Masui. The Japanese journal of anesthesiology
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Anesthesiologists should be familiar with the management of airway and be able to recognize and identify potential difficult airway. These entities include congenital craniofacial deformities with micrognathia (e.g. Robin sequence, Treacher Collins, Goldenhar's, Crouzon's syndromes) and metabolic diseases causing the deposit of accumulated by-products (e.g., Hurler's, Morquio's, Beckwith-Wiedemann syndromes). ⋯ Intubation with a fiberscope can be utilized through LMA or through a specially designed face mask. Face mask designed for fiberoptic intubation has a 15 mm port for connection with the breathing circuit and another 22 mm port covered with a rubber membrane through which the fiberscope is introduced and directed to the larynx and trachea followed by the tracheal tube while ventilating and anesthetizing the pediatric patients with inhalational anesthetics. Getting used to these two modalities, LMA and fiberoptic intubation of the trachea, gives a great advantage in handling of difficult pediatric airway and intubation.
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Review
[Quality assurance in airway management: education and training for difficult airway management].
Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. ⋯ The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently.
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A 69-year-old man with chronic renal failure was scheduled for artero-venous shunt surgery for sustained hemodialysis. On the pre-anesthesia interview, the patient complained of no respiratory symptom. Chest x-ray showed some tracheal deviation. ⋯ The cause was unknown but not from inflammation or tumor. The patient complained no respiratory distress after the surgery. In such unpredictable tracheal stenosis with easy mask ventilation, LMA is a considerable option for respiratory management.
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Propofol and droperidol decrease the incidence of postoperative nausea and vomiting (PONV). We investigated the incidence of PONV after total intravenous anesthesia (TIVA) with propofol alone versus combined use of droperidol and propofol. ⋯ Droperidol was useful in reducing the incidence of early nausea and vomiting after total intravenous anesthesia with propofol and fentanyl in the patients undergoing laparoscopic surgery.
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A 57-year-old man with carcinoma of the esophagus was scheduled for a subtotal esophagectomy. We used a bronchial blocker tube to perform one-lung ventilation (OLV). ⋯ When we cannot perform a complete OLV with a bronchial blocker tube, we should consider the possibility of a tracheobronchial anomaly. When one is found in the right superior lobe bronchus, we should use a standard double lumen tube to perform the OLV.