Masui. The Japanese journal of anesthesiology
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Several previous reports have established the Pentax Airway Scope (Pentax AWS, S-100, HOYA-PENTAX, Tokyo, Japan) as an efficient tool for endotracheal intubation in adult patients. To date, however, there are no reports on its use with the INTLOCK blade for neonatal and pediatric patients. In this case, we performed tracheal intubation using a Pentax AWS attached to a neonatal-type INTLOCK blade (ITL-N) twice, 1 day and 10 days after birth, in a neonatal patient complicated with Arnold-Chiari malformation. ⋯ We initially attempted tracheal intubation using a Miller's laryngoscope in the first operation and a Macintosh laryngoscope in the second, but we could not achieve tracheal intubation with either of these instruments. Upon switching to a Pentax AWS with an ITL-N, however, we successfully achieved tracheal intubation in both operations. Further research is needed to facilitate the effective use of the Pentax AWS in such cases.
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Case Reports
[A case of prolonged neuromuscular blockade possibly related to a high anti-acetylcholine receptor antibody level].
Prolonged neuromuscular blockade is a relatively common complication of general anesthesia. Some previous reports have shown that positive serum anti-acetylcholine receptor antibody (AChR Ab) might contribute to this complication. ⋯ Although this patient had mediastinal tumor diagnosed as thymic carcinoma two years before the operation, preoperative clinical evaluation was negative for myasthenia gravis (MG) and the tumor was in remission at the operation. These observations suggest that preoperative measurement of anti-AChR Ab level might be recommended for patients with mediastinal tumor regardless of symptoms of MG and that neuromuscular blocking agents should be administrated carefully in anti-AChR Ab positive patients under monitoring of the neuromuscular blockade.
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Macroglossia is the commonest symptom of Beckwith-Wiedemann syndrome (BWS) and sometimes requires surgical tongue reduction for cosmetic, feeding, drooling and speech problems. ⋯ Airway disorder was not alleviated by tongue reduction surgery or glossopexy.
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A 64-year-old woman was scheduled for the removal of hepatic cystadenoarcinoma. The preoperative examination did not reveal any neurological disorders. Anesthesia was induced with midazolam (5 mg) and remifentanil (0.1.ag x kg-1 x min-1) and the trachea was intubated following administration of rocuronium. ⋯ Two min later, she became fully awake and alert with increase in BIS (above 90). Laboratory examination showed that the plasma concentrations of propofol, midazolam, and its active metabolite alpha-hydroxymidazolam before administration of flumazenil were within the range considered to have no sedative effects. From experience of this case, administration of flumazenil may be beneficial for improvement in consciousness in cases with unexpectedly delayed emergence from anesthesia.
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It has been demonstrated that preparatory ultrasound scanning can facilitate lumbar epidural anesthesia. We compared longitudinal with transverse approach of ultrasound imaging to test the precision and the quality of acquired images in cesar ean delivery patients. ⋯ Both planes provided accurate information about the epidural space and depth, and the longitudinal plane was superior in the imaging quality. It was suggested that both approaches may help identify epidural spaces.