Journal of anesthesia
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Journal of anesthesia · Jan 2008
Case ReportsIndependent lung ventilation combined with HFOV for a patient suffering from tracheo-gastric roll fistula.
This case report describes the difficult respiratory management of an esophageal cancer patient with acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) caused by a postoperative tracheogastric roll fistula. A single-lumen tracheal tube could not seal the fistula, and therefore a double-lumen tracheal tube (DLT) for the left side was used. Although the proximal cuff of the DLT failed to seal the fistula, independent lung ventilation (ILV) improved blood gas levels. ⋯ This combination allowed the maintenance of adequate oxygenation, and the HFOV to the right lung decreased the PaCO2 level during surgery without interruption of the surgical field. These techniques provided the opportunity to successfully remove a necrotic gastric roll and achieve closure of the fistula using an intercostal muscle flap. This report documents and discusses the difficulty of performing appropriate anesthetic management of a patient with these complex complications after esophageal surgery.
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The Airway Scope (Pentax, Tokyo, Japan) is a new device used for tracheal intubation. It allows visualization of the glottis through a non-line-of sight view. The aim of the present study was to evaluate the suitability of this device for the tracheal intubation of surgical patients. ⋯ No dental damage was encountered, though minor mucosal injury caused by the blade was experienced in 2 patients. The Airway Scope consistently permitted a better intubation environment. With its potential advantages, the Airway Scope could be an effective aid to airway management in surgical patients.
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Journal of anesthesia · Jan 2008
Preoperative plasma brain natriuretic peptide level is an independent predictor of postoperative atrial fibrillation following off-pump coronary artery bypass surgery.
Atrial fibrillation (AF) is a frequent complication after coronary artery bypass surgery. Postoperative AF can lead to thromboembolic events, prolonged hospital stay, and increased costs. Recent reports have shown that an elevated plasma brain natriuretic peptide (BNP) level is associated with AF. The purpose of this prospective study was to test the hypothesis that preoperative BNP level is a predictor of postoperative AF following off-pump coronary artery bypass surgery (OPCAB). ⋯ Preoperative BNP level is an independent predictor of postoperative AF following OPCAB. Our findings permit us to stratify the risk of AF and to plan prophylactic strategies in high-risk patients.
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Journal of anesthesia · Jan 2008
Comparative StudyIn-line head and neck position is preferable for tracheal intubation with the Airtraq laryngoscope compared to the sniffing position.
We aimed to determine which position, the in-line head and neck position or the sniffing position, was preferable for tracheal intubation with the Airtraq laryngoscope. In all, 20 anesthetists performed tracheal intubations on a manikin with either an in-line head and neck position or the sniffing position. ⋯ The score for preference of position, on a visual analogue scale, was better for the in-line head and neck position than for the sniffing position (P < 0.01). We concluded that the in-line head and neck position was preferable for tracheal intubation with the Airtraq laryngoscope compared to the sniffing position.