Masui. The Japanese journal of anesthesiology
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For religious reasons, Jehovah's Witnesses do not accept homologous blood transfusions. Instead, they request alternative medical care that does not involve such transfusions. A 58-year-old woman, a Jehovah's Witness, was scheduled for pancreaticoduodenectomy for pancreatic carcinoma under general and epidural anesthesia. ⋯ Lactated Ringer's solution 3,300 ml, physiological saline 200 ml, and hydroxyethylated starch 500 ml were infused during the operation. Although her postoperative Hb and Ht dropped to 8.7 g x dl(-1) and 26.8%, respectively, no transfusion was performed. Anesthesiologists should respect the demands of Jehovah's Witnesses, and should attempt to manage surgery without transfusion.
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GlideScope videolaryngoscope (GVL) is a novel indirect laryngogoscope for tracheal intubation. Both mid-size and large blades of the GVL are available for adult patients. The distortion of the anterior airway anatomy and cervical spine motion using the mid-size GVL is unknown. We compare the degree of anterior airway distortion and cervical spine movement during the use of the mid-size GVL compared with the large GVL. ⋯ The tip of the mid-size GVL during laryngoscopy is anteriorly positioned and the distortion of the anterior airway was greater with the mid-size GVL than with the large GVL.
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Recently, rigid indirect laryngoscopes with integrated tube guidance such as Pentax-AWS (AWS) and Airtraq (ATQ) are clinically available. They are known to improve the laryngeal view and facilitate intubation compared to the Macintosh laryngoscope (MAC). However, whether these new devices are easy to learn for novice laryngoscopists is not well understood. We surveyed medical students regarding their usefulness in intubation procedure on mannequin. ⋯ With minimal instruction including practice, the AWS seemed to achieve safer intubation with better laryngeal view for novice laryngoscopists.
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Case Reports
[Infectious endocarditis with aortic annular abscess detected by intraoperative transesophageal echocardiography].
We experienced a case of an endocarditis with persistent fever despite appropriate antibiotic therapy. Intraoperative transesophageal echocardiography showed bicuspid aortic valve with vegetations which caused a severe aortic regurgitation. ⋯ Patients with bicuspid valve infectious endocarditis incur high risk of abscess formation. It is important to have frequent observation of the infected valve preoperatively and careful observation during operation to detect further abnormalities which may cause alteration of the procedure.
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Hyperglycemia is common in critically ill patients with approximately 90% of patients treated in an intensive care unit (ICU) developing blood glucose concentrations greater than 110 mg x dl(-1). Recently the international multicentre NICE-SUGAR study reported increased mortality with adopting intensive glucose control for critically ill patients and recent meta-analyses do not support this approach. ⋯ Unresolved issues include whether increased blood glucose variability is inherently harmful and whether even moderate hypoglycemia can be tolerated in the quest for tighter blood glucose control. Until another level I evidence will be available, clinicians would be well advised to hasten slowly and abide by the age-old adage to "first, do no harm".