Inadvertent insertion of a nasogastric tube (NGT) into the trachea and distal airway can sometimes occur in intubated patients during general anesthesia, and there are usually several signs leading to the suspicion of misplacement. I report a case of intrabronchial misplacement of an NGT without definite signs of malposition. The patient was 41-year-old man who underwent laparoscopic cholecystectomy under general anesthesia. After anesthetic induction, an NGT was inserted from the left naris and advanced without resistance. A gurgling sound could be heard over the left epigastrium by injecting air, and serous liquid was suctioned from the NGT. There were no definite signs of NGT malposition initially. However, intrabronchial misplacement was suspected because of synchronized movement of a disposable glove attached to the proximal end of NGT with mechanical ventilation at the end of the operation, and confirmed by chest radiography postoperatively. In conclusion, inadvertent intrabronchial misplacement of an NGT in an intubated patient can occur without definite signs during general anesthesia, in which a neuromuscular blocking agent is administered. In such situations, the potential of intrabronchial misplacement should be constantly borne in mind. And the proper positioning of NGT should be rechecked carefully at the slightest hint of trouble by changing the position of NGT or by confirming with direct laryngoscopic exposure.
胸椎後縦靭帯骨化症（ossification of the posterior longitudinal ligament：OPLL）に対する後方除圧術中に運動誘発電位の波形が消失，下肢体性感覚誘発電位の振幅が低下したため手術を中止し，術直後に両下肢麻痺が生じた症例を経験した。麻痺が改善した術後14日目に施行した後方除圧固定術では，術後に下肢麻痺の増悪を認めなかったことから，後方固定は胸椎の制動や，除圧による後弯の悪化を予防することにおいて重要と考えられた。また，術中の運動誘発電位と下肢体性感覚誘発電位を併用するmultimodality monitoringの使用は，非可逆的な脊髄障害の予測や，手術継続や中止の判断など手術戦略を考慮する上で有用であった。