Masui. The Japanese journal of anesthesiology
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Recent advancement in ultrasound technology allows us to visualize detailed structures around the airway. One of the important roles of the airway ultrasound is to identify cricothyroid membrane where the emergent invasive access should be performed. ⋯ Airway ultrasound can also be used to confirm correct position of the tracheal tube and laryngeal mask, difficult laryngoscopy prediction in obese patients, assessing vocal cord function, prediction of the post extubation stridor, and so on. We also introduce perioperative evaluation of the airway via sonography (PEAS) protocol in this review.
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Comparative Study
[Effects of amino acid infusion in preventing intraoperative hypothermia: comparison between sevoflurane versus propofol].
Amino acid infusion was reported to be effective in preventing hypothermia during surgery. We investigated whether the antihypothermic effects of amino acid infusion depend on the anesthetic agent used for surgery. ⋯ Core and peripheral temperatures increased after amino acid infusion in patients receiving sevoflurane or propofol. Our results suggest that the antihypothermic effects of amino acid infusion do not depend on the anesthetic used.
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We report the successful rescue ventilation of a patient with severe obstructive sleep apnea syndrome after induction of general anesthesia using the i-gel supraglottic airway device. A 55-year-old man was scheduled for resection of a cerebellopontine angle tumor. He suffered from severe obstructive sleep apnea syndrome and routinely used continuous positive airway pressure. ⋯ We immediately inserted the i-gel device to provide sufficient ventilation. As tracheal intubation with the i-gel device was difficult, we intubated a spiral tube (internal diameter, 8.0 mm) using the Pentax-AWS Airwayscope. Our findings suggest that the i-gel device may be useful for emergent airway rescue in the event of impossible ventilation for patients with severe obstructive sleep apnea syndrome.
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Case Reports
[Anesthetic management of a patient with osteogenesis imperfecta combined with mandibular defect].
Osteogenesis imperfecta (OI) is a rare hereditary disorder characterized by an excessive tendency to bone fractures and retarded growth. We report an anesthetic management of the patient with OI who has the history of vertebral bone fracture by coughing. A 44-year-old female underwent mandibular resection and reconstruction with a metal instrument due to ossifying fibroma 35 years ago. ⋯ Considering incomplete respiration after extubation, the tracheal tube was extubated after inserting the tube exchanger into the trachea through the tube. The tube exchanger was pulled out after confirming spontaneous respiration and upper airway patency. The patient was cooperative, and respiratory and hemodynamic conditions were stable throughout.
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Patients with Klippel-Feil syndrome (KFS) frequently encounter difficult airway management due to skeletal abnormalities, including fusion of two or more vertebrae and short neck. We report successful tracheal intubation using the air-Q supraglottic airway device (air-Q). A 46-year-old woman (height, 149 cm; weight, 62 kg) with KFS was scheduled to undergo vertebral arch plasty for cervical spondylotic myelopathy. ⋯ Using a size 2.5 air-Q, sufficient ventilation was finally achieved. We performed fiberoptic tracheal intubation through the air-Q using a tube with an internal diameter of 6.0-mm. We then exchanged the 6.0-mm tracheal tube with a 7.0-mm spiral tube using a 10 Fr tracheal tube introducer.