Masui. The Japanese journal of anesthesiology
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As a variety of new airway devices has been introduced, the practice of airway management has seemingly become more complex. Among them laryngeal mask airway (LMA) is the single most important development in the past 10 years. It has become a commonly accepted device for routine and rescue airway management, and is now listed in the American Society of Anesthesiologists (ASA) Difficult Airway Management Algorithm as an airway and a conduit for tracheal intubation. ⋯ Recent information about standardization work of ISO for rigid laryngoscopes, tracheal tubes and supralaryngeal airway devices are also discussed. Each airway devices has unique properties that may be advantageous in certain situations but disadvantageous in others. Choice and combination of device based on experienced clinical judgment may be crucial to their application.
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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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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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Case Reports
[Prolonged respiratory depression after fentanyl administration in a patient with mitochondrial encephalomyopathy].
A 21-year-old man with mitochondrial encephalomyopathy underwent surgery for removal of a maxillary cyst. During the induction of anesthesia, the patient fell into the state of apnea after intravenous administration of fentanyl 100 microgram. ⋯ The respiratory depression lasted for about 120 minutes after administration of fentanyl, and was antagonized by naloxone 40 microgram. This case suggests that careful administration of fentanyl is mandatory in a patient with mitochondrial encephalomyopathy.
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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.