Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case Reports Comparative StudyPentax-AWS airway Scope as an alternative for awake flexible fiberoptic intubation of a morbidly obese patient in the semi-sitting position.
For anesthesia induction in a morbidly obese patient with a full stomach, awake flexible fiberoptic bronchoscope (FOB) intubation in the semi-sitting position may be a suitable choice. A new rigid indirect videolaryngoscope, the Pentax-AWS system, has a unique feature of an adjustable built-in monitor and is designed to be used in patients in various positions. However, the efficacy of its use in such situations has not been investigated or reported. ⋯ The patient's trachea was intubated with the Pentax-AWS by an anesthesiologist positioned at the patient's right and facing her. The Pentax-AWS offered easy intubation under good visualization of the glottic aperture as a consequence of its adjustable integrated monitor, in contrast to difficult intubation with other videolaryngoscopes which require an external monitor. This report illustrates that the Pentax-AWS is useful as an alternative for flexible fiberoptic intubation under these circumstances, as a consequence of its adjustable built-in monitor and integrated tube channel.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialPostoperative analgesia with minidose intrathecal morphine for bipolar hip prosthesis in extremely elderly patients.
It is known that an optimal dose of intrathecal morphine for analgesia after total hip arthroplasty in older patients is 0.1 mg. On the other hand, minidose intrathecal morphine (0.05 mg) is useful for analgesia after the transurethral resection of the prostate in elderly patients. We evaluated the postoperative analgesic effect of minidose intrathecal morphine after bipolar hip prosthesis in seniors (age 85 years or more) undergoing spinal anesthesia. ⋯ The results show that minidose intrathecal morphine provides a good analgesic effect without side effects, and it would be an effective and safe procedure for bipolar hip prosthesis in seniors.
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Journal of anesthesia · Jan 2009
ReviewEthical issues in anesthesia: the need for a more practical and contextual approach in teaching.
Teaching ethics to medical students is one of the current topics of major interest. Issues of ethics pertaining to anesthesia are unique. This article reviews these issues with respect to the preoperative, intraoperative, and postoperative periods. ⋯ In addition to separate modules in didactic and clinical formats, incorporating the ethical aspects into every clinical problem has many advantages. This approach will stimulate students to ponder over the ethical dimension of every clinical scenario, and the reinforcement of this approach during teaching in the clinical setting may help in inculcating these qualities in the students. Additionally, this approach contextualizes these issues to the local and regional perspective, instead of lecturing on the ethical codes developed elsewhere.
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For direct laryngoscopy, we compared midline and left-molar approaches with respect to ease of intubation, using a Macintosh blade. We investigated the relationship between failure of the left-molar approach and preoperative risk factors for difficult intubation. ⋯ Difficulty in the insertion of the endotracheal tube limits the efficacy of the left-molar approach. It is not possible to predict the failure of intubation with the left-molar approach by considering the preoperative risk factors.
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Journal of anesthesia · Jan 2009
Case ReportsSuccessful treatment with hydrocortisone for heat stroke with critical illness-related corticosteroid insufficiency: transitional changes in serum cytokine and cortisol concentrations.
A 37-year-old man was transferred to our emergency center because of heat stroke with circulatory shock. Despite aggressive body cooling, massive intravenous transfusion, and supply of inotropic agents, shock was persistent. To evaluate adrenal function, an adrenocorticotropic hormone stimulation test was conducted and the results indicated that he had critical illness-related corticosteroid insufficiency (CIRCI) as a result of adrenal insufficiency. ⋯ He was discharged on the thirty-seventh hospital day. Serum cortisol and cytokine concentrations were initially high and the cytokines decreased subsequent to hydrocortisone administration. It is speculated that CIRCI is an exacerbating factor in heat stroke, and hydrocortisone may be a potential therapeutic approach in such patients.