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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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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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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Anesthetic management of a patient with giant mediastinal tumors is challenging from the perspective of both cardiovascular and respiratory management. We report the successful use of the Pentax-AWS Airwayscope (AWS; Hoya, Japan) and a tracheal tube introducer in the left lateral position for a patient with a giant mediastinal tumor. An 18-year-old man weighing 62 kg was scheduled for resection of a giant mediastinal tumor. ⋯ The head of the double-lumen tube was placed in the right bronchus under the guidance of a bronchofiberscope. Following tracheal tube placement, posture was shifted from the left lateral position to supine position without affecting vital signs. After median sternotomy, a muscle relaxant was administered for immobilization.
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Case Reports
[Successful tracheal intubation using the GlideScope AVL in a pediatric patient with Pierre Robin syndrome].
We report a successful use of GlideScope AVL in a pediatric patient with Pierre Robin syndrome. A 36-day-old boy weighing 2.8 kg with Pierre Robin syndrome presented for tracheostomy after several weeks of trial airway management in prone position, who had failed to relieve his obstructive apnea. ⋯ A tracheal tube (2.5 mm ID) with 90 degrees angled stylet, however, did not advance into the glottic opening, colliding with the anterior wall of the larynx and/or the laryngeal ventricle. Bending the tip of the stylet in a direction opposite to the inherent memory of the tube facilitated the placement of the tube into the trachea