Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsBronchoscope-guided intubation through a Laryngeal Mask Airway Supreme in a patient with a difficult-to-manage airway.
We report a case of an obese patient who presented with laryngeal edema and difficult ventilation after failed attempts to intubate. A Laryngeal Mask Airway Supreme (LMA Supreme) reestablished the ventilation and allowed bronchoscope- guided intubation of the trachea. The case suggests that the LMA Supreme may be useful in patients with a difficult airway.
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Journal of anesthesia · Jan 2009
Case ReportsHyperkalemia during surgery: is it an early warning of propofol infusion syndrome?
We present a case of severe hyperkalemia in a 48-year-old man after short-term infusion of an average dose of propofol. We suspected that the hyperkalemia in this patient was a sign of propofol infusion syndrome. ⋯ There were no other evident causes of hyperkalemia as documented by laboratory data. The procedure was abandoned and the patient was taken to postoperative recovery, where his potassium levels returned to normal at the end of 10 h.
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Journal of anesthesia · Jan 2009
Case ReportsDexmedetomidine facilitates induction of noninvasive positive pressure ventilation for acute respiratory failure in patients with severe asthma.
Noninvasive positive pressure ventilation (NPPV) has been reported to be effective for acute respiratory failure in patients with severe asthma. Although NPPV requires less sedative than invasive mechanical ventilation, agitated patients with severe asthma should be given the minimum sedation necessary to facilitate the induction of NPPV. Two asthmatic patients (a 65-year-old man and a 32-year-old woman) separately presented to the intensive care unit with exacerbating respiratory failure. ⋯ While the Ramsay sedation scale was maintained at 2 or 3 during the continuous dexmedetomidine infusion, we successfully weaned the patients from NPPV by reducing the inspiratory PAP. Dexmedetomidine helped the agitated patients cooperate with mask ventilation without inducing respiratory depression. We conclude that dexmedetomidine may be a valuable sedative to facilitate the induction of NPPV.
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Journal of anesthesia · Jan 2009
Desflurane requirements for laryngeal mask airway insertion during inhalation induction.
We hypothesized that the simultaneous use of low concentrations (<6%) of desflurane, nitrous oxide (N(2)O), and fentanyl would allow a laryngeal mask airway (LMA) to be inserted safely with inhalation induction of desflurane, even in nonparalyzed patients. This prospective, observational study was performed to determine the 50% effective concentration (EC(50)) of desflurane for LMA insertion in such patients. ⋯ We demonstrated that N(2)O-desflurane inhalation induction with a normal tidal breathing technique after premedication with fentanyl can be used safely without any adverse airway events in nonparalyzed patients. In such patients, the EC(50) of desflurane for successful LMA insertion was 3.61 +/- 0.31% (95% CI, 3.13-3.90).
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialEffects of landiolol, a short-acting beta-1 blocker, on hemodynamic variables during emergence from anesthesia and tracheal extubation in elderly patients with and without hypertension.
Tracheal extubation and emergence procedures induce abrupt changes in hemodynamics and humoral responses. We conducted a prospective randomized study to examine the effects of the short-acting beta-1 blocker, landiolol, on hemodynamics during emergence from anesthesia in elderly patients with and without hypertension. ⋯ This study indicates that the use of a landiolol infusion for preventing hemodynamic instability in elderly patients during the emergence period would be dependent on the presence or absence of hypertension in these patients.