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nasal cavity. Tracheal intubation was performed without any muscle relaxants, with the use of sevoflurane (3%) and a continuous infusion of remifentanil (0.3 μg/kg/min). General anesthesia was subsequently maintained with desflurane (4–5%), oxygen (1 L/min), and air (2 L/min) in addition to remifentanil (0.15–0.2 μg/kg/min). Local anesthesia was administered via buccal infiltration of the left posterior maxillary and mandibular regions using 3.6 mL of 2% lidocaine (72 mg) with 1:80,000 epinephrine (0.045 mg). The surgical procedure was completed uneventfully and the

heart rate was 120 bpm. In addition to standard electrocardiogram, pulse oximetry, noninvasive blood pressure, and end-tidal CO 2 , bispectral index (BIS) and train-of-4 (TOF) monitoring were performed. General anesthesia was induced with thiamylal (150 mg), fentanyl (0.1 mg), and desflurane (1.2 minimum alveolar concentration [MAC]) in air and oxygen. After these drugs were administered, his blood pressure decreased to 108/66 mm Hg and his heart rate to 103 bpm. Rocuronium (20 mg) was administered to facilitate nasal tracheal intubation. Anesthesia was

being partly or entirely halogenated, making them more stable and less toxic. 8 Fluroxene was introduced in 1951, the same year halothane was first synthesized. Halothane, an ethane, was then introduced for clinical use in 1956, followed by methoxyflurane, the first of the methyl-ethyl ethers, in 1960. Enflurane was introduced in 1972 and isoflurane in 1980, and both of these agents limited the nephrotoxicity and hepatotoxicity of methoxyflurane. Desflurane and sevoflurane were synthesized in the 1960s and 1970s but did not become commercially available for clinical

/kg/min remifentanil and 40 mg rocuronium, followed by nasal intubation. Anesthesia was maintained with 6% desflurane and 0.1 μg/kg/min remifentanil. For the final 2 hours of the operation, 1 mg/kg/h (16.7 μg/kg/min) propofol was administered to reduce emergence excitement. In addition, we administered 75 μg fentanyl and 50 mg flurbiprofen for postoperative analgesia as well as 1.25 mg droperidol and 10 mg metoclopramide to prevent postoperative nausea and vomiting. During the operation, vital signs were generally stable, with a systolic blood pressure of 85–110 mm Hg, heart rate of

scheduling of her treatment in order to ensure rapid care should she again develop postoperative pneumonia. The respiratory medicine specialist recommended not using antibiotics prophylactically due to concerns of effectiveness and potential risks. It was also recommended to start antibiotics empirically if pneumonia symptoms were observed. Second, we decided to use desflurane rather than sevoflurane for anesthesia maintenance because of its speedier recovery and more favorable pharmacokinetic profile (lower blood:gas and tissue:blood partition coefficients). Third, we

rocuronium 36 mg, and nasal intubation with a cuffed preformed nasal endotracheal tube was successfully completed without any difficulties. Local anesthesia was administered via infiltration using 12 mL of 1% lidocaine with 1:200,000 epinephrine. General anesthesia was maintained desflurane 3.5% along with oxygen 1 L/min, air 3 L/min, and remifentanil continuous infusion 0.2 to 0.3 μg/kg/min. Patient Status Index (PSI) values obtained from SedLine monitor were kept between 32 and 45. The patient's vital signs were stable throughout the 38-minute operation. Acetaminophen

required more drugs than did others. In this elegant study, a group of redheads were studied against a dark-haired cohort for their responses to a noxious electrical stimulation while anesthetized with desflurane. An increase in the desflurane requirement was more highly statistically significant among redheads than among dark-haired women. To further confirm this finding, 9 of the 10 redheads were found to be either homozygous or compound heterozygotes for mutations on the melan-cortin-1 receptor that is known to result in red hair. In addition to confirming an old

the anesthesia machine into a gaseous state prior to its delivery to the patient. N 2 O and/or inhaled volatile agents are administered to the patient via a mask or breathing tube which is connected to a corrugated circuit to the anesthesia machine. The 3 most commonly used inhaled anesthetics—isoflurane, sevoflurane, and desflurane—undergo very little in vivo metabolism in clinical use. 2 Less than 5% of these volatile anesthetics is metabolized by the patient. 3 Because they undergo very little metabolic change inside the body, upon exhalation by the patient

Dental treatment, 185 Dentistry, 31, 139 Desflurane, 42, 91 Diagnosis of anaphylaxis, 160 ED 95 , 147 Ehlers-Danlos syndrome, 204 Electrocautery, 95 Electromagnetic interference, 95 Electrosurgery, 95 Emanuel syndrome, 201 Emergency medicine, 62 Epinephrine, 17, 71 Gag reflex, 181 General anesthesia, 31, 91, 156, 201 Health care quality improvement, 192 Hemoglobin A1c, 208 Hyperglycemia, 208 Hypermobility type, 204

ARB-related refractory hypotension. Therefore, the patient was instructed to withhold telmisartan as long as possible prior to the second operation. Accordingly, the patient abstained from taking any telmisartan for the 5 days prior to the second scheduled operation. Also, the atenolol was held for the same period as the telmisartan, and the inhalational agent for anesthetic maintenance was changed from sevoflurane to desflurane. The anesthetic course throughout the second operation proceeded without any recurrence of the ARB-induced refractory hypotension, and all