Masui. The Japanese journal of anesthesiology
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Recently, in addition to bronchofiberscope, the new equipments to manage difficult intubation are available. However, it is unknown whether the incidence of difficult intubation decreases or not. In order to determine the incidence of severe difficult intubation, we conducted a survey of patients who presented with severely difficult intubation during 2005-2010. ⋯ The incidence of severely difficult intubation was 0.3% in Hokkaido university hospital during 2005-2010.
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The "BURP" maneuver (back, upward, right lateral, pressure) improves the visualization of the larynx for experienced anesthesiologists during orotracheal intubation in patients with difficult airway. We investigated whether this maneuver has same efficacy for inexperienced residents in anesthesiology. ⋯ We concluded that "BURP" maneuver was effective even for inexperienced residents. More than two months were required for the residents to develop laryngoscopy skill.
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Case Reports
[A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient].
We experienced the airway management of a morbidly obese patient in prone position utilizing PENTAX-Airwayscope (AWS) which is a novel airway device for endotracheal intubation. A 29-year-old man, who was 150 kg in weight and 51.9 kg x m(-2) in body mass index, was scheduled for the discectomy for lumbar disc herniation. After the topical anesthesia with lidocaine spray, the patient lay on his stomach by himself on the table. ⋯ With the patient breathing spontaneously, we successfully inserted the reinforced endotracheal tube. After the maintenance of anesthesia with continuous infusion of dexmedetomidine, ketamin and remifentanil, the patient awoke clearly without pain and endotracheal tube was removed safely in the prone position. Although the prone position is not the standard position for endotracheal intubation under general anesthesia, our technique could be performed in emergency situations.
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Comparative Study
[How to improve positioning of the head--the sniffing position, considered to be suitable for endotracheal intubation].
The sniffing position, a combination of flexion of the neck and extension of the head, is considered to be suitable for the performance of endotracheal intubation. To place a patient in this position, anesthesiologists usually put a pillow under a patient's occiput. However, with a regular pillow, the resulting extension of the head tends to be suboptimal. ⋯ The triangular pillow improves the laryngoscopic view and facilitates endotracheal intubation by optimizing a patient's head position.
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Enhanced recovery after surgery (ERAS) protocols aim to improve patient care, reducing complication rates, and shortening hospital stay following colorectal surgery in Europe. In cooperation with colorectal surgeons, ERAS protocols were initially introduced in our hospital to the patients undergoing open colorectal resection in July 2010. ⋯ We, anesthesiologists as perioperative physicians, can improve key elements of perioperative care such as patients' counseling, perioperative analgesia and early mobilization by collaboration with surgeons and nurses, to facilitate postoperative recovery.