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BIS has not been evaluated for sedation in ICU. We examined BIS for evaluation of sedation with propofol in ICU.Eighteen male patients undergoing head and neck surgery (ASA-PS 1 x 2 and age75 years) were randomly allocated to one of two groups receiving postoperative sedation with propofol in ICU. One group was monitored for sedation by BIS, and the other group by Ramsay score.There were no significant differences between the two groups in the total-dose of propofol, and recovery time.The use of BIS for sedation could not improve the management of postoperative sedation in ICU.

We experienced a case of fulminant malignant hyperthermia during laparoscopic surgery, which is the first reported case of this kind. A 69-year-old man, weighing 69 kg, underwent laparoscopic colectomy for cecal colon cancer. He had a remarkable familial history of malignant hyperthermia (MH). His uncle had MH from enflurane. In addition, 6 male relatives died at operation, exercise or drinking. However, he hid it intentionally because of social concern about inheriting abnormal genes and of inadequate explanation from medical personnel. Anesthesia was induced with fentanyl 100 microg, propofol 60 mg and vecuronium 9 mg intravenousely and maintained with nitrous oxide, oxygen and sevoflurane. About 120 min after the induction of anesthesia (50 min after pneumoperitoneum), PETCO2 increased to 54 mmHg. Thirty min later, body temperature (BT), heart rate (HR), PETCO2 and airway pressure (Paw) increased rapidly to 37.5 degrees C, 92 beats x min(-1), 62 mmHg and 3/33 cmH2O, respectively. The diagnosis of MH was made. The inspiratory gas was changed to 100% O2, and a bolus of 100 mg dantrolene was given. He had BT of 39.7 degrees C, HR of 152 beats x min(-1), PETCO2 of 123 mmHg, Paw of 3/40 cmH2O at the worst point. Rise in Paw and arrhythmia turned up frequently as complications of laparoscopic surgery, but they are very similar to the first symptoms of malignant hyperthermia. The decrease in BT with CO2 pneumoperitoneum can mask symptoms of MH. Awareness of this fact is important not to delay the diagnosis.

We had two adult cases of flaccid epiglottis. Flaccid epiglottis in adults is quite rare, and it is sometimes misdiagnosed and mistreated. Particularly, it is likely to be treated as an asthma attack, and is often confused with a paradoxical vocal cord movement. Patients are frequently seen with dyspnea owing to upper airway obstruction, with misdiagnosis, and tend to be overtreated with emergency intubation or tracheostomy after failed attempts at ventilation. We had two such difficult cases. The first case is seen with sudden dyspnea after extubation in the I.C.U, and the second had a trouble for ventilation with a difficulty in discriminating asthma and other disease. However, it is quite safe to ventilate sufficiently with appropriate diagnosis.

We report a patient with subglottic stenosis who required insertion of the Montgomery T-tube. During the operation, we could keep stable anaesthesia and adequate ventilation under general anaesthesia using continuous intravenous infusion of propofol with laryngeal mask airway (LMA).

Ampulla (Takotsubo) cardiomyopathy resembles acute myocardial infarction, with absent coronary stenosis. We report a case of catecholamine resistant ampulla cardiomyopathy, successfully managed using intra-aortic balloon pumping (IABP). After laparotomy, the patient developed circulatory collapse. T wave inversion was observed on electrocardiogram. In spite of circulatory support using high dose cathecholamines, the hemodynamics of the patient showed no improvement. Upon starting IABP, the patient's hemodynamics were improved and the dose of catecholamines could be reduced. Because the ampulla cardiomyopathy is considered a subtype of 'stunned myocardium' and the hemodynamic disorder is temporary and reversible, IABP appears effective for hemodynamic management.

A 74-year-old male was operated for sigmoid colon cancer. Because of an agglutination of the patient's platelet, it was difficult to measure his platelet count under ethylene diamine tetra acetate (EDTA), heparin or citrate as anticoagulants with an automated cell counter. Even though there was a strong possibility of pseudothrombocytopenia, anesthetic management for the patient was safely conducted. His condition was stable throughout the perioperative course and no bleeding tendency was observed. Nitrous oxide, oxygen, sevoflurane, propofol and pancuronium were useful in this case.