Masui. The Japanese journal of anesthesiology
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One-lung ventilation and lung isolation are frequently required in thoracic surgery. In clinical practice, lung isolation is achieved by use of a double-lumen endotracheal tube and a bronchial blocker. A novel bagel shaped bronchial blocker, the Fuggiano's bronchial blocker, has been designed to prevent displacement of the blocker from its position in the bronchus. In this study, we evaluated the clinical performance of the Fuggiano's bronchial blocker for the lung isolation. ⋯ We conclude that, for routine use, the Fuggiano's bronchial blocker is preferable to achieve a lung isolation because of its facility in placement and a better quality of lung deflation. Fuggiano's bronchial blocker may be an alternative airway device for one-lung ventilation, and further work is required.
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Case Reports
[Acute pulmonary edema in adult caused by tonsillar hypertrophy following removal of laryngeal mask airway].
Negative pressure pulmonary edema (NPPE) has been described after acute airway obstruction. In the following case, we observed a rare occurrence of pulmonary edema caused by chronic tonsillar hypertrophy in a woman following removal of laryngeal mask airway (LMA). A 38-year-old woman with breast cancer underwent mastectomy under general anesthesia using the LMA. ⋯ She was then intubated to secure airway and provide adequate ventilation with PEEP. Fortunately, the symptoms progressively remitted satisfactorily, and she was subsequently extubated 18 hours later with no complications. NPPE is an infrequent medical emergency and its early diagnosis and recognition are likely to lead to successful management of this potentially serious complication.
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Comparative Study
[Comparison of airway scope and videolaryngoscope portable VLP-100 in the presence of a neck collar--a manikin study].
Tracheal intubation should be performed with great care in the multiple injury patient, particularly when damage to the cervical spine is suspected. The patient with unstable cervical spine requires a neck collar in prehospital area, and medical personnel may be required to perform tracheal intubation. We compared Macintosh laryngoscope with the Airway Scope (AWS), and Coopdeck videolaryngoscope portable VLP-100 (VLP-100) in a manikin model with the presence of a neck collar. ⋯ The AWS may possess advantages over conventional direct laryngoscopes in patients with restricted neck movement.
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Case Reports
[Plasma concentration of propofol was 4.4 microg x ml(-1), 4.5 hours after completion of its administration].
Propofol is one of the most commonly used intravenous anesthetic drugs because its distribution, metabolism and excretion are rapid. Recovery from anesthesia using propofol infusion is generally smooth. We have therefore taken this opportunity to report on a case of delayed recovery from anesthesia in a 58-year-old man who underwent removal of a light maxillary sinus mucocele. ⋯ It was 16 hours after the end of operation and the administration of propofol had been completed before the trachea could be extubated. His plasma concentration of propofol was 4.4 microg x ml(-1), 4.5 hours after administration. In this patient we could not prove a metabolic abnormality with propofol, but it was strongly suspected.
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We report a case of late-onset systemic toxicity due to ropivacaine over dose, and its successful reversal with 20% lipid emulsion (20% Intralipos). A 40-year-old woman, 40 kg, ASA-I, was scheduled for laparoscopy-assisted myomectomy of the uterus in which 40 ml of 0.375% ropivacaine was injected for bilateral US guided transversus abdominis plane block (TAPblock) under general anesthesia. Anesthesia proceeded uneventfully and she could go back to the ward 15 min later, but 3 hours after TAPblock, her blood pressure dropped to seventies and she became unresponsive. ⋯ She received a total of 230 ml 20% Intralipos, which was discontinued due to her rapid emergence with no further seizure episodes. This case suggests that early and sufficient use of lipid emulsion may lead to a good outcome. We recommend the immediate availability of lipid emulsion along with other emergency therapeutics at the ward after TAPblock.