Masui. The Japanese journal of anesthesiology
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Williams syndrome is caused by the deletion of genetic material from chromosome 7, including the elastin gene. Affected individuals frequently have connective tissue disorders and skeletal hypoplasia, resulting in micrognathia and mandibular retrusion. These conditions hinder adequate visualization of the larynx and render intubation difficult. ⋯ After 8% lidocaine spray to the larynx, and then 4% lidocaine spray to the vocal cords and trachea using a bronchoscope, we accomplished awake, fibreoptic-guided orotracheal intubation easily and quickly on the first attempt using a Parker Flex-Tip tube. Difficult tracheal intubation should be anticipated in Williams syndrome patients. Awake, fibreoptic-guided technique is easier and safer than direct laryngoscopy for intubating such patients.
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It is more difficult to intubate the double-lumen bronchial tube into the left bronchus than the right bronchus, and it is more difficult in a left decubitus position than normal position. And it is most difficult in the flexional decubitus position. ⋯ We examined the cause of difficulty in intubation of the left bronchus in the decubitus position with 3DCT. We concluded that the cause is the increase in the size of the angle, and for the tube to be intubated in the left bronchus, the patient position must be changed from the flexional position.
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Antiemetic drugs, which are usually prescribed with opioids, occasionally induce extrapyramidal symptoms(EPS). ⋯ EPS were found in 6 of 109 patients during palliative care. We concluded that it was important not to forget the appearance of antiemetic-induced EPS when prescribing antiemetic drugs in palliative
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It is generally recognized that dental injury during general anesthesia is an important problem. We retrospectively evaluated the profiles of dental injuries during general anesthesia and associated factors for the development of dental injury. ⋯ Of 30,845 patients who underwent general anesthesia in the period, the dental injury developed in 110 patients (0.36%) during general anesthesia. The incidence of dental injury was higher in patients above 60 years of age, The patients who had received mouth guards had significantly lower incidence of dental injury compared with those without mouth guards (0.06% vs. 0.37%, P < 0.05). The left upper incisors were involved most commonly in the development of dental injury, and the timing of dental injury was most frequent at the time of tracheal intubation.
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A 37-year-old woman without history of ischemic heart disease or any coronary risk factors was scheduled for caesarean section. Under spinal anesthesia, the patient's blood pressure (BP) decreased to 93/72 mmHg. Although 6 mg of ephedrine was administered intravenously, BP continued to decrease to 75/40 mmHg and she complained of nausea. ⋯ The anesthetic course was uneventful thereafter. This cardiac event seemed to be derived from coronary spasm caused by acute sympathetic stimulation. The observations in this case suggest that the possibility of intraoperative coronary spasm should be considered even in a healthy patient.