presence of NOMI (non-occlusive mesenteric ischemia) can be diagnosed by contrast ultrasound using Sonazoid®. In patients with fever, US is useful not only for the diagnosis of abdominal abscess but also for the drainage. By evaluating the colon with POCUS, we can detect the pseudomembranous colitis which often is overlooked. In conclusion, POCUS is an essential tool for the proper management of postoperative patients.

The evaluation of the lung has usually been considered off-limits for ultrasound, because ultrasound energy is rapidly dissipated by air. Lung ultrasound is not useful for the evaluation of the pulmonary parenchyma and the pleural line. However ultrasound machines have become more portable, with decreased start-up time, while simultaneously providing improved image quality and ease of image acquisition. Additionally, lung ultrasound is highly accurate for the diagnosis of pneumothorax, hemothorax. pleural effusions, pulmonary edema (cardiogenic or noncardiogenic), interstitial syndrome, and pneumonia. These factors make lung ultrasound suitable for operating rooms, intensive care units, and emergency departments. Adequate interpretation of lung ultrasonographic findings, including artifacts, requires some training and experience. Since lung ultrasound abnormalities, however, are well defined and easy to recognize, learn and reproduce, operator dependence is minimal. So let's try lung ultrasound! In this article, the author will discuss the examination method for adequate lung ultrasonographic images, lung ultrasonographic findings and signs, leading to the diagnosis.