Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of a morbidly obese patient undergoing laparoscopic right nephrectomy].
A 41-year-old man weighing 196 kg (body mass index of 62.5 kg m2) with renal cancer was scheduled for laparoscopic right nephrectomy. On the day before surgery, we confirmed the intraoperative patient position with the patient and medical staff to prevent neurological deficit during the intraoperative period. For postoperative analgesia and prevention of respiratory complications, an epidural catheter was inserted under radiography and ultrasound guidance. ⋯ During neumoperitoneum at 12 mmHg, mechanical ventilation was achieved without hypercapnia, hypoxia or elevated airway pressure, with rate of 12 min-1, FIO2 of 0.6, PIP of 25 cmH2O and PEEP of 8 cmH2O. The surgery was completed and his trachea was extubated in the operating room. He did not develop any perioperative complications and was discharged on the 10th day after the surgery.
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The first case was a 69-year-old woman with rheumatoid arthritis undergoing posterior occipito-cervical fusion. Although the operation was successfully performed, airway obstruction developed immediately after extubation. Her upper airway obstruction probably came from pharyngolaryngeal edema. ⋯ We used cricothyrotomy tubes (Mini-Trach II) in these two patients with postoperative upper airway obstruction and performed assist-ventilation via the tube. After starting ventilation through Mini-Trach II, we succeeded in intubation. We belive that cricothyrotomy in well-trained hands can be used safely for the management of the patient with a difficult airway.
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Case Reports
[Use of Airwayscope with pediatric intlock in a patient with first and second branchial arch syndrome].
First and second branchial arch syndrome is a congenital anomaly of craniofacial dysplasia involving organs derived from the second branchial arch. The main characteristics are microtia and mandibular hypoplasia. A 6-year-old boy was scheduled for adenoidectomy and bilateral myringotomy and tube placement. ⋯ Control of the bronchoscope consequently became easy We successfully guided it to his glottis and performed tracheal intubation. His condition was stable during the procedure. In conclusion, we safely performed tracheal intubation in a patient with first and second branchial arch syndrome using the AWS and a fiberoptic bronchoscope.
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Although tracheal laceration during surgical procedure is a rare complication, it can be life-threating. Its immediate recognition and treatment are important. A 72-year-old man with aortic valve regurgitation was scheduled for aortic valve replacement. ⋯ Air leaks were no longer present. After surgical repair, the aortic valve replacement was performed. The postoperative courses of both tracheal laceration repair and aortic valve replacement were uneventful.
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We recently encountered three cases of the leakage from the connecting portion of sevoflurane vaporizer in Fabius Tiro produced by Drager company, and in one case of those, oxygen saturation decreased. The connecting portion had leakage merely in the contact with the fixture of the monitor, because of the structure easily displaced by an external force. Further, it was difficult to detect the leakage due to the ability to correct the insufficient supply of fresh gas by taking in air. We hope a reform of the connecting portion and an alarm to inform it if the anesthesia machine detects the leakage.