Journal of anesthesia
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Journal of anesthesia · Apr 2010
Case ReportsUnexpectedly difficult intubation caused by subglottic stenosis in Wegener's granulomatosis.
A 76-year-old woman was scheduled to undergo abdominal aortic repair for progressive abdominal aortic aneurysm. After inducing general anesthesia, the 7.5-mm internal diameter (ID) tracheal tube could not be advanced below the level of the vocal cords because of resistance, and intubation was re-attempted several times using smaller tubes. An otolaryngologist was consulted and subglottic stenosis of unknown origin was suggested. ⋯ She was diagnosed with Wegener's granulomatosis 46 days after the operation because she developed symptoms of renal dysfunction, hemoptysis, gastrointestinal bleeding, and presence of anti-neutrophil cytoplasmic autoantibodies (c-ANCA). The patient was treated with steroids but died 89 days after the operation because of pulmonary bleeding and renal dysfunction. Tracheal stenosis is a rare presenting feature of Wegener's granulomatosis that usually occurs late in the disease; however, anesthesiologists around the world need to bear in mind that the disease can present airway symptoms and can be the cause of airway obstruction.
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Journal of anesthesia · Apr 2010
GlideScope videolaryngoscope reduces the incidence of erroneous esophageal intubation by novice laryngoscopists.
The purpose of this study was to evaluate the performance of the GlideScope videolaryngoscope for tracheal intubation by novice laryngoscopists compared with that of the Macintosh laryngoscope. Under supervision by staff anesthetists, non-anesthesia residents performed tracheal intubation using either the GlideScope videolaryngoscope (n = 100) or Macintosh laryngoscope (n = 100). The time required for airway instrumentation, the number of attempts required until successful intubation, and erroneous esophageal intubation were investigated. ⋯ Fewer attempts until successful intubation were made with the GlideScope videolaryngoscope than with the Macintosh laryngoscope (p < 0.05). Erroneous esophageal intubation with the GlideScope videolaryngoscope was less frequent than with the Macintosh laryngoscope (p < 0.05). Compared to the Macintosh laryngoscope, the GlideScope videolaryngoscope reduces the incidence of erroneous esophageal intubation by less experienced laryngoscopists.
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Journal of anesthesia · Apr 2010
Randomized Controlled TrialLidocaine pretreatment reduces the frequency and severity of myoclonus induced by etomidate.
The objective of this study was to assess the effects of lidocaine on the incidence and severity of myoclonic movements induced by etomidate. Sixty patients were randomly assigned to receive either 20 mg lidocaine or saline (n = 30, each), 30 s before administration of etomidate (0.3 mg/kg). ⋯ Pretreatment with lidocaine significantly reduced both the incidence and severity of myoclonic movements. As a conclusion, lidocaine is an effective and safe drug to reduce the etomidate-induced myoclonus without significant side effects.