[Propofol anesthesia for ambulatory surgery in adults]

We reported 131 cases of ambulatory surgery in adults mainly anaesthetized with propofol infusion. Without any premedication, anesthesia was induced with propofol and fentanyl. A laryngeal mask airway was inserted using intravenous injection of vecuronium. Anesthesia was maintained with continuous infusion of propofol and intermittent fentanyl administrations, and local anesthetic infiltration was combined. All patients received air and oxygen mixture (FIO2 0.4) throughout the procedure. During surgery, metoclopramide and flurbiprofen axetil were given to prevent postoperative pain, nausea and vomiting. After surgery, patients were observed at the daycare unit in ward. Average age was 42 years and ASA risk was 1.3. Operation time and anesthesia time and hospital stay were 43.4 minutes, 70.6 minutes and 332 minutes, respectively. In 25 patients (19%) analgesics were needed for postoperative pain. Although 3 patients (2.3%) were unsuccessful as ambulatory surgery due to excessive pain, all patients including these three could be discharged within 24 hours after surgery. We conclude that combined anesthesia with propofol, fentanyl and local anesthetic is suitable for ambulatory surgery in adults.

[A case of difficult intubation with tracheobronchial anomaly]

We experienced a case of difficult intubation with tracheobronchial anomaly. A 66-year-old male was scheduled for subtotal esophagectomy. We used a univent bronchial blocker tube (UBT) to separate the lungs because of difficulty with tracheal intubation using a 37 F double lumen tube (DLT). Intraoperatively, we could not separate the lungs due to tracheobronchial anomaly in the right lung, and attempted to change the tube. We could insert a 35 F DLT to the trachea and separate the lungs. In the case of difficult or impossible conventional direct-vision intubation, the use of DLT is a relative contraindication. However, in this case, the separation of the lungs with UBT was difficult because of tracheobronchial anomaly.