Masui. The Japanese journal of anesthesiology
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Anesthesia for patients who undergo surgery for femoral neck fractures can be associated with severe cardiopulmonary complications. ⋯ The surgical techniques selected for hip hemiarthroplasty, which is associate with an increase in intramedullary pressure, may be a significant risk factor for cardiorespiratory deterioration from anesthesia in patients undergoing surgery for femoral neck fracture.
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We describe the clinical use of a new video-laryngoscope (GlideScope, GS) in patients with a difficult airway and morbid obesity. In 4 patients with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottic opening (Cormack-Lehane grade I or II) was visualized with GS. ⋯ GS also provided a good view of glottic opening in a patient with morbid obesity. GS will have a profound impact on the management of the difficult airway.
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We experienced a case of the abortive malignant hyperthermia (MH) that had developed during operation. The patient was a 14-year-old girl, and plastic surgery was scheduled under general anesthesia. Serum creatine kinase (CK) levels were high with 505 IU x l(-1) at the preoperative examination. ⋯ As sevoflurane, promotes the CICR (calcium-induced calcium release) mechanism, the trigger of this case is probably sevoflurane. As for the symptom that makes us doubt MH first, there is a maked rapid rises of Et(CO2). Therefore, it is important monitor and recognize the first symptom of MH.
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Pentax AWS Airway Scope (Pentax, Japan) is a new videolaryngoscope. We successfully used the device in 15 patients and in other two patients with difficult airways. In a 51-year-old woman, after induction of anesthesia and neuromuscular blockade, laryngoscopy using a Macintosh blade showed only the tip of the epiglottis and tracheal intubation failed. ⋯ At laryngoscopy using a Macintosh blade, the epiglottis was long and tubular, and tracheal intubation failed. With the Airway Scope, the trachea was intubated easily. We believe that the Pentax AWS videolaryngoscope is useful in patients with and without difficult airways.
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Mulvihill-Smith syndrome is a rare disease that belongs to progeroid syndromes. This syndrome is characterized by a senile face with an underdeveloped lower half, short stature, microcephaly, multiple pigmented nevi, immunodeficiency, hearing loss, and high-pitched voice. We report anesthetic management of a 27-year-old woman, 138 cm and 27 kg, with this syndrome, who underwent removal of mandibular cyst, partial resection of tongue and keratoplasty. ⋯ The changes of blood pressure during anesthesia were extraordinary, suggesting the presence of advanced arteriosclerosis. The postoperative course was uneventful, with stable hemodynamics, and the patient was discharged from the hospital on 9th postoperative day. Anesthesia for Mulvihill-Smith syndrome should be performed with caution for the potential risk of difficult airway and unstable hemodynamics.