Thoracoscopic radical esophagectomy for esophageal cancer

Thoracoscopic esophagectomy for cancer has become common in the 10 years after the introduction of the procedure, with advances in instrumentation and techniques. Thoracoscopic surgery is associated with the advantage of preserving pulmonary function and reducing pulmonary complications by reducing chest wall injury and blood loss. Although it cannot be evaluated subjectively, understanding the microanatomy under a magnified view, education through viewing on a monitor, and the ability to reproduce the whole procedure are advantages. However, to perform lymph node dissection as efficiently as in open surgery, substantial learning of the procedure is necessary. To steepen the learning curve, sharing and disclosing knowledge and information are essential, as well as direct instruction and hands-on seminars given by skilled experts.     

Postoperative neuroleptic malignant syndrome that occurred repeatedly in a patient with cerebral palsy

A wide variety of neuroleptic agents are associated with neuroleptic malignant syndrome (NMS). However, the association between general anesthesia and NMS is uncertain. We report a case of a patient with cerebral palsy, who showed signs of NMS only after repeated general anesthesia. The patient received general anesthesia three times in a period of 9 months. The first anesthetic passed uneventfully. NMS symptoms were observed only after the second and third anesthetics. The NMS was effectively treated with IV dantrolene and the patient recovered on both occasions. Inhalational anesthetics, muscle relaxants and fentanyl were suspected as possible triggering factors for NMS. After examining the three anesthesia records and previous publications, we surmized that a nondepolarizing muscle relaxant was associated with NMS in this patient.