Journal of anesthesia
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Journal of anesthesia · Apr 2016
Optimal length of the pre-inserted tracheal tube for excellent view in nasal fiberoptic intubation.
Inexperienced physicians frequently have difficulty performing nasal fiberoptic intubation. A pre-inserted tracheal tube of the appropriate length allows an excellent view of the laryngeal opening. The purpose of this study was to determine the ideal length of a pre-inserted tracheal tube for nasal fiberoptic intubation and to investigate if it could be predicted from easily measureable patient parameters. ⋯ The optimal length of pre-inserted tracheal tube for nasal fiberoptic intubation can be predicted using a newly developed formula with three patient parameters, namely, height, the NM distance, and weight. Application of this equation in the clinical setting should facilitate nasal fiberoptic intubation.
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Journal of anesthesia · Apr 2016
Cuff depth and continuous chest auscultation method for determination of tracheal tube insertion depth in nasal intubation: observational study.
Incorrect endobronchial placement of the tracheal tube can lead to serious complications. Hence, it is necessary to determine the accuracy of tracheal tube positioning. Markers are included on tracheal tubes, in the process of their manufacture, as indicators of approximate intubation depth. In addition, continuous chest auscultation has been used for determining the proper position of the tube. We examined insertion depth using the cuff depth and continuous chest auscultation method (CC method), compared with insertion depth determined by the marker method, to assess the accuracy of these methods. ⋯ UMIN No. UMIN000011375.
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Journal of anesthesia · Apr 2016
Case ReportsMonitoring cerebral tissue oxygen saturation at frontal and parietal regions during carotid artery stenting.
Cerebral oximetry is normally placed on the upper forehead to monitor the frontal lobe cerebral tissue oxygen saturation (SctO2). We present a case in which the SctO2 was simultaneously monitored at both frontal and parietal regions during internal carotid artery (ICA) stenting. Our case involves a 79-year-old man who presented after a sudden fall and was later diagnosed with a watershed ischemic stroke in the distal fields perfused by the left middle cerebral artery. ⋯ The SctO2-MAP correlation was more consistent on the stroked hemisphere than the non-stroked hemisphere. This case showed that SctO2 can be reliably monitored at the parietal region, which is primarily perfused by the ICA. SctO2 of the stroked brain is more pressure dependent than the non-stroked brain.
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Journal of anesthesia · Apr 2016
ReviewReview of crisis resource management (CRM) principles in the setting of intraoperative malignant hyperthermia.
The practice of medicine is characterized by routine and typical cases whose management usually goes according to plan. However, the occasional case does arise which involves rare catastrophic emergencies, such as intraoperative malignant hyperthermia (MH), which require a comprehensive, coordinated, and resource-intensive treatment plan. ⋯ However, physicians can become expert in the global process of managing emergencies by using the principles of crisis resource management (CRM). In this article, we review the key concepts of CRM, using a real life example of a team who utilized CRM principles to successfully manage an intraoperative MH crisis, despite there being no one on the team who had ever previously encountered a true MH crisis.