Journal of anesthesia
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Journal of anesthesia · Jan 2008
Case ReportsCalcineurin-inhibitor-induced pain syndrome after bone marrow transplantation.
Calcineurin-inhibitor-induced pain syndrome (CIPS), a rare complication seen in patients with organ transplants, is associated with the use of calcineurin inhibitors (CIs) such as cyclosporine (CSP) and tacrolimus (FK). Patients with this syndrome usually present with severe leg pain. This case report demonstrates the successful pain control of this pain syndrome in a 42-year-old female patient who had been given CIs (FK and CSP) as an immunosuppressive agent after a bone marrow transplant. ⋯ Due to the presence of allodynia, our patient's pain had neuropathic pain-like characteristics, unlike the pain in previously reported patients with other organ transplants. Her pain was successfully relieved by the administration of oral amytriptyline, clonazepam, oxycodone, and intravenous lidocaine, all of which ordinarily have an analgesic effect on neuropathic pain. CIPS in patients with hematopoietic stem cell transplants treated with FK may have a mechanism by which neuropathic pain may develop that is different from that in patients with other organ transplants.
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Journal of anesthesia · Jan 2008
Case ReportsOrotracheal intubation with an AirWay Scope in a patient with Treacher Collins syndrome.
Treacher Collins syndrome (TCS) is a congenital malformation of craniofacial development; in these patients conventional direct laryngoscopy is very difficult and often unsuccessful because of the upper airway malformation. A 20-year-old man with TCS was scheduled for elective tympanoplasty. The patient showed the characteristic facial appearance of TCS, and a difficult airway was anticipated. ⋯ Next, the AirWay Scope was easily inserted, and his glottic opening was clearly visualized. An 8.0-mm-internal-diameter tracheal tube was then advanced into the trachea without any difficulty. The AirWay Scope is a very useful airway device for orotracheal intubation; it provides an excellent view of the glottis without requiring alignment of the oral, pharyngeal, and laryngeal axes, and appears to be promising for use in patients with a difficult airway.
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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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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.
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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.