Masui. The Japanese journal of anesthesiology
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Case Reports Comparative Study
[Unanticipated endotracheal tube displacement in a short-neck patient with a history of chronic rheumatoid arthritis: a comparison of three kinds of endotracheal tubes].
Endotracheal tubes are known to have a risk of being displaced at neck extension or flexion or rotation. However, the displacement seldom causes clinical problems. An 74-year-old patient suffering from chronic rheumatoid arthritis underwent debridement in the infected knee under general anesthesia. ⋯ Therefore, we compared the hardness of the three popular endotracheal tubes. We found the hardness of HLE was higher than the others. This might be one of the reasons for dangerous displacement of the endotracheal tube in our case.
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The incidence of postoperative paralysis after thoracic and thoracoabdominal aortic operations has decreased, but is still high in comparison with other operations. The analysis of the mechanism involved in the ischemic tolerance of the spinal cord could contribute to the protection of the spinal cord from ischemia. The identification of the Adamkiewicz artery and the predictive factors for postoperative paralysis in the preoperative period, the use of motor evoked potential, several adjuncts to keep the spinal cord circulation, the stabilization of the hemodynamics with good oxygenation, and hypothermia contribute to the prevention of the spinal cord ischemia. ⋯ Among the anesthetic drugs, narcotics might exacerbate the motor function after the spinal cord ischemia. The analgesic drugs which do not aggravate the spinal cord dysfunction would be expected. Good cooperation of surgeons and anesthesiologists greatly contributes to the finding of the spinal cord ischemia during this operation.
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The prediction of the hypnotic states is useful to maintain the adequate anesthesia. During propofol anesthesia, the respiratory depression has been documented in a dose-dependent manner. Therefore, we investigated whether the respiratory depression under the spontaneous breathing reflected the estimated effect site propofol concentrations (Cp) in a dose-dependent fashion. ⋯ We concluded that the respiratory parameters during spontaneous breathing were useful indices to predict the changes in the effect site propofol concentrations and to maintain the adequate anesthetic levels.
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Case Reports
[Airway obstruction during one-lung ventilation using a bronchial blocker and a tracheostomy tube].
We describe our experience with a 60-year-old man who had severe airway obstruction during one-lung ventilation with the tracheostomy tube using a bronchial blocker. The blocker, deriving from Univent tube, was passed through the tracheostomy tube and placed in the right main bronchus. We checked that the blocker was in appropriate place with a bronchofiberscope and obtained good one-lung ventilation with the patient in the left lateral position. However, just after the start of operation, when the skin was incised, sever hypoxia and resultant bradycardia and hypotension occurred, probably because of not only malposition of blocker but also atelectasis in the upper lobe of the dependent lung by secretion.
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A 27-year-old patient with asymptomatic idiopathic prolonged QT interval syndrome underwent elective caesarean section. We selected combined spinal-epidural anesthesia to avoid excessive sympathetic stimulation. ⋯ The anesthetic course was uneventful, and the infant showed no complication during the perioperative period. In conclusion, we consider combined spinal-epidural anesthesia as a safe anesthetic strategy for caesarean section in a patient with asymptomatic idiopathic prolonged QT interval syndrome.