Masui. The Japanese journal of anesthesiology
-
A 26-year-old man was scheduled for surgical extraction of a large epiglottic cyst. Mask ventilation was possible under propofol anesthesia without muscle relaxant. It was difficult to see the glottis using either a Macintosh laryngoscope or by fiberoptic bronchoscopy. ⋯ A reinforced tube was inserted nasally, and a fiberoptic bronchoscope was passed through the tube into the trachea. The tube was then passed over the fiberscope into the trachea. We believe that the Pentax AWS laryngoscope may lift the epiglottis and its cyst atraumatically, and may facilitate nasal fiberoptic intubation in a patient with a large epiglottic cyst.
-
Case Reports
[Spinal anesthesia for a inguinal hernia repair in a small child with laryngeal stenosis].
We experienced spinal anesthesia for inguinal hernia repair in combination with general anesthesia in a 4-year-old child with functional laryngeal stenosis and tendency of laryngeal edema. His airway was managed without endotracheal tube or laryngeal mask airway because these devices could worsen the upper airway stenosis. Spinal anesthesia offered reliable and potent analgesia leading to safe anesthetic management under spontaneous breathing. Although spinal anesthesia in combination with general anesthesia is not common in pediatric patients, it is effective and safe to apply for a case requiring more reliable and potent analgesia with understanding anatomical and physiological characteristics in children.
-
Intraoperative somatosensory-evoked potential (SEP) monitoring has become a part of neurosurgical procedures. In this study, we evaluated the effect of dexmedetomidine on SEP monitoring during neurosurgical anesthesia. ⋯ These findings suggest that dexmedetomidine has possibilities to produce an ideal environment as an anesthetic adjunct in patients requiring intrapoerative SEP monitoring.
-
Case Reports
[Intermittent bradycardia-dependent bundle branch block during sevoflurane and remifentanil anesthesia].
Cardiac arrhythmia and bradycardia occasionally occur from the effect of inhaled anesthetic agent and opioid on cardiac conduction. We experienced a case of intermittent bradycardia-dependent bundle branch block (IBDBBB) during sevoflurane and remifentanil anesthesia. A 17-year-old woman suffering from recurrent left ottitis media was scheduled for tympanoplasty under general anesthesia. ⋯ After intravenous injection of atropine 0.5 mg, the waveforms of QRS complexes recovered to normal sinus rhythm at HR 90 beats x min(-1). Sevoflurane and remifentanil in adolescence could induce ventricular conduction disturbance and result in IBDBBB. Atropine could be effective for IBDBBB induced by sevoflurane and remifentanil.
-
Case Reports
[Increased dose of remifentanil caused difficult ventilation at emergence from general anesthesia].
Remifentanil induces a higher incidence of respiratory rigidity than other opioids, especially when it is given at bolus injection for anesthetic induction. A 71-year-old man underwent pharyngo-laryngeal surgery under general anesthesia with remifentanil and sevoflurane. At the end of surgery, the ventilation through a tracheal tube became difficult due to muscle rigidity simultaneously with the increased dose of remifentanil and the decreased sevoflurane concentration. It should be kept in mind that increased doses of remifentanil during as well as at the end of surgery cause difficult ventilation associated with muscle rigidity.