The present study showed that priming with rocuronium or vecuronium reduced the incidence of difficult ventilation by avoiding the muscle rigidity caused by remifentanil.

A 78-yr-old man was admitted to our hospital because of repeated episodes of pneumonia. Both fiberoptic bronchoscopy and esophagoscopy revealed a large tracheoesophageal fistula and protrusion of the metal stent from the esophagus into the trachea. Placement of a Dumon stent was planned for sealing this fistula under general anesthesia. Anesthetic management is difficult because of the care needed to prevent aspiration of esophageal contents and diversion of oxygen through the fistula into the stomach from the trachea when patients are under mechanical ventilation. Our method of sealing a large tracheoesophageal fistula with a Sengstaken-Blakemore tube was performed successfully.

pulmonary thromboembolism, (2) cardiac arrest, (3) neurological recovery discharged on foot on the 67th hospital day.