This report concerns a 16-year-old boy with Morquio syndrome who underwent adenoidectomy and bilateral tympanostomy tube placement for obstruction of upper airway and serous otitis media. The induction of anesthesia and tracheal intubation had no problem. Pulmonary oximetry value showed at 95 to 96% during anesthesia. The operation was prolonged and the estimated blood loss was 450gram. SpO₂ showed a marked decrease after extubation of the trachea. He was reintubated and mechanically ventilated with continuous sedation in ICU. On the first postoperative day, the extubation failed again. The upper airway showed an edema and a redness, and the intra-tracheal mucosa showed the same findings under fiberoptic bronchoscope and laryngoscope. The chest X-ray showed the findings of pneumonia. He was extubated without dyspnea on the 6th postoperative day. The pneumonia continued.
Perioperative evaluation of the airway and management of respiration would be important in oral surgery in a patient with Morquio syndrome.

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We experienced the anesthetic management of a 55-year-old woman with pulmonary thromboembolism (PTE) undergoing hysterectomy for adenomyosis uteri. She received preoperative anticoagulant therapy with low-molecular-weight heparin and temporary and prophylactic placement of inferior vena cava filter in an attempt to prevent PTE. During surgery, rapid induction of percutaneous cardiopulmonary support (PCPS) was prepared by femoral circulation. Surgery was performed successfully with no recurrence of PTE during the perioperative period. We conclude that preoperative anticoagulant therapy and insertion of IVC filter are useful maneuvers to prevent massive PTE. In cases of complicated PTE, intraoperative preparation of PCPS is also recommended to support pulmonary insufficiency.

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We implemented the field test of the newly developed equipment Rachel^TM-N₂O whose function is to break N₂O down into N₂ and O₂. General anesthesia was applied with the use of sevoflurane while keeping N₂O flow at 4l · min^-1 and O₂ at 2l · min^-1 within the circuit. The excess anesthetic gases were introduced into the treatment parts where the temperature of the catalyst is set at 400°C. N₂O was decomposed to the lower limit of detection of 5 ppm and no nitrogen oxide compound in the form of by-product was observed at the exit of the catalyst bed. The present study indicates that Rachel^TM-N₂O can successfully reduce 73% of ‘greenhouse gas’ from an anesthesia machine assuming that all energy is converted into CO₂.

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A critical incident is reported where the inhaled anesthetic concentration suddenly dropped due to disconnection of the built-in vaporizer from the anesthesia machine. Anesthesia was continued by using a different anesthesia machine and completed uneventfully. We were not able to detect the loosening of the vaporizer handle using pre-use checkout procedures. Vaporizer disconnection can be difficult to detect, especially when the loosening of the vaporizer handle is the cause of the disconnection. The Japanese Society of Anesthesiologists recommends that we should check the vaporizer connection by observing. It is difficult, however, to check up by watching from the front with this type of anesthesia machine. Therefore, in addition to checking the anesthesia machine preoperatively using the recommended checkout procedures, we should pay attention to the loosening of the vaporizer handle.

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