There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.

Which tube is the best one for the one lung ventilation? It is open to discussion of tube choice for the patient with tracheostomy after total laryngectomy. In this situation, we can use the bronchial blocker. We report the case of using a Univent Ⓡ tube in a patient with tracheostomy after total laryngectomy for one lung ventilation. Successfully, the patient received esophagectomy, esophageal reconstruction and pyloroplasty due to esophageal cancer without any complications.

Background: Remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short lasting pharmacokinetics. It is likely to make it a very useful opioid for clinical practice. The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to compare sedative and cardiovascular effects of remifentanil and fentanyl during target controlled infusion (TCI) of propofol by monitoring BIS and hemodynamics. Methods:Fifty-two patients undergoing total abdominal hysterectomy were randomly assigned to remifentanil group and fentanyl group with 26 cases in each group. Anesthesia was induced with propofol (4μg/ml) and either remifentanil (0.5μg/kg) or fentanyl (1.5μg/kg) and was maintained with inhalation of 50% nitrous oxide and 50% oxygen mixture and a continuous infusion of either remifentanil (0.2μg/kg/min) or fentanyl (0.03μg/kg/min). Depth of anesthesia, hemodynamic changes and adverse reactions were observed.Results: The number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly lesser than that in the fentanyl group (P ＜ 0.05). During intubation, skin incision, maintenance of anesthesia and extubation, remifentanil group shows lesser fluctuation of hemodynamic value than those in the fentanyl group (P ＜ 0.05). BIS was significantly decreased both groups during infusion of propofol, but no difference was found between the two groups. There was no significant difference between the two groups in the aspect of adverse reactions.Conclusions: Remifentanil with propofol TCI based anesthetic can prevent the fluctuation of heart rate and mean arterial pressure during the operation especially, during intubation.