Masui. The Japanese journal of anesthesiology
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Case Reports
[Arytenoid cartilage dislocation caused by endotracheal intubation which resolved spontaneously].
Arytenoid cartilage dislocation following tracheal intubation is a rare complication. A 48-year-old man underwent an operation for laparoscopic cholecystectomy under general anesthesia. Although no anaesthetic or operative problem had occurred, hoarseness was noticed after the operation, continuing beyond 25 days thereafter. ⋯ About four weeks later, the arytenoid cartilage dislocation resolved spontaneously. Other findings suggest that spontaneous reduction can be expected in many patients with anterior arytenoid dislocation. Patients suffering from arytenoid cartilage dislocation should be observed for several weeks if possible because there exist some reports in the literature describing spontaneous resolution after its dislocation.
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Primary tracheal cancer is extremely rare, but critical tracheal stenosis is seen in many cases. Although laser resection or stent placement is performed under general anesthesia, anesthetic management for tracheal tumor is extremely difficult in terms of airway management. We report a 65-year-old woman scheduled to undergo bronchoscopic laser surgery and insertion of Dumon stent for tracheal tumor which severely obstructed the upper airway. ⋯ Although desaturation due to unsuccessful venous drainage and difficult ventilation by laryngeal edema during the operation and tracheal obstruction by a clot after the operation was observed, the patient's clinical condition improved. In cases of severe tracheal stenosis, airway obstruction by hemorrhage, secretion and laryngeal edema, etc. occur easily. Therefore, some kind of measures should be taken for the operation and a number of precautions must be taken during the perioperative period.
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Two patients with myasthenia gravis were scheduled for surgery. Anesthesia was managed with remifentanil and propofol target-controlled infusion without the use of muscle relaxants. ⋯ Throughout the surgery, muscle relaxants were not required. Thus, the use of these drugs for inducing anesthesia provided good conditions for tracheal intubation and surgery, and it precluded the need for muscle relaxants.
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Brachial plexus block (BPB) frequently accompanies phrenic nerve palsy (PNP). ⋯ These results suggest that BPB with the modified supra costal approach provides sufficient analgesia with a significantly lower degree of PNP. We suppose that distribution of local anesthetics is altered by changing the location of the needle-tip on the 1st lib. Amounts of local anesthetics distributing around the phrenic nerve can be reduced by the modified supra costal approach, leading to the significantly less reduction in FVC after BPB.
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The i-gel, invented by Muhammed Aslam Nasir, is a new supraglottic airway, consisting of a mask and a tube. One notable feature of the i-gel is that the rim of the mask is designed to conform to the anatomical shape of the larynx. This enables the device to provide an airtight seal without the cuff mechanism. ⋯ No airway complications occurred during the anesthesia, and spontaneous breathing could be maintained. No blood was detected on the device, after uneventful removal in all the patients. We believe that the i-gel is useful in maintaining a clear airway during general anesthesia.